I first knew something was wrong during a CrossFit workout about six months after I’d given birth to my first son. I was doing back squats and felt some unusual pressure down there—like something was about to fall out. I finished my workout, ignored the discomfort and then continued to ignore it each time I exercised, thinking I’d simply gone too hard, too soon after pregnancy. But after a couple of months, I finally worked up the courage to see my ob-gyn.
MY DIAGNOSIS
At age 33, I had Grade 2 Pelvic Organ Prolapse. “Your pelvic floor is made of several muscles, and like any muscle, these can stretch to the point of injury,” explains Dudley Brown Jr., M.D., an obstetrician- gynecologist in Palm Beach Gardens, FL. “The problem occurs when the muscles and ligaments that hold up your internal pelvic organs abnormally stretch and/or tear,” he says.
THE RESULT
Your organs (including the bladder, uterus, rectum, and intestines) may drop down, putting pressure on the walls and floor of the vagina. “If the injury progresses, these muscles can no longer help contain the organs. This is when prolapse occurs,” says Brown. Prolapse can create issues ranging from a relatively mild level of Grade 1 (ligaments slightly stretched; pelvic organs slightly out of place) to Grade 2 (pelvic organs are near the vaginal opening), Grade 3 (part of one or more of the organs is protruding out of the vagina), or Grade 4 (one or more pelvic organs has fallen out of the vagina).
It’s also more common than you may think, with up to 30% of women living with the condition. Risk factors include vaginal birth, obesity, chronic constipation, hysterectomy, and a family history, but repetitive heavy lifting may also cause problems for some.
If you’ve ever had a little bit of pee trickle out when you jump rope, run, or sneeze, be warned: It’s a symptom of a weakened pelvic floor, which can lead to prolapse. And while you may not have trouble in your 30s or 40s, it’s more likely to become an issue at the onset of menopause, since a loss of estrogen can also cause weakened pelvic-floor muscles. Those of us who experience intra- abdominal pressure from weightlifting and then push down on a weak pelvic floor may especially be at risk.
In its early stages, treatment can be relatively simple, including a series of exercises to strengthen the pelvic floor. Surgery to tighten pelvic-organ ligaments, a vaginal sling, or even a partial or full hysterectomy is often recommended for more serious cases.
Even if you’ve never had kids or felt a little extra discomfort yourself, all women should do some form of pelvic-floor exercises as a preventive measure, warns Karly Treacy, a yoga instructor based in Los Angeles who specializes in pelvic-floor training. “Pelvic-floor dysfunction is becoming somewhat of an epidemic,” she says. “Because so few of us actually inhale and exhale completely in our daily lives, the diaphragm and pelvic floor never fully stretch or activate. That results in short and tight pelvic-floor muscles, which can allow for prolapse to occur.” Think of the muscles like elevator doors that are supposed to close, she adds. “When they are tight or weak, the doors stay open—which means anything can get through.”
And if you are pregnant or newly postpartum, remember that you’re at higher risk of developing a prolapse, which means keeping your lifting to the lighter side. “There’s no need to stop training—just go for higher repetition with low weight. Listen to your body and modify your training as needed,” says Brown.
Nearly a year postpartum with my second child and after extensive pelvic-floor physiotherapy, daily exercises, and a decision to wait on surgery, I’m hopeful my issue will continue to improve. I’ve learned the hard way to be gentler with my body and to listen to its signs and signals. My lesson: Train smarter, not necessarily harder.
THE MUSCLES YOU REALLY NEED TO WORK
Most of us know about Kegels, exercises that help strengthen the muscles of the pelvic floor. Here’s how to make them more effective and what else you can do to stay strong inside.
WORK THEM IN:
Stop and start your urine flow a few times daily. This will help you identify your pelvic-floor muscles so you can work them throughout the day.
BE REGULAR:
Work the pelvic-floor muscles with three sets of 8–10 reps of Kegels per day.
REVERSE YOUR KEGELS:
“It’s so important to keep these muscles toned but not tight,” says Brown. That’s where reverse Kegels come in: On an inhale, bring your breath into your side ribs, expanding them and at the same time relaxing your pelvic-floor muscles. On the exhale, push all of the air out of your belly completely and tighten the pelvic muscles as if you’re pulling a string up inside of you. Try five sets of 10 reps with a minute rest in between sets. Do these in addition to regular Kegels.
