How to Exercise Safely with Enterocele

Living with an enterocele, a type of pelvic organ prolapse where the small intestine bulges into the vagina, can be challenging, but it doesn’t mean you have to give up on physical activity. In fact, targeted, safe exercise is crucial for managing symptoms, strengthening supporting muscles, and improving overall quality of life. The key lies in understanding how to move your body in a way that supports your pelvic floor rather than strains it. This comprehensive guide provides clear, actionable steps to help you exercise safely and effectively with enterocele.

Understanding Enterocele and Its Impact on Exercise

An enterocele occurs when the supportive tissues and muscles of the pelvic floor weaken, allowing the small intestine to descend and create a bulge in the vaginal canal. This can lead to symptoms like a feeling of heaviness or pressure in the pelvis, discomfort during certain activities, and changes in bowel function. The primary concern with exercise, particularly high-impact or strenuous activities, is the increase in intra-abdominal pressure (IAP). When IAP rises, it puts downward force on the pelvic organs, potentially exacerbating the enterocele. Therefore, the core principle of safe exercise with enterocele is to minimize downward pressure and maximize upward support.

The Foundation: Pelvic Floor Muscle Training (PFMT)

Your pelvic floor muscles (PFM) are the cornerstone of support for your pelvic organs. Strengthening these muscles is paramount for managing enterocele. These exercises are often referred to as Kegel exercises, but proper technique is crucial to avoid worsening your condition.

Mastering the Pelvic Floor Contraction (Kegels)

This isn’t about simply squeezing your glutes or inner thighs. It’s about isolating and engaging the specific muscles that support your bladder, bowel, and uterus.

How to Do It:

1. Find the Muscles: Imagine you are trying to stop the flow of urine mid-stream or trying to hold back gas. The sensation should be an inward lift and squeeze, not a bearing down. You should feel a lift around your vagina and anus.
   • Concrete Example: While sitting on the toilet, try to stop your urine flow for a second. That’s the feeling you’re aiming for. Or, imagine picking up a blueberry with your vagina and lifting it upwards.
2. Slow Contractions (Endurance):
   • Position: Lie on your back with knees bent and feet flat on the floor, or sit comfortably with knees slightly apart. This position reduces gravity’s pull.

   • Action: Gently squeeze and lift your pelvic floor muscles as if drawing them upwards and inwards. Hold this contraction for 5-10 seconds while breathing normally. Avoid holding your breath, straining your abs, or clenching your glutes.

   • Concrete Example: Contract your PFM for a count of 5, then slowly release for a count of 5. Repeat 8-10 times. Focus on the slow, controlled release as much as the contraction.

3. Fast Contractions (Power):

   • Position: Same as slow contractions.

   • Action: Quickly squeeze and lift your pelvic floor muscles, then immediately relax them. This trains your muscles to react quickly to sudden increases in IAP, like during a cough or sneeze.

   • Concrete Example: Perform 10-20 quick “flicks” of your PFM, focusing on a strong, rapid contraction followed by immediate relaxation.

4. Frequency: Aim for 3-5 sets of both slow and fast contractions daily. Consistency is key. Integrate these into your daily routine – while brushing your teeth, waiting in line, or driving.

Common Mistakes to Avoid:

• Bearing Down: Never push your PFM downwards. This directly counters the goal of supporting your organs.

• Holding Your Breath (Valsalva Maneuver): Holding your breath during exertion significantly increases IAP, putting pressure on your enterocele. Always exhale on exertion.

• Engaging Other Muscles: Avoid squeezing your buttocks, inner thighs, or abdominal muscles. The movement should be isolated to the pelvic floor.

Breathing: Your Internal Pressure Regulator

Proper breathing is a cornerstone of safe exercise with enterocele. It helps manage intra-abdominal pressure and supports the pelvic floor.

Diaphragmatic Breathing (Belly Breathing)

This deep, controlled breathing technique engages your diaphragm, which works in conjunction with your pelvic floor to manage pressure.

How to Do It:

1. Position: Lie on your back with knees bent or sit upright comfortably. Place one hand on your chest and the other on your abdomen.

2. Inhale: Breathe in slowly through your nose, allowing your abdomen to rise. Your chest should remain relatively still. Feel your pelvic floor relax and lengthen as you inhale.

3. Exhale: Exhale slowly through your mouth, gently drawing your belly button towards your spine. As you exhale, you should feel a gentle lift and engagement of your pelvic floor muscles. This is the “core breath” and should be synchronized with your exercises.

   • Concrete Example: Practice this for 5-10 minutes daily. When lifting a light object, preparing for a squat, or engaging in any physical exertion, exhale as you exert force. For instance, when rising from a chair, exhale as you push up.

Safe Cardiovascular Exercise

Cardiovascular activity is vital for overall health but requires careful modification with enterocele. Focus on low-impact activities that minimize jarring and downward pressure.

Recommended Activities and How to Adapt Them:

1. Walking: Excellent low-impact option.
   • How to Do It: Maintain good posture, with a tall spine and relaxed shoulders. Engage your pelvic floor gently with each step, especially as your foot lands. Start with shorter durations and gradually increase.

   • Concrete Example: Begin with 15-20 minute walks at a moderate pace. If you feel any heaviness or pressure, slow down or take a break. Progress to longer durations as tolerated, focusing on controlled breathing and gentle PFM engagement.

2. Swimming and Water Aerobics: The buoyancy of water reduces gravitational pull, making these ideal.

   • How to Do It: Focus on smooth, controlled movements. Avoid high-impact jumps or quick changes in direction common in some water aerobics classes. Standard swimming strokes are generally safe.

   • Concrete Example: Try laps using breaststroke or freestyle. For water aerobics, modify jumping jacks to large steps in the water, and avoid any exercises that involve forceful downward pressure or wide-leg stances. “Deep water walking” is also an excellent option.

3. Cycling (Stationary or Outdoor): Seated cycling minimizes impact on the pelvic floor.

   • How to Do It: Ensure proper bike fit to maintain good posture and avoid excessive forward lean. Maintain a comfortable resistance level.

   • Concrete Example: Start with 20-30 minutes on a stationary bike, focusing on consistent pedal strokes and controlled breathing. If riding outdoors, choose flatter terrain initially to avoid straining on inclines.

4. Elliptical Trainer: Provides a low-impact full-body workout.

   • How to Do It: Focus on smooth, even movements. Avoid excessive speed or resistance that causes you to strain or hold your breath. Maintain an upright posture.

   • Concrete Example: Begin with 15-20 minutes, gradually increasing duration. Incorporate arm movements for a full-body workout, but ensure your core and pelvic floor remain supported.

Activities to Avoid or Modify Heavily:

• High-Impact Activities: Running, jumping (jumping jacks, box jumps), skipping, intense aerobics, plyometrics. These significantly increase IAP and downward force.

• Activities Involving Wide Leg Stances or Deep Squats/Lunges: While some modified squats and lunges can be safe, exercises requiring a very wide stance or deep knee bend can increase strain on the pelvic floor.

• Heavy Weight Lifting (without expert guidance): Especially overhead lifting or exercises that involve bearing down.

Safe Strength Training

Strength training is crucial for building overall strength and supporting your pelvic floor, but it must be done with specific considerations for enterocele. The focus is on controlled movements, proper breathing, and appropriate weight.

Core Principles for Strength Training with Enterocele:

• Exhale on Exertion: Always exhale as you lift or exert force. This helps to activate your deep core muscles and pelvic floor, minimizing downward pressure.

• Gentle Pelvic Floor Engagement: Think of a gentle “lift” of your pelvic floor before and during the exertion phase of each exercise.

• Avoid Bearing Down/Bulging: If you feel any downward pressure, bulging, or heaviness, stop the exercise or reduce the weight/intensity.

• Maintain Neutral Spine: Avoid excessive arching or rounding of your back.

• Light Weights, Higher Reps: Initially, prioritize lighter weights with higher repetitions to focus on form and muscle endurance rather than maximal strength.

• Listen to Your Body: This is the most important rule. If something causes discomfort, modify it or stop.

Recommended Strength Exercises and How to Adapt Them:

1. Pelvic Floor Friendly Core Exercises: These focus on deep core stability without increasing IAP excessively.

   • Transverse Abdominis (TA) Engagement:
     • How to Do It: Lie on your back, knees bent, feet flat. Inhale. As you exhale, gently draw your lower belly button towards your spine, as if zipping up a tight pair of jeans. Keep your upper abs relaxed. Your back should not flatten against the floor.

     • Concrete Example: Practice this gentle engagement for 10-15 repetitions, holding for 5 seconds each. This is the foundation for all other core exercises.

   • Bridging: Strengthens glutes and hamstrings, supporting the pelvis.

     • How to Do It: Lie on your back, knees bent, feet hip-width apart. Engage your TA and PFM gently. As you exhale, lift your hips off the floor until your body forms a straight line from shoulders to knees. Avoid arching your lower back. Inhale as you lower slowly.

     • Concrete Example: Perform 3 sets of 10-15 repetitions. To progress, try holding a small, soft ball between your knees and gently squeezing it as you lift.

   • Bird-Dog: Improves core stability and balance.

     • How to Do It: Start on all fours (hands and knees), maintaining a neutral spine. Engage your TA and PFM. As you exhale, slowly extend one arm forward and the opposite leg backward, keeping your torso stable. Avoid arching your back or shifting your weight excessively. Inhale as you return to the starting position.

     • Concrete Example: Perform 3 sets of 8-10 repetitions per side. Focus on slow, controlled movement, imagining a cup of water balancing on your lower back.

   • Modified Plank (Knees Down): Builds core endurance without excessive pressure.

     • How to Do It: Start on your forearms and knees, forming a straight line from head to knees. Engage your TA and PFM, and keep your core stable. Avoid letting your hips sag or arching your back.

     • Concrete Example: Hold for 10-30 seconds, for 3-5 repetitions. As you get stronger, you can gradually increase the hold time.

2. Lower Body Strength (Pelvic Floor Friendly):

   • Wall Squats (Shallow): Strengthens glutes and quads with back support.
     • How to Do It: Stand with your back against a wall, feet about 12 inches away. Engage your TA and PFM. As you exhale, slowly slide down the wall, bending your knees to a shallow squat (knees should not go beyond 90 degrees, and ideally stay above hips). Hold briefly, then exhale as you slide back up.

     • Concrete Example: Perform 3 sets of 10-15 repetitions. Focus on keeping your core engaged and avoiding any downward pressure sensation.

   • Narrow Squats/Lunges (Shallow): Reduce stress compared to wide or deep variations.

     • How to Do It: For squats, keep your feet hip-width apart. For lunges, take a smaller step forward than usual. Focus on maintaining an upright torso, exhaling as you lower, and engaging your PFM. Do not go deep enough to feel any pressure.

     • Concrete Example: Perform 3 sets of 8-12 repetitions. Focus on controlled movement and ensuring your knees track over your toes. If you feel any discomfort, reduce the depth.

   • Glute Bridges (as described above): Crucial for hip and glute strength, which directly supports the pelvis.

3. Upper Body Strength (Seated or Supported):

   • Seated Rows (Resistance Band or Machine):
     • How to Do It: Sit upright with good posture. For a resistance band, loop it around your feet or a stable anchor. Pull the band towards your torso, squeezing your shoulder blades together. Exhale as you pull.

     • Concrete Example: Perform 3 sets of 10-15 repetitions. Ensure your core is gently engaged throughout.

   • Seated Dumbbell Bicep Curls/Overhead Press (Light Weight):

     • How to Do It: Sit on a sturdy chair or bench. For bicep curls, keep elbows tucked. For overhead press, use very light weights and avoid pressing directly overhead if it causes discomfort. Exhale as you lift.

     • Concrete Example: Perform 3 sets of 12-15 repetitions with light dumbbells. Focus on controlled movement and maintaining good posture. If the overhead press causes any pelvic floor symptoms, avoid it.

Strength Training Activities to Avoid or Heavily Modify:

• Crunches, Sit-ups, Leg Raises (Double Leg): These can significantly increase IAP and put undue pressure on the pelvic floor.

• Heavy Deadlifts, Overhead Squats, Olympic Lifts: Unless you have very strong PFM and expert guidance from a pelvic health physical therapist, these are generally not recommended due to extreme IAP.

• Plank (Full Version): While a modified plank (on knees) can be safe, the full plank may be too much pressure for some individuals, especially initially.

• Push-ups (Full Version): Can increase IAP. Modified push-ups (on knees or against a wall) are safer.

Posture and Body Mechanics: Everyday Exercise

Good posture and mindful body mechanics aren’t just for formal workouts; they’re critical in daily activities to support your pelvic floor and manage enterocele. Every movement is an opportunity to practice safe mechanics.

Key Postural Principles:

1. Tall and Aligned: Imagine a string pulling you up from the crown of your head. Keep your ears over your shoulders, shoulders over hips, and hips over ankles. Avoid slouching or excessive arching of your lower back.
   • Concrete Example: When standing, check your alignment in a mirror. Consciously draw your shoulders back and down, slightly tuck your chin, and gently engage your lower abdominal muscles.
2. Neutral Pelvis: Avoid tucking your tailbone excessively or arching your lower back. Find a comfortable, neutral position where your pelvic floor can function optimally.
   • Concrete Example: Practice gently rocking your pelvis back and forth while standing or sitting to find the midpoint where your spine feels most aligned.
3. Mindful Lifting: Whether it’s groceries, a child, or a laundry basket, proper lifting technique is paramount.
   • How to Do It: Get close to the object. Bend at your knees and hips, keeping your back straight. Engage your pelvic floor and exhale as you lift, using your leg muscles. Avoid twisting your torso while lifting.

   • Concrete Example: When picking up a heavy bag, squat down rather than bending at your waist. Exhale forcefully as you stand up, drawing your pelvic floor and lower abs upwards.

4. Sitting and Standing:

   • Sitting: Sit with your feet flat on the floor, knees slightly below hips, and your spine supported. Avoid slumping.

   • Standing: Distribute your weight evenly over both feet. Avoid locking your knees.

   • Concrete Example: If you sit for long periods, get up and move every 30-60 minutes. When standing up from a chair, lean forward slightly, engage your core and PFM, and exhale as you push up through your legs.

Beyond Exercise: Lifestyle Factors for Enterocele Management

Safe exercise is part of a larger picture of enterocele management. Addressing other lifestyle factors can significantly reduce symptoms and improve your ability to exercise comfortably.

1. Prevent Constipation: Straining during bowel movements significantly increases IAP and puts immense pressure on your pelvic floor.
   • How to Do It:
     • Diet: Consume a high-fiber diet rich in fruits, vegetables, and whole grains.

     • Hydration: Drink plenty of water throughout the day.

     • Positioning: Use a squatty potty or a small stool to elevate your knees above your hips when having a bowel movement. This straightens the rectosigmoid angle, making elimination easier.

   • Concrete Example: Aim for 25-30 grams of fiber daily. Start your day with a glass of water and try to drink at least 8 glasses throughout the day.

2. Manage Chronic Cough: Persistent coughing creates repetitive downward pressure on the pelvic floor.

   • How to Do It: Address the underlying cause of your cough with a healthcare professional. If you have a cough, try to “brace and lift” your pelvic floor before you cough.

   • Concrete Example: If you have allergies, manage them with medication. If you smoke, quitting is essential. When you feel a cough coming on, quickly contract your PFM and then cough.

3. Maintain a Healthy Weight: Excess body weight, particularly around the abdomen, increases constant pressure on the pelvic floor.

   • How to Do It: Work towards a healthy weight through a balanced diet and consistent, safe exercise. Gradual, sustainable changes are more effective than crash diets.

   • Concrete Example: Consult with a nutritionist or healthcare provider to develop a personalized plan.

4. Avoid Holding Your Breath or Bearing Down (Beyond Exercise): This applies to any activity where you might naturally hold your breath, such as lifting or straining.

   • How to Do It: Practice exhaling on exertion in all daily activities.

   • Concrete Example: When opening a stuck jar, carrying a heavy bag, or pushing a piece of furniture, remember to exhale as you exert effort.

When to Seek Professional Guidance

While this guide provides comprehensive actionable steps, individual circumstances vary. Consulting with a healthcare professional specializing in pelvic floor health is highly recommended.

Who to Consult:

• Pelvic Health Physical Therapist (PT): These specialists are trained in diagnosing and treating pelvic floor dysfunction. They can assess your specific enterocele, teach you correct pelvic floor activation, and design a personalized exercise program. They can also provide biofeedback to help you learn to engage your muscles correctly.
  • Concrete Example: Your PT might use real-time ultrasound or internal palpation to help you visualize and feel your pelvic floor muscles working. They can guide you on modifying specific exercises based on your symptoms and strength.
• Urogynecologist or Gynecologist: These medical doctors specialize in pelvic floor disorders and can diagnose the extent of your enterocele, discuss treatment options (including pessaries or surgery), and advise on exercise limitations.

Signs You Need to Adjust Your Routine or Seek Help:

• Increased Heaviness or Bulging: Any worsening of your prolapse symptoms during or after exercise.

• Pain: Pelvic pain, lower back pain, or vaginal discomfort.

• Urinary or Fecal Leakage: New or increased incontinence.

• Inability to Engage PFM: Difficulty feeling or performing Kegel exercises correctly.

• Persistent Symptoms: If your symptoms do not improve with consistent, safe exercise and lifestyle modifications.

Conclusion

Exercising safely with an enterocele is entirely possible and highly beneficial for your health and well-being. By prioritizing pelvic floor muscle training, adopting mindful breathing techniques, choosing low-impact cardiovascular activities, and modifying strength training to reduce intra-abdominal pressure, you can continue to enjoy an active lifestyle. Remember that consistency, proper form, and listening to your body are your greatest tools. Coupled with smart lifestyle choices and professional guidance, you can effectively manage your enterocele symptoms and maintain a vibrant, active life.