Let’s Talk Prolapse - Part 5 - Is Running OK?
This is a million dollar question, and one that comes up all the time.
Can you run with a prolapse?
The short answer is YES!
If running is meaningful to you, improves your quality of life and brings you joy, then yes.
Returning to running is about understanding your risk, and mitigating it.
Before you start running:
1. Avoid or fix any constipation. Constipation leads to straining and aggravates your prolapse. Make sure you stay hydrated and are getting enough fibre.
2. If you are significantly overweight, consider using diet and low impact exercise to reduce your weight. Running when overweight can increase the risk of your prolapse worsening. This results from the increased load placed on the pelvic floor.
3. Work on your pelvic floor muscle strength and participate in low impact strength/ resistance training for 12 weeks. Our Strong Mama: Rebuilding Better Postnatal Program will guide you, week by week, towards the function and strength needed for running.
4. Work with a women’s health physio to guide you. Wear compression shorts or a pessary as appropriate.
Once you are ready:
Get the go ahead from your physio
Gradually introduce jogging
Start with intervals
Slowly increase the intensity
Have at least 48 hours of rest between sessions
If your symptoms increase following a run, try the following recommendations:
Spend extra time over the next 48 hours resting horizontally or in an inverted position (lie on the ground with your legs resting up on the couch), and reduce the intensity of your training for the next week.
Reduce your running speed. Increased running speed requires more pelvic floor activation. Therefore reducing running speed may lesson the impact of running on the pelvic floor, especially important with prolapse.
Run on soft surfaces. Avoid always running on concrete, and try running on grass and sand.
Run on the uphill, walk on the downhill. Uphill running reduces the impact on the pelvic floor, so it’s better for your pelvic floor (but hard on your cardiovascular system!). Downhill running increases impact and jarring on the pelvic floor, so walk the downhill instead.
Limit running distance. The longer the running distance, the more repeated the impact upon the pelvic floor and the more fatigued your pelvic floor will become. Avoid running long distances in the early months.
Reduce your stride length. Shorter stride length will allow your heel to strike the ground less forcefully than with a long stride, reducing the impact on your pelvic floor.
Keep up your cross training. Keep working on your overall strength, flexibility and mobility. You need to keep improving your overall strength so that you can with time run further. Alternate running with other low impact cardio exercises such as swimming or cycling. This way you can keep improving your fitness without the impact on your pelvic floor.
Avoid running when fatigued or unwell. Like everything else, pelvic floor muscles don’t work as well when the body is tired. Try to listen to your body and prioritise rest on those days when you need it.
Run with your menstrual cycle. You may notice that your prolapse symptoms lessen in the first part of your cycle (from onset of bleeding until ovulation) and that they bother you more in the latter part of your cycle (from ovulation until bleeding commences). This is because your hormones fluctuate throughout your cycle, affecting the elasticity of your connective tissue. In the early months of returning to running you may prefer to run longer distances in the first half of your cycle when your symptoms are milder, and focus more on restorative and low-impact exercises in the latter half of your cycle when your symptoms are more noticeable.
Next week we will offer a suggested postnatal ‘Return to running program’, so be sure to check it out!
References:
Leitner M, Moser H, Eichelberger P, Kuhn A, Radlinger L (2017).Evaluation of pelvic floor muscle activity during running in continent and incontinent women: An exploratory study. Neurourol Urodyn, 36(6) pps 1570-1576.
Fozzatti C, Riccetto C, Herrmann V, Brancalion M, Raimondi M, Nascif C, Marques L, Palma P.(2012) Prevalence study of stress urinary incontinence in women who perform high-impact exercises. IntUrogynecol J,23(12), pps 1687-1691.
Delancey, J (2016) What’s new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstet Gynecol.29 (5), pps 420-429.
Li C, Gong Y, Wang B. The efficacy of pelvic floor muscle training for pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J 2016; 27(7): 981-992. [PubMed]