Important Information on Your Pelvic Floor and the Muscles that Support It

The pelvic floor muscles play a crucial role in urinary and bowel continence, as well as stabilizing the abdominal and pelvic organs, and core stability.
Pelvic floor dysfunction is related to the muscle imbalances of the pelvic floor. These muscle imbalances are referred to as
hypertonic(too much tension), orhypotonic(too little tension).

The most common issue in pelvic floor dysfunction is incontinence (loss of urine control).
When approaching “pelvic floor training”, it is vital to work on creating a sense of balance to the pelvic floor muscles. These are voluntary muscles and healthy muscle is based on range of motion.
For a healthy, functional pelvic floor there needs to be strength and support as well as length and flexibility. (Think of a New Trampoline- strong enough to withhold weight, but flexible enough to move)

It is noted that as many as 1 in 3 women suffer from some form of pelvic floor disorder.
Yoga offers the benefits of breathing practices, stress reduction, and stimulates the entire body, including internal organs.

*The best way to identify your pelvic floor muscles and to identify any imbalances is to go to a licensed physical therapist that specializes in treating pelvic floor dysfunction. A therapist will not only assess the situation, but give you exercises tailored to what you need, as well as do manual release of the muscles if they are too tight. However there are other in-home ways to locate these muscles successfully.

Common signs that can indicate a pelvic floor problem include:

*accidentally leaking urine when you exercise, laugh, cough or sneeze

*needing to get to the toilet in a hurry or not making it there in time
*constantly needing to go to the  toilet
*finding it difficult to empty your bladder or bowel
*pelvic organ prolapse~ this may be felt as a bulge in the vagina or a feeling of heaviness, discomfort, pulling,  dragging or dropping around the vagina.
*pain in your pelvic area, or painful sex

Anatomy of the Pelvic Floor

The Pelvic floor forms a diamond shape made of the space between the tailbone, pubic bones and the two ischial tuberosities aka- the sits bones. These muscles form a hammock-like support for the organs of the pelvis (e.g. bladder, uterus, urethra, small bowel, and rectum) in three layers.

The two most common types of incontinence are:                                                                                                          

Stress incontinence and Urgency incontinence
Stress Incontinenceoccurs when a small amount of urine leaks out after internal pressure quickly builds, such as when one sneezes, coughs, laughs, or lifts a heavy weight.  Stress incontinence is more common in women than in men, and is typically caused by factors that weaken the bladder muscles, such as aging, childbirth, excess weight, and surgery—particularly hysterectomy in women and prostate surgery in men. The most common cause of stress incontinence is urethral hypermobility. When the support provided by the pelvic muscles is relaxed or lost, the bladder neck and urethra may shift, sag, or drop into a lower position during periods of activity, thus causing pressure on the bladder neck area. The pressure on the bladder will exceed the pressure on/in the urethra. If the bladder neck or urethra opens briefly, leakage occurs.                                                                                                                
Urgency incontinencehappens when the body signals its immediate need to release urine without the usual build-up warning. You may have a sudden, urgent, and uncontrollable need to urinate, you may have overactive bladder, which can cause you to have urge incontinence. The feeling can occur even when the bladder contains only a small amount of urine. Urge incontinence typically occurs when the bladder contracts at inappropriate times, and these bladder spasms can result in incontinence. Bladder contractions can be the result of damage to the nerves or muscles of the bladder, or hypertonic pelvic floor muscles.

There can be many different causes of urinary incontinence, listed below are some of the more common causes:
Childbirth- this alters the normal support of the bladder.                                                                                      Pregnancy- caused by the weight of the growing fetus on the bladder structures or by certain hormonal changes, which increase urinary output.                                                                                                                                   Age- our pelvic floor muscles can become weakened with age.                                                                            Hysterectomy-Because a woman’s uterus shares muscles with the bladder, having a hysterectomy to remove the uterus (or any other pelvic surgery for that matter) runs the risk of damaging the bladder’s muscle support system and leaves space for the other organs to shift.                                                                               Menopause-many of the mechanisms that allow the bladder to do its job properly are estrogen sensitive.                                                                                                                                                                                        Caffeine- is both a diuretic and a bladder irritant. Caffeine is implicated in directly causing irritation of the bladder lining. People who do have bladder problems, on average, do better if they reduce their caffeine consumption.                                                                                                                                                                                Weight- excessive weight gain puts additional stress on the muscles of the pelvis.                                         Medications- Certain medications act as diuretics.                                                                                                               Alcohol- is a diuretic. It causes you to produce more urine, which can contribute to urge incontinence.
Chocolate, spicy or acidic foods-The bladder muscle has all kinds of nerves that can be affected by irritants, like acidic foods.

While this list may appear daunting, for the average woman childbirth and/or aging is usually the culprit for mild stress incontinency, and thankfully there are yoga poses and exercises we can do to work the pelvic area to help diminish and control bladder problems.

Importance of the Breath~ learn to Breathe FIRST!
The movements of the pelvic diaphragm mirrors that of the respiratory diaphragm.  When we inhale the respiratory diaphragm moves down and expands, moving the pelvic floor in a downward motion. As we exhale the respiratory diaphragm draws back up, allowing the pelvic floor to move in an upwards movement.
This explains why when we are “training” the pelvic floor, the engagement of muscles is done on the exhalation and the release is done on the inhalation.

Diaphragmatic breathingactually acts as a massage to the pelvic floor.
As you inhale the pelvic floor should receive the breath, as you exhale the pelvic floor should contract slightly. Healthy pelvic floor stretches as you breathe in and down, contracts as you breathe out.
Experience the sits bones moving away from each other as the space between them broadens with the breath in.

Transverse Abdominus

Deep abdominal muscle resembles a corset or a back brace and it acts like one too. It functions as an armor of support to your bladder.
If this muscle is strong, it will help keep the pressure of coughing, sneezing, and lifting away from the bladder. This will greatly reduce the leakage of urinary incontinence.



So how do you know if your pelvic floor is too tight or too loose or perfectly in balance?
Lets start with the most common

Hypotonic(weak or stretched)
Stress Incontinence
Mixed Urinary Incontinence
Prolapsed Organs
Multiple births
Menopause (aging)
Gas noise escaping from vagina
If you are focusing on slowly engaging the pelvic floor and holding it for 5-10 counts and you find it difficult to maintain the tone for that long, you may need to focus on strengthening. 
*Hypotonic muscles will respond well to strengthening exercises such as Kegels, but instead of thinking“squeezing”, think “toning”.

Hypertonic(too tight) pelvic floor muscle will register as “weak” because it is unable to generate force due to the fact that this muscle is already in its tightest (and shortest) position, and it loses its ability to release and can spasm.  
Urge Incontinence
Urinary Urge or Frequency
Pelvic Pain
Pain with intercourse, tampon use, GYN exams, prolonged sitting
Interstitial Cystitis, Irritable Bowel Syndrome
History of sexual abuse
If you are doing quick “blinks” of the muscles and are unable to have that quick release reaction or if you cannot do a slow 3 count release, you may need to focus on lengthening and relaxing the pelvic floor.
*Hypertonic muscles respond well to diaphragmatic breath, relaxation practices, internal massage.

Both conditions can cause incontinence
*It is possible to have a combination of both
*Too tight causes problems, too loose causes different problems, a combination of the two, you must address tightness first.

Leslie Howard
The Bathroom Key- put an end to incontinence  by; Kathryn Kassai
Verde Valley Myofascial Release, Jody Hendryx PT

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