Pelvic Organ Prolapse (POP)

Yoga Nashit – Women's Yoga Teachers' Course 2018-2019

Submitted to: Mira Artzi Padan

Submitted by: Lori Erlich [email protected] Mobile phone: +972-54-5572891 Table of Contents:

I: About Yoga Nashit Page 1 II: What is the Pelvic Floor? Page 2 III: What is Pelvic Organ Prolapse (POP)? Page 3 IV: What are the Symptoms of POP? Page 4 V: What are the Causes of POP? Page 5 VI: Conventional Medical Solutions for POP Page 6 VII: AlternativeSolutions for POP Page 7 VIII: Yoga Nashit Solutions for POP Page 8 IX: Yoga Nashit Practice for POP (20 Mins) Page10 X: Personal Summary Page15 XI: Bibliography

About Yoga Nashit

Yoga Nashit - Women's Yoga - is a unique type of yoga practice which specifically takes into account women's bodies and women's health, and was developed by Mira Artzi-Padan in the late 1990s. Though Yoga Nashit was pioneered in Israel, it soon gained international recognition and is followed and taught by many female enthusiasts, worldwide. More information can be found at http://www.yogaforwomen.co.il Yoga Nashit is appropriate for EVERY woman and at EVERY time in her life - no matter how challenging that time might be for her. Yoga Nashit gives a woman her own individual set of tools to introspect and connect with her own mind, body and spirit so that she can strengthen and support herself and live a life of optimal health. Yoga Nashit allows a woman to connect with her inner-self and empowers her with the tools to deal with the hormonal and life cycle changes that she experiences through and during puberty, menstruation, childbearing years, possible infertility, menopause, aging and more. Yoga Nashit supports a woman by enabling her to listen and to understand how her body changes over her life cycle, and as a result of natural hormonal cycles or other changes in her life, and assists her to acquire and equip her own "toolbox" to be better prepared for these changes. For example, Women's Yoga helps a woman deal with some of the physical and emotional changes associated with menopause - including heat flashes, urinary incontinence, potential prolapse of the pelvic floor and the pelvic organs (prolapse of the bladder or other internal organs) and more. Women's Yoga not only assures women that these are not uncommon symptoms, but also provides tools and techniques which - when practiced during physical exercise and in daily life - a woman can relieve many of the symptoms in order to lead a healthy and comfortable quality of life. Such tools and techniques include strengthening her pelvic floor muscles and her internal core muscles, changes in her posture, lifestyle adjustments, breathing techniques, awareness and more. Yoga Nashit combines breathing techniques and pelvic floor exercises (mula bandah) with a diversified yoga practice. Yoga Nashit enables each woman to experience improvements in her physical health, emotional state and overall well-being. Yoga Nashit can assist each and every women to take ownership over her mind, body and spirit in a way that is best and most appropriate for her.

What is the Pelvic Floor?

The pelvis is a bony structure which is located at the base of the spine. It is shaped like a "basin" and composed of several large and strong bones which are naturally fused together to form a strong and stable base of the body. The pelvis is the center of posture and movement of the entire body. The lower part of the pelvis includes a complex muscular system, which looks like a large cradle or "hammock" and supports all of the organs within it. This muscular system includes a layer of ring-like muscles which close over the lower pelvic organs and form a layer of muscles which elevate the internal pelvic organs against the force of gravity. The pelvic muscles are connected to the pubis bone and the sacral bone, and form the supporting cradle structure. These muscles encircle the pelvic floor's three openings: the urethral opening, the vagina opening and the rectum opening. These three levels of muscles create an action of closing and elevating the internal pelvic organs against the force of gravity, as well as releasing and relaxing when there is need to urinate or to give birth (and while sleeping). The strength and flexibility of these pelvic muscles affects the position of the pelvic organs within the pelvis and their ability to function efficiently. Think of the pelvic floor like a floor in a building: in order to support the weight of whatever is on it, it must be firmly attached to the structural beams. Similarly the pelvic floor.

What is Pelvic Organ Prolapse (POP)?

Pelvic organ prolapse (POP) is the descent or drooping of pelvic organs from their normal and natural positions. POP happens when the fibromuscular tissue, fascia, and ligaments which are supposed to be supporting the pelvic organs become weak, damaged or relaxed. This allows one or more of the pelvic organs to drop or press into the vagina or anus, or out of the vagina or anus. POP can happen to any of the pelvic floor organs, including:

 Bladder/Urethra  Uterus/Uterine  Vagina  Small bowel  Rectum

The following are different types of Pelvic Organ Prolapse:

 Cystocele: A prolapse of the Bladder into or out of the Vagina, the most common condition  Urethrocele: A prolapse of the Urethra (the tube that carries urine)  Uterine prolapse: A prolapse of the Uterus into or out of the Vagina  Vaginal vault prolapse: A prolapse of the Vagina  Enterocele: A prolapse of the Small Bowel or of the Small Intestine  Rectocele: A prolapse of the Rectum into or out of the Vagina

What Are the Symptoms of POP? Symptoms of POP (Pelvic Organ Prolapse) are felt differently depending on which organ is drooping. For example, if the bladder prolapses, urine leakage may occur. If the rectum prolapses, constipation and uncomfortable intercourse may occur. Small intestine prolapse might cause a backache as well as uncomfortable intercourse. Uterine prolapse is also often accompanied by backache and uncomfortable intercourse. Common symptoms of POP include:

 Vaginal tissue bulging or the feeling that "something is coming out" of the vagina  Pelvic heaviness/fullness or pressure in the pelvis  Pelvic pressure that gets worse with standing/coughing or as the day goes on  Lower backache or pelvic pain  Lower abdominal pressure or discomfort  Urinary problems including: leaking of urine (incontinence), a chronic urge to urinate, urine retention, difficulty getting all of the urine to empty from the bladder due to bladder pressure on the urethra, frequent urinary tract infections (chronic UTIs) etc.  Fecal leaking (fecal incontinence)  Bowel emptying problems including chronic constipation  Flatulence  Problem inserting tampons  Needing to manually reposition the prolapse to empty the bladder or bowel  Spotting or bleeding from the vagina

 Painful intercourse or problems with sexual functioning

Some women develop more than one pelvic floor disorder simultaneously, such as pelvic organ prolapse with urinary incontinence or needing to manually reposition the prolapse in order to urinate as well as frequent/chronic UTIs.

What are the Causes of POP? Essentially anything that puts increased downward pressure in the abdomen can lead to pelvic organ prolapse. Common risk factors of POP include:

 Pregnancy, labor and childbirth (the most common causes)  Vaginal childbirth (multiple vaginal childbirths)  Giving birth to heavy babies  Menopause and hormonal changes/loss of estrogen  Increasing age/aging  Obesity and being overweight  Chronic constipation and straining  Respiratory problems with a chronic, long-term cough  Previous pelvic surgery (including prolapse surgery or hysterectomy)  Pelvic organ cancers  Pelvic floor muscle dysfunction  Regular heavy lifting  Exercise overload

According to some studies, family history and genetics may also play a role in pelvic organ prolapse. The collagen of the connective tissues/fascia may be genetically weaker in some women, perhaps placing them more at risk. Pelvic floor disorders affect one in five women in the United States. Pelvic organ prolapse happens more often in older women and in white and Hispanic women than in younger women or women of other racial and ethnic groups. According to Dr. Christiane Northrup, M.D. in her book "Women's Bodies, Women's Wisdom" - "Prolapses of all kinds are more common in women of northern European heritage and in those with red hair. The reason for this is that blondes and redheads have a collagen layer that is thinner than those who have darker skin. African Americans and those with darker skin are the least likely to experience prolapse." In women, the front wall of the vagina supports the bladder. This wall can weaken or loosen with age. Significant bodily stress such as childbirth can also damage this part of the vaginal wall. If it deteriorates enough, the bladder can prolapse, meaning it is no longer supported and descends into the vagina. This may trigger problems such as urinary difficulties, discomfort, and stress incontinence (urine leakage caused by sneezing, coughing, and exertion, for example). Prolapsed bladders are commonly associated with menopause. Prior to menopause, women’s bodies create the hormone estrogen, which helps keep the muscles in and around the vagina strong. Women’s bodies stop creating as much estrogen after menopause, and those muscles tend to weaken as a result.

Conventional Medical Solutions for POP

Conventional treatments for pelvic organ prolapse depend on the type of prolapse, the woman's symptoms, her age, other health problems and whether she sexually active. Conventional medical solutions for POP may include one or more of the following:

 Hormone Therapy by vaginally inserting estrogen cream which helps to replenish vaginal tissue thickness (due to loss of natural estrogen produced by the body).  Surgery to support the uterus or vagina. During surgery, the doctor may use the patient's own body tissue and stitches or a synthetic mesh to help repair the prolapse and rebuild pelvic floor support. This type of surgery is recommended for sexually active women with serious prolapse of the vagina or uterus.

 Surgery for prolapse can be done through the vagina or through the abdomen. Over the years, a number of procedures have been developed which allow a woman to keep her uterus by having it surgically suspended in the pelvis rather than removed. Often the doctor will choose to perform vaginal surgery using a multitude of dissolvable stitches. This method requires a high level of medical expertise and precision.

 If the doctor opts to use synthetic mesh to repair the prolapse, it will probably be through the abdomen. Due to recent safety issues, mesh is no longer used to repair prolapse through the vagina. This is because the use of surgical mesh through the vagina to treat POP has been associated with higher rates of mesh-related complications, including mesh poking through the vaginal skin, pelvic pain and pain with intercourse. In 2019, the FDA ordered manufacturers of surgical mesh for the transvaginal repair of POP to stop selling and distributing their products in the U.S. (If a woman had surgery with mesh to repair pelvic organ prolapse through the vagina, she may not need to do anything if she does not have any symptoms or problems. However she should speak to her doctor or nurse if she notices any symptoms or problems, such as vaginal bleeding or discharge, pelvic pain, or pain during sex.)

 Insertion of other devices instead of mesh to support the pelvic organs, for example POP Medical's EnPlace or new NeuGuide for POP support. These are said to be "minimally invasive systems" but their use should be studied closely.  Surgery to close the vagina. This surgery, called colpocleisis, treats prolapse by closing the vaginal opening. This can be a good option for women who do not plan to have or who no longer have vaginal intercourse.  Hysterectomy for treatment of pelvic organ prolapse. Approximately 15% of the hysterectomies done in the USA are for pelvic organ prolapse. Alternative Solutions for POP

Alternative solutions for pelvic organ prolapse also depend on the type of prolapse, the woman's symptoms, her age, other health problems and whether she sexually active. Alternative solutions may include one or more of the following:

 Use of a Pessary which is a removable device inserted into the vagina to support the pelvic organs. Pessaries come in many different shapes and sizes. Pessaries are often the first treatment that a doctor will try. Certain types of Pessaries can treat both pelvic organ prolapse and urinary incontinence.  Pelvic Floor Physiotherapy which includes pelvic floor exercises to help strengthen the pelvic floor muscles. Pelvic floor muscle exercises can also help women who have pelvic organ prolapse as well as urinary incontinence.  Changing of eating habits to help with bowel problems, and other digestive related POP symptoms. The recommendation might be to eat more foods with fiber. Fiber helps prevent constipation and straining during bowel movements.  Alternative medical therapies such as acupuncture, homeopathy or various massage treatments, etc.

Researchers are studying a variety of ways to prevent pelvic organ prolapse. The following steps may reduce one's risk of developing a pelvic floor problem:

 Maintain a healthy weight or lose weight (if you are overweight). Women who are overweight or obese are more likely to have pelvic floor problems.  Choose foods with fiber and drink plenty of fluids. Fiber helps prevent constipation and straining during bowel movements. Preventing constipation may reduce the risk of some pelvic floor disorders. Avoid bearing down to move your bowels.  Do not smoke. Smoking can lead to chronic cough, which puts stress on the pelvic floor muscles.  Perform pelvic floor exercises to strengthen pelvic muscles and support the weakened fascia.  Avoid heavy lifting.

Yoga Nashit – Women's Yoga - Solutions for POP

Yoga Nashit – Women's Yoga, was developed by Mira Artzi Padan to help women deal with some of the physical and emotional changes in their lives, including potential prolapse of the pelvic floor and of the pelvic organs. Women's Yoga not only assures women that these are not uncommon symptoms, but also provides tools and techniques which - when practiced during physical exercise and in daily life - a woman can relieve many of the POP symptoms in order to lead a healthy and comfortable quality of life. Such tools and techniques include strengthening her pelvic floor muscles and her internal core muscles, changes in her posture, lifestyle adjustments, breathing techniques, awareness and more. Women's Yoga provides a woman with a toolbox to work with herself- with her body and her mind, while adapting it to her changing needs. A woman can continue exercising gently, even when symptoms are acute and/or painful. Pain, suffering and tension in the body frequently testify to the lack of proper blood circulation in that area, leading to a rise in stress hormones and constriction of blood vessels. Yoga Nashit exercises reduce stress and increase blood circulation, particularly towards the pelvis and the lower abdominal organs, improve organ function and renewing the connection between the nervous and endocrine systems (the internal secretion system). Understanding of Yoga Nashit exemplifies the connection between the diaphragm and the pelvic floor – which rise and lower in a synchronized manner during regular breathing. In addition to exercises (and medical treatment if necessary), Yoga Nashit practitioners also often recommend going for pelvic floor physiotherapy, nutritional consultation, and other alternative medical therapies such as acupuncture, homeopathy or various massage treatments to alleviate discomfort and prevent further damage. It is important to remember that pelvic floor surgery repairs POP damage but not its causes. Yoga Nashit supports women and provides movement, posture and breathing rehabilitation techniques to avoid further damage to this complex region. With any pelvic floor problem, it is recommended to first turn to medical consultation and a certified pelvic floor physiotherapist for initial diagnosis and to rule out other potentially serious problems. Yoga Nashit provides women with an opportunity to observe themselves and to make an in-depth acquaintance with themselves. Yoga Nashit helps women to listen and pay attention to the everyday habits which compose their lives, from a physical as well as an emotional and mental perspective. The physical exercise on the yoga mat is only a small part of the mental, emotional and spiritual exercise – of the unity of the physical with the emotional and spiritual, of the breathing with the body and mind. In many ways, exercise on the mat serves as a research laboratory which focuses on the patterns of one's life: when a woman become acquainted with them during the exercise, she can identify tools for new inner stability and alignment. These tools allow her to bear the journey of life with less pain and pressure.

Unfortunately there is no one rule for all women seeking to exercise safely with prolapse problems. Women differ with respect to the capacity of their pelvic floor to support general exercises as well as individual risk factors that may increase her likelihood of prolapse problems with inappropriate exercises. Yoga Nashit teaches mula bandha and other pelvic floor safe exercise, incorporated with all of the Yoga Nashit techniques, not just on the mat, but in everyday life, to prevent or treat POP problems. In some cases, these exercises can not only deter further damage but also actually improve POP symptoms. Yoga Nashit guidelines which are particularly aimed at supporting women with POP symptoms include:  Avoid intense abdominal muscle bracing  Avoid extended breath holding and straining  Avoid sustained and intense core abdominal contraction  Minimise the amount of body weight supported through the upper limbs  Avoid wide leg deep squats  Avoid wide leg forward bends  Promote appropriate contraction and relaxation of pelvic floor muscles.

Long-term Yoga Nashit exercise supports the health of the pelvic floor and the pelvic organs while decreasing the likelihood of potential symptoms such as urine leakage or incontinence and prolapse of pelvic organs.

Yoga Nashit is suitable for all women, of all ages, who are in good physical condition. It is suitable for women who have never done any physical exercise and for those who exercise frequently. Yoga Nashit does not invalidate or replace any other exercise regime, but rather enables the development of new attentiveness to a woman's body and soul. However, one must remember that understanding the exercise's strength requires time and patience. It is not complicated, but its effects are deep and powerful. Each time one practices this form of yoga, she will learn to pay better attention to her entire pelvic area in general, and develop a deeper relationship with her pelvic floor muscles in particular.

The following poses can be practiced as part of the exercise regime, or can be used as stand-alone therapeutic poses. They are similar variations of a few well-known poses. In order for them to be effective, it is important to thoroughly understand the exercises of the mula bandha, the stabilizing muscles, and the closed muscle chain which tightens with the increased intra-abdominal pressure. Avoid putting pressure on the lower back and pelvis throughout these exercises. A woman should make sure to relax her buttock muscles while doing these exercises. If the pelvic floor damage is progressive, she should not perform these exercises, but rather to visit a pelvic floor physiotherapist for further instructions.

Yoga Nashit Practice for POP (Approximately 20 minutes)

In yoga, breathing is always through the nose, with the exception of specific exercises. The mouth is seen as an organ for eating, and serves as a backup for breathing when the nose is blocked. # Position & Image Explanation 1 Shavasana 1. If you feel tension in the lower back, place Lie on your back and relax your body. pillows under your knees or place your feet hip distance apart. There is no need to support this pose against the force of gravity. 2. If the props do not help and you are still uncomfortable, you can also exercise in a comfortable sitting position, however, this position involves mild resistance to gravity. 2 Work with breathing 1. Gently elongate the exhalation and Exhale at length through the nostrils. visualize sending it far away from you. 2. When extending the exhalation, the diaphragm rises, relaxes itself, opens up and massages the base of the heart and lungs.

3 Practice mula bandha 1. While extending the exhalation, practice Gather the transverse abdominal mula bandha: gathering and raising the muscles inward and visualize them pelvic floor muscles. This should not affect hugging the spine. the buttocks, which are not contracted - but only the muscles which help you to restrain yourself. 2. Do not cut off or stop the breath, exhale until the end. 3. Be curious about the full length of your breath at this moment, and its connection to the movement of the pelvic floor. 4. At first, you will not be able to clearly experience the sensations, and you may even feel resistance. Continue patiently. It will happen with practice. 4 At the end of the exhalation allow a 1. By allowing a break/a delay at the end of break/a delay. the exhalation, you can stop and create an interval in which the diaphragm is high, relaxed and open, the pelvic floor muscles are gathered inward and upward and the transverse abdominal muscles are hugging the lower back. Connective tissue connects the lower part of the diaphragm to the upper part of the pelvis. 2. With each exhalation, when it opens, relaxes itself and ascends, it "pulls" slightly on the upper part of the pelvis and affects its movement. 3. A moment before you inhale again, in the same deep muscular movement, the pelvis rolls slightly backward and the hip bones, the iliac, turn inward. This movement, together with the tightening abdominal corset, elongates the lumbar spine but does not cancel it. 4. Pause in the moment, allow the feelings of focus and introspection to become clear. Do not panic from the retention of exhalation, rather give yourself over to it. The gap, this break with the inner gathering, is a most significant moment in understanding the exercise. During this interval, all the abdominal and pelvic organs are gathered upward - they go on a journey during exhalation together with the ascending diaphragm. During their journey, they undergo massage and stimulation, which strengthens them. 5 Inhale: when the body wants to bring 1. When you inhale, you allow the air to flow in air, relax as if you are gently back into the body, release the abdomen unraveling something from within and the pelvic floor and feel how the you by inhaling. diaphragm contracts and descends as the air volume in the lungs increases. The air seems to flow from the pelvis to the abdomen, the thorax and the back of the heart. The pelvis will roll slightly forward, so you will feel a slight arching of the lumbar spine. With the diaphragm's descent and contraction, the pelvic and abdominal organs also descend. 2. They will ascend again with the next exhalation. Their journey can be some three centimeters long. This is a deep and significant massage for these organs. They will receive good blood supply, effective metabolism and their function significantly improves. 6 Practice breathing – inhaling and 1. This breathing is significant when the exhaling - without releasing the mula intra-abdominal pressure is continual and bandha. you are unable to release the pelvic floor. 2.You will frequently encounter this situation during everyday life. For example, when holding your baby or carrying groceries home. In this situation, the intra- abdominal pressure rises and persists, and you must enable the deep muscles to provide good support to the abdominal and pelvic organs over time, in order to prevent them from being compressed downward. 3.Exhale in the same manner that you exhaled at the beginning of the exercise. 4. Gather the pelvic floor and the transverse abdominal muscles well. 5. With the next inhalation, do not relax the muscles, even though they will always slightly relax themselves. This is their reaction to the diaphragm contracting and descending, but you will be able to re-gather them with the next exhalation. 6. Gather the stomach inward and inhale toward between the ribs. 7. Expand the thorax forward, backward and to both sides. 8. You can place your hands on the ribs and feel the expansion. The pinky and the ring finger can feel the stomach gathered in, as it supports the back, stabilizes it and lengthens. 7 Yoga Mudra: place your hands in the 1. Thumb to thumb, index finger to index earth mudra yoga mudra position. finger, forming the shape of a diamond between the fingers. 2. They are placed together on the bellybutton and the pubis. The earth mudra allows a connection to the uterus, to the pelvis. It simulates the uterus. 8 Relax your jaw: lie on your back 1. Relax your legs, arms, shoulder blades, In order to release tension from the nape and shoulders. 2. Relax your lower jaw: pelvis, the jaw muscles must also be tension around the jaw joint is transferred released. via the nape muscles to the spine and the nervous system, and from there to the pelvis. 3. You can open your mouth, stick your tongue out and exhale (like blowing vapor on a window). 4. When inhaling - relax. 5. Repeat this several times, until the jaw is released. 9 Lie on your back and plant your feet. 1. Exhale and squeeze your inner thighs Cross one leg over the other (“coffee- tightly together. 2. Pay attention to your shop style”), with one foot on the lumbar back pressing against the mat, and floor, and the other foot in the air. to the feeling of retention. 3. Relax while inhaling. 4. Practice this pose four times on each side, and maintain the squeeze even when inhaling, without releasing it, for a few breaths. 5. Uncross your legs.

10 Bring your knees to your abdomen, 1. Squeeze in the same manner. 2. Make and again cross your thighs. sure your lumbar spine lengthens on the mat. 3. In the two exercises mentioned here you can roll your pelvis backward. 4. Let your buttocks lift a little from the mat, without swinging. Feel of the activation of the abdominal and pelvic floor muscles.

11 Repeat your previous position but 1.Lift your pelvis a little in this pose, in the with pelvis lifted. direction of the half-bridge. 2. Activate your inner thigh muscles and mula bandha throughout the pose. 3. Now please turn over to your "hands and knees" on to an "all 6" pose. 4. Arch and then release your back (convex/concave) to "cat/cow" poses in order to relax and release your lower back. 12 Move into the downward facing dog 1. From the "all 6" pose after having done pose with legs crossed. "cat/cow", pull your hips up to the downward facing dog pose, cross your right leg, in front of your left, and extend it to your left. 2. Exhale and squeeze your inner thighs tightly against each other. 3. Soften your knees, keep your stomach well tightened. 4. Repeat with other leg crossed. Repeat again on both sides.

13 Move back down into a seated pose. 1. Pull your buttocks back, sitting bones on the mat. 2. Inhale, and raise your arms, exhale and fold forward. 3. Place your hands on the floor, on both sides of your body, or on your feet. 4. You can make use of a belt. 5. Exhale again, and squeeze in the same way.

14 Shoulder Stand in order to return the 1. To ascend without support from a wall, lie internal organs to their correct place on your back and gather your knees to your stomach. 2. Place your arms on the floor close to your body, exhale and raise your knees toward your face without a swinging movement. 3. The gathering will come from a stable and secure mula bandha movement against the force of gravity.

15 Root your upper arms, place your 1. Your mula bandha is already fully hands on your lower back. activated, your abdomen is gathered inward This position might be enough for you. 2. If you wish to continue, exhale and raise your legs to the ceiling. 3. Feel your inner thigh muscles, as if they are squeezing an imaginary ball as you elevate to the Shoulder stand. 4. Make sure your neck is long and that the cervical spine retains its natural curve. 5. Breathe complete breaths. Do NOT do this pose if you are during your monthly menstruation period. 16 Supta baddha konasana (reclining 1. Lie in the reclining bound angle pose at bound angle) pose. the end of the day on its own or as part of an exercise. 2. It is possible to be in this pose at any time of the month to practice an additional variation of the reclining bound angle pose. 3. This pose adds vitality to the breathing and to the body. 17 Final relaxation pose for relaxing Feel the effects of this short practice on your breaths. mind, body and soul. Listen to your breathing. Enjoy the time that you gave to yourself, for yourself! You're strong! You're stable! You're balanced! Enjoy!

Personal Summary

I have a confession to make: I actually have a vested interest and a true reason for which I have studied to be a Yoga Nashit teacher and have prepared this abstract.

Here is my goal: If I can help even one woman to take care of her pelvic floor and to avoid POP and possible surgery, then I have met my goal and my primary mission was achieved. If I can help more than one woman – 2 or more woman…or potentially even many more women to protect their pelvic floor – then I can proceed throughout the rest of my life knowing that I have spared unnecessary discomfort, trauma, hassle and pain to other innocent women.

The first 54 years of my life were just like that of many other women: I studied, I worked, I lived a healthy and active lifestyle, I had 3 children (by natural childbirth), I traveled and I enjoyed life. I was never overweight. All of a sudden, one day while standing cooking in my kitchen, I felt my pelvic floor prolapse – right then and there, with no advance notice. Prior to that, I had never hear of Yoga Nashit, POP or even the words: pelvic floor.

I proceeded to look for ways to alleviate the discomfort and hassle associated with POP and eventually underwent very painful pelvic floor surgery. Fortunately, during my recovery period, I heard about Mira Artzi Padan and Yoga Nashit, which I have been practicing ever since. From that time on, I set myself a goal to help inform other women to learn to protect their pelvic floor.

Please help me to meet my goal! Learn and understand about your pelvic floor- it's the center of your body. Maintain a moderate weight. Eat healthy foods with fiber and be sure to drink lots of water. Don't smoke and avoid excessive coughing. Make every effort to avoid heaving lifting. And go out there and practice Yoga Nashit – Women's Yoga. You'll be grateful that you did! And your pelvic floor will thank you! Good luck! You're strong! You're stable! You're balanced! Enjoy!

Bibliography

Continence Foundation of Australia, 2013: https://www.google.co.il/search?hl=en&tbm=isch&source=hp&biw=1536&bih=753 &ei=tmYbXZrWLbmGk74P0JisiAQ&q=pelvic+floor+muscles&oq=pel&gs_l=img.1.0.35i 39l2j0l8.1916.2496..5117...0.0..0.303.815.2-2j1...... 0....1..gws-wiz- img.ZXUMuEYyQfo&safe=active#imgrc=_DJexh4p1vZrKM Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/pelvic-organ- prolapse

Prolapse Exercises Inside Out: A Complete Guide to Prolapse Exercises for Women; By Michelle Kenway, Healthy Fit Solutions Pty Ltd 2014, www.pelvicexercises.com.au

US Department of Health & Human Services, Office on Women's Health; Website https://www.womenshealth.gov/a-z-topics/pelvic-organ-prolapse

Women's Bodies, Women's Wisdom; By Christiane Northrup, M.D., Bantam Books 2010, pages 180-181 WebMD Website: https://www.webmd.com/women/guide/prolapsed-bladder#1

Yoga Nashit – Yoga for Women book; By Mira Artzi-Padan, Kindle Edition 2014, www.yoganashit.com Yoga Nashit website; By Mira Artzi-Padan, http://www.yoganashit.com https://www.google.co.il/search?hl=en&biw=1536&bih=753&tbm=isch&sa=1&ei=AI ckXb3JM9GXsAeg2IiYDA&q=Symptoms+POP&oq=Symptoms+POP&gs_l=img.3..0i8i3 0l6j0i24.2617.2617..3051...0.0..0.294.294.2-1...... 0....1..gws-wiz-img.OrqeNMpL- cA#imgrc=1QBETluhdJG_fM: