Let’s talk about cardio. I know there are a lot of questions about what women can and can’t do for cardio when experiencing prolapse and/or incontinence symptoms. This happens to be a loaded question because the answer is dependent on your conditioning level, your over-all strength, and your symptoms of pelvic floor dysfunction. So while I can’t give you any “definite” on what you should or should not do, I can provide some thoughts that may help guide you.
To begin, it’s important to have an understanding of all the muscles of your pelvic basket and how to activate those muscles. Establishing a baseline strength of these deep core muscles through appropriate strengthening exercises is important before beginning any cardio. When you begin with a solid base strength, you will continue to build on this strength as you introduce cardio, further decreasing your symptoms. If you skip the base-building step, you will more than likely note increased symptoms with cardio activities. With this understanding, we can move forward and discuss the positives and negatives of many cardio choices.
Let’s first talk about walking for fitness. Walking is a fantastic activity. However, I would like to give a few tips to make your walking better for your body and for your pelvic floor. The first tip is to focus on your push off. Feel your toes (your big toe especially) work to push you forward. This simple change of focus will decrease your heel strike and decrease the force of impact of every step. It also promotes hip extension and naturally lifts your chest. You will feel like you are walking taller, which is a good thing!!!
Now let’s talk about swimming. It is one of the best cardio choices for women experiencing pelvic floor dysfunction. Actually, it is one of the best cardio choices for anyone. It is an exercise that works both upper and lower body muscles and it promotes extension as you stretch your body out in the water. As you work to balance your body in the water and work your swimming strokes, it works the many stabilizing muscles, including your transversus abdominus (TA) and multifidi that are so important to pelvic floor recovery. So swimming gets a big thumbs-up from me. For those of you who just don’t like to put your face in the water, you are still not off the hook! You can get in the water holding a kick board with your arms and your head above water, allowing you to still work your lower body in an extended position.
How about biking? Again, I like this exercise because of the position it puts your body in. A good bike fitting will require you to reach forward to your handle bars which will roll you forward onto your sitting tripod, which is your right sit bone, your left sit bone, and your pubic bone. This is a position that frees your tail bone from pressure and automatically activates your TA because of the forward reach of your arms. Biking is a great form of cardio that will have a positive effect on pelvic floor symptoms
simply because of the positioning alone.
Let’s move on to cross country skiing. This is an excellent non-impact form of cardio that also promotes extension since it is focused on hip extension and push-off on every stroke. Again, it is both an upper and lower body workout that will enhance pelvic floor strength if you have already established a solid base strength AND provides exceptional cardiovascular conditioning.
The four exercises I discussed - walking, swimming, biking, and cross country skiing – alll get a thumbs up from me, and you would do well to rotate these exercises into your weekly routine. Now let’s talk about some of the more controversial or
demanding forms of cardio.
We’ll first talk about running because it is an activity that many of us love and want to continue for years to come. I will speak from a personal stand point and I encourage any of you to share your stories as well. I have been running since discovering my prolpase 8 years ago and my pelvic floor is better conditioned today than it has been since discovering my prolapse. That being said, I think I am a different runner than I used to be. I don’t run on consecutive days, instead I cross train every other day. Is this because of my pelvic floor or my knees or my hips…probably for the recovery of all three! My body responds well to rotating impact and non-impact activities. Also, I pay attention to my running style, taking care to limit my heel strike and on hill running days, I now walk back down the hill instead of running down, again to limit heavy heel contact and pounding on my body. What I do get out of running is exceptional cardiovascular conditioning with both endurance runs and high intensity interval training. My personal story is that my pelvic floor is its strongest right at the peak of my triathalon training. It is a positive story that lets you know that you don’t have to give up running. However, there simply is no research at this point to support or dispute this…just personal stories. So share yours, positive or negative, about running with prolapse, so that other women can read and learn as well.
Finally let me cover a couple of other cardio choices that have come up. The elliptical machine is one that many women like because it is lower impact. My concern with the elliptical machine is the focus on flexion. Your hips flex forward but there is minimal to no hip extension on the elliptical machine. If you love this machine and choose this as your form of cardio, then be sure to work in at least 2 hip extension exercises following your elliptical workout.
Kickboxing is another workout that many women ask about. This is a tough one, because although I recognize that it provides an excellent power and cardiovascular conditioning, it is very difficult not to increase your intra-abdominal pressure when you kick or punch. These power strikes that produce a sudden increase of downward pressure on your pelvic floor are tough on supportive tissues that aren’t 100%. It is never a problem to try an activity like kickboxing, but if you feel increased pressure on your pelvic floor with every kick or punch, it is probably not your best choice for cardio.
Hope this information is helpful as a guide. Please feel free to ask questions and share your personal stories as well.