Who IS at risk of prolapse?
49% of all post natal womenwill experience prolapse*
So if you have had children, you have one chance in two of this being you.
Recently I wrote about exercise induced prolapse which has had over 21,000 reads! It was also picked up by Mamamia and shared nearly 700 times! I know that many people still don’t really understand what prolapse is (even if they have one) – so I wrote this article to answer that question.
However, while we are starting to see more of a conversation around incontinence (packaged nicely as LBL), the idea of your uterus falling out of place does not seem to rate that highly on lists about what women should know about their bodies.
This horrifies me because even just a little awareness of the risk factors could make a difference to what side of that statistic above you land on. And although the marketing machine, that created the euphemism LBL, makes to normalise leaking a little bit of wee when you work out. Please remember, it is not normal. It is common, but not normal.
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. And 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. (At the end of this blog, there is a link for you to get help)
So here is my list of the top 10 or risk factors to be aware of.
And remember the more boxes you tick below, the more at risk you are.
(Not all will be affecting you today, but they may well do in the future:)
- 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.
If you have LBL or identify several of these risk factors, ask your trainer what education they have to ensure that you will not be damaged. If they look blank, or at the very least do not ask you about your pelvic floor as part of your initial assessment, this trainer is not for you. They may have some other great muscles that flex, but that is not a true indication that they have best advise for your health needs (Women specific training is simply not covered in Certificate III or IV in Fitness).
2. Multiple births or birth trauma
As the statistic above states, 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. The more children you have, and the older you are when you have them, increases your risk.
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.
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.
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
I personally see this a lot 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. They 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. A big sign of this is asking them to breathe deep and watch the shoulders move, but the belly doesn’t.
Why does this matter?
Your breathe initiates the movement between diaphragm and pelvic floor. Inhale and diaphragm descends and pelvic floor relaxes. Exhale and pelvic floor contracts. It is a symbiotic relationship that represents the tensegrity of movement. No muscle should ever be ON or OFF all of the time, not if we want to move functionally and pain free.
Gripping your abdominals and then adding extra intra-abdominal pressure eg: loaded movement, your pelvic floor will wear the load.
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.
And then take this opportunity to breathe deep. If you experience anxiety… this advice is especially important to you.
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 too, especially if you are breast feeding.
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
- 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.
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.
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 about 2 months in the lead up to hay fever season.
For coughing fits, sit down and try to exercise the knack. Make sure (like number 8 below) you take time to recover afterwards. Check out the video below how to do the knack!
Vomiting, much like the list on number 7, presents 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
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 not just for your body to heal… but 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.
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, and even those with a youthful demeanor are not immune. The saggy and thinning effect on the outside, is equally reflected on the inside. Add into the mix the hormone upheaval of menopause, you may find that this is the straw that breaks the camel’s back and pushes you to the join the 50% of women who experience prolapse.
The main hormonal changes that come during menopause, is the decline of estrogen, which is responsible for elasticity and repair of our tissue. Hence why we get wrinkles and our bone density starts to decline. And making us more at risk of prolapse.
Also it should be noted that if you mother or grandmother experienced prolapse, your chance is higher still.
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.
Other factors that should 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?
All of the women that I see (and have seen) in my studio, share with me their stories. These women share the one thing that caused them to prolapse eg: their PT pushed them too hard, they had a bout of whooping cough, a terrible case of constipation, they helped out at a working bee and lifted something out of the ordinary… the list goes on and on.
However, when we unpack all the details of how they move, work, breathe, deal with stress, how they birthed, their toileting habits and exercise history – a larger story unfolds.
It might have been the one movement that caused the prolapse, but rarely does it come on it’s own.
Understanding your unique set of risk factors can really help you make informed daily and larger life decisions.
If at this point in time, 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.
*Statistic put out by Continence Foundation of Australia
PS. I have featured a few people and businesses in this blog… because there are many, many avenues of support and help. You don’t need to suffer in silence, or feel alone! List of contributors included in this blog are:
Michelle Kenway – another wonderful Women’s Health Physiotherapist based in Queensland, who has a whole swag of brilliant video’s.
This is just a few of the many people doing great stuff helping women live active lives. If you would like me to find the best person for you – please feel free to send me an email and let me know where you are (location) and what are your specific concerns, and I will do my best to connect you with someone who can help.
Or if you are a fitness professional or women’s health professional – why not join us at the Women’s Health and Fitness Summit – being held on on the 28th & 29th October in Melbourne at The Grand Hyatt? Our goal is to update and educate all, about the diverse factors that impact on women’s health and fitness… AND link fitness and allied health professionals so that we can keep all women active, but without increasing their risk of exercise-induced incontinence, or exercise-induced prolapse.
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