Organ Prolapse and Yoga

Recently the blog received a question from a yoga teacher asking about the role of yoga to both reduce the likelihood of prolapse in her students (most of whom are middle aged mothers of at least one child), and to serve as a therapy to those who have had the surgery and are looking to improve the situation. She also wanted to know if there any poses or actions that could potentially damage this area.

There is certainly a role that yoga can play in the management of reproductive organ prolapse, but there are also some poses, movements and breathing methods that could potentially exacerbate the condition. For our readers who may not be familiar with what a reproductive “organ prolapse” means, Wikipedia defines the term prolapse as “to fall out of place.” There can be different kinds of prolapses. The bladder, intestines, bowel, uterus or vaginal walls can “fall” or collapse downwards. A prolapse of one of these organs results when there is too much intra-abdominal pressure in the abdominal and pelvic cavities, causing a downward force that the pelvic floor muscles (PFM’s) and surrounding connective tissue are unable to support. The organs can even fall down through the vaginal opening.

It is beyond the scope of this post to outline the causes of a prolapse. But it is important to clarify the common misconception that prolapses are caused by weak PFM’s. Yes, if the PFM’s are weak, they won’t be able to hold or support the downward force of these organs, leading to an increase risk of a prolapse when the intra-abdominal pressure rises. However, there are other connective tissue structures like fascia and ligaments that help hold all of our pelvic organs in their respective space and place. You can imagine if these structures are damaged during childbirth, or if one of these organs is removed, as in a hysterectomy, that it will change the support system in the entire cavity. This is important to understand because it will dictate how you address the prolapse with yoga or other exercises.

To answer our reader’s questions, we need to look at some yoga poses that might help improve support within and surrounding the pelvic and abdominal cavities without increasing an unfavourable amount of pressure, and then look at ones that might cause an unwanted increase in the intra-abdominal pressure, potentially worsening the prolapse.

Let’s first take a look at what poses or activities to avoid (or consider re-evaluating) in your practice:

1. Poses that tend to unfavourably increase the intra-abdominal pressure (IAP) are some of the intense core poses such as Boat (navasana), Four-Limbed Staff pose (Chaturanga Dandasana), Plank pose (on elbows or hands) or variations of these poses.

   

2. Uddiyana Bandha forcibly and considerably increases the IAP and can exacerbate prolapse.

3. Depending on the severity of the prolapse, forward bending poses with the legs abducted (wide apart), may induce an increased downward pressure in the pelvic cavity that the PFM’s cannot support, such as Garland pose (Malasana), Wide-Legged Forward bend (Prasarita Padottanasana), Extended Child’s Pose (big toes are touching, heels and knees are wide apart, and arms extending forward).

4. Power or flow yoga transitions where there is jumping. Repeated jumping consistently increases the downward force. 

5. Breath Holding. If ANY yoga pose is too challenging for you or causes you to strain and hold your breath, then this can cause an increase in the intra-abdominal pressure, worsening your prolapse. Proper breathing during any yoga practice or other activity is always important for pelvic health and overall health of many systems of your body!

6. Avoid Kapal Bhati Pranayama (vigorous abdominal contractions during breath method).

7. Avoid activities such as heavy lifting or “pushing” (as in constipation). Lifestyle choices (forcing yourself to take several trips to unload groceries) and nutritional changes (increase bowel motility and softening) may be helpful.

Here are some poses or activities that may help manage or reduce symptoms in your practice:

1. Slightly elevate hips during Legs up the Wall pose (Viparita Karani), Supported Bridge pose (Setu Bandha Sarvangasana), Reclined Cobbler’s pose (Supta Baddha Konasana), Supported Shoulderstand (Salamba Sarvangasana).

2. Focus on awareness of the pelvic diaphragmatic breath or Reverse Kegel. Many people experiencing a prolapse assume that their PFM’s are loose and need to be tightened.  However, Jocelyn Unger, a PT pelvic health specialist at the University of Arizona Health Network agrees that the majority of women she treats that have weak and ineffective PFM’s, but also that they demonstrate tight PFM’s.  For this reason, she, along with many of the leading pelvic health specialists, recommend focusing first and foremost on the RELAXATION and release of the PFM’s before learning to engage and activate.

3. Breathe. It is important to ensure you are breathing effectively and not holding your breath in all your yoga poses, and in all your activities of daily living. Breath holding can increase strain and pressure against the pelvic floor. However, you must be even more mindful of effective breathing strategies in standing poses; because the force of gravity pulls downwards, the position of standing may be a somewhat precarious position if the prolapse is moderate to severe.

4. Mountain pose (Tadasana) and modified Powerful pose pose (Utkatasana) with a block between the thighs, ensuring proper postural alignment.  Alignment of the spine and pelvis can influence the position of the abdominal and pelvic organs and also influence the effectiveness of the PFM’s ability to contract. Ensuring you have a natural low back curve with a neutral pelvic alignment in your standing poses is important. An assessment from your physical therapist can help you determine where your optimal lumbo-pelvic position should be. Modify the Powerful pose simply by not squatting down as far so that there is no extra unwanted downward pressure.

5. Pranayama (breathing methods) that are meant to calm the nervous system would be beneficial for addressing anxiety that sometimes causes you to hold tension in the pelvic area. Nadi Shodana (alternate nostril breathing), Abdominal-Diaphragmatic breathing (Belly Breath) and Bee’s breath (Bhramari) may be useful.

Once you have practiced pelvic diaphragmatic breath awareness and learned to release the PFM’s, then you may be ready to start a gentle engagement of the pelvic floor muscles AS YOU EXHALE. Lie on your back with your knees bent and feet flat on the mat, or sit upright in a comfortable position. As you inhale, allow your belly to naturally move out. As you exhale, very gently draw your lower belly inwards, keeping your spine and pelvis neutral.  Inhale and relax, allowing your belly to soften. During the next exhalation, you can try to add a gentle lifting sensation of the pelvic floor. This is an extremely subtle movement, but is the beginning of learning how to incorporate gentle core activation movements, which may be part of your overall prolapse yoga program. I recommend seeking a health care professional who can help you accurately activate these muscles before you start engaging them in your yoga practice, as research shows they often are not engaged properly in group settings.

It is important to understand that these poses do not treat a prolapse. There are a variety of causes, severities and treatment options for different prolapses, so it is wise to follow advice from your health care practitioner as to which treatment approach is best suited for you and your specific case.

Finally, our reader asked about using yoga to prevent organ prolapse for her students. It is inaccurate for me to say these exercises will help prevent a prolapse, because there are truly so many different factors that contribute to prolapse, some of which we can’t control. Therefore, it would be almost impossible to pinpoint the cause that may be unique to each of your students. However, if you take into consideration some of the above tips and recommendations, this may help reduce some of the risk factors. I would strongly encourage ALL women to visit a Physical Therapist who specializes in pelvic health PT at any stage in life, so their alignment and pelvic floor health can be individually assessed, and a home program unique to their needs can be implemented.

A visit to your pelvic health specialist does not need to be only when a dysfunction arises! As a yoga teacher, it would be helpful if you could find a pelvic health PT in your area that you can team up with to discuss individual home yoga programs for your students with these prolapse concerns. The PT could assess each woman and then communicate with you what areas need to be addressed for optimal pelvic health. This would be a great preventative and health creation approach. Pelvic health PT’s are found in these online directories across Canada and the USA. 

This article is not intended to act as medical advice, nor to diagnose or replace your current treatment. Please seek clearance and guidance from your licensed healthcare professional prior to participating in any of the tips, advice, practices or movements mentioned in this article.

Reprinted with permission from Yoga for Healthy Aging

Shelly Prosko, PT, PYT, CPI is a Physical Therapist and Yoga Therapist, Shelly is dedicated to bridging the gap between yoga and modern healthcare philosophies and believes it is essential in order to create and sustain optimal health. She received her Physical Therapy degree at the University of Saskatchewan, Canada, and her medical therapeutic yoga training at Professional Yoga Therapy Studies in North Carolina. Shelly has been integrating yoga into her physical therapy treatments since 1998, addressing a wide variety of conditions including chronic pain. Currently, she travels across North America offering specialty Physio-Yoga Therapy workshops, lecturing at Medical College programs, instructing at Yoga Therapy Trainings, presenting at International Conferences and actively promoting the integration of yoga therapy into our current healthcare system. Shelly is dedicated to inspiring, empowering and educating health professionals, yoga teachers, therapists, students and people in pain about ways yoga can be used safely and effectively to address a variety of health issues and improve quality of life.  Please visit www.physioyoga.ca for more information.