Many runners are concerned about pelvic organ prolapse and its influence on this condition. This article explores running’s interaction with the pelvic floor and factors contributing to pelvic organ prolapse.
Understanding Pelvic Organ Prolapse
Pelvic organ prolapse (POP) occurs when one or more of the pelvic organs descend from their normal position. These organs, including the bladder, uterus, rectum, small intestine, and vaginal vault, are supported by the pelvic floor, a hammock-like structure of muscles, ligaments, and tissues. When these supports weaken, organs can sag or bulge into the vagina.
Prolapse types depend on the affected organ. A cystocele, or bladder prolapse, is when the bladder bulges into the front wall of the vagina. A rectocele occurs when the rectum pushes into the back wall of the vagina. Uterine prolapse involves the uterus descending into the vaginal canal.
Other types include enterocele, where the small intestine bulges, and vaginal vault prolapse, affecting the vaginal vault after hysterectomy. Individuals with POP might experience a feeling of pressure, heaviness, or a bulge in the vagina.
How Running Relates to Prolapse
Running is a high-impact activity that places repetitive stress on the pelvic floor. Each stride generates ground reaction forces, traveling to the pelvic floor. This repetitive impact increases intra-abdominal pressure, a force that pushes downward on the pelvic organs.
While running introduces significant forces, a healthy pelvic floor is designed to absorb this stress by reflexively activating its muscles before and during foot strike. However, if the pelvic floor muscles are weak or dysfunctional, they may not adequately manage these forces. In such cases, running can contribute to or worsen existing pelvic floor issues.
Running is rarely the sole cause of pelvic organ prolapse. Instead, it typically acts as a contributing factor or can exacerbate symptoms in individuals with pre-existing pelvic floor weakness. Repetitive running over time, combined with other risk factors, can challenge the pelvic floor’s ability to maintain organ support.
Other Factors Influencing Prolapse Risk
Beyond running, numerous factors influence prolapse risk. Pregnancy and vaginal childbirth are considered the most significant risk factors, due to stretching and tearing of pelvic tissues during delivery. The risk increases with multiple vaginal deliveries or deliveries involving forceps or vacuum assistance.
Advancing age is another factor, as tissues naturally weaken over time, including pelvic organ supports. Menopause, specifically the decline in estrogen production, can further reduce the strength and integrity of connective tissues in the pelvic floor.
Chronic straining from persistent constipation or chronic cough places sustained downward pressure on the pelvic floor, potentially weakening it. Heavy lifting also stresses these supportive structures. Additionally, obesity increases intra-abdominal pressure and adds to pelvic floor load, raising prolapse risk.
Strategies for Prolapse Prevention
Runners can adopt several strategies to reduce their risk of developing or worsening pelvic organ prolapse. Strengthening the pelvic floor muscles through specific exercises, such as Kegels, is a primary preventive measure. These exercises help improve muscle tone and endurance, enhancing the pelvic floor’s ability to support organs.
Maintaining good posture and running form is important. Proper alignment, such as stacking the ribcage over the pelvis and leaning slightly forward, can help distribute forces more effectively and reduce downward pressure on the pelvic floor. Adjusting running cadence to take more, shorter steps can also lessen impact forces.
Strengthening the core muscles supports the pelvic floor and improves overall stability during running. Ensuring adequate hydration and consuming a fiber-rich diet can prevent constipation and the associated straining that stresses the pelvic floor. Gradually increasing running intensity and mileage allows the pelvic floor to adapt to increasing demands, reducing sudden overload.
Running with Existing Prolapse
For individuals already experiencing pelvic organ prolapse, continuing to run may be possible with careful management and professional guidance. Monitor symptoms like increased heaviness, pain, or urinary leakage, as these can indicate that the current activity level is too much. Modifying running practices can help alleviate symptoms and prevent worsening of the prolapse.
Adjustments might include running shorter distances, reducing speed, or choosing softer surfaces like grass or trails instead of concrete to lessen impact. Incorporating cross-training activities, such as cycling or swimming, provides cardiovascular benefits while reducing direct stress on the pelvic floor. Using supportive garments like a pessary, a removable device inserted into the vagina, can provide internal support to the pelvic organs during activity.
Consulting with a healthcare professional, particularly a pelvic health physical therapist, is recommended for personalized advice. These specialists can assess pelvic floor function, recommend specific exercises, and guide safe return to running or modification of training. They can help individuals remain active while managing their condition.