I have been diagnosed with a prolapse – should I stop all abs exercises?

Ok, let’s start by getting a few things clear…

  1. I don’t think abs exercises are bad for pelvic floor health – I think it’s very necessary to stay globally strong, and that includes exercising the abdominal wall!
  2. I don’t think there are absolutes here, it’s not black and white that there is one RIGHT way to do abs exercises and any other way is WRONG. But what I am saying is that there are ways of doing abs exercises that are more likely to cause downward pressure into the pelvic floor…

Take an example of the type of patient I’ve seen many times in clinic

  • She attends boot camp style of exercise classes, which include abs exercises like sit ups, russian twists and mountain climbers done with speed and often with weights

  • She has started getting symptoms either of a prolapse or stress incontinence and comes to see me

  • I test what’s happening in the vagina when she’s doing abs exercises, and find that the vaginal walls are being pushed downwards.

We then work on slowing the exercise down, doing it without weights resistance (for now) and finding a breathing and pelvic floor/core strategy that doesn’t cause downward pressure in the vagina.

Then she gradually increases speed and weights back up to whatever her ‘tipping point’ is where she can still control that pressure management.

She doesn’t have to stop Boot Camp – she just has to be empowered to know how to use a different strategy and movement pattern so that she can continue.

I wonder if this has made you reflect… could there be movements that you are doing in your exercise regime that are being done in a way that pushes down into your pelvic floor? In particular with abs exercises… Could you, rather than stopping the exercise you love (or continuing it but ‘putting up’ with symptoms), perhaps learn a different way of doing it so that it creates less pressure?


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