Can I Lift Weights with Pelvic Organ Prolapse?

Pelvic organ prolapse (POP) occurs when the bladder, uterus, or rectum drops down into the vaginal canal. This is primarily caused by laxity in the connective tissue (fascia) and is often influenced by pelvic floor muscle weakness or poor management of intra-abdominal pressure.

While the diagnosis can feel daunting, it is incredibly common—and it doesn’t necessarily mean your days in the weight room are over. In fact, the latest research suggests that staying active might be one of the best things you can do.

What Does the Research Say?

Historically, women with POP were told to avoid lifting anything heavier than a gallon of milk. However, our understanding of the pelvic floor has evolved significantly.

1. Heavy Lifting May Not Be the Culprit

A landmark study (Forner et al., 2020) surveyed nearly 4,000 physically active women and found a surprising result: women who lifted heavy weights (>50 kg / 110 lbs) actually reported fewer POP symptoms than women who lifted light weights (<15 kg / 33 lbs). In fact, those lifting light weights were over twice as likely to report symptoms like vaginal bulging.

2. CrossFit vs. General Exercise

Other research has shown that women participating in CrossFit do not have a higher prevalence of POP symptoms compared to those doing other types of exercise (Gephart et al., 2018). While high-impact activities like running and jumping can sometimes exacerbate symptoms, strength training focuses on controlled movements where pressure can be managed more effectively. A Physical Therapist can help you learn how to manage pressure with both high impact symptoms and symptoms with controlled lifting. 

3. The "Training Effect"

Recent reviews suggest that exercise may actually have a protective effect. By strengthening the pelvic floor and surrounding muscles (the hips, core, and low back), you may decrease the "levator hiatus" (the opening in the pelvic floor), providing better structural support for your organs (Bø & Nygaard, 2020).

Tips for Lifting with POP

If you want to lift weights with POP, the goal isn't to avoid movement, but to optimize it.

• Master Your Breathing: The "exhale on exertion" (breathing out as you lift) is a great starting point to reduce downward pressure. However, some experienced lifters do better with a "core brace" or a strategic breath hold. A pelvic floor PT can help you find the strategy that keeps your symptoms quiet.

• Monitor "The Bulge": If you feel a sensation of heaviness, pressure, or a physical bulge during a specific lift, it’s a sign to modify. This doesn't mean you have to quit the exercise forever; it might mean adjusting your stance, reducing the weight, or shortening the range of motion (e.g., swapping a deep back squat for a box squat).

• Consider a Pelvic Support: For some women, wearing a pessary (a small device inserted into the vagina) during exercise provides the internal structural support needed to lift heavy without symptoms.

• Coordinate, Don’t Just Contract: While Kegels (pelvic floor contractions) are helpful, they are most effective when integrated into your lifts. Practice "the knack"—a well-timed pelvic floor contraction right before you initiate the heaviest part of a lift.

See a Pelvic Floor PT

Every pelvic floor is different. A pelvic floor physical therapist can perform an internal assessment to see how your muscles respond to pressure. They can help you bridge the gap between "rehab" and the "squat rack," ensuring you have the strength and coordination to reach your fitness goals safely.

The Bottom Line

Current research shows that physically active women who lift heavy weights do not have an increased prevalence of POP symptoms. You don’t have to choose between your long-term health and your love of lifting. By listening to your body and managing your internal pressure, you can stay strong and active with POP.

By Dr. Cindi Rauert, PT, DPT

Research Cited

1. Forner, L., et al. (2020). Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. International Urogynecology Journal. (This study found that heavy lifters had lower rates of POP symptoms than light lifters).

2. Bø, K., & Nygaard, I. E. (2020). Is physical activity good or bad for the female pelvic floor? A narrative review. Sports Medicine.

3. Middlekauff, M. L., et al. (2016). The impact of acute and chronic strenuous exercise on pelvic floor muscle strength. American Journal of Obstetrics & Gynecology.

4. Gephart, L. F., et al. (2018). Intraabdominal pressure in women during CrossFit exercises. Baylor University Medical Center Proceedings.