For women approaching middle age, urinary incontinence and vaginal weakness due to a compromised pelvic floor can be a common problem, particularly after childbirth. The drop in hormones around perimenopause can worsen these conditions. A 2019 study by Kolodynska found that urinary incontinence affects 50 percent of post-menopausal women and twice as many women as men. A study by Huang in 2018 found that yoga was beneficial to sufferers of urinary incontinence, and Cramer (2018) found that yoga can reduce menopausal symptoms in general.
What is the pelvic floor?
The pelvic floor is a bowl-shaped group of muscles situated at the base of the torso between the tailbone and the pubic bone. They support the pelvic organs, keeping them in place.
Why is it important?
A strong pelvic floor provides support for bladder control and prevents organ prolapse. It can heighten sexual sensations. The pelvic floor muscles are part of the core group of muscles, which also affects posture.
Why does the pelvic floor weaken?
Pelvic floor weakness can have several causes, including pregnancy, childbirth, pelvic surgery, the hormonal changes of menopause, and aging.
What are the symptoms of a weak pelvic floor?
Some of the physical symptoms of a weakened pelvic floor are urinary incontinence, pelvic pain, pelvic organ prolapse, and diminished sexual response. Psychological, social, and sexual issues may also arise due to resulting emotional distress, embarrassment, diminished self-esteem, and associated disruption of daily activities.
How can yoga help?
Regular yoga practice can help strengthen the pelvic floor, reducing and even eliminating symptoms of weakness. Yoga can benefit stress incontinence – the kind that happens when you cough, sneeze, or jump – particularly. While the standing poses detailed below build strength, the hip opening poses and those involving forward bends provide beneficial stretches for the pelvic floor.
Additionally, yoga can help calm the nervous system, leading to calmness and a greater sense of well-being. It is necessary to consult your health provider to discuss your suitability before starting any exercise program.
Equipment
You will need a yoga mat, a bolster or firm pillow, three blankets, a belt, a block, and two bricks for the following poses. Stay in each pose for 10 seconds and gradually build up to 30 seconds. It is important to breathe normally in each pose and keep the facial muscles soft; resist the urge to frown or tense the jaw, particularly if a pose is challenging.
1) Tadasana (Mountain Pose) with brick
Tadasana is usually done with the legs and feet together. In this version, you place a yoga brick between the top of your thighs and then bring the feet as close as possible together, with the heels aligned. Grip the brick with your inner thigh muscles and feel like you are trying to draw the brick further upwards. Grip your front thigh muscles and press them to the bone. Move your tailbone into your body and lift your front body from the pubic bone to the navel, the navel to the sternum, and the sternum to the chin. Stand tall, rolling your shoulders back and down and lifting your chest, keeping your head and gaze level. Your arms and hands should be straight by your sides, slightly away from the body, with the palms facing inward. Breathe normally.
2) Utkatasana (Fierce Pose)
Stand tall in tadasana with the inner edges of the feet together. No brick is required this time. Raise your arms vertically, reaching your spread fingertips towards the ceiling as you draw your shoulder blades down your back. Keep your tailbone towards the body and the same lift in your front body as above. Your front thigh muscles should be gripped and pressed back to the femur bones. Bend at the hips, knees, and ankles, keeping your weight in your heels as you lower your hips. Keep your arms straight, reaching up to provide lift in the torso.
To come out of the pose, press the feet down as you straighten the legs with firm thighs and hips, lowering the arms last, back to tadasana.
3) Virabhadrasana II (Warrior II Pose)
From tadasana, separate your feet by a distance equal to the length of one of your legs (you may need to start with a shorter distance and with practice work up to this). Turn your legs so that the right foot and kneecap point directly to the right and your left foot turns inwards slightly. Align the heel of your right foot with the arch of your left foot. Keep your torso facing forwards as you extend your arms straight at shoulder height, palms facing down, reaching into your fingertips with your shoulders rolling back and down, and chest lifted forwards. Move your tailbone into your body and keep your torso upright as you bend your right leg to a right angle. Your right shin should be vertical, your right knee tracking towards the little toe side of your right foot. Keep pressing your left heel down. Turn from the base of your neck and gaze over your right middle finger.
To come up, straighten the front leg, turn the feet forward so they are parallel, and carefully bring the feet together in tadasana before repeating the pose to the left.
4) Prasarita Padottanasana (Wide-legged Forward Bend Pose)
Place two bricks ready at the front edge of your mat. Like above, from tadasana, separate your feet by a distance equal to the length of one of your legs. Your heels should be aligned, and the outer edges of your feet parallel. Grip your front thigh muscles and press them back to the femur bones. Take your tailbone in and create the same lift in the front body as in tadasana above. Put your hands on your hips and point your elbows behind, rolling your shoulders back and down and lifting your chest forward. Keep the firmness in your thighs and hips as you hinge at the hips and bring your torso forward, leading with the chest and keeping the chin lifted. When your torso is horizontal with the floor, place your hands on the bricks under the shoulders. Keep the chin lifted and the sternum drawing forward. If your upper back is rounding, take more height under your hands until you can raise your chest ahead in the pose.
To come out of the pose, heel-toe your feet together in a zig-zag motion, place your hands on your hips, and keep your legs and hips firm as you lift your torso and step back to tadasana.
5) Malasana (Garland Pose)
For this pose, you will need a sturdy table or countertop that will not move while you are using it for support. It must be high enough that when you come into the pose, your arms reach upwards to hold on to it. You may also need a block.
Grip the table or equivalent and take a step or two back. With your feet together, bend your knees and ankles so you come into a deep squat with your torso between your knees. Press your heels firmly down and use your grip on the table to keep your arms straight and parallel and your torso lifting. You may need to adjust your distance from the table to achieve this.
To leave the pose, use your grip on the table to help you stand up and straighten your legs to tadasana.
If your heels do not reach the floor when you are in the pose, place a block underneath them so you can press them into that instead.
6) Chatushpadasana (Four-footed Pose)
Lie straight on your back in the center of your mat. Bend your legs, drawing your heels towards your hips, placing your feet parallel to each other on the mat and about hip-width apart. Straighten your arms on either side of your torso and grip the sides of the mat. Move your tailbone into your body as you press into your feet and lift your hips off the mat. Tuck your upper arms and top shoulder bones underneath your body so your chest lifts. Press the tops of your shoulders and your feet down as you press your buttock bones further up towards the ceiling, rolling your inner thighs down towards the floor. It is important to keep the thighs parallel in the pose and not let the knees splay. The shins should be vertical.
Slowly lower the hips to the mat to come out of the pose. Rest for a few breaths with the hands on the abdomen, and the legs bent, knees together, and feet apart.
7) Supta Baddha Konasana (Reclined Bound Angle Pose)
Place your bolster on your mat with a folded blanket on one end of the bolster for your head. Have two more rolled blankets ready. Make a large loop in your belt.
Sit on the mat at one end of your bolster, the end further away from the blanket, and draw the soles of your feet together, letting your knees fall outwards so your legs make a diamond shape. Place the belt loop over your head so it goes across your sacrum, then along your inner thighs, and loop it under your feet. Tighten the belt as much as is comfortable so your heels come towards your perineum. Recline back onto your forearms, and using your hands, move your buttock flesh towards your heels. Then lie back to the bolster so it is longitudinally under your torso (your hips and legs are on the floor). The folded blanket should be under your head but not under your shoulders. Your head should be level; if your chin or forehead is tipped up, adjust the blanket accordingly. Place the rolled blankets underneath the top of the thighs; they should not be pushing the thighs closer together, just supporting them where they are. Let your arms rest a small distance from either side of your torso, with the palms facing upwards.
Close your eyes and breathe normally. If this pose is comfortable, you can stay in it for five to ten minutes. If the inner thighs are tensing and cannot be released, place more height under your thighs accordingly.
8) Savasana (Corpse Pose)
Place your folded blanket at one end of your mat. Lie back so the blanket is under your head but not under your shoulders. Your head should be level; if your chin or forehead is tipped up, adjust the blanket accordingly. Use your hands to move your buttock flesh towards your heels. Place your arms slightly away from your sides, palms upwards, and feet hip-width apart. Extend into your fingertips, firming your upper arm muscles and drawing your shoulder blades down your back. Press your heels away, gripping your front thigh muscles. Then, release the grip on the arms, shoulders, and legs. Soften the facial muscles.
With the eyes closed, draw your attention to the sensations of the breath in the body, the feel of the air in the nostrils, and the rise and fall of the chest. Stay in the pose for five to ten minutes.
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