Optimizing Bladder Control: Strengthening the Pelvic Floor

As a yoga teacher and pelvic floor physical therapist, I blended the two disciplines together as part of a holistic model of care to create this video for optimizing bladder control through strengthening the pelvic floor.

This video is recommended for people who experience:

  • weakness in the pelvic floor
  • urinary incontinence
  • fecal incontinence
  • pelvic organ prolapse
  • diastasis rectus abdominus
  • hip and/or back pain due to loss of core strength and flexibility

How does this video help?

The breath, core, and pelvic floor work together for optimal pelvic health.

In this video, we work to mindfully:

  • increase strength of the gluts, hip rotators, abdominal wall, and pelvic floor muscles
  • flexibility of the lower extremity and spine
  • improves balance via increasing core strength and standing postures
  • coordinate the breath and pelvic floor during functional tasks like squatting
  • improve sexual function by increasing awareness and blood flow to the pelvic floor

What if I have urinary urgency?

Urinary urgency is often associated with tightness of the pelvic floor muscles. Along with manual therapy or a dilator home program, the pelvic floor relaxes when the nervous system is balanced.

A yoga practice can decrease the sympathetic nervous system activation (fight-or-flight reaction) through mindful movement and breathwork.

If you experience urinary urgency, the “Calming Flow” is an excellent place to start.

What to know

Appropriate diagnosis

When seeking treatment for urinary incontinence, pelvic organ prolapse, or any other pelvic concern, please seek out the appropriate medical provider.

Your provider will be able to create a treatment plan that might include pelvic health physical therapy, medication, acupuncture, nerve blocks, therapeutic exercise, dietary tips, yoga, and mindfulness.

Avoid constipation

If you and your provider suspect diet might play a role in your symptoms, being properly hydrated, increasing fiber intake and avoiding irritants may provide relief. Often constipation can make urinary urgency and leakage worse.

Some techniques to try are:

  • elevating your feet on a Squatty Potty (or stool)
  • working with the pelvic floor muscles (lengthen or strengthen)
  • abdominal massage

Stool consistency is a self-assessment tool you can communicate to your provider.

Mobilize

Movement that feels safe in your body is critical to feeling like your best self. This is why so many people love using yoga as an adjunct treatment modality to decrease back, hip, pelvic and other persistent pain and increase strength of the extremities, core, and pelvic floor.

Yoga offers the opportunity for slow, mindful movements with breath work and inner reflection. Relaxing, developing awareness, and integrating breath into your movement increases flexibility of the body and the mind.

Yoga helps control the release of compounds in your body: serotonin (the feel-good neurotransmitter) and cortisol (the stress hormone). The majority of serotonin is produced in the gut. Strengthening the parasympathetic nervous system response through gentle movement can be helpful in the balance of cortisol and serotonin.

Breathe

Conscious breathwork, or pranayama is another non-invasive tool to decrease superficial muscle overactivity and increase core awareness. See the pranayama section below for a continued discussion.

Aspects of a yoga practice

Eight limbs of yoga

The Indian sage Patanjali outlined “eight limbs of yoga” in the Yoga Sutras.

You may be familiar with asanas (physical postures) and pranayama (breathwork), but these are only two of the “eight limbs of yoga” as outlined by the Indian sage Patanjali in the Yoga Sutras.

Meditation, compassion, and other concepts and practices of yoga can be applied in the holistic model of healing the pelvis and general wellness.

Pranayama

Iyengar describes pranayama as “extension of breath and its control.” Pranayama can be practiced alone or in coordination with asana. Mindful pranayama encourages the student to explore diaphragmatic breathing without gripping and holding tension in the chest and ribcage.

To learn more about the relationship of the breath and the pelvic floor, check out this video of pelvic floor movement with the breath. If you wish to gain knowledge about different types of pranayama, read these blogs:

Asana

Asanas are the most widely known aspect of yoga. Prior to asanas, warm-ups are an ideal way to introduce movement. Gentle and slow movements combined with conscious breathing, act to warm up muscles, lubricate joints, and direct the focus of the student inward to the mind-body-spirit connection.

Here are a few examples of warmups and postures that are included in this video.

Alternate arm leg extension

Alternate arm-leg extension

  1. Start in table top position: on your hands and knees with hands directly under shoulders and knees directly under your hips.
  2. Engage the transverse abdominals (see below for transverse abdominal activation).
  3. Press your hands into the floor.
  4. Lift your right arm forward. If this is easy, point the left the leg back. If you are unable to keep your pelvis from shifting to the right, or if you have pain, try just the arm or just the leg.
  5. Stay connected with your breath and create length from the top of the head to the tailbone, keeping your spine long.

Bridge

Bridge asana yoga pose

  1. Rock your pelvis so that your spine is flat.
  2. Roll your pelvis off of the floor, imagining that you are lifting one vertebra at a time.
  3. As you are in bridge choose to contract the pelvic floor in isolation, with the breath (on the exhale is the natural movement of a pelvic floor muscle contraction but it works with both the inhale and the exhale!), or with an inner thigh squeeze (block or ball).
  4. You might choose to advance to unilateral bridging by holding one foot off of the floor for 7 to 10 breaths and repeating on the other side.

Squat

Squat asana yoga pose

  1. Find Mountain Pose.
  2. Inhale, send your sitz bones back as you keep your back straight and imagine you are about to sit in a chair.
  3. Exhale, gather and lift your pelvic floor muscles as you straight your knees and return to Mountain Pose.

Transverse abdominal contraction and progression

Transverse abdominal contraction and progression

Activation cues to create a lower abdominal brace:

  • Pull the two hip points together
  • Zip up a pair of tight hip huggers
  • Pelvic floor muscle contraction (as if stopping the flow of urine)

This should be done at 20–30% effort so that your abdominal wall does not puff out due to overexertion.

  1. Lay on your back with your knees bent and feet flat. Maintain your abdominal contraction as you lift your right heel. Replace your heel and lift the left. Your goal is to keep your pelvis even—monitor at the hip points.
  2. Progress above by lifting the entire foot without allowing the pelvis to rotate. Alternate feet and “march.”

Warrior 2

Warrior 2

  1. Start in Five Pointed Star with your hips wider than hip distance apart.
  2. Turn your left leg out from the top of your hip.
  3. Bend your left knee, sending it over the second toe.
  4. Check your right foot. Does it feel good to have a stretch on the outer lower leg by maintaining a parallel foot?
  5. Arms can come out to the sides, reaching out from the center of the body.
  6. Stay here or create a flow by inhaling in Warrior 2, exhale as you straighten the front leg and contract the pelvic floor.
  7. This is one of the hardest positions to feel a pelvic floor contraction in, so don’t be surprised if you can’t activate well here! That’s normal!
2018-06-20T11:41:19+00:00

2 Comments

  1. […] Optimizing Bladder Control: Strengthening the Pelvic Floor is designed to offer gentle loading to the pelvic floor and rest of the core. This video can be a useful home program to have as you work on regaining function and gentle loading of the abdominal wall. […]

  2. […] pelvic floor and core strength for women with prolapse. If you are interested in yoga, check out Optimizing Bladder Control: Strengthening the Pelvic Floor. The content is similar to a traditional physical therapy program with the additional focus of the […]

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