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If you’re human, you have a group of muscles at the bottom of the pelvis that you and everyone else uses for the most basic everyday functions—to walk, lift things, exercise, pee, poop, have sex, and, for some, bring life into the world. Those are pretty critical functions for a part of the body most of us rarely concern ourselves with…until there’s an issue with pelvic floor dysfunction.
Issues related to pelvic floor dysfunction range from incontinence (urinary leakage with jumping jacks, anyone?) to uncontrolled and ill-timed gas (like an “oops” during Downward-Facing Dog at a studio class).
Some of the most common contributors to pelvic floor dysfunction that I see in my role as an occupational therapist specializing in pelvic health apply to those of us who are born female. Stress to the pelvic floor muscles are brought on by pregnancy, childbirth, and the hormonal changes that accompany getting older.
However, many pelvic floor issues can be brought on by stealthily subversive habits that almost all of us engage in at least once in a while. Recent research suggests that at least 32 percent of women and 16 percent of men will experience at least one pelvic floor health issue during their lifetime, and that’s based only on subjects who reported their dysfunction. Many of us don’t realize that some of the issues they experience can actually be traced back to their pelvic floor muscles.
The Anatomy of the Pelvic Floor
The pelvic floor contains 14 to 16 different muscles that are woven together in three layers. Like any other muscle in the body, the pelvic floor muscles can also become weak, tight, and/or fatigued. This causes pelvic floor dysfunction.
Pelvic floor dysfunction can manifest as an array of symptoms:
- Sensing an overwhelming urgency to pee or needing to pee all the time
- Constipation or straining with bowel movement
- Leaking pee or poop of any amount (urinary or fecal incontinence)
- Difficulty urinating
- Difficulty controlling gas
- Experiencing pain during sex
- Experiencing pain in the lower back, hips, and/or tailbone
- Feeling heaviness in your pelvis (pelvic organ prolapse)
- Feeling pain during a gynecological exam or when you insert a tampon
7 Things That Contribute to Pelvic Floor Dysfunction
If the following actions are engaged in once in a while, there are typically no consequences to the well-being of your pelvic floor. However, if they become habits, both inside and outside of your yoga practice, they can contribute to issues.
1. Taking “Just-in-Case” Pees
It’s five minutes before yoga class begins and, like clockwork, a line forms outside the stalls in the locker room. Simply the sight of seeing folks wait for the restroom can make others feel like they should go, too.
Although taking a “just in case” restroom break tends to be an ingrained practice dating back to early childhood (thank you, parents), it’s not great bladder hygiene for adults.
The bladder and brain constantly communicate with one another and fall into routines based on your habits. Going “just in case” creates and reinforces neural pathways that indicate your bladder needs to be emptied, even if you go just a few drops. Rest assured, your bladder can hold up to 500ml of fluid. That’s the equivalent of a 16-ounce bottle of water and then some.
2. Hovering Over a Public Toilet
There are also times when you actually do have to pee but find yourself in a less-than-pristine public restroom situation, so you decide to squat over a toilet without sitting down.
The mechanics of evacuation include releasing the pelvic floor muscles with no pushing or straining necessary. But hovering or squatting over a public toilet activates your core and pelvic floor muscles rather than relaxes them. This position makes emptying your bowels or bladder more difficult by requiring effort to initiate evacuation. This causes unnecessary strain.
It’s best to sit your bum down. Use whatever form of protection brings you ease of mind, whether seat covers, toilet paper, or an eco-friendly sanitizer spray.
3. Sucking in Your Stomach
Contrary to the unfortunate and outdated programming that some of us experienced as children around false beauty standards and fitness fads, a sucked-in abdomen does no one any favors.
To clarify, engaging your core and sucking in your stomach are two entirely different actions. Engaging the core begins with the contraction of the lower abdominal muscles, as if you were pulling on a pair of tight pants. It’s followed by the rib cage pressing downward and inward, as if it was protecting your internal organs. Engaging your core in this manner provides stability.
Sucking in your abdomen is more of an illusion. When you draw in your tummy, your mid abdomen sucks inward, the ribcage presses outward and upward, and the pelvic floor pushes down. This destabilizes your body by creating rigidity and tension rather than strength.
Your abdominal cavity has its own natural pressure system that interacts with the abdominal wall and visceral organs. The pressure oscillates throughout the day based on internal movement (i.e., breathing and digesting) as well as external movement (i.e., exercise).
Imagine squeezing the middle of a balloon. Cinching it in this fashion sends the pressure up (toward the ribs) and down (toward the pelvis). This is what sucking in your stomach does to your abdominal cavity. Over time, increased pressure on the pelvic floor can lead to tension, weakness, and a lack of coordination in your pressure system.
4. Holding Your Breath During Your Yoga Practice*
Have you ever found yourself doing something hard, whether physical or mental, and realized you’d been holding your breath? Consider Chaturanga Dandasana. It’s a challenging shape that, when practiced properly, works your entire core and engages muscles from head to toe. With such intensity, holding your breath is a common tendency.
Returning to the image of a balloon, holding your breath during physical intensity is like pushing on the balloon from the top. The pressure responds by moving outward, which restricts core activation, and downward, which restricts the natural movement of the pelvic floor muscles.
A habit of holding your breath in Chaturanga, or any challenging pose or workout, inhibits the natural deep core and pelvic floor connection which allows you to hold such intense shapes and builds strength. As you lower yourself in Chaturanga, aim for a long, slow exhalation. This will activate your core muscles and draw a response from your pelvic floor as well.
*There are specific pranayama practices that involve intentional breath retention. Practice these under the supervision of experienced yoga teachers.
5. Overtucking Your Tailbone
There’s a lot of controversy around the cue “tuck your tailbone.” As a pelvic floor therapist, I, too, have an opinion on this, although the cue to tuck or drop your tailbone isn’t what I have an issue with. It’s how it gets interpreted.
Many people hear this cue and find an extreme shape, flattening their spines and scooping their pelvis under. Overtucking the tailbone results in clenching of glute muscles and overactivation of the pelvic floor muscles. This can create pelvic floor tension, hip pain, lower back issues, pain with intercourse, as well as urinary and bowel concerns.
There is no such thing as “perfect posture.” We need to learn the beautiful nuances of our bodies and understand that our spine position changes when we walk, sit, sleep, and roll. Your yoga positions need to allow for that shift as well and enable you to move in and out of pelvic tilts and not get stuck in one plane.
6. Prolonged Mula Bandha
There is a deep energetic foundation to the practice of mula bandha, which is an energetic lock of the pelvic floor muscles. Unfortunately, this meaning is sometimes lost in translation in yoga classes. Also, in certain yoga traditions, it is standard to keep your mula bandha engaged whether you are inhaling or exhaling.
But our pelvic floors are responsive, adaptive, and autonomic. No one needs to “lock” the pelvic floor for the entire duration of a yoga practice. Pelvic floor muscles should be able to reflexively adapt to the movements of your breath, your core, and the musculature of your hips and spine.
Engaging in prolonged mula bandha does not equate to healthy pelvic floors. Moving through all ranges of motion and developing good overall core strength does.
7. Wearing Tight Clothes
You won’t get me out of my yoga pants. However, high-waisted yoga pants and sports bras that are too tight inhibit abdominal expansion (think back to the balloon) and block the rib cage from moving fully and organically. Prolonged exposure to restrictive clothing, including ill-fitting bras and pants, can create abdominal tension and disrupt the usual pressure management within the core canister. This can also result in difficulty breathing, and yes, pelvic floor dysfunction.
This is especially true for types of clothing worn specifically for movement and exercise. Yoga pants and sports bras that fit well will not only feel better but improve your ability to breathe and allow for greater core activation.
In addition, improperly fitting underwear (i.e., constriction around the legs) does not allow for normal blood flow into the lower half of the body. Consider this permission to purchase clothes based on fit rather than size! And if you’re someone who lounges in their yoga pants you may want to consider a more relaxed fit.
It’s the little things that can make all the differences when it comes to preventing and managing pelvic floor issues.
RELATED: The Best Yoga Poses for Pelvic Floor Dysfunction, According to Physical Therapists
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