Estimated reading time: 12 minutes
Can you lift weights with pelvic organ prolapse (POP)? I have been asked this question many times since setting up this platform in 2017. There was a time I would have said ”Definitely not!”, however; I found myself asking that very same question of myself and the answer led me to compete in a bodybuilding competition in December of 2019!
If you have been following my story, you will know that I had surgery during 2013 to repair a rectocele. During that same operation, my surgeon implanted mesh to act as a “preventative” measure against stress incontinence. I subsequently had many complications with the mesh and had to have it removed leaving me completely incontinent.
At the time of my mesh removal surgery, my surgeon noted that I still had a rectocele even though my rectocele had been surgically repaired during the first surgery. Recurrence of POP is not uncommon following surgical repair as POP repair surgery does not address the root cause of the issue instead only treating a symptom. When we add to this the high risk of developing cystocele following mesh removal surgery, it is not surprising that I was told never to lift anything heavier than a kettle of water again. That’s around 2kg (4.5lbs). Not a lot of weight, right?!
Following the mesh removal, the last thing on my mind was whether or not I could lift weights with POP. I had to deal with being completely incontinent. Even walking at the pace of a snail was making me leak. The doctors had said I would just have to accept a life of incontinence. The surgery to remove the mesh had also removed a lot of my own tissues (removing mesh from the pelvis is like removing chewing gum from hair). I was told the only option to restore continence would be a future surgery. This was something I was not willing to believe!
Opportunities to Learn
Determined to prove that it was possible to regain continence without surgery, I set out on my journey of rehabilitation and within 18 months had fully regained continence. With my newfound continence, I returned to my strong yoga practice (the Ashtanga method) and considered myself to be fit and strong. Knowing I still had my prolapse, I was careful when it came to lifting things.
Life has a way of presenting opportunities to question your beliefs. Such an opportunity presented itself when my son came home with a pull-up bar. Considering myself strong, I assumed that pulling myself up wouldn’t be a problem and I didn’t consider the pull-up to be lifting something. That first pull-up taught me two things.
Firstly, yoga is all push and no pull. Expecting my muscles to perform well on a pull exercise was foolish. My body had not been trained to distribute tension under load in the pull direction.
Secondly, the same holds true for the pelvic floor. It was foolish to believe that my pelvic floor could deal with stresses of force from a pull-up when I had not trained with any pull exercises.
I pulled myself up aggressively without thinking about my pelvic floor and leaked for the first time since I had regained continence just a few months earlier. I was really shocked. I could run, jump, dance, laugh, cough and sneeze without leakage but this single pull-up had beaten me. It was time to re-evaluate my thought process.
When tackling pelvic floor dysfunction, a big emphasis is placed on managing intraabdominal pressure. This has particular importance when it comes to POP as downward pressure can exacerbate symptoms. Whereas the pull-up hadn’t triggered my POP symptoms, it did result in a leakage episode. I realized that I had refused to accept that surgery would be needed to restore my continence, but I had accepted without question that I could never lift heavy things again. This lead me to question, if I’m not training my tissues to manage load in all directions, am I really maximizing the potential natural support for my pelvic organs?
Questioning What I Was Told
I decided to question what I had been told – To never lift anything heavier than 2kg (4.5lbs) – while at the same time finding my own answer to the question “Can you lift weights with Pelvic Organ Prolapse?”.
Wanting to improve my pull strength, I decided to add a weekly climbing session. I expected I may experience some further leakage symptoms or POP symptoms when I began climbing but I had no issues. So why did I leak with the pull-up? The time to peak force with a pull-up is much higher than when climbing. With a pull-up, especially untrained, it’s a more sudden jerky movement. Whereas climbing was going to help with pull strength, it wasn’t necessarily going to make me “pull-up” strong.
The challenge was that I practiced yoga. I wasn’t a gym person. Any time in my life where I held a gym membership, I typically attended group classes such as aerobics or spinning. To try to improve my pull strength, I changed my focus attending body pump and circuit training. Although these classes do use weights, they don’t produce the same hypertrophic (muscle building) effect as focused gym training.
After two years of faffing around with random gym classes, I wasn’t seeing any noticeable improvements in my pull strength. I could do a single pull-up without leakage but felt that there was room for more improvement. I realized that the missing link was consistency.
With my yoga practice, I was very consistent practicing six days per week. The consistency with yoga resulted in dramatic gains in flexibility and strength. If I wanted to become stronger, I needed to make a commitment to focus on building strength. I signed-up with a fitness coach and began training 5 days per week.
What the Research Says
Studies into weight lifting with POP are few and far between. No study directly asks can you lift weights with pelvic organ prolapse, however; one recent study published in August 2020 surveyed 3934 women and found that “physically active women who lift heavy weights for exercise do not have an increased prevalence of POP symptoms”. This is just a single study and the authors have also stated that “Advice on the contribution of heavy weight lifting as part of a physical activity regime to the pathophysiology of POP requires further investigation”. More studies are definitely needed.
Learning to Balance Tension
Not many coaches are pelvic floor aware and most that I have spoken to have never heard of pelvic organ prolapse. When I had my first session with my new coach, she told me that I will probably leak during some of the exercises – as though it was a given! I explained that leaking is not a given and should not happen during exercise. If it does, it is indicative of a pelvic floor dysfunction that needs to be addressed.
I knew during that first session with my new trainer that I wasn’t going to get good advice on how to engage my pelvic floor during weightlifting to support my prolapse and prevent leakage. I needed to be the person who is responsible for taking care of my pelvic floor health at the gym.
In the beginning, I approached every exercise from the perspective of my pelvic floor first, and the muscle being trained second. If you have watched my YouTube video on upgrading your pelvic floor exercises, you will know that I train my pelvic floor using an RPE scale. During my gym sessions, I would begin each exercise with a contraction at an RPE of 4 on this scale. This was a conscious contraction. These RPE 4 contractions are the equivalent of pre-tensioning the pelvic floor, something which should eventually happen without conscious thought.
After a few months of conscious effort, it became automatic. That didn’t mean I could just forget about my pelvic floor at the gym. When practicing exercises that require bracing, such as squats, a stronger contraction was needed. The downward pressure from abdominal bracing needs to be matched with upward pressure from the pelvic floor in order to provide enough support for the pelvic organs. If the downward pressure exceeds the upward pressure, leakage is likely, and POP can become symptomatic.
If we approach the body from the perspective of bio-tensegrity, we can see that the body is a unity with everything suspended in a network of connective tissue (fascia). You could visualize it as a 3-dimensional connected network that distributes load and tension.
Biotensegrity in Action
With POP, taut and restrictive connective tissues can pull the pelvic organs out of their normal anatomical position. This is one of the reasons pelvic floor muscle training helps to relieve the symptoms of POP as increased pelvic floor tone lifts the pelvic floor reducing the pull on these tissues by providing additional support for the organs from below.
Pelvic floor relaxation can also help to improve the symptoms of pelvic organ prolapse as it encourages a release of tension in the pelvic floor. Tight muscles and tissues cannot respond to increased load and so releasing and relaxing hyper-tonic tissues also reduces pulling on these tissues allowing the system of biotensegrity to work more efficiently.
When you think about this biotensigrity model, you can visualize how improving the tone of the muscles above the pelvic floor can also help with the overall lift and support from above as everything is connected.
Learning to balance intraabdominal pressure under varying loads from different positions teaches your body to deal with directional forces of tension and load. If you choose to never lift anything heavier than a kettle of water again, your body will not be able to lift anything heavier than a kettle of water.
Setting Functional Goals
You need to ask yourself “what I want my body to be able to do?” Ask in functional terms, for example: lift your child, carry your suitcase, pull yourself up onto a platform at an event so you have a better view. Then consider what type of strength is needed to be able to perform that action. This allows you to set a goal that supports the life you actually want to. live. Progression is a slow and steady process and requires consistency.
My goal was to be able to do pull-ups without leaking. To do this, I started light and slowly increased the weights over the course of one year. I was amazed at how both my strength and my physical body changed.
In the summer, I switched coaches and agreed to compete at a local bodybuilding competition. It wasn’t something I had ever imagined doing. Previously, I had very little respect for the sport. It wasn’t until I experienced the level of discipline and commitment required to compete that I found respect for a sport that from the outside seems so vain.
From a strength perspective, the improvements were dramatic. On the leg press I progressed from 25kg (55lb) to 250kg (550lbs). With deadlifts, I progressed from 20kg (44lbs)) to 80kg (176lbs). My squats progressed from 40kg (88lbs) to 100kg (220lbs). With pull-ups, I progressed to being able to perform multiple pull-ups with good form.
I listened carefully to my body as I increased the weight and did not push beyond the limits of my pelvic floor. I didn’t have a single leakage during my entire year of lifting and my POP remained symptom free. My pelvic floor strength also dramatically increased as the year passed, which surprised me as I didn’t realise there was more to gain.
So now, when I am asked “Can you lift weights with pelvic organ prolapse” my answer is a definite YES. Now if you were to ask me should YOU lift weights with POP, I would answer that IT DEPENDS ON YOU!
You can only ever move from where you are to where you can be. If I had started lifting weights before regaining continence and restoring control over my pelvic floor, I would not have been able to manage my intraabdominal pressures. You must be able to walk before you can run.
Always start from where you are and progress from there. If you are suffering from stress incontinence or have a symptomatic POP, work on restoring continence and improving POP symptoms before adding weights. You can always improve things.
Building a Strong Foundation
This infographic gives you a sneak peek into the pelvic floor portion of the Eight-Phase Training program. Pelvic floor training is just a part of the overall program which is designed to guide you in building a solid functional foundation onto which you can build overall strength. I believe having a solid functional foundation is imperative before you start lifting heavier things.
You are the one who knows your body best, the one who experiences how it functions from day to day. You are the one responsible for deciding what you do with your body. Setting functional goals for yourself will help you to gauge the type of training needed for you.
Start from a strong foundation and remember that just as there is progress, there can also be regression. If you do something that triggers your symptoms, take a step back and make an assessment to identify the root cause. You will likely see an imbalance in distribution of tension through your body. Work to improve your ability to deal with that distribution of tension and progress from there to empower your flower.
Remember you should ask your pelvic floor physiotherapist if you can lift weights with your pelvic organ prolapse and you consult with them before embarking on any program of rehabilitation.
If you would like to see my journey to strength, check out my Instagram account: https://www.instagram.com/denise_zendivineyoga/