Incontinence & Prolapse Can't Kill You...But Inactivity and Poor Mental Health Could
This is a big call for a Women’s Health Physio to make. That there could be anything more important for a woman that to have a strong pelvic floor, well supported pelvic organs, and a bladder and a bowel that don’t leak.
For the best part of the last decade, I have been vagina-centric.
My training taught me that if a woman had a prolapse (which is 50% of the population who has given birth), then she should choose only low impact, low load exercise for the rest of her life to ensure that the condition didn’t worsen. This was the only way to prevent surgery.
There were patients along the way that took my advice and gave up their beloved running, or netball, or Boot Camp, because they trusted me that it was the only way.
I’m fairly sure there were a lot of them that, unbeknown to me, simply cancelled their next appointment and decided that they couldn’t work with me because they would rather die than give up their exercise of choice.
Did I prevent a lot of prolapses from worsening? Possibly. Did I cause an increase in poor mental health and an increase in risk of osteoporosis in some patients? Very likely.
Over the last few years, under the guidance of @physiodetective, @mishfit (credit for words in image), Taryn Hallam and others, I have re-evaluated the way I view exercise goals in women with prolapse and incontinence – and I know a lot of other Pelvic Health Physios have too. I closely studied the literature and realised that there wasn’t actually much basis in my uber-conservative approach.
Where did the advice come from that if you lift weights it should only be in a seated position? Where did the advice come from that you should only squat with knees hip width apart? Not a randomized controlled trial, that’s for sure. It was expert opinion, which was well-meaning I’m sure, but not based on high level evidence.
Now I listen carefully to what women want to do, and I assess them as an individual. With internal examination I can test what is going on with increased load and pressure, and even if I can’t (like with running), I can test regularly over time so that it can be proven whether things have changed.
As they get back to what they love. I take the guess work out of it and only advise against an activity if it’s definitely causing problems - and even then, it’s up to the patient if they choose to do it. Maybe they can’t face life without exercise, but can face life with a prolapse - who am I to decide for them?
With Postnatal Depression and Anxiety week having just finished, I feel like this is a really important point to discuss. For some women, a life of Pilates and swimming sounds perfect. For others, life without CrossFit is no life at all.
Exercise can play a major part in mental health, and I take care not to forget that.