Most women accumulate the risks of prolapse over time. Although just one may tip you over the edge, they are certainly not usually in isolation. Understand the 10 most significant risk factors for prolapse. Being fore warned is being fore armed.

49% of all post natal women will experience prolapse*

So if you have had children, you have one chance in two of this being you.

* Statistics from Continence Foundation of Australia

Often when women experience prolapse, they can pin point it to a single activity. Here are a couple of examples that have been given to me:

• straining to quickly do a poo
• lifting a heavy wheel barrow at a school working bee
• pulling down a broken garage door

For other women prolapse can’t be pinpointed to a specific activity, but was a feeling that something wasn’t quite right down there. Many women have described finding their prolapse in the shower while washing themselves. And the discovery can be quite a shock. For many women prolapse is not even a word or issue they are familiar with. And Dr. Google can be incredibly confronting.

If you are not 100% sure what prolapse (also called POP – Pelvic Organ Prolapse) – then I recommend this blog – Prolpase 101

It is easy to assume that your prolapse was caused by a single incident. Or an unfortunate by-product of childbirth. But the reality has a lot more layers. In fact, prolapse is more often a build up factors and with only one being the straw that breaks the camels back.

When we unpack all the details of how we move, work, breathe, deal with stress, how we birthed, our toileting habits and exercise history – a larger story unfolds.

It may have been the one movement that caused the prolapse, but rarely was is it the starting point.

Understanding your unique set of risk factors can really help you make informed daily and larger life decisions.

Here are my top 10 to be aware of!

1. Exercise Induced Incontinence. Exercise Induced Prolapse

Yes, it is a thing. And it is not limited to women. Men can also rectally prolapse, have incontinence and erection problems from pushing weights that are too heavy. Weight training is essential, especially for bone density as we age. But we need to lift to our weakest point. The pelvic floor is a muscle like any other – it can get weak with little use, tired from over use and increase in strength with correct training. We want to aim to build pelvic floor muscle mass, much the same way you would with other muscles. And just because you can’t flex it in the mirror, doesn’t mean it is not important.

High impact cardio exercise, trampolining and gymnastics top the list of exercise options with worst pelvic floor outcomes. There are lots of ways to modify to get the sweaty work out you might crave and remember that they may be off the table for now, but train right and they might be able to return to your exercise regime in the future.

To read more about how you can negate pressure on your pelvic floor – check out this blog – How to say NO! to your Personal Trainer.

My advice:
Find out if your trainer has certified education around pelvic floor. Women specific training, especially practical information around pelvic floor and exercise prescription is not covered in Certificate III or IV in Fitness. If they look blank at your question, this trainer is not for you. If they do not ask you about your pelvic floor as part of your initial assessmen, this trainer is not for you.

I have written a number of research based education courses to help Fitness Professionals better work with women. You can find them here!

2. Multiple births or birth trauma

If you are postnatal (and postnatal is not limited to having small children, but is your considered life stage until you either get pregnant again, or hit menopause) – then you are at risk of prolapse. The more children you have, and the older you are when you have them –  increases your risk.

Physical birth trama is something that may or may not be indentified right away and may include:

• perineal tears
• episiotomy (the incision made in the perineum during childbirth)
• pelvic floor muscle damage, including levator avulsion
• pelvic fractures
• pelvic organ prolapse (POP)

My advice:
If you already have a significant prolapse, or levator avulsion – explore your options to have a C-section instead of a vaginal birth. And for each and every birth take time post birth to heal.

For more information and support around birth trauma – be sure to check out Australasian Birth Trauma Association (ABTA).

3. Are you a bendy person?

Hyper-mobility of our joints and ligaments affects our whole body, including pelvic floor and all the fascia that holds up our internal organs (ie: bladder and uterus). If you can do any of the things in the image below (or take the beighton score here) your hyper-mobility will definitely impact on the ability of your pelvic floor to work with gravity and other strains on your pelvic floor.

My advice:
If this is you, be super observant and movement conservative just before you menstruate, or on the first few days of menstruation – with the added hormone of relaxin you may be able to become a human pretzel… but just don’t.

4. Tummy Grippers

This is very common with new mums. They have their babies and look down on their tummy in dismay. In order to minimise their pouch, they suck it in. This sucking in becomes their normal and after awhile, they hardly recognise that this is what they are doing. These same mums might go to pilates, with even more emphasis on “core” or told by their yoga instructor to “pull their belly button to spine.” But never reminded to relax their abdominals and obliques. To test if you are a tummy gripper, breathe deep and watch if only the shoulders move, and not the belly. 

Why does this matter?

Your breath initiates the movement between diaphragm and pelvic floor. Inhale and diaphragm descends and pelvic floor relaxes. Exhale and pelvic floor contracts. This is the correct symbiotic relationship between diaphragm and pelvic floor. No muscle should ever be ON or OFF all of the time, not if we want to move for optimal functionality and be pain free.

Gripping your abdominals and then adding extra intra-abdominal pressure eg: loaded movement,  your pelvic floor will wear the load.

My advice:
Channel your inner Homer Simpson… he never, ever cares about holding in his tummy. Give permission (at least once per day if you are a serial tummy gripper) to let your tummy be where it wants to be.

If you are doing intensive core workouts, make sure in the conclusion stretch you specifically allow your tummy muslces to relax.

If you are told to suck your belly to spine by your fitness professional / yoga teacher etc, IGNORE this cue and instead, draw in your pelvic floor and feel the your deep abdominal muscles (transversus abdominus) contract naturally.

And then take this opportunity to breathe deep. If you experience anxiety… this advice is especially important to you.

5. Constipation

Who talks about constipation? Exactly… and therein lies the issue! Straining over your stool (poo) creates massive pressure on your pelvic floor… and for many women who have never experienced constipation before – it can happen right after child birth, when your pelvic floor is already at risk!

If this is you… and you know that you don’t / can’t eat enough fibre, or perhaps it is  a part of your normal toileting behaviour… please, please, please don’t labour over your poo. There are plenty of cheap / easy / edible products that can soften your stool and improve your toileting behaviour. Plenty of water is a must.

Oh and check out this delightful video:

My advice: A stool for a stool!
You don’t have to purchase a squatty potty (in fact they don’t ship to Australia at the time of writing this), but you may already have a little stool that your kids use to reach the tap – keep this handy for your number 2’s!

6. Repetitive heavy lifting

This is different from your exercise routine. I want you to think about your life and the regular heavy lifting you might do.

This might include:

• lifting your toddler/s into the car
• gardening
• caring for another adult, that involves lifting
• basket of heavy washing
• carrying ALL your shopping bags in one trip from the car
• DIY around the house
• carrying heavy suitcases up and down stairs
• with your job ie: baker, nurse etc

What you need to remember is what is heavy for one person, may be light for someone else… so it is difficult to make hard and fast rules. But repetitive lifting (and many of these things listed above fall into that category) is what we want to be mindful of. As a mother it may be impossible to NOT do these activities, so learning how to lift correctly is key.

My advice:
Learn to squat using your butt, rather than your back.  Push from the ground using your legs and exhale, audibly, on the hardest part. The heavier the object the louder your exhale. The heavier the object, the more mindfulness on your pelvic floor contracting.

7. Smoking and /or seasonal hay fever / whooping cough / flu

It may seem odd to put these together, but all of these represent constant coughing, which in turn places ongoing stress onto your pelvic floor. We know smoking is bad for your lungs, however that persistent smokers cough, does no favours for your pelvic floor either.

Suffering from seasonal hay fever or catching a bad cold or worse, whooping cough can also play havoc.

My advice:
If you know you get hay fever, have the drugs on hand to deal with it. If you are opposed to taking medication, although it has been disproved, many people swear by ingesting a small bit of locally sourced honey each day for a few weeks  leading up to hay fever season.

For coughing fits: Sit down and use The Knack.  The knack is Make sure (like number 8 below) you take time to recover afterwards. Check out the video below how to do the knack!

Michelle Kenway – short video on how to do the “knack”

8. Vomiting

Vomiting, much like the list for number 7, represents enormous pressure on your pelvic floor. And although nobody likes to get a vomiting bug, it can happen to the best of us. And with young children attending day care, it can be difficult to escape when the vomit bug does the rounds.

I devoted a whole blog to this one here.

My advice:
Keep your distance from people who have had a vomiting bug and be sure to wash hands with soap before eating. After the vomiting has done it’s dash, make sure you allow time for your pelvic floor to recover – it will have just had a marathon work out and it may need extra time and care.

9. Your weight makes a difference

I am a big believer that healthy weight comes in all shapes and sizes, however, loosing just a few kilo’s can make a difference to your pelvic floor.

My advice:
Be mindful of how your weight affects your leakage. Notice any correlations and find the weight that works best for you and your body.

10. Age and menopause

Gravity and time affect us all. We see this in our skin, as a natural part of ageing. The saggy and thinning effect on the outside, is equally reflected on the inside. Add into the mix the hormone upheaval of menopause. For many women who managed the whole childbirth and lifting babies, menopause is the straw that breaks the camel’s back.  For the 50% of women who experience prolapse stistically, they are likely to do so during this changed hormone environment.

The main hormonal changes that come during menopause, is the decline of estrogen. Estrogen is responsible for elasticity and repair of our tissues. Estrogen decline is not only responsible for wrinkles, but also our loss of bone density. Weight training is essential for all older women to ensure strong bones for the later stages of life.

Also it should be noted, that if you mother or grandmother experienced prolapse, your chance is higher still.

My advice:
Absolutely include weight training for bone density and remember if you don’t move it, you loose it… but look at either getting training advice that is suitable for your age and stage of life, or learn to modify. Most of all, don’t forget to listen to your body!

Most fitness programs have been designed on men, by men, for men. They simply don’t accommodate the changing hormones in your life cycle of pregnancy, post-natal and menopause.

For Fitness Professionals, I have several online courses to help you train women who are peri-menopause / menopausal and post-menopausal safely and effectively – you can find them here

Leaking a little bit of wee (or poo) is actually your body telling you that it is struggling and needs some extra support, attention, care and love. However, getting back on the Kegel (pelvic floor contraction) band wagon may not be the answer either, and could make your incontinence worse! It is essential that you get the right diagnosis from a trained professional to work out exactly why you are leaking.

Other factors to trigger further investigation with a pelvic floor specialist:

• Do you have tampons that fall out or push out of place?
• Do have any heavy sensation around the vaginal area?
• Do you have painful sex or reduced sexual pleasure

If you are ticking quite a few things on this list, all is not lost. But do be more mindful. Learn the skills, or seek someone who can teach you the skills to move, walk, lift, breathe, and perform daily functions that work with your pelvic floor and intro-abdominal pressure.

My goal is to help women navigate exercise safely. Prolapse and other pelvic floor issues are NOT life threatening, but inactivity is!

I am creating a short course for women to help women work out safely – no matter what kind of exercise you do!

If you’re a fitness professional or any other service provider for women and want to become an EVEolution™ partner CLICK HERE.

If you’re interested in learning more about EVEolution™ CLICK HERE

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