Let’s dive into an awkward subject, shall we? In fitness, we’re accustomed to discussing our hamstrings, glutes, biceps, the like. We explore the ins and outs of the large muscles in our body because they’re familiar and frankly, easy to feel (and sometimes see) during exercises. We’re less apt to talk about the small muscles deep in the pelvis because it typically involves discussing the big “V-word”…that’s right, VAGINA. I said it. Now let’s embrace the elephant in the room. 

Many of us are hesitant to talk about incontinence, leaking, prolapse and pains “down south.” We hear that mysterious exercises called “kegels” help, but we wonder whether we’re doing them right or not. Beyond that, we’re left in the dark. We assume that surely, these issues only happen following childbirth or into old age as we decline in fitness, but that’s not the case. Women can suffer from weakened pelvic floor muscles at any age, with or without having given birth, despite high or low levels of fitness, and even when knowing how to perform kegels. Sounds a bit daunting, but fear not… 

Confession Time

Take me, for example. I was at the gym doing a HIIT workout a few months ago when BAM. A gush of fluid rushed out of my “V-word” during a squat jump. I felt my face flush. What the ****??? I scaled down my workout that day and was nervous to run or jump during my next couple workouts. I wasn’t having any more leaking following that incident but I felt an increasing urge to pee, like all the time, for the next few days. And my girlfriends who have road-tripped with me already know about my notorious “tiny bladder” and its pit-stop needs. 

It was about four days later and my body still felt off. My husband and I decided to spend that Sunday evening taking our toddler to the grassy park overlooking Reagan National Airport to watch the planes coming in to land. Our son was giddy with excitement, having seen these planes many times from afar. Everything felt blissful and I was entranced by my child’s smiles. We were walking back to the car to head home when I felt a very sudden and very alarming feeling. It was as if something had fallen out of my vagina. It freaked me the heck out. Big time.

When I followed up with my OBGYN, I was told that my bladder was slightly lower than normal but that I wasn’t even a stage-1 level of pelvic organ prolapse. I was shocked because I thought certainly this feeling had to be associated with a more extreme condition. I was told to go home and do more kegels. That just wasn’t good enough for me, though. As a fitness professional, I know to always question one-stop-shop solutions, even healthy ones like performing kegels more regularly. That just couldn’t be enough, I thought, especially if I’m at a higher risk for developing true pelvic organ prolapse moving forward.

Let me take a step back and give you a little background as to where my body was at the time:

• It was almost 1.5 years after giving birth to my son and I had recently finished breastfeeding
• I stayed in shape during my pregnancy and postpartum, and was still regularly exercising
• I had experienced zero issues with my vaginal health as I returned to pre-pregnancy fitness levels following childbirth – no vaginal tears (wowzers, I got lucky there) and no leaking or issues with bladder control
• I was confident that I was doing kegels right but, admittedly, hadn’t done them as much following the first 6 months of the postpartum period

I couldn’t understand why this was happening to me at this point in time, so late after giving birth to my son, and with no warning signs. I knew there had to be a professional who could shed more light on the situation…and there was.

The Pelvic Floor 

I met a fantastic professional named Dr. Jennifer Nelson (PT, DPT, COMT, CMTPT) with Therapydia in Washington, DC, and she was the one who helped me get to the bottom of why this could be happening to me…and let me tell you, the answers were completely unexpected, but perfectly logical, at the same time. Here’s why she believed *my case* of near-prolapse occurred:

1. Overly TIGHT muscles, not weak ones, particularly in my abdomen.
2. Years of being in the fitness industry, sucking every core muscle in unnaturally, shifting the tilt of my pelvis under muscle tension and creating excess intra-abdominal pressure.
3. An accident from nearly 10 years ago that caused my left piriformis to stay cramped up, causing a chronic stress on my pelvic muscles (this was something that could only be released through INTERNAL, manual palpation…that’s right, through the vagina).
4. Caffeine consumption irritating the bladder and causing it to become hyper-reactive and perhaps inflamed (ahem…yes, I confess I was drinking more coffee than I should have been due to normal mom-fatigue). Apparently artificial sweeteners and alcohol can cause similar irritation.
5. Hormones adjusting back to pre-pregnancy levels following the natural weaning of my son. In other words, breastfeeding hormones can keep joints and muscles more loose and tender, just like during pregnancy, so my body’s sudden, enhanced tightness may have been from hormones acting like a roller-coaster.

Every woman’s experience with prolapse symptoms, whether they’re full-blown or not, is different and brought on by unique causes.

Reality Check: Prolapse is Common (albeit not talked about)

While learning more about my own experience with these sensations, I discovered how common pelvic organ prolapse is. Prevalence in post-menopausal women is over 40% and in younger, pre-menopausal women, who have given birth to one child, mild to moderate prolapse has been discovered to be quite common as well. While weakened pelvic-floor muscles are thought to be one of leading causes of prolapse, there is still more being discovered.

Running, Lifting & Pilates

There are some researchers who suggest that increased abdominal pressure, created from lots of endurance running, heavy lifting, and/or Pilates and core exercises, contributes to prolapse issues. This begs the question: Are we hurting our bodies through modern exercise?!? 

My thought is that we are doing our bodies GOOD through modern exercise, but that we need to increase our awareness of the excess pressure we create in our core which contributes to the “downward push” of our organs, when not kept in check. We also need to keep in mind that just because contemporary images of beauty align with a flat stomach, devoid of any of the natural roundness which has marked beauty and women’s bodies for centuries, doesn’t mean that standard is right. Modern women are sucking in their tummies at the expense of their vaginas. That’s the unfortunate truth, ladies.

How Do Women Prevent Prolapse?

For starters, it’s important not to ignore those good, ol’ trusty kegels. They help maintain the integrity of the small, but oh-so-crucial, pelvic floor muscles. The key is to practice these regularly (I know, I know…not the first thing most women add to their to-do list at the start of each day) and to hold the contraction for the appropriate amount of time; 10 seconds per kegel. Focusing on the release of the muscles from the contraction is just as important as the tightening of them. This is a good rule to apply to gym exercises too.

Another way to stay on top of preventing prolapse is to take a gradual approach to getting back into shape following childbirth. Upcoming app Matriarc is a great place to start. It helps women regain fitness during the postpartum period with a heavy focus on SAFE core and pelvic exercises.

Additionally, allowing the stomach to be soft and relaxed, in its natural state, is important. Frankly, it sucks to think about the damage our egos (mine included) could be causing to our bodies. So, let’s all be confident women in the shapes we possess rather than twisting and contorting (and sucking in) to conform to society’s “norms.” Our bodies are pretty awesome without all the [intra-abdominal] pressure. 😉

*Please note that this list of suggestions is not all-inclusive. If you’re concerned about your risk of pelvic organ prolapse or are experiencing leaking, incontinence or a feeling of pressure in your vagina, please contact your OBGYN right away.* 

Yours in health and wellness,

Maggie