You can lift with prolapse—and here's how

Fear thrives where facts are fuzzy—especially around pelvic organ prolapse. We open the blinds with clear explanations, zero scare tactics, and a practical path back to the barbell. You’ll hear why the vagina isn’t a hollow tube, what normal movement of vaginal tissues looks like when you bear down, and how providers actually assess prolapse across the anterior, posterior, and apical walls. More importantly, we focus on what your symptoms mean for your life and training, not just what a grade says on paper.

We get honest about timing and healing. Early postpartum tissues are remodeling, so a six‑week verdict rarely predicts your long‑term baseline. Think of prolapse like stretch marks: some bodies show more change, some less, and sensitivity varies. When heaviness or that “golf ball” sensation shows up, we map out next steps—conservative care to coordinate your pelvic floor, simple recovery positions to calm flares, and how a pessary can act like a sport-ready brace with the right fit. We also outline when surgery is typically considered, what options exist, and the trade‑offs to discuss if future pregnancies are on your mind.

Then we take on the weight room myths. Occupational lifting data isn’t the same as structured strength training, and newer research doesn’t show a significant increase in descent among strenuous sport athletes. Translation: you didn’t “cause” prolapse by one heavy session. We walk through a return-to-lifting framework—clean up bracing to avoid bearing down, use your breath as a pressure gauge, manage load to raise your symptom threshold, and reintroduce the belt with purpose. Along the way, we tackle constipation, coughing, and pelvic floor tightness, so you’re not clenching your way into more discomfort.

If this conversation eased your fears or gave you a plan, share it with a friend, subscribe for more evidence-based guidance, and leave a review to help other moms find reliable support.

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Transcript

Why Prolapse Sparks So Much Fear

What Normal Vulvar Anatomy Looks Like

Defining and Assessing Prolapse

Symptoms, Grades, and What They Mean

Early Postpartum: Wait on Diagnoses

Risk Factors You Can’t and Can Change

Reframing Prolapse Like Stretch Marks

SPEAKER_00 0:28

We want to talk about the realities of being a mom who loves to exercise. Whether you're a recreational exerciser or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey. We're going to talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everyone and welcome back to the Barbell Mamas podcast. Christina Private here, and today we are going to be talking about pelvic organ prolapse. Before we do, I want to tell you guys that we are so excited we are in our new house, but I can definitely tell if you're seeing the video from this episode that mama's eyes look real tired. And so I apologize for that. We are in the middle of a crazy move and deadlines are really intense. So sleeping is kind of in that non-existent category, but we are trying to make it work. But today's episode, we're going to be talking about prolapse. In the pelvic health space, pelvic organ prolapse is probably the condition where there is the most amount of fear. There's a lot of hopefully well-meaning, but definitely misguided recommendations that you can see online. This is one of those conditions that if you Doctor Google it, it'll say a lot of pretty scary things. And my goal for this podcast is to try and improve some of those fears for you, to try and switch this messaging from one of fear to one of empowerment and to give you all all the knowledge that you need in order for you to feel successful with this. And so, what I will tell you as well is I am a person who is navigating exercise with prolapse. I have no idea what grade it is, but I have had two deliveries. I have been on and off symptomatic for not a ton of time, but I have had symptoms in my postpartum journeys, and I have gotten back to lifting. And I have been holding my breath and I use a weightlifting belt and I don't really have any issues with that. And so the first and probably most common question that we get at the barball mamas is can I keep lifting if I was diagnosed with a prolapse? And the answer is yes, but that's me getting ahead of myself. It was like my TLDR of this podcast. And so let's kind of take a big step back. Before we get into the definitions of prolapse and how we assess it, all of those things, the first thing we need to do is kind of get a lay of the land. And what I mean by that is so commonly, and I will agree that this is was definitely me, we do not take time as females, especially before babies, to take a look at what our vulva looks like, to use a mirror or take our phones and see what it looks like down there. What we rely on, and what I definitely did before I got into pelvic health, is our anatomy textbooks are biology classes of what the female reproductive system looks like. We don't have, like our male counterparts, an appendage that we can easily see. What we have to do is actually look down there and kind of get into awkward positions to see what that looks like. And then when we have kiddos or get pregnant, whether we've had a vaginal delivery or a cesarean, again, we don't really look down there a lot. Or we start to look down there when things feel different than they did before. When we think about the way that our textbooks have made our vagina look like, it has made it look like our vagina is a hollow tube. And the first thing that I want to tell you is that that is not true. When you look up at your body and look into that hole, into your vagina, that introitus is the hole where the vaginal opening is, you will see tissues touching together. That is 100% normal. It is absolutely supposed to be like that. And it is because our vagina is not a hollow tube, it is smooth muscle. It would have to be made of something like cartilage, like we see in our neck, in order for us to have a hollow tube. So that does not exist. And it is supposed to be able to move around based on how our bodies are moving, our fatigue, our organs, our babies within our bellies. Like that is supposed to shift and move. And so you will not see a hollow tube. You will see tissues touching together, and that is 100% normal. The other thing is that when we strain or bear down, we should feel or we should be able to see rather, we can't always feel it, but we can some we should be able to see some change in our tissues. What I mean by that is when we start talking about the assessment for prolapse, we talk about like bearing down as if we were having a bowel movement and we're looking for the amount of movement. There isn't going to be anyone who has zero movement when we do that. So if you see movement on your body, we are supposed to see some movement. Okay, so those are kind of my disclaimers when we are starting to talk about this. Let's get into the definition of prolapse. So pelvic organ prolapse, by definition, is the descent of one or more of the pelvic organs towards the vaginal opening. From a symptoms perspective, it is the sensation of a heaviness or bulging feeling around where the vagina opens. There's a lot to unpack here. So, first let's talk about that first definition. Descent of one or more of the pelvic organs towards the vaginal opening. This definition makes it seem like your organs are going to fall out of your body. And that is a very vulnerable feeling to get that diagnosis, and that is the definition. That is not what is happening. It is the pressure of one of your abdominal contents pushing against the wall of your vagina, and that is causing an increase in range of motion of that vaginal wall towards where your vagina opens. So you are not going to experience your organs falling out of your body. And trust me, you are not alone if that is what you thought. It is around how much pressure is being put on either wall, either the front or the back or the top, and how much is that moving your vaginal wall when you are straining? So that gets to the next piece of it. So when we are looking for prolapse, if you are getting evaluated for a prolapse, what individuals are gonna get you to do, whether it's your polloclorptee or your urogyne or your birth provider, they are going to get you on your back. They're gonna be taking a look at your uh vagina, that introitus, that opening of the vagina, and they are gonna ask you to bear down or strain as if you are going to push out a watermelon or a baby or have a bowel movement, and they're gonna see what you do, and that's gonna be where they do their assessment of the amount of range of motion in your body. Know that there are going to be individual differences, right? Take a look at your friend group. You have some of your friends who are really flexible, and your some of your friends are extremely stiff. That is going to be true around prolapse as well. When we are giving you a kind of diagnosis of prolapse, we are first and foremost asking you what symptoms you are experiencing, and then the grade or the type of prolapse that you experience is the amount of range of motion that you have and where that range of motion is coming from. So if you are looking at, say somebody will say they used to kind of talk about which organ they were thinking was moving, and really they've moved away from that in the research. And it's is it the anterior wall, posterior wall, or the apical wall? So is that the wall that's facing closest to the bladder and the urethra where urine comes out? Is it closer to the rectum or where your anus is, or is it coming from above, and that's where your cervix and uterus is? So, where are we seeing this range of motion coming from, and how much range of motion do you have? Then we're gonna say, okay, what are your symptoms? What are you experiencing? And oftentimes individuals will say things like, I feel like I'm rolling over a golf ball, or I feel like there's a nodule or something sitting there within my vaginal opening, and it's really unsettling, or it's something that feels bad. Other things people may speak to is this feeling of heaviness around the vaginal opening. That heaviness is a tougher one because sometimes that heaviness is that your pelvic floor is really tired, and sometimes it's a symptom of prolapse. And so you kind of have to do a bit more digging to figure out for you what is that symptom, and what are we gonna do about it. I do not recommend getting a diagnosis or trying to be evaluated for prolapse in the early postpartum period. There is so much healing that is going to happen in those early several months that are going to influence you. Getting a diagnosis of prolapse at six weeks postpartum is like getting your sling off after a shoulder surgery and asking what your range of motion is going to be like at six months, right? We just don't know at that point where your range of motion is going to settle in at. And I have seen so many examples of people who have gotten that diagnosis really early, but it really was just healing tissue. And it really threw them for a loop mentally to be feeling those symptoms and feeling like there was a permanent damage that has happened because of pelvic organ prolapse. The other thing that is important to know, kind of speaking very generally to prolapse, is that there is a very big disconnect between the amount of range of motion that a person has and the amount of symptoms that they experience. So you can have individuals who have a bigger range of motion, say a grade three and are completely asymptomatic, don't have any issues. And you can have other people who have a grade one and are very symptomatic. What that tells us as providers is that the range of motion, while it can be important for some decisions, is not as important as how you are feeling and trying to figure out what we can do to touch and reduce the symptoms that you are experiencing. That is the most important thing. The next question that we get asked all the time is did I cause this? Was there something that I did that caused me to have a prolapse? What we see is that there are a couple of things that are modifiable risk factors, and there are a couple things that aren't. Most of our risk factors are things like age. Individuals are more likely to experience symptoms of prolapse as they get older. What happened during your labor and delivery, higher amounts of tearing, needing to use an instrument like forceps to get baby out, and the number of vaginal births that you had are some of the biggest risk factors for prolapse. Other things are obesity, having a condition that makes you have a chronic cough, long-standing cough, and different types of conditions that lead to hypermobility throughout your entire body. So an example is something like Ehler-Danlos syndrome, which causes kind of all over your body hypermobility. Those individuals who are kind of double-jointed in all of their joints, they can kind of they try and straighten their elbow and it kinks a little bit into hyperextension. Those are individuals who are going to be at higher risk for a pelvic organ prolapse. And one of our biggest risk factors is giving birth vaginally. And so talking about that vaginal delivery is important. When we look at all women who have given birth vaginally or even just have been pregnant, we see that our body changes during our pregnancy, right? We see that, you know, our skin stretches and it doesn't go back 100% to where it was. Some people can have their belly button that changes and stretches. There are some people who get more stretch marks than others. But when it comes to our vagina, we have this assumption that everything is going to go back 100% to where it was. And so I got myself into a bit of hot water, but I stand by what I said, where I really do believe that we need to think about pelvic organ prolapse like a stretch mark. Why do I say this? I say this because we are gonna have some people who are gonna give birth vaginally and they're not gonna are gonna have pregnancies and they're not gonna get any stretch marks, right? Those individuals that you love to hate on who didn't get any stretch marks on their body. You're gonna get some individuals who do get stretch marks, but they see them as their tiger stripes. They are proud of their those stretch marks. They don't, they're not really bothered by them. And then you're gonna get other people who it's the only thing that they can see. They see that loose skin. It affects their body image. They don't want to have sex with the lights on anymore. They spend a lot of money in order to get those stretch marks to look different. They go for surgery to get those stretch marks improved. This is the same for our vagina. We're gonna have some people who don't have any issue after a vaginal delivery. Some people are gonna have that increase in range of motion, but it's not something that they really pay attention to or notice. And you're gonna get other people who, whether they have one stretch mark or they have a belly full of stretch marks, are going to be very, very sensitive to their appearance and in this case to that increase in change in range of motion. One of the things that I do as a provider to try and help with this is I give the expectation of what are normal sensations to have after a vaginal delivery. For example, it is normal to feel more movement up and down down there when we start getting back to impact and barbell movements. Before giving birth vaginally, you probably didn't notice any movement up and down of your perennial body. So the amount of space between the edge of posterior edge of your vaginal opening and your anus, but that is going to move up and down more because you have given birth to a baby. That is normal. And some increase in range of motion of that front wall, that anterior wall, the wall that connects from your vaginal wall to your bladder, there is a normal increase in range of motion after giving birth vaginally in um in postpartum women. So those things are normal. That increase in range of motion is normal. And when we aren't afraid of those sensations because we knew they were coming, it can really change the game and it can really help individuals feel like they are healing a little bit better or more smoothly. So there are going to be some of these changes, but we really want to think about prolapse kind of the way that we think about stretch marks is that after a pregnancy and into our postpartum journey, there are going to be changes in sensation that we feel, but those changes in sensation are not necessarily bad. It's when those symptoms start to become really bothersome that we may seek more help. When do we seek more help? This is my next kind of segue. If you are a person who has healed and you know, stitches are out and you start getting to movement and you're starting to feel this tennis ball-like feeling, and you aren't sure of ways to help or improve those symptoms, I encourage you to go to a pelvic health specialist. What they are going to do is they're going to be able to give you the right steps to bridge you back to whatever movement you want to be able to do. If you are thinking, you know, there are some people who are thinking about things like surgery or they see that surgery is an option. When may meet we make the leap from seeing a pelvic health physical therapist, for example, to going to see a urogynecologist or an obstetrical surgeon that may work on a surgical option. First, we want to try conservative management. We're gonna try and see if there are ways that we can increase your strength and coordination of your pelvic floor. Is there ways for us to work on, you know, what your work to rest intervals are? Can we change some of your positions to help improve symptoms? Number one, conservative management. The second option for conservative management is something called a pessary. A pessary is essentially like a brace for your vaginal walls. So if you think about what the a what an ankle brace does, right, is that it gives support to our ankle so that we don't have as much movement. A pessary does the same thing for the vaginal wall. A pessary is something that you insert, and sometimes a uh urogyne will insert it for you, especially if you're having issues with um your range of motion or your function. Other times it is you that inserts it yourself. Some people will insert it just for specific activities that bother them. For example, if they're going on a run and they have that heaviness feeling with running, I've seen some people use it specifically just for sport, or there's times where people will use it all the time. There are different shapes, and so there is a bit of trial and error that can happen when you are working through trialing out a pessary. There are different types. There are, you know, cubes and ones that look like little donuts. You have to figure out what works for you, and sometimes it does take one or two tries to get a type of pessary that works for you. Sometimes the trouble is finding a provider that is able to fit pessaries. Um, it's cool because there has been a shift in the last little while to try to get physical therapists trained in to into measuring for pessaries, which I think is great because there isn't a ton of euroguines that do it. And sometimes getting in to see them or finding the euro guyne that does it can be kind of a barrier or a challenge. And therefore, you can kind of look around to see if there's any providers in your area. There are also kind of Amazon type uh types of uh pessaries that you can try out just to see if it feels better for you. Something like um Amazon has the revive is a brand that you can use in order to see if it works. Sometimes the go-to for me would be if you are having symptoms of prolapse, that bulging feeling, but you feel better when you have a tampon in, for example, that might be a person that I would really go to and think a pestery might be a good option for you. This is something that I want you to try. What are things that would make me trigger more towards surgery? Surgery is more for higher grades of prolapse. So grade three or more specifically, grade four. So a grade four prolapse, and this is the one that you see the most often when you are googling it, is when the vaginal wall can actually be seen outside of the body when you strain. And so it kind of can look like a golf ball that covers the vaginal opening, and it can be quite alarming, and it is not common, but it is common enough. And that is, I kind of compare it to a hernia, right? So when you have a hernia, when you strain, you see this pocket pop up in your abs that you can kind of maneuver and you can push it back in, and it doesn't, it's not a medical emergency by any stretch, but it is something that people are watching, and you know, we're more likely to repair it because there's chances that we lose blood flow or other types of things, and so you weigh the cost benefit. And for example, for people who are thinking about getting pregnant again, they usually won't repair a hernia because it'll get stretched and with the stitches as baby develops for a subsequent pregnancy. It's the same thing for individuals experiencing prolapse symptoms, a grade four prolapse. So it's kind of like that herniation, just in a different place. And so that would be kind of where people would be considering more of a surgical option. And there are a variety of different surgeries that individuals can experience. Important to know one of the surgeries that individuals do is a hysterectomy, and the idea is to take that pressure off the vaginal wall by removing something in the abdominal contents. Obviously, this is not done for somebody who is thinking about having children. Um, they oftentimes try and keep the ovaries so that your estrogen supply stays where it should be for as long as possible. But it's important to know that there is a risk between 6 and 12% for individuals who get a hysterectomy for a prolapse of having a different type of prolapse develop afterwards. And so if this is you and you're kind of having these conversations, it's important to discuss all of your options with your provider. Okay, kind of gone through a lot here. So let's talk about treatment and management and where exercise fits into this conversation. There are a lot of people who think if you lift heavy weights, you are going to give yourself a prolapse, or if you get back to exercise too early, or if you did something that you strained yourself, you caused your prolapse immediately. And the first thing that I want to say is that we don't have any research to support that. We're actually starting to develop research that goes against that recommendation. Where did this come from? When we looked at some of the risk factors for prolapse, and by we I mean researchers very smart and much smarter than me. They were looking at all of these things in a person's lifestyle that could potentially lead to changes in support around the pelvis. One of the risk factors that came up, one that I didn't mention earlier because I wanted to bring it into this conversation, was that individuals who have a job that requires them to lift heavy weights repetitively, continuously, are more likely to have descent or an increase in range of motion compared to those who don't. That because we didn't have any research on resistance training or strength training in general, and that was the only research we had, the recommendation became don't lift heavy weights because it'll cause a prolapse. It is very different to spend eight hours a day doing repetitive lifting tasks versus the 30 to 60 minutes that most individuals do for resistance training. The other really important variable is that you go to your job for 40 hours a week, and if you don't feel good or you are on your period or you're having, you know, heavy flow or you can't change your job. You kind of have to push through it, especially if you don't have any paid time off or you don't have any sick days. That's not true for the gym. You know, you can change your symptoms, or you can change your gym routine, you can change the amount of weight you put on the bar to respond to how your body is feeling. And so when we teased that apart, it was very different. And we have now gotten a couple of studies that have come out that look at the amount of dissent for females who have done strenuous exercise for several years, and we have not seen a huge change compared to those who or any change that was statistically significant between those that participated in non-strenuous sport and those that participated in strenuous sport. I think that's important. And coming back postpartum, you may have sensitized your system, but we cannot say that you caused a prolapse based on, you know, pushing it a little bit too heavy in the gym this one, this one session, right? You may have flared up your symptoms, but just like if you had a shoulder injury, you didn't say, Oh, I tore it on that rep, unless it was something like really, you know, you saw that bicep. But that's not the case for prolapse. And it can be a moment where you sensitize your body because you pushed it a little bit too hard, but we cannot say that you you kind of caused irreparable damage through exercise. When we are thinking about having a person who is trying to get back to lifting, who is experiencing prolapse, what we're gonna do from a clinician perspective, and this is gonna be tough to make kind of blanket recommendations because there is a lot of difference. Um, we're gonna try and see one, is there any other associated symptoms with your prolapse? So are you experiencing constipation? Individuals who are experiencing prolapse also tend to have pain. So, for example, pain with penetrative intercourse, tamp on speculum, finger, sex toy, those types of insertions can be painful. You can have more widespread pelvic pain, um, or you can kind of see things that may make you think that there is a tightness around the pelvic floor, and issues like constipation can come up as something that may we may experience. We want to make sure that we are avoiding things like straining, we're trying to clear any of our constipation issues, and we want to make sure that we are contracting our pelvic floor as much as we need to, but not more. Those symptoms of heaviness or feeling like things are falling out, which is another thing that some individuals describe, can make us want to clench everything all of the time. And then that pulls us into these experiences of tightness. And so working through, gradually being able to relax your pelvic floor and get used to what that sensation feels like, and start feeling like that isn't a threatening or really vulnerable experience, is kind of some of the stepwise progressions that we're gonna be using in order for you to have an improvement in your symptoms. Other things when you're experiencing a sudden and immediate change. In your symptoms are to put you into a recovery position. When your legs are exhausted from a big workout, the first thing you want to do is get off your feet. When your pelvic floor is exhausted from a good workout, whether that's standing and doing household tasks or being in the gym, we want to get you into a pelvic rest position. What that's gonna look like is lying on your back with a pillow under your bum. And that is essentially gonna take all of the weight off of your pelvic floor and give your pelvic floor some time to rest. And staying there for several minutes, usually at least three is going to be able to help improve your symptoms in the short term. That's kind of like that immediate tries to make your symptoms feel better when you're you're feeling that heaviness and it's really starting to bother you. If you can do that, because sometimes you can't exactly do that in the middle of a busy commercial gym. And then when we're trying to think about getting you back to lifting, when you are experiencing those symptoms under heavy loads, the first thing we're gonna do is dial back the amount of pressure in your belly. We're gonna focus on your bracing and then we're gonna gradually build your tolerance. So, first with let's talk about bracing. I've done a whole episode on teaching you the proper way to brace, but when you are experiencing prolapse, if you are bearing down when you brace, this is one of the first things that we are going to clean up. We're gonna figure out the way that you're bracing, try and make it the best strategy for you and see if that touches or changes your symptoms. From there, we're gonna use your breath like a pressure gauge. So when we're doing valsalva and holding our breath and bracing really hard, that is the most amount of pressure. When we exhale on the hardest part of the movement, that essentially acts as a pressure release. That can sometimes change a person's symptoms and it can help a ton with trying to get you below that threshold where you're experiencing those symptoms. And then the third thing we can do is manipulate the load on the bar. So if you're experiencing symptoms at 150 when you're squatting, can we accumulate a bunch of reps at 140, clean up some of your movement patterns, and then again inch into 150 and see if your symptoms threshold has increased to 160. So those are types of things that we will do kind of from a rehab perspective to gradually make it so that you can tolerate more and more before those symptoms come on. Then from there, and once you're able to tolerate that okay, then we'll add the weightlifting belt. And then, same thing, we want to make sure that you're using the weightlifting belt appropriately at the appropriate time, and we're managing any flare-up of symptoms that we experience and we know what to do about it. When it comes to the way that we describe prolapse, I think it is so important for us to recognize that that increase in range of motion is gonna happen throughout our life, right? Our vagina is gonna get wrinkles, right? Our skin is gonna go show signs of age and what our body has been through, our bellies are showing signs of age and what our body has been through through our motherhood journey, and our vagina is going to as well. And so we definitely want to treat the symptoms. This is not meant to dismiss anyone who is experiencing symptoms, but it is to give you that reassurance that one, you did nothing wrong, two, there is absolutely help. And three, we really want to focus on those symptoms and what are ways that we can improve them in order for you to feel as strong and supported as you possibly can. Okay, if you have any other questions about this, I really hope that you reach out. If this has maybe prompted you to go see somebody, I really hope that that is true. I hope that maybe after this episode, your fear, if you had a lot of fear around being pregnant and getting a prolapse or being able to return to lifting postpartum, I hope that has eased some of your fears. And I think the more conversations that we have around this and we really start to look at what the research is saying, the more we can support mamas to feel good postpartum and then know where to go when they're feeling bad. All right. If you have any other thoughts, let me know. Otherwise, have a wonderful week and we'll see you all next time.