The Pelvic Floor Muscle

I found this article online by Ruth Jones really interesting about the use of the pelvic floor muscles and fascia for yoga and for everyday life.

Ruth Jones, MCSP, PhD student Southampton University UK, and Stanford University California USA, has been conducting cutting edge research on the Pelvic Floor Muscles (PFM), also know as Mula Bandha in the context of Ashtanga Vinyasa Yoga.

You will know the importance in your Yoga practice to engage your Pelvic Floor Muscles (PFM) or mula bandha, but did you know that the PFM have other functions such as contributing to spinal stability, pelvic organ support, urinary and faecal continence, sexual function and performance? What a great group of muscles to keep working well! And how do you know that you are contracting the PFM effectively when over 30% of the female population contracts incorrectly at their first attempt? We do not have the statistics for men, yet it would not be far fetched to suggest that the percentage could be higher. Or am I just biased?

Here is what I will cover with this article:

  • The basics of Pelvic Floor Muscle anatomy and physiology
  • How to correctly engage the PFM
  • How to incorporate it into and outside your Yoga and Pilates practice

Pelvic Floor Anatomy

It’s not just all about the muscles: the Pelvic Floor is actually a complex structure made up of muscle and fascia. It can be divided into three sections: the fascia, the levator ani muscles (PFM) and the superficial sphincters/perineal muscles.

The fascia gives attachment to the PFM and surrounds the muscles and pelvic organs. Sometimes there can be a tearing of this fascia and the supporting ligaments which gives rise to Pelvic Floor disorders such as incontinence. It won’t matter then if the PFM are strong and contract at the right time, someone may still have incontinence because the bladder or urethra (figure 1) is not supported in the correct anatomical position.

figure-1.gifFigure 1. Schematic Diagram of the PFM and organs.

The levator ani is the collective name given to the PFM (figure 1 and 2) and is sometimes divided into the Pubococcygeus, Puborectalis, Pubovaginalis and Iliococcygeus. The Pubococcygeus arises from each side of the front of the pubic symphysis (midline joint), and passes around the urethra, vagina (in women) and anus to insert onto the coccyx. As you can tell from their names, the Puborectalis is the name given to those muscle fibres that loop from the pubic bone around the rectum and Pubovaginalis from the pubis around the vagina. The Iliococcygeus originates from the right or left Ilium on the pelvis and attaches to the coccyx.

figure-2.jpgFigure 2. 3D MRI reconstruction of Female PFM
Reprinted with kind permission of Lennox Hoyte

The Superficial Perineal muscles are as their name suggests superficial or less deep than the levator Ani and are thought to have an important role in sexual activity. They all insert and meet at the perineal body, which is almost like a central tendon between the anus and scrotum in men and anus and vagina in women. The external anal sphincter encircles the anus, attaches in the front to the perineal body and behind to the coccyx.

The nerve supply to the Pelvic Floor is mainly through the Pudendal nerve originating from the 2nd to 4th sacral nerve roots. Have you ever noticed little girls or boys walking/bouncing on their tip toes when they want to go to the toilet? This is because the nerve supply to the calf muscles has a similar origin as the PFM, and by contracting the calf muscles, there is a reflex response of the PFM and the bladder contraction is quietened down. So if you ever find yourself caught short, go up and down on your toes vigorously and it’ll give you a few minutes grace. On that note, have you ever been sitting down for a long time, for example on a car journey, get up or out of the car and are suddenly desperate to go to the loo? Again, the skin at the back of your legs has been stimulated whilst you have been sitting down, and this stops the bladder from contracting too strongly. Once you stand up, that reflex inhibition is lost! So if you don’t want to be caught short gain, try contracting your PFM (see below) before you get out of the car.

The muscles of the PF have both slow (type 1) and fast (type 2) twitch muscle fibres, but since the role of the PFM is mainly to provide support over a sustained period of time, they are predominantly type 1. This is important to remember within your yoga (or Pilates) practice. Towards the end of your practice, especially if you have been contracting them too hard, they are going to be more fatigued. So if you develop awareness of these muscles, feel when they can no longer lift and hold, and perhaps call it a day with your practice…until the next time!

Guidelines for activating the PFM

These are the guidelines I use to assist people to activate their PFM (or Mula Bandha):

  • Imagine your PFM as a sling that attaches from your tail bone at the back (sacrum and coccyx) to your pubic bone at the front.
  • Now take a breath in, and as you breathe out, gently squeeze the muscles around your back passage, as if you were trying to prevent wind (gas/flatulence) escaping.
  • Bring this feeling forward (remembering the muscular sling) towards your pubic bone as if you were trying to stop yourself from urinating (having a pee).
  • Keep holding this contraction as you imagine that you are on the ground floor of an elevator, you want to lift your PFM as if you were going to the 1st, then 2nd 3rd etc floor.
  • Keep breathing as normally as you can, whilst holding onto your PFM. Aim to hold for 10 seconds, before releasing your PFM.
  • Repeat up to 10 times, breathing normally.
  • Remember to release all the way back to the ground floor, as holding on too much may be as much of a problem as not being able to hold onto them at all.

Also, you may have noticed that your abdominal muscles were also engaged as you pulled in your PFM. This is perfectly normal as long as you do not tilt your pelvis or hold your breath as you do so. In yoga the abdominal muscles activating is part of the Uddiyana Bandha (the abdominal lock), and the Mula Bandha is almost always activated at the same time as that lock.

As I said earlier, many people do not activate their PFM correctly when first asked to do so. Without being examined, we cannot tell for sure whether you’ve got it “right”. Having said that, below are some tips to make sure that you are not activating too much of the incorrect muscle groups:

  • Many people bear or push down when they try to activate their PFM, as if they were straining to go to the toilet. Remember to squeeze and lift, as described above, rather than pushing down.
  • Keep your buttock cheeks (bottom muscles/butt), inner thigh, and leg muscles relaxed.
  • There should be no movement of your spine or pelvis as you engage your PF or abdominal muscles.

Timing of Contraction: It seems that the timing of contraction is as important as strength of PFM contraction. In women who do not have a Pelvic Floor Dysfunction, there is a small PFM contraction before they cough, or raise their intra abdominal pressure. It appears that this pre-contraction is lost in women who have Stress Urinary Incontinence. It maybe the case that this loss of pre-contraction is also lost in other women with prolapse of the pelvic organs, so encouraging them to also do a pre-contraction seems logical. There also seems to be a correlation between Pelvic Floor disorders and back pain, although we have a good idea why this is. So if you get back pain, or if you have noticed that your PFM are not as they used to be, whether due to childbirth, high impact sports such as trampolining, or just aging, its a good habit to contract your PFM just before you cough or sneeze, lift anything heavy, or even just bending over, as well as contracting your PFM as described above twice a day.

Tips from the clinic to bring your PFM into your Yoga practice

As I have previously said, it’s not all about strength: letting go fully, timing of contraction, endurance and anatomical position of your pelvic organs are all important aspects of good PFM function. So what to do in your Yoga practice? From what we know about PFM physiology to date, these muscles are mainly designed for endurance. There is evidence that the end of a workout, these muscles are as fatigued as the rest of your body. So, if you contract them too hard, they are going to tire and it will be difficult to maintain throughout your practice, potentially leaving your spine and pelvic organs vulnerable to strain. We don’t know how quickly they recover either, so just after your practice, especially if you know that you have a PFM disorder, it maybe well worth contracting your muscles before you lift or bend over, as extra protection.

Back to your practice, as a good rule of thumb, I would suggest contracting around a quarter of your maximum effort. Try this now. Contract your PFM, as detailed above, as hard as you can. Let go of that contraction by half, then by half again. You should still be able to feel the lift, but be able to breathe easily from your diaphragm. Frequently people find it hard to do both!

Over time your awareness, the endurance, coordination and strength of your PFM will improve, allowing you to work harder for longer…should you wish! Yoga is a great way to maintain and improve the health of your Pelvic Floor. Imagine looking and feeling as good on the inside as you do on the out!

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