Which Exercises are ‘Safe’ for Postpartum Pelvic Organ Prolapse? Asking for a Friend
I wish I had a magic formula to determine which exercises will work for you, but there isn’t one. Any exercise can be a bugger to a prolapse for some and the same exercise can be supportive for others. Some may irritate someone who is early postpartum, but not someone who is getting back to exercise a year or two into the postpartum period.
Better questions are:
Does this exercise support you right now, at this stage in your recovery?
Can we modify the exercise to make it supportive and less symptomatic?
Or do we just need to wait and try again in a week or two or more?
So rather than have a naughty or nice list of exercises (unsafe or safe for prolapse), let’s generate some ideas to help you understand your symptoms as a guide. They can help you determine how to modify activities for you, individually- based on your tissues, your delivery, your recovery timeline, the type of activities you are pursuing, and what modifications are available to you for the exercises you are interested in.
How long since delivery?
Early postpartum tissues will be more sensitive and more easily irritated by movements and loads (this is normal, and not necessarily associated with a prolapse). Think of those sensations as signals that healing is in process, and they are alerting you to be gentle with yourself, take heed, slow down, or change something. Learning to listen and modify what you are doing when they occur can look like taking a break, but it can also be sitting down instead of standing for a diaper change, interacting with the baby in the swing for a bit instead of holding them, or walking around the block (prolonged positions are sometimes irritating and movement can be the salve).
Learning to do this early on, can help you reduce fears and develop some control over the symptoms and sensations. You can support your recovery by finding ways to adapt movement to stay active and not irritate symptoms. It also creates some personalized tools to ease the symptoms if you pushed a little too hard one day (Ex: when I feel X, it feels better when I do Y). You have already left yourself breadcrumbs for the path back to reducing the symptoms.
If you have learned to hear increased symptoms as a signal to change something or cool it, it can ease fears of a flare-up and keep you in control.
As you ramp your activities up and start reintroducing fitness movements, load, impact, etc.-symptoms are your guide again. They can alert you that you are hitting your limit for that activity, that workout, or that day. A lack of symptoms during an activity that was previously provocative can be your signal that it’s time to take it up a notch. Be aware that this process won’t necessarily follow a prescriptive timeline, everyones path and pace is different.
Sometimes symptoms get grouchy when you introduce a new activity, this may be a signal to you that the tissues aren’t ready-right now. Consider how to practice a lower level of that goal activity (less weight, less range of motion, see more ideas below), and then try again in a few weeks.
My clinical experience is that as you move from more acute stages of healing to further out from your delivery- the symptoms get more predictable. You know what your triggers are, and can build in some strategies to manage them and/or avoid them.
So what becomes ‘safe’ for you is different than what might feel ‘safe’ for others, the goal is putting those pieces together in an individualized way.
Some Ideas for Exercise Adaption
1. How are you moving (not what kind of movement)?
A study by O’Dell (2007) compared the intra-abdominal pressure generated in crunches (often considered ‘unsafe’ for prolapse) vs downward dogs (usually considered ‘safe’ for prolapse). Participants generated a range of pressures that were similar for both activities. Some did a low pressure crunch, while others did a high pressure downward dog. Therefore, the activity wasn’t the bad guy, how they did it made the activity potentially symptom free or symptom full. Adapting how you are doing the activity can help you keep any activity in the lower pressure range and likely more tolerable to your tissues.
Start by not holding your breath during an activity that irritates your prolapse or focus on exhaling prior to and during the exertion. (Check out more on that here)
More recently Campos (2025) found that runners with stress urinary incontinence demonstrated running patterns that resulted in absorbing impact forces at the hip and pelvis, while runners that stayed dry absorbed impact at lower leg and ankle. Changing running patterns and form can alter how and where your body is absorbing impact. Extrapolating this to prolapse symptoms, keeping the forces further away from the prolapse near the lower leg and ankle may help reduce symptoms as you gradually build back running resilience.
A place I like to start is to encourage folks to lean into the run. (Check out more about that here), and to rotate the torso while running (Check out more about that here)
2. How much? How often?
If an activity is bugging your prolapse (or any other pelvic health issue) consider how much you are doing. The volume of abdominal exercises in postpartum programs is often out of balance with the amount of exercise devoted to other muscle groups. Heavy emphasis on abdominal work may generate increased forces and pressures from above that may overwhelm the pelvic musculature and organ supportive tissues below. Those tissues are regaining strength, coordination, timing, and resilience. They may not be able to match those forces and pressures from above yet!. Please remember your whole body went through the pregnancy, not just your abs.
Look at your workout plan, and balance out the program. 30 ab-targeted reps may be enough to restore some strength and keep you symptom free…..whereas 150 reps may ramp-up your prolapse symptoms.
As you restore your tissues, they may require more recovery than you are accustom to- less sets, less reps, fewer sessions a week, slower progressions. YOU as a whole may require more recovery than you realize, as sleep and fueling opportunities become less consistent when you have a new baby and stress increases when you add in work, other kids, life.
Recognize that when your physical and emotional tank is low, it might be a good day for less intensity and lower volumes….or a walk….or a break….or a cookie.
3. How fast?
Speed is a big consideration when tissues are healing and regaining resilience. Slow it down! When re-building the timing and coordination of pelvic tissue, you need to give it some mental focus. This is actually the first part of any strengthening program-your neurology has to set up the pattern for your biology. The brain and pelvic organ support system may need time and practice to be able to catch-up and re-learn movement patterns at the gym.
Learning to use the abdominal-diaphragm-pelvic floor system together within movements and fitness will help build that timing and patterning back. That system may need to start slow, then you can gradually pick up speed overtime.
4. How about try something new?
Vary your training! Many activities have repetitive movements like running, or consider if you are moving only in one plane (everything is flexion and extension such as crunches, bicep curls, squats). Shake things up! Consider other movement and fitness patterns to give the tissues a break from the same types of forces over and over again. For example, the abdominals are active when you do a push-up and a squat, but the forces and pressures generated in the activity are distributed more globally, not directly at the pelvic floor and organs. Switching things up can also be a part of your recovery strategy for the tissues when you are starting back to more challenging activities.
Find new ways to move, it will offer your tissues more opportunities to recover, build resilience, practice new patterns, and adapt.
To summarize the long answer- tailor your program to YOU and your symptoms! By applying some new ideas, you can help make any exercise ‘safe’ (or ‘nice’) for prolapse. And please, stay hopeful!
Don’t wanna miss a post?
Wanna tell a friend?
Cobb WS, Burns JM, Kercher KW, Matthews BD, Norton HJ, Heniford BT. Normal intra-abdominal pressure in healthy adults. J Surg Res. 2005;129(2):231-235. doi:10.1016/j.jss.2005.06.015
Campos NC, Fonseca ST, Nunes LJ, et al. Inefficient impact absorption and reduced shock attenuation in female runners with stress urinary incontinence. J Biomech. 2025;187:112753. doi:10.1016/j.jbiomech.2025.112753