I have pelvic organ prolapse. Are there any exercises I should avoid?

DEAR DOCTOR K:

I have pelvic organ prolapse. Are there any exercises I should avoid?

DEAR READER:

Pelvic organ prolapse is a condition in which the uterus, bladder, urethra or rectum drop down and press against the walls of the vagina. Normally your pelvic floor — a sling of muscles and ligaments that stretches from your pubic bone to your tailbone — holds your pelvic organs in place. Pelvic organ prolapse results from a weakened pelvic floor.

I’m not aware of good numbers on how common pelvic organ prolapse is. One large survey estimated that about 3 percent of women recognize the symptoms of pelvic organ prolapse. Another large study, called the Women’s Health Initiative, found that 40 percent of women had some detectable prolapse when they have a gynecologic examination. However, most were not experiencing bothersome symptoms from the condition.

There are a few exercises you should avoid at the gym. For example, don’t lift heavy weights, especially over shoulder height. Also avoid high-impact aerobic activities involving jumping or hopping, and sit-ups. Check with a trainer at the gym to see how you can modify strength training, core exercises and aerobics to reduce stress on your pelvic floor.

Of course, there is one activity you shouldn’t avoid: Kegel exercises. These exercises can actually strengthen your pelvic floor. Here’s how to do Kegels correctly:

Locate your pelvic muscles. Pretend you are trying to avoid passing gas. Women can pretend to tighten their vagina around a tampon. Both actions involve the pelvic muscles. You will feel a correct contraction more in the back than the front, like you are pulling the anal area in or stopping gas from escaping.

Choose your position. You can start by lying on your back until you get the feel of contracting the pelvic floor muscles. Later, you can practice while sitting or standing as well.

Practice contractions. Practice short contractions and releases (sometimes called “quick flicks”). And practice longer ones (gradually increasing the strength of the contraction and holding it at your maximum for up to 10 seconds).

Relax between contractions. Consciously relax the muscles between each repetition. Hold the relaxation phase for the same amount of time as the contraction.

Keep other muscles relaxed. When doing pelvic floor exercises, don’t push out your abdominal muscles, contract your leg or buttock muscles, or lift your pelvis.

Make repetition routine. It is more effective to spread the exercises throughout the day than to do them all at once. One simple starting regimen is to do 10 before getting out of bed, 10 standing after lunch, 10 in the evening while sitting watching TV, and another 10 before going to sleep. You can do them at other times as well: in the car sitting at a stoplight, or waiting in a grocery line.

Avoiding the wrong exercises, and methodically doing Kegel exercises, can greatly improve the symptoms you have because of pelvic organ prolapse. While surgery sometimes is necessary to correct the problem, usually avoiding the wrong exercises and doing the Kegel exercises will give you the relief you need.