Prolapse and Running Physiotherapy Guide to Avoid Prolapse Worsening (2024)

This running and prolapse information recognizes that some female runners want to run despite having a prolapse.

This Physiotherapist information aims to lessen the impact of running on the pelvic floor and reduce the risk of worsening prolapse and running .

How to reduce pelvic floor and prolapse impact with running:

1. Reduce running speed

Increased running speed requires more pelvic floor activation. ² Therefore reducing running speed may lesson the impact of running on the pelvic floor particularly when the pelvic floor muscles aren’t working well (i.e. with prolapse).

2. Alternate running surfaces

Avoid constant running on hard surfaces such as roads and concrete pavements. Try to mix up running sessions to include softer running surfaces such as grass, gravel and sand.
Water running is an excellent form of low impact running.

3. Avoid downhill running

Running on flat surfaces reduces the physical impact when compared with running downhill. Downhill running increases impact and jarring on the pelvic floor.

4. Limit running distance

The longer the running distance, the more repeated the impact upon the pelvic floor. Try to avoid running long distances particularly on a regular basis.

5. Reduce stride length

Shorter stride length may help to reduce some of the physical impact associated with running. This may allow your heel to strike the ground less forcefully than with a long stride.

6. Mix up workouts

Alternate running workouts with other low impact forms of fitness exercises. These include cross trainer and elliptical machines, cycling and spin classes.

7. Manage your body weight

The more body weight you carry, the more you load the pelvic floor when you run. Pelvic floor strain is more likely in obese and overweight women with running, just as lower limb strain is more prevalent among overweight runners.

Running when overweight can increase the risk of prolapse worsening. This can result from the increased load abdominal and upper body weight places on the pelvic floor with impact.

8. Avoid running when fatigued or unwell

Pelvic floor muscles don’t work as well when the body is tired. Pelvic floor muscles and supports work most effectively when the body is well rested.

Who is Most at Risk With Prolapse and Running?

The risk of prolapse problems with running is increased with factors that weaken your pelvic floor OR increase the load.

1. Factors that increase the load of running:

• Long distance running
• Running speed ¹
• Road running
• Running when overweight
• Running with weights

2. Factors that weaken your pelvic floor:

• Having a prolapse
• Previous pelvic surgery including prolapse and/or hysterectomy
• Weak pelvic floor muscles
• Recent childbirth
• Previous vagin*l delivery
• Previous traumatic vagin*l delivery (forceps delivery, breech birth)
• Multiparity (multiple births)
• Menopause and beyond
• Obesity and overweight
• Chronic constipation and straining
• Chronic coughing
• Family history of prolapse

Unfortunately women with prolapse have accompanying pelvic floor muscle and tissue dysfunction.³

Does Prolapse Get Worse With Running?

Running with a prolapse can weaken pelvic floor muscles and tissues potentially making prolapse worse.

The degree to which running impacts upon your prolapse may be influenced by:

• Your pelvic floor strength and how well it’s working
• Your body weight
• How far you run
• How fast you run
• Running surfaces
• Recovery time between your runs

If you have a prolapse your pelvic floor already has some level of dysfunction.

The combination of repeated downward pelvic pressure and a lack of pelvic floor support can contribute to prolapse worsening.

Running is a high impact exercise.

When you run or jog, every time your heel strikes the ground a force is transferred to your pelvic floor. Normally the pelvic floor activates with a reflex contraction after the heel strikes the ground when running.¹

If your pelvic floor isn’t working well, the landing impact can force your pelvic floor and your prolapse to move downwards (shown right).

This is why some women feel prolapse symptoms such as bulging and heaviness associated with running. When the force is repeated or large for example long distance running or if you’re overweight respectively, there is a greater potential for pelvic floor strain.

When strain is placed upon the pelvic floor, the pelvic floor muscles and tissues stretch and weaken especially if the pelvic floor lacks the strength to withstand this strain.

Currently there is little research into running and prolapse however studies show that women who perform high impact exercises more commonly experience pelvic floor problems such as bladder leakage compared with women who keep their exercises low impact.²

Prolapse and Pelvic Floor Support

Pelvic prolapse results from poor pelvic organ support.

Lack of pelvic organ support is caused by weakness in thepelvic floor musclesand connective tissues. When the pelvic floor muscles and tissues weaken, they can’t support the pelvic organs (including the bladder, uterus and rectum).

This lack of support contributes to pelvic prolapse when the pelvic organs protrude into the vagin* or from the rectum.

How to Improve Your Pelvic Floor Support for Running

Regular Pelvic Floor Exercises

Regular daily pelvic floor exercises will optimize the condition of pelvic floor support in order to withstand the pressure associated with a variety of fitness exercises.

A strong well supported pelvic floor will better withstand the pressure and impact associated with running when compared with a weak dysfunctional pelvic floor. Commitment to regular ongoing pelvic exercises is an essential to ensuring and optimizing long-term pelvic floor support.

Use a vagin*l Pessary

A vagin*l pessary is a discreet pelvic floor support device that sits within the vagin* and supports prolapsed vagin*l tissues. A vagin*l pessary is a useful device for women who want to continue running despite having a prolapse.

A well fitting pessary device can reduce prolapse and running symptoms and allow a woman with pelvic floor dysfunction to continue her regular exercise routine. Gynaecologists are usually trained to fit vagin*l pessary devices for prolapse support and management and it can be worth discussing your suitability for a pessary.

Ensure Postnatal Recovery Before Running

Before recommencing running, ensure that your pelvic floor is well recovered from pregnancy and childbirth.

Strengthening for weak muscles can take 5-6 months. Pelvic floor muscles don’t function as well during breastfeeding owing to the lower levels of circulating oestrogen. Take this factor into account when planning your return to running after childbirth.

Download Prolapse and running article as a user friendly PDF

References

¹ Leitner M, Moser H, Eichelberger P, Kuhn A, Radlinger L (2017).Evaluation of pelvic floor muscle activity during running in continent and incontinent women: An exploratory study.Neurourol Urodyn, 36(6) pps 1570-1576.

² Fozzatti C, Riccetto C, Herrmann V, Brancalion M, Raimondi M, Nascif C, Marques L, Palma P.(2012) Prevalence study of stress urinary incontinence in women who perform high-impact exercises. IntUrogynecol J,23(12), pps 1687-1691.

³ Delancey, J (2016) What’s new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol.29 (5), pps 420-429.