Updated: Aug 22, 2019
Pelvic Floor Empowerment
The pelvic floor and all that we know about it, including it’s ligaments and musculature, and of course its other remarkable capabilities is, for the majority of our population still a very deep mystery. Attitudes formed for this beautiful and intriguing zone of our anatomy come from our social or religious beliefs, emotions, and past experiences and may range from joy to angst. Everyone deserves healthy consensual sexual experiences free from pain and suffering, if that is what they desire, however a large majority of women and even many men suffer in silence.
Pelvic floor dysfunction (PFD) refers to a variety of disorders that may include pelvic pain, painful intercourse, urinary or fecal incontinence, pelvic organ prolapse and Irritable Bowel Syndrome. PFD can happen to anyone at anytime. For women it can be provoked by the trauma of childbirth, poor self-esteem or from sexual or surgical trauma. It has been linked to low back pain, SI Joint pain, and hip pain.
Countless women live every day with urinary incontinence , and not just a small leak here or there from a cough or a sneeze. It is so prevalent that huge corporations are selling products that combine pantyliner's with panties. Marketing is geared towards touting how these panties are created to be discreet and that you can still be sexy while showing no trace of the dreaded panty line. Furthermore it is common for elite female athletes to experience leaking during training from overly strong or hyper-tonic pelvic floor musculature. Even men are not exempt. PFD can be caused by an enlarged prostate, prostate cancer and we know by the volume of commercials and pharmaceutical advertisements that millions of men experience varying levels of erectile dysfunction (ED). Instead of suffering from these lifestyle altering conditions, both women and men can benefit from learning the correct way to tone and more importantly relax the pelvic floor.
For me, pelvic floor awareness occurred on my 50th birthday. It was the best party I could have imagined. Catered with amazing food, a raw bar, fireworks a bonfire and a rocking band. I was crazy dancing all over the place when I bust out one particular move and it happened. A warm quick burst of urine uncontrollably leaked from my bladder and I wet myself. “Welcome to the next half of your life” I remember thinking. Here I thought I was aging pretty successfully with no big health concerns. Granted stress incontinence isn’t coronary heart disease, but… Urinary incontinence! Seriously WTF? I had birthed two children, was fairly active, practicing yoga, surfing, mountain biking, and a healthy weight. Maybe this was just what to expect as part of the normal aging process. But no. Know that this is not normal. I have been incorporating pelvic floor toning in all of my yoga and it has enhanced every aspect of my pelvic health. And you too can reclaim pelvic floor health and enjoy pelvic empowerment.
For my husband; He suffered a stroke from a hemorrhagic tumor that bled into his brain requiring surgical intervention. Pelvic floor nerve damage left him incontinent of urine.This is when I snapped into nurse, yoga therapist researcher mode. I eventually found an exceptional on-line pelvic floor educational series designed by pelvic floor expert Physical Therapist/ Yoga Therapist Shelly Prosko. I was also inspired by my adjunct instructor Marlysa Sullivan MS PT C-IAYT and classmate Pelvic Floor Goddess, Jess Gruber of D.C., (both from the Masters of Science in Yoga Therapy program where I recently completed my first year out of two at the Maryland University of Integrated Health). And acturally it wasn’t my rare leaking I was concerned about, but it was to learn and understand how to help my beloved reclaim bladder control. By the way I’m happy to report that he did and he’ll be the first to tell you that as an added benefit, his orgasms are (for a seventy year young man) quite spectacular. Mine too have reached new and most splendid heights!
For women: When pelvic health issues arise I recommend you be safe and see your gynecologist who will on examination check to see if your pelvic floor is either lax (hypo-tonic) or tight (hyper-tonic) the latter being the most common finding. Aside from the psycho-bio physiological issues mentioned above, what else contributes to PFD? Posture is a huge culprit, the position of the spine while driving and the slouching into a couch at the end of the day which reverses our normal lumbar curve are examples. Commuting long hours, sitting at a desk all day, the habitual hiking of one dominant hip while holding a baby and birth control or hormone replacement along with the normal aging process could also be contributing factors. There are so many layers of muscles interwoven with intricate connections that form this fascinating yet vital area of our bodies which can either atrophy or become overly tight with habitual postures.
If your doctor finds laxity, they will likely prescribe the old fashioned Kegal to help strengthen the complex musculature and delicate tissues that circle and surround both the elimination and reproductive systems. If unfamiliar, this is usually described to their patients as a contraction of the muscles used to stop the flow of urine or a clenching of the buttocks and the anal sphincter when it’s clearly not a socially appropriate time to just let one rip.
To repeat, most women are already very tight and this type of Kegal will only make the problem worse because over tightening usually makes symptoms worse. What I’m talking about is the new Refined Kegal and especially the Reverse Kegal. Muscles are meant to take rests. Imagine walking around with a flexed bicep for your entire day. Twelve hours later when you go to release that bicep curl the muscle is so hyper contracted that it becomes stuck in that contraction and can not easily release. With our current lifestyles, pelvic floors are stuck in contraction. Many women due to so called ‘social norms, or wanting to conform to a certain looks by sucking their bellies in, or walk around in high heels, and tight fitting clothes may find themselves suffering with PFD related conditions like SI Joint pain.
Visiting your gynecologist is truly the only way to know whether you have a tight or lax pelvic floor. Some doctors may refer you to physical therapists specifically trained to do external and internal pelvic floor massage. This helps to break up adhesions in the connective tissue or myofascial planes in and around the vulva that will allow relaxation to begin. If you are not referred please advocate for yourself and tell your GYN that you would like to work with a pelvic floor specialist if this is a treatment modality you wish to try. Where a yoga therapist can help is with guiding you into relaxation through your koshic layers where moving inward to develop body awareness and heightened sensation begins. This is termed as embodiment and is necessary for learning the correct way to subtly and precisely engage the pelvic floor.
Developing embodiment is essential to cultivating the delicate actions needed to perform the most gentle lift of the perineum, and even more importantly how to fully relax this mild contraction to the correct rhythm of the breath. When performing these exercises the goal is to sense a broadening of the perineum on the inhale and a faint lift of the perineum on the exhale. The perineum is defined as the space between the reproductive genitalia and the anus. In the yoga world this area is linked to our root chakra, the Muladara chakra which sits at the base of the spine. The root chakra when balanced allows us to feel safe and secure and likely when unbalanced can also be a contributing to pelvic floor dysfunction. For those who practice engaging Mula bandha note in the instructions that follow that this energy lock when performed, should be super subtle.
Anatomically the respiratory diaphragm moves in tandem and in the same direction as the pelvic diaphragm. To experience this for yourself, sit upright on the center of the sitz bones, your upper body weight equally distributed over your pelvis. Inhale and notice when you fill your chest with breath that your belly may and should also expand. On the inhale the dome shaped respiratory diaphragm flattens and moves downward pressing the abdominal contents towards the slight dome shaped pelvic diaphragm. The bladder, uterus and rectum nestle snugly onto the pelvic diaphragm or pelvic floor. Notice on your next few inhales if you feel a slight widening of the sitz bones, buttocks and hamstrings, and then more specifically, place your awareness on the pressure of your perineum as it presses downward into the crotch of your pants.
Once you begin to have an understanding of that internal sensation you are ready to focus on the sensation that occur on the exhales. As you exhale the respiratory diaphragm lifts and you should sense pressure lifting from the pelvic diaphragm as the pelvic organs are no longer somewhat compressed. This is when the subtle lifting contraction known as pelvic floor engagement should occur. Notice that this is a very gentle lift and not a grand squeezing of the urinary and anal sphincters. But wait... We are not done yet. When practicing this full contraction and relaxation series you must learn how to allow the entire pelvic floor to fully release and relax on inhales. A yoga therapist specializing in pelvic floor health can guide you towards mastering these movements.
There also seems to be a place in pelvic floor health for using cannabis topicals. Canna lubes are making their way to the stage in this arena. They can be THC/CBD infused, or CBD infused alone. They are available as suppositories too. A note of caution is that latex based condoms degrade when they come into contact with oils. Water based canna lubes generally have a mixture of oils such as coconut oil, which my gynecologist is really keen on.
Know your source and ingredients. Organic is best for protecting our tender parts.
Besides heightening sensation, cannabis lubes may help relieve pelvic pain. I recently had the pleasure of working with one beautifully vibrant and very modern older woman who had been having pelvic discomfort with intercourse for a few years. Regular water based lubes and dilators recommended for her did not help. After employing both the canna lube with the gentle pelvic floor exercises she reported back after a few days stating that her pain was nearly gone, and that her sexual life had been greatly enhanced. Also as I have written before in a past blog post, body awareness and becoming embodied is not easy for a vast majority. Therapeutic cannabis can often assist in allowing one to begin experiencing the sensation of 'going inward' with more ease. Observing, feeling and understanding these embodiment skills are necessary for successful pelvic healing and overall pelvic floor health.
So many people assume that leaking is due to a weak or lax pelvic floor and is just part of the normal aging process. And then there is the myth that once you have a baby it’s all over because a partner won’t enjoy the same level of satisfaction (read 'tightness') with intercourse. The truth is that the vagina has the innate ability to return to it’s original size and pliability if only we know the correct ways to assist it. Pain and suffering doesn’t have to compound the mystery of this anatomical and physiological wonderland. And for men who also suffer with life changing symptoms of urgency, frequency, leaking and ED, know that the notion that life is over and this is just a normal part of aging does not have to be true. Nope not true. Reclaim pelvic empowerment!