Episode #82: All things prolapse with Aliya Dhalla (Episode #13 Refresh)
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In this educational episode, Rhonda sits down with pelvic health physiotherapist Aliya to revisit the important (and often misunderstood) topic of prolapse. Together, they break down what prolapse really is, common myths, and why symptoms matter more than grades.
This episode is packed with compassionate strategies to help you feel confident moving your body again. Rhonda and Aliya share practical tips for managing symptoms, strengthening support muscles, and using tools like pessaries or support garments, all while reminding you that prolapse doesn’t have to hold you back from exercise, motherhood, or living fully.
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🔗 Links & Resources Mentioned:
Book with Aliya online or in-person in Toronto @ Box Wellness Co.
Listen to Aliya’s podcast: The Not Your Mother’s Pelvic Floor Podcast
Support options mentioned for prolapse: Poise Impressa, Uresta, Hem Support Wear
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📝 Episode Talking Points:
What prolapse is (and what it isn’t)
Why prolapse “grade” doesn’t always match symptom severity
Common misconceptions and the emotional impact of an early prolapse diagnosis
Symptom management through pelvic floor strength, breath work, and relaxation techniques
The role of surrounding muscles (glutes, hips, core) in pelvic floor support
Avoiding constipation and managing intra-abdominal pressure during daily life
Returning to strength training, running, jumping, and other activities safely
Using tools like pessaries, tampons, or supportive underwear to reduce symptoms
Understanding how stress, cycle, and nervous system tension can affect symptoms
Tracking patterns to better understand your body and build confidence
How to gradually increase tolerance to load and pressure during exercise
Post-surgical considerations and the ongoing role of pelvic floor physiotherapy
Key message: prolapse doesn’t have to hold you back from movement or a full life
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Episode #82: All things prolapse with Aliya Dhalla (Episode #13 Refresh)
Welcome to Pelvic Health and Fitness, a podcast for moms who want real honest conversations about their body, their health movement, and everything in between. I'm Rhonda Chamberlain, orthopedic physiotherapist, pre postnatal fitness coach, and mom of two. I'm here to share practical tips, informed insights, and the kind of support I wish more women had access to.
Whether you're navigating pregnancy, postpartum recovery, perimenopause, menopause, returning to exercise, or just trying to stay strong through the chaos of everyday life, this space is for you. We'll talk pelvic health, fitness, and the emotional ups and downs of motherhood with zero focus on weight loss, and a strong focus on realistic sustainable movement that fits into your real life.
No, all or nothing mindset. No gimmicks, no quick fix. Is no bs. Just small, consistent steps that support your long-term health. A quick reminder, this podcast is for education and general information only. It's not medical advice, so please be sure to connect with your healthcare provider if you have specific concerns.
I'm so glad you're here. Let's do this.
Hey friends. Welcome back to another episode of the Pelvic Health and Fitness podcast. Today I'm excited to invite a very special guest, my friend Aliya. And Aliya has been here before she was here for episode number 25, tips to Have Great Poops. She's really great at talking about that, so if you want to go back and have a listen to that, I'll put that in the show notes.
Um, today we are going to be rerecording episode number 13, which is all things prolapse. Um, the research and advice is always evolving in this area, so I thought it would be a great chance to update some things and have a good chat with Aliya. So before we talk to Aliya, I'm going to introduce her.
So Aliya is a pelvic health physiotherapist with over 12 years of experience. She focuses on women's health, including prenatal and postpartum pelvic health, preparing people for labor and delivery, and addressing common issues such as leaks, pelvic pain, painful sex, and diastasis recti. She has extensive training in pelvic floor dysfunction, the treatment and management of incontinence, prenatal and postnatal pelvic health considerations.
Cesarean section recovery and diastasis recti Rehab. Aliya's mission is to educate and empower women about the changes that occur in their bodies. Throughout their lifetimes. Thanks for being here, Aliya. So happy to be back to chat with you, Rhonda. Thanks for inviting me. Of course. Yeah, so Prolapse is probably similar to you, something I talk about often with clients, lots of fear surrounding it.
So I hope today will be. A chance to kind of bust some myths about prolapse and get into why it's not something we ne necessarily have to fear. So how about we just dive right in. Aliya, what is prolapse? Do you wanna just explain to our listeners what prolapse actually is? Yes, for sure. And I totally agree.
I feel like if people go online to Google or go on Reddit or even Ask Chat GBT, it could be scary what they find. So I'm happy to have the chance to chat about it with you, and I think a definition is a great place to start. So the way that I explain to my patients and to my kind of online friends is that a prolapse is when one or more of our pelvic organs is sitting lower in the pelvis than it used to.
So our pelvic organs, um, are sort of supported by two main systems. There are the pelvic floor muscles, of course, that do help to support the organs, especially against gravity and against intraabdominal pressure, which is pressure that's coming like from above. And this is type of pressure that we have changing throughout our body.
All the time, like when we raise our voice, when we stand up from a chair, when we cough, right? All these things. And so the muscles, of course, they do help to support and counteract that pressure. They help to support our organs, but there's also a more passive support system, which is like soft tissue, like ligaments and connective tissue that also help to sort of anchor the organ.
To other organs, to bones, to other structures, and kind of help them keep their proper place within the pelvis. So when we have a pelvic organ prolapse, it's when one or more of our pelvic organs is just sitting a little bit lower in our body. And that could be our bladder, it could be our rectum. It could be our uterus, most commonly.
Awesome. And then, yeah, so how they are sitting in our uterus, that's how then they're graded, right? So you might, um, if you have a prolapse and you're listening, you might have been told by someone that you have a grade. 1, 2, 3 prolapse. So do you wanna just explain how they're graded, Aliya and what they, what the grading system means?
For sure. So just to clarify, I think you just made an accidental, like you misspoke a little bit and you said where they sit in your uterus and what I think you Oh, sorry. Meant to say. Yeah, you meant to say, I think sit in your pelvis, right? Yes, yes, yes. So where your organ sit in your pelvis. Yes, exactly.
Depending on how low they are or how much descent there is, uh, your prolapse might be graded. As like a 1, 2, 3 or a four, and one is less kind of low and four is quite low. Um, and this is very much dependent on the person who is assessing you, the position that you are assessed in. Maybe even things like the time of the month are you constipated, different types of things, right?
Mm-hmm. Um, so generally speaking, a grade one would be where, you know, that would kind of be. Actually within a normal range, a normal amount of descent. Um, so the organs are still kind of sitting up fairly high within the pelvic, the pelvis, rather a grade two is when they're kind of approaching a little bit more towards the opening of the vagina.
A grade three would be where they're at the level of the vagina. And a grade four is where they're outside of the body, where part of the organ is presenting outside of the vaginal opening. Um. So that's kind of like more simplistically what to think about. So nowadays, more of the kind of advice and clinical.
Guidance or clinical guidelines for, for addressing and treating prolapse, how to approach it. Is that like a grade one really that is sort of within a normal range of motion, if you will, of the pelvis. Uh. Of the pelvic organ. So if someone's told that to you, like, that's fine. Yes. Yeah, that's great.
And I, one thing I was very surprised to learn about prolapse. I. First was starting to learn about it, and I myself dealt with a grade two prolapse postpartum. Um, and even as a physiotherapist, we aren't necessarily taught these things in school. Mm-hmm. So there was a lot of learning that I had to do and weeding through definitely a lot of the fear that is out there.
Mm-hmm. But I was surprised to find out how common it actually is. And do you find, is it roughly like 50% of people, would you say? Yeah, that's kind of like what the numbers are that are thrown out there. I mean, you can find different types of, or different numbers, like the incidents or how many people do have pelvic organ prolapse.
But the most recent one that I've read is in line with what I've been reading recently, which is like one in two of us who have given birth vaginally. We'll end up with a pelvic organ prolapse, and that is kind of what I see, I would say in my practice. But what I will say is that. Um, there is a difference between someone who has.
One or more of their pelvic organs that are sitting lower in the pelvis than they used to. And someone who feels symptomatic. Yeah. Meaning there are many people who come in postpartum or just like, you know, had kids many, many years ago or maybe never had children, and they're seeing me for something else.
They're not coming in with the classical symptoms of prolapse, which we can kind of, you know, describe it as, it feels like heavy or pressure down in my pelvis or like something is falling out of my vagina or like a tampon is kind of crooked in there. Like these are typical things that people will say when they're experiencing symptoms of pelvic organ prolapse.
So there's so many cases I can't even count them, of people that have come to see me with. Out those types of symptoms, but they're coming to me with another concern, and when we move forward to do an internal exam, I notice that they do have descent of one or more of their pelvic organs. So that is what we would call like an anatomical prolapse where anatomically right, the anatomy is sitting in a lower position than it did or ideally should.
However, it wouldn't necessarily be what we call like a clinical prolapse because clinically. They don't have symptoms. So in order to sort of have a diagnosis of pelvic organ prolapse, we need to have that anatomical descent, and we also need to have clinical, clinical symptoms or bothersome symptoms or functionally restrictive symptoms.
Right. Um, so I do see a lot of people that don't have any of this pressure. They have no idea that something's going on down there and it's not bugging them. Mm-hmm. Um, but I'm able to see something. So it's, it's interesting about prolapse is that. Having one or having a very, you know, like severe prolapse or maybe a very mild prolapse.
There's not very much correlation between prolapse and the severity of the descent and symptoms and how bothersome those symptoms are. Right? Yes. Like people will come in. With no symptoms at all. And I may notice a grade three prolapse or people will come in with very, very bothersome symptoms and maybe at best they have a grade two prolapse, right?
So that is stuff that happens all the time because prolapse is something that really is a very individual experience, and I think it's a little bit more than just physical. There's a lot of kind of emotional psychosocial stuff happening around it too. Um. Yeah, I don't know if you, that's something that you have conversations with your clients with about, or if that's something you experience yourself.
Yeah, definitely. I think that was an eyeopener for me too, that the symptoms do not always necessarily correlate with the severity of the anatomical prolapse, and that was for sure my experience, and I think it makes sense that people can get hung up on. The grading and how bad is it? But I always try to reassure my clients that regardless of the severity, anatomically, there's so much we can do to improve your symptoms.
And I think if we focus on that versus what's anomic. Anatomically happening. Um, people, ty typically do a little bit better, which I understand can be hard because we want to know what's happening and we want to reverse that prolapse. Um, but again, trying to focus more so on what can we do and what, how can we progress and what you wanna do in your life without symptoms or less symptoms.
I think that's where I try to focus more so. For sure, for sure. And I have the same types of conversations with my patients too. In fact, it's like really challenging for me to convince people to not check, right? Wow. So like, don't take a mirror. Don't look every day. Don't put your finger inside every day.
Don't look for a bulge or feel for a bulge. Or every day do a scan to be like, how bulgy do I feel today? How prolapse am I feeling today? It's really like quite the conversation to convince people to just. Be free of that a little bit. And once we're able to get there, it actually is a game changer. Um, like freeing yourself from like, being so hypervigilant about prolapse is really an important part of recovery.
In terms of symptom recovery. Um, but it is challenging, right? Because there's so much, I think, fear about prolapse or so much concern about how did it happen? Will I make it worse? Um, how is this impacting like my ability to do things that I like my exercise activity choice, my sex life? Like, there's so much behind a diagnosis of prolapse and the symptoms of prolapse.
I think that it is, it is challenging, but it is important. So I'm s. Like, I love that you're also having those types of conversations where like, it doesn't matter the grade it, it doesn't, that's very easy advice to give, but yeah. Yes, for sure. I know. Um, so along with that, I know this hap this question comes to me as well, probably you too.
Uh, clients will then say. Can I reverse my prolapse? Are there certain things I can do to get it from a grade three to a grade two or a grade one for example? Yeah. So I'd love to hear how you talk through that with your clients. Yeah, so people do ask like, can we fix this? Can I like put it back? Will it go back?
And, and so I usually, you know, I tell people gently that like the evidence that we have doesn't. Tell us that conservative treatment like exercises or pelvic floor therapy or like, you know, other kind of strategies or lifestyle stuff that this is going to reverse our prolapse by a grade or more or anything like that.
Right? Um. The only way to do that is for surgery. Right? Yeah. And that's not always indicated for everybody. That may not always be necessary, and in many cases it isn't. And in cases it is obviously. Um, so I kind of share with people like right off the bat, we're not gonna reverse it, but it that like the, the anatomical descent is less.
Important to your quality of life and your kind of future than managing the symptoms, right? Right. So you can have freedom from the symptoms, you can feel confident in what you're doing, and you can manage your symptoms that is very manageable and the right type of pelvic floor muscle training and the right type of kind of like strategies and lifestyle, lifestyle changes and advice.
This is what's actually making a difference in our experiences of living with a prolapse. Um, so I usually will say that I will not like lead people astray and be like, do these exercises and you will, you know, go from a three to a four, like a three to a two. That's not gonna happen. Yeah. Um, so I often will kind of just tell 'em upfront and then educate on the fact that what we actually wanna do is change the symptoms.
Right. And we can think about. Sort of why we are where we are, right? Like what can we change? So going back to why we have a prolapse in the first place, it is some kind of failure in that support system, right? So we have the muscular support system and then we have like the connective tissue support system.
We can't change the connective tissue support system, um, but we can change the muscular support system. And so we're gonna do everything that we can to reduce the burden. On the connective tissue support system and to strengthen up that muscular support system to do the best that we can. And I like to use the example of, um, okay.
Do you have those hair ties that are the rubber curly ones? Yes. You know those ones. Okay. So, you know those ones, they do get stretched out. Like, I have a ton of hair. Right. So soon enough mine will stretch out like quite big. Yeah, but did you know that if you blast that under a hair dryer or you put it into a cup of hot water, it will actually shrink up and go back to its original size?
Yeah. So I did not know that. Yeah, so, uh, I think like ages ago I created some content about this and I never ended up posting it, but it's an analogy I like to use. And even if people are like, even though like, oh, I didn't know I could do that, they understand that it does stretch out, but then you can do something and it will go back to what it was.
Versus like the traditional, you know, elasticy ones, elasticy hair ties, that once you stretch 'em out, you know that that's not gonna be holding up your hair and you can't do anything about it. You throw that thing away. Right? Yeah. So I like to use the analogy that our muscles are, like the coil rubber ones that you can change, you know, make them make it tight again, and the connective tissue, like our ligaments and whatnot, that support system is more like those elastic ones that once it's stretched out.
You can't do much about it. Um, so I like to kind of make that analogy and say we're gonna do the best that we can to, you know, build up the muscle right. And we're gonna do the best that we can to maybe not ask more of the elastic hairband than we need to. Right. So like for me, I wouldn't put my, all of my hair up in, in an elastic hairband that's stretched out.
Maybe I'll just do a half pony. Right? Yeah. And that's a way that I can manage. And so that's how I like to kind of bring them in to understand that there's two support systems. One, we can change, one we can't, and we do the best that we can. Um, I love that. It's a great analogy. Yeah, it works well, right? I liked it.
I don't know if I like heard it somewhere or if I just one day like I was doing my hair and I was like, this is how it works. Um, but there's other analogies out there too that maybe you've heard about. It's, it's like a boat in the water. Yeah. Have you heard about this one? This analogy? Okay. I don't know a lot about boats, so I'm gonna try not to mess it up, but it is a good analogy.
It's like a boat in the water that's tied with a rope to the dock. Okay. So the boat is tied to the the dock with ropes and it's floating in the water. If the water level drops down, what happens to the boat? It goes lower and it's stretching more on the ropes that are tying it to the dock. The ropes are like the connective tissue.
The water is like our muscles, so if we add more water into the pond or the lake, the boat will rise up again. The boat is our pelvic organ here, so that's another kind of analogy that's maybe a little bit more visually. Yeah, effective, but that's a good one too. But like, I don't know much about boats, so I have a hard time explaining that one.
I can explain. No, that makes sense. I can explain hair ties better. I can picture the boats too. That was good. Yes. Um, I would love to hear clinically, um, so if a client comes to see you very early postpartum, so say they come right at six weeks and you do see a descent of the organs clinically because they're so early postpartum.
Do you see a reversal of the prolapse because of just time and healing? Yeah. This is a good question. I can't speak for like my colleagues and other people who do the same work that I do, but like I will never say anything at that time. It's so early. Oh my God, of course. At six weeks, eight weeks, 10 weeks, even 12 weeks.
I'm not saying anything. I'm not, I'm noting it in my chart. I'm using very vague language. I'm not like hiding what their body is doing, but I'm telling them that you are so early postpartum. Your body, your tissues haven't even recovered yet. There's like some tissue recovery that needs to happen in a reasonable timeframe and within one or two or.
Maybe even three months. Like we're, we're still in that healing phase, so everything is gonna feel lower, everything is gonna look like it's sitting lower. Even things like, I don't know if you experienced this when you were postpartum with your girls, but like in those early weeks, and for some of us, like early couple of months, we might still have bladder control problems.
We might still have like a hard time holding in a fart that when it used to not be a problem, like nothing is gonna be super normal. Yeah, in those early days and everyone's early days, you know, period is gonna be different than the others. So I note it and I do not talk about it. Um, I, if it's really severe.
And they're having symptoms and they're having functional problems. For example, if they're having, um, an anterior vaginal wall prolapse or what's also known as a cystocele where the bladder is sitting lower, it's crowding into the vaginal canal. Sometimes we can get symptoms of incomplete bladder emptying or dribbling, like if these are symptoms also that are showing up.
Obviously I'm not gonna ignore it. We're gonna talk about how to move past it, um, and to navigate and to manage. Generally, if they're asymptomatic, they feel okay, but I'm noticing a prolapse. I'm not gonna see anything. I'm gonna say things like, things look like tissue's still healing. Things look lower than they used to be, but that's totally normal at this point.
We're gonna keep an eye on it. Like that's the language I'm gonna use because I've had so many patients come in and tell me that. And these are patients that didn't see me early on postpartum that maybe are seeing me months or even years later, that were told very early postpartum that they have a prolapse and they've held onto that.
Held onto that for months or years. Right. Being like I was told that I have a prolapse and upon assessment I'm like, you literally have nothing. Everything is fine. You were told something that was just not in my opinion, appropriate to say so early on when there was still so much tissue healing. Right.
Um, so yeah, I make it a point to like. I never say anything like that because the emotional damage I've had to undo from other providers has been quite a lot. Um, and also like, just from a personal standpoint, like. I also have a prolapse after having my son. And I didn't have that exact kind of, you know, scenario where I was told very early on that's not what happened to me.
But I do understand the emotional impact of being told that and feeling symptoms like that is something I still acutely feel. Um, and so I really wanna protect people from having to go through something like that if like really we don't need to even be having that conversation. Yeah. That makes so much sense.
And then do you clinically see. A prolapse, improve. From that early diagnosis to later on when you check them again? Yeah, yeah, for sure. For sure. Yeah. Like if I'm seeing someone really early and things are looking like looser and lower in time, many of them just start to be a little bit higher and tighter.
Right? Yeah. And then we do, you know, we're already by that point, we're reestablishing the connection between the breath and the pelvic floor and the deep core. We're getting things working again. Pumping the pelvic floor muscles, so it's helping with circulation. We're introducing positions like I know you like your z lying.
So doing all these types of like restorative positions and you know, in many cases people are okay. Right. And then as the stats tell us, in many cases, some of us, we are left with a little bit of descent and that's okay too. Yeah, totally. Um, I agree. And I, I think still to this day, I probably have like a, between probably a grade one and a two.
Prolapse and I will say that to clients too. I have a grade two prolapse. I have little to no symptoms. I still very, every so often, and we'll talk about this as we proceed. With working out, I have to be mindful of how I do things, but it doesn't impact my life. Right. So I think that's a good sort of, um, way to go into our next chat here.
So the goal is not to reverse the prolapse or necessarily stress about anatomically what's happening. I want you all to realize that again, there's so much we can do. To manage the symptoms. So we're not necessarily working on fixing it per se, but how can we still live a great quality of, of life, do the things that we want to do and learn how to manage those symptoms.
So let's get into a chat about that. Aliya. What are some of sort of the top strategies that you teach your clients to learn to manage prolapse symptoms? Yeah, that's, that's a great, this is a great question and I'm happy to chat about this with you because I agree, right? We have to just figure out how to manage symptoms and be as symptom free as we can so that we have that freedom to do all the things that we want to do and like, frankly, we probably need to be doing, right?
Yeah. Um, so the things that I'll usually say is like, let's make sure that we have. Adequately strengthened our pelvic floor muscles, right? Just like any other muscles in our body, our pelvic floor muscles, they'll respond to strength training and to progressive overload. And just like any other muscle in your body, the more that you work it out, the bulkier it gets, like the bigger it gets, right?
So if you're able to bulk up your pelvic floor muscles a little bit more, and especially, you know, the, the deeper portion of our pelvic floor, which provides a little bit more of that lift, kind of, um. Action. Then we're gonna get a better lift and support of our pelvic floor organs against gravity and against pressure that's coming down from above.
So let's just make sure we're not ignoring pelvic floor muscle training. Yes, the research does show us that this is like first line of defense. It does a great job at reducing symptoms. Um. So for sure we're gonna address that. Um, we're going to also address things like strengthening outside the pelvic floor because if we're relying on, you know, the pelvic floor muscles to do all of that work, um, we do definitely want things like the muscles that help to stabilize our hips and our glutes and our inner thighs.
We want all the muscles around the pelvis as well, including our abdominal wall. We want everything to be strong. The stronger you are, especially the glutes, the stronger our glutes are, the better supported I think. Um, our pelvic floor is itself and the more that we can allow the pelvic floor muscles to do their job, we know that we have strong muscles outside helping us to actually do the bigger movement stuff.
Yeah. Um, I think things like avoiding constipation is really an important piece of it because we want to sort of avoid. Repetitive, unnecessary downwards force onto the pelvic floor, especially as maybe those structures are healing, or especially as we're building up the strength and tolerance of the pelvic floor muscles themselves, right?
So we wanna avoid constipation because constipation, um, like having hard stool in our rectum just makes more work for the pelvic floor muscles and the structures of that connective tissue. Um, it creates more work. For those structures in order to support the weight of a rectum that is now full of hard poop.
And then when it comes to emptying. The poop. Often if it's hard, we have to strain, right? And that straining is putting a downwards pressure onto our pelvic floor structures that like when we're prolapse we, we can try to avoid that. And when it comes to symptom management, in fact, chronic constipation is one of the reasons why we may have prolapse.
So it is really common in like the. After a vaginal childbirth population, but it is not like, it's not seen in other populations. Right? I have a, a number of patients that I see and that I have seen that have never had children and that have prolapse. Um, so things like con chronic constipation, chronic coughing, um, you know, really improper lifting techniques, um, you know, over maybe a long period or with heavy loads.
This can be, uh, a reason as to why we end up with pelvic organ prolapse. So managing constipation, I think would be up there. Another thing would be to, um, just learn how to manage generally pressure better in our body, right? Yeah. So proper lifting techniques, proper breathing techniques when we're lifting, um, how to maybe in some cases kind of.
Activate your pelvic floor muscles so that they're counteracting the pressure that's showing up or increasing when you're lifting a heavy load. Um, and that might be more of a beginner, intermediate strategy. Maybe not something we have to do forever, but it is a good strategy, especially when we're learning how to move, um, and trying to manage our symptoms.
So that's kind of. Really the big ones like let's get strong inside and outside the pelvis. Let's like try to have good, easy poops and not strain too much and let's learn how to manage pressure better using our breath to kind of modulate that. I love that. Yeah. The one thing I chat with my clients about too, and this was.
My experience with prolapse, and I'm curious if you see this clinically too. Prolapse symptoms can sometimes, um, sorry, I'll reword that. A hypertonic pelvic floor or a lot of tension held in the pelvic floor and the abdomen. Can mimic prolapse symptoms. Um, that was my experience, I would say is that again, maybe fear associated with the diagnosis.
Then I had a response of clenching my pelvic floor constantly trying to think about pulling those organs up and I would hold my pelvic floor in tension all the time. So when I started to mindfully. Notice how often I was doing that and sucking in my belly and squeezing my bum. As soon as I started to offset that and think about breathing and relaxing and doing, you know, positions like Zed lying that we talked about, working on hip mobility, that then helped to decrease my prolapse symptoms even though most likely anatomically nothing was changing with my prolapse per se, but I was learning to like down train my pelvic floor.
So, and that's always an interesting conversation too, right? Because I agree with you. Yes. We wanna do Kegels. We wanna strengthen the pelvic floor and we have to learn to let go of that tension too. Right. So yeah, I'd love to hear kinda what you chat about with your clients about that. Yeah, that's for sure.
Something that shows up a lot is something that I caution people on too, is that like, look, I get it, like personally I get it. And also. From a clinical perspective, I get it. It's such an icky feeling like a prolapse doesn't hurt for most of us, right? It's just, it's just gross. It feels yucky. It's something like a na, something nagging that you can't ignore, but it's not painful.
Now when we get into, okay, what does this diagnosis mean for us? What does it make us feel about ourselves? What does it make us afraid of? Right? For sure. That is not a feeling that we like to feel and. I think generally many of us wanna make ourselves feel better, whatever it is, right? So that kind of clenching or like sucking up, right?
Like pulling everything up and into your body. Like you mentioned, you're clenching your abs, you're squeezing your butt. All of this stuff to try to like make the prolapse go back inside your body. Yeah, it makes sense. I understand why we do this. I, I'm sure I do this as well. Um. Definitely my patients.
Some of them do this as well and I usually will warn people like, don't get into that habit. Especially if we're early in our days of kind of discovering that perhaps we have a prolapse and we're gonna manage it together. I do caution them against it because overactive pelvic floor muscles and like, especially if you're thinking about sucking in your belly and then that's creating actually pressure that's going down to your pelvic floor and your pelvic floor is also squeezing and pulling the pressure up, like you're just generating a ton of pressure and.
Your abs and your pelvic floor are actually not meant to be able to like do that for so long. Um, so if we get into this loop of having hypertonic or overactive pelvic floor muscles all the time, that actually can mimic the feeling of prolapse. It can make it feel worse and it can kind of mimic that sensation, that sensation of pressure.
'cause when we're sucking everything in, we're generating a ton of pressure, especially if we're sucking in our abs or clenching like re belly, like, you know, we're. Bracing our abs all the time. It's creating a lot of pressure downwards. So prolapse or not, your pelvic floor is not gonna be able to manage that on a long-term basis.
So it can make the sensation worse. It can kind of create another problem where we have like overactivity of the pelvic floor muscles and suddenly we're getting more urges to go pee. Or we're having a hard time emptying our bladder or bow fully, or like we're having sex, uh, pain with sex. Like who knows, right?
We can get all of these different types of. Situations that do show up when we have more kind of overactive pelvic floor muscles. So it is something that I see as something that I like to warn against because the reaction makes sense, like why we do it makes sense to me. Um, and for many people it doesn't make sense.
Why we shouldn't do that. So I do like to educate on that. Yeah, yeah, for sure. And that, if that does resonate with you all listening, I would say again, the best things that helped me is mindfully working on, um, relaxation breathing. So learning, um, I think it was, uh, my friend Anita, you know Anita as well.
Holistic health physio, uh, teaches, um, flower bloom breathing. So when you inhale, think about pelvic floor relaxing, and then on the exhale the flower continues to be blooming. So it doesn't do the contraction. Mm-hmm. So I always try to include a balance of both strategies with my clients. Again, yes, we wanna work on Kegels, we wanna work on that strength piece, and we want to check in and see if you are able to actually let that tension go and do that throughout the day too, especially.
If you're someone that tends to carry tension in your body, which is many of us. Mm-hmm. Um, so yeah, so strategies that would help with that. That flower balloon. Breath Z lying. So laying on your back with your legs up on something or legs up the wall is a great one as well. And just working on hip mobility or other relaxation strategies to lengthen and again, relax the tissues that attach to the pelvis.
I find that's a really beneficial thing too. And probably pelvic floor. Well for sure pelvic floor therapy would help. This as well to see if there is actually any, uh, tissue release that needs to be done. Right, Aliya? Yeah, for sure. That can be helpful. And another one of like my favorite relaxation positions, especially for prolapse, is puppy pose.
I love puppy pose and for, for those who are listening and they're like, I don't know what this is. Okay, so imagine that you're on hands and knees and then you drop down to your forearms. So your bum is in the air and your head and your chest and your shoulders are closer down to the ground. I often say like, you know, fold your arms one over the other.
Make a little pillow for your head, or grab a pillow so that you can really rest in the position where your booty is up and your head is down. And what that, it just feels so good because gravity's actually pulling your pelvic organs. Off of the pelvic force structures. Um, and so that gives you a temporary, like almost immediate like ha that like downwards pressure, sensation is gone because you're in this position.
If you hang out there and you do that kind of, that flower, bloom breath. I love, I love, um. Using kind of that language that Anita kind of, I think she, let's say she invented it. Coined it, yeah. Coined it. Nice. Or like just diaphragmatic breathing, if that is something that you're familiar with in your body.
Um, like if you can really settle into a puppy pose, let your belly go, like really let it go. Um, puppy pose is really lovely. It's, it's one of my favorite kind of go-tos for prolapse and like, making us feel good in the moment. And also. Lasting as well. I love that. That's great. Um, the one thing I did wanna touch on too, Aliya, and this is something I chat with my clients about as well, is instead of attaching fear to the symptoms, trying to get curious about our symptoms too, so that we can kind of understand why symptoms might change and come and go, um, as we heal, but then just also as a human, where our body's constantly changing.
So one of the things I chat about is. Tracking it maybe according to your cycle. And I know you know, folks that maybe early postpartum, their cycle hasn't returned. This is a little trickier, but just starting to notice if there is trends in that regard too. 'cause I think there is, um, a very common occurrence where leading up to your period, maybe during ovulation or during your period.
Folks will experience an increase in symptoms. Um, so is that something you chat about with your clients too? For sure. I do encourage them to look for patterns and almost as a way to understand, because sometimes what will happen, and this kind of goes back to what we chatted about earlier, how like the severity of the anatomical kind of descent.
It doesn't always match up with when we feel very symptomatic. And that's confusing. It's confusing for people to understand like, why does that happen? And I actually don't have a good answer. Like, I don't know why that happens, but what we can do is to look for patterns or look for like. Almost like negative associations, right?
So for example, yeah, I ask people to like watch their cycle. Do you notice this is coming up at a certain time of the month? Then it's happening a couple times over. Like maybe that's a pattern. And then if that's happening, okay, then we don't panic about it that day. Especially if like a, you know, onset of symptoms or worsening of symptoms is something that might get us into a spiral of like, oh, things are getting worse.
I've made this worse. What did I do? Um, so I do like to encourage that. I encourage like, check in. Are you constipated? Did you miss a poop? Right? Um, are you stressed? Mm-hmm. Right. That's a big one. Emotional stuff, stress, nervous system kind of. State it's gonna make a difference. And maybe that's because a lot of us, we have a stress response where we hold a lot of tension in our body and our jaws and our bellies and our thighs and our bums and our pelvic floors.
Maybe that's why, right? Maybe when we're stressed, we're really hyper attuned to what's going on in our body where our body's scanning for threat. Maybe like, who knows? I don't have all the answers, but this does show up from time to time. So I will get them to scan these types of things and also. Let's just say that they have a little bit of anxiety or fear about returning to specific activities or exercise, right?
Instead of like being hypervigilant that, okay, I did some jumps the other day and now look at how terrible I feel. Let's also think about those times that like, oh, I ran around in the backyard with my kid and I, I played ball with 'em, and like, I feel great. I feel fine. Right. So just looking at like those, I did all these hard things and I feel fine versus only looking for what is it that flared up my symptoms Because often they're gonna flare up for like literally no reason.
For sure. There's not really any correlation. Um, and so yes, I do encourage people to look for patterns, to look for kind of reasons to trust their body a little bit more because I think it's a really common experience for us to feel that we can't. Trust our body, that we've done something wrong to our body that um, you know, our body maybe has let us down.
And I think that's a hard place to be. Um, and so kind of encouraging people to, um, little by little trust that their body is okay and that they can do things that they enjoy and they can do so safely. Um, I think that's an important step. I love that. And that takes us to our next section really nicely.
And this is something you and I, Aliya both loves talking about strength training and the importance of just adding more movement into our life. And I think, you know. Things have changed over the years, thankfully. But I think at some point in the guidance given towards, uh, women dealing with prolapse men as well to avoid heavy lifting.
Right. And I think yes, again, there has to be mindfulness in terms of lifting heavy when you're dealing with a prolapse. However, you and I are both proponents of this, that you need to strength train, you need to build strength, you need to get stronger to feel good as a human. And like you said, just build back that trust and confidence in your body again.
So let's get into a bit of a chat about that. 'cause I know even for myself as someone that's a physiotherapist and I've worked out my whole life, I 100% had fear associated with getting back into strength training and fitness. With my prolapse prolapse diagnosis and before I learned about all of these strategies, it would happen where I would do a workout and my symptoms would come right back.
So it was very touch and go for me for a while, and I stopped all working out for a a period of time 'cause I was so lost of what to do as I started to learn more about prolapse and pelvic health and how to manage my symptoms. I was so thankful to finally get back to things again. So what do you chat about with your clients if they are, you know, wanting to get back to like, running, lifting, jumping, all those things that, um, bring them that quality of life piece, but they're dealing with prolapse.
Yeah, I think that. It is a discussion that I do enjoy having, of course. Um, and I, I do feel like you said super strongly that we should be active, we should be more active. And unfortunately, sometimes when people come and they've had, um, you know, a, a medical provider, tell them that, okay, you have prolapse and like, okay, you shouldn't lift anymore, or that's it.
No more like jumping, do low impact, maybe just swim and they're. Crushed because maybe they enjoyed doing more than that before, or maybe they had, you know, hopes of doing this now, or just even the fact that they were told that they couldn't because of their prolapse. Like that feels. That's crushing. Um, and it's also really hard to convince someone that it's okay to do something when their doctor said, you should never jump or do impact or lift more than 10 pounds.
Like, that's not even realistic information, especially if you're a parent. Right. Um, so I, I do love having these conversations. And of course it would be different based on the person I'm talking to, but. It's always about like, let's gradually get back to what you've been doing or what you want to do, and let's understand that it's going to be like a bumpy road to get there.
Yeah. And um, the same way that like if you haven't worked out in some time and you're returning back to the gym. Right, that you won't be able to do as much as maybe you used to do when you were more regular. You won't feel the same doing those exercises with the same intensity or the same weights that you used to and after.
You're gonna feel really different than you did the day after a workout when you were in the group, right? So starting and building back strength is always gonna feel different than when you're like, well, within a routine and. Most people can relate to that, whether they've had a personal experience of that, or they can, they just understand that if they've never done squats before, that when they do, you know, their first set of squats ever, even if it's just body weight, the muscles are gonna burn the next day and the day after, they're gonna feel really sore and stiff.
People can usually understand that concept. So then once we are. On the same page there, I often like to introduce him to the concept that like your pelvic floor also needs to accommodate and be able to, um, like slowly increase its tolerance to. Loads or to impact or to pressure. Um, and so we may feel symptomatic during exercises or we may feel a little bit more bulgy after, and we can use that as data, right?
And how we feel during the exercise and after, and how quickly that feeling goes away and how other feelings are coming and going can help us to decide if we're progressing well or if we need to scale back or modify. Um, but just understanding that. As our muscles of like our general body need to accommodate to the intensity and the load and all these different things.
Our pelvic floor muscles also need to be able to, to manage that pressure. Um, and it will take time. So, uh, it doesn't necessarily mean that we always have to be symptom free when we're exercising. We just need to be aware of what's going on. So again, like kind of tracking or keeping. Keeping an eye on patterns and rhythms and other things that are going on.
And sometimes I share like my own experience where like, I remember, um, I used to have like, I used to feel like very bulgy and very symptomatic with doing sits like just one, one sit up. And I would be like, Ew, this is gross. And I could, I could do them, but like the amount of pressure that I was feeling down into my pelvic floor was a very yucky, and I did not like it at all.
Um. A sit up is a pretty high generating, like intraabdominal pressure activity. Yeah. Right. So it's not to say that I kept doing sits and nothing else. I was doing other things to strengthen my body, my core, my glutes, the whole thing. Um, and like soon, and I don't even remember when it was, but like situps.
Don't, are not a problem. And I'm able to do much higher level core exercises like pull ups and like toast to bar on the bar, which are higher level core exercises that create more pressure. Um, and I'm, I'm symptom, I'm symptom free 99% of the time. Right. So, but it doesn't go from zero to nothing. You go through these phases where you're like, Ew, this is gross.
I don't like the way this feels. And then maybe you slow down, you modify, you do a mini crunch. I don't know. You do other things. Yes. And then your body. My, obviously my abs needed to get stronger, but my pelvic floor became more tolerant to the pressure and to counteract it, right? So that doesn't mean that, um, we always need to be symptom free, and that's something that's also hard when there's a lot of fear associated with movement.
I love that and so important, and I relate to the sit up piece too. And for me, again, even as I got back into heavy lifting, there are still times that for me, I can feel pressure more so into my bum. Like I can feel kind of pressure. But this is the cool thing too about when you learn to manage symptoms like prolapse, you just learn so much more information about your body and how your body works.
And so as I've learned. I now have different strategies that I can try to employ. So when I'm lifting heavy, for example, I just really consciously think about a nice big inhale into my lat. So sort of like that umbrella breath. And then that for me helps to just generate enough, um, support of my core system.
When I do that heavy squat, it feels that much better, so I just check in with myself if I feel a bit symptomy. Did I do that? Big breath? Probably not. So then when I do that, it really helps. Similar with situps, I've had, um, issues with feeling pressure in my pelvic floor with situps as well. But if I intentionally, again, go back to that breath, nice big belly breath before I do the sit up, think about a bit of that brace, and then do a sit up.
It's symptom free. So it, it's, it's cool. And I think this is where, you know, working with someone like Aliya or I. Would be very beneficial if you're listening to this conversation and you're like, this is so overwhelming, I wouldn't even know where to start. Um, definitely recommend that. So let's get into, um, just treatment.
So, um, we touched on the pelvic floor physiotherapy piece. So obviously that's, um, I would argue like first line of defense, if you have the means to see an internal therapist. Highly recommend that just to get information about what's happening. Check in with are you doing a Kegel correctly? Are you able to relax that pelvic floor?
Do you have that coordination piece that when you do cough or sneeze, you can contract the pelvic floor so that you're not putting that pressure downwards? Um, what would be some other things outside of pelvic floor physiotherapy to treat prolapse? Um, great question. So I love talking to people about using external or internal support.
Um, 'cause that honestly, some, for some of us, it's like the mental support that, that it gives us. Like just knowing that we have something there, I think. Um, let me just really quickly explain something that I probably should have explained before that maybe some people listening already know, but maybe some don't.
But when we have a pelvic organ prolapse, yes, one or more of our organs are sitting lower in the, in the pelvis, but what's happening is that those organs are. Crowding the vaginal canal, right? So the vagina's on the inside, right? It's the birth canal. And if the rectum is not well supported as it used to be, or the bladder's not well supported, or the uterus is not well supported, those things are not just like gonna fall out of their own respective holes per se.
It's more like they're crowding and they're collapsing into the walls of the vagina. So that bulging or that that heaviness or that pressure we feel is actually crowding into the vaginal wall Now. When we wear something like a pessary, which is an internal support device, you can have ones that are more custom fit for you in the sense that you can try a different, different shapes and different materials, different sizes.
Um, and what that is is like something that goes. Inside your vagina like a tampon would, and it's a little bit more rigid and it basically helps to maintain the size or the shape of your vagina and it prevents the organs from above or on either side from crowding into it. So we don't get that bulgy sensation.
We don't actually get the physical bulging or crowding of the vaginal canal, and it can manage our symptoms very, very well. Um, so APA is a great idea. Many people, myself included, call it like a sports bra for your vagina, right? Like you can exercise without a sports bra. I could go for, I don't have big boobs, but mm-hmm.
I could go for a run without a sports bra and I could do it. Would I prefer better support? I would, right? So the same thing with a pessary. Like you could do all those things. You could do your running and jumping and lifting without a pessary. If you had a prolapse. You might feel better if you had a little bit more support from a pessary.
So people like I personally am not someone who fits people for pessaries, but some pelvic floor physiotherapists will do this if they have the right training and the right place in their area of work. Um, and also like urogynecologist or other medical providers will maybe be able to do this as well.
There's also some really cool, yeah, there's some cool, cool products that you can also try to see if maybe you'd be a good fit for a pessary before going down that road. Um, you can try like using a regular tampon to see, does having something inside the vagina that supports the wall slightly, does that change your symptoms?
So that can work. Or there's another type of a. A tampon is obviously absorbent, right? So there are some people who might be concerned that like putting something in that's absorbent when you don't have your period. Like is that okay? That makes me feel weird. Totally fair. There's something else that's called a Poise Impressa and it's kind of like a tampon and it does a similar idea.
You insert it into your vagina and it kind of helps to support the vaginal walls. So that's something that you could try. They're uh, disposable, I believe so you can. Buy a box of them and see does this make you feel better? It's not absorbent material. And then there's other, um, things out there that will help to do similar things.
Um, uh, there's Uresta, which is a pessary, but is a little bit more marketed towards urinary incontinence. Uh, so leaking, but it is a reusable pessary. You insert it into your body and it helps to support the bladder a little bit better. Um, I spoke to kind of their clinical team and it's not really indicated and it probably won't work for more severe prolapses, but like it's something that you could try if you wanted.
It's fairly inexpensive, um, relatively speaking like, comes in at around a hundred bucks, so it's worth a try. But there are these types of things that can provide internal support of the vaginal walls. Um, something else that I like to talk to people about is like using compression shorts or compression underwear or even specific undergarments that are made for prolapse.
There is a company out of the states called Hemp Support Wear, and they have really cool underwear that the crotch area has a really neat hammock. Like, it's like a compressive hammock system that really helps to give you external support of the perineum. And like that, the opening, right, where things feel like they're falling out from is a really cool product.
I really like it. Um, so I'll sometimes share that with people, but even just like regular compressive shorts that you have, like that can sometimes make us feel more secure. And at the end of the day, for a lot of us, that's what we need. We need to feel safe in our movement. We need to feel like something's not gonna fall out of our body.
I love that. Very cool. Yes. And then if you know all of these things, we try and we do everything we can to help support the person, help support their symptoms, but sometimes there is a level of severity that we can't help. Right. So then. Surgery is an option. Um, we're not gonna get into the ins and outs of that, but that is definitely an option if you're dealing with very severe symptoms that are impacting your quality of life and the descent is significant.
Um, yes, and I'm sure you see that as well, Aliya, folks that end up having surgery or come to you post-surgery as well. For sure. There is obviously always a time and a place where maybe we're gonna need some surgical intervention. And definitely I would say that if you are awaiting surgery or con or considering surgery, that it is good to see someone like me just to make sure that everything else is working really, really well.
Because surgery is a great option for us, right? But we wanna make sure that we maximize our results. Um, and that we're still, it doesn't take away from us needing to kind of do the most that we can to protect that area in the sense that like, have muscles that are nice and strong. We wanna, the same way, we wanna take off some of the load from the ligaments that might be stretched out, right?
Um, by avoiding constipation or managing our pressure a bit better. Like, we still wanna do that after a surgical correction, right? We still wanna make sure that we're. Doing all the other things, the lifestyle strategies, the pressure management, things being strong, we still want all that stuff. So I think that it is really important.
Even like pre and post-surgical, um, pelvic floor physio I think would be helpful. But it is, it is not always accessible or available to all of us. But yeah, of course as a time where we need surgery. If you can for sure. Awesome. Well, we touched on so many things, Aliya. I know prolapse is a very heavy, big topic.
So yeah, thank you for having this chat with me today. Is there one sort of take home message that you want to leave our listeners with in regards to prolapse? Um, I think it would be that if prolapse makes, if a diagnosis of prolapse makes you feel like worried or scared about your capability or your function or your, you know, your.
Your option to do physical things, like don't let that scare you. Don't let that stop you. Um, find someone to support you or find products to help, to support you, to find that confidence, um, in finding joy in movement and finding trust in your body. Again, I think that would be it. I think that would be it.
Like find ways to trust your body and to to move your body again, because things will only get better from there. And we really don't wanna stop like moving and lifting, um, as we age, right? We really wanna keep our bones as strong as it can, our muscles as strong, like keep our independence like, you know, the downstream, the downstream impact of limiting our movement in our activity is.
Way it is way too damaging, so, okay. We have to find something to keep us going and for us to trust our body. Yes. I love that so much. So again, if you're listening, you're dealing with prolapse and you're feeling overwhelmed, if you have the means, definitely reach out to a pelvic floor or physio if you can.
Um, someone like myself that might help guide you back into exercise. 'cause it, like Aliya said. So important for us in our long-term health journey. So thanks again, Aliya. How if clients are listening to this episode today and they're like, you know what? Aliya knows what she's talking about. I really wanna go see her specifically.
How can we do that? Well, I work out of a clinic in Toronto here. I have my own little practice, uh, downtown at Queen and Spadina. So you can head to my website, box wellness.co and you'll be able to find information about my clinic. You can book an appointment, you can find more information about me. Um, I have my own podcast as well.
Um. Well, Rhonda's gonna, you're gonna be coming on as a guest soon. Yes. Um, where I like to kind of have conversations like this, but also just have some educational episodes. And I do have some stuff on prolapse, on lifting with prolapse and, and different stuff like that. So if you wanna keep learning from me, you could do it that way as well.
And then I do show up on Instagram and I teach, and I have a lot of content already there on Instagram at Box Wellness Code that you could check out and learn about your pelvic floor. Amazing. Thank you so much, Aliya. Such a great chat. So happy to have you here. Thanks, Rhonda.
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