Online Professional Development Module Series
Pelvic Floor Physiology 101 - for every woman
with Lisa Fitzpatrick
Disclaimer • This is a prac cal and simple presenta on and is intended as a guide to the pelvic floor for women for informa onal purposes only. • Please consult with a qualified health professional prior to making any major decisions which may affect your health. • This is a collabora on made between Sacred Women’s Business and Bliss Baby Coaching with love and an inten on to support women of all ages. This presenta on is copyright.
• ~ Namaste ~
Pelvic physiology
• Healthy pelvic floor movement relies upon: • symmetry • cylinder of control integrity • healthy diaphragm movement • healthy breath pa erns • sound joint health in the sacro-iliac joints (SIJ), hips and lumbar spine • Adequate management of stress
Relax and release
• Releasing ght and hypertonic muscles in the pelvic floor may have the following benefits: • i. decrease/eliminate pelvic pain • ii. Improve range of mo on in muscles, ssues, joints and nerves • iii. Improve circula on and nourishment • iv. Improve overall func on • v. reduce injury
Relax and Release • Some research has shown that a ght pelvic floor can lead to longer second (pushing) stage of labour • However some studies have also shown that pelvic floor exercises lead to improved strength and relaxa on capacity, assis ng labour • Perineal massage may be worth taking a look at to prepare the perineum for childbirth as it can reduce pain. There are a plethora of resources available on the ‘how-to’ of perineal massage during pregnancy.
Relax and release • Always hold stretch for at least 5 breaths • Never bounce (it triggers the myota c stretch reflex and a muscle will contract) • A er 60 seconds, no more lengthening occurs but stretch is op mised • Rewind – rou ne – reward over 6 weeks for results • Be gentle and take a ‘li le and o en’ whole body approach (just 10 mins a day)
Relax and release • Internal self-release technique • Use a lubricant (Sylk is all natural) • Crook lying or side lying with open knee • Press around edges of vagina – find points of tenderness or firmness and a empt muscle contrac on against finger. Check L and R symmetry • Gently press at end of contrac on into relaxa on and hold for 5-6 secs. Feel changes in sensa ons, length and input
Relax and release • Ideal asana for relaxing and releasing the pelvic floor: • Reclined baddha konasana • Viparita karani (legs up the wall) • Savasana – especially post yoga nidra • Supported si ng • Child pose
Reclined baddha konasana
Legs up wall - Viparita karani image thanks to sarvyoga.com
Child poseimage thanks to yogamagazine.com – balasana
Principles of integrity • Max (extreme) – sub max (every day) – rest (quality of tone) – relax (stretch beyond res ng tone) • Progress by engaging in progressive loading (increase reps, increase hold me, increase weight/resistance) • Isolate front, back and sides • Sidelying can support gravity elimina on
The Hissy Lift • Place your hands firmly into your waist • Hiss to feel waist, then Hiss again to feel PF • Does the waist expand? • Does the pelvic floor descend/stay neutral or li ? • The pelvic floor should naturally li on the hiss
Te s t s • Hiss • Cough • Shhhhhh • Sneeze • Laugh
Muscle strength grading 0 = no contrac on 1 = flicker or trace 2 = ac ve movement, gravity neutral/eliminated 3 = ac ve movement against gravity 4 = ac ve movement against gravity with resistance 5 = ac ve movement against gravity with firm resistance
Gravity assisted
• Image thanks to www.yogaselec on.com
Gravity neutral
• Image thanks to www.yogicwayoflife
Against gravity
• Image thanks to www.stylecraze.com
Muscle testing • Test posterior wall, le and right sides • Full pelvic floor contrac on moves the muscles upwards and slightly forwards • Small muscles (only 1-2cm of movement) • Eliminate larger muscles such as gluteals, adductors, quadriceps and hamstrings • Increase dura on of hold 1sec-5sec-10sec hold
Instruction guidelines
• Sit with an elongated spine keeping a neutral lower back with a mild inward curve, finding your best posture • Relax your large leg and thigh muscles, bu ocks, feet, and abdominals • Relax pelvic floor before contrac ng it • Women who are familiar with using tampons can imagine squeezing and drawing a tampon up higher into the vagina.
5 ‘T’ prompts • Tea • Telephone • Television • Traffic • Talking
Conditions + procedures • Vulvodynia – pain of the vulva o en involving symptoms of burning and irrita on. Also referred to as vulva ves buli s • Vaginimus – painful spasmodic contrac on of the vagina in response to physical contact or pressure, especially sexual intercourse • Vaginoplasty – ghtening the muscles with surgery • Femili – laser, non-surgical, rebuilding of collagen • Labiaplasty – surgery to labia majora
Conditions • Pelvic organ prolapse (POP) – the descent of the abdominal organs • Cystocele – bladder pushes forward on the wall of the vagina • Uterocele – the uterus migrates. Normal vaginal depth is 5-6cm • Rectocele – colon and rectum unsupported by the ligaments or the pelvic floor, sags inwards towards the vagina causing a bulge on the posterior vaginal wall
Identifying prolapse (POP) • POP is characterised by descent of any of the pelvic organs inside the vagina or beyond the vaginal entrance and impacts quality of life. • Affects up to 50% of childbearing women (Thakar & Stanton 2002) • Prolapse symptoms are reported by 21% of women (Slieker-ten Hove et al 2009) • POP is the most common reason for hysterectomy, a er cancer, for menopausal women in the USA (Swi et al 2005)
I Identifying POP • Stage 0: No prolapse is demonstrated. • Stage I: Most distal por on of the prolapse is more than 1cm above the level of the hymen. • Stage II: Most distal por on of the prolapse is 1 cm or less proximal to or distal to the plane of the hymen.
Identifying POP • Stage III: The most distal por on of the prolapse is more than 1cm below the plane of the hymen • Stage IV: The most distal por on of the prolapse is more than 1cm below the plane of the hymen. • Stage V: Essen ally complete eversion of the total length of the lower genital tract is demonstrated
Identifying POP • Prolapse symptoms are a departure from normal sensa on, structure or func on, experienced by the woman in reference to the posi on of her pelvic organs. • Symptoms worse at mes when gravity is involved (e.g. a er prolonged periods of standing or exercise) and be er when gravity is eliminated (e.g. lying supine).
Identifying POP • Vaginal bulging: Complaint of a “bulge” or “something coming down” through the vaginal opening. The woman may state that she can either feel the bulge by direct palpa on or see it aided with a mirror. • Pelvic pressure: Complaint of increased heaviness or dragging in the perineum and/or pelvis. • Bleeding, discharge, infec on: Complaint of vaginal bleeding, discharge or infec on related to dependent ulcera on of the prolapse.
Identifying POP • The need to digitally re-place the prolapse or to apply manual pressure to the vagina or perineum or rectally to assist voiding or defeca on. • Low backache: Complaint of low, sacral (or “period-like”) backache • Other symptoms: urinary hesitancy, slow urine stream, history of recurrent urinary tract infec ons (UTIs), faecal incon nence • (Extracted from Haylen et al 2010)
Prolapse poses to avoid • Boat Poses/Navasana - modify by raising one leg only or hold thighs and keep knees bent. • Plank - modify by weight bearing through knees rather than through feet • Deep squat poses - avoid poses involving deep squats 6-12 months post partum or stop completely • Forward bends with wide legs - avoid or modify wide leg forward bends which increase downward pressure in a vulnerable wide leg posi on such as Forward Bend with V-Legs.
Prolapse poses to avoid • Upper body weight bearing - weight bearing through the upper limbs increases downward pressure on the pelvic floor with poses such as Crane Pose and plank. Down dog may be ok as gravity assists pelvic floor posi on. Ensure no breath holding occurs during upper limb weight bearing. • Uddiyana bandha (“belly lock”) - this bandha should be avoided by women seeking to avoid increasing pressure on their prolapse. • Double Leg Li - modify by raising one leg only as in apanasana or avoid completely
Gadgets
• Yoni eggs (stretch and strengthen) • Cones (aquaflex) – with 10g weights • Periform (for feedback) • Vibrator • Pericalm (for strengthening)
Rules
• Always use The Knack before coughing, sneezing and li ing • Adopt a tall posture (cylinder of control) • Change inflammatory diet and lose weight if needed • Reduce cons pa on and maintain hydra on • Learn pelvic floor and transversus abdominus connec on • Adopt abdominal breathing pa ern and relax abdomen (esp) when releasing bladder and bowel
Rules
• Don’t ‘hover’ in standing over a public toilet (allow larger leg muscles to relax) • Don’t pee in the shower (it can support your brain to associate running water with peeing and trigger the reflex) • Never sit on the toilet and wee while blowing your nose (!) • If you experience incomplete emptying of the bladder, gently rock pelvis forwards and backwards to fully empty.
Rules • Avoid ght belts (especially if they push your waist in and down) • Avoid constric ve garments • Reduce abdominal fat • Lie down with hips up every day
Instructions for pelvic floor exercises • Please refer to your medita on ‘Pelvic Floor Prac cuum’ for verbal instruc ons to engage the pelvic floor to improve both relaxa on and strength.
Myths #1 Pelvic floor muscle exercises don’t work • There is much evidence to show that pelvic floor muscle exercises are effec ve when the exercises are done correctly and when taught and supervised by a physiotherapist who specialises in con nence and women's health or a Con nence Nurse Advisor. • They may not work if there are other causes of urine or bowel mo on leakage (for example, infec on, inflamma on or underlying bowel disease).
Myths #2 I'm too old for pelvic floor muscle exercises Age is no barrier to the benefits of pelvic floor exercises. Older people are just as likely to benefit from pelvic floor muscle exercises for incon nence #3 I don't need to do pelvic floor muscle exercises Everyone (including women who haven't had a baby, and men) benefits from doing pelvic floor muscle exercises. For men, pelvic floor muscles not only help to control the bladder and bowel but they also assist in sexual func on.
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references
• See Resources list in Pelvic Floor Playbook • Special acknowledgements to feminine trailblazers: • Heba Shaheed, Mary O’Dwyer, Kathryn Peden, Tammy Lynn Kent (women’s health physios), • Julie Rossmanith, Rosita Avigo (Avigo co- founder) • Leslie Howard – pelvic floor yoga teacher training