Last Updated on November 27, 2020 by Heather Hart, ACSM EP, CSCS
Today we’re going to talk about something that many readers may find uncomfortable or taboo, but I feel needs to be discussed: running with pelvic organ prolapse. Pelvic organ prolapse (or POP) is incredibly common – upwards of 50% of women will experience it in their lifetime (Weintraub et al, 2020)
Yet we RARELY hear about it, because our vaginas are supposed to bring us shame or some other antiquated nonsense like that. Runners can carry on endlessly about the state of their illiotibial band or plantar faciitis, so as far as I’m concerned, this is another body part that can affect running. So it’s up for discussion.
I’m sharing because there are not enough first hand experiences from runners talking about this. I’m sharing because I hope to break taboos when it comes to discussing our bodies. Especially female anatomy. Look, I’m not going to start a post with something along the lines of “this is a lady problem, gentlemen you may want to tune back another day”. Nope. Bodies and body parts are not taboo, my friends. Some of us may have different anatomy, sure, but our struggles aren’t anything to be embarrassed or ashamed of. So, men, please DO stick around. Especially if you are a coach to, spouse or friend of, or simply supporter of female runners and athletes.
Because for many of us, this is a reality we never wanted to face, but have to.
What Exactly is Pelvic Organ Prolapse?
Whew. Now that I got that long introduction out of the way, let’s get on with some science. Much like a hernia, where your intestines push through a weakness in your abdominal wall, a pelvic organ prolapse is when either your uterus, rectum, or bladder (or sometimes all three) push through a weakness in the muscle and tissue of the vaginal wall. Depending on the severity of the prolapse, some women might only feel a pressure or fullness in their vagina or rectum. Others might actually see tissue hanging out.
B) Bladder (cystocele) prolapse
C) Rectum (Rectocele) prolapse
D) Uterine prolapse
source: www.uptodate.com
Surprised you haven’t heard of pelvic organ prolapse before? It’s likely because many women are too embarrassed to seek help, never mind talk about this problem in a public setting. Which I, of course, think is ridiculous (not their feelings – that I get. I think it’s ridiculous that we encourage women to suffer in silence because it’s something that involves body parts we’ve deemed “private” or “unmentionable”.)
VAGINAS ARE NOTHING TO BE ASHAMED OF LADIES!
Does Pelvic Organ Prolapse Happen to Men?
Pelvic organ prolapse and pelvic floor disorders do indeed affect men, though much less frequently. Studies show between 2-4% of men suffer from some time of pelvic floor disorder (MacLennen et al, 2005)
How Does Pelvic Organ Prolapse Happen?
There are a number of ways that pelvic organ prolapse can happen to women.
- Pregnancy, labor, and childbirth (this is the most common reason)
- Obesity.
- Respiratory problems with a chronic, long-term cough.
- Constipation.
- Pelvic organ cancers.
- Surgical removal of the uterus (hysterectomy)
That third one? Chronic cough? That’s what got me. A gnarly cold with a cough that wouldn’t go away after Sadler’s Creek Stumble 24 hour race in 2019. One night I woke up coughing violently, and physically felt something let go in my pelvis. The next day I noticed an uncomfortable bulge (it almost felt like a tampon falling out) while I was running. Soon after, a doctor confirmed my suspicions: a prolapse (more on the doctors visit below).
Now, I’ve put my body through hell in the past. I’ve birthed two babies (including a really big one, who is also responsible for the DR). I’ve run thousands of miles, including two 100+ mile races, a 90 miler, an 84 miler, and a 75 miler (and I’m proud of each one). I exercise almost daily, I lift heavy…I train this body to be strong. And what did my body do in turn? It gave out because of a three week cold when I couldn’t stop coughing.
Go. Freaking. Figure.
Because I’m a science nerd, I actually looked at research articles regarding this topic. Sure enough COUGHING causes more intra-abdominal pressure than even running and jumping.
Seeing a Urogynecologist
Once my prolapse appeared, I immediately stopped running and lifting. I was fearful of making it worse. It took me two months before finally getting an appointment to see a urogynecologist, a specialist in the world of pelvic organ prolapse. The physician I met with was incredibly professional, thorough, and most importantly, sympathetic. He listened, for a long time, and answered all of the questions I had to ask. He didn’t end our appointment until he was certain all of my questions and concerns were addressed. I’ve never had a doctor show such patience and compassion. No wonder it took so long to get in to see this guy.
(If you’re local, I’m happy to give a recommendation.)
My diagnosis was exactly what I expected and already knew: a bladder prolapse (cystole) through the anterior (front) wall of the vagina. The prescribed course of treatment, however, was not what I anticipated. Ultimately, the doctor let me know that a pelvic organ prolapse is considered a “quality of life” issue, not a “life or death” issue.
You see, with my hernias, there was always a chance of strangulation of the intestine. This is considered an emergency situation…and can potentially even lead to death. Thus, surgery was necessary to fix this bodily malfunction. Twice in my case, ugh.
But, when your bladder (or uterus, or rectum) prolapses through the muscle in your vaginal wall? Well…it sucks. It’s uncomfortable. It’s problematic at times. But it’s not going to kill you.
Thus, the physician left me with three options:
Do Nothing.
The “do nothing” option left me feeling equal parts deflated and optimistic. The doctor claimed that a moderate, reasonable amount of running would not make the prolapse any worse. Further, he claimed there was no research/literature available proving otherwise. This of course went against everything I’ve read in every (gloom and doom filled) online forum. Though, no actual research was provided there either, just hearsay.
Alas, he’s the expert, not the internet keyboard warriors. So I cautiously trusted his word.
Admittedly, “doing nothing” almost felt like a “life is hard and these are the cards you drew, so suck it up” sentence. It felt unfair. An air of “why me?” sets in.
Get Fitted for a Pessary
A pessary is a prosthetic device of various shapes and sizes inserted into the vagina to reduce the protrusion of pelvic structures (in my case, the bladder) into the vagina. The idea is that this could be worn while running to reduce symptoms, such as discomfort or even urine leakage.
Surgery
The doctor took time to explain to me exactly what this surgical procedure would look like. It included a hysterectomy, tacking the bladder back up where it belongs, and rebuilding the muscular wall that has collapsed (among other things I don’t remember, because it was a lot of medical terminology I was unfamiliar with). This option requires a minimum of 3-4 months of recovery time. No running, no heavy lifting (more than 10 lbs), no sex, etc.
This, currently, was not an option for me, for financial reasons.
So I left the doctors office with permission to run (in moderation), lift (in moderation) and get back into the habit of regular core and posture work, to help aid with pelvic floor health.
Running with Pelvic Organ Prolapse: My Experience
I won’t lie, initially I was terrified to continue running or resume any sort of normalcy in my fitness routine. Even though the doctor assured me I would be OK, I feared doing something to make my situation worse. A quick google search will give you dozens upon dozens of articles encouraging women to avoid running with pelvic organ prolapse. Despite what my physician said, many other experts agree that the increased intra-abdominal pressure from high impact sports, like running, can weaken the pelvic floor.
The general online consensus, if you must run, is to:
- Keep your distances short.
- Mix up your running surfaces: trails, sand, dirt, etc. result in lower impact on the pelvic floor.
- Manage your body weight: the weight of the upper body and abdomen is transferred directly to the pelvic floor during high impact exercise such as running. Less weight = less impact.
- Alternate running with lower impact exercises (cycling, swimming, etc.)
- Shorten your stride and increase turnover to lower impact.
While these tips are helpful, I’ve found there is more to managing running with a prolapse, which is what I share in the remainder of this post.
It’s important to keep in mind that the following is what I’ve learned in my personal experience of running with pelvic organ prolapse. Your situation, and the parameters surrounding your prolapse may be different. So as always, please refer your physician for personal recommendations. This post is not meant to diagnose, or treat anyone.
Run Early
It’s sounds crazy, but it’s completely true: gravity effects the severity of prolapse over the course of the day. I – and many women – are less symptomatic first thing in the morning, after laying down all night, versus at the end of the day, after being on my feet. So I try to take advantage of this, and run earlier rather than later in the day.
Monitor “heaviness”
This goes in line with the aforementioned “run in the morning” point. I have learned to really tune into how my body is feeling, and monitor my prolapse symptoms. If I’m feeling like my pelvic floor is tired, or “heavy”, I’ll skip a hard or high impact workout (like running). Instead opt for something lower impact (like riding my bike).
For many women, their prolapse will feel “heavier” during their menstrual cycle. It’s important to know that pelvic organs are not rigidly held in the exact same position at all times. The bladder and rectum are changing shape and size based on their contents, the uterus is changing size during the course of the monthly menstrual cycle, and even the position of the cervix is changing depending on where you are in your monthly cycle.
Run with a tampon/pessary if necessary
Tampons provide similar temporary relief to prolapse symptoms as a pessary: both provide urethral support and compression. When I run later in the day, or if I’m having a “heavy” feeling day, I will run with a tampon inserted. It alleviates the heavy feeling and allows me to run normally. Again, this is something you should discuss with your doctor first.
Lift with Awareness
Intraabdominal pressure when lifting weights can exacerbate the symptoms of a prolapse. My doctor stressed the importance of learning to focus on letting my muscles do the work, and avoiding the all too common pushing down on or straining the pelvic floor. I won’t lie – this is an ongoing practice. But it’s definitely helping.
Pelvic Floor Exercises
I am a certified exercise physiologist – but I’ll be the first to tell you that pelvic floor strength is not my specialty as a professional. I will tell you that I’ve read a ton of conflicting information regarding what exercises to do – or not do – to help strengthen your pelvic floor and alleviate pelvic organ prolapse symptoms. It can be confusing and frustrating. Personally, I’ve focused on integrating more pelvic floor and diastasis recti friendly exercises into my routine (think: heel drops, bird dogs, and bridges), and I feel that they have helped me. My suggestion is to consult a physical therapist who specializes in pelvic floor health who can help guide you and create a pelvic floor strengthening routine that caters to your specific needs.
Healthy Diet
I’ve spent the better part of this year truly learning how to properly fuel my body (thanks in large part to Coach Will at On Pace Wellness). Proper nutrition supports healthy tissue, which is exactly what we are going for when healing (or at least not exacerbating) a prolapse.
The Mental & Emotional Toll of Pelvic Organ Prolapse:
Arguably, the mental and emotional toll of pelvic organ prolapse really is the hardest part. As a long time endurance athlete, I’m accustomed to being uncomfortable. However, the idea that something is “wrong” with my body, and won’t ever easily be fixed, can feel incredibly disheartening. And we aren’t talking an ACL tear, this is a very intimate (though not taboo) part of your body that affects day to day life.
Further, as an athlete who spends a ton of time analyzing – and over analyzing – how to train my body to do what I want it to do, the lack of control I felt when developing a prolapse was frustrating.
For me, I’ve definitely had to weigh the pros and cons of continuing to run. Indeed, there are many women who have chosen to find another form of exercise to enjoy, and not take the risk that accompanies the high impact, repetitive motion of running. Personally, running is a large part of who I am (no matter how many times I try to deny it). Further, running is a form of mental healthcare for me. So, I choose to run.
More than anything, for me, this experience has been a practice in patience, and truly learning to tune into my body, even to this day, nearly a year later.
So, if you’ve come to this post looking for some hope that you can indeed run despite a prolapse diagnosis, I hope my story helped.
Heather Hart is an ACSM certified Exercise Physiologist, NSCA Certified Strength and Conditioning Specialist (CSCS), UESCA certified Ultrarunning Coach, RRCA certified Running Coach, co-founder of Hart Strength and Endurance Coaching, and creator of this site, Relentless Forward Commotion. She is a mom of two teen boys, and has been running and racing distances of 5K to 100+ miles for over a decade. Heather has been writing and encouraging others to find a love for fitness and movement since 2009.
Lori Branin
Since you’ve sort of sworn off FB, I thought I’d better leave my comment here too, lol.
A pessary was not an option for me. Well, medically it was, but the doctor mentioned it, and I was immediately like WTF?!?!?!?! NO!!!!!
Anyway, glad you went for a run!!! That’s exactly what I would have done too! ❤️❤️❤️
Heather Hart, ACSM EP-C
Really? Why is that? From what I gather, it’s no different than a tampon or a menstrual cup, in the sense that when it’s properly fitted, you don’t really notice it. (Thanks for commenting here! I’ve sworn off the FB for a bit. I can conveniently “push” the posts to FB directly from my blog, but I have no idea what anyone is saying over there, haha)
Kathleen Schwartz
Thank you!!! Just began this journey. I too can’t imagine giving up running. It was helpful reading your thoughts.
Rachel Frutkin
You’re a rockstar. It’s hard to step away from an identity that you’ve known for so long but you’re a strong woman and you’ll adapt and persevere. Just make sure you follow the doctor’s orders — moderation! 🙂
Stacey
Oh man so sorry for your pain ! Please check out Katy Bowman’s podcast and web site Nutritious Movement and her book about this very topic . It will al change her life
Alicia S.
A friend also has prolapse and uses a pessary. She’s been running for 8+ years with it. Once it’s in, she doesn’t notice it. She hasn’t reached ultra distances yet, but breezes through marathons.
Good luck!
Kathleen Schwartz
Thank you. Encouraging information.
Christine
Just want to say thanks for sharing! Fellow runner recently diagnosed with a prolapse here. This thing isn’t talked about enough, but people like you who are willing to share makes it easier!
Karen McDonald
Thanks for being so open with your prolapse. My pelvic issues have been driving me crazy. So I’m on a fitness craze. If the YMCA has a class I try it out. Never dreamed I would be going to Zumba!!
Looks like you are headed in the correct path. You are an amazing strong lady!!
Pelvic therapy is my next move. Hang in there!! Karen
Pete
Ugh. This sounds awful. I know you said you weren’t insured but I’m curious to know if you were is the surgery something that would be covered or would insurance basically consider it elective since it is “quality of life”? I’m a male and obviously haven’t experienced this but dealt with another quality of life issue a couple years ago that insurance basically said “Life’s rough. Suck it up Buttercup.” Ultimately, I fought and won but find it tremendously frustrating that the US healthcare system basically expects us to live in pain the solution otherwise costs too much.
Emilie
Thank you for sharing. I just experienced the same thing, haven’t seen a doctor yet, still in some kinda denial. But this helped me to see it’s not the end of the world even tho the feeling is awful and the thought of not being able to run or lift as I use to scares the shit out of me, cuz who am I then? It really helps to gather some courage to make an appointment instead of feeling sorry for myself.
You are a big inspiration and I hope you find your way forward.
Mal
I was just diagnosed with POP myself. Feeling very discouraged. How are things? How are you managing running-wise?
/Mal
Aissa
Hi. Glad to have read your post on prolapse and running. I’m a runner too and I’ve been diagnosed with uterine prolapse a week ago.
The doctor I consulted told me I could still run. Still mulling over if I should go get a pessary or have surgery. I still badly want to do more run / tri races.
Please do share your updates. Would love to hear from a fellow runner / athlete. Tc!
Stephanie
Pelvic floor physical therapy! POP is not an end of running diagnosis! Get some professional help. Get empowered by some committed-to-fitness professionals. I would do this first-line, then use a pessary as an adjunct if you need it. You will not be disappointed!
-a pelvic floor PT with POP who loves to run 🙂
LB
Triathlon is my life, did an olympic distance race while pregnant (very early)… at 8weeks pp was diagnosed with stage 3 POP and now I’m too scared to move off my bed! Thank you, you have given me hope!!!!!!! (Got a pessary yeaterday).
Danni
Thank you for sharing. I just got diagnosed with POP myself. The ultimate cause was heavy lifting, and it is not like I did not know the risks but it happened. I am an avid runner, and feel terrified at the prospect of not being able to exercise. Not to mention that when diagnosed with such condition, we should maintain healthy weight. How would you control weight without exercising – with diet alone??? I started researching the condition, and it appears that cycling should be okay. I would be very interested to find out more about your further experience. No matter what doctors recommend, I prefer a real world advice.
Ann
Thanks for sharing your great story. I’m 55 and was blessed with a hysterectomy at 25 for POP. Ran numerous marathons in CO, No ultras (yet)! Postmenopausal grandma now, and craps starting to sag,WTH???? it reminds me of the feeling when my babies heads were crowning. I joke, I’m spoiled because I’ve had a maintenance free vagina for 30 years! Went to urogyn last week , round two! have surgery date. I’m looking forward to a new suspension for Christmas. ( I even insisted she/urogyn call NorthFace for super strong gortex, because I intend to run and lift again ) Stay strong and run on sister!!!
CL
Thank you for this! I first noticed my POP after my second child but it has gotten more pronounced since I have gotten back into running. I’ve been so terrified I would have to stop because so much information online discourages you from running with a prolapse. This article is a breath of fresh air and gives me hope that maybe I don’t have to give up running after all.
Catherine
Thank you soooooo much for this. I’ve been afraid to run since my pop diagnosis 2 years ago. But it’s such a mental strain to fear movement and not have a fulfilling exercise outlet. Lately, I’ve found more and more recommendations to stay active and strong to combat pop issues. I’m ready to try things out again slowly. Thank you!
Emily
Thanks for sharing your experience. I have just been diagnosed with a rectocele and the thought of not being able to run again is so depressing! I am booked in to see a specialist for more advice but in the meantime I’m doing a lot of work on my pelvic floor (ie, kiegels).
Stacy
Thanks for being so open and sharing! It’s nice to not feel alone!
Anna
Hi: I just found this blog post. I was an ultra marathon runner and cross fitter. I even ran up until I gave birth. Sadly my daughter got stuck and in the process of delivering her I gained a prolapse. No one told me. Took me 5 months to figure it out.
This gives me hope. I can’t quite run a mile yes at 12 months PP but I hope someday to life heavy and run 50k races at least again.
HL
Thank you so much for your insight. Avid runner and just self diagnosed POP. Plan to see GP next week. Frustrated that this as happened and stay fit, strong, and have a healthy diet. However it’s not the end of the world. Planning on trying an easy run on the morning with a tampon. Physio on cards too. Thanks again.
Andrea
Was just diagnosed with stage 3/4 rectocele prolapse. I am an ultra marathoner and Ironman triathlete. Because of the severity of my prolapse I do need to have surgery to repair it. I have been told my running and high interval training days are over. I am not willing to accept that. Reading your posts have been very informative and helpful and have given me hope that I will be able to get back to running after healed from surgery. THank you.
Corrine
Hi just reading your post and wondering how things have progressed? I have been diagnosed with grade 2/3 rectocoele and desperate to find a way back to marathon running. I have been offered surgery but wondering on how this went for you- trying pelvic floor physio and pessaries whilst I weigh up options
Ashley
I normally don’t leave comments to posts, but this one brought tears of hope when reading your post and all the shared experiences in the comments section. I LOVE being physical active, running, hiking, strength training, and just all around being up for any adventure. After my POP diagnosis (stage 2bladder, stage 1 uterus) I was terrified of doing anything to make it worse. Each specialist gave different advice on activity ranging from running is fine to don’t use your core at all (wth?! It’s my core, I use it for everything). It took four tries but I finally have a pessary that fits with the cube. I’m scared but ready to get back to camp gladiator and running, to feel strong in my body again. Your post and the comments were the last bit of encouragement I needed. Thank you for sharing!
Britt
First time I’ve ever commented on a site… THANK YOU!!! I love everything about this post. YES men should know what this is, YES women should know too and NOT feel ashamed. YES let’s take the stigma out of everything vagina. And YES, let’s all feel hope that we don’t need to give up self care for… self care.
My POP really improved when I stopped breastfeeding my last kiddo. But now 2 years later, as I slowly increase my mileage to 10 miles a week (first time since firstborn 6 years ago) it’s baaaaaaaack. I just scheduled an appt, I think I’m finally ready for that pessary 🙂
Keri
I had a hysterectomy 10 wks ago and now have a grade 1 cystocele and rectocele. I never had any issues before the surgery. I am absolutely devastated. I have been a runner my entire life. I do not trust my surgeon after this and have made an appointment with a urogyno for a second opinion. Thank you for this article. You have given my hope that my life is not over.
Anonymous
It’s been a long journey since I first read this disarming article two years ago. I have run with over 700 sanitary pads since 2017 before taking myself to a surgeon. I tried one pess, it was supposed to work twice, which isn’t helpful. I was despairing until I found Sophie Powers, the ultra runner who ran UTMB with a pess. She told me runners often do well with a cube. I just got fitted for one that fits like a glove, until I get surgery. As I used it for the first time, I got flashbacks of all the times I missed out on jumping and running with my kids. On the shameful times I sat in someone’s car, embarrassed to smell of urine. Of all the clothes that have a permanent odor. I have a new lease on life. Mama runners, time to care for yourself.
Mary
This post is the greatest birthday person anyone could have given me (today on my 59th birthday). I’m a lifelong athlete who discovered my POP two weeks ago. I’ll be seeing a pelvic floor PT at the end of the week. I’ll see a urogynecologist in a couple of months. I’ve been obsessing over this stupid POP for weeks. I’m a surfer and I’m curious as to how straddling a surfboard, which is what you’re doing most of the time in the water, will affect the prolapse. But I’m a tough old(ish) broad. I’m not giving up surfing. Deep squats? Yes (I’m giving those up). Running anything other than intervals? Yes (I’m giving that up . . . probably). Surfing? Never! POP will not stop me. Period!
Megan
Hi! This was an informative post. I found it because I actually had the surgery and was looking for information on starting to run again after recovery. In my situation, I had surgery to correct a uterine and rectal prolapse and also had a bladder sling to correct stress incontinence. My doctor explained that many women live with peeing a little during exercise or coughing and think it’s part of life, but you actually don’t have to live this way. My surgery went very well and I’m so happy with the results. It’s had a positive impact on my quality of life. Anyway, the main reason I’m commenting is because my insurance paid for the entire procedure. I don’t even have that great of insurance (Cigna) and my Urologist said most insurance companies will pay. For people who think they can’t afford it, I would make the urology appointment, get the insurance codes for the procedure and send them to your insurance company for feedback.
Katharine
Thank you for this article, which I have found very helpful and full of sensible, practical advice. I have suffered with POP for several years – it started when, having come late to running (I started at about 48) and enjoying it so much, I put on a little weight, and then did a lot of lifting when I moved house. Not keen on surgery I am trying to make the best of it: a pessary helps and I have started running again and once experienced some slight bleeding directly afterwards – I think from the pessary being slightly lose and rubbing. I am concentrating on my general fitness – having lost a stone (I’m now 10 stone at 5’3″ and would like to get down to 9 stone). I try to do the pelvic floor exercises regularly but often forget. But i have found that things do improve when I do so. I haven’t run further than 5km in recent months since returning to running but am not yet feeling that my pelvic floor is string enough to run on a regular basis.i’ll think about running early in the day.