Resident sweet spot Phitness expert, Dr. Lauri Romanzi, continues her answer of yesterday’s question:

Q: Dear Dr. Romanzi: What is vaginal prolapse and can Kegel phitness prevent it?

A: Yesterday, I answered part of this question by giving some background from my book on incontinence and prolapse, titled: “Plumbing and Renovations“. Today, I’ll finish with why it happens, as well as the importance of Kegel phitness.

First, let’s look at why prolapse happens:

In other areas of the body, people accept connective tissue defects as something that can happen to anyone, and if it happens to you, get it fixed!

Tear your knee ligaments, get it fixed and go to rehab. Develop and inguinal hernia, see the surgeon. Damage your rotator cuff, it’s either physical therapy or reconstructive surgery.

But for some reason, when it comes to connective tissue disorders in the female pelvis, the common response is … to do nothing. And to blame something. Women often live with severe prolapse for decades, believing nothing can be done. They blame themselves; “I never did those Kegel exercises”. Or they blame the medical system; “my last baby came out so fast right in the bed. That’s why my uterus dropped”, or “I had an episiotomy”, or “I didn’t have an episiotomy”.

Many are convinced that the prolapse “should not be happening to me; I eat right, exercise and stay healthy”. It’s none of those things, because prolapse is just the same as all other wear and tear conditions; a little bit of nature and a little bit of nurture. If your connective tissue is extra-elastic (are you double jointed or can do splits with no problem?), you birth children and live long enough, you are at risk for pelvic organ (vaginal) prolapse.

As with most hernias and ligament tears, vaginal prolapse is more likely to happen to you as you get older whether you stay in shape or never exercise at all, because all connective tissue regenerates more slowly and with less strength in older people than in younger people.

But when it comes to women and vaginal prolapse, a growing body of research yields some fascinating explanations as to why some women can birth many children with no prolapse whatsoever, while other women’s bladders drop after the very first baby is born.

Medical research shows that women with prolapse have different proportions of collagen (connective tissue) Type I vs Type III and biochemical differences in the enzymes that modify collagen regeneration compared to women without prolapse.

Another study showed women with prolapse are more likely to have a specific marker on chromosome 9, helping explain the tendency for family clusters of vaginal prolapse, with the second factor in this nature vs. nurture paradigm being childbirth. Big babies and long labors make a woman more prone to pelvic floor disorders. In other words, women who are super-elastic are prone to prolapse, particularly if they give birth to large babies after long labors.

Kegel Exercise and Prolapse:

It makes sense that Kegel exercise should prevent prolapse, but medical researchers have yet to answer that question.

There is plenty of data, by the way, showing that Kegels are great for bladder control and a few studies that show Kegels will give you a stronger orgasm, but these are completely different issues than whether or not Kegel exercising the muscles that lie at the bottom of the pelvis, perpendicular to all of the connective tissue supports holding up the uterus, bladder and rectum, will hold your vaginal parts in place, reduce your lifetime risk of prolapse, or pull prolapse back into position once it occurs.

Thus far, there is but one single study, published late in 2009 by the fabulous heroine of Kegel exercise – Dr. Kari Bo – that looks at Kegel muscle fitness and prolapse. This study compared the Kegel strength of 49 women with prolapse to that of 49 women with no prolapse, and the women without prolapse had measurably stronger Kegel muscles.
This single compelling study allows us to figure out whether women without prolapse have stronger muscles due to genetics, or whether having stronger Kegel muscles truly reduces life-time risk of prolapse.

That very important question remains unanswered. If you have severe prolapse, it is unlikely that Kegels will do much to pull your parts back into position, any more than sit-ups help a large groin hernia. On the other hand, when it comes to Kegels and prolapse, one can only apply a healthy dose of common sense; it is probably very helpful to keep your pelvic muscles in good shape with Kegel exercises.

With all this said, my recommendation would be to start your Kegel routine (if you don’t already have one) just to be safe. I invite you to obtain a free copy of a Kegel exercise DVD featuring the preeminent Dr. Bo (it’s like Moses handing down the tablet) by visiting her website today.

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