Yoga and The Pelvic Floor
As women we are exposed to relentless conditioning from an early age. As a teen growing up I remember wriggling around the floor trying to squeeze into the tightest jeans I had and then standing uncomfortably all evening barely able to talk let alone eat as I was trying to constantly hold my tummy in to stop the button from bursting open. I have a feeling this was fairly common!
After having children I was desperate to lose my mum tum as quickly as possible and return to “normal” so that I could look good as well as care for my children and be a great wife, study and work. The pressure women are under with the increasing influences of social media, other people and not forgetting the pressure they put themselves under to look a certain way, is insane.
By the time we reach adulthood most of us are in a whole world of imbalances when it comes to the pelvic floor. We are either constantly gripping as we hold our tummies in to look good aesthetically, over brace our abdominals during exercise or generally hold tension there because we are stressed.
Without even realising, these habitual patterns can cause weaknesses. Poor posture also plays a part and then pregnancy and childbirth are thrown into the mix which is the biggest contributor of pelvic floor weakness. Women can often blame their dysfunction on their child bearing days and are often told by GP’s and healthcare workers that its normal to leak after having after having a baby and put up with it (look at the range of Tena ladies in the supermarket, its bigger than ever!).
We can also store a lot of emotion and negative memory in our hips so the combination of postural habits, physical and emotional experiences can lead to an unhappy and unhealthy, poorly functioning pelvic floor which can affect us both physically as well as emotionally.
In this essay I will explore what the pelvic floor is, how it should function ideally, how the pelvic floor is affected when it is dysfunctional, and how Yoga can help improve our pelvic floor health, both physically and emotionally.
So what is the Pelvic Floor, how should it function and in what ways can it function sub optimally?
Anatomically we can think about the Pelvic Floor as the layer or sling of muscles (not just one muscle!) that our torso sits in. This hammock like layer of muscles and fascial tissue attaches and stretches from the tailbone (coccyx) to the pubic bone and side to side to the ischial tuberosity’s or sit bones, across the floor of the pelvis.
These muscles support the internal organs of the pelvis, the bladder, the bowel and the uterus. This layer of muscles has to have enough ‘give’ to absorb force and shock or impact for when we cough, jump, laugh but also strength to support the pelvic organs. A happy pelvic floor will give you control over your bladder and bowel at all times, prevent prolapse and is also important for sexual function.
The Pelvic Floor works in sync with the diaphragm. When we inhale the diaphragm moves down and the pelvic floor relaxes and descends, as we exhale, the diaphragm moves up and the pelvic floor ascends increasing support and stability of the bladder and bowel. If the diaphragm is moving well the pelvic floor will engage well.
This muscle is no different from any other, in order to contract is has to fully lengthen. We couldn’t keep the arm in a tight bicep curl constantly, it would eventually fatigue and become exhausted. The pelvic floor muscle is the same.
Not in the scope for this essay but important to mention that in order for the diaphragm and the pelvic floor to work together in harmony one would need to look at breathing patterns, if the person is a shallow breather or has a paradoxical breathing pattern, their posture, and rib mobility. If a client was really struggling with these issues it might be sensible to refer out to a specialist.
Dysfunction and its causes.
Its often after pregnancy and childbirth that we start to give the pelvic floor some attention or notice things feel different but for many people there are many other reasons apart from childbirth that the pelvic floor doesn’t perform as well as it could. Other contributing factors include menopause, obesity, surgery, bearing down on the pelvic floor during exercise, heavy lifting, chronic coughing, constipation, stress and poor posture. Men can also suffer from a weakened pelvic floor, especially if they have issues with the prostrate.
Physical symptoms associated with a weakened pelvic floor include leaking urine with coughing, sneezing, running or laughing (stress incontinence), urge incontinence, sensation of a heaviness or dragging feeling, pelvic organ prolapse, back pain, hip pain, constipation or painful intercourse.
How Yoga can help
The Breath - Pranayama
A common misconception is that a tight or hypertonic pelvic floor is a strong pelvic floor. The reverse is actually true. As mentioned the pelvic floor needs to be able to fully descend on the inhale and contract on the exhale. If the inhale is shallow the pelvic floor is unable to fully lengthen and its ability to fully contract is limited.
Stress, anxiety and asthma often causes us to take short, shallow breaths which prevents the pelvic floor moving through its full range of movement and can lead to pelvic floor tightness. This can also become a fixed habit postpartum where the woman hasn’t returned to a full 360 breathing pattern after having baby pushed up against the ribs during the latter stages of pregnancy. The ribs can also stay wide post pregnancy with limited mobility which will also have an impact.
Incorporating Pranayama, one of the eight limbs of Yoga outlined in Patanjali’s Yoga Sutra and encouraging our students to utilise their breath efficiently in every class, inhaling into the base of the ribs and belly encouraging our ribs to expand followed by exhaling and engaging the pelvic floor (mulabanda) on the exertion, will have huge benefits.
The pelvic floor muscles and abdominal muscles co-contract therefore contracting the pelvic floor at the right time, in line with the exhale at the hardest part of the movement, is optimal for gaining correct alignment, strength and flow in our asana practice.
The autonomic nervous system (ANS) is our body’s ability to function automatically. Our heart rate, breathing, digestion and excretion, occur almost on autopilot - we don’t have to consciously think about it. The ANS is then split into two systems or branches that complement each other, the sympathetic nervous system (SNS) which is our “fight or flight” or stress response and parasympathetic (PSNS) which is “rest and digest” or relaxation response.
The vagus nerve is the main nerve of our parasympathetic nervous system. This wandering nerve which is one of the longest nerves in the body, runs from the brain down to the abdomen including the pelvic floor and acts as a communication centre for our internal organs. Its is critical to our ability to rest and digest.
If the the breath is utilised efficiently we can send a signal via the vagus nerve down to the pelvic floor to encourage it to relax as well as contract. This will help to manage intra-abdominal pressure or load during practice and during savasana when we want to encourage complete relaxation.
Muscle Activation
The pelvic floor doesn’t work in isolation and it is important that we activate and work the surrounding muscle groups to maintain balance, alignment, health and optimal function of the pelvis (both stability and mobility) and remember that neighbouring muscle groups will always try to compensate for weakness leading to an overactive muscle group. Timing or synergy of contracting these muscles is key and needs a fully interconnected system to function properly. Everything is connected!
Muscles of the core
Rectus Abdominus
Internal and External Obliques
Transverse Abdominus
Erector Spinae
Multifidus
Other key muscle groups
Adductors
Abductors
Gluteus maximus
Iliopsoas
It's also important to note here the function of the feet. The arches of the feet are said to be one of the four diaphragms of the body, the pelvic floor is another, the thoracic diaphragm is the obvious one and the roof of the mouth is another. If a client is clenching their jaw they are also clenching their pelvic floor! Additionally working the arches of the feet so that the foot is balanced and strong and the plantar fascia is lengthened is also key!
This essay wouldn’t be complete without mentioning a very significant muscle, the Psoas. The Psoas is a fear reflex muscle which inserts in the lower lumbar region of the spine and up into the diaphragm and extends through the pelvis to the femur. It is the main muscle that connects the upper half of the body to the lower and is a spinal and hip stabiliser.
The Psoas and the respiratory diaphragm work together to provide stability to the front of the spine during movement and sitting. When the Psoas is tight, due to poor posture (think desk based job) it will affect our ability to breathe deeply as it is attached to the diaphragm. If we can’t breathe deeply our nervous system senses a threat or danger and the flight or fight response is activated, cue tightness and an unbalanced system. So although not located physically to the pelvic floor it does have a major influence on the functionality of the pelvic floor. If we can release the Psoas in our Yoga practice as we do as part of the myofascial release work at the start of a Water flow we can encourage length and rotation in the hip as well as allow the body to relax into the postures and allow free flow of energy and therefore the pelvic floor is able to function in a more optimal way.
Emotional Release
Storing negative memories and emotional tension in our pelvic area can create pain and dysfunction in the pelvic floor. The body can get used to holding on to this stuck energy. This level of tension, stress or anxiety can almost become addictive as the body learns to hold on to it in this way. Practising Yoga consciously, using a blend of Pranayama and muscle activation to release the Psoas and allow the pelvic floor to ascend and descend can help decrease that tension and allow for release.
In a Yoga practice working with the areas of the body that are located in the Svadhistana Chakra and working on the body parts associated with the Water element, hips, sacrum, inner thighs we can physically open up those areas to allow for the balance of expansion and contraction of the pelvic floor and its surrounding muscles.
To summarise, teaching the importance of lengthening and relaxation is just as important as the contraction. Reminding a class that relaxed, flexible muscles are stronger than tight, short muscles and including poses such as Balasana (Childs Pose), Supta Baddhakonasna (Reclined bound angle) Marjaryasana/Bitilasana (Cat cow), Ananda Balasana (Happy Baby), Supta Tarasana (Reclining Star) and Eka Pada Rajakapotasana (Pigeon Pose) to encourage relaxation of the pelvic floor with the inhale.
This is also key for a pregnant women to take time to relax the pelvic muscles to prepare those muscles for relaxing during delivery (some poses more suitable than others subject to pelvic girdle pain etc).
By joining the dots and treating the body as the whole interconnected system that it is, a healthy pelvic floor means our core can work more efficiently. It can become stronger with improved prolapse symptoms or reducing the possibility of future prolapse and improved diastasis recti. Perhaps being able to take on new activities that we had previously ruled out such as cross fit or running. We can breathe more deeply, our stress levels lower. Constipation is no longer an issue. Less chance for us to leak when jumping, laughing or dancing. Post natal recovery can be better, reduced back or hip pain and even a better sex life!
Yoga asks us to release tension. A Vinyasa (meaning to link movement to breath) practice moving breath by breath, movement by movement meaning we can connect more deeply within ourselves allowing the body to ebb and flow, to contract and release, means we can teach our pelvic floor to do the same. The benefits of pelvic floor awareness are endless and can be life changing. Our ability to skilfully tune in to our own wisdom, to disentangle and to heal ourselves in order to have more freedom in our own bodies both emotionally and physically can be achieved through awareness of the pelvic floor and the practice of Yoga.
