Words of warning: strength training and pelvic floor

[VelociraptorsVelociRapping]

For those who don’t know me, I’m a long-standing contributor to this board (particularly the >5st threads) and I’ve lost just under 9 stone on MJ since April ‘24.

There is (rightly) lots of discussion of the importance of resistance and strength training on this board and it’s incredibly important. I’d just like to share my experience as a word of caution.

I significantly increased my strength training earlier this year and also started doing a lot of Pilates. After a few months I started to notice what I now know are the early symptoms of pelvic organ prolapse and went to a physio who specialises in women’s health and pelvic issues.

She confirmed a mild prolapse. I ticked most of the risk factor boxes (overweight for many years, two pregnancies with big babies, one instrumental vaginal delivery with complex birth injuries) and the prolapse would very likely have happened at some point but I undoubtedly hastened it along by significantly increasing my strength training with a weak pelvic floor. Some of the Pilates moves were also exacerbating the issue where they involve bearing down on the pelvic floor. Squats are one of the very worst culprits.

I’m posting this here because many of us have been overweight or obese our whole adult lives before successfully losing weight on MJ. I know that the temptation is to jump straight in to vigorous exercise but if you already have any symptoms of weak pelvic floor (eg stress incontinence or bladder weakness when you sneeze, jump or run) or if you have no symptoms but have any of the other main risk factors (multiple pregnancies, heavy babies, instrumental vaginal delivery or birth injuries, menopause) then please consider getting a pelvic health check and some specialist advice before continuing with your new regime. I know it’s extra money to find when virtually all of us are already funding the jabs privately but early treatment makes all the difference. I’m now following a specialist training plan devised by my physio which is already making a difference to my symptoms and if I am disciplined about the exercises, probably for the rest of my life, I should be able to avoid surgery.

Onwards and downwards!

Also be very wary of any belts that constrict your middle (like weight lifting belts for instance) as that plus the pressure from lifting is a nightmare for a weak pelvic floor...

Thank you for sharing this!

I agree with you. I was under pulmonary rehab (via hospital) where they put you on those leg weight machines, constantly encouraging you to lift more and more. I now have a prolapse that isn't bad enough for surgery but my life is "ruined" regarding my bladder and bowel. Not a single peep of warning or advice. I had been fine prior to that.

Can you share which exercises are ok for this?

This is why I am so wary of any classes at the gym or personal trainers who insist on squats and weights etc. the pressure in class would be to follow these routines and I would not want to do these exercises for that very reason

Silly question, but how do you go about getting a pelvic health check?

I was referred by my gp

Strength training is so important though to reduce muscle loss and will help in old age. I just wonder how to balance this with making sure we do the 'right' exercises. It's such a minefield it really is.

Eugh sounds about right. It's the same when you're pregnant. Noone warns you that you might be incontinent after childbirth due to prolapse. A bit of leaking is sadly normalised, when actually while it is common, it's definitely not normal. And noone mentions you might constantly wet and poo yourself.

@Notoironing big caveat here that I am absolutely not a specialist but based on the advice I've been given I am avoiding any exercise which use both legs at once, eg squats or Pilates moves with both legs in the air. My physio had me doing one-leg 'scissors' at first and I have now progressed to single-leg deadlifts with a weight.

@lostinthesunshine I Googled women's pelvic health physios and found someone who works out of a private clinic. I'm afraid that around here at least the NHS offer is largely non-existent.

You are so right. Not sure what the answer is. Kind of need gym professionals who do prolapse friendly classes, but not sure if they would be very popular as might be embarrassing signing up!

You can eventually do those exercises like heavy squats though you just have to get your pelvic floor stronger too. When I first started strength training a few years ago I was alarmed to find I was leaking urine. No way could I have done a box jump or skipping as I would full on wet myself (this did not happen in everyday life). I got some advice and exercises from a women’s physio and now I have no issues and can squat heavy weights with absolutely no problem. The physios said I had a mild degree of prolapse and I initially thought I’d be incontinent for life and was so upset but it was all resolvable. Just to say that there is hope and heavy lifting is not necessarily off the cards for ever. She did also warn me off Pilates as apparently some of the moves are very bad for pelvic floor which I never would have thought.

This genuinely makes me absolutely furious. It's normal in France, for example, for all women to be referred to a pelvic physio postpartum to ensure that everything is returning to its usual function. I was once given Tena Lady pads in a 'goody bag' for an NCT event and was absolutely horrified.

Sadly we live in a capitalist society which would rather sell us incontinence pads than normalise treatment for the underlying issue. There is absolutely no reason why a young-ish woman in otherwise good health should be doubly incontinent after childbirth if she is given access to proper assessment and treatment.

I'm sorry, I thought I was clear on this in my OP but perhaps I wasn't. The problem is rapidly increasing strength training before first checking that the pelvic floor is strong, and strengthening this first before progressing to heavy lifting.

Thank you so much for posting this. I know there are private women's health physios so am thinking I might book an appointment. How do they assess your pelvic floor or test for a prolapse?

I’ve already had a bowel prolapse repair about six years ago. I think due to weight strength training that repair is now looking in jeopardy and I feel so stupid but I was using a female PT who seemed to know about this stuff but I’m not sure now. I have an appointment with my GP in a couple of weeks and if I need physio or more surgery I have private health care through work so might explore that. It’s so depressing.

In my case, after taking a full history (particularly of my pregnancies and births) she asked for consent to perform an internal exam, which involved her placing a gloved finger in my vagina and asking me to tighten and release my muscles so she could assess where they were weak. She asked me to do this both lying down and standing. She also did an ultrasound to assess that in my case the prolapse was both bladder and bowel. This also enabled her to diagnose an unhealed diastasis recti (separation of the abdominal muscles) from my pregnancy with DC2, who is nearly 8(!). This was approx 3cm at my first appointment and had healed by 9mm when I went for a follow-up because my pelvic floor was already strengthening and supporting the abdomen.

Please don't feel stupid. The messaging is all about how important strength training is for women, and it is, but the pelvic floor has to be strong first and this is the part which isn't getting through, even to PTs. From my limited understanding it's a very under-researched and under-resourced area, like many fields of women's health.

Yes I was going to say that when I saw mine it did necessarily involve an internal exam but it was a lot less bad than eg a smear test.

Thanks for this. I had diastasis recti with my first dc, no idea how fixed it is, I also know my core strength is q weak so definitely going to look into this.

it's about technique and good instruction.
which is sadly often lacking.
with a good pt/physio it shouldn't become worse.
I agree strength training at home without good guidance is problematic.