8 Tips for Running Safely with Prolapse
If you’ve been diagnosed with pelvic organ prolapse, you might be thinking “Can I run? Will it make my prolapse worse?”
The great news is there is a lot you can do to manage prolapse symptoms and get back to running. You are NOT broken. You can do this.
Here’s everything you need to know about pelvic organ prolapse, why it happens, and how to get back to running safely.
What is pelvic organ prolapse?
Pelvic organ prolapse is when your organs — like your uterus, bladder, and/or rectum — start to drop into your vaginal canal.
It can feel like pressure, heaviness, or low back pain, but it can also feel like you’re sitting on something, a foreign object is between your legs, or your partner is hitting something during sex.
Why does prolapse happen?
Prolapse happens when your pelvic floor muscles (or other muscles that attach to your pelvis to help stabilize it) become too weak to support the downward pressure of your organs.
It can technically happen at any point in your life (especially if you’re constantly straining when using the bathroom), but it’s really common after giving birth. It can happen immediately postpartum or it can happen gradually over several months.
It’s possible to reduce or eliminate prolapse symptoms, especially if it’s mild (i.e. all organs are >1 cm above the vaginal opening). Your symptoms can also get worse, which is why it's important to monitor them and take the right steps to heal.
Can I run with prolapse?
It depends on how severe your prolapse is. If your doctor diagnosed you with grade 3 or 4 prolapse, you should avoid jumping right into running. Instead, you should focus on reducing your symptoms to prevent further damage to the tissues.
If you have a milder case, it’s okay to start running again — but you still need to work on reducing your symptoms and modifying your movement to prevent them from reappearing or worsening.
Tips for running with prolapse:
Managing your pressure throughout the day
If you want to start running with prolapse, you’ll need to focus on reducing pressure throughout the entire day — not just while running.
Our bodies can only tolerate so much. If you reduce the demands on your pelvic floor throughout the day, you’ll have more capacity to challenge your pelvic floor when it comes time to run:
Breathe. Our breath is healing. As you inhale, your diaphragm allows your pelvic floor to relax (which is so important for people with prolapse) and as you exhale, your pelvic floor lightly activates. Be mindful of your breath throughout the day and even take time to do diaphragmatic breathing when you can.
Be mindful when lifting your child (or anything else). When lifting anything, make sure you inhale, place it close to you, exhale and then lift. This applies to your little one, groceries, laundry or dumbbells.
Cough it up. When many women cough, laugh or sneeze, they generate pressure downward. Instead, think about contracting your pelvic floor with each cough/laugh/sneeze and think about coughing/laughing/sneezing upwards rather than downwards. Think about the way it feels when you pop your ears on a plane. You’re pushing the pressure up to relieve it.
Avoid straining on the toilet. Chronic straining on the toilet can prevent your prolapse from healing. This one can be tough, but there are some tricks for making it work:
Always sit down to pee and don’t force your bladder to empty too quickly.
Manage any constipation issues you could be having with diet (fiber is key!), hydration, and/or magnesium. (We have even more tips here.)
Use a squatty potty/step stool to elevate your feet when you’re on the toilet.
Inhale and then lightly exhale as you evacuate your bowels — imagine you’re blowing out birthday candles.
You might also have the urge to support the area between the vagina and the anus with your hand during a bowel movement. This is encouraged if it feels helpful.
Don’t suck in your stomach. Don’t hold your stomach tight at all times. Increased pressure from chronically sucking in your gut creates a constant downward pressure that will definitely worsen a prolapse.
2. Do the prep work before running
Running requires adequate strength and range of movement. If you’re lacking in any of these areas, your body will be forced to compensate in order to run:
Hip and calf strength
Impact training
We do a deep dive into the strength and mobility needed for running (and how to address any limitations you might have) here.
3. Change your speed with cadence training
Running is a high impact sport — but research shows that you can reduce the impact running has on your body by running at a 5-10% higher rate of cadence than your norm.
To do this, you’ll reduce your speed, but increase your step rate (the goal is to have shorter, quicker steps).
The goal is to aim for a cadence of about 170 beats per minute (bpm). You can use a small digital metronome to get the hang of this or run to songs that are 170 bpm and try to match them. You can also use apps like Wahoo Fitness, Run Cadence and Trail Mix to get more personalized cadence metrics.
These running drills can help, too:
Lean forward and tappy, tappy.
Upright toe taps. Use a small step and tap each toe to the step on the beat.
You can learn more about cadence training in our blog post here.
4. Check your running form
Proper running form is key to reducing pressure in your body. Have someone record a slow motion video of you running to see your form (You might be totally surprised by what you find!).
Here’s what proper form looks like:
Your forefoot should hit the ground first
If your heel hits the ground first, you have a heel strike. When you have a heel strike, you’re putting a lot more impact on your body. If you find that you’re striking your heel, cadence training can be a huge help.
You should be leaning forward
Leaning back is super common during pregnancy and it can be a tough habit to break. But if you’re leaning back while running, your pelvic floor takes a lot more impact, which can worsen prolapse symptoms.
Drill to fix it:
Lean forward to wall
Get tall like someone is pulling your high ponytail straight upwards
Lean forward like you are on skis, from the ankle up
Think nose over toes while keeping your ribs tucked down
Your trunk should rotate slightly, with your arms swinging back and forth at 90 degrees
It might come as a surprise, but your upper body has a lot to do with how efficiently you can run. You activate your core through your trunk and it needs to rotate a bit as you run.
Drill to fix it:
As you’re running, picture as if you had a flashlight attached to your sternum and picture pointing the flashlight at a clock: from 3 to 9, 9 to 3.
5. Change the surface you’re running on
Make sure you’re choosing soft running surfaces. That means avoiding concrete and sticking to treadmills, gravel, and asphalt, which allow for a little more bounce.
When you’re on your treadmill, you can also increase the incline to 2%, which naturally puts your body into a forward lean.
6. Run without a stroller (at first)
If you can, avoid pushing a stroller while running — at least at first. Pushing a stroller alters your form and creates more pressure on your body (gripping the handle, pushing down on it, or even leaning into it creates extra pressure).
7. Understand which days are good for running
Learn that it’s OK to take a day off from running — especially if you’re not getting enough sleep. Research shows that getting less than seven hours of quality sleep makes you more likely to get injured during endurance exercise.
8. Follow a training plan
Most running injuries or an increase in prolapse symptoms occur because people take on too much too soon. Rather than aiming for the same speed or distance you ran pre-pregnancy, you should slowly increase your speed and distance with a proper training plan. This will increase your tissue tolerance, or how well your body can withstand the pressure from running again.
So until your symptoms improve, limit distance. You can also follow our 12 Week Return to Running Program which helps you progressively increase the workload week by week.
Monitoring for an increase in symptoms:
Here are some signs that you might not be tolerating running with prolapse:
Heaviness or pain in the vagina
Flat butt
Pain (low back, hips, knee)
Leaking during running
Abdominal wall dysfunction
If you’ve covered all of the bases we’ve walked through (strength training, mobility, fixing your form, cadence training, managing daily pressure) and still don’t see improvement, it’s probably a good idea to hold off on running until you’ve found a way to manage your symptoms. We know how hard it can be, but you need to be good to your body for it to be good to you!
*A note on prolapse severity
Please note the “grade” of prolapse doesn’t always match up with your symptoms. There are some women who are incredibly symptomatic with a “grade 1” prolapse, and some whose prolapse is more severe in grade but are not generally bothered by symptoms.
Fake it till you make it
Some women find some relief from external support. Here are a couple of things you can try:
Tampon insertion: if you have cystocele or rectal prolapse, tampons can provide support from inside.
Underworks Vulvar Varicosity and Prolapse Support Boy-Leg Brief: these provide support and can help reduce swelling.
Need some help returning to running?
Our Expecting and Empowered app is designed to help women evaluate their bodies to see if they are ready to run! Through our app assessment, we’ll take your through a series of tests to test your strength and identify any potential weaknesses. If you’re not quite ready yet - no problem! We’ll provide a customized strength training program to help you rehab and get there!
AND we’ve created a 12 Week Return to Running Program if you’re newer to running or it’s been awhile! Try them out today in the Apple App Store or Google Play Store today.
Remember this prolapse running mantra:
“I can feel my body growing stronger. I am grateful and I will never give up.”
References:
Heiderscheit B, Chumanov E, Michalski M, et al. Effects of step rate manipulation on joint mechanics during running. Medicine & Science in Sports & Exercise. 2011;43(2):296-302. doi:10.1249/mss.0b013e3181ebedf4
Johnston R, Cahalan R, Bonnett L, et al. General Health Complaints and sleep associated with new injury within an endurance sporting population: A prospective study. Journal of Science and Medicine in Sport. 2020;23(3):252-257. doi:10.1016/j.jsams.2019.10.013