The pelvic floor muscles support the bladder, uterus and bowel, so maintaining their strength is essential. In this guest post, we asked Anja what causes a weak pelvic floor, and what can be done to maintain strength in these important muscles.
Anja Brierley Lange is the author of the best selling book, Teaching yoga for the menstrual cycle – an Āyurvedic perspective. She is an experienced yoga teacher and āyurvedic practitioner (BSc, PGDip) and has specialised in female anatomy and physiology. Anja offers classes, workshops and consultations online and in person. Learn more on yogaembodied.com including online courses about the pelvic floor and menstrual cycle awareness.
The pelvic floor is an intricate system of layers of muscles. And like all muscles: if you don’t use them you lose them. Or rather, they get weaker or tighter. Because like all muscles the pelvic muscles can also get tense.
I like to use the example of the “pandemic pelvis” for why we might have a weak pelvic floor or bladder issues.
The pandemic pelvis refers to reports on how the past few years have affected our pelvic health. We have been more sedentary. Spending time slouching on the sofa or sitting in unsupportive chairs. No commutes or walking to train or tube. No walking to the office or to various meetings. We might have missed our exercise classes. We didn’t get out to socialise. We lacked the general movement patterns that are usually part of everyday life.
Many of us also experienced anxiety, tension and stress. Below I’ll share how all of this affects our pelvic floor and could lead to a weak pelvic floor and potential bladder issues.
The pelvic floor is like a hammock at the base of our pelvis. When we spend a lot of time sitting and especially if we slouch or tuck our tailbone the base of the pelvis contracts. In turn, the muscles tighten.
Tight muscles lack mobility and flexibility. They may have decreased blood and lymphatic circulation too.
Tight muscles can also manifest pain and discomfort. Most of us can relate to tightness in our necks and shoulders. It’s uncomfortable and can be a real pain. It’s the same for the pelvic floor.
This is a pattern many of us experience but was certainly highlighted during the pandemic and us working from home on unsupportive chairs and lacking commuting and even walking around the office.
You might think you want to tighten your pelvic floor. But remember tight muscles are not strong muscles. Tight muscles can in fact be weak.
The weak and tight pelvic floor can create all the issues you associate with loose muscles. And some symptoms specifically associated with the pelvic floor: Incontinence, leaking, pelvic pain, constipation, piles, discomfort during sex, and prolapse.
So if you think you have a weak pelvic floor or weak bladder you might actually want to relax the pelvic muscles – and then learn to engage.
I show you more in this video.
Do you know how you tighten your shoulders when you are stressed? Or clinch the jaw? Most likely you also contract the pelvic diaphragm. It’s a natural physiological response to a fight, flight or freeze response. And we do it unconsciously. This also means we forget to release the tension again. During the pandemic, we might have experienced extra pressure, anxiety or stress. This will also have affected our pelvic floor.
The pelvic floor is sometimes (perhaps more accurately) referred to as the pelvic diaphragm. The diaphragm is a dome-shaped structure. We also have a diaphragm underneath our lungs called the respiratory diaphragm. When we inhale the lungs expand and the respiratory diaphragm is pushed slightly downwards towards the abdomen. This is why the belly expands and moves as we breathe. At the same time, the pelvic diaphragm also expands. This happens all on its own without us having to think about it. When we exhale both the diaphragms will rise back up again.
This means that every time you breathe you are moving and exercising the pelvic floor! Without having to think about it.
The problem is that so many of us are tense, stressed and anxious. We may always feel like we are in a rush and we forget to breathe properly. If we don’t breathe properly it will affect our pelvic floor health and our pelvic organs.
The good thing is that if we remember and re-learn how to let our bodies breathe their natural breath both our pelvic floor and mental health may benefit.
As a yoga teacher, I often say that “Everything is connected”. We know how our breath can affect our mental health concerning stress, anxiety and even depression. The pelvic diaphragm is part of our breathing pattern and the fight, flight or freeze response. Body, mind and breath are indeed connected.
There are obviously other reasons why we might experience a weak pelvic floor. Life events such as pregnancy, birth, postpartum, perimenopause and post menopause are all affecting our pelvis and pelvic diaphragm.
During pregnancy, our hormones change dramatically which can affect our ligaments and muscles. The hormone progesterone increases which may lead to a relaxation of muscular and fibromuscular structure. The weight of the growing uterus, baby or babies and placenta also puts pressure on the pelvic muscles and bladder which can lead to symptoms such as stress incontinence.
Although stress incontinence is common postpartum research suggests that urinary incontinence arises from multiple physiological factors. Intra-abdominal pressure during pregnancy, constipation, hormonal changes, the physiological birth process and any potential trauma to the body during birth can all affect the pelvic floor.
Understanding how to relax and engage the pelvic diaphragm before and during pregnancy will benefit after birth too. I also highly suggest that anyone who has given birth (vaginally or cesarian) visits a women’s health physiotherapist to get assessed so they receive individualised support for postpartum recovery.
Another time when our hormones change again is during perimenopause. This is the time of transition from having regular periods to eventually no longer having a menstrual cycle. This lead-up can take 5-10 years. Menopause itself is the one-year anniversary of having no menstrual phase at all. Anytime after that is post menopause.
In this transition and postmenopause the hormone oestrogen changes. Eventually, it will decrease as we move towards postmenopause. Oestrogen is an important hormone for our muscles as well as our vaginal and urogenital systems. This is another time when we may experience changes in our pelvic floor and urinary continence.
These hormonal changes are natural and we can work with our bodies to enhance our pelvic health regardless of where we are in our lives.
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Pelvic floor exercises are essential to maintain strength and prevent urinary incontinence. Yoga can be a great way to strengthen the pelvic floor muscles; follow Anja’s advice to learn more.
There can be many reasons why your pelvic floor muscles become weak, including inactivity, pregnancy, childbirth and age. Speak to your doctor if you’re concerned, and for more advice on exercises and treatments to help.
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