Is it Safe to Run with Pelvic Organ Prolapse?

In support of Incontinence Awareness Month June 2015

Is it Safe to Run with Pelvic Organ Prolapse?

I was a recreational runner pre-baby. Post-baby, I suffered stress incontinence when I returned to the sport. I was fine while running, coughing or sneezing, but if both happened simultaneously I peed my pants. Although it improved as I recovered, it never fully resolved until I addressed it with a restorative exercise program. From a pelvic floor assessment I found out I have both a grade one cystocele and rectal prolapse.

There are many moms who run with symptoms of incontinence, from a few drops to full bladder leakage. The solution is not to wear a pad, it is to address the obvious weakness and strategically strengthen the muscles to support the sport. Here’s what you need to know.

1. Running involves impact and requires the core strength necessary to support it.
Stress incontinence is a symptom of core dysfunction and often related to diastasis recti (although not always). Running on a non-rehabilitated, non-optimal, symptomatic core invariably places strain on the supportive ligamentous structures that support the organs, due to pelvic floor weakness. This will further weaken the core, exacerbate pelvic floor symptoms, and can lead to pelvic organ prolapse.
The abdominal tension created and sustained by a functional core can support the position of organs with impact. This will protect the abdominal wall, the lower back and the pelvic floor. Running with incontinence is a sign that your core is weak and your risk of injury is high.

2. Stress incontinence can result from anticipatory core dysfunction.
The brain anticipates movement; when the core functions optimally it engages prior to the movement. But, if this timing is “off” these messages are delayed, the core engagement occurs a nanosecond late, and the result is….. urine leaks from the force of impact.
3. Because incontinence is a symptom of core dysfunction, there is invariably a lack of pelvic stability.
A non-optimal core is unable to stabilize the pelvis functionally through the demanding sport of running, resulting in pronation and over compensation by other stabilizing muscles such as the piriformis and psoas. These muscles become overused in a compensatory way, which typically results in hypertension and pain, impedes alignment and further exacerbates core dysfunction. A definite problem.

Here are some tips:

1. A dedicated deep core (Core 4) program must be the underlying restorative program to support running. . Deep core work will improve the synergy of core recruitment, strengthen the fundamental weaknesses and improve the anticipatory timing of the autonomic core.
2. Pelvic Floor Physiotherapy is your best friend if you are running with incontinence and/or pelvic organ prolapse. It can help identify and strategically strengthen pelvic floor weakness. It will ensure you are recruiting your deep core functionally. It can serve as a baseline to assess any increase in core weakness and any occurrence/worsening of pelvic organ prolapse.
3. Pfilates is a pelvic floor rehabilitation exercise program that can strengthen the pelvic floor and improve the timing of the anticipatory core.
4. The Hypopressive Method is a low pressure exercise system designed to effectively lift the pelvic floor, treat pelvic organ prolapse, and optimize the core fascial system.
5. Releases and stretches for compensatory strategies are a must. Activation work for inhibited muscle groups such as mulitifdus and glute medius will also support better pelvic stability control for running. Talk to your trainer or physio about these.

Remember that although incontinence is a symptom of core dysfunction, pelvic organ prolapse can be completely silent. The compensatory strategies the body recruits can be so effective that no symptoms occur.

Has being assessed with a prolapse affected my running? Yes it has. I ran 5 half marathons post-baby and just as I shudder to think of the pounding on my pelvic floor, I cringe to think about what degree my prolapse would be had I not done a comprehensive rehab program (and continue it to this day). I limit my distances to 5k, reap the benefits, minimize my risk, and focus on strength training. Train smart, train hard, and train for life. Get the results you want in the safest most effective way. Avoid injury by training with me :)