We really need the collective diaphragm of the pelvic floor – its muscles, ligaments and connective tissues – to be working properly. If it’s not, organs move around and bladder, vagina, uterus or rectum can prolapse; we can experience incontinence (leakage) and/or pain during sex, none of which is to be tolerated. If you are experiencing ANY of these symptoms, please don’t tell yourself you have to live with them. You don’t!
Hello, I’m Adrienne, whats your name and how is your pelvic floor?
Yes the day will come when I will totally unfazedly introduce myself as such. I’m obsessed. My son told one of his teachers that “the words pelvic floor are my mammy’s favourite words” (when they were asked to put the word ‘floor’ in a sentence)
This is a kind of whistlestop tour of my work with this today. Feel free to get in touch and talk about it. You know I’d love to!
In case you’re wondering, I don’t mind sharing that mine is TERRIBLE. Or at least it used to be! It was always bad. Long bus journeys were torture. As a young twenty-something-year-old I used to ask the Citylink (Go Bus now) driver to stop somewhere between Dublin and Galway (usually Supermacs in Moate) and make the whole busload wait so I could run in and use the facilities. 18 months after my second pregnancy I had a uterus prolapse. I have lots of theories why my pelvic floor was so terrible: genetics; posture; and the habit of sitting at a desk being a diligent student all my life; but who knows? The good news is, I almost completely cured the prolapse, through yoga, physiotherapy, and awareness. My pelvic floor responsiveness is still not so hot. But I continue to learn and work with it. Hence the obsession.
And to my pelvic floor, I say sorry for calling you terrible: you are glorious, and I will take care of you.
I hope to keep writing and sharing much more about this but for now, a few words on the instructions I usually give in my yoga classes, to aid anyone who wants to bring them into their own yoga practice or indeed and better still, to ultimately bring this awareness to any movements that you make. They might sound complicated: but they are pretty fundamental! What makes them different to the typical “kegel” (named after Mr Kegel who “invented” them) is that they involve breath awareness and are a lot more involved than just the kind of rapid “squeeze release” we more typically associate with “kegel exercises”. Kegels are just one aspect and not the whole story. Read on!
Where are the pelvic floor muscles?!
These muscles that are inside the glutes (bum muscles!) and which are slung inside, and contain the bottom openings of, your pelvis: they form a diamond shape between your sitz bones (the bony parts of your bum), your pubic bone, and your tailbone, and they also involve ligaments and connective tissues. Check out this lovely graphic here
They are also known as a diaphragm, and when they’re functioning properly they actually move like the diaphragm under your ribs: inhale, they both move down; exhale, they both move back up. Which is why breath awareness is so important!
They support all the organs that are within your pelvis: including of course the uterus. We really, really need them to be working properly. If they’re not, organs move around and bladder, vagina, uterus or rectum can prolapse; we can experience incontinence (leakage) and/or pain during sex, none of which is to be tolerated. If you are experiencing ANY of these symptoms, please don’t tell yourself you have to live with them. You don’t!
And this is not strictly about the pelvic floor muscles being too weak, or too tight: we just need them to be responsive to our movement; and we need them to know how to dial it down and relax when we are not moving. And we need them to be able to respond to your own brain’s signal to yield when they have to: especially, for our purposes, think: birth! And whilst we’re talking about it, this is a timely reminder to emphasise how important it is to be able to access calm and focus for your mind, which also refers. It’s why we do yoga, which is a system of integrating body and mind.
Underactive or overactive pelvic floor?
It can be that the pelvic floor is either underactive, or overactive: this is important, and knowing which one is causing us problems makes all the difference – basically, Kegels alone will make an overactive pelvic floor WORSE.
I have some recommendations for further reading on this (see links for Catherine Middlebrooks, Isa Herreras and Katy Bowman below) but for now I’m going to hand you over to Catherine Middlebrooks of BRB YOGA for more on this:
- For an OVERACTIVE PELVIC FLOOR read her blog post here
- For an UNDERACTIVE PELVIC FLOOR read her blog post here
- For the DIFFERENCE between both read her blogpost here
What can we do?
Alignment and breath
In yoga by its very design, we are already doing loads that goes far to support the pelvic floor. We constantly tune into our alignment which helps enormously to activate the pelvic floor accordingly. We are also focusing on BREATH which makes a key difference too. We practise pelvic floor activation with enormous awareness, and – crucially – we synchronise this awareness with the breath.
Glutes and legs
And of course no muscles work in isolation. We need the legs and glutes underneath, and the core above, to be strong and responsive too keep the pelvic floor in turn strong, in balance and responsive. Come on legs and glutes: support that pelvic floor and all that comes above it! Keep using them as much as you feel you can in pregnancy: being upright (not slouching!), walking loads, swimming: and of course yoga!
We need all of these muscles to be able to RELAX too: this is just as important. Which is why yoga is such a beautifully thorough way to tune into and work with your body. Your yoga class is a huge inspiration to your muscles and ligaments. A little every day is even better.
Shoes v no shoes: Being barefoot and/or NOT wearing shoes with heels helps. This doesn’t just mean high heels: it’s actually difficult to find shoes that have no heel, even runners have a tiny wedge heel which shortens our calf muscles and affects our posture and thus affects our pelvic floor. So being barefoot if you can is good!
A note about going to the toilet
Try not to “just-in-case” pee. It confuses the bladder! Take note and see if you are able to hold on for up to 4 hours. And then if you can pee for up to the count of 10 or 12 (count 1000, 2000, 3000 -)
Pregnancy will challenge this, I know and that’s OK – if you gotta go you gotta go!
Use a squatty potty step for good alignment. Any kind of step that elevates your knees higher than your hips will do.
Pelvic floor and core (that rhymes!) work together. In my classes, I instruct about core awareness: and for anyone who is new to yoga or new to my classes, I always say – that this is a fairly technical layer of instruction that might be too much just now: if it is, be patient and let the understanding come. In time we get used to practising these exercises along with deep the core muscles.
Bear with me: when I talk about “the core” I’m referring to what gets called TVA: the Transverse Abdominals, which are your deepest-most core muscles, under your rectus abdominus (six-pack!) and your oblique muscles; for our purposes, we are interested in where they cross your lower abdomen, below your navel: your zipper area, if you were wearing a pair of low-slung jeans (like they had in the nineties). The approach is not to suck in your entire belly (you kind of can’t anyway if you’re pregnant, cos of lovely growing bump!) but to isolate a fairly subtle engagement of these deep muscles in your low abdomen, above your groin, below your navel, and to combine your awareness of them with the pelvic floor exercises. Place your fingers here: and exhale sharply. See if you can feel the muscles here gathering. Or, in the all-fours position, hover the knees above the floor about an inch or two, we can really begin feel these deep, “zipper area muscles” firing. Even if you can’t feel it firing for sure: just pretend. It will come.
And make an appointment with a women’s health physiotherapist (see further resources below). Unfortunately I’m writing at the time of an unprecedented national health crisis lockdown when physiotherapists are not taking clients. Reach out to them to find out more though, and there is much we can do in the meantime, which is why I’m endeavouring to share more and reach out more online.
What else can we do?
One of the things suggested by Catherine Middlebrooks is purchasing an internal pelvic floor massager – yes it’s intimate, and it’s definitely something to consider trying out for yourself in times (like the time of writing!) when we can’t get to a Physiotherapist. (I bought this one here.)
How to practice pelvic floor exercises
I teach them three ways. All are important!
Firstly: as above: the rapid squeeze/release that most people think of as kegels. Very important; just not enough on their own.
Secondly: we slooooowly and gently, and with the breath, and with core awareness. Gently squeeze or engage the pelvic floor muscles starting at the back passage, then the vagina opening, then the area around the urethra (where you pee from), then lastly bringing a very light engagement (about 25% of effort) to the core muscles: specifically, the TVA (see “Core” below), or the deep zipper area muscles.
- INHALE: think RELAX
- EXHALE: think gentle squeeze; emphasis on gentle here.
INHALE: SLOWLY relax the deep muscles of the zipper area, relax urethra area, relax vagina area, relax back passage
EXHALE: SLOWLY engage muscles around the back passage, engage vagina area, engage muscles around the urethra, and engage the deep zipper area
We usually practice a good few rounds of this (it varies!) and always complete them by then allowing the pelvic floor to reeeelaaaaaax.
In our yoga class we combine this practice with the movements, which is even more important that just practising them in stillness. We don’t necessarily need them when are still, unless for practice, and of course to teach the pelvic floor and core to relax.
Thirdly: we work on practising them slooooowly, as above: and add in the practice of holding the contraction whilst continuing to breathe: and finally relaxing, and leaving the pelvic floor to relax.
Again, it’s just as important for the pelvic floor to be able to soften, yield, relax.
Hopefully, if everything was operating beautifully like the most ingeniously elaborate machine that your body is, you wouldn’t even have to think of any of this: it will all just happen organically and naturally. But because most of us don’t live lives where we are using strong legs and glutes and using all kinds of varied and wide-ranging movements in an organic way in response to a diverse kind of landscape – think barefoot, on the uneven terrain of mountains! –then, consciously working with the pelvic floor in this way can be fairly crucial.
- Check out writing, social media, podcasts and courses by Isa Herreras Katy Bowman and Catherine Middlebrooks
- Check out videos about the pelvic floor by the Physiotherapy department at the Rotunda Hospital
- Image for a good idea of where and what the pelvic floor muscles are
- Talk to a women’s health physiotherapist! I recommend Laura Carroll of Livewell Waterford; and Anne Dempsey chartered Physiotherapist was a great help for prolapse. I also know of Milltown Physiotherapy Dublin. If you are pregnant or post-natal contact the physiotherapy at your local hospital. I hear great things about the physios at Physio Southeast and Wexford General Hospital. Please let me know if you have any other recommendations, either here where I am in Wexford or wherever you are based