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Pelvic Floor Safe Exercising

18 April, 2013

Tonight I was sending an email to the owner of my gym to draw him (and his great Goodlife Gym at Graceville) into the Pelvic Floor Safe exercising web and was trawling through all my blogs to link him in to one that succinctly summarized all the key points….and I realized there wasn’t one!?! How could that be? I mean I have mentioned it repeatedly as a concept in lots of blogs but there wasn’t a designated blog on this very important topic. And that is about to change.

Of course there is a fabulous book Inside Out by Michelle Kenway, one of my guest bloggers, and I can’t recommend this book highly enough. Michelle coined this term pelvic floor safe exercising and it is such an important concept to embrace when exercising following childbirth and especially when you have had any gynae repair surgery or even following a hysterectomy. The term means that when exercising you must protect your pelvic floor by avoiding sit-ups, curl-ups, crunches, double leg lifts and lifting excessively heavy weights. And of course by bracing or engaging your low tummy, vagina and anus prior to doing any exercises in the gym.

So whilst Pilates and Yoga have excellent elements to them it is critical to modify them to incorporate pelvic floor safe concepts. Similarly, going to the gym, where you can increase muscle mass and undertake exercises to maintain bone density and improve cardio-vascular fitness, can also cause havoc if you are doing activities which cause unnecessary increases in intra-abdominal pressure which can funnel down the vagina which we have already identified as a hernia portal. This is when pelvic organs such as the bladder, uterus and bowel can prolapse and descend to even OUT of the vagina. I assure it isn’t a good look – having washboard abs but a significant prolapse ‘down below’. These wrong sort of exercises especially boot camps have helped feed my family over the years……

female-six-pack-abs         Anterior wall prolapse copy

So what can we do? Firstly if you’ve had a baby or gynae repair surgery, give your pelvic floor (and abdominal muscles if you’ve had a baby) a chance to recover post delivery or post-op. Take your time – it’s not a race to get fit – if you do it in a careful, measured, ‘paced and graded’ way then you won’t introduce ridiculous downward forces which will cause lax fascia (such as the walls of the vagina) to descend.

Start your pelvic floor muscle training early post-natally but wait till your surgeon gives you the word post-operatively. Start with gentle walking, for short distances and increase as you feel stronger making sure you assess downward drag the next day before you increase the length of the walk and the intensity of the pace.

There are ‘pelvic floor safe’ exercises in the back of both of my books which you can gradually add to your rehab programme – because that’s what it should be – a rehab programme. If you ‘did’ your knee at netball or skiing then you wouldn’t jump back on the netball court or skis and perform at the highest level at 6 weeks post knee reconstruction. You would have a careful programme mapped out for you by your surgeon, physio and PT and similarly that’s what should happen in those crucial early days after a baby or an operation.

But if you have not just had a baby or an operation, you still have to be very careful – walking on a treadmill, cycling, airwalkers or cross-trainers, light weights, narrow-base lunges, swiss ball work and there are lots more you can safely do – just remember that prolapse is affected by gravity and ultimately if you keep pushing and bearing down hard with the wrong sort of exercise it will come out.

  1. shirley owen permalink

    Dear Sue, I read with dismay that the Fistua programme may close for lack of funds. I do hope that you have been able to sell your idea to a Women’s magazine and promote the need for some maker of women’s products, perhaps one of the dress designers to donate a $ for every garment sold or a manufacturer Garnier or a product (Dove) that is sold, as a philantrophic gesture that they could use for self promotion, in fact a Win Win for all, to keep this funding going. Keep up your good work Sue and thank you for the nice things you said about me that I read when I downloaded your blog when you went to the last Conference. I just happened to read it and I thought I must go and say hello. Shirley

  2. Thank Shirley for your comments- yes a great idea about Dove, Garnier or a dress designer. I’ll get my thinking cap on and maybe get Katie, my daughter who is in PR in Melbourne onto it! You were always a wonderful mentor to me along with Ruth, and got my passion for continence issues ignited! Take care Sue x

  3. Sue– great blog post! This is always a struggle for some of our patients to understand, especially postoperatively! I’ve found the handouts at “Pelvic Floor First” to be helpful for some of my patients…of course there is not a “one size fits all” protocol for returning to exercise, but the principles on the handouts are very good. Check them out:


    • Hi Jessica
      Yes very familiar with the pelvicfloorsafe ex site. In fact it was Michelle Kenway the author of the InsideOut book who kindly allowed the CFA – the peak body in Australia for educationg on continence issues- to use her terminology on their site. Michelle advised closely on establishing the programme to try and spread the word about pelvic floor safe exercising to gyms, Pilates instructors and Yoga teachers. The Continence Foundation of Australia are an amazing organisation in Australia, very dedicated to continence issues and we are lucky in Australia that governments have seen the importance of funding organizations like this to help preventatively-a sure way to cut millions off the health budget expenditure!

      • That is so interesting to hear about the history of this in Australia! I wish the US had more organizations like that. Keep up the great posts— we love reading them! And, if you have time, check out our blog (a baby in comparison to yours!):

  4. Julie permalink

    Hi I’m going to be having surgery in x few weeks time for a grade 4 prolapse this will include a hysterectomy. I’m getting a bit worried I assume this feeling is normal. I have just bought your book, I am wanting to find out what exactly are the safe exercise after surgery. Is there a booklet describing such exercises?

    • Hi Julie
      There are pelvic floor safe exercises in the back of the book and a post op regime of exercises to do in the first 12 weeks and then advice for what to do afterwards. Also Michelle Kenway’s book Inside Out which we also sell on the website teaches you about what is safe and not. Hope this helps

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