Lifting Weights and Prolapse

Lifting Weights and Prolapse

The pelvic organ prolapse “world” is rich with fear- and LOW on scientific research.
With 10% of all women having some sort of pelvic organ prolapse surgery in their
lifetime this is not a “niche” issue. It’s a BIG TIME global public health issue! Like,
billions of dollars a year big!

I want to review some recent evidence that might shock you if you have been diagnosed
with prolapse. Especially if you’ve been fed the narrative that you shouldn’t lift anything
heavy ever again after your diagnosis.

A 2019 study by Lori Forner ( An epic Australian pelvic floor physio/researcher) looked
at a HUGE survey of close to 4000 women of varying activity levels(1). They fell into the
categories of:
1. Light Lifters (Max Lift <15kg * 33 lbs)
2. Moderate Lifters (Max  50 kg *110 lbs)
3. Heavy Lifters ( Max Lift >50 kg *110 lbs )
4. Non- Lifters

Did they find that the lifters had more prolapse? Despite what a fear mongering provider
might have told you that was NOT the case at all!

Before we get into the fun details of weightlifting / prolapse lets look at some other cool
things they found!
First:
- Of all the survey participants 14.4% had symptomatic prolapse. The largest
category of people with symptoms were in the non-lifter group
Next:
Things that WERE associated with POP symptoms:
- Number of vaginal births
- Hx of constipation
- Hx of hemorrhoids
- Familty Hx of Prolapse
- Weight Lifting Category

Things that WERE NOT associated with POP symptoms:
-BMI ( Body Mass Index) – basically a height to weight metric
- Forceps Delivery
- Cesarean Birth (meaning there wasn’t a higher OR lower risk of prolapse with c-
section)
- Hysterectomy

- Menopause Status
*Many things that historically been associated with symptoms of prolapse
So what did it say about lifting!?
Physically active women who lift <15kg were more likely to report symptoms of prolapse
than women lifting >50 kg
Boom…
While this was simply a survey and there was no physical assessment of the subjects
this. Is HUGE!
This takes away the myth that heavy lifting = prolapse symptoms… it doesn’t help us
understand everything, but it’s such a great insight!

“But Hayley… I’m a runner! Surely lifting weights is harder on my prolapse than
running?!”

Maybe not?

Lori Forner again with the epic research in 2020 comparing pelvic floor symptoms in
runners vs Cross Fitters (2) .

Guess what she found? Runners who had had vaginal births, had higher POP and AI-
Anal Incontinence rates (yes, pooping pants) at 12.7% with prolapse symptoms and
34% with AI

 Pardon… 34% or runners pooping their pants… need to circle back to this
another time!

People who participated in Cross-Fit Brand workouts had 7.8% with prolapse symptoms
and 27.7% with AI

 Still high on the pooping pants, this really has my attention! But I digress
While I think a big limitation here is that people who have symptomatic prolapse are
often too scared to get into something like Crossfit and so either self select into different
activities, like running or lower impact workouts …or

NO ACTIVITY AT ALL!

Which I think is something really important to talk about!

A 2022 Study that came out July of this year (3) looked at the relationship between
bone mineral density in post menopausal women and severity of pelvic organ prolapse.

Women with low grade prolapse had SIGNIFICANTLY HIGHER bone mineral density
than those with high grade prolapse at both the femur neck and the spine when all other
differences between the groups was controlled.

In this study they talk about some important other factors in regards to hormone health
and ligamentous support, genetic and other potential lifestyle factors what they don’t
talk about in this study is how critically important RESISTANCE EXERCISE is for
maintaining bone health as we age and progress into menopause.

A 2015 meta-analysis showed that “combined resistance training” which included
resistance training AND high impact weight bearing exercise as able to not only
maintain but improve the bone mineral density of post-menopausal women at the
femoral neck and the spine (4).

While we know correlation does NOT equal causation and we have no direct long-term
studies looking at progressive resistance training and prolapse (yet!) I feel that this more
recent research guides the next logical step to encourage more women with pelvic
organ prolapse to pursue progressive high impact resistance exercise. I truly think it is
the future of prolapse recovery!

So, how do we get to this stage of feeling comfortable returning to progressive or high
impact resistance exercise when we are still symptomatic?

Working with an evidence informed, movement positive pelvic floor PT in person or
online is a great first step… but if that’s not in the cards for you right now…

I will be going into detail on this during the Prolapse Webinar Sept 20 th 7PM EST – with MAMASTEFIT
Recording Available

References:

1. Forner, L.B., Beckman, E.M. &amp; Smith, M.D. Symptoms of pelvic organ prolapse in
women who lift heavy weights for exercise: a cross-sectional survey. Int Urogynecol
J 31, 1551–1558 (2020). https://doi.org/10.1007/s00192-019-04163-w

2. Forner, L.B., Beckman, E.M. &amp; Smith, M.D. Do women runners report more pelvic
floor symptoms than women in CrossFit®? A cross-sectional survey. Int Urogynecol
J 32, 295–302 (2021).
3. Ko YR, Lee SR, Kim SH, Chae HD. Pelvic Organ Prolapse Is Associated with
Osteoporosis in Korean Women: Analysis of the Health Insurance Review and
Assessment Service National Patient Sample. J Clin Med. 2021 Aug 23;10(16):3751.
doi: 10.3390/jcm10163751. PMID: 34442044; PMCID: PMC8396992.

4. Zhao R, Zhao M, Xu Z. The effects of differing resistance training modes on the
preservation of bone mineral density in postmenopausal women: a meta-analysis.
Osteoporos Int. 2015 May;26(5):1605-18. doi: 10.1007/s00198-015-3034-0. Epub 2015
Jan 21. PMID: 25603795.