Pelvic Floor: It’s NOT Always About KEGELS!

Using Yoga To Help Pelvic Floor Dysfunction by Dr. Jessica Klain

Kegels do not solve all pelvic floor issues. Sometimes Kegels can even make things worse!
Kegels are an exercise that focus on activating and contracting the pelvic floor muscles – the
muscles that collectively make a “hammock” at the bottom of the pelvis by attaching to the pubic
bone in the front and the coccyx (aka “tailbone”) in the back. The pelvic floor muscles are
responsible for supporting organs, maintaining sphincter control for bowel and bladder activity,
play a major role in sexual function, provide strength and stability, and help with circulation.
There are two main types of pelvic floor dysfunctions: weakness and hypertonicity (tightness).
The first step to addressing pelvic floor dysfunction is determining if the problem is due to
weakness or hypertonicity. The next step is to develop a plan to thoroughly address your habits
and dysfunction.

Symptoms of weak pelvic floor include urinary or bowel leakage, stress incontinence (i.e.
leaking with coughing, laughing, or bearing down), tampons that fall out, accidently passing gas,
reduced sensation, and/or not making it to the toilet in time. The pelvic floor can become weak
following pregnancy/giving birth, obesity, abdominal or pelvic surgery, chronic coughing, and/or
repetitive heavy lifting. Symptoms typically develop overtime and tend to linger if not treated
appropriately. Common treatment strategies for pelvic floor weakness include breathing,
activation, low back and hip strengthening, posture control and activation, spine mobility, and
Kegels.

Yoga poses to help improve pelvic floor weakness include:
● Tree Pose
● Mountain Pose
● Chair Pose
● Bridge Pose
● Boat Pose
● Warrior I/II/III Poses
● High Lunge

Additional focus on pelvic floor activation and strengthening can be achieved by working to lift
the pelvic floor as you work through the yoga poses listed. Be sure to continue normal
breathing pattern to avoid clenching or bearing down through your core and pelvic floor
muscles.

Symptoms of a hypertonic pelvic floor include incomplete bladder emptying or bowel movement,
trouble starting urination or a bowel movement, constipation, sudden urge to urinate, and/or
painful sex. Hypertonicity of the pelvic floor can develop due to fibroids, STDs, irritable bowel
syndrome, ulcerative colitis, pelvic pain, low back pain, fibromyalgia, hypermobility, and/or
endometriosis. Similar to pelvic floor weakness, hypertonicity symptoms tend to develop overtime and continue until directly addressed. Common treatment strategies to reduce
hypertonicity include internal pelvic floor assessment and manual therapy by a trained
specialist, diaphragmatic breathing, hip mobility, and muscle relaxation strategies. Kegels are
NOT an appropriate treatment strategy for hypertonicity as they tend to contribute to the
overactivation of the pelvic floor muscles and can make symptoms worse.

Common yoga poses to reduce pelvic floor hypertonicity include:
● Happy Baby
● Childs Pose
● Supine Twist
● Reclined Butterfly
● Pigeon
● Lizard
● Yogi Squat/Malasana
● Cat/Cow

Additional relaxation can be promoted by relaxing and breathing into the pose, holding the pose
for 3-5 minutes as tolerated, and performing several times a day.

Every woman, man, and child as a pelvic floor. That means everyone can develop pelvic floor
dysfunction, not just post-partum women. Each person may present differently in symptoms
and response to treatment. The suggestions above are a good place to start to address pelvic
floor weakness or hypertonicity. Additional treatment strategies that may help include: trigger
point dry needling, myofascial release, joint specific mobilization, posture training, progressive
activation and strengthening, and/or Pilates.

Pelvic floor dysfunction can greatly interfere with quality of life. Even though pelvic floor
ailments are common, that doesn’t mean you have to suffer. Combining yoga with other
treatment strategies is a great way to improve pelvic floor function and reduce symptoms. Just
keep in mind, Kegels aren’t the answer for every pelvic floor issue!