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The Down Low on your Down Below: What you might like to know about your Pelvic Floor Health

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June is Pelvic Organ Prolapse (POP) Awareness Month - but anytime is a good time to chat about this!

I don't think I've ever heard anyone talk about POP openly or with any detail before this year. I am extensively trained and aware of movements that may or may not contribute to POP, what (typically) to avoid when working with susceptible populations, and how to create better pelvic function and support, but never have I heard causal conversion about what it is and how it feels physically and emotionally to live with POP. It’s always talked about as if no one in the room actually has it and how we’re going to keep it that way. It’s a little bit of a taboo to talk about our “Down There”!

First off WHAT is Pelvic Organ Prolapse?

"Prolapse" refers to a descending or drooping of organs. Pelvic organ prolapse refers to the prolapse or drooping of any of the pelvic floor organs, including: Bladder, Uterus, Vagina, Small bowel, Rectum.

Some people notice nothing at all, but others report these symptoms with pelvic floor dysfunction and organ prolapse.

Some people notice nothing at all, but others report these symptoms with pelvic floor dysfunction and organ prolapse.

In the body, the pelvic floor muscles span the base of the pelvis and support the pelvic organs. There is also support of these organs from above via connective tissue/ligaments and fascia. The pelvic organs are meant to be suspended from above, and supported from below. When something happens to disrupt this balance, a prolapse is likely to occur.

(Learn more about different types of prolapse here)

Years ago, 13.5 to be exact, in the immediate postpartum time after my second child was born, I realized that I couldn’t tell if I had to urinate and often felt like I couldn’t fully empty my bladder. I assumed it was because I had just had a baby and her birth was crazy fast. I slowly regained sensation but continued to feel like I hadn’t “finished the job".

I returned to my dance career unable to jump. Thankfully, I wasn't in pain, but I was leaking urine, I was incontinent! 

Many, many postpartum bodies find themselves unable to laugh, sneeze and cough let alone jump... and I was one of them. 

It was a nuisance. I would excuse myself from class or rehearsal to use the washroom in hopes that I wouldn't all-out pee my pants. Like many of us, I thought this was just part of having had babies. I never thought to mention it to anyone, and I certainly didn't think to challenge our medical system to say this was unacceptable.

I thought it was normal. It's not.

It IS common, but it's not normal. 

Back then, no one talked about pelvic health during pregnancy or after giving birth. Healthcare professionals and pregnancy books alike said "do kegels". Well, they weren't entirely wrong but they weren't right either. 

There was a huge lack of knowledge about the contributing factors, risk factors, preventative measures and what the symptoms were. No one was telling me what to look for or that my daily physical activities, certain exercises, and postural habits may all have been sealing my pelvic floor fate!

This is when I began my in depth studies on pelvic health, specifically so that I could work with pregnant and postpartum clients. I changed the way I moved physically throughout my days and how I exercised. I brought new awareness to the way I taught Pilates, exercise and dance.

I thought I’d done a decent job of rehabilitating my pelvic health.

Fast forward to the present day.

Three and half years after my third baby and rehabbing a significant Diastasis Recti Abdominus, I began noticed a downward pressure when I used the toilet. My bladder emptying issues came back/ seemed more frequent and I was getting some low back pain/ ache.

I booked a physical with my family doctor... About 5 years earlier I had asked my doctor to check my pelvic health and she poo-pooed my concerns. This time I insisted that my doctor refer me to a pelvic floor physiotherapist.

In a one hour session, my physiotherapist congratulated me on having excellent pelvic floor and transverus recruitment (yay! my inner core worked!) AND confirmed that I had a grade 2+ Cystocele (bladder prolapse) and grade 2 Uterocele (uterus/ cervical prolapse).


I walked home crying. It was a huge emotional blow. I can’t explain why I felt so devastated and why some days I still do. I thought I had done "all the things". After all, she said I had an excellent core! All I knew now was I was "in it" for the long haul. I would always have to be aware of my symptoms and make a conscious effort to keep from getting worse. There was no turning back time or “fixing” this. I might be able to see measurable improvement, but more likely the best I can hope for is to physically train and work toward symptom-free physical exertion. I felt like I'd failed myself.

I spend my days working on posture, breathing, effectively recruiting and releasing my inner core with a specific focus on PROPERLY doing a "Kegel". I integrate this with walking, sitting, standing, and I'm working on squatting... all things I need to be able to do in my life and in my profession. (All things I do with my clients too!) I'm more susceptible to injury and I'm worried I'll hurt myself. I never stop thinking about it... it's exhausting. I'm constantly thinking that my parts will fall out of my body, and contemplating whether or not I should get sized for a pessary, use estrogen creams or if I’ll require surgery. 

Significantly more research has gone into pelvic floor dysfunction and pelvic organ prolapse in recent years. We have a much better sense of the importance and impact on the quality of life our pelvic floor health has on us. Stay tuned for more blogs on these subjects!

Thankfully, Pelvic Floor Physiotherapists are popping up all over the place as are Pilates Specialists (like myself) who are trained to help one reintegrate movement, build strength and better function. Even doctors and midwives are more aware of pelvic floor health and directing clients to these services.

My hope is that this information will decrease your chances or catch your issues early!

Treatment for pelvic floor dysfunction and prolapse is very individualized and can be effective if it’s timely and targeted. Please seek out assessment and guidance if you are pregnant, as part of your 6-week postpartum checkup (anytime after the birth of a child - the sooner the better!) or if you have any of the symptoms listed.

If you are in the Greater Toronto Area and looking for a Pelvic Floor Physiotherapist ask me for a recommendation in your area!

If you would like to know more about Pelvic Floor Health, how to exercise and function safely throughout your pregnancy and postpartum year, contact me & sign up for the newsletter here!


Written by Ruth Ruttan, Doula & Pre & Postnatal Pilates Specialist at Retrofit Pilates

Ruth has enjoyed watching many bodies change, stay functional and become powerful humans. Education is at the centre of her approach, believing that knowledge is power and that informing our minds and bodies will help build an extraordinary life experience. Creative by nature and armed with an excellent knowledge of functional anatomy and physiology of pregnancy & birth, Ruth loves working with all sorts of bellies, babies and bodies!

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