I thought I would start the year with a blog, I've wanted to write for sometime. It's about something a little bit embarrassing, something we don't usually talk about. But like most embarrassing, non talked about things, it's actually better that we deal with it directly. So switch off now if you don't want to talk about Pelvic floor and incontinence in Yoga.

Let me qualify immediately that I'm not an expert on this topic and there are physio's who do specialise in this area. Let me know if you need one. But I do want to bring the discussion to the table as something we need to be aware of in our yoga classes.

There are many different pelvic floor problems that might result in many different symptoms. The most disturbing symptoms are obviously urinary and/or faecal incontinence. Some of these symptoms can be managed by pelvic floor strengthening and others are more structural issues that are not amenable to exercise.

 

Commonly, pelvic floor weakness has been associated with women post pregnancy following vaginal delivery, but I've supported woman of all ages with and without children that have had weakness in this area. Many men with prostate issues also experience some of these issues.

Personally when I started ocean swimming I started to develop a hyperactive bladder or urge incontinence (was called frequency when I was at Uni). Being in the water for a long period swimming it seemed unnecessary to hold back the urge to urinate even with very little in my bladder. As a consequence I quite quickly experienced a lesser capacity to hold the normal quantity of urine. Fortunately it improved quickly with the right approach. Incidentally, woman are also vulnerable to this with the hormone changes of peri and/or menopause.

What to do!

• Do not be embarrassed to see a doctor or physiotherapist that specialises in Pelvic Floor work. They will assess and accurately diagnosis to connect you with appropriate management.

• Constipation can be an associated problem that compounds the symptoms as straining increases the downward pressure on a weakened pelvic area. Make sure you get plenty of healthy fibre and consider food supplements like Psyllium and maybe consider consulting a naturopath or dietician for more guidance.

• Regain and maintain a strong pelvic floor – we do a lot of this in yogaphysio classes and I emphasize constantly that it is subtle 10-20% effort. If you find your symptoms are worsened by attempts at Pelvic Floor exercise, then you might be working the wrong muscles and it's best to consult a specialised physio. Interestingly this can be more often the case if you have strong abdominals.

• If like me, your issues relate to bladder capacity. You will need to use relaxation strategies to resist the urge to pee, until the bladder is fuller, thus retraining the nervous system.

What not to do!

• The following practices engage a strong abdominal contraction, increasing downward pressure on the weakened pelvic floor and can worsen many symptoms.

  • If you are lying on your back, don't lift both legs straight together, instead bend knees into the chest and work with one leg at a time, within the range that you can be confident you are using your pelvic floor correctly.

  • Deep squats – don't take hips lower than the knees.

  • A full plank position (from hands and knees) may also create too much intra-abdominal pressure. You can work more gently in a kneeling plank.

So, teachers and students need to be aware of and cater for the possibility of the pelvic floor issues, so that we can all continue to enjoy yoga in a safe and beneficial way.