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I had the privilege of recently presenting two of my Medical Therapeutic Yoga workshops at the Sedona Yoga Festival 2014, one of which was a topic that is so rarely discussed:  “Pelvic Health: Pelvic Floor & Much More”.  I was so fortunate to have had such an incredibly attentive audience consisting of health care practitioners, yoga teachers, yoga students, and the general public. Everyone was so open and embraced the messages and concepts that I had to share. I’m so passionate about this topic and am continually reminded about how misinformed the majority of the population is, including many health care professionals, are about what it takes to create and sustain healthy pelvic floors.

The Pelvic Health workshop mainly focused on the factors that influence a healthy pelvic floor, the different types and causes of incontinence, and how and why a combination of physical therapy and yoga therapy can be extremely beneficial in treatment of incontinence and pelvic pain dysfunctions. I also discuss the controversial topic of Kegels, and whether or not they are as effective as traditionally promoted.

I’d like to take this opportunity to share part of my follow-up newsletter that I sent to the participants of the conference workshop, with the intention of offering some educational content on this topic with a wider audience.

I included some valuable resources as well as provided more thorough answers to few of the questions from the workshop:

1)  Here is a recent blog post I was asked to write re: incontinence. It is a nice summary of some of the main topics covered in the workshop. Please share with anyone you think may benefit!

2)  Pelvic Health Solutions is a wonderful informative website for almost anything you want to know about pelvic health. It was developed by 2 PT’s and is an evidence based site. Some of what was discussed in the workshop is included in the site, but also goes into much more detail of specific dysfunctions. When they talk of ‘reverse kegel’, that is what we do in the workshop when we observe the pelvic diaphragm naturally descend during inhalation. We actually ‘downtrain’ the muscles.
Just a reminder that I purposely do not explore a kegel or a knack because it truly requires a one on one visit to ensure you are performing it correctly.

The other reason I focus more on the ‘reverse kegel’ concept is because our culture ‘jumps’ on the kegel bandwagon as soon as we leak or are told we are ‘weak’.  But in fact, we need to FIRST know how to release the muscles before they can be used again, strengthened or before they can become pain free.

3)  When I discussed ‘bladder retraining’ for urinary frequency with an overactive bladder (i.e., not always running to the bathroom just because you feel a slight urge), there was some confusion as to how to know when to hold, and when to go. The question arose: “I thought it was unhealthy to hold though”.

Bladders are meant to hold urine. When it reaches about 200-400ml, we feel a normal response or urge to void.
The chronic holding of urine at this volume (when we should be voiding), results in an overstretched bladder that may lose elasticity and tone as we age. This may predispose you to bladder infections and ineffective bladder emptying. BUT conversely, emptying your bladder too often may eventually decrease the amount of urine the bladder can hold comfortably. If you empty too frequently, before it is ‘full’, you are increasing the bladder’s sensitivity more and more; to a point where it won’t tolerate holding the ‘normal’ amount of urine that a healthy bladder is supposed to hold. The bladder can no longer be controlled; rather, it controls you. With repeated bathroom trips for ‘just in case’ reasons, the bladder begins to signal a need to urinate with smaller and smaller amounts of urine, resulting in increased urges and frequency of urination. Eventually you have ‘urges’ to go, even though the bladder volume of urine is well under the normal amount it is meant to hold. This causes tightness, pain, and a whole host of other pelvic dysfunctions, including incontinence b/c the muscles are fatigued from holding all the time. It’s a slippery slope. The bladder begins to CONTROL the brain. This is why a BLADDER RETRAINING program that is supervised by a women’s health PT specialist is very helpful. It is difficult to retrain bladder habits on your own, without help. They can help you fill out a bladder log, keeping track of urges, fluid intake and help you set up a voiding schedule that progresses slowly over time, in a safe and effective way.

What you can do now if you have urges that you feel may be ‘overactive’:
You can start to use the abdomino-diaphragmatic breath in conjunction w/the pelvic diaphragm rhythm (‘reverse kegel’) to help ‘calm’ the urge.  Any meditation methods and positions that were performed in the workshop where we were ‘observing’ the pelvic and respiratory diaphragm rhythm and relaxing the pelvic floor muscles, will help ‘pass’ the urge.

4) Another question about ‘what is normal voiding amounts’ was asked. I answered that it really depends on each person:  the amount of fluid intake, activity level and bladder size can all play a role in your bladder emptying schedule.
The literature for “normal” voiding states that we should be voiding about every 2-4 hours per day (5-8 trips to bathroom); and no more than 0-1 times per night. Another resource stated every 3-6 hours. It really depends on how much fluid you intake.  Approximately 1500 -2500 ml of fluid are required each day (AGS Foundation for Health).
But more, if you are more active or on hot days where you might sweat more.
Literature recommends not intaking fluids past 7pm to avoid night time bathroom visits.

5)  If you are looking for a PT that specializes in Pelvic Health in your area, your national PT association has online directory of practitioners:
USA: APTA section on Women’s Health
Canada: CPA division of Women’s Health

I would recommend that your PT communicate with your yoga instructor; and together, they can develop a home yoga practise unique to your specific dysfunction or needs.
If you are lucky, you might be able to find a PT that is also a yoga therapist!
The directory of PT’s that use yoga as therapy:
www.fizzyyoga.info
The directory of health care professionals that use medical therapeutic yoga in their practise:
Professional Yoga Therapy Studies Find a Therapist page

6)  Ginger Garner, founder and director of Professional Yoga Therapy Studies, is a PT, ATC, PYT (Yoga Therapist) and women’s health specialist and advocate. She is based out of NC.
She has a wonderfully informative blog and other resources that you may be interested in and find valuable.
Here is part 1 of her recent blogpost on pelvic pain:

7)  Lastly my YouTube channel has video demonstrations of the TATD breath (at 10:05 minute mark) and abdomino-diaphragmatic breath patterns. I post a variety of PhysioYoga related material, so if you subscribe (it’s free), you will automatically be notified when I post a new video.
Thanks for your openness to learn and explore some new concepts surrounding pelvic health!

Namaste and deep gratitude

Shelly Prosko, PT, PYT, CPI
Physical Therapist, Professional Yoga Therapist, Certified Pilates Instructor
www.physioyoga.ca