Understanding the Pelvic Floor: how Goldilocks matters
Have you ever heard of the goldilocks analogy used to describe pelvic floor health?
Not too hard. Not too soft. Just right.
But, what does that feel like?
How do you know if it’s functioning correctly or not?
How can you support your pelvic floor in yoga and other forms of exercise?
Pelvic floor health is U N D E R R A T E D!
Perhaps it’s because it’s hidden from view or maybe it’s perceived, in some respects, to be taboo.
But the truth is, it needs to be spoken about.
Some pelvic floor stats
According to the Continence Foundation of Australia, many activities and experiences impact the health of the pelvic floor, such as:
Strenuous or high intensity sports (running and weightlifting to name a few).
Pregnancy and/or childbirth.
Holding in urine or stools when you felt the urge 2 hours ago.
Going to the toilet ‘just incase’ you might need to use the toilet when you’re otherwise busy.
Do you fall into any of these categories?
Pelvic Floor health impacts males and females. According to one study, 65% of women and 30% of men that consult their doctor give an account of some type of urinary incontinence, but only 31% seek help. In another study, 1 in 20 people were found to experience substandard bowel control.
According to Anne Patterson, as seen on Jean Hailes website, the main types of incontinence are:
Stress: coughing, sneezing, running, jumping, etc.
Urgency: racing to the toilet
Prolapse: bowel or bladder
Soiling: from the bowel
What is the Pelvic Floor?
The Pelvic Floor (PF) is a group of muscles which form the floor of your inner core. The inner core is cylindrical and is made up of the:
Diaphragm - the roof. It is the main muscle of respiration.
Lumbar Mulitifidius - the back. They are the deep lower back muscles which help to stabilize the spine at each vertebra.
Transverse Abdominus - the front. They are the deepest layer of abdominal muscles which maintain light tone to support posture.
Pelvic Floor (a.k.a the pelvic diaphragm) - the floor. A hammock of muscles designed to hold our internal organs such as bladder, bowel, intestines, and uterus.
The Pelvic Floor is made up of 4 main muscles:
Levator Ani - three pairs of muscles that run either side of the urethra, vagina and rectum
Coccygeus - a group of muscles that runs along the back of the pelvic cavity and coccyx
These muscles are inserted to ligaments along the pelvic cavity, public bone and coccyx. When optimally functioning, this group of muscles contract and release together. When contracted, the sphincters and internal organs are lifted. When relaxed, the sphincters can open, allowing fecal matter (urine and faeces) to pass.
What does optimal pelvic floor health feel like?
According to Anne Patterson, good posture allows for healthy tension of the PF. Slouching can exacerbate pressure on a particular area of the PF, which we want to eliminate. Before active engagement of the PF muscles, good posture allows people to feel even distribution of weight on the pubic bone and sitting bones. Slouching will cause more pressure on the coccyx.
Women should be able to get a sense of PF muscles contracting in and up, around the urethra, vagina and rectum. Some cues to help with identifying your pelvic floor are as follows:
Pretend you are stopping the flow of urine (urethra)
Imagine you are lightly holding in a tampon and menstrual cup (vagina)
Stop the passing of wind (rectum)
Visualise your PF as a diamond shape. On an inhale, imagine the diamond grows in size as you relax your PF muscles. On an exhale, imagine the diamond reduces in size as you contract your PF muscles in and up.
Visualise your PF as an inverse parachute. On an inhale, imagine the parachute ballooning outward, down towards the floor as you relax your PF muscles. On an exhale, imagine the parachute lifting up in your core as you contract your PF muscles in and up.
In a healthy functioning PF, it shouldn’t matter what visualisation you use to connect with your pelvic floor. However, you may find when you use one cue over another, it makes it easier to connect with specific parts of your PF. In this instance, it may suggest there is PF dysfunction.
Physiotherapists, specialising in this area, will often conduct an internal examination to assess the health of your pelvic floor. This is quite likely the best way to assess if all muscles are working harmoniously, making sure that one muscle is not functioning more optimally than another.
Pelvic Floor dysfunction occurs if the muscles are either too tight, too loose, or perhaps a combination of both. If Pelvic Floor dysfunction is experienced, it commonly presents, but is not limited to, the following ways:
Bladder and/or bowel issues (incontinence or infection)
Pain
Painful sex
Prolapse of organs
Pelvic floor and childbirth
In a study conducted by Memon & Handa (2013), there was no major differences to suggest vaginal delivery had more of an impact on pelvic floor dysfunction than c-section. This study highlighted that there are so many factors that can have an impact on the heath of the pelvic floor during pregnancy and childbirth, such as obstetric intervention (e.g. forceps delivery), a lengthy second stage of labour, weight of the baby in utero, and lacerations during childbirth (e.g. episiotomy or tearing of the perineum).
Supporting optimal pelvic floor health on and off the yoga mat
The following is a basic introduction to Pelvic Floor exercises that should be practiced daily:
Gently contract PF muscles and hold for 3 seconds
Release for 3 seconds
Repeat 3-4 times
Gradually increase the amount of time you hold and release the muscles, but only when you need a little bit more of a challenge
PF exercises can be practiced lying down, sitting and standing. Eventually, with practice, PF exercises should be done whilst standing, lifting and lowering. This requires a great deal of concentration, so practice where there are no distractions and you can focus on it.
Ways of testing the health of your PF :
Coughing or sneezing. Does your PF stay contracted? Or, can you feel it drop?
Standing. Let the PF muscles relax completely. Switch on the PF and then sit down. Does your PF stay contracted? Or, can you feel it drop?
Remember to:
Keep your buttocks relaxed
Minimum core engagement should be felt below the navel
Breathe easily
Relax fully between contractions. Relaxation is as important as contraction!!
The above points may be quite challenging for some people and may require some practice, especially if your PF is weak or if you are new to PF exercises. The PF is like any other muscle that we are trying to tone and strengthen - continued practice is key.
Daily exercises that support and improve the health of your PF, can be found at:
Whilst performing yoga, key things to remember:
Speak with your teacher and let them know if you experience PF dysfunction or weakness. Let them know if you have been advised to avoid certain things and give specifics, if possible, about your condition. Don’t be embarrassed. A good yoga teacher will provide a range of modifications you can try
Speak with your teacher about modifying poses like Plank (Kumbhakasana). This pose can be done whilst lying flat on the floor and bracing your core and PF. Gradually you can build on the pose by coming up onto your forearms, and then lifting your torso off the mat, supported by your knees
Shorten and/or narrow your stance in lunging and squatting postures as these poses put pressure on your pelvic floor, such as Anjaneyasana (High or Low lunge), Virabhadrasana I and II (Warrior I and II), Utkata Konasana (Goddess Pose), etc. Avoid deep squats or lunges
Activate your PF before transitioning to another pose
Use your breath as a metronome to release your PF on an inhale and contract your PF on an exhale
If holding your PF for longer than an inhale to support yourself in a posture, continue to breathe deeply. PF contraction does not mean holding your breath
Avoid jumping into postures, for example, transitioning from Uttanasana (Standing Forward Bend) to Chaturanga Dandasana (Four-Limbed Staff Pose)
Soften your jaw to help relax your pelvic floor - there is a direct correlation between these two muscle groups! Try parting your lips or connecting the tip of your tongue to the hard palate, just behind your teeth
Yoga is excellent for correcting posture and alignment which will ultimately support your pelvic floor
If you are at all unsure of the condition of your Pelvic Floor, I encourage you to contact a Physiotherapist specialising in this field so that you can gain peace of mind. They can help clarify specific approaches and actions you may need to take to suit your pelvic floor needs.
And remember... Goldilocks!
Looking for a Physiotherapist specialising in womens and pelvic health?
Here’s a few local practices I would highly recommend:
Melbourne Pregnancy and Pelvic Physiotherapy (Essendon)
Pelvic Health Melbourne (Altona North)
Inner North Physiotherapy (Thornbury)
References
Continence Foundation of Australia
Memon, H. U., & Handa, V. L. 2013. Vaginal childbirth and pelvic floor disorders. Women's health (London, England), 9(3), 265–277,
viewed 4 September 2019
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