Yoga and Your Pelvic Floor
Last summer, I attended Leslie Howard’s Yoga for the Pelvic Floor Teacher Training, and though I knew it would be inspiring, I didn’t realize how the training would completely change the way I think about the pelvic floor and it’s context, the greater body and self. Most current cultural beliefs on pelvic floor –and even the attitude of many yoga teachers and practitioners– are based along some level of assumption that this area is weak, and needs more tone.
The “pelvic floor” (although truly, it is more of a “dome” than a floor; only cadavers have hammock shaped pelvic floors…!) refers to the dynamic layers of muscle which span the inner pelvis. Pop culture would have most women believe that ladies are too “loose,” and need more tone in the pelvic floor, but that’s not true. This patriarchal belief system would also would have men think it’s better not to relate to -much less discuss and learn to sense- the pelvic floor, unless they have learned about Mula Bhanda, which is often misunderstood as “squeeze everything down below,” which for many folks means tightening an already gripped up area. (Mula Bandha (“root lock”) is an ancient, powerful, esoteric yogic technique aimed at containing and lifting kundalini energy through the central channel, or sushumna nadi. For most people, if this were actually to occur it would probably result in a psychological breakdown. In some modern yoga classes Mula Bhanda is taught casually and interchangeable with lifting the pelvic floor muscles.) But I digress. We want to have healthy tone, of course, but in the context of healthy skeletal support, through functional posture and position in the pelvis, where the pelvic floor muscles can relax, receive good circulation, and when needed, contract effectively.
While some people have hypotonic pelvic floor muscles, where lack of tone and postural misalignment cause issues, many people (even postpartum moms!) have too much tone in the pelvic floor muscles, and because of that tightness, the pelvic muscles are weak. When this area is not able to be both strong and relaxed, serious health issues can develop.
What about Kegels? Leslie says, kegels are “urethra-sphincter-centric, 60 years old, and named after a guy.” When people try to do Kegels they are usually indiscriminately gripping, often focussed on the action of “stopping pee,” constricting the urethra. Pelvic floor yoga is focussed more on learning to sense the 3 layers of muscle that make up the pelvic floor, create functional alignment in our structure to support this area, and then using specific actions, poses, and breath work to release and/or tone those muscles so that they can function optimally, with good circulation, strength, and the ability to be very strong AND relax fully as appropriate.
We can practice yoga for the pelvic floor in nearly every pose…
But wait, which poses are the right ones for you? If Leslie’s hypertonicity/ hypotonicity approach rings true to you, as you may have guessed, if you are on the tighter side, or looser side, (and this may change depending on which layer of muscle you are focussing on) your work will be quite different depending on what you need, since you have a specific goal, in any given pose. When we practice specifically for our body’s needs to address the challenges and asymmetries that have developed, then our yoga practice can truly become transformative and healing.
The first step to pelvic floor yoga is to deepen you relationship with your own pelvis and pelvic floor muscles. Being able to sense the area is key. So let’s take a quick look at anatomy.
Imagine the pelvic floor as a diamond shape. Feeling down to the sitting bones, also called the ischial tuberosities, will give you a sense of the sides of your diamond. The bottom tip of the tailbone in back (the coccyx) and the public bone in front (the pubic syphisis) create the back and front of your diamond. This diamond of bony attachment points needs to be spread wide, so the muscles have space and become taught, like a trampoline.
The first (outermost, or bottom) layer of the pelvic floor muscles are called the bulbospongiosus muscle in men, and the bulbocavernosis muscle in women, although both terms have been used in the past for either gender. This beautiful figure-eight shaped muscle attaches to the pubic symphisis in front, loops around the front opening where the genitals are, connects to the perineum, and then loops around the anal sphincter in back where it attaches to the coccyx. The perineum acts as an anchoring point to all three layers of muscle.
The second layer the transverse perineal muscles. These 2 muscles span the lateral dimension left and right, attaching to the perineum (or “central tendon,” located right in the middle of the diamond) to the sitting bones on either side.
The third, inner most layer is called the levator ani, which is made up of different bundles, woven together to create a broad sheet, or “parachute” shape which, when healthy, moves with the breath between a mild concave and convex position, mirroring the dome of the diaphragm below the lungs, and the soft the palette in the back of the throat. The levator ani attaches at the front, inside the pubic symphisis, then by the obturator faschia, it connects to the inner surface of the spine of the ishium, or, the surface of the inner circle of the pelvis, and in back, it connects to the bottom two “segments” (remember, the coccyx is fused into one bone) of the tailbone.
Feeling down to the pelvic floor with your awareness and your hands is a good way to start. (At the bottom of this post is instruction for self massage.) In my pelvic floor workshop, we spend a lot of time learning how to sense the 3 layers and get a feel for where these muscles are on the hypotonic-hypertonic continuum. Just like in the the rest of the body, many folks have a combination of gripping and laxity.
HYPERTONICITY: Too much gripping. If you have urge incontinence (where you feel like you have to pee all the time but not much comes out), pelvic pain in men (pain may stem from tight pelvic floor muscles as well as issues in the prostate) and women — vulvadinia (external pain) or vaginal pain, vaginismus (where the first 2 layers of the pelvic floor get so tight penetration is impossible), lichen sclerosus (an autoimmune disease that creates scar tissue around the genitals in men and women), irritable bowel syndrome, or interstitial cystitis, you most likely tend towards some hypertonicity. Although there have been no studies I know of on the subject, there may even be a link between gripping in the pelvic floor and prostate cancer. This pattern often correlates to a pelvis that is too tucked under, with the attachment points of the pelvic floor collapsed and compressed.
HYPOTONICITY: Not enough tone. If you have stress incontinence (where pee leaks out when you don’t have a full bladder and need to pee, such as on a trampoline or when you cough… this can also happen with poo…), or prolapsed organs (where the pelvic organs, most commonly the uterus, press down and sometimes fall through the vagina or anus) this means you need more strength. Many women who have had babies experience issues from underactive pelvic floor muscles. Learning how to sense and strengthen these muscles, and have a healthy anterior tilt (not tucking the tail under) in the pelvis is key to avoid these issues becoming exacerbated later in life.
Here is an example of two different ways of working with one pose; the first version for releasing, softening, and inviting breath through the inner pelvis, the other is for increasing tone. Consider studying with Leslie or me if you are want more hands on experience… this is just the tip of the iceberg.
As an example, lets explore Bound Angle Pose.
For Relaxing: Supta Badha Konasana: With a bolster to support the spine and head, pillow under the head, rolled blanket to support each leg, sandbag on each upper thigh.
Important Cues: Take time to allow yourself to settle, spread out completely, and shift away from thought, and in to feel the body from the inside. Watch how easily the mind becomes distracted, critical, or analytical, and keep returning to the breath, and the feeling of it’s nurturing, effortless rhythm. Soften the root of the tongue, so that it becomes more fluid and passive, allow the throat to become round, relaxed, spacious, and release the soft pallet. This will assist the lower belly and inner pelvis to relax and receive the breath, so that the inhalations can descend, broadening and expanding, down through the lower belly, and down into the inner pelvis, all the way in to the layers of the pelvic floor. Exhaling, allow everything to relax in towards the naval center. Over time, allow the pelvic floor to become more and more receptive to the effortless, smooth, easy movement of the inner breath. Fully receive the cleansing, gentle inner massage of the breath, the irrigation of fresh circulation flooding the vital organs. Keep exploring what else can let go.
Avery in Supta Badha Konasana with 3 blankets, a bolster, and 2 sandbags.
How it helps: Softening the throat and the soft pallet helps release the visceral body, the tongue particularly relates to the lower belly and pelvic organs. Feeling down into the pelvis to invite softening and receptivity can help this area relax and increase awareness of what is happening in the pelvic floor. One of the specific gifts of this pose, when we use props to fully support the yielding of the body, is the increase of breath and movement to the abdominal and pelvic region. Restorative poses are important for establishing relaxation in the nervous system, which gives us a doorway inward to sense the subtler layers of our being. As BKS Iyengar says, “We can rise above our own limitations, only once we recognize them.”
For Toning: Badha Konasana: Sitting at a wall, use a rolled blanket support wedged firmly behind the sacrum. As needed, give support to the outer legs with blankets, wedges, or blocks.
Important cues: Strongly press the heels together. As the inner thighs extend outward, from the pubic symphysis towards the inner knees, draw the out thighs in towards the out hips, creating a conveyer belt effect of muscular external rotation. Bring the awareness down to the inner pelvis, sensing the 4 corners of the “diamond:” the pelvic floor attaches to the sitting bones on the side, the pubic bone on front, and the coccyx in back…and the perineum serves as an anchor for all the layers of pelvic floor muscle at the center of the diamond. Explore receiving the breath into the pelvic floor on the inhalations, and then as you exhale, draw the sides of the diamond, the sitting bones, muscularly IN towards the perineum. Imagine the line between the sitting bones becoming thicker and shorter. Repeat for several breaths, releasing on the inhales, engaging on the exhales. Then try the 2nd layer: Draw the front and back of the diamond in towards the center. After several cycles, try all 4 corners at once. Where they meet in the middle lift upwards, as though you could lift along a central channel that extends up through the body, all the way through the crown of the head. Lastly, if this is going well, explore a few rounds holding this tone through an inhalation and exhalation, releasing in between rounds to let any habitual tension. Especially watch for the belly, keep it relaxed! It will try to ump on board to hep, but that will only create compression and tuck the pelvis. Explore lifting the pelvic floor while keeping the jaw and inner organs soft. The anal sphincter may come along for the ride, but specify the origin of the action in the muscles and perineum.
How it helps: Using the blanket supports the untucked position of the pelvis, the stability of the sacrum, and gives feedback if the pelvis is tucking instead of the pelvic floor muscles engaging, which is common amongst beginners; if the pelvic floor is engaging students may be able to sense the sacrum pulling into the body, not pushing towards the wall. Pressing the heels awakens strength and stability, while exploring these incremental pelvic floor exercises builds tone, as well as awareness in layers one and two of the pelvic floor. This pose increases circulation to the pelvic organs and pelvic floor, and the action of externally rotating the legs predisposes the strength in the pelvic floor.
I hope you these poses give some insight to your practice. If you have any questions, answers, revelations, let me know! I love learning about how yoga practice can nourish us.
Pelvic Floor Self Massage
Massage is a great way to gain awareness, and relax pelvic floor muscles.
Here are some tips.
Make sure you are warm, can relax, and won’t be disturbed. Lube or oil may help increase comfort, especially if you are exploring inside the anus. Where ever you are going to massage, it’s a good idea to gently touch around the external body first, to warm up your hands, hone your awareness, and relax the pelvic area. External massage for the inner sitting bones can be a nice place to start. Relax the jaw, tongue, throat, to help release down below. Remember you are receiving a massage: shift into receptivity, relaxation.
Find the perineum, and explore it’s soft texture, before increasing pressure. Establish an attitude of reverent curiosity, rather than trying to push towards some end result. Remain receptive to your body’s feedback.
If you are massaging inside the anus, massage the anal sphincter to help it relax, and once it softens, entrance will be much easier. If it feels tight or painful, don’t force it, but massage more externally, while softening and relaxing the body with your exhalations. Once the anal sphincter releases enter slowly. Press the finger around the inner curve, feeling the flu 360 degree area. There is much you can feel through the soft, thin wall of the anus.
If you are massaging inside a vagina, use your thumb to find layer one, since the fingers can get lost in the many different areas and textures.
Feel the inner perineum, then see if you can locate layer one, the figure 8 loop, and layer two, the transverse perineal muscles, on either side. See if they feel tight, or soft. Compare left and right. Pressing into the muscle and releasing, move from the center out to the sides, and back in. Notice if working on one side for a minute effects it compared to the other side. See if you can feel the inner shape of the pelvis, and the ischial tuberosities from the inside. Feel towards the back of the inner anal sphincter, and along the labia, or around the base of the penis. Look at anatomy drawings to help you visualize the layers of muscle. Fingers can reach deeper into either opening. Explore circular motions, to sense the different areas. Notice which parts feel restricted or resistant, and which areas feel soft. Make a note of how this changes day to day, week to week. Mull over what activities and life experiences are affecting your pelvic floor muscles.
At the end of your exploration, take some time to hold your hands softly over this area and let that warmth of your hands help you to emanate gratitude and healing to the inner pelvis: organs, muscles, genitals. Thank yourself for taking time for this important self care.