Exercising with pelvic floor dysfunction can be scary, whether you are a mom who just had a baby, a dad who is recovering from prostate cancer surgery, or a CrossFitter who began leaking urine during certain lifting exercises. Regardless, you want to lead a healthy, active and strong lifestyle, but instead you are fearful of making things worse. I’ve been there and I’ve treated many clients who have been there too. So let’s talk about how to approach an exercise feeling knowledgeable and empowered rather than unsure and uneasy.
What do people mean when they describe an exercise as “safe” for the pelvic floor?
There is a common belief that exercises producing large increases in intra-abdominal pressure (IAP) may compromise the function of the pelvic floor; and therefore, many exercise recommendations are based on minimizing an increase in pressure. Unfortunately, these generalized exercise guidelines are unlikely to be helpful. One big limitation in classifying exercises as safe or unsafe based on IAP is that research consistently shows large variations in IAP among different people performing the same tasks (Shaw 2014). In other words, an exercise that causes a large increase in IAP in one person might not in another.
Additionally, when researchers compared IAP in “unsafe” exercises to their widely accepted pelvic floor “safe” versions (e.g., push-ups vs. wall push-ups, weighted vs. unweighted lunges, squats vs. narrow squats), the modified versions did not necessarily result in decreased IAP (Tian 2018). Because of this, we cannot make a definitive list of exercises that are safe vs. unsafe for the pelvic floor.
Exercises that are appropriate for you should be highly individualized, based on your ability to perform them with proper technique and form. The good news is, there are no exercises that are always off limits. So there is hope that you will be able to work back up to participating in your favorite exercises, whatever they may be.
Are exercises that cause high intra-abdominal pressure actually bad for the pelvic floor?
The generation of IAP in and of itself is not a bad thing. We need it in varying degrees for stability when performing daily activities. In fact, without any IAP it would be impossible for us to get out of bed or up from a chair. The problem arises when our pelvic floor is not able to match the pressure we produce during an exercise or activity. That's where you can get into trouble.
We don’t currently have enough evidence to say that exercises with high IAP cause or worsen pelvic floor dysfunction (Bo 2019). So maybe the focus should not be on avoiding IAP, but rather it should be on how to better manage it. A pelvic floor physical therapist can help you develop breathing and movement strategies to manage this pressure, as well as the response of your pelvic floor muscles to it during the exercise.
Even if you are able to avoid all exercises that might cause a large increase in IAP, consider that many daily movement tasks may produce IAPs similar to exercise. For example, transitioning from sit to stand generates a similar pressure as many Pilates exercises (Coleman 2015). And what about when you have to run to catch a bus, carry your toddler, or lift a heavy grocery bag? The point is, we cannot stop living our lives because of pelvic floor dysfunction. Exercising can help us improve our strength and confidence to do the occasional strenuous tasks that life throws at us.
How do you know if an exercise is appropriate for you?
The most straightforward way to judge if an exercise is appropriate for you is noticing if it provokes your pelvic floor symptoms, such as having pelvic pain, pelvic heaviness, a bulging sensation, or urinary leakage. If it does, that doesn’t mean you can never perform that exercise. But you might need to change your strategy.
For example, many people find that exhaling with effort helps them get more core and pelvic floor activation. You can also play around with the position of your pelvis. Are you tucking your tailbone in or overarching your back? You may find that you feel stronger and less symptomatic in a more neutral position. You also may simply need to try an easier version of that exercise initially, and then build up to the more challenging version as you get stronger.
You can also self-assess your pelvic floor at home to check for bearing down or bulging during exercise, by placing a finger on your perineum or in the vaginal canal. You ideally want to feel things moving in and up rather than down and out during exertion.
It is good for everyone to develop an awareness of what their pelvic floor is doing during exercise and activities, but it is also helpful to see a pelvic floor physical therapist to help guide you and to give you individualized recommendations.
You can learn more about pelvic floor dysfunction by visiting our Pelvic Health page.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.
- Shaw JM, Hamad NM, Coleman TJ, et al. Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. J Sports Sci. 2014;32(12):1176–1185. doi:10.1080/02640414.2014.889845
- Tian T, Budgett S, Smalldridge J, Hayward L, Stinear J, Kruger J. Assessing exercises recommended for women at risk of pelvic floor disorders using multivariate statistical techniques. Int Urogynecol J. 2018;29(10):1447-1454.
- Bø, K., Nygaard, I.E. Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review. Sports Med (2019) doi:10.1007/s40279-019-01243-1
- Coleman, T. J., Nygaard, I. E., Holder, D. N., Egger, M. J., & Hitchcock, R. (2015). Intra-abdominal pressure during Pilates: unlikely to cause pelvic floor harm. International urogynecology journal, 26(8), 1123-30.