Running With Prolapse: Can You Keep Running?

Running with prolapse can feel confusing. You may wonder whether running will make your prolapse worse or whether vaginal heaviness means you are causing damage.

For many women, running is about more than fitness. It can improve mood, support bone and heart health, provide time alone and help you feel connected to your body.

The reassuring news is that a prolapse diagnosis does not automatically mean you need to stop running.

Running places increased demand on the pelvic floor. Therefore, it may trigger symptoms in some women. However, current research has not shown that recreational running inevitably causes prolapse or permanently worsens an existing prolapse.[1–3]

Instead of labelling running as either safe or unsafe, we need to consider your symptoms, running load and individual pelvic floor capacity.

What is pelvic organ prolapse?

Pelvic organ prolapse occurs when one or more pelvic organs move downwards towards the vaginal opening.

It may involve the:

• Bladder and front vaginal wall
• Bowel and back vaginal wall
• Uterus or cervix
• Top of the vagina following a hysterectomy

Symptoms may include vaginal heaviness, pressure, dragging or a noticeable bulge. Some women describe it as feeling like a tampon is sitting too low.

Symptoms can change throughout the day. For example, you may feel comfortable during normal activities but notice heaviness after standing, lifting or exercising for longer.

Does running with prolapse make it worse?

Research cannot yet give us a simple yes or no answer.

Studies show that running can temporarily change pelvic organ support. However, we do not have strong long-term studies showing that recreational running causes permanent prolapse progression.[1–3]

This distinction is important.

Temporary movement or heaviness after running does not necessarily mean you have permanently worsened your prolapse.

What happens to the pelvic floor after running?

A 2024 study assessed women before and after approximately 37 minutes of treadmill running.

After the run, researchers found:

• A larger opening through the pelvic floor muscles
• A lower resting position of the bladder neck
• Temporary lengthening of some pelvic floor support structures
• No reduction in pelvic floor muscle contractile function

The findings suggest that running temporarily affected the passive support tissues. However, the pelvic floor muscles did not appear to become weaker after the run.[2]

A follow-up study found similar temporary changes. Interestingly, the amount of pelvic floor loading measured during the run did not predict which women experienced the greatest changes.[3]

Therefore, the body’s response is more complex than “more impact equals more prolapse”.

Researchers still need to determine:

• How quickly support returns to its usual position
• Whether repeated temporary changes have a long-term effect
• How different stages of prolapse respond
• Why one runner experiences symptoms while another does not

What is intra-abdominal pressure?

Women often hear about exercise causing “pressure down” or “force on the pelvic floor”.

The technical term for this is intra-abdominal pressure, or IAP.

IAP is the pressure created inside your abdominal cavity. It naturally rises when your diaphragm, abdominal muscles and trunk work together.

This occurs when you:

• Cough or sneeze
• Lift or carry something
• Stand up from a chair
• Jump
• Perform abdominal exercises
• Run
• Strain to open your bowels

Intra-abdominal pressure is not automatically harmful. Your body uses pressure to stabilise your spine and transfer force during movement.

Pressure also does not simply travel straight down onto the pelvic floor. Your diaphragm, abdominal wall, spine and pelvic floor work together to contain and manage it.

How does running pressure compare with everyday activities?

Laboratory studies have compared the approximate pressure created during different tasks.[4–6]

The values below provide a general guide. They are not safety limits.

A separate study examined women carrying 13.6 kg, similar to carrying a three-month-old baby in a capsule. The amount of pressure changed depending on how they carried the load. Some carrying positions created pressure within a similar range to moderate running.[5]

This provides an important perspective. Running is not the only activity that increases pressure through the abdomen and pelvic floor.

However, running is different because the pressure and impact occur repeatedly. A cough may cause one short, high-pressure event. In contrast, a 30-minute run may involve thousands of repeated pressure rises.

Therefore, pelvic floor demand depends on more than the highest pressure number. It also involves:

• How often the pressure occurs
• How quickly it rises
• How long the activity continues
• Running speed and terrain
• Fatigue
• Pelvic floor strength and coordination
• Connective tissue support
• Recovery between sessions

Women also produce very different pressures during the same task. As a result, there is no recognised IAP number above which an activity suddenly becomes unsafe.[4,6]

What are ground reaction forces?

Intra-abdominal pressure is only one part of running.

When your foot lands, it applies force to the ground. The ground then applies force back through your body. We call this a ground reaction force.

Your feet, ankles, knees, hips, trunk and pelvic floor all help absorb and transfer this force.

These forces are a normal part of running. In fact, muscles, bones and tendons need progressive loading to become stronger.

However, running repeats the force with every step. Speed, stride length, cadence, hills and fatigue can all change how quickly your body absorbs it.

The aim is not to remove all force. Instead, we want to expose your body to a manageable amount and gradually build its capacity.

What does heaviness partway through a run mean?

Some women feel comfortable at the start of a run but develop vaginal heaviness after 10, 20 or 30 minutes.

This provides useful information about your current running capacity.

It does not automatically mean you have damaged your pelvic floor. Instead, the accumulated demand may have temporarily exceeded what your support system can comfortably manage.

Symptoms may be influenced by:

• Running duration
• Running speed
• Hills or long downhill sections
• Pelvic floor or leg fatigue
• Your overall weekly training load
• Constipation or straining
• A persistent cough
• Postnatal recovery
• Hormonal changes
• Sleep and recovery

Use the point at which symptoms start as a guide.

For example, if heaviness regularly begins at 25 minutes, start with a 15-to-20-minute run. You can then build gradually as your symptoms and capacity improve.

Changes that may make running more comfortable

No single running style will suit every woman. However, several changes may reduce cumulative loading and improve comfort.

Start below your symptom threshold

Finish your run before heaviness or bulging becomes noticeable.

This is not necessarily a permanent restriction. Instead, it gives you a comfortable baseline from which you can rebuild.

Monitor your symptoms:

• During the run
• Immediately afterwards
• Later that day
• The following morning

Use run-walk intervals

Walking breaks reduce the number of consecutive running impacts. They also provide regular opportunities for recovery.

You could begin with:

• Two minutes running and one minute walking
• Three minutes running and one minute walking
• Five minutes running and one minute walking

Run-walk intervals are valuable whenever you return to running after childbirth, injury or a long break.

During time away from running, your pelvic floor, legs, bones and tendons lose some running-specific capacity. Gradual exposure allows these tissues to adapt again.

Therefore, it is usually better to complete a manageable amount consistently than to return immediately to your previous distance.[10]

Reduce your running speed

Faster running usually increases the demand placed on the body.

Initially, replace sprints, fast intervals and hard hill sessions with a comfortable pace. You should be able to hold a conversation.

However, avoid slowing down by reaching further forward with each step. A relaxed pace with comfortable, relatively quick steps may feel better.

Trial a small increase in cadence

Cadence is the number of steps you take each minute.

Increasing cadence while keeping the same speed usually shortens your stride. Research shows that a moderate cadence increase can reduce vertical ground reaction forces, braking forces and loading rates.[7]

However, this does not mean every runner needs to reach 180 steps per minute.

Start by finding your natural cadence. Then trial a small increase of approximately 3% to 5%.

How to measure your running cadence

You can calculate cadence with the stopwatch on your phone:

1. Run at your usual comfortable pace.
2. Once settled, count every footfall for 30 seconds.
3. Multiply the result by two.

For example, 82 steps in 30 seconds equals 164 steps per minute.

Alternatively, count each time one foot lands for 30 seconds. Then multiply the number by four.

Some running watches and phone apps also measure cadence.

Once you know your usual cadence, use a metronome app or music with a matching beat to practise a small increase.

Helpful cues include:

• Take slightly shorter and quicker steps
• Let your feet land closer underneath you
• Run quietly
• Think about moving forwards instead of bouncing upwards

Early research has found links between slower cadence, longer ground-contact time and greater pelvic floor symptoms. A small 2026 study also found improved running mechanics and urinary symptoms after cadence retraining.[8,9]

However, researchers have not yet shown that cadence changes reduce prolapse progression. Therefore, treat cadence as one possible tool rather than a rule for every runner.

Choose flatter terrain initially

Downhill running often creates greater braking forces.

If your symptoms are sensitive, start on a flat and predictable surface. You can gradually add hills as your capacity improves.

Reduce excessive bouncing

Some runners move further up and down with each step.

Cues such as “run quietly” or “keep your head relatively level” may reduce abrupt loading. However, your body should still feel relaxed.

Avoid holding your breath, pulling your stomach in or making your whole body rigid.

Consider your whole week

Your pelvic floor responds to everything you do, not only running.

Your weekly load may include:

• Strength training
• Group exercise
• Carrying children
• Long periods of standing
• Work demands
• Poor sleep
• Constipation
• Limited recovery

You do not need to avoid these activities. Instead, balance your training and recovery while your capacity builds.

Try to change one running variable at a time. For example, build duration before adding speed, hills and extra sessions.

Should you squeeze your pelvic floor while running?

There is no evidence that you should hold a pelvic floor contraction throughout your entire run.

The pelvic floor needs to respond dynamically. It contracts, lengthens and coordinates with your breathing and abdominal muscles during each stride.

Constantly squeezing may cause fatigue, interfere with breathing or increase abdominal bracing.

Instead, the goal is to develop enough strength, endurance and coordination for the pelvic floor to respond automatically.

How can pelvic floor physiotherapy help?

Running with prolapse involves more than checking whether you can perform a strong pelvic floor contraction.

A pelvic health physiotherapist may assess:

• The type and stage of your prolapse
• Pelvic floor strength and endurance
• Muscle coordination and relaxation
• Bladder and bowel symptoms
• Constipation and toileting habits
• Abdominal and leg strength
• Single-leg control
• Impact tolerance
• Running technique and volume
• When symptoms begin

Treatment may include pelvic floor training, whole-body strength work, impact preparation, running modifications and gradual exposure.

Clinical guidelines recommend supervised pelvic floor muscle training as a conservative treatment for symptomatic stage one or stage two prolapse.[11]

Can a pessary help you run with prolapse?

A vaginal pessary is a removable silicone device placed inside the vagina to support the pelvic organs.

For some women, a pessary can significantly reduce heaviness or bulging during running.

Some women wear a pessary only for running or exercise. Others wear one to support them during everyday life as well.

Depending on the pessary type, you may learn to insert and remove it independently.

A pessary needs to be individually fitted. The correct style and size should:

• Provide adequate support
• Stay in place during movement
• Feel comfortable
• Allow normal bladder and bowel emptying
• Avoid pain, rubbing or bleeding

Clinical guidelines recommend considering a pessary for symptomatic prolapse. You can use one by itself or alongside pelvic floor muscle training.[11,12]

A pessary does not mean that your pelvic floor has failed. Instead, it is another support option that may help you participate in activities that matter to you.

Other ways to support your pelvic floor

Treat constipation

Repeated straining increases pelvic floor demand. Improving stool consistency, bowel position and emptying technique can help.

Manage a persistent cough

Coughing creates repeated high-pressure events. Speak to your doctor if your cough continues or is difficult to manage.

Build whole-body strength

Your calves, thighs, hips and trunk help absorb running forces. Building strength throughout your body means your pelvic floor does not manage running alone.

Use other forms of cardiovascular exercise

Temporarily reducing your running does not mean stopping exercise.

Walking, cycling, swimming and shorter run-walk sessions can maintain your fitness while you build running tolerance.

When should you seek help?

Consider seeing a pelvic health physiotherapist if you experience:

• Vaginal heaviness, pressure or dragging while running
• A vaginal bulge
• Symptoms that increase as your run continues
• Symptoms that remain worse later that day
• Bladder or bowel changes
• Pelvic or vaginal pain
• Uncertainty about returning to running
• Fear that prolapse means you must stop exercising

You do not need to wait until your symptoms become severe.

The takeaway about running with prolapse

Running places repeated demand on the pelvic floor. It may also temporarily increase pelvic organ movement or trigger symptoms in some women.

However, current research does not show that every woman with prolapse must stop running. It also does not show that recreational running inevitably causes permanent prolapse progression.

If heaviness begins partway through a run, use it as information about your current capacity.

Shorter runs, walking intervals, a comfortable pace, a small cadence adjustment and gradual progression may help. Pelvic floor rehabilitation and a correctly fitted pessary can provide further support.

A prolapse diagnosis does not need to be the end of running. With individual assessment and the right support, many women can continue working towards the activities they enjoy.

At Uplift Women’s Health Collective, our pelvic health physiotherapists can assess your prolapse, pelvic floor function and running demands. We can help you develop an individual rehabilitation plan and discuss whether a vaginal pessary may help you feel more supported during exercise.

Book online via our website (Book Now) or call (03) 8828 4761 to speak with our team and arrange an appointment.

References

1. Bø K, Anglès-Acedo S, Batra A, et al. Strenuous physical activity, exercise, and pelvic organ prolapse: a narrative scoping review. International Urogynecology Journal. 2023;34:1153–1164. doi:10.1007/s00192-023-05450-3.
2. Bérubé MÈ, et al. The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence. International Urogynecology Journal. 2024;35:127–138. doi:10.1007/s00192-023-05674-3.
3. Bérubé MÈ, Niederauer S, Graham R, Hitchcock R, McLean L. Is pelvic floor loading in female runners associated with post-run changes in pelvic floor morphometry or function? BJU International. 2025;136(4):707–718. doi:10.1111/bju.16842.
4. Shaw JM, Hamad NM, Coleman TJ, et al. Intra-abdominal pressures during activity in women using an intra-vaginal pressure transducer. Journal of Sports Sciences. 2014;32(12):1176–1185. doi:10.1080/02640414.2014.889845.
5. Coleman TJ, Hamad NM, Shaw JM, et al. Effects of walking speeds and carrying techniques on intra-abdominal pressure in women. International Urogynecology Journal. 2015;26:967–974. doi:10.1007/s00192-014-2593-5.
6. Dietze-Hermosa M, Hitchcock R, Nygaard IE, Shaw JM. Intra-abdominal pressure and pelvic floor health: should we be thinking about this relationship differently? Female Pelvic Medicine & Reconstructive Surgery. 2020;26(7):409–414.
7. Figueiredo I, Reis e Silva M, Sousa JE. The influence of running cadence on biomechanics and injury prevention: a systematic review. Cureus. 2025;17(8). doi:10.7759/cureus.90322.
8. Ron NJ, Dolbinski SC, Hodonicky EG, et al. Associations between running mechanics, functional lower-extremity strength, and stress urinary incontinence in parous female runners. Journal of Women’s & Pelvic Health Physical Therapy. 2024;48(3):147–153. doi:10.1097/JWH.0000000000000302.
9. Ron NJ, Olmstead SR. The feasibility and preliminary effectiveness of a six-week independent cadence retraining program on parous runners with stress urinary incontinence. Journal of Women’s & Pelvic Health Physical Therapy. 2026;50(1):34–41. doi:10.1097/JWH.0000000000000359.
10. Deering RE, Donnelly GM, Brockwell E, et al. Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. British Journal of Sports Medicine. 2024;58(4):183–195.
11. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE Guideline NG123. 2019.
12. Bugge C, Adams EJ, Gopinath D, et al. Pessaries for managing pelvic organ prolapse in women. Cochrane Database of Systematic Reviews. 2020;11. doi:10.1002/14651858.CD004010.pub4.