What is prolapse? Fitness Pilates News

Welcome to this week’s Fitness Pilates newsletter.

It’s been so lovely to see so many of you over the last week across our Fitness Pilates sessions, Level 3 Reformer courses and Level 3 Mat training. The energy, questions and enthusiasm have been fantastic, and I travelled to Bridlington yesterday to the beautiful Willow studio and we have lots more training lined up. 

This week, I wanted to revisit an important topic that comes up time and time again — prolapse. We’ve talked about this before, but it’s always worth refreshing and looking at it with updated understanding, especially as it is so very common.

What is prolapse?

A prolapse occurs when one or more of the pelvic organs (such as the bladder, uterus or rectum) descend into the vaginal wall due to weakness or dysfunction in the pelvic floor muscles and supporting structures.

It can present as:

• A feeling of heaviness or dragging
• A bulge or pressure in the vaginal area
• Discomfort during exercise
• Changes in bladder or bowel function

Who is affected?

Prolapse is incredibly common, particularly in:

• Women post-pregnancy and childbirth
• Women in peri and post-menopause (due to hormonal changes)
• Those with a history of heavy lifting or high-impact exercise
• Anyone with chronic coughing, constipation or increased intra-abdominal pressure

Many clients may not openly talk about it, so awareness and sensitive coaching is key.

Stages of prolapse

Prolapse is generally classified into stages:

• Stage 1: Mild descent, often minimal symptoms
• Stage 2: More noticeable, may feel heaviness or pressure
• Stage 3: Organ descends close to or at the vaginal opening
• Stage 4: More severe, requiring medical intervention

As instructors, we’re not diagnosing, but we do need to recognise signs and adapt exercise accordingly.

Pelvic floor function – a more technical view

The pelvic floor is not just a group of “squeeze muscles” — it’s a complex, dynamic system made up of the levator ani group (pubococcygeus, puborectalis, iliococcygeus) and connective tissue that works in coordination with:

• The diaphragm
• The deep abdominal system (particularly transverse abdominis)
• The hip stabilisers
• The fascial system

Functionally, the pelvic floor must be able to contract, relax, lengthen and respond reflexively to load and pressure.

Prolapse is not simply “weakness” — it is often a combination of:

• Reduced muscular support
• Altered coordination and timing
• Increased intra-abdominal pressure
• Changes in connective tissue integrity (especially post-menopause)

What does the latest research say?

Recent research continues to support the role of pelvic floor muscle training as a first-line intervention.

• Improves symptoms and quality of life in women with prolapse
• Can improve muscle strength and support in stages 1–3
• Works best when combined with functional movement and breathing strategies

There is also growing evidence that:

• Poor pressure management and heavy loading strategies can worsen symptoms
• Integrating pelvic floor work into full-body movement patterns is more effective than isolated exercises

Understanding pelvic floor types (this is key)

One of the biggest shifts in understanding is that not all pelvic floors are “weak”.

Clients will generally fall into two categories — and many are a mix of both.

Hypotonic pelvic floor (underactive / weak)

• Reduced strength and support
• Poor activation and endurance
• Often linked with prolapse symptoms
• Common post-pregnancy or with deconditioning

These clients benefit from:

• Gentle strengthening
• Activation work
• Gradual, progressive loading

Hypertonic pelvic floor (overactive / tight)

• Muscles are too tense and cannot fully relax
• May present with pelvic pain or discomfort
• Often poor coordination rather than true weakness
• Can also coexist with prolapse

These clients need:

• Relaxation before strengthening
• Breathwork and down-training
• Mobility and release work
• Careful cueing (less “lift and squeeze”)

How do you recognise the difference?

You’re not diagnosing, but you can spot patterns.

Hypotonic signs:

• Heaviness, dragging sensation
• Leakage with impact or coughing
• Poor core control

Hypertonic signs:

• Pelvic pain or discomfort
• Feeling tight rather than weak
• Gripping, bracing and limited mobility

 Many clients present with a combination of both — weak and overactive.

The safest and most effective approach

1. Start with breath (this works for everyone)

• Lateral breathing
• Rib cage expansion
• Relax on inhale
• Gentle lift on exhale

2. Add gentle activation

• “Lift and release” rather than constant squeeze
• Subtle, low-level effort
• Focus on timing with movement

3. Always include relaxation

• Release cues
• Stretching
• Mobility
• Down-regulation

Key coaching cue

Instead of:
“Squeeze your pelvic floor”

Use:
“Gently lift as you exhale… and fully let go as you inhale”

This works for:

• Weak pelvic floors
• Tight pelvic floors
• Mixed presentations

Fitness Pilates – what to focus on

Fitness Pilates is perfectly placed to support clients with prolapse when programmed well.

Focus on:

• Breath-led movement
• Pelvic floor coordination (lift AND relax)
• Neutral alignment and posture
• Controlled, low-load strength work
• Functional movement patterns
• Slow, mindful transitions

Great exercises include:

• Pelvic tilts and imprint work
• Glute bridges
• Side-lying leg work
• Seated and standing posture work
• Controlled core activation
• Mobility and flexibility work

Exercises to be cautious with

Avoid excessive intra-abdominal pressure and downward force.

• Double leg lifts
• Full roll-ups or aggressive flexion
• High-impact movements
• Heavy loaded squats or overhead lifting
• Long or poorly controlled plank variations
• Breath holding

Key takeaway for your classes

This is not about stopping movement — it’s about smarter movement.

Fitness Pilates works because it:

• Improves coordination
• Manages pressure
• Builds strength safely
• Encourages awareness

Your role is to guide, not diagnose.

Hope that helps and feel free to pass onto your clients and class members – is there any condition you would like me to cover? Whats app me 07976 268672 

CPD & Course Offers on SALE this weekend.

If you’re looking to expand your knowledge or bring something new into your timetable, now is a great time to invest in your CPD as `I have added lots to this weekends sale.

We currently have some fantastic offers running across courses.

If you’d like to complement your Fitness Pilates classes with strength-based programming, take a look at Lift Lean, which is also included in the current sale.

As always, if you have any questions or would like support with your programming or clients, just drop me a message. 07976 268672

CLICK HERE to view the CPD sale