For some people, this is a sensitive topic. It can feel embarrassing to discuss and the symptoms can cause people to withdraw from activities they enjoy for fear of having an "accident". It can also cause pain and discomfort at times.
I'm talking about pelvic organ prolapse - or POP for short. Approximately 50% of women have some degree of pelvic organ prolapse. POP can occur due to various reasons including straining during childbirth or constipation, vaginal delivery, pelvic surgeries such as a hysterectomy or even menopause. POP can occur with any of the pelvic organs - bladder, uterus or rectum - and can range in severity from being completely asymptomatic to being extremely symptomatic and requiring surgery.
"A few weeks ago I pooped my pants. Literally."
Let me tell you a story about my experience with rectal prolapse...
A few weeks ago I pooped my pants. Literally. I was in my kitchen unloading the dishwasher after my morning workout and doing all of the things for my kids - like fetching cereal that they would ultimately leave half eaten on the table - when I felt what I thought was gas. BUT NOPE, poop came out. THANKFULLY I was home and was able to quickly go upstairs to change and clean up, but that didn't make it any less frustrating or embarrassing. Since the birth of my second son I have been dealing with the symptoms of this prolapse that generally ramp up at certain times in my menstrual cycle.
My prolapse was diagnosed by my pelvic health physiotherapist somewhere in the range of 4-6mo postpartum. At my initial appointment with her around 6-8 weeks postpartum there was still some residual swelling from my vaginal birth and I hadn't yet really tested out activities that might cause it to be symptomatic - like impact exercise or long periods of standing. When she diagnosed it at a later appointment a lot of things made sense - I was getting this bulgy sensation 'down there' during some exercises like squats, deadlifts and anything with vertical impact like when I attempted a jumping jack. I could also see something pushing out of the back of my vagina when I was sitting on the toilet that didn't look like it was supposed to be there (which in fact, it wasn't). In the end, it was diagnosed as a mild to moderate - or grade 2 - rectocele, also known as a rectal prolapse.
With this particular poop incident, I had already noticed that my pelvic floor and prolapse were angry in the days leading up to it. There were a few specific things that triggered symptoms that created the perfect storm - sex, impact exercise and ovulation.
So lets talk though these:
Sex or any other type of vaginal penetration (like using a tampon) can trigger symptoms. For some this might be TMI about me, but in this instance, the position I had been in during sex caused irritation to the prolapse. I experienced a sharp, shooting pain and we immediately had to stop. The following day, my prolapse felt irritated and my pelvic floor felt tense as if it was protecting itself from further irritation.
Impact activity - specifically running in my situation - about 2 days after the painful sex incident. While I was running sprint intervals on my treadmill, I could feel the tension and gripy-ness of my pelvic floor. It didn't matter how I adapted my breath or my run technique, things just felt off.
Hormones. I was in the ovulation phase of my menstrual cycle. Personally, I experience mild to moderate ovulation cramping for a few hours or up to half a day when my ovaries release a follicle during ovulation. This cramping tends bring about some tension in my pelvic floor and the hormonal changes tend to trigger some mild constipation - which in turn stresses my prolapse.
All of these things happening in succession created this perfect storm and compromised the integrity of the function of my rectum. Does this happen often to me? No, not at all. For the majority of the time, the prolapse is asymptomatic, except around my period. I usually have a few days where the drop in hormones (estrogen and progesterone) cause some constipation. This constipation, in combination of using a tampon puts pressure on the prolapse and I experience some pain/discomfort for 1-2 days, especially if I have trouble managing constipation.
So after this incident, what did I do?
First I backed off of impact activities during my workouts for a few days to let it settle. I avoided jumping, bouncing and running. This didn't mean I had to stop all impact activities forever, it just meant that I needed to let my symptoms settle, avoid more irritation and then slowly build back into these activities as my symptoms subsided.
Second, I did some pelvic floor relaxation through breath work to help relieve the feelings of grippy-ness and tension.
This legs up position while laying on your back is one of the most restful positions for your pelvic floor. You can add a pillow or rolled up blanket for comfort if the floor is hard and roll into and out of the position from your side - ESPECIALLY if you are early postpartum. Once in position, focus on deep belly breathing and allowing your body to sink into the floor, taking gravity and pressure off of your pelvic floor.
Third, I made sure to up my water and fibre intake to relive constipation and ensure I didn't have to strain when having a bowel movement. If you're curious as to what your stool should look like and how often you should be having a bowel movement, refer to the Bristol Stool Scale.
And what I really want to make clear here is that you CAN STILL EXERCISE WITH PELVIC ORGAN PROLAPSE. It's the HOW YOU EXERCISE that might need to be adapted to manage symptoms. As I mentioned above, impact can be taken out or adapted, various breathing and pelvic floor relaxation techniques can be used and in some cases pelvic floor strengthening can be done though the guidance of a pelvic health physiotherapist or postnatal exercise specialist (like myself!).
In my group coaching program The STRONG Motherhood Collective for pregnancy, postpartum or parenthood I provide modifications and adaptations for POP (or any other pregnancy or postpartum related issues). These modifications allow you to still feel STRONG and CAPABLE in your body in whatever stage it's at. POP in most cases can be managed and supported by exercise when done properly.
I'm opening enrolment for the next session of The STRONG Motherhood Collective to the waitlist on Monday, March 21, 2022.
This program will provide 3 planned-for-you workouts each week delivered to you via my mobile and desktop app that you can do when its convenient for YOU - plus an opportunity to have a weekly live coached class if you choose. If you are on the waitlist you will also have access to a SPECIAL BONUS 30min coaching session with me within the first month of the program so we can get specific on your body's needs when it comes to exercise.
Join the waitlist HERE and be the first to have access to enrolment!
I cannot wait to support you.
Your Coach,
Jen