Hiking with Prolapse

Hiking with prolapse is possible (wahoo!!!), and it's an AWESOME alternative to high-impact exercises like running. The ups and downs and uneven terrain of hiking trails will amp up your workout WITHOUT repetitive pounding. That being said, there are some aspects of hiking that can aggravate your condition if you're not careful. The following are my top tips for hiking with prolapse. This article is intended for women with mild to moderate prolapse. If your prolapse is severe (to the opening of — or protruding outside of — your vagina), please consult your healthcare provider.

Before I get started, here's a little soapbox: PROLAPSE IS NOT A DEATH SENTENCE. Yes, it's a condition that needs some careful attention and precautions, and you should be evaluated by a women's health physical therapist to determine your SPECIFIC, individual needs. However, a diagnosis of prolapse does NOT mean that you're destined for a sedentary future. You can ABSOLUTELY exercise; in fact, it's imperative to exercise (within safe limits) in order to maintain — and even improve — the strength and resilience of your pelvic floor and core muscles. I have had many clients prevent the progression of — and even REVERSE — prolapse naturally, using a combination of exercise, improved breathing mechanics, and better posture/alignment.

Onto my tips for hiking with prolapse:

1) Gradually build up.

First and foremost, start slowly. Don't dive into a 5-mile hike the first time you hit the trails after your prolapse diagnosis. Begin with very short hikes — much shorter than you think you "should" be able to do — and work up from there. Give yourself a "win!" Do a hike that you KNOW you can handle successfully.

If you push yourself too fast, too far, too soon you could end up injuring yourself and significantly aggravating your prolapse. So even though it can feel frustrating to start with baby steps, when you build up slowly, it will get you so much farther in the long run. 

In summary, GENTLY push your limits and "find your edge" WITHOUT jumping over the cliff! 

2) If you're using a backpack or daypack, choose one that fits appropriately and — ideally — has chest and hip straps/belts.

Hiking with prolapse: wear a well-fitted daypack with chest and hip straps to help keep it close to your body, and to evenly distribute weight!

A well-fitted backpack with chest and hip straps keeps it close to your body and helps distribute the weight of the pack EVENLY. You don't want the belts to "squeeze" you, but they should be snug and feel supportive. Make sure the hip belt isn't fastened too high (it needs to be below the waist/belly button, not AT the waist/belly button) so that it doesn't pinch around your middle. Again, the idea is to evenly distribute the weight so nothing is dangling and throwing off your posture.

If the weight isn't distributed evenly (i.e. if it's dangling off your back as seen in the picture below) it will mess with your alignment and compromise your posture.

Do NOT do this: 

I can’t state this strongly enough: POSTURE IS KEY.

If your low back is arched because your pack is dangling (as seen in the pic above), you’ll develop low back pain AND your abdominal muscles will be long, overstretched, and not able to support your core properly. If your shoulders and neck are FORWARD to help offset the dangly-ness of the pack, this will also impact your pelvic floor. "Hunchy-ness" up top translates to increased intra-abdominal pressure down below, which translates to increased DOWNWARD PRESSURE on the pelvic organs.

Weight

When it comes to loading your pack, please remember that prolapse requires special care. Any extra weight you carry will be transferred to your pelvic floor (and will increase the impact of each step you take) and could aggravate your condition... So pack carefully, and pack light. Maybe your backpack carries extra clothes and toilet paper for the trail, and your partner's pack carries the water, snacks, and heavier items. Packing light doesn't mean you're a wimp; it just means you're working SMARTER and caring for your body.

3) Speaking of posture, hike tall and proud.

Incorporating ideal posture into everyday activities such as sitting, standing, walking, and HIKING (!) will retrain your pelvic floor and core muscles to fire in their optimum position (for optimum function). When you're hiking up a hill, rather than dogging your way up the incline with a hunch-back, keep your back straight and strong, and your posture tall! Breathe steadily, exhaling as you propel yourself upward, and get your arms into it. You might even consider using trekking poles if you're walking a very steep trail. Furthermore, don't jut your chin forward!

Many women naturally (and unintentionally) jut their head and chin forward, especially when going uphill. When you jut your chin forward it causes a breakdown in your posture: your pelvis rotates back, downward pressure increases on your pelvic organs, and your core muscles are no longer in a good position for firing and support. The video above provides some great tips to help!

KEY TAKEAWAYS: instead of hunchy, head-down hill walking — and instead of chin-jutting uphill walking — do the RIGHT THING for your core and pelvic floor: keep your posture tall and your ribs gently drawn in.

4) Proper breathing is key.

Breath holding during resistance exercise can also contribute to prolapse, and hiking up hills is ABSOLUTELY a form of resistance exercise (What's resisting you? Gravity!) Breathing evenly and steadily throughout your hike and especially considering your breath pattern when hiking uphill and/or stepping UP (i.e. onto a root or a rock) is essential. Remember this mantra that I learned from my friend Jenny Burrell of Burrell Education: "EXHALE ON EXERTION." Performing an exhale as you do the heavy lifting (i.e. lifting yourself as you step up) relieves abdominal pressure and causes a gentle lift of the pelvic floor.

5) Take a break and elevate your pelvis.

You're hiking... It's hard work! Take a break. Women with prolapse often feel a gradual increase in symptoms as the day progresses, such as a feeling of dragging in the pelvis or achiness in the low back. If you start feeling that, DON'T PUSH IT. Take off your pack, and lie down with your bum resting on your pack or a rolled-up jacket or sweatshirt. I call this "hips up time!"

Elevating your bottom in this type of supported bridge position allows your pelvic organs to return to their natural positions and your pelvic floor to return to a higher resting position; this will take a load off of you AND your pelvic floor! 

While you're in this resting position, take the opportunity to connect with your pelvic floor muscles. Breathe deeply into your belly, and feel your pelvic floor gently descend with each inhale, and lift with each exhale. The video below describes the “reverse kegel” for pelvic floor muscle relaxation. Lying in this supported bridge position is a great time to practice the “reverse kegel” (also known as “pelvic drop”)!

6) Before you go, prepare your pelvic floor.

Kegels are great, but they're not the be-all/end-all pelvic floor exercise, ESPECIALLY if you're going to be clambering up and down hills... You need to do some functional training of your pelvic floor AND get your glutes in tip-top condition.

How do you "functionally train" the pelvic floor? The key is to break down the activity (i.e. hiking) into individual components and then create exercises that gradually progress from the basics up to the full challenge of the sport. To start, connect with your pelvic floor via breathing, and then integrate it into progressively challenging activities that mimic hiking. This quick video provides an idea of how to gradually progresses to greater and greater functional challenges. Be sure to repeat the progression on BOTH SIDES!

You might also enjoy this functional exercise routine, which breaks down the act of jumping into its most basic components to keep it pelvic floor friendly...while jumping isn't typically involved in hiking, this is a great workout if you're wanting to tackle more intense/rigorous terrain:

7) Consider a pessary.

A properly fitted pessary (talk to your gynecologist, midwife, or in some regions your physical therapist) to see if this might be an option for you. Pessaries act to support your pelvic organs and in some cases, they can be used sporadically (i.e. only when you're exercising) and removed on your own. Don't have a pessary? For mild cases of prolapse, consider inserting a tampon and see if that helps you feel more supported during your hike.

Like I said earlier, pelvic organ prolapse is not a death sentence, and it does NOT mean that you're doomed to a sedentary future of sitting in an easy chair.

YOU CAN GET BACK OUT ON THE TRAILS... You CAN go hiking with prolapse!*

Check out my Lift program if you want to learn more about NATURAL prolapse relief and recovery at home. 

Hiking and prolapse... How to cope! 

Prolapse can often be managed conservatively, without surgery, especially if it's addressed in its early stages. Don't ignore it or assume there are no alternative solutions. seek the care of a women's health physical therapist, safely train your pelvic floor and core, watch your posture (don't hunch! un-tuck your butt!), and exhale on exertion.

Until next time... Happy trails!

*This blog post and all of the advice/information on www.vibrantpelvichealth.com is informational only and not intended to be a substitute for individualized medical diagnosis and treatment. Please talk to your healthcare provider to find out what's appropriate for your body and your personal needs.