Pilates for Prolapse? YES…but also No

Chances are, if you are struggling with symptoms of pelvic organ prolapse (uterine, bowel, or bladder) your doctor has suggested exercises for your pelvic floor health. It’s far more common than you might believe, and concerns more than serial mamas or those with declining (o)estrogen in peri/menopause. New evidence suggests over-training can also lead to pelvic floor dysfunction, prolapse, and stress incontinence (Skaug, et al., 2022) well before the age we think it “normal”. 

If you talk to any devotee or teacher of Pilates, they will tell you it’s the panacea for whatever ails you, including prolapse. As of May 2022, facts.net reports that 11 million people practice Pilates in the United States alone (Tadashi, 2022), some for fitness and many for health or rehabilitation. There is a growing body of scientific research on its efficacy to address things such as muscle endurance, flexibility, balance, posture (Kloubec, 2010), chronic pain, disability (Byrnes et al., 2018), and mental health (Fleming & Herring, 2018).

What is prolapse? 

Prolapse happens when the uterus, bladder, or rectum descends into the vagina. It comes in various degrees, and can cause back and pelvic pain, pressure, heaviness, and even a palpable or visible protrusion at the entrance of the vagina. 

Will Pilates cure my prolapse?

An unpopular answer among devotees is “maybe, but sadly, NO.” However, will it help you manage some symptoms of prolapse? The answer is a resounding YES, especially if these symptoms include stress incontinence or difficulty in defecation. In simple terms, if you leak urine when you jump, sneeze, laugh, or lift heavy things, or if you strain when passing stools, Pilates, performed correctly, can help you!

The bad news

If you have severe prolapse symptoms that interfere with the quality of your life, you may be offered surgery when conservative measures have no impact. It’s not a guarantee, it may not help forever, but it might be your best option. 

It’s worth mentioning here that you could also ask your doctor if hormone therapy might be an option to assist with vaginal atrophy if that is a contributing factor. Only a medical professional can counsel you about this, so we won’t discuss it here.

The good news

There is a great deal of non-surgical and non-pharmaceutical intervention you can explore to improve pelvic floor health, and learn strategies and movements to decrease the pressure on your prolapsed organ(s). See more about hypo-pressives below.

It’s important to understand that “strengthening” is not enough for pelvic muscle and organ health and function. Pilates is extraordinary for both strengthening and lengthening pelvic floor, core abdominals, hips, and back. It’s also great for coordinating movements and breath to reduce intra-abdominal pressure during effort, as well as increasing blood-flow to pelvic areas to help hydrate and lubricate vaginal tissues and increase sexual sensation. 

The repertory is vast for both the mat and the apparatus so it is highly adaptable to a myriad of levels, ages, and conditions. An experienced instructor will help you find the best choices for your body and situation.

The bad news to use for good

Training incorrectly can actually make your prolapse worse. Pelvic floor conditioning must be more than instructing women to “engage your pelvic floor” or “Kegel” during a movement. In truth, many people don’t know how to do either correctly, and many medical professionals don’t explain it well. Vague instructions leave room for misinterpretation. 

I have had clients who, with other teachers, had “leaks” in class or the sensation that something was going to fall out of their vagina during certain exercises. Clearly they were not guided to engage, relax, or breathe to minimize pressure on their prolapse. 

I have re-trained clients who, with general anatomical information, assisted awareness, and task-oriented imagery, “get it” very quickly. Not all Pilates educators have the same quality or amount of training, nor do all have working knowledge of pelvic floor anatomy and function. 

Additionally, large Pilates classes taught for high volume are low in instruction. There is no way, for even the best teachers, to address the specific needs of the prolapse-affected client in a large, mixed-level mat class.

Read the full version of this article in Issue 1 of Female Health & Fertility magazine. Available for purchase here.

References:

Byrnes , K., Wu, P. J., & Whillier, S. (2018). Is Pilates an effective rehabilitation tool? A systematic review. J Bodyw Mov Ther. , 22(1), 192–201. https://doi.org/10.1016/j.jbmt.2017.04.008 

Caufriez, M. (n.d.). Filosofia del Concepto. https://caufriezconcept.com/. Retrieved from https://caufriezconcept.com/

Fleming, K. M., & Herring, M. P. (2018). The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complementary Therapies in Medicine, 37, 80–95. https://doi.org/https://doi.org/10.1016/j.ctim.2018.02.003

Kloubec, J. A. (2010). Pilates for Improvement of Muscle Endurance, Flexibility, Balance, and Posture. Journal of Strength and Conditioning Research, 24(3), 661–667. https://doi.org/10.1519/JSC.0b013e3181c277a6 

Kuhn, A., Santi, A., & Birkhäuser, M. (2011). Vaginal prolapse, pelvic floor function, and related symptoms 16 years after sex reassignment surgery in transsexuals. Fertility and Sterility, 95(7), 2379–2382. https://doi.org/https://doi.org/10.1016/j.fertnstert.2011.03.029 

Skaug, K. L., Engh, M. E., Frawley, H., & Bø, K. (2022). Urinary and anal incontinence                among female gymnasts and cheerleaders-bother and associated factors. A cross-sectional study. International urogynecology journal, 33(4), 955–964. https://doi.org/10.1007/s00192-021-04696-z

Tadashi. (2022, May 20). Pilates Facts. facts.net. Retrieved January 23, 2023, from https://facts.net/pilates-facts/