Prevent Pelvic Organ Prolapse! Fall into a Healthy Pelvic Floor Routine the Pilates and Pfilates Way!

Pelvic floor exercises (kegels) have been evidenced to increase pelvic floor strength, improve sexual function, improve bladder and bowel function, prevent further pelvic organ prolapse, and even decrease prolapse stage. When lower abdominal muscles are recruited, research has shown that healthy functioning pelvic floors, normally contract just before the lower abdominal muscles do, indicating that strengthening the lower abdominals should be a part of any pelvic floor strengthening program. Research also reveals that the “maximum strength kegel” is produced when the buttocks, inner thighs, and lower abdominals are recruited along with the kegel. Thus, research has just described the perfect exercise routine “recipe” for maintaining healthy pelvic floor function: the Pilates and Pfilates exercise methods.

Pilates, created by Joseph Pilates, is designed to strengthen the core including the abdominals, back, gluteal and inner thigh muscles. Pilates focuses on precise movement patterns to facilitate the core to prevent back injury.

Pfilates (pelvic floor Pilates) was created by Dr. Crawford, a urogynecologist, who researched pelvic floor engagement during 10 specific Pilates moves through use of electromyography. (EMG) Pfilates takes the well-known kegel and applies it to functional positions that augment pelvic floor recruitment, utilizing the gluteals, abdominals, back, and inner thighs.

Correct movement is key to both exercise programs. Thus, ideally, it is recommended to work with a certified trainer of both disciplines. (Since 20-30% of the patients in one study have been discovered to do the kegel incorrectly with just a verbal command, and 10% were actually doing damage by bearing down, you may want to see a women’s health PT or OT first to make sure you are doing it correctly. Some studies have shown a higher percentage of patients performing the kegel incorrectly). Smaller classes are also key to getting corrections and modifications from the instructor as needed.

When Pilates and Pfilates are performed correctly, they are effective in reducing back pain and preventing pelvic organ prolapse. So, this autumn, as we fall back and gain an hour, don’t let your pelvic organs fall, but do let yourself fall into a daily healthy pelvic floor routine!

Braekken IH, et al. Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. Am J Obstet Gynecol 2010; 203: 170.e1-7.

Hagen S, et al. A randomized controlled trial of pelvic floor muscle training for stages I and II pelvic organ prolapse. Int Urogynecol J 2009; 20: 45-51.

Stupp L, et al. Pelvic floor muscle training for treatment of pelvic organ prolapse: an assessor-blinded randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunction 2011 (Epub ahead of print)

Piya-Anant M, et al. Integrated health research program for the Thai elderly: Prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women. J Med Assoc Thai. 2003; 86: 509-515.

Ghroubi S, et al. Effect of conservative treatment in the management of low-degree urogenital prolapse. Ann Readapt Med Phys. 51: 56-102.

Critchley D. Instructing pelvic floor contraction facilitates transverses abdominis thickness increase during low-abdominal hollowing. Physiother Res Int. 2002; 7(2): 65-75. Case control 3b.

Sapsford RR, et al. Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Neurourol Urodyn. 2011; 20: 31-42. Case series 4.

Bo K. Pelvic floor muscle training. In: Evidence-based Physical Therapy for the Pelvic Floor. Bo K, Berghmans B, Morkved S, Kampen MV (eds). Philadelphia: Elsevier, 2007.
www.familypracticenews.com. February 15, 2007. Simple questions can help uncover urinary incontinence. Found at http://www.rheumatologynews.com/fileadmin/content_pdf/fpn/archive_pdf/vol37iss4/70230_main.pdf, 10-22-12.



  1. I have used the Incostress medical device to help with kegels and found it invaluable as I am able to identify the pelvic floor to start exercising.
    I now use this with the Pfilates program which was developed by a brilliant gynaecologist Dr Bruce Crawford in the USA.
    I would like to see clinical trial data to show that kegel training reduces pelvic organ prolapse. Do you have this evidence? the references do not show actual trial data.

  2. Gina Jay

    You can check Janet Hulme website: http://phoenixcoresolutions.com/index.php?page=research. Janet Hulme, a pelvic floor Physical Therapist, who developed the “Roll for Control” exercises has numerous studies, with at least one showing a decrease in prolapse after 6-8 weeks of pelvic floor strengthening.

    Therapy is known to help mostly with grades I and II, but it is also helpful even in surgical candidates to strengthen prior to surgery (not at all unlike patients who strengthen their knee prior to knee surgery). Strengthening the muscles prior to surgery can make for an easier recovery, unless complications from the surgery arise. I’m sure you saw that much of the research concludes that strengthening should be the “first line of defense” for any patients with symptoms of pelvic floor dysfunction.

    I will look for more studies to further address your question. I do see improvement in prolapse grades in the clinic in my patients who are diligent with their exercise program.

    Also, even if strengthening decreases a prolapse grade, a person who has poor bowel voiding habits, such as chronic bearing down due to constipation, could be at risk for further prolapse. Thus, it is important to address diet and healthy voiding habits.

    I’m glad you found success with Dr. Crawford’s program. I like it, too.

  3. Gina Jay

    I think what needs to be clarified is that the endopelvic fascia is divided into three layers. If the fascia of the arus tendinous pubic in level II is disengaged by forceful delivery or surgery, then the main support of the vaginal vault can be compromised leading to vaginal vault prolapse. This is because the lateral walls of the vagina are held up in a “H” shape, attaching mainly to just fascia (connective tissue). This type of prolapse would most likely lead to surgical correction.

    The urethra is fixed at level three. Level three consists of the distal vagina and perineum, supported by attachment of endopelvic fascia into the ischiopubic rami. This area is often addressed with pelvic floor therapy. We see this area compromised a great deal with chronic bearing down for bowel movements and even straining to void urine if a person is usually rushing.