Prolapse and Lifting: Restrictions or Revelations? Part 1: Understanding Intra-abdominal Pressure


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.

ketchup bottle photo

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.

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Kathe Wallace

About Kathe Wallace

Kathe Wallace has practiced physical therapy since 1976, focusing on pelvic floor rehabilitation since 1988. As a nationally recognized leader in the pelvic floor specialty of physical therapy, she evaluates and treats many types of conditions referred to her by medical specialists in orthopedics, physical medicine and rehabilitation, urology, gynecology, gastroenterology and colorectal surgery. Full Bio.. →

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