The MamasteFit Podcast Episode 126 – Understanding Pelvic Organ Prolapse: Causes, Symptoms, and Management

Gina: Welcome to the MamasteFit Podcast. In this episode, Hayley and I are going to be talking all about pelvic organ prolapse. So what should you do if you’ve been told that one of your organs is maybe falling out of your body? And, why you should not be scared of this diagnosis. We’re going to break it down, all in this episode.

Welcome to the MamasteFit Podcast. We’re going to be talking all about pelvic organ prolapse in this episode. It’s something that I currently have, I think Hayley has prolapse- I think a lot of people have prolapse that may not know that they do, but sometimes when we hear this diagnosis, it’s super scary. “Oh my God, all my organs are falling out of my body.” Like, you may have been told that you can never run again, you should never lift heavy again, you should never jump. And so usually there’s like a long list of things you “should never do again” because it might make it worse, or you may suddenly start clenching in your pelvic floor and feeling lots of heaviness, or may be feeling really symptomatic. So we’re going to break down in this episode our personal journeys with learning that we had pelvic organ prolapse and how we are still able to live a very active and unrestricted life, even with that diagnosis.

So Hayley, could we start by explaining what prolapse is? ‘Cause some folks might be like, “Wait, what is that?”

Hayley: Of course. Yeah. I think when it comes to prolapse, so much of the fear and anxiety and unknown comes from just not knowing what it is, and, so that’s good that you want to break down what it is.

In our pelvis, we have multiple organs in our lower pelvis, right? And so we have our bladder in the front, then we have our vaginal canal, our cervix, and our uterus all in one line. And then we have our anus and our rectum in the back, right? So there’s three sort of holes, and three organs attached to those holes. So pelvic organ prolapse is when one of those organs or, if you don’t have a uterus, your vaginal vault, so the cervix or where the cervix was, or something called an enterocele, which is when your small intestine can also begin to descend into kind of that pelvic cavity. So, we can have a cystocele, which is related to the bladder. You are going to have a urethrocele, which is related to the urethra, like the tube. We can have a uterine prolapse, and we can have a rectocele, which is the rectum, and we can have then a rectal prolapse itself. So there’s a number of different types of prolapse, and often what I hear from people when they come in to see me is, “Oh, my midwife, or my OBGYN at my six week appointment told me I had some prolapse,” and didn’t really go into the details of what that was, or what part, or how much? Just, “A little prolapse,” which is not particularly helpful.

Gina: Yeah.

Hayley: So then what do we all do? The immediate Googling of, “prolapse,” and then you’re going to see a lot of very scary images of people’s, like, entire bladder pushing out of their vagina, or their entire cervix and uterus coming out- and those are extreme cases of prolapse and likely not what you’re dealing with.

So between the bladder and the vagina, there’s tissue, and between the vagina and the rectum, there’s also like layers of tissue. And when a baby comes out of our vagina, the vaginal canal is very stretched by the baby. This is a good thing, right? This allowed your baby to exit your body. And so the walls of the vaginal canal are thin to begin with, and so you want to imagine it like a toilet paper tube, right, like it has some give to it, but it still has some sturdiness. And so postpartum, the vaginal canal is if you took that toilet paper tube and rolled it and rolled it until it broke down a little bit. So now, when you press on it, there’s not as much give, it kind of has a little less sturdiness to it. And again, this is really normal in the postpartum period.

So, then what is normal to have happen after you have a baby is your bladder, which typically will rest on the vaginal canal, and your rectum that’ll rest on the vaginal canal, now can press into the vaginal canal more, okay? So the bladder will push into the wall of the vagina, and you might be able to see it or feel it. And when the bladder is pressing through the wall of the vaginal canal, it looks ridge-y, like the bladder is bumpy on the surface. It is not actually your bladder, it is the impression of your bladder through the vaginal canal, so I think that’s always- or the rectum through the vaginal canal- and I think that’s always like a good reminder for people is that it can’t actually come out of your body because it’s pressing through that tissue. Right? It can descend beyond the opening of your vagina if it’s progressing, but it’s not going to just drop out the bottom ’cause it can’t ’cause there’s tissue blocking it- unless you have a fistula, but that’s a whole other conversation! So, if it’s your bladder pressing into the vaginal canal, it’s called a cystocele. Okay? If it’s your rectum pressing through the vaginal canal, it’s called a rectocele. If it’s your uterus, your cervix coming straight down, it’s just a uterine prolapse. And then the enterocele’s, the differential is a little bit different, but you can, on exam, we can determine if small intestine has moved through there. And then for urethroceles, it’s just sometimes people will see the urethral like opening has a little bit of like more fullness to it than it did before. So it’s potential urethrocele, urethral prolapse. And then, a rectal prolapse is when like the anal sphincter is getting like that pressure straight out the bottom. So lots of language there.

Gina: Yeah!

Hayley: Lots of terminology. But the big ones that we see, the most common ones that we see postpartum are going to be our bladder, cystocele, or our rectum, rectocele. And yeah, I’d say those are the main ones that I see clinically.

Gina: Yeah. And so all of that sounds really scary, to be told, oh, my organs are not where they’re supposed to be, or maybe things are starting to move a little bit lower. So I think there’s a lot of fear involved with prolapse in general ’cause it’s not something that’s like really well understood. And sometimes folks don’t know that they had it ’cause they weren’t having any symptoms until maybe a provider casually mentioned it to them, and may or may not have given them any sort of information with that.

So with my first, I didn’t know I had a prolapse ’cause I wasn’t symptomatic, I didn’t have any issues from it- and I still have, I think, a really similar grade that I did after my first now, after four kids, but I don’t have any symptoms from it. So if nobody had told me, I would not know that I had one. And I think that’s probably standard for most people. Most people probably don’t have symptoms. I only found out that I had a prolapse because I was looking at my medical records and the PT that I saw, wrote it down there, but she didn’t tell me that because it wasn’t an issue for me, it wasn’t important information that I needed to know about my body, and she probably knew that if she told me that I would get stressed out and I would become very fearful of moving my body. And so now I am here after four kids, my cystocele is essentially the same as it was four babies ago. I can run a marathon, I can jump, I can lift heavy, and so I can still live a very full life, but I don’t have any symptoms from it at all. Like it doesn’t impact my life in any way. I know that there are people that do have more symptoms and I’m really thankful that there’s a lot of things that we could do to help resolve those symptoms so that we can live that very active life. But I just, want listeners to know that if you do have that diagnosis, it doesn’t mean that everything is over. Like you can absolutely still live a really active life. I sometimes like to compare prolapse to having looser skin after we give birth, like where our bodies are just a little bit different, but it doesn’t mean that there’s a functional change. It doesn’t mean that we’ve decreased in function because we had a baby. Just like how we might have stretch marks or looser skin, like our body is different, but that doesn’t always equal a functional issue. And it’s similar with prolapse, like, there might be differences in our body, but it doesn’t mean that it doesn’t function in the same way or it doesn’t have the same capability again.

What was your experience with learning that you had prolapse?

Hayley: Yeah. My experience was, yeah, similar in that after I had my son, I really did not know anything about my pelvic floor. I wasn’t having a ton of symptoms and I started running- there’s like a local running group and the only time my couple-week-old baby was not screaming was when I was running with him in the stroller. So I joined this running club, and one day after he hadn’t really slept that night, I went out for a couple mile run and came home and hopped in the shower, and as I’m like showering, I like, can feel something’s not right. And so then I’m like got in my mirror and I’m like, standing over the mirror like trying to figure out what the hell is going on, and then start the doom scroll. And I’m looking at pictures and being like, “Yeah, that looks like what I’m seeing,” like I see this kind of like bulgy thing, like inside my vagina, that I don’t remember seeing before, but I don’t know if I ever really examined this closely before.

Gina: Yeah.

Hayley: So maybe it was here, maybe it wasn’t.

Gina: I did the same with the mirror and panic of, “What is this? Is that normal?!”

Hayley: “Is this what it’s supposed to be?”

So then, yeah, I saw a pelvic PT that used to practice locally and they’ve since retired, thankfully, and they told me that I had prolapse and that I probably shouldn’t run. And granted yes, at a couple weeks postpartum, I probably shouldn’t have been running yet, but, like, weightlifting was off the table, took all these things off the table in order to not, for this to… Not even, there was no like statement of, “Oh, this will get better if you stop for a period of time.” It was like, “No, your life now means that like you can’t do any intense activity.” And my background in sports medicine where I had worked with people who had like completely torn a hamstring or torn their ACL, or ruptured their Achilles, and we see those people heal from these major soft tissue injuries, that I immediately was like, “Nah.”

Gina: Like, “That can’t be true.”

Hayley: My vagina is redeemable because I’ve seen how capable bodies are of healing from other major injuries. And then I, not long after that, took my first pelvic floor course, ’cause it was like this mission of: this can’t be the only therapist in town. This can’t be the only person who’s giving this advice.

And yeah, I think, I wasn’t a pelvic floor physical therapist before I had my first kid, and that diagnosis pushed me into it. And I think as I learned and as I healed and progressed, as my worry about the prolapse decreased, my symptoms also decreased. Not to say that there wasn’t physiological things happening, but our pelvic floor isn’t just orthopedic. Our pelvic floor is heavily emotional and somatic. And so when we’re worried about something coming out of our vagina, it obviously makes sense that you might tighten your pelvic floor, clench those muscles to try to keep stuff up, right? Because we just feel, “Oh shoot, if it’s going down, I better squeeze upwards.” And something that I think is really important for people to know is that the different parts of our vaginal canal have better sensation than others. So the top parts of our vaginal canal don’t have awesome sensation, but the bottom parts of a vaginal canal do. So if we squeeze our pelvic floor and we bring our pelvic floor up towards those organs, then we’re going to feel them more, right? Because now the bottom part of our vaginal opening that has more nerves, has more sensation is going to be closer to where those organs are hanging out.

So this is particularly true in cases of low grade prolapse, and I think this is incredibly frustrating for people who are dealing with a lot of symptoms, ’cause like, “I am having all this pressure, I’m feeling all of these symptoms and they keep telling me I just have a mild grade one prolapse and it doesn’t feel like it!” And so then there’s still a lot of dismissal, “Oh, a grade one prolapse is normal, it’s pretty typical.” But what we feel symptom-wise and the grade of our prolapse does not necessarily correlate. A cool example that I’ve seen clinically is I had a client, and I was seeing her for hip pain, not necessarily her pelvic floor, but we wanted to rule in and rule out if her pelvic floor was really contributing to this hip pain. And I had her bare down like you do in a pelvic floor exam. And her, she’d had her uterus removed, but they left her cervix, and they didn’t tack it- which is not what happens anymore but when she had that surgery, that’s what they did. So her cervix was untethered and when she bore down, her entire cervix came out of her body, and I saw it. And she’s like, “Oh yeah, that. That doesn’t bother me,” and just pushed it back in. And so this grade four prolapse, so like the most extreme level of prolapse that one could have, was completely asymptomatic to this woman, did not bother her one bit. But where people will have a grade one prolapse, the lowest grade of prolapse, which means that the organ is higher up in the vaginal canal, they tend to be far more symptomatic for people, and I think that can be really confusing for people to navigate.

So even though I was having a lot of symptoms of this prolapse, my grade was progressing, and even as my grade progressed from a high 2 to a lower 2, to maybe a 1, my symptoms sometimes would still be just as bad. And so it was like, my grade is getting better, I’m healing, body’s getting stronger, but why do I still feel this? And I think, as I started to learn more about regulating pressure and distributing force and regulating my nervous system, that’s when I started to really feel like the symptoms could get better, not just to the organs.

Gina: Yeah, I definitely, there was definitely moments, especially like early postpartum where I would have more symptoms, or just that sensation of heaviness, and it wasn’t necessarily that my organs were sitting any lower. It was usually times where I was on my feet for a long time, and I was like clenching a little bit more, especially the early postpartum where I’m like, everything’s falling out, like I’ll just lift up. So usually if I did like some back expansion breathing and some like hip shifts and just rested, I usually found that the symptoms resolved pretty quickly from there, just ’cause I was able to release the tension and release that like drawing up and clenching that I was having. And so even like outside of the early postpartum, if I was like baby wearing a lot, sometimes I would be a little bit more symptomatic because I was falling into this really extended position. And so if I would just find a round and like breathe there for a little bit, usually the symptoms would resolved pretty quickly for me. And so a lot of it for me when I was more symptomatic was times where I was stuck in an extended posture, and I was clenching a little bit more in an attempt to stabilize, and that’s when I was like definitely more symptomatic.

When I am exercising, especially when I’m starting to lift weights- and this applied for pregnancy and for postpartum, even up to now- one of the things that I find really helps support my pelvic floor and my prolapse is what you were talking about with pressure management. So learning how to coordinate how I am breathing and adjusting pressure gradients within my abdominal cavity, within my thoracic cavity as I am moving a load. And so prolapse can be related to how well you manage pressure, so if we are not managing pressure well and we’re bearing down a lot, either putting more pressure down to the pelvic floor and then adding on muscular activation on top of that, we could feel more heaviness from that as well.

And so my like biggest tips when it comes to, one, understanding what pressure management even means is, when we inhale, we should increase pressure, especially down into our abdominal cavity. And this increase in pressure is helping to stabilize our spine. So if we think about a soda can that’s still sealed where we haven’t popped it open, the pressure within that can is really strong, so if I put like a weight, a weighted plate on top of it, the can would maintain its position. But if I open the can, and then also emptied all the liquid in it, and then I put a weight on top of that, it would probably collapse, ’cause there’s no pressure to help maintain its position anymore. And so that’s what we want when we’re lifting weights, especially if we’re lifting heavier weights, is we want to have that pressure to help stabilize our spine so that it can maintain its position under a load.

But, during pregnancy, and especially in the earlier part of postpartum, our ability to manage pressure and to withstand it from like bearing out becomes a little bit harder as things really begin to change for us. So during pregnancy, our abdominal wall is being stretched, where we’re balancing is changing, so there’s a lot of physiologic changes happening during pregnancy, and then in the postpartum, the tissue has more laxity to it still, as it’s healing. And so if we try to increase all of that pressure to help maintain a heavy load, we’re probably going to have points of leaking.

Hayley: Yeah.

Gina: We’re not going to be able to quite manage that pressure as well. So it’s like when you have a brand new balloon and you blow it up, it can maintain its position, there’s still some give in places, versus like a grocery bag that’s much thinner- it’s much easier to manipulate and change that, and it’s a little bit harder for it to maintain its position as well. And, if you blew too much air into this weak ass grocery bag, it would probably leak out in places. And so not that, that grocery bag and our core and all of that can’t regain density again, which is what happens when we lift weights, but we have to be mindful that it’s maybe not quite the same as outside of pregnancy, outside of this kind of first six months postpartum.

So, when it comes to lifting heavier weights, we may not be able to lift quite as heavy during pregnancy because we can’t manage the pressure, and we may need to not just hold our breath and increase tons and tons of pressure, we may need to reach a point where we can exhale and add on that muscular activation.

And so the second part of pressure management is learning how to exhale, and making sure that we’re lifting up so that we’re countering that increase in pressure with exertion. And so usually what this will look like is you may inhale at the top of your squat, lower down, begin to come up, and at some point in the ascent you exhale and lift up with the pelvic floor, pull the core in to withstand that like pressure from exertion. So as we’re standing up, there’s more pressure coming down from the weight, and then we’re adding on that muscular activation to counter it, is like the main thing. So essentially when you’re moving with gravity, we’re usually increasing pressure with our inhalation because the eccentric portion of the movements, or the lowering portion or lengthening, we tend to be stronger. And then we’re coming up out of movements, or we’re moving against gravity, we’re going to exhale to lift up to counter the increase in pressure with exertion. We have a whole YouTube video where I break down how to breathe and maintenance help to support your pelvic floor during pregnancy that you can also use in the postpartum as well.

But that’s like my overview with pressure management and how I continue to lift even with a prolapse, even now in the postpartum. And eventually all of this thinking and, “Okay, I inhale here, I exhale here,” becomes more second nature, and you don’t have to, like, really think about it a whole ton. But during pregnancy, and I would say like the first six months postpartum, there’s a little bit more mindfulness to it- because you can lift weights with prolapse, and you can do it without increasing symptoms. And I think it’s important to lift weights with prolapse because when we add on additional load and resistance, this is what helps to increase that muscle density, which is going to help our pelvic floor be stronger to withstand increase in pressure.

Hayley: Yeah! Yes. There’s so many, so many good pieces in there. And I think one of the things that I always like to remind my clients is, yeah, strength training, period, is better for us long term in terms of our health and wellbeing, well into our aging than the risk of prolapse and not doing any strengthening. Like, doing nothing is worse for you as a human than strength training and having some symptoms. Right?

Gina: Yeah.

Hayley: It’s sort of like, if you have a torn ACL, or you have a meniscus tear, right, and it’s doing okay and you can manage it, doing nothing, and not doing any exercise at all, and not loading it, and not strengthening around it, is going to lead to worse outcomes for that meniscus in 5, 10 years from that meniscus tear. Whether you exercised or not, you may or may not need surgery for that to repair it, because it has a problem.

Prolapse surgery is one of the most common surgeries that women have. We don’t need to feel shame or guilt about this if we do eventually need surgery to repair a damaged tissue. But if you never exercised from the time of your diagnosis or the beginning of your prolapse, to the time that maybe you did need surgery- and I would argue that if you exercised, you may be less likely to need that down the line- you’re going to be a whole lot worse off.

Gina: Yeah.

Hayley: Period.

Gina: It’s much harder to recover from injury and surgery in a lower state of conditioning for sure.

Hayley: And, our role as medical providers to first, do no harm. Telling someone to do no activity is harmful, straight up. There’s no ifs ands or buts about that, in my mind. Do I sometimes talk about, we sometimes talk about pulling back and optimizing position?

So I think a big thing that I see in like the rehab space, like the individualized one-on-one space, is that pregnancy and, even a lot of people before pregnancy, let’s be real, are- if we’re thinking about this can analogy, which I love- is we’re not just all regular old cans, right? We’re all frigging dented cans. And so in pregnancy we get even more dented, where one side of that can is more open as the uterus grows forward, and then the backside is going to get compressed. And what that looks like across the pelvic floor is that then the front half of that pelvic floor is going to get elongated and the back is going to crinkle up and get tight. And then some people, we add a little twist to that can, so now we’ve got a dented and rotated can. So when we’re looking at corrective exercise, right, when I see a new patient and they’re navigating prolapse and they want to get back to weightlifting, we sometimes go, “Okay, let’s pull back for just a minute. Let’s get your can un-dented using different repositioning strategies, different breathing strategies, so that when you get under the bar, now you’re not so dented and twisted up of a can. So now we can use those breathing strategies and that’ll make a more intuitive sense in your body.

But I think for the clinicians, if you have a client and you’re trying to get them back under the bar, you’re trying to get them back into doing more, and they just keep running into these barriers of, “I can’t, my form can’t change, or my symptoms keep flaring up and I’m doing the same things,” it’s considering, “What’s going on in this person’s body to the left and right. Do they have an element of asymmetry that’s impacting their ability to really get this equal recruitment?” It might mean that doing the same thing on both sides, like back squatting or traditional dead lifting, might not be optimal for that person for right now. So maybe we’re working in more unilateral work, where we’re biasing things differently on one side versus the other. And that’s not necessarily like pulling back, ’cause we might be able to load that person heavier when we’re doing work asymmetrically and we’re being mindful of how that person’s “can”…

Gina: Yeah.

Hayley: …is messed up.

Gina: Yeah.

Hayley: Or not, “messed up,” that’s right term. But, is twisted.

Gina: Yeah.

Hayley: Because we’re all a little twisted. Our bodies are not perfectly symmetrical.

Gina:

I see that with a lot of the gym clients that are also like seeing you guys as well, where I’ll walk in and they’ll be deadlift with a slightly staggered stance and they’re like, “Yeah, this helps my pelvic floor feel better for right now as I continue to get stronger, this setup is helping me to feel asymptomatic,” and I’m like, “That’s awesome!” And sometimes when I jump- so like we went to a trampoline park last week for one of my kids’ birthday parties- and I, when I jump with both my feet together, eventually I start to feel a little bit more heaviness.

Hayley: Yeah.

Gina: So I’m like, “This doesn’t feel great.” But once I stagger my stance, I’m able to keep jumping, and play on the trampoline and do all this stuff. And usually it’s like my left foot comes back just a little, my right foot’s a little bit more forward, and that usually like right away, clears up any sort of heaviness that I’ve been feeling, just from changing my position- which is different than if I was jumping with more of a bilateral or even stance, but I’m still able to do the movement. So I think there’s a lot of value in not necessarily saying, “Never again,” to weightlifting, ’cause I think lifting weights is incredibly beneficial and I think our generation now is seeing how beneficial it is for the women in the generation above us or the, even the next two or three generations. Like we have these older women that are starting to lift weights that are really improving the quality of their life because of it. And I’m like, “I would like that too, for myself.”

Hayley: Yeah.

Gina: And so we can just add these slight modifications and these slight posture changes to really help to relieve symptoms that we may be feeling. And I think that there’s tons of value in doing that. Like, maybe you can lift heavier now that you’ve had this slight shift, ’cause now we’re asymptomatic. Or maybe we do have to pull back a little bit on the weight because we had this posture shift that we can then build, improve our positioning from, and then we’re going to find that we’re much stronger down the line, too.

Hayley: Oh yeah. Yeah, and I think for me, from my first to my second, I really approached my second postpartum knowing that I had this previous prolapse diagnosis. And with my first, I had more cystocele symptoms with my first, and immediately after my second I was having more rectocele symptoms. So I’m like, “Now I’m a pelvic floor physical therapist. I’m not going to panic. I’m going to splint if I need to splint to make sure I’m emptying bowels well.” And then I went, “Okay, this postpartum is now an opportunity, right?” This is an opportunity for me to actually even change habits and change patterns that have been ingrained in me, even from like way before having kids, right? So I played volleyball, lots of asymmetrical rotation, lots of one-sided tightness in my body. And so I was able to take that really adaptable time in our body and that fresh postpartum period and really change things that I hadn’t been able to fully change before. And so I think that perspective when people are thinking about, like if maybe they’re in a second pregnancy after prolapse diagnosis and they’re feeling really worried and stressed out about that- and while we do know the more pregnancies we have, we maybe increase our risk of prolapse- but if we address some of the whys, then we can actually see that all feels better. And now, yeah, after my third, feeling great, the prolapse is a non-issue for me, and I hope to keep it that way, basically.

Gina: Yeah. Yeah, for me, sometimes I have a little bit more like rectocele symptoms and having the squatty potty and then splinting is like a super helpful way for me to still continue to do…

Hayley: Yep.

Gina: …whatever I do, with prolapse, and manage these like little symptoms I might be having here and there.

Hayley: Yeah. The symptoms are a yellow light, I think. if you feel a symptom, it doesn’t mean that you’re damaging tissue, but it is a sign that, okay, there’s something that needs to be adjusted here, addressed here, and working with a pelvic floor physical therapist or a strength coach who’s aware of some of these things can help us better address that for long-term health.

Gina: Yeah. I definitely found for myself, like going into my first pregnancy from a more athletic background that I was not very good at listening to my body.

Hayley: Oh gosh, no.

Gina: I was, like, I had body awareness but I was like, “Be quiet. no, like I will run through this injury.” And I did have a lot of movement pattern or habits that were just less optimal ’cause I was compensating really well for performance. But I was never going to be like, “Oh, let me just take a month and like really rework my squat form.” No, I’m going to do like a mobility warmup and then jump into my workout at my super heavy load, ’cause I had an ego that I needed to maintain. But after the birth of my first, and then after each of my kids, similar to you, where it’s like I had this really cool opportunity to rebuild, to move out of these poor movement habits. And my like level of injury is significantly lower than it was pre-kids. Like I was injured all the time. When I was in college, I had more like SI joint and like just general discomforts, like pre-kids. And since having kids, because I have improved how I’m moving my body, I have more body awareness, I actually listen to my body’s messages- when it’s like, “Please, don’t do that,” I’m like, “All right, fine.” Before I would be like, “Shh! Be quiet.” Because I took the time postpartum to connect with my body and to relearn, I lift heavier than I did before and I lift heavier without pain.

Hayley: Oh, absolutely.

Gina: Like I can run faster, I can run further without pain. And I think that’s a huge thing that I take away from all of my postpartum experiences, is I can still do all of the same things I did pre kids, but I do them without being in pain- and now I got all these cute kids to hang out with, too. But, I didn’t give birth and then immediately have all that, there was probably a four to six month process of, okay, now I have to rebuild. I’m aware of there are changes that are happening with my body, so I can’t just go for a 10 mile run today. I can’t lift a thousand pounds today. Like I need to reconnect with my breath ’cause that’s how I’m going to help relieve symptoms that I may be feeling, how I can help to manage my prolapse. I need to make sure that I’m incorporating my mobility work so that I can work on my positioning, incorporating some more of that asymmetrical work to help with the rotation and twist that I have within my own body.

And then eventually I’m going to make it to a point- which at one day postpartum may feel so far away where you’re like, “Oh my God, six months from now I might be able to lift really heavy again? That’s so far, that’s half a year!” And you’re just like in the trenches, and now you have this prolapse diagnosis and you’re like, “It’s just never going to be the same again.” It comes really quick. You’ll hit that year mark postpartum much faster than we’re all wanting to. Zoe’s just hit her 10 month mark, and I’m like, excuse me.

Hayley: Yeah, slow down, please.

Gina: It’ll happen. It’ll happen really quick, and if we are slow with the process and we’re patient with the process, it really will pay off and we can do all of these things without having symptoms and without being in pain.

Hayley: Yeah.

Gina: Which I think is huge.

Hayley: Yeah. I think a huge thing is feeling in control. And so when we have strategies and techniques and ways that we modify that can, one, help our symptoms feel better, and two, help us feel strong and understand how our body is working. That’s going to mitigate a lot of the fear and unknown of, “I don’t know what causes my symptoms. I don’t know like why some days it’s better, why some days it’s not. Is this related to my cycle? That’s weird because I’m postpartum. Is this because I got really constipated? Is this because…” trying to piece out like all of the causes of symptoms. But I think there’s, yeah, it’s so true of, I just need to trust this process and keep working the process and stick with it. And, know that as as you get stronger in your entire body, your pelvic fascia also gets stronger.

I think another really important point that I don’t want to miss out on this episode is that our pelvic floor is not what holds up our pelvic organs. And I think a lot of people think that. I think a lot of pelvic floor therapists thinks that.

Gina: So what holds ’em up? Just the fascia?

Hayley: There’s pelvic fascia. There’s tons of pelvic fascia that connects our uterus to our spine and to our abdomen. There’s tons of connective tissue, so if anyone’s ever done like a cadaver dissection, it’s really hard to get in there and get all those organs because there’s so much fascia holding it all.

Gina: That makes sense why there’s more sensation at the opening where the pelvic floor is, because there’s, if there’s all this fascia and connective tissue between that, yeah, that makes sense.

Hayley: Yeah. And then the pressure, like it is, and it’s also normal for organs to move- like these, or our organs are not meant to just be cemented in place. As we jump, our guts move up and down, our digestive system moves up and down and our diaphragm moves up and down, that’s squeezing and compressing, compressing all of our guts and our pelvic organs, like this is good.

Gina: Yeah.

Hayley: But I think when we then get stiff in response to holding and keeping things in, then that stiffness is really a big contributing factor.

Gina: Yeah. Like when we think about physics with impact force, the slower, or more time it takes you to reach the conclusion of your impact, the less force there’s going to be, ’cause it distributes that force a little bit more. This is why we have a car accident and there’s an airbag that’s helping to slow down your like acceleration, which helps to decrease the force on you. And so if we’re jumping, if you think about the difference between jumping with like stiff legs versus with a bend in your knee, like you’re landing with the same point of contact with your feet, but it’s either like straight legs and you jump and then it’s just like pelvic floor, stiff pelvic organs hit, or it’s bend as you jump and land, and then we have a little bit more time to impact, which helps to decrease the force on the pelvic floor, on the pelvic organs as well.

So it would make sense that if we are clenching and we’re not, we don’t have any give with our fascia and with the muscles, that when we are moving our bodies, like things are going to probably feel a little bit more pressure-y and there’s going to be just more force happening within our body. And so we do need that pelvic floor to give and to release, and for me personally, I find that when I do more release work and I do let my pelvic floor have give, I have less symptoms.

Hayley: Oh yeah.

Gina: I feel much better within my body, as opposed to being afraid and like clenching up and holding in. There’s lots of value to learning how to release in a way that still helps you feel comfortable within your body. And fortunately we have a lot of support for you to do that.

So we have our postpartum fitness programs that are designed to help support you from about four to six weeks postpartum, whenever you get your “all clear,” or you feel ready to start. And we’re going to progress you with learning how to reconnect with your breath to start. So it’s going to be mostly body weight movements at first, some more floor based movements as you learn, can I extend my arm as I exhale properly? Can I inhale to breathe into my back? And so we have the 24 workout progression where we take you from the floor, learning how to breathe, all the way to being able to do weighted squats again. In our progression, we have follow along videos that you can watch and work out with me at the same time, but we also have self-paced workouts if you prefer to work out on your own- and there’s demo videos with all of those. And so you can join our postpartum fitness programs and we will help guide you to feel good in your body again. Our programs are not specific to prolapse or diastasis or leaking because when we think about a full body approach, all of those things tend to be resolved and helped with our programming as well.

And if you’re a professional, we have our movement professional mentorship community that you can join where we are going to be going live all month of August, talking all about prolapse. And now if you’re listening to this episode, and August is long gone, all of the content that we shared in August about prolapse is still available within the community, and so you’ll be able to review old content as well. So if you are looking to help support your clients to feel confident in their bodies as they are navigating a pelvic organ prolapse- whether you’re a physical therapist, you’re a fitness trainer, maybe you’re a doula or a medical provider- our mentorship community is going to be a great option for you to learn directly from Hayley, from me, and from Casey as well. So you can check out both of those options- our fitness program, in addition to our mentorship community, down in the notes below.