Pelvic Organ Prolapse

By Dr. Tamara Vead

Pelvic Organ Prolapse

“I have Pelvic Organ Prolapse! What can I do?” 

There is no “One-size fits all” answer here!  Guidelines can be very vague and increase fear and anxiety.  Let’s dive into it a little more. 

Pelvic Organ Prolapse simply means that one or more of the pelvic organs (bladder, uterus, rectum) have dropped into the vaginal canal. This can present with symptoms of pelvic heaviness or pressure, sensation of sitting on something, difficulty emptying your bladder or bowels, leaking, discomfort with sex, or back pain. Recent research shows that it can also be completely asymptomatic, meaning it is there with examination, but you are completely unaware of it.

Did you know that pelvic organ prolapse can be seen in up to 50% of women1; however, only 3-12% of women will report symptoms.2 Following a diagnosis of prolapse women can often feel isolated with increased anxiety that movement and lifestyle can/will make the prolapse worse. Common recommendations have included:  limited lifting, use of a support device, and decreased participation in impact sports and workouts. So, what CAN you do?  

There is good news!

A specialized therapist can assess your ENTIRE body looking for posture deviations, muscle imbalances, and coordination problems that are impacting pelvic pressure and support. Research shows improvement in pelvic organ prolapse and symptoms with conservation pelvic therapy!1  

A pelvic floor therapist can work with you to:

– Regulate pressure down into your pelvic floor.

– Improve breathing mechanics

– Decrease scar tissue or muscle tightness impacting organ position

– Strengthen your pelvic floor muscles and ALL the surrounding muscles…Abs, back, hips, and feet…that impact posture and joint support.

– Restore proper muscle coordination. 

Once your pelvic floor is working synchronously with surrounding muscles and you are stronger and balanced, you can incorporate your activities of choice without fear! We help patients with pelvic organ prolapse very frequently.  We have many patients that are athletes that have returned to sport without symptoms. Let us help you experience life again!


1. Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003882. doi: 10.1002/14651858.CD003882.pub4. PMID: 22161382.

2. Espiño-Albela A, Castaño-García C, Díaz-Mohedo E, Ibáñez-Vera AJ. Effects of Pelvic-Floor Muscle Training in Patients with Pelvic Organ Prolapse Approached with Surgery vs. Conservative Treatment: A Systematic Review. J Pers Med. 2022 May 17;12(5):806. doi: 10.3390/jpm12050806. PMID: 35629228; PMCID: PMC9142907.

Postpartum Guidelines

Postpartum Guidelines

As research progresses, guidelines change.

As I grow and learn the new research, I have started to change how I treat my postpartum patients/clients.

I wanted to discuss new postpartum guidelines and apologize if my blog from 3 years ago in any way created fear in those of you returning to the gym/exercise postpartum. That was never my intention. My intention was to educate you and help you be as smart as you can with return to the gym. We have to recognize everyone is different.

What has not changed is tissue healing. We still need to make sure we are giving tissues adequate time to heal.  With still need to treat postpartum recovery like we just had surgery because birth is a MAJOR event. It is still trauma to the pelvic floor or core depending on vaginal delivery versus C-section. BOTH require rehab. They just look a little differently so we must recognize that. If you had a C-section, your pelvic floor is still involved and the core is absolutely involved which ties in with the pelvic floor anyways.

We need to focus on STRENGTH early on and slowly building strength back. Strength comes BEFORE impact. Think more strength creates more stability as well as our STRONG foundation to build on. This means we will build from body weight load to weight lifting BEFORE we start jumping.

Some ladies may be able to start light jumping at 8 weeks, some may wait until 12 weeks and some, depending on symptoms may be longer. It is important to be PERSON SPECIFIC but general guidelines can help women be smart as they slowly return.

Understand that return time can be faster based on many factors like prior strength, birth factors like tearing and length of delivery, genetics, number of births, rehab done between births etc.

There are a series of tests I go through with mommas in my office to clear them to return to light jumping movements like pogo jumps, penguin hops, jumping jacks, then running, then to higher impact like box jumps and double unders. We are also keeping in mind volume and intensity. We want to build to the volume a person goes back to and eventually the same intensity they want to get back to.

One of the best pieces of advice is, LISTEN TO YOUR BODY. There are certain signs and symptoms your body can communicate when you are doing a little too much too quickly.

Here are those signs and symptoms:

-urine leakage

-heaviness in pelvic floor area

-abdominal muscle cramping

-pelvic floor muscle cramping

-pelvic pain

-feces leakage or difficult holding back gas

-low back pain

-soreness that last longer than 2-3 days

-vaginal bleeding


-excessive doming or coning with activity

These are the common areas or movements I see moms go back to a little too early on and they complain of these symptoms or we see these symptoms present.


-Box jumps

-Jumping jacks


-Sit ups

-Ab mat sit ups

-Pull ups


-Kipping movements

-Double unders

-Ski jumps

-Skater jumps

-Deadlifting too heavy too quickly

-Back squatting too heavy too quickly

-front squats & wall balls w/ improper breathing

Keep in mind you may have no symptoms with these and be ready for some of these movements before others. Impact movements, I do not recommend before 8 weeks postpartum but some of these movements like planks we can start as early as 2-3 weeks postpartum depending on a patients core control, diastasis, # of pregnancies and positioning for the plank. Sit ups, I see value in starting as early as possible WITH assistance or some form after relaying the foundation of core control and breath control.

If you had a vaginal delivery, it could take you longer to get back to the impact movements like running and jumping. As for a c-section, it typically takes longer to gain all of your gymnastics or core, ab exercise movements back without symptoms.

It is super helpful to work with healthcare professionals, personal trainers, and coaches that understand this and these guidelines as well as what SYMPTOMS to watch for.

If you are a coach and personal trainer and are unsure, please reach out to me.

If you are postpartum, I would recommend seeing a pelvic floor PT, like myself,  for at least ONE visit.

Virtually or in-person sessions are SUPER beneficial and the research is showing patients are getting better through telehealth which is awesome!

Let me know your feedback

-Dr. Jenn Frankoski

O’Dell KK, Morse AN, Crawford SL, Howard A. Vaginal pressure during lifting, floor exercises, jogging, and use of hydraulic exercise machines. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Dec;18(12):1481-9. doi: 10.1007/s00192-007-0387-8. Epub 2007 May 22. PMID: 17982711.

Gephart LF, Doersch KM, Reyes M, Kuehl TJ, Danford JM. Intraabdominal pressure in women during CrossFit exercises and the effect of age and parity. Proc (Bayl Univ Med Cent). 2018 Apr 9;31(3):289-293. doi: 10.1080/08998280.2018.1446888. PMID: 29904290; PMCID: PMC5997050.

Do you Leak with Jumping?

Here are some tips for you.

Do you leak urine when you jump? Did you know it’s really common for women to leak but does not have to be your “Normal.”😎.
💧Do not believe someone when they say “oh honey it’s always going to be that way… you had babies.”🤦‍♀️🙄.
💧Did you know your pelvic floor is actually a group of muscles that work with your core , your diaphragm, and your brain🧠 ?
💧That means it can be retrained. 👏The answer is not just kegels and sometimes the answer is no “kegels” for a little bit or no kegels period.
💧Our pelvic floor works with our entire body as a system. 🎛. It’s all linked together and leaking is our body’s way of communicating that something is not right. You can have urine leakage💦 from a number of different variables that you want to address. Possible causes:
🔗weakness in your lower body.
🔗changes in your posture with jumping/running etc.
🔗weakness in your hips.
🔗improper breathing patterns.
🔗 poor coordination of the pelvic floor muscles.
🔗 consuming too many bladder irritants like caffeine, coffee, artificial sweetners, alcohol, citrus fruits and even carbonated beverages😮.
So, be encouraged and know that pelvic floor PTs, like myself can do an evaluation and help empower you to CHANGE this.
I am working on some other self-help resources to help you near and far. I can’t wait to get those available to you.

#pelvichealth #incontinence #athletes #womenshealth #crossfit #diastasisrecti #leaking #leakingwithjumping

-Dr.Jennifer Iskat Frankoski, DPT, PT, PCES, Cert DN

Diastasis Recti

I have 3 finger diastasis width, what am I supposed to do?

Is there treatment for Diastasis Recti??

Simple Answer…YES

First off, the width of your diastasis recti is not the ONLY component that should be addressed. Don’t freak out if someone tells you that you have a 3 finger separation.  There is HOPE! It is normal to have some diastasis recti during the 3rd trimester of pregnancy and for 6-12 weeks after pregnancy because your rectus abdominus muscle must separate in order for the belly to expand to make room for a growing baby.  The problem occurs when women do nothing to protect the healing process, they stress it more by doing particular movements too soon, they never retrain their core, pelvic floor, and posterior chain correctly, or there were imbalances present prior to pregnancy that could have contributed to the current issues. It is also important to recognize that during pregnancy we need to be smart with our training to not overload the rectus abdominus and pelvic floor and modify movements appropriately.

Trained health professionals, especially pelvic floor physical therapists, can be trained to assess width, depth, breathing, core control, the posterior chain, pelvic floor coordination AND load transfer testing.  We should check basics but BUILD on them.  A health care professional that knows how to treat diastasis recti SHOULD be looking at all of these components.

So what matters most?

All matter because they all are linked together. How you stand and sit aka posture all affect how your diastasis recti can heal or not heal. Your shoulder, ribs, hips and back positioning all affect your core and your pelvic floor. If you have a muscular imbalance in any of these places, it can create abnormal stress on the trying to heal diastasis recti. For example, a rib flare can create more tension on the abdominal muscles, low back and shoulder. Or a hip that is “tighter” than another can causing more pulling through the core muscles and back if the person is a runner and they do not have equal hip extension motion.  Even walking can place more stress on a DR if a patient has poor coordination and body awareness.

So what are some ways to protect the diastasis recti or help with healing?

–          Retrain OR learn how to engage your whole core including lower core including transverse abdominus, obliques and understand when you are using a rectus dominant pattern

–          Strengthening all the muscles of the core starting with gentle movements showing you can control basics and build on it

–          Typically no full sit ups right away (you can eventually get back to these) or planks but it depends on the patient. I have some patients I allow to do these earlier or immediately with assistance because they actually can engage everything correctly and they are not bearing down or out and they can control the #coning.

–          Strengthening everything around the core

–          Make sure you are breathing correctly

–          Correct poor posture

–          Not jumping back into front loaded exercises like push ups, planks, ski erg, pulls ups, toes to bar, or muscle ups too quickly or without being assessed first

–          Correcting baby holding mechanics

–          Understanding how to contract and relax core through various movements including rotational movements, dumbbell and barbell movements

–          Having a pelvic floor physical therapist that understands and treats diastasis recti help evaluate you, find the source or cause of non healing diastasis recti and guide you along the way to recovery.

– Work with a trained professional during your pregnancy to prevent overloading the rectus and worsening diastasis postpartum.

Just understand it is not the end of the world if you have some “separation” and lots of other assessments should be performed before you freak out OR go back to particular movements too quickly if you are unsure. Don’t be scared to move or fear all these movements.

Seek correct and proper guidance to get you back to doing what you love.

Got more questions?  We love helping our pregnant and postpartum athletes train smart before, during and after pregnancy. Call or text to schedule an appointment.  980-221-9687

photo credit:

#diastasis #diastasisrecti #postpartum #postpartumcare #postpartumfitness #crossfit #burnbootcamp #postnatalfitness #fitmoms #momfitness #postnatalcare #pelvichealth

Accessory Work- Train Smarter

Accessory work

AmazonBasics Cast Iron Kettlebell, 35 lb

What is accessory work? and why is it important?
Accessory work in summary is the small, tedious movements that most athletes do not like to take the time to do but are extremely important for complex movements. Online definitions in the athletic world suggest that accessory work is defined as exercises that compliment larger, more complex movements like a squat.

Within the therapy world accessory work means a couple different things including “accessory movement” which relates to the specific joint mechanics and also accessory exercises that compliment the larger movements as well. I often call accessory work also “prehab”

Why is it important?

It is important to “activate”/ warm up the muscle tissues correctly before you work out. I use the term activate in quotes because the muscles are only truly fully inactive in someone with a spinal cord injury or neurological damage. So really with are warming up the specific muscles and increasing blood flow to them.

It’s not just about everything feeling “warm” but your about your brain connecting with the specific muscles you are asking to work through movements. It’s about creating more neural pathways to those muscles to help you better recruit them.

The accessory work along with prehab exercises can be done on days of working out as well as on days of rest depending on how heavy you are doing loaded accessory work.

For example, your program might call for accessory work of single arm dumbbell overhead press building to heavier weight. As a Physical Therapist, I break that down even more for someone with hx of or current elbow pain and they might do light weight skull crushers to “activate” the tricep muscle as prehab/accessory work before the heavier accessory work.

For the lower body, a great “accessory exercise” is doing single leg deadlifts to improve blood flow to the hamstrings and glutes while the brain is connecting with these muscles knowing it should utilize them more when doing squats or deadlifts. This also helps improve motor control and balance. You could also do them heavier to build strength as well.

The goal is that your choice of exercise compliments your other movements planned.

Train Smarter. Train specific

If you want to HEAR me talk a little bit about this. Head over to the Ultimate Athlete Podcast. Straight about it. Episode 10. “Train Smart and avoid injuries”

#trainsmart #athletes #ultimateathlete #dpt #sleep #accessorywork #recovery #singlelegdeadlifts #RDL #SLDL #prehab #kettlebellwork

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