Pelvic Floor

Lesson Overview
In this lesson, we focus on the pelvic floor, including its contribution to core functioning.

Objective
Become proficient in describing the pelvic floor, its role in core functioning, potential issues,
and teachings that can contribute to pelvic floor health.
Description
Describe the location and healthy movement of the pelvic floor. Explain how pelvic floor
muscles contribute to core functioning. Describe potential issues associated with the pelvic
floor and what may cause the issues. Describe teachings and practices that can contribute
to pelvic floor health.
Questions Answered Here
1. Describe the pelvic floor. Provide a visual and remark on its function and
sensitivities.
2. Where is the pelvic floor located?
3. What defines healthy, natural movement of the pelvic floor?
4. Describe three general functions of the pelvic floor.
5. How do pelvic floor muscles contribute to core functioning?
6. What are some potential issues associated with the pelvic floor?
7. What factors may lead to pelvic floor weakness?
8. What factors may lead to a tight pelvic floor?
9. What other habits, practices and factors may cause pelvic floor issues?
10. What teachings and practices may contribute to pelvic floor health?

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

Introduction
The pelvic floor is often described as a “hammock” of muscles.
• This “hammock” is designed to keep the pelvic organs (bladder, uterus and rectum) in place
and to support spinal and pelvic stability.
• These muscles respond to an increase in intra-abdominal pressure (coughing, sneezing,
laughing or straining).
• The urethra, vagina and rectum pass through the pelvic floor muscles and are affected by
their contractions and relaxations.
The “bony landmarks” that define the pelvic floor are:
1. Pubic bone in front
2. Tailbone in back
3. Sit bones (Ischial Tuberosities) on either side
Healthy, natural movement of the pelvic floor includes both lifting and narrowing, plus widening
and releasing.
Visuals: Trampoline and/or Kite
An optimally functioning pelvic floor [is like] a trampoline. It supports the weight of all our pelvic
organs and allows any extra load to just bounce off its healthy, elastic fibers, tensing and releasing
naturally… Eric Franklin compares natural movement of the pelvic floor to a kite. As you stand up the
pelvic floor slightly lifts and narrows similarly to a kite picking the wind and taking off. Reversely, as
you sit down (with untucked tail, using your sitbones) the pelvic floor widens and releases to its full
length, like a kite descending down, opening and landing.– Ivanna Demmel

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

Functions
Overview
1. The pelvic floor supports the bladder and reproductive organs (including a growing uterus
in pregnancy).
2. As a part of the core, pelvic floor muscles work in cooperation with the deep abdominal
and deep back muscles to stabilize the low back.
3. A healthy pelvic floor is associated with enhancing sexual comfort, sensation and arousal.

Specifically
Karlyn Driedger, PT, BScKIN, MScPT explains these five important functions of the pelvic floor:
1. Sphincteric
2. Support
3. Stability
4. Sexual
5. Sump-pump
Sphincteric
• The muscles of the pelvic floor wrap around and control the opening of the bladder and
rectum.
• They prevent leakage when there is an increase in intra-abdominal pressure.
• These muscles also have to relax appropriately to allow for urination and bowel
movements.
Support
• The muscles support pelvic organs against gravity and increased intra-abdominal pressure.
• In women, excess strain on the pelvic floor (during pregnancy) or weakening of the pelvic
floor (age, hormonal changes) can lead to prolapse.
Stability
• The pelvic muscles have attachments to the pelvis and hips and are an important part of
the “core.”
• These muscles work in cooperation with hip, abdominal and back muscles to control
movement of the sacroiliac and hip joints as well as stabilization of the low back.
Sexual
• A healthy pelvic floor is associated with enhancing sexual comfort, sensation and arousal.
Sump-pump
• The pelvic floor muscles act as a blood/lymph pump for the pelvis.
• A loss in this action can contribute to swelling or congestion.

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

Potential Issues
Overview
Pelvic floor issues may include:
1. Weak pelvic floor muscles
2. Tight pelvic floor muscles
3. Pelvic floor muscles overpowered by other muscles

Potential Causes of Pelvic Floor Weakness

• Pregnancy and childbirth
• Chronic constipation
• Aging
• Menopause
• Surgery
• Factors that raise intra-abdominal pressure
Factors that raise intra-abdominal pressure include:
• Chronic coughing
• Heavy lifting
• High impact exercise
• Being overweight or obese

Potential Causes of Pelvic Floor Tightness

• Stress
• Anxiety
• Overactive bladder
• Poor posture

More Potential Causes of Issues

Other habits, practices and factors that can cause issues include:
1. Constantly tucking the coccyx (tailbone).
2. Practicing Kegels when pelvic floor muscles are tight.
3. Practicing exercises that induce muscular imbalance, particularly those that develop
overly strong abdominals in relationship to a weak pelvic floor.
4. Issues in recruiting pelvic floor muscles can occur as a result of regular straining with
bowel movements, constant coughing, pregnancy weight, childbirth, infection, pain, poor
movement patterns, trauma and surgery.
Can’t Lift, Can’t Relax, or are Overpowered
The pelvic floor muscles cause problems when they are: weak and not strong enough to lift when
you run or sneeze; tight and cannot relax; overpowered by excessive tightness in trunk and waist
muscles. – Pelvic Floor & Core Works
Habits That Don’t Allow Pelvic Floor to Release
Untucking the tailbone opens the pelvic outlet, tucking it closes it — tightening the pelvic floor.
The dog with his tail down between his legs is an equivalent of you sitting on your sacrum, the
back supported by a chair or a couch. If you spend multiple hours a day in this position, your pelvic
floor doesn’t really have a chance to release and allow the muscle fibers to regain their natural
length at resting state. So gradually it shortens. – Ivanna Demmel

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

 Kegels May Not Resolve Weakness
A Kegel is a muscular contraction. For women who have a tight pelvic floor, concentrically
contracting the muscles regularly will simply aggravate the tension issue. Muscle that is either
too long or too short looks the same when you measure its force production. Which means just
because something is weak or unable to do a bout of work does not automatically imply that
concentric contraction is the correct prescription. – Katy Bowman
More on Limitation of Kegels
Kegel muscles mainly strengthen the muscle that “cuts off” the flow of urine, the puborectalis.
They do not strengthen the backward acting muscles and ligaments which control other
symptoms such as pain, urgency, nocturis, bowel and bladder emptying. – Peter Petros
Kegels Can Over-Tighten, Leading to Weakness, Not Strength
The longtime runner and yoga and Pilates teacher was shocked [to learn]… her pelvic floor
muscles were so weak she had developed pelvic organ prolapse… she’d spent years working her
abs and religiously did Kegels to strengthen her pelvic floor muscles — part of the larger group of
muscles we refer to as the “core.” How were these muscles not strong enough to do something
as basic as keep her organs in place? Treacy’s doc had a surprising answer: She’d actually been
overworking her pelvic floor, causing an overtightening that led to weakness, not strength.
“Think about what a tight muscle looks like,” says Treacy. “It lives in 
a shortened, contracted
state, and because it’s not pliable, it’s actually 
not as strong as it could be.” – Meaghan Rabbitt
Abdominal Muscle Strength Exceeds Pelvic Floor Ability
Your abdominal muscle strength may exceed the ability of your pelvic floor. If you have or are at
risk of pelvic floor problems, then it is important you train for the ‘weakest link’ and put your
pelvic floor first. There are a number of ways to modify your core exercises to protect your pelvic
floor. Cease strong abdominal exercises… [and practice] pelvic floor safe core exercises. – Pelvic
Floor First
Tight Inner Thigh Muscles
Tight muscles in the inner thighs can also contribute to pelvic floor issues. – Lynn Shattuck,
Huffington Post

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

Practices

Introduction
• To promote healthy pelvic floor functioning, learning proper contraction of pelvic floor
muscles is a vital aspect of productive strengthening efforts. As with the TA, learning to
identify and properly recruit pelvic floor muscles is a primary component of core activation.
• Traditional teaching of Kegels can lead to pelvic floor weakness rather than strength.
Changing the way they are taught and practiced can lead to proper balance.
• Some exercises and pose examples that can contribute to pelvic health include Setu
Bandhasana (Bridge Pose) (including a dynamic version of Bridge), Opposite Limb
Extension, Plank Variations, Forearm Plank Variations and Wall Sit.
Wall Sit

1. Stand facing away from a wall.

2. Place your back against the wall and then walk your feet out in front of you so that the wall
is supporting you.
3. Bend your knees until they are at 90-degree angles and engage your pelvic floor. Keep your
navel drawing up and in towards your spine so that your lower back is pressing into the wall.
4. Reach your arms straight out in front of you hold for 60 seconds, then release.

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

 Most Do Not Know How
Unfortunately, 65% of people that think that they know how to contract their pelvic floor muscles
are doing it incorrectly. – Diane Lee & Assoc Physiotherapy
Learning the Subtleties Important Before Strengthening
Before trying to strengthen the pelvic floor muscles it’s important to identify the slow, subtle action
of correctly tightening and lifting without stronger muscles taking over. – Pelvic Floor & Core Works
Choosing Core Exercises To Avoid Muscular Imbalance
Your abdominal muscle strength may exceed the ability of your pelvic floor. If you have or are at
risk of pelvic floor problems, then it is important you train for the ‘weakest link’ and put your pelvic
floor first. There are a number of ways to modify your core exercises to protect your pelvic floor.
Cease [these] strong abdominal exercises:
• Sit ups, curl ups, crunches
• Abdominal exercises with medicine ball
• V-sit
• Hundreds
• Double leg lowers
• Plank position on hands and feet (eg ‘hovers’, full push ups)
Pelvic floor safe core exercises
• Single leg extension with one leg supported by a hand on stationary knee or moving foot on
ball
• Knees side to side with feet on ball
• Modified plank on hands or knees with a slight bend at the hips
• Wall push ups
• Ball bridge (feet on ball or back on ball, +/- single leg lift)
• Arm and leg lift on all fours
• Leg lift sitting on the ball
• Shoulder rotations with back on the ball
• Standing balance work on the bosu or balance disc
Lift your pelvic floor first and hold it during the exercise, then relax afterwards. Notice how many
repetitions you can do before your pelvic floor muscles tire. You may need to add some rests, or
reduce the number of repetitions you do in a row, while your pelvic floor muscle fitness improves.
Please note: whilst these exercises are pelvic floor safe, you will also need to consider the number
of repetitions, abdominal challenge, number of sets, length of rest and your fatigue level – which
also affects your pelvic floor function. – Pelvic Floor First

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

More Exercise Examples

Exercise to Find Pelvic Floor Muscles

Lie on your back, or side, or sit with the spine in a neutral posture. Firmly palpate your abdomen 1-2
inches inside of your hip bones. Try the following cues to connect to (contract) your pelvic floor:
• Females – Think of your vagina as a clock, pubis is 12, tailbone is 6, left lateral wall is 3, right
lateral wall is 9. Visualize drawing the 12 to the 6, the 6 to the 12 and finally gather the 3 and
9 toward the middle of the clock and gently lift.
• Females – Nod your clitoris down toward the vaginal opening, curl your tailbone toward your
clitoris, now gently imagine sucking a jellybean up off of the floor toward your head.
• Females – Visualize ‘squeezing’/close off the urethra (as if to stop urine flow), hold this while
you ‘squeeze’/close the anus (as if to stop flatulence) and gently lift.
• Males – visualize gently drawing your testicles up and forward into your abdomen. (aka
‘bring the boys home’).
• Males or Females – Think about a guy wire or line from the anus up to the back of your pubic
bone and connect along this line.
– Diane Lee & Assoc Physiotherapy
Changing How Kegels are Taught & Practiced
The oft-given instruction to squeeze the muscles that stop the flow of urine “often leads to a
tightening of the wrong muscles, which in turn can lead to everything from urinary incontinence and
pain during sex to pelvic organ prolapse.” (Meghan Rabbitt)

Consider these instructions instead:

Picture the pelvic floor muscles between your two sitting bones.
• Inhale, and as you exhale, draw the muscles together as if they were the two halves of an
elevator door closing to meet in the middle.
• Once this door is closed, lift the elevator up and then release.
Next, imagine the pelvic floor muscles between your pubic bone and tailbone.
• Inhale, and as you exhale, draw those muscles together in the same elevator-door fashion, lift
the elevator, and then release.
Now, draw all four elevator doors together at once, meeting at one point in the middle, then lift and
release. Repeat 5 times, and rest.
– Meghan Rabbitt

Rev. 2.0 Reprinted with permission from Yoga Teacher Central

 Inner Thigh Activation
Some teach inner thigh activation to help with pelvic floor recruitment. For instructions on inner
thigh activation, see “Core Integration with a Block” here.
Squatting
Reading Katy Bowman’s last book … I’ve started to incorporate more movement into my life other
than and independently from exercising. And especially, I’ve started to squat more, when playing with
my toddler, picking things off the floor and even going to the toilet. Learning to untuck my tail has
made me finally realize why I still had to push my baby out and not bear it gently down, letting the
gravity do the job, in spite of all the birth preparations and beautiful relaxation techniques I mastered
beforehand. – Ivanna Demmel

Online Resources
Please see online version for links to more resources.

Rev. 2.0 Reprinted with permission from Yoga Teacher Central