Modifying floor exercises?

Body: 

I was diagnosed with a triple prolapse (uterine, cystocele and rectocele) four months ago. My doctor prescribed the usual approach—Kegels under the supervision of a physical therapist. After three months of Kegel exercises, I have seen no change in my condition.

I recently came across wholewoman.com and I promptly ordered "Saving the Whole Woman" and the “First Aid for Prolapse” DVD. I am very much taken by the approach and have been successful in altering my posture for a good portion of the day, depending on my activities.

I am terribly disappointed, however, that I am unable to do the floor exercises presented in the beginning exercises on the DVD because my inflexible 69 year old knees and hips will not allow me to sit with my lower legs tucked under my thighs or to assume the cross-legged pose, without pain.

Can these exercises be modified so that I can do them while seated in a chair? If so, how high should the chair be (ie. what should the angle be between my torso and my hips)? Also, I have some balance issues with some of the exercises done in a standing position. Are there any modifications of those exercises that I should know about?

Welcome Dido, thanks for posting and sharing your experiences. I'm glad you found us and glad you ditched the Kegel approach.

Yes, the exercises can be modified. Sitting in a chair that is the right height for your feet to be flat on the floor is probably best. If balance is an issue, you can hold onto something (like the back of a chair) but you should also be working towards the goal of improving your balance.

Unless you have a hip or knee injury, or a condition that prevents you from safely doing so, you should also strive for greater flexibility over time. Use it or lose it! This work is as much about hip health as anything else. At 69 you need to cultivate more flexibility if you can. Is there more to your story that we should know?

A cushion for underneath your butt can help with these floor positions, by increasing comfort and also leveraging more lumbar curvature.

Take it slow and don't do anything to harm yourself, but do consider gradually working the stiffness out of those joints if you can. The hips dvd has some great moves. - Surviving

Thank you, Surviving 60, for your suggestions! I will try them.
I'm not sure what all would be helpful for you to know about my story, but I'll give it a try so see if there is anything useful in it.
First of all, I have never been limber or supple. I’ve always just accepted that that is the way I am, though ten years ago I took weekly classes in Viniyoga with a wonderful teacher for a year, but became discouraged by the fact that I couldn’t seem to improve my flexibility. Then other things took over in my life and I stopped. Six years ago I fell on some icy steps and suffered a T vertebra compression fracture. That brought an end to my daily habit of jogging. I did some physical therapy to help remedy that condition. I am rarely bothered by it, except when I spend more than a couple of hours a day playing my cello. Also, at age five I broke my coccyx and have been plagued all my life by pain while seated in airplane seats and other similar circumstances.
As for my prolapse problem: forgive me if what I have to say about it is far more than is relevant or useful.
When I first saw my gynocologist, he speculated that my condition had been provoked by a bout of acute bronchitis a month before. At a subsequent visit he said the fact that my first child, born 37 years ago, had been delivered using forceps, followed by an episiotomy, may also have been a contributing factor. Since then, I have also wondered if the fact that I had taken up a program of weight training a couple of months before I came down with bronchitis might also have contributed to my condition. I also recognize that two vaginal deliveries and my age are important factors.
When I saw him a second time, to assess the effects of doing two and a half months of Kegels, he seemed pleased that the physical therapist had reported that I had made progress in both the strength and endurance of the Kegels. He recommended continuing working with the physical therapist, and if my condition did not improve, to try using a pessary. He also described the surgical procedures to remedy the cystocele and rectocele. It was these descriptions that drove me back to the internet to find out more about these troubling-sounding procedures that luckily brought me to Whole Woman.
Also at that same appointment, I asked about the efficacy of using estrogen cream, something I had read about in the pamphlet he had given me at my first appointment. ( I should say that I am 69, started menopause when I was 50 and have never taken hormone replacement therapy. He prescribed a very low dosage of Estrace—1 gram twice a week for a month-- to be reduced to once a week after that.) I have been taking it for two weeks and have noticed that the bulge from my vagina is less pronounced more of the time.

Luckily my symptoms are not extreme. The pain in my left groin and hip that was a three week prelude to my discovering the prolapse has ceased. I do not suffer from urinary incontinence, though I sometimes feel that I don't empty my bladder completely (but then I have had that feeling for years). I do not suffer from constipation, though I have to strain and use splinting, suggested by the physical therapist, to get things moving past the 'blockade' at the outset of a bowel movement.

In reading about pessaries, I learned that they are least effective for rectoceles, the aspect of my condition that seems to be the most pronounced as that is what I believe I see protruding from my vagina most dramatically before and after a bowel movement. I believe that neither the doctor or the physical therapist have a very good idea of my condition because they have examined me only while I am lying on my back. They have not seen what I see when I check myself in a small mirror when I am standing. When I have described what I see to the physical therapist, she said I was seeing the rectocele. However the drawing in your book of a cystocele Fig. 3-4 on pg. 33 (of the updated version of Saving the Whole Woman) comes closest to looking like what I see. So, I guess I really don’t feel that I have received a fine-tuned diagnosis. I am considering getting a second opinion from another doctor. I’m wondering if it would make sense to see a urologist as well. I’m apprehensive about putting myself in the hands of more doctors who will propose the same old, standard, wrong-headed approach to this problem.

Thanking you in advance for any advice you can give in response to this rather long-winded account!

Dido70

Hi Dido70,
Welcome to the WW community. I'm so glad you found this site. Thousand sod women have benefitted from this approach and I'm confident that anyone who engages with this approach can not only improve their symptoms but also feel happier or better generally.

For women who find the 1st Aid To Prolpase exercises difficult to follow, one possibility is to adapt these. Doing some a postures seated rather than standing, with feet flat not he floor and thighs parallel to the floor is one adaptation, working upto but within your limits is another way of adapting some postures. Viniyoga teachers are generally trained to work well with adaptations, so one possibility is to follow a yoga dvd and go through these exercises with a viniyoga teacher if there is anyone you could visit. Or better still, if you're lucky enough to see a WW teacher, they would also be able to advise. There is also a WW dvd for elders, which has been specially designed for women who wish to follow a gentler regime. I do encourage you to engage with WW exercises as they can be an important factor in improving pop symptoms.

It sounds a sir some of your symptoms may have already improved a little. This may be due to beginning to engage with the WW approach.

You identified various factors in your life history which you thought may have contributed to your current pelvic organ prolapse (pop). They all sound likely contributors. I think must of us have had those 'aha' moments!

Re further examinations. It's very much a personal choice. Just bear in mind that in all likelihood the medics will be seeing pop issues through the same education and paradigms. Some women find it helpful and others don't - so each woman's call…

You may find the on-line course helpful. Apart from 5 wonderful lectures, there is a WW exercise programme which I find is not as demanding as the 1st Aid to Prolapse and includes a 30' consultation with a WW practitioner.

Wishing yo all the best,
Love wholewomanuk

Hi again Dido - I wanted to discuss the Estrace. It is my understanding that this works to lessen prolapse symptoms by thickening the vaginal walls so the bulge is less evident. I personally don't find this to be sufficient reason to use hormones, but everyone needs to assess the risk and make that choice for themselves. Doctors tend to minimize the degree of absorption of these substances, but clearly they are getting into your system in a big way.

I myself have never had a formal diagnosis of my 'celes, and for myself, I see no reason to go to a surgeon and hear what he or she has to say! Some women feel a need to do this in order to rule out other conditions. I never did. I'm just saying this so that if you decide you don't need another doctor's opinion, you will realize you are not alone in this. Prolapse is prolapse, and the management is the same regardless of what type of prolapse and what "degree" a doctor declares you to have at any specific point in time.

I can tell that you are doing fine. Keep it up and keep us posted on your progress. - Surviving

I am extremely grateful to both Surviving 60 and wholewomanuk for your thoughtful responses to my situation and suggestions for sources of information to help me with adapting the beginning exercises for my inflexible body. I clearly have not exhausted the resources available on the Whole Woman site. It is a bit overwhelming, but your steering me to specific places should be a great help.

In addition, your comments about Estrace confirm my suspicions that it may be more potent than my doctor led me to believe. I had always been firm in my decision not to take HRT right from the start, almost 20 years ago, and when he prescribed it, giving the reason that you stated, I had misgivings about abandoning my resolve. I think I will toss the stuff.

Feeling far more empowered thanks to you...

Dido

Well, that's a beautiful word and it certainly describes what this work does to a person.

Since my own journey began, I've often speculated about some of the popular measures that pass for "treatment" of prolapse. Estrace in particular (which elsewhere I have actually seen as a suggestion made to nursing moms, if you can believe that). I think there is a fear of this bulge, and anything that lessens our sensation of this bulge must be a good thing, huh? That is SO not the case. Same is true of pessaries; they may mask the bulge but they just aggravate things in the long run. The message I wish women would hear, is that they do not need to be afraid of the feeling. It is a great feedback mechanism and it really gets you to tune into your body, which is the ONE AND ONLY way to manage prolapse. - Surviving

So well said, surviving!! I love the way you always look at prolapse as a feedback mechanism and not as a hindrance, although I know early on in this journey I didn't want to accept that fact. But, now? Yes, that is exactly what it is and how I view it.
Thank you for your wonderful words and steadfast deliverance of them!

Thank you again, Surviving, for your comment. It has helped me view my POP as parallel to my way of coping with the symptoms of menopause (without HRT). Having decided not to "treat" the natural process of menopause with drugs, I settled in to learn to cope with and adjust to the disagreeable aspects of menopause- severe hot flashes for years, vaginal dryness, etc.. by simply modifying minor aspects of my daily habits, like learning what factors prompted hot flashes (certain foods, environmental conditions or emotional situations) in order to avoid them or coping when I couldn't avoid them, like never wearing turtlenecks, like dressing in layers so that it would be easy to take the top one off when I suddenly heated up, etc.. And it took my family awhile to adjust to my strange behavior-- suddenly leaving the dinner table to step outside into the cold night air for a minute or two, opening a car window to catch a cooling breeze, etc..

POP poses more challenging and persistent forms of discomfort, but I am hopeful that by taking charge I will be able to handle them with in a similar way. Attitude is all important and fear is our worst enemy.

And thank you, Aging gracefully, for your confirmation of the wisdom of Surviving's words.

Have you tried red clover for your menopausal symptoms? It comes in many forms: tea, balm, and even pill, I think. Many of the ladies here swear by it. My mom actually uses the balm for vaginal dryness, instead of that nasty hormonal cream. Women aren't meant to have that much estrogen in them at an older age. I don't care what the doctors say about it not absorbing in that much. She was even having side effects from it. Not good! And, Christine uses a dab of honey inserted vaginally for the dryness. The honey helps feed the lactobacilli in the vagina, and from what Christine says, it really helps.

AG, were you around when Louise told us about the hot flashes she was getting, just from applying some Estrace (or similar) for several days to toughen up her tissues for some procedure or test she was getting? Can't recall the exact scenario, but her doctor requested it, and she did it, because it was just for a very short duration. Wow....

Yes, now that you mention it, I think I do remember that. I also like the way she talks about the red clover taking up the estrogen receptor sites without having the estrogen side effects. Something about a parking garage, a really good analogy. Can't remember what thread that was on, but great info.

Thanks for the red clover information. Although at this point, 20 years after starting menopause, I have only the occasional hot flash, the idea that red clover balm might be a substitute for estrogen cream is very welcome. You two have been enormously generous in your advice.