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8. Weight Lifting & Prolapse with Dr. Jessica Jenkins
134 Plays1 month ago
Strength training is having a massive moment for women in midlife, but it comes with a silent side effect showing up in clinical offices: pelvic organ prolapse. In this "15-Minute Consult," Dr. Rachel Pope sits down with Dr. Jessica Jenkins, PT, DPT, ATC, to discuss how to protect your pelvic floor while lifting heavy, managing internal abdominal pressure, and keeping your organs exactly where they belong.
Key Takeaways:
- Prolapse Isn't Just for Older Women: Heavy lifting can bring undetected pelvic organ prolapse to light even in young, active women in their 20s who have never given birth.
- The Danger of Holding Your Breath: Holding your breath or bearing down (Valsalva) during standard strength training acts exactly like straining on the toilet, sending massive downward pressure straight onto your bladder and uterus.
- The Golden Rule of Lifting: When the movement gets hard, breathe out. On the exertion phase (like pushing up from a squat), exhale, pull in your lower abs, and engage your pelvic floor (Kegel) to push the pressure upward.
- Listen to Your Body: Experiencing a distinct heaviness or a "tampon is stuck inside" sensation during or after a workout means the weight is too heavy, the pace is too fast, or your mechanics need a reassessment.
- Underutilized Support Tools: Pessaries (silicone support rings) can be worn strictly as "sports gear" to physically support tissues during workouts. Localized estrogen is also highly effective for restoring tissue extensibility before diving into core rehab.
- The Power of Hypopressives: This specialized vacuum-breathing technique creates negative pressure in the abdomen, involuntarily lifting the pelvic floor up and in to help train the abdominal wall to support internal organs.
Quick Training Tips:
- Never hold your breath during the exertion or lifting portion of an exercise.
- Exhale and contract your pelvic floor as you lift to redirect internal pressure safely toward your diaphragm.
About Guest Expert Dr. Jessica Jenkins:
Dr. Jessica Jenkins is a Doctor of Physical Therapy, Certified Athletic Trainer, and the founder of the Cleveland Pelvic Wellness Center. Driven by her own experience navigating a pelvic floor injury as a competitive cross-country and track athlete, she blends sports medicine principles with specialized pelvic floor rehabilitation to help active individuals master core stability and pressure management.
Connect & Resources:
- Learn More About Dr. Jenkins: Cleveland Pelvic Wellness Center
- Watch on YouTube: Our Womanity Channel
Free Resources: Get your free copies of:
➡️ The Proactive Perimenopause Guide
➡️ "She's Just Under Construction" partner Guide
Disclaimer: This podcast is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.
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Transcript
Introduction to Prolapse Concerns in CrossFit
00:00:00
Speaker
Did you know that almost 2 million people do CrossFit across the U.S.? That's amazing and that's great for strength training, but what I want to know for all those people doing CrossFit and have vaginas, are you experiencing prolapse?
Consultation with Dr. Jessica Jenkins
00:00:15
Speaker
This is a thing that I am consulting Dr. Jessica Jenkins, doctor of physical therapy, about today.
00:00:21
Speaker
Because I'm seeing it in my office and I've seen it before, but now I'm seeing it much more regularly of women who are beginning strength training and starting or maybe exacerbating the problem of pelvic organ prolapse.
Case Study: Young Athlete's Prolapse Experience
00:00:37
Speaker
I had a young girl come see me in the office in her 20s. And she's like, i feel like there's something wrong with my vagina. It feels like there's a tampon in there all of the time. And when I examined her, she had straight up prolapse and the kind of prolapse that I tend to see in older women. Right. Like not that it's only in older women. Of course, I see women in their 30s and 40s, maybe after having children who
Does Strength Training Exacerbate Prolapse?
00:01:00
Speaker
have prolapsed. But even for women who haven't had children, i see see this kind of prolapse in the 60s and 70s. That's like that typical age range that I see. it But this woman was in her twenty s And she was in college. And i was trying to figure out why on earth does she have prolapse? Like, is it genetic? Maybe what is happening here? She had never given birth. She was a college athlete and she was lifting crazy heavy weights as part of her training. And I'm like, I think you have prolapse because you are lifting like crazy. And it was the only thing that we could really figure out besides, of course, maybe some genetics. So I've seen that from time to time.
00:01:37
Speaker
And I have worried about all of the emphasis on strength training that myself, I'll take ownership for it. And lots of other people are telling women to do in their midlife and beyond, and yet not really also equipping them with what they need to do to protect their pelvic floor. And now I'm seeing it in the office where my patients are coming in and they've been strength training and they've never strength trained before. And they're like, oh my God, what is happening to my vagina? And I'm like, oh yeah, that's your uterus prolapsing death.
Raising Awareness: Protecting Pelvic Floors
00:02:07
Speaker
That's your bladder prolapsing down. and I don't, you know, I don't think that the strength training caused it but maybe it exacerbated it or maybe it wasn't so obvious before. And now that they're strength training, they're finding it obvious. Anyway, all of this is to say, keep thinking about you and all my colleagues in pelvic floor PT. I'm like, oh my gosh, how do we get the word out that women need to protect their pelvic floors while they're like deadlifting, right? My patient was deadlifting.
00:02:33
Speaker
Sure. do you know what sport she played? It was like a ball sport. A ball sport. Okay. lot running, a lot of jumping, a lot No. No. Which is why I was like, what and what could be causing this? And then it just seemed like it's just the strength training.
Breathing Techniques and Prolapse Prevention
00:02:48
Speaker
That's wild. Did she have any like hypermobility that you know of? Or you probably don't get a chance to really assess that. I mean, I usually ask a little bit, but she didn't have anything anything obvious or anything else crazy. Weird. Yeah.
00:03:00
Speaker
I have patients like Ehlers-Danlos patients who are in their 30s with terrible prolapse. I've definitely had those, but they already come in with that diagnosis of Ehlers-Danlos. So I don't know. Yeah. But all these little other women who are in their like menopausal plus years who are strength training for the first time.
00:03:19
Speaker
What should I be telling them? I mean, that is fair. Three minute consult for you. Yes. I feel like I've been hearing it more and more because it's out there now. Like we need to build bow. We need to lift heavy. yeah And you're right. We are not giving women like instructions except for like maybe how much to lift or like maybe how often to lift. But where are they getting their lifting mechanics from? Like are they going to YouTube? Are they going to a trainer? Which none of those people typically yeah are versed in like what it's doing to your pelvic floor.
Managing Pressure During Lifting
00:03:51
Speaker
what I'm going to say is heavy lifting, especially like power lifters and stuff. There's a certain technique where you literally do like a Valsal, you like bear down and that contracts your abs. And it is a very good technique and actually needed for really heavy lifting. But otherwise we need to be talking to women about like, are they breathing? Because you're holding your breath and you're lifting heavy, that's basically like sitting on the toilet and straining.
00:04:18
Speaker
like it's strength training, but it's not crazy. And I am definitely don't breathe when I do the lifting part. Right. so I mean, even if pick up smaller things, I'll be like, huh.
00:04:29
Speaker
And now that... You're opening up my child, right? I'm closing off the back of your glottis, though. And then if you... pay attention. Where do you feel that pressure? It's going all down to your abdomen and pelvic floor. yeah So it's all about like pressure management.
Role of Physical Therapy in Pelvic Health
00:04:45
Speaker
i shouldn't say it's all about pressure management because there, there are lots of times where just like, this is happening, even though you're managing your pressures really well because you're lifting heavy or, things like that. But yes, we have to be talking to women about even during the day, like when you laugh, is your belly going like out when you laugh? Ha ha ha.
00:05:03
Speaker
Or is it coming in and in? And that's what it should be doing. But also to make sure your pelvic floor is not coming down when your belly is coming in. So it's a lot of like really tiny training that you do in physical therapy to learn like what's happening. If you already have really good body awareness and you could tell a woman like, hey, What's happening to your belly? What's happening to pelvic floor? And they're like, oh, I know what's happening. And then that's good awareness. But I would say most of the time, people don't have a good enough awareness of at least their pelvic floor to understand what's happening even during a laugh. And by the way, I'm doing kegels right now because I'm like, no, I just wouldn't give up my own.
00:05:39
Speaker
Yes. But it's about like what's happening during the day. Cause that's going to like the, the set of like, Oh, Hey, what's, how is your body set up for the day then to do your lifting? Like, have you been laughing or straining to have a bowel movement? Like, are you constipated at all? deration Right.
00:05:57
Speaker
Right. To have a bowel movement. You should not. There shouldn't be no closing of the glottis. Okay. So what should they be doing though? Like say they are bending down, they're protecting their back, they're lifting with their arms and legs and they're about to lift a heavy weight. What are they supposed to be doing? I mean, I hear you talking about the glottis. How do we, how can we explain that to people? Yes. So what I would say is when the action is hard, you should be breathing out, pulling in the abs and pulling up the pelvic floor muscles.
00:06:28
Speaker
So, know, in a squat, like maybe it's a little easier to go down, right? Because gravity is helping you. And then when you're pushing back up, that's when you would want to be making sure your pelvic floor muscles are engaged and those low abs are engaged and you're breathing out. Okay. but makes sense Okay. So if you know that a person is doing Kegel exercise correctly, because I know a lot of people do not do them correctly, but if they know that they are doing them correctly, can they do Kegel exercise while they lift and that would give them production? Yes, please.
00:07:02
Speaker
Okay. Two for one, right? I mean, yes. You're just always interacting the pressure in a way. yeah great Exactly. Because your your abdomen is like this this container of pressure.
00:07:16
Speaker
And so which way is it going? So you want it you want it to kind of be like up and in down below and like the pressure goes up onto your diaphragm, which is okay. Your diaphragm can do that. Yeah. Okay. So
DIY Pelvic Floor Protection Advice
00:07:29
Speaker
that would be like the basic thing for someone who's like listening to this and going to work out later today. And they're like, I can't get in with a pelvic floor physical therapist right now to figure this out. Like do a gaggle and don't hold your breath when you do the actual lifting. Right. Correct.
00:07:43
Speaker
Okay. Okay. So if someone is just doing repetitive movements, like I'm thinking about rowing where like my trainer will tell me to like row on one side and the other back and forth, lifting a kettlebell in each arm.
00:07:55
Speaker
So that whole time I'm going to have to take a breath in. I'm going to to breathe out. Like how, how would I protect my pelvic floor doing something like that? Yeah, faster motions, it's it's a lot harder, right? and And sometimes I feel like what women need is not going, they need at a slower pace, right? If you're noticing prolapse symptoms while you're lifting or right after you lift,
00:08:18
Speaker
And it lasts into the next day. Like there's probably, you're probably not ready for that weight, especially if you're like being aware of your pelvic floor of like, you know, like when you're doing those faster movements, all you can do is like try to hold in your pelvic floor and your abs. Your pelvic floor is synergistic with your diaphragm. So every time you take a breath in, your diaphragm moves down and your pelvic floor muscles are going to move down, which is why we say do things on the exhale.
00:08:41
Speaker
Because that'll help the diaphragm and the pelvic floor to move together. But you're going to have to take a breath in, right? And that's okay. yeah That's okay. Just try to be aware what's happening down below. and if you feel like I can no longer maintain this kegel or i can feel the prolapse happening, that's the time you need to be stopping and like rethinking like, is this an exercise for me right now? Yeah.
00:09:02
Speaker
And is it also possible that some of the prolapse is getting exacerbated because people are lifting too heavy too fast? Like if they lift more gradually to work up to those weights, would that be better? Is that part of, I mean, it's just kind of a guess.
00:09:18
Speaker
Yes, 100%. That's what I tell people is like, hey, if you can get up to a pretty high weight, as long as you are have some awareness, as long as you have some deep core strength, it might take you more time than you know, someone else or it might take you less time. But I if you care about your organs prolapsing, you should definitely listen to your body. And there is like um building your body's capacity. So let's say you do a workout and you get some of that prolapse feeling, but the next day you wake up and you're like, okay, it feels pretty normal again. Then, you know, there is going to be, it's like having a tendonitis, right? You're like, okay, we got to exercise and cause a little bit of the pain for it to get.
00:09:57
Speaker
better. And so it's okay to have a little bit of that prolapse feeling. But if you're noticing, no, by the end of the day, I'm, I feel prolapse again, even though I didn't lift weights, then like we need to reassess. yeah And sometimes it's just a matter of mixing up what you're doing, like doing some up upright stuff and then going laying down and like doing some plank stuff. If you want to do your abs or, yeah, Yeah, that makes sense.
Post-Surgery Lifting Concerns
00:10:18
Speaker
I mean, the other thing is that i I told my patient last week who had pretty similar situation that like, it's not like this caused prolapse, you probably already had that prolapse, but it's not always that obvious or noticeable until something is happening, right? I have patients who get a terrible bronchitis and they're cough, cough, coughing, and like that puts the pressure on their pelvic floor. And then they come in like, what the hell happened to my vagina? Yeah.
00:10:41
Speaker
And so i I do feel like it's not that it's causing that, but maybe now you're going to notice it or it's going to be maybe exacerbated. And so if we can prevent that, that would be great. The other thing I've had patients who after having surgery are like really desperate to get back into the gym and they're like, okay, it says here that I can't lift more than 20 pounds for four weeks. Is there any way around that? And sometimes I have thought like, well, what if you like sit down? Could you sit in a chair and do some arm weights?
00:11:10
Speaker
like would that put less pressure on your pelvic floor? then You still are upright and like gravity is working down on you, right? Cause your, your pelvic floor has to hold up your organs, but I mean, sitting is less strenuous on the pelvic floor. So I i mean, I would think lightweight would be fine. i still don't think I would say like, go ahead and do your 20 weights and sitting. Yeah. Okay. Yeah. I mean, studies is sitting yeah yes I, mean I feel like I tell people this bothers then can do something about You know, we've got pessaries, which a lot of women are not aware of what pessaries are. They are like a silicone ring or, know, they come in different shapes and sizes, but the ring is the one I most commonly... fit for women. And it literally just pushes the prolapse up and gives them that support that they're not getting from their vagina otherwise. And told them you could wear this just when you go to the gym and like that would help reduce the symptom, but it's not going to reduce the pressure on the pelvic floor from the activity that they're doing, which is great. Well, do feel like pessary is really underutilized, especially in our population who don't know about it, the population that we're speaking about also us. Yes. Yeah. Right. But yes, there's nothing wrong with having that support during, it's like, it's not going to like, like you said, right. It's not going to hurt you. It's not going to do the work for you. It's just so that you're not experiencing that. But yeah, also being aware of your pelvic floor is going to be helpful so that you won't feel it later so i mean all the weighted baths and all the huge marketing that's out there maybe i need to start a mystery for yes midlife woman 100 do it right special they have to make a special one for sport i love this idea
00:12:58
Speaker
It'll be, it'll be out there like in two weeks probably. Right. Exactly. It's too late. It's too late. Maybe you just put it on like the regular market, like not one that you, you know, kind of like some women, I had one woman use her old diaphragm and she was like, and that worked. Like, I don't feel the prolapse anymore. Or like, you know, the cups for the diaphragm. There is surgery. I mean, you can have your prolapse repaired. You can have the prolapse suspended. Like that's the whole field of urogynecology has, has provided these surgeries for women. But then again, you get back to your workout routine after six weeks of taking a break, like that just might recur over time. So you want to learn these,
Seeking Medical Evaluation and Low Pressure Fitness
00:13:38
Speaker
these skills, these exercises that I think we can learn from people like you and pelvic floor physical therapy of how to really protect your pelvic floor. Right. But I mean, almost all of my women who are working out and experiencing this, I would send to someone like you because they might benefit from a pessary, but they also might benefit from estrogen, right? like Yes. Their tissues are not extensible enough and they're not getting the support that they need because they're not going through their full range of motion. So I'm like, hey...
00:14:05
Speaker
Let's make sure you don't need some other medical things before we get it to the nitty gritty of your core. That's so true. I will say a technique that I've learned over the years, they're called low pressure fitness or hypopressives. They're kind of like this vacuum breath that you do that's an exercise. Yeah. It literally creates a a vacuum in your abdomen and your pelvic floor muscles lift up and in kind of involuntarily. And if you do them enough, like you strengthen your muscles in that position. And so, you know how like your organs are all like kind of suspended by fascia and ligaments and things. And so ligaments are connected to like your abdominal wall. And so if your abdominal wall is higher, it's pulling those organs up and in. And I, when people really get into it and they practice it,
00:14:48
Speaker
They do really well with those prolapse symptoms. Yeah, I love that. Well, thank you so much. This is super helpful and exactly what I've been trying to figure out of a way to talk about with women in a broader scale than just in my office. Should we go for run?
00:15:03
Speaker
Yes, let's do it. You win the test race. I'll leave. it's