Does physical activity exacerbate grade 1-2 (mild to moderate) cervical (neck) prolapse?

From the Guidelines

Grade 1-2 cervical prolapse does not typically worsen with moderate physical activity, and women with this condition can generally continue regular physical activities with some modifications. The evidence suggests that physical activity has no adverse effect on women with short cervix and could even delay delivery 1. In fact, preventing all physical activity increased the rate of preterm birth in women with a short cervix, while exercising more than 2 days a week for more than 20 minutes did not increase the risk of preterm birth 1.

Key Considerations

• High-impact exercises like jumping, heavy weightlifting, or activities that significantly increase abdominal pressure should be avoided or modified.
• Low-impact activities such as walking, swimming, or cycling are recommended.
• Pelvic floor exercises (Kegel exercises) are beneficial and recommended—perform 3 sets of 10 contractions daily, holding each contraction for 5-10 seconds.
• Core-strengthening exercises that don't increase downward pressure can also help support the pelvic organs.

Evidence-Based Guidance

The guidance is based on the fact that mild prolapse is a structural condition where the supporting tissues of the cervix are weakened but still functional, and moderate activity generally doesn't place enough strain on these tissues to cause significant progression of the condition. A study by Grobman et al found that preterm birth at less than 37 weeks of gestation and at less than 34 weeks of gestation was more common when women were placed on any type of activity restriction, whether pelvic, work, or nonwork rest, in both inpatient and outpatient settings 1.

Recommendations

• Women with grade 1-2 cervical prolapse should be advised to avoid high-impact and/or strenuous physical exercise as a precautionary measure.
• In the absence of other complications, women with grade 1-2 cervical prolapse should be encouraged to meet current physical activity recommendations.
• If you experience increased discomfort, heaviness, or bulging during or after exercise, reduce intensity or try different activities.

From the Research

Grade 1-2 Cervical Prolapse and Physical Activity

• The provided studies do not directly address whether grade 1-2 cervical prolapse gets worse with physical activity.
• However, some studies suggest that symptoms of pelvic organ prolapse, including cervical prolapse, can worsen with exertion 2.
• It is also mentioned that patients with symptomatic prolapse may experience worsening symptoms with physical activity, but this is not specifically stated for grade 1-2 cervical prolapse 2.
• Conservative management options, such as pelvic floor physical therapy and pessary use, are recommended for patients with symptomatic prolapse, but it is not clear if these options are effective in preventing worsening of grade 1-2 cervical prolapse with physical activity 3, 4.
• Surgical treatment options are also available, but the decision to undergo surgery should be based on individual patient factors, including the severity of symptoms and the patient's overall health 5, 3, 4.

Management of Pelvic Organ Prolapse

• The management of pelvic organ prolapse, including cervical prolapse, typically involves a combination of conservative and surgical options 5, 3, 4.
• Conservative management options include pelvic floor physical therapy, pessary use, and lifestyle modifications, such as avoiding heavy lifting and exertional activities 3, 4, 6.
• Surgical treatment options include transvaginal, laparoscopic, and abdominal approaches, and the choice of procedure depends on individual patient factors, including the severity of symptoms and the patient's overall health 5, 3, 4.

Prevention of Worsening Symptoms

• While the provided studies do not specifically address how to prevent worsening of grade 1-2 cervical prolapse with physical activity, they do suggest that conservative management options, such as pelvic floor physical therapy and pessary use, can help to manage symptoms and prevent worsening of prolapse 3, 4, 6.
• Additionally, lifestyle modifications, such as avoiding heavy lifting and exertional activities, may also help to prevent worsening of symptoms 2, 6.