Pelvic Organ Prolapse and Exercise: Why Searching for “Prolapse-Safe” Workouts is NOT Serving You and What To Do Instead

Can you exercise with pelvic organ prolapse? Can you lift weights? Squat? Run? Do planks? What exercises should you avoid with prolapse?

If you have pelvic organ prolapse (POP), chances are you’ve Googled at least one of those questions.

And chances are you’ve also come across a list of “safe exercises for prolapse.”

Maybe it told you not to lift heavy weights and that you shouldn’t run or jump. Maybe it said don’t do crunches or planks (I used to preach this too).

You’ve probably also seen that you shouldn’t hold your breath or squat too deeply or with load and definitely don’t do anything that creates too much “pressure.”

The American Urogynecological Society, an organization devoted to the care of women with pelvic floor disorders, recommends that in order to prevent pelvic floor disorders, women should “avoid increased pressure inside the abdomen,” “avoid heavy lifting” and “avoid repetitive strenuous activities .

Suddenly, having prolapse feels like an end to the exercises you love and you now look at movement as scary or ‘unsafe’.

I want to offer you a different perspective.

Your vagina is not fragile and you are MORE than your pelvic floor.

In an attempt to ‘protect’ the pelvic floor we are increasing other health risks and creating a whole lot of fear!  Fear and inactivity could in and of themselves contribute to worsening symptoms!

A prolapse diagnosis does not automatically mean you need to spend the rest of your life protecting your pelvic floor from exercise in fact that is the OPPOSITE of what to do.

Rather than trying to eliminate pressure (which we can’t do by the way) and avoid movement, I want you to think about something much more useful:

Building a Buff Muff that is strong, responsive, resilient and capable of managing the demands of your life is what you want.

Because the goal of pelvic floor fitness isn’t to make your world smaller.

It is to increase your capacity so you can keep doing the things that matter to you and that will help you age powerfully!

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when one or more pelvic organs — such as the bladder, uterus or rectum — descend into or bulge into the vagina.

Common prolapse symptoms can include:

• vaginal heaviness or pressure
• a sensation of something “falling out” or something inside the vagina
• feeling or seeing a bulge at the vaginal opening
• pelvic dragging or aching
• difficulty emptying the bladder or bowel
• low back pain
• tampons that don’t sit right or that get pushed out
• symptoms that worsen later in the day or after certain activities

Prolapse is incredibly common, but common does not mean inevitable, untreatable or the end of exercise.

Pelvic floor muscle training is one of the conservative strategies with evidence for improving prolapse symptoms, pelvic floor function and quality of life.

But…people think pelvic floor muscle training is kegels and it is important to know that it is about far more than doing endless Kegels!

More on that shortly.

Can you exercise with pelvic organ prolapse?

1000% Yes! In fact it is essential. Having pelvic organ prolapse does not mean you need to stop exercising.

There is no universal list of exercises that every woman with prolapse must avoid or do for that matter.

Exercise is one of the most powerful tools we have for supporting our healthspan AND our pelvic floors.

We need muscle.

We need strong bones.

We need cardiovascular fitness.

We need core stability.

We need balance, power and metabolic health.

And as we get older, maintaining those things becomes increasingly important — not less.

So telling women with prolapse to “avoid heavy lifting” or “stick to gentle exercise” can have unintended consequences.

I don’t want your pelvic floor diagnosis to prevent you from training the rest of your body.

I want your pelvic floor to become PART of how you train your body.

 

What exercises should you avoid with pelvic organ prolapse?

This is probably the question I get asked most often.

And my answer may surprise you:

There isn’t one exercise or one group of exercises that every woman with prolapse needs to avoid.

There is also no evidence to show that there is a weight that is ‘too heavy’ for the pelvic floor or that there is a cutoff for intra-abdominal pressure that puts women more at risk for pelvic floor disorders yet women are constantly told to not lift anything over 10 lbs. Where did that weight come from?  Ten pounds is very heavy for some and light as a feather for others. It is not about the weight, or the exercise. It is about the execution of the exercise and the capacity of your pelvic floor in that exercise.

This doesn’t mean that I am saying do whatever you like and don’t worry about your pelvic floor.

Your symptoms, pelvic floor function, training history, technique, breathing strategy, load, volume, recovery and current capacity all matter.

Research also shows that pelvic floor responses to intra-abdominal pressure during exercise and activity can vary substantially between two people doing the exact same exercise.

That means two women could perform the exact same exercise, same sets and reps and experience it very differently AND have different IAP measurements.

One woman may comfortably deadlift 100 pounds without symptoms while another may notice symptoms when lifting 20 pounds.

Neither experience tells us that any exercise is universally “safe” or “unsafe.”

It tells us that capacity is individual.

Is intra-abdominal pressure bad for prolapse?

This deserves a big conversation because pressure has become the villain of pelvic health.

Intra-abdominal pressure, or IAP, is the pressure generated inside your abdominal cavity.

And guess what?

Pressure is normal. We all have it. We all need it. We all face it and guess what? Standing up from a chair increases intra-abdominal pressure. So should we be avoiding standing up from a seated position?? 

You create intra-abdominal pressure when you:

• breathe
• cough
• sneeze
• laugh
• lift groceries
• pick up a child
• exercise
• poop
• lift weights
• yell

Your body was designed to manage pressure.

The question isn’t:

“How do I avoid intra-abdominal pressure?”

A much better question is:

“How can I train my body, namely my pelvic floor, to manage the pressure I’m creating?”

Recall that research has not established a single intra-abdominal-pressure threshold above which pelvic floor damage occurs. Pressure also varies considerably between individuals performing the same movement.

Pressure itself isn’t the enemy.

Your ability to respond to pressure is what we need to consider and if we avoid hard things because it will somehow protect the pelvic floor, we are actually just increasing the likelihood of issues because pressure happens and if we never train under load and pressure guess what gets harder?

Your core is a pressure-management system

I want you to picture your core as a canister.

At the top is your diaphragm.

At the bottom is your pelvic floor.

Around the front, middle and back are your abdominal and spinal muscles.

These structures don’t operate independently.

They work together to help regulate pressure as you breathe, move, lift, run, jump, cough and poop.

Your pelvic floor therefore needs to work as part of this team and do more than squeeze.

It needs to:

Contract.
Lift.
Release.
Lengthen.
Respond reflexively.
Coordinate with your breath.
Adapt to changes in pressure.

That’s why I talk about pelvic floor fitness, not simply pelvic floor strength.

A Buff Muff isn’t a pelvic floor that is clenched as tightly as possible all day.

A Buff Muff is one that can respond appropriately to the task at hand.

 

Are “pelvic-floor-safe” exercise modifications actually safer?

Not necessarily.

This is where things get particularly interesting.

Research examining intra-abdominal pressure during different exercises has found that exercises commonly labelled “pelvic-floor safe” don’t necessarily generate substantially less pressure than their supposedly unsafe alternatives. Remember, it is about the execution of the exercise and what is easy for one person is hard for another so that will drastically change the intra-abdominal pressure.

One study comparing recommended pelvic-floor-friendly versions of exercises with conventional versions concluded that the recommended versions did not necessarily reduce pelvic-floor loading.

Even everyday activities can create significant increases in abdominal pressure. Remember coughing and standing up from a chair?

That doesn’t mean everyday activities are dangerous.

It means pressure alone is a poor way to divide movement into good and bad categories.

 

What about heavy lifting and prolapse?

This is where we need nuance.

Heavy lifting can generate substantial intra-abdominal pressure, and research has explored an association between chronic heavy occupational lifting and pelvic organ prolapse. Some studies have also found temporary increases in vaginal descent or prolapse symptoms following strenuous exercise.

We cannot take those findings and conclude:

“Heavy lifting causes prolapse, therefore women with prolapse should never lift heavy.”

And what if we looked at other variables and measured trained and untrained pelvic floors with the activities?  

There are too many variables involved, including pregnancy and birth history, connective tissue, pelvic floor injuries, age, menopause, training history, body composition, technique and individual capacity.

We also have to consider what happens when women don’t strength train.

Loss of muscle and bone is not exactly a recipe for healthy aging. We lose muscle every year as we age and we start losing bone after our late 20’s. This loss is even greater and faster in the early post menopausal years and guess where we have muscle and bone?

In our pelvis. 

So instead of asking:

“How little can I lift without hurting my prolapse?”

I would rather help you ask:

“How can I progressively build my body’s ability to lift?”

That is a very different mindset.

Can you lift weights with pelvic organ prolapse?

Many women with pelvic organ prolapse can and do strength train, including progressively lifting heavier weights, provided the program is appropriate for their individual symptoms and capacity.

The starting point will not be the same for everyone.

Maybe today you can comfortably squat holding 10 pounds.

Great.

That is your starting point.

Over time, perhaps that becomes 15.

Then 20.

Then 30.

This is progressive overload — gradually asking your body to tolerate more so it adapts and becomes more capable.

We use this principle throughout exercise science and your pelvic floor shouldn’t automatically be excluded from it. 

One study looked at a group of women with prolapse symptoms and put them into a light, moderate and heavy lifting category. Those who lifted the heaviest had the fewest prolapse symptoms. This study di not look at type or stage, it simply had women who were symptomatic with prolapse lift weights and the group lifting over 50kg reported fewer prolapse symptoms.

 

Can you run with pelvic organ prolapse?

For some women, yes.

For others, running may initially increase heaviness, pressure or bulging.

That doesn’t necessarily mean: 

“My body can’t run anymore.”

It may mean:

“My current capacity doesn’t yet match the demands of running.”

There is a big difference.

Running involves repetitive impact and requires strength and coordination throughout the entire body.

So your return-to-running plan may include pelvic floor training, calf and leg strength, hip strength, impact preparation, walking intervals, short running intervals and gradually increasing volume.

Instead of jumping from “I have prolapse” to “running is unsafe,” we build the capacity required for running.

 

Should I stop an exercise if I feel prolapse symptoms?

Symptoms are information. That’s it.

And they are influenced by SO MANY THINGS.

They do not indicate severity, worsening or improving and 

They aren’t an emergency alarm.

If you notice increased heaviness, dragging, pressure or bulging during or after exercise, get curious.

Ask yourself:

What did I do?
How much did I do?
How heavy was the load?
How tired was I?
What time of day was it?
Was I stressed?
How was I breathing?
Did symptoms settle afterward?
How did I feel later that day?
How did I feel the following morning?

This gives you information you can use.

Symptoms are your body asking for something to change.

Maybe you need to decrease the weight.

Maybe you need fewer repetitions.

Maybe you need longer rest periods.

Maybe you need to change your breathing strategy.

Maybe you need to improve pelvic floor strength or coordination.

Maybe you need to build more overall strength.

Maybe you need to change the time of day your exercise.

Maybe there is another exercise that achieves the same goals that is better suited for your capacity right now.

Or maybe you simply progressed too quickly.

Modify doesn’t have to mean avoid.

That distinction is HUGE.

 

How do you exercise safely with prolapse?

Instead of searching for a magical prolapse-safe workout, I recommend focusing on five things.

1. Know your pelvic floor

Can you contract and lift your pelvic floor?

Can you relax it?

Can you coordinate it with your breath?

Can you generate a strong contraction?

Can you maintain endurance?

Can it respond quickly?

If you’re not sure, a pelvic floor physiotherapist can be incredibly helpful.

 

2. Learn to manage pressure

This is where breathing, positioning, load and strategy come into play.

Sometimes exhaling during the hardest part of an exercise can help.

Sometimes exhaling before the hardest part will help.

Sometimes exhaling at the start and holding will help.

Sometimes changing your stance helps.

Sometimes reducing load or repetitions helps.

And sometimes, once you’ve built enough capacity, you won’t need the modification anymore.

A modification can be a bridge, not a life sentence.

 

3. Strengthen your whole body

Your pelvic floor doesn’t live on an island.

Train your:

legs.
glutes.
hips.
back.
core.
upper body.

Your goal isn’t simply to have a stronger vagina.

Your goal is to have a stronger human attached to that strong vagina.

That’s whole-body pelvic floor fitness.

Oh, and PS, tight doesn’t equal strong.

 

4. Progress gradually

Find a starting point your body tolerates.

Then progressively challenge it.

Increase resistance.

Increase repetitions.

Increase range of motion.

Increase impact.

Increase speed.

Increase complexity.

Not necessarily all at once!

This is how your body adapts.

5. Pay attention to your symptoms

Your symptoms are one piece of the puzzle.

They can help you determine whether your current training dose matches your current capacity.

That doesn’t mean you have to be completely symptom-free every second of every workout.

It means we’re paying attention to how your body responds and using that information to make decisions.

 

Do Kegels help pelvic organ prolapse?

Pelvic floor muscle training can improve prolapse symptoms and pelvic floor function, particularly for women with symptomatic prolapse.

Research reviews have found improvements in prolapse-related pelvic, urinary and bowel symptoms as well as pelvic floor strength and quality of life following pelvic floor muscle training. Changes in anatomical prolapse stage are less certain.

But effective pelvic floor muscle training isn’t simply:

“Do 10 Kegels at every red light.”

A proper program should take a whole body approach and consider:

• strength
• endurance
• coordination
• relaxation
• timing
• breathing
• functional movement
• progressive overload

And those pelvic floor skills need to translate into your actual life. We need to train the pelvic floor dynamically.

Because nobody’s goal is to become amazing at lying on the floor doing Kegels.

Your goal is to live your life with confidence and joy and without limits.

 

What is the best exercise for pelvic organ prolapse?

There isn’t one.

The best exercise program is one that helps you build the physical capacity required for your life and your goals while appropriately managing your symptoms.

If you want to hike, let’s prepare you to hike.

If you want to lift your grandchildren, let’s train you to lift.

If you want to run, let’s build toward running.

If you want to garden, travel, ski, play pickleball, CrossFit or lift heavy weights, those goals should influence your training.

Your diagnosis shouldn’t determine your destination.

It helps us determine the route.

 

What if exercise makes my prolapse feel worse?

If exercise consistently causes significant or worsening symptoms, don’t just push through it — but don’t automatically give up the activity either.

This is an excellent time to work with a pelvic floor physiotherapist who can assess your pelvic floor strength, coordination, muscle tone and prolapse and help determine what may be contributing to your symptoms.

There are also other conservative tools worth discussing.

A pessary, for example, can provide additional support for some women during exercise.

Addressing constipation, chronic straining, coughing and other repeated sources of pelvic floor loading can also be important.

And if you’re in perimenopause or menopause, genitourinary changes associated with declining estrogen deserve consideration as part of your overall pelvic health picture.

Optimizing pelvic health requires a holistic whole body approach that includes lifestyle and exercise.

 

The Buff Muff Bottom Line

If you remember nothing else from this article, remember this:

Having prolapse does not mean you have a fragile or broken vagina.

You don’t need to spend your life obsessively trying to avoid pressure.

And you don’t necessarily need a list telling you which exercises your body is allowed to do.

You need to understand your body.

You need a pelvic floor that can contract and relax.

You need whole body strength.

You need whole body mobility.

You need mind body coordination.

You need progressive exposure to the things you want your body to be able to handle.

You need a whole-body approach.

And sometimes you need a little support and guidance along the way.

That is what I mean when I talk about building a Buff Muff.

We’re not training your pelvic floor so you can become really good at doing Kegels.

We’re training your pelvic floor so you can become really good at living your life and aging with power!

Frequently Asked Questions About Prolapse and Exercise

Can exercise make pelvic organ prolapse worse?

Some strenuous exercise can temporarily increase prolapse symptoms or vaginal descent in some women, but the long-term relationship between specific forms of exercise and prolapse progression is not fully understood. Exercise recommendations should therefore consider your symptoms, pelvic floor function, goals and individual capacity rather than relying solely on universal avoidance lists.

Can I do squats with prolapse?

Many women with prolapse can squat. The appropriate depth, resistance, repetitions and breathing strategy depend on your current strength, symptoms and capacity. Squats do not need to be universally classified as safe or unsafe.

Can I do planks with prolapse?

Many women with prolapse can perform planks. If planks provoke symptoms, the exercise can be modified by changing position, duration or intensity while you build capacity.

Can I lift heavy weights with prolapse?

Some women with prolapse can progressively return to heavier resistance training. Heavy lifting can generate high intra-abdominal pressure, so your individual symptoms, pelvic floor function, training history and progression should guide your program. Current evidence does not provide a universal weight limit that applies to every woman with prolapse. Lift what you can manage well and then progressively add load.

Can I run with prolapse?

Some women with prolapse can run without significant symptoms. Others benefit from first building pelvic floor, leg and whole-body capacity and then gradually introducing impact and running volume.

Are Kegels good for prolapse?

Kegels are one form of pelvic floor muscle training. Pelvic floor muscle training is recommended as a conservative treatment for many women with symptomatic pelvic organ prolapse and can improve symptoms and pelvic floor function.

What is the safest exercise for prolapse?

There is no single exercise that is safest for every woman with prolapse. Exercise should be individualized according to symptoms, pelvic floor function, physical capacity and goals.

Should I avoid abdominal exercises with prolapse?

Abdominal exercises can be scaled and progressed just like other exercises. In fact abdominal curl ups have been found to be associated with lower mean maximal IAP than standing up from a chair. The appropriate exercise depends on your symptoms, capacity, breathing strategy, technique and overall program.

Does intra-abdominal pressure make prolapse worse?

Intra-abdominal pressure occurs normally during breathing, coughing, lifting, exercise and everyday movement. Research has not established a single pressure threshold known to cause pelvic floor dysfunction, and pressure generated during the same activity varies considerably between individuals.

Key Takeaway

Stop asking only, “Is this exercise safe for my prolapse?”

Start asking:

“What does my body need so I can build the capacity to do this?”

That question opens the door to something much more empowering than avoidance.

It opens the door to pelvic floor fitness.