Our lady parts have been much in the news this last year within the political arena, particularly so the last few weeks. With all the attention on female anatomy in the media, I decided it might be a good idea to have a little better understanding of just how said parts actually work, so spent the last weekend of summer attending a workshop entitled “Demystifying “Down There:” Yoga for the Female Pelvic Floor – with the nationally known instructor Leslie Howard. And what an enlightening weekend it was!
The term “female pelvic floor” refers to a group of muscles that form the muscular base of operations for our torso, a muscular hammock if you will that supports the organs within the pelvis. The pelvic floor gets a lot of attention during pregnancy and postpartum, because the process of pregnancy, during which the uterus grows from the size of a pear to the size of a watermelon, puts increased pressure on this essential part of our anatomy, which can lead to an increased need to pee (urge incontinence) and on occasion, the loss of pee when you’re coughing, sneezing, or just plain getting around (stress incontinence). Women are also naturally concerned about their ability to stretch and avoid tearing as the baby passes through the vaginal opening. We want women to have strong, but pliable pelvic floor muscles that can support our internal organs, easily stretch around the baby’s head as it crowns during birth, and quickly regain their tone postpartum
Anatomy of “Down There”
Even though this part of our female anatomy is getting a lot of public attention these days, many of us don’t have much understanding about its basic structure. First off, it’s hard to see, unless you use a mirror. Second, much of it is internal, rather than external. In our culture, the first time many women pay much attention to their pelvic floors is when they become pregnant. So a little anatomy is in order here.
The “pelvic floor” is actually not one muscle, but several layers of muscles that help to support our internal organs. The first layer of muscle can be thought of as a “compass rose” that runs front to back from the pubic bone to the coccyx (the bulbocavernosis), and from side to side from the perineum to the sit bones (the transverse perineals. (For a detailed, three dimensional video that shows all the major structures of the pelvic floor much better than I could explain, click here. It’s well worth the view.)
There are three openings along the length of the bulbocavernosis, the urethra, the vagina, and the anus, and the bulbocavernosis snakes around them like a figure eight. The perineum is the area between the vagina and the anus, and it is this area that gets a lot of attention during the birth process.
The next innermost layer of muscle is known as the levator ani. These have almost a bowl-like shape at the bottom of the pelvis, with a U-shaped an opening for the urethra and vagina, and are the muscles that do most of the heavy lifting of the abdominal organs. When we take a breath in, the thoracic diaphragm balloons downward, pushing the abdominal organs toward the pelvic floor, which in turn moves downward and stretches slightly. When we exhale, the thoracic diaphragm moves upward, followed by the abdominal organs, and finally the pelvic floor. We can accentuate this natural stretching and toning by bringing conscious awareness to our PF’s. But more on this later.
Childbirth, Your Pelvic Floor, and You
Many pregnant women are concerned about “tearing” during the childbirth process (in fact, at last week’s prenatal yoga class, when I asked if anyone had been thinking about about their pelvic floor, one mama responded “who’s NOT thinking about it!”). For years many care providers routinely performed episiotomies, a surgical cut in the perineum toward the anus, in an attempt to minimize tearing. Turns out, this procedure actually causes more harm than good in most cases, as tears that occur naturally tend be smaller, and heal faster and less painfully than surgical cuts. So it’s a great idea to discuss with your care provider his or her use of routine episiotomy, as there is no evidence to support this practice.
While it is true that the birth of a child will often cause a degree of bruising and/or tearing of the pelvic tissues as the baby emerges, it is also true that we can minimize the degree of tearing and enhance the healing process by toning the pelvic floor muscles so that they are both strong and supple.
Imbalances in the Pelvic FloorThe pelvic floor muscles are like any other muscle in the body – they work best when strength is balanced with flexibility. While most women need to focus on strengthening the pelvic floor, particularly in pregnancy, which puts additional weight on the pelvic floor muscles, some may also have too much tone. This can contribute to pelvic pain and may increase the risk of tearing during birth.
What to Do if You Need Extra Help
If you experience any pain or discomfort in your pelvic muscles that interferes with your activities of daily living or lasts for more than a couple of days, contact your care provider. They may be able to refer you to a Women’s Health Physical Therapist, of whom we have a number in Richmond. WHPT’s specialize in working with women throughout the reproductive cycle and can do a detailed evaluation and tailor an individualized physical therapy program to meet your needs.
Exercises to Strengthen the Pelvic Floor
- Sit quietly, evenly balanced on this sit bones. Breathe down into your belly and pelvic bowl. Notice how your pelvic floor stretches and widens slightly as you inhale, and how it lifts gently as you exhale. Continue for several breath cycles until you feel familiar with this area of your body.
- Now imagine that you are drawing the left and right sit bones toward one another with your next exhalation. Use the smallest amount of effort you need to activate your pelvic floor muscles – you want to avoid engaging the buttock or thigh muscles, which will have a tendency to take over. Continue, contracting side to side slightly as you exhale, letting the pelvic floor expand as you inhale. Continue for 8 – 10 breath cycles.
- Next, imagine that you are drawing the pubic bone and the tailbone toward one another, narrowing the pelvic floor from front to back. Again use the least amount of effort necessary, so you engage just the pelvic floor, again on your exhalations. Continue for 8 – 10 breath cycles.
- Finally, imagine that you are drawing the four corners of your “compass rose” – L and R sit bones, pubic bone, and tailbone, toward one another. Pause. Then on your next exhalation imagine that you are drawing the vaginal opening in and up into your abdomen (imagine the feeling of gripping around a tampon – that should help you locate the contraction in the proper area). Inhale and relax completely. Continue for several breath cycles, checking to make sure you are not engaging the abdominal or buttock muscles, or gripping the anal sphincter.
Take 5 minutes a couple of times a day to practice these – using less muscular effort until you feel until you feel like you have the hang of it. Then practice 5 minutes a day for the rest of your life. My favorite time to practice PF exercises is while sitting in my car at stoplights or standing in line at the bank. It’s just about the right amount of time, and nobody will know but you. Or try these toning exercises while you are in a full or partial squat, when the pressure of the abdominal organs on the pelvic floor will make them feel more pronounced.
Practiced daily, along with movements that lengthen or relax the pelvic floor, these exercises will help you maintain tone throughout your pregnancy and postpartum, and help prevent incontinence issues during menopause, when lowered estrogen levels contribute to a loss of flexibility.
Next week we’ll focus on a few yoga poses and techniques that can help to stretch the pelvic floor muscles.
Leslie Howard’s website has some fabulous articles and resource.
Women’s Health Physical Therapy – Info and Useful Links