Lifting Techniques for POP
Do you find it challenging to find educational material that will encourage patients to stay engaged in their activities and discourage them from becoming overly cautious? I have found lifting education to be an important simple first step in the rehabilitation of POP. Some lifting techniques naturally increase the downward pressure on the pelvic organs more than others. Patients need to learn breathing techniques, body positioning and activation of the pelvic floor muscles.
This lifting with POP education handout focuses on the effects of technique and breathing on lifting activities. The strategies described come from reviewing the literature and working with POP in my clinical practice. The patient education handout was developed as part of an independent study project with Heather Bridgham SPT, University of Washington Department of Rehabilitation Medicine, Department of Physical Therapy.
Women presenting with Pelvic Organ Prolapse (POP) are frequently told many exercises and activities are unsafe and therefore should be avoided. Often, little information is provided about the specific techniques to be used in these exercises or activities. For example, a lifting technique can be done with either a squat or a lunge position, and breathing patterns used to do the lifting can strain the pelvic floor muscles or incorporate them into the task. Without specific information about technique, many exercises and activities are put on the “avoid or harmful” list.
When exerting while lifting or exercising, there is a natural increase in intra-abdominal pressure (IAP). The key is to understand which activities naturally increase IAP more than others and to use breathing patterns and pelvic floor muscle activation during these pressure rises.
Let’s use an analogy to better understand IAP.
Think about an upside-down ketchup bottle. Hitting the bottom of the bottle increases pressure (similar to IAP) and empties out the contents. But if the cap is on, no ketchup comes out. Similarly, during an increase in IAP caused by lifting or exercise, a healthy (non-POP patient) using her pelvic floor muscles is like keeping the cap on her pelvic contents.
Now, back to the ketchup. Sometimes the ketchup won’t come out even when the cap is off and pressure is applied, and then suddenly it does come out. Why? Because disrupting the surface tension and integrity creates an easier flow. Disruption of the surface is like a pelvic floor dysfunction seen with POP because of muscle and fascia integrity changes. Research shows that in healthy women, using the PF muscles during increases in IAP supports the continence mechanism and the pelvic organs. These concepts are explained in a research looking at the differential effects of Valsalva and straining maneuvers on the pelvic floor. For the complete IAP literature review add the complimentary download to your cart.
Pelvic floor muscle training (PFMT) is used to improve strength, endurance, and coordination of the pelvic floor muscles. There are two hypotheses regarding the use of PFMT for prolapse: (1) that strengthening these muscles can improve the structural support for the pelvic organs, and (2) that women develop a “knack” for consciously contracting their pelvic floor before/during increases in intra-abdominal pressure.
What research currently says about pelvic floor exercise training.
Within the available literature, there is general consistency regarding prescribed dosage comprising of 3 sets of 8-12 max pelvic floor muscle contractions per day. The duration of specific pelvic floor muscle training should be conducted over a 3-6 month period on the basis of muscle physiology, necessary for muscle hypertrophy. However, strength is not the only measure of muscle function and unfortunately there is a lack of research comparing muscle training, or looking at sub maximal pelvic floor exercise in conjunction with motor control training.
Consider an individualized exercise program
Administration of PFMT is more beneficial for the patient when the supervised training is given individually rather than in a group. This accounts for individual strength and activity differences. Further research is needed to identify the characteristics of patients that predict positive/negative treatment outcomes. The majority of the literature reviewed focused on short duration effects of PFMT; therefore, longer duration follow-up studies of PFMT are warranted.
This complimentary literature review download includes 14 articles addressing exercise science and pelvic organ prolapse.
GPostpartum women have lots of questions and need patient education for pelvic organ prolapse. My clients often think they are alone with the symptoms, reporting a feeling of isolation or “feeling different” than other women. One patient asked, “Does my vagina have stretch marks too?” Another reported, “It feels like I’m growing a testicle!”
Most of these women first consulted the internet when looking for answers about what they were feeling in their bodies. Internet searches for prolapse are plagued with what I call "doom and gloom" information, especially if you are a postpartum mom. Prolapse symptoms often cause women to stop or change exercise, daily activity routines and/or sexual activities. They report feeling less feminine and more self–conscious about their bodies. A new mother adjusting to changes in her body and trying to return it to its pre-pregnancy state needs to know all of her recovery options.
I'm delighted to provide a free informational handout on pelvic organ prolapse that introduces physical therapy as a first line of treatment. Please feel free to share it with your patients, physicians and fellow therapists.