I recently read that in France all women get pelvic floor and abdominal physical therapy sessions covered through the national health system whereas in Australia (and UK and US) the most you can expect is a leaflet from the hospital or maternal and child health centre telling you to do pelvic floor exercises or ‘kegels’ to prevent incontinence. Many women only realise they have been doing these exercises incorrectly when they get referred for therapy too late. It’s as if the subject is still taboo in Anglo society and there is no where near as much open discussion as there should be. Even the nurses and midwives admit that they ‘forget to do them’.
So why are they important?
The pelvic floor muscles are the hammock of muscles that hold the pelvic organs (the bladder, bowel and uterus) in place from below. Pregnancy and childbirth stretches and strains this muscle and connective tissue. Unless they are built back up again through exercise it can lead to incontinence or prolapse of one of the organs. After birth the muscles can feel quite weak as if everything is going to ‘fall out’. Doing too much straight after birth, straining to use the toilet, heaving lifting or returning to high impact exercise too soon are all risk factors for developing a prolapse. It’s really important to continue pelvic floor exercises throughout pregnancy and post birth and to be very mindful of this area of the body in all activity. And.. pelvic floor weakness is not only the domain of mothers, it can affect anyone particularly if there is a family history of weakness of these tissues or where a lot of strain is put on them through exercise or heavy lifting.
How can yoga help?
Engaging the pelvic floor muscles is incredibly important in yoga and is a part of the practice of Mula Bandha (the Root Lock). The practice of yoga can improve pelvic floor strength and likewise pelvic floor strength will improve your yoga practice.
There are three elements to the pelvic floor region and they can be hard to locate if you are not mindful of them. This area is often called the ‘dead zone’ as many people just don’t have an awareness of the muscles and how to engage and relax them. Frequently when people are told to “practice Kegels” they do not engage the correct muscles or exercise them in the correct way. Furthermore, the conventional practice of ‘squeezing’ the muscles only addresses one half of the problem, for truly strong pelvic floor muscles we need to learn to both hold and relax them. The squeezing action can be useful to find the muscles in your body but once located there are a variety of different exercises that can be done with awareness on the breath and while practicing yoga asanas.
The front section of the pelvic floor can be located by contracting muscles as if you were going to stop yourself from urinating mid-way. The back section is engaged by contracting the anus. The middle section can be found by inserting a finger into the vagina and squeezing it (for women) or contracting the muscles needed to attempt to stop ejaculation (for men).
Once these muscles have been located there are a number of ways they can be strengthened and lengthened. The most useful exercises I have found can be done while standing, walking, sitting (feeding a baby), lying down – in fact wherever and whenever you can.
- Inhale and relax the pelvic floor muscles (imagine them expanding out as your abdomen expands). Exhale and contract and lift all three parts of the pelvic floor. Repeat. Start by doing 5 and increase to up to 50 as you progress! (The inhale and exhale feel the wrong way around here but this exercise helps to both lengthen and contract the muscles.)
- Inhale to contract the pelvic floor muscles and hold for 5-10 seconds while breathing normally. Increase the length of the hold as you progress. Repeat 5-10 times.
- Exhale to relax and then inhale and incrementally contract first the front section, then the middle and then the back while breathing normally. Continue to contract the muscles until you are holding as tightly as you can and then release. Repeat 5-10 times.
Some useful yoga postures for pelvic floor strengthening are Malasana (squat), Viparita Karani (Legs up the wall), Balasana (Child’s pose) and Baddha Konasana (Reclined bound angle). The above exercises can be done in these postures or the postures can be held while breathing mindfully and bringing attention to the pelvic floor area.
Pelvic floor weakness affects many more people than we know, as no one seems to like to talk about it, but if we don’t start being more open and ensuring that those at risk (particularly pregnant women and new mothers) take these exercises seriously the consequences of this weakness will continue to affect many in society. Not to mention the many other positive effects that having a strong awareness of this area will have on your yoga practice and general health. It helps build core body strength and creates a strong foundation at the base of the body, which enables you to hold the postures longer and protects the low back muscles making postures safer. Using Mula Bandha to support postures from your core allows the distal muscles to relax, enabling the body to use less energy to hold the pose. Mula bandha also increases your energy and improves concentration and mental clarity.
For more information about Mula Bandha (which is much more than just the physical contraction of the muscles) see this great Yoga Journal article.