Time to build a better house for women. The information and conversation around prolapse has historically been about supporting the pelvic organs from below by increasing pelvic floor strength. While this can be an important part of a global intervention strategy, if it is the only strategy offered it may not address other contributing factors, and women can be frustrated by a lack of progress.  I tell my patients who have tried programs that only focus on the pelvic floor….the strength of the floor of your house won’t matter if the roof comes falling in. The falling ‘roof’  is the result of high pressure or high muscular force strategies such as breath holding or abdominal gripping in functional and fitness tasks. This creates significant pressure and load from above on pelvic organs below. If this is not addressed alongside  pelvic floor specific work, then resolving prolapse symptoms may have added challenge. 

Providing new mommies with an understanding of the global system-from roof to floor- would be a protective measure for them in the early stages of post-partum to help them prevent prolapse. Moms are usually given the thumbs up to start pelvic floor contractions immediately following delivery. Let’s also help them understand what is happening with their roofs. Out of the gate, let’s teach them to breath through movements and transitions in and out of the bed or chair, or as they pick their newborn up out of the crib. This will help to blow off some of that pressure from above to protect new stitches and prevent adding load on the pelvic organs below and  diastasis in front. I like to use the cue  Blow Before You Go (BBYG) with my new mamas. This means asking them to start their exhale BEFORE movements or transitions and continue the exhalation through the exertion. This simultaneously blows off pressure before they even start to move and triggers an automatic recoiling response from the pelvic floor to lift and support organs from below. It also begins to reconnects the post-partum diaphragm, abdominal wall and pelvic floor to work to work together as a system, creates tension in the abdominal fascia, and helps to bring the sides of the abdomen back together. It’s win-win-win.

(Side Note: The Blow Before You Go strategy is NOT the same thing as exhaling with exertion. BBYG is a preparatory strategy that helps get the system ready for a challenge in addition to assisting within the challenge. Exhale with exertion only helps within the challenge.)

In addition, a lack of attention to the roof of the system may be a contributing factor to the high rate of need for re-repair after prolapse surgery. If those patterns of movement and stability strategies with high pressures and forces from above are never addressed pre-op,  chances are they will continue  post-op. The surgical “fix” will wear down over time as high loads and pressures continue their downward push. (Please note: I recognize there are other reasons for why the surgical correction may not have longevity, such as an undiagnosed pelvic floor avulsion. However, learning to manage pressures from above via a strategy like BBYG is an important part of supporting the system that protects the organs, avulsions and the repair). 

Try some simple steps.

Simple first step and great new habit to build: Stop holding your breath for movements, function and fitness (low loads).

Second step: Try Blow Before You Go instead! Take an inhale, then start your exhale before you move to both blow off pressure, and to trigger pelvic floor support from below, continue that exhale through the rest of the movement. This integrates the whole system (Diaphragm, Abdomen, and Pelvic Floor) into movements patterns. You may need the added “umph” of a more conscious pelvic floor lift from below to match the level of demand, support your prolapse or as you learn to reconnect.

Third step: Pay attention to how you are participating in activities that trigger your prolapse symptoms. Explore modifications  to relieve the symptoms. You can change your strategy-like steps one or two above. Or you can change the demand-shorten the range you are moving through, reduce your speed, or lighten the load to see if you can find a way to continue positive movement participation without symptoms!

Let’s build a better house for women to prevent, heal and manage prolapse.

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