Yoga for Pelvic Health: Managing Stress Incontinence

“Leaking is common, but NOT NORMAL.”

— Pelvic Health Professionals Everywhere

Our society has normalized leaking as a part of womanhood. That somehow after you have a baby, all women will suddenly leak. “It's no big deal, just wear a pad”. While it may start out as a nuance, as you age leaking can turn into a greater issue.

Dealing with stress incontinence can be challenging, affecting both men and women. In this blog post, we'll explore what stress incontinence is, its causes and contributing factors, and most importantly, how yoga and movement can be a valuable tool in managing pelvic health.

What is Stress Incontinence?

Stress incontinence refers to the unintentional loss of urine, often occurring when the muscles around the urethra become weak. It's the situation where laughter, coughing, running, or jumping leads to leaks. Contrary to common belief, stress incontinence is common but NOT NORMAL.

Different Types of Incontinence - It's crucial to understand that there are different types of incontinence, stress, urge (over active bladder), overflow, functional and mixed. Importantly, you can experience stress incontinence even if you've never given birth.

Causes and Contributing Factors

• Certain medical conditions

• Certain medications

• Childbirth

• Chronic cough

• Genetics

• Obesity

• Menopause

• Smoking

• Surgery

• Engaging in high-impact activities over the years

It’s important to point out that conditions like stress incontinence are rarely “caused” by a single factor and it’s usually a result from a combination of factors over a period of time.

Treating Stress Incontinence

Effective management of stress incontinence involves a multifaceted approach including both physical therapy and lifestyle changes.

• Pelvic Floor Physical Therapy: Seeing a pelvic floor physical therapist is essential for addressing issues related to the pelvic floor, such as stress incontinence. These specialized PTs provide a thorough examination, targeted exercises and techniques, and overall support addressing pelvic health concerns.

• Lifestyles changes: Adopting a healthy weight, avoiding smoking, and incorporating regular exercise, including pelvic floor exercises, can significantly reduce symptoms and improve overall pelvic health.

Specific exercises that address stress incontinence:

• Kegels: Kegel exercises, although beneficial, are not meant to be done indefinitely.

• “The Knack”: "The knack" refers to a technique for pelvic floor contraction aimed at preventing stress incontinence. It involves consciously engaging the pelvic floor muscles before and after experiencing downward pressure, such as during coughing or sneezing, providing additional support to prevent urine leakage.

“The good news is that you can improve stress incontinence with movement. Most people think that movement means huge changes but really its lots of small, impactful strategies. And it's ok if everyone's movement choice looks different.”

- Dr. Kelsey Daniels, The Mobility Project

Yoga for Pelvic Health

Yoga during pregnancy and postpartum can play a pivotal role in supporting pelvic floor health. Incorporating specific yoga poses into your routine can aid in strengthening and toning the pelvic floor muscles. Here are some yoga poses to consider:

Bridge Pose

• Strengthens pelvic floor muscles.

• Promotes flexibility in the spine.

• Enhances overall pelvic stability.

Chair Pose

• Engages and tones pelvic floor muscles.

• Builds strength in the lower body, including the pelvic region.

• Improves posture and alignment, supporting pelvic health.

Child’s Pose

• Relaxes and stretches the pelvic area, releasing tension.

• Encourages mindful breathing, reducing stress that can impact pelvic health.

• Provides a gentle stretch to the hips and lower back.

Locust Pose

• Strengthens the back and pelvic region.

• Improves posture and spinal alignment, benefiting overall pelvic stability.

• Engages multiple muscle groups, contributing to pelvic floor strength.

Incorporating yoga into your routine can be a positive step towards managing stress incontinence and promoting overall pelvic health. By understanding the causes, adopting healthy habits, and embracing targeted yoga poses, you can take control of your pelvic well-being. Consult with healthcare professionals, pelvic floor pts and trained movement professionals to create a personalized plan that suits your needs, ensuring a holistic approach to managing stress incontinence.

Yoga and Hypermobility

Hypermobility in the elbows

Hypermobility means your joints can move beyond the normal range of motion. The connective tissue or fascia around the joints are very flexible.

• Hypermobility is on a spectrum, meaning it varies in severity. It may affect one area or all over the body. Common areas of hypermobility are elbows, wrists, fingers and knees.

• Hypermobility usually doesn’t cause any pain or medical issues.

• Hypermobility is relatively common and affects 20% of the population. In some people, excessive flexibility maybe a rare inherited condition, Ehlers-Danlos syndromes (EDS).

Hypermobility and Pregnancy

During pregnancy, an increase in hormones (notably relaxin) increases flexibility in the body. This is one way the body is preparing for birth. Low back and pelvic pain is a common symptom during pregnancy. The presence of hypermobility is one of several factors associated with developing lower back pain. Increased instability of the sacroiliac (SI) joints may be responsible for pelvic pain in pregnancy. 

Yoga and Hypermobility

Typically, when a hypermobile individual practices yoga they may look amazing and flexible, however it is usually borrowed strength or a compensation. Individuals with hypermobility should seek out a strength based yoga practice. Regardless of if you are pregnant or not pregnant, training your body to use your muscles during exercise and daily life can help prevent injury and excess strain.

Practicing yoga with hypermobility:

1. Start in a smaller range of motion

2. Find the work

3. Observe the sensation

4. Once you have established what the work is in your body, then you may begin to explore the posture

Yin Yoga

Many yogis, especially flexible ones are drawn to a “stretchy” yoga practice. While, there is nothing wrong with “stretching”, overtime it may contribute to, long and weak muscle tone. This doesn’t mean you should never practice a yin style practice.

Tips for practicing yin in a hypermobile body:

• Instead of going to your edge – do 70% or less in your stretch

• Ease into postures

• Hold for less time

Rib Cage Breathing

Rib Cage Breathing

Rib cage breathing is the main breath taught at Prenatal Yoga Las Vegas because it is optimal for pregnancy and beyond. Chest breathing tends to be short and shallow and belly breathing heavy focus on breathing downward can compromise a weak pelvic floor. Rib cage breathing focuses on expansion throughout the sides, front and back of the lungs. During pregnancy internal organs are shifted to make space for a growing baby. Often times this can cause breathing to feel labored and restrictive. Practicing rib cage breathing allows for maximum oxygenation while keeping the core stable and strong.

More About the Breath - Breath Awareness

INHALE

• Air fills the lungs

• Lungs expand

• Rib cage expands

• Diaphragm moves down

• Pelvic floor moves down

EXHALE

• Air is forced out of lungs

• Lungs shrink

• Rib cage relaxes

• Diaphragm moves up

• Pelvic floor moves up

Tips for Practicing Rib Cage Breathing

• Try practicing rib cage breathing from different positions. Standing, siting, on your back, and on your stomach (if not pregnant.) This will increase your breath awareness.

• Try rib cage breathing with a strap or belt around the rib cage to increase breath awareness.

• Visualization - Visualize an umbrella in your lungs. On the inhale, see the umbrella open. On the exhale visualize the umbrella closing. Do this for 10 breaths.

What is Pelvic Floor Physical Therapy and Who Needs it?

What is Pelvic Floor Physical Therapy and Who Needs It?

Guest post by Julie Haake, PT

Julie Haake, PT

Pelvic health, or pelvic floor, physical therapy is a niche of physical therapy for both women and men that focuses on the pelvis and pelvic floor, hips, low back, and abdominals. The pelvic floor is the layer of muscles that covers the bottom of the pelvic cavity (think of the area that touches the seat when you ride a bike) that supports the organs within the pelvis, aids in functions related to urinating and defecating, and assists in sexual function.

Just like a muscle in your arm can become weak, or tight and tender, the muscles of your pelvic floor can do the same and result in pelvic floor dysfunction. Your pelvic health physical therapist is highly trained to examine and assess the mobility, strength, endurance, and power of your pelvic floor and surrounding muscles. Most of the time, this consists of an internal (intravaginal or rectal) examination. They will also check for trigger points, or tight spots in your muscles, that may be referring pain to your hips or low back.

Your provider may give you exercises to help strengthen or relax your pelvic floor based on their findings. This is why it is so important to see a pelvic health physical therapist!! Everybody is different, and your treatment plan will be individualized and tailored to your specific needs. There is no one size fits all plan for rehab and recovery.

Some, but not all, of the symptoms a pelvic health physical therapist can treat are: urinary incontinence or frequency, fecal incontinence, constipation, pelvic pain, dyspareunia (pain with sex), post-prostatectomy, post-partum (vaginal delivery or C-section) conditions, and post-hysterectomy complications.

So… who needs it?

New moms

The list of ways a pelvic health physical therapist can help a new mom seems endless… and this is the case whether you gave birth vaginally or via C-section! From problems like urinary incontinence to managing your C-section scar, a pelvic health physical therapist is equipped to assist you through your postpartum journey, help you handle the effects of any complications you endured during the birthing process, treat and prevent clogged milk ducts, and guide you in safely returning to exercise or sexual activity without pain.

Someone who involuntarily leaks urine

Involuntary leakage of urine, also called “urinary incontinence,” commonly happens when you cough, laugh, lift something heavy or lift weights, run, get home from work, hear running water, or can’t get to the bathroom on time. This may be a common occurrence, but that does not mean that this is normal! This occurs when our intra-abdominal pressure increases (the pressure inside our body below the diaphragm and above the pelvic floor), or due to environmental or behavioral triggers. This problem can be treated with pelvic floor physical therapy intervention and behavioral changes!

Someone experiencing fecal incontinence or constipation

Many times, fecal incontinence is due to weak pelvic floor muscles, and constipation can be due to overactive pelvic floor muscles. Fecal incontinence occurs due to a lack of control of bowel movements, and can occur with running, lifting, and jumping, or when you just can’t make it to the bathroom on time. On the other hand, constipation is the occurrence of infrequent bowel movements, usually less than 3 times a week. In some cases, these bowel movements can be painful. Your physical therapist can assist you in finding the root of the issue, strengthening or relaxing your pelvic floor muscles, and creating behavior modifications so that you can live your life without worrying about leaking fecal matter or constipation.

Someone having pelvic pain

Pelvic pain is commonly related to overactive pelvic floor muscles. This type of pain could be a constant dull ache, a sharp pain with certain movements, numbness and tingling, pain with sex, or pain due to an underlying condition, such as endometriosis or PCOS. Your physical therapist is equipped to help you feel better, whether that be through manual therapy and trigger point therapy to assist in releasing tight muscles, helping to mobilize nerves to relieve numbness and tingling, or prescribing dilators to decrease pain with sex.

If you’d like to learn more about pelvic floor physical therapy and how it can help you, check out www.juliehaakedpt.com, @juliehaakedpt on instagram, or call or text (817) 680-1489 to schedule your complimentary 15 minute discovery call to see if we are a good match!

The Story of My Pelvis

​I had never thought about the story of my pelvis until I started to dive deep into pelvic health work. The stories we tell ourselves are powerful and often reflect our inner and outer world. As both physical and emotional manifestation, stories we tell ourselves about our pelvis start early in childhood. It starts off as something innocent, as “poop is yucky” but later in our teens coupled with poor eating habits leads to constipation. In American society we have strong messages about the female pelvis. Things like, “cross your legs, be a lady” and the infamous “thigh gap”. 

Nearly one third of women have experienced sexual assult in their lifetime. (CDC)

The story of our pelvis is a combination of what we learn from our families, friends and media, our experiences, the actions of others, and our physical health. Messages about our menstural cycle and sexuality are especially important. Sexual assult is so common in American society, I can't help but wonder the cumulative effects. Naturally if part of the body has been injured or hurt, there is a natural guarding. After years of guarding, the muscles shorten and become tense. Our pelvic floor muscles work in tandem with other muscles groups. Tightness in one area can affect the entire system.

Our story affects how we give birth, have sex, release, and move through out our daily lives.

Angela Reis in pigeon pose circa 2012.

Before I had children, I thought pelvic health issues meant leaking and that was about it. I didn’t give it a whole lot of thought. Looking back, I can see how in my early 20s I had urge incontinence. I didn’t leak but I had to go often. I remember going out on dates and having to use the restroom several times during my date. Granted, my liquid intake was up but still not normal. Even in my early teaching days I made sure to use the restroom before and after class. I would try to go even if I didn’t have to because I had a fear of having to stop on the way home to use the restroom. We all know what it’s like trying to find something when we need it. 

Then fast forward to my first child being born. I didn’t notice any immediate problems. My focus was no longer on myself but this tiny human I created. Seven months in I got pregnant again so at that point I wasn’t concerned about getting my pre-baby body back. The second pregnancy came with more aches and pains but not unmanageable. After the birth of my second, I felt like a train wreck. I had zero sense of core. At my six week checkup with my midwife she said that I had a slight cervical prolapse but nothing she was concerned about.

I continued to have urge incontinence because at this point I didn’t know what it was or that it was a problem. However, I also started having stress incontinence. Things like laughing or jumping would cause me to leak. That was worrisome for me. I started educating myself more on pelvic health by taking courses and reading books. Physically, I didn’t do any planks for about two years after my son was born and crunches not until more recently.

Eventually, my core regained strength and stability. That’s when I started having back pain. Excruciating, keep you up all night back pain. I went and saw the chiropractor and with a few adjustments, I was back on track. My chiropractor said it was SI joint and is pretty common. I had a bad habit of holding my kids on a certain hip so she advised that I switch it up. 

Currently in my journey, both urge and stress incontenience has ceased. I haven't had any presistent back pain. I feel a lot more stable in my center, even as a heavier woman. Knowing everything I know now, I wish I had learned about pelvic health before I became pregnant. Pelvic health is an underrated but vital part of every persons life. Without pelvic health, we wouldn't be able to release waste, walk upright or maintain sexual health. Pelvic health issues are treatable. 

If you would like to learn more about pelvic health, join us on September 19 & 26 for our Yoga for Pelvic Health Workshop. This is a two part live online workshop. Both parts will be recorded in case you are unable to attent one part. Take back your pelvic health!
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Why is pelvic health important?

When I start to talk about pelvic health, most people think that pelvic health is exclusively related to leaking and/or women problems. If you're not someone who is currently leaking, you may write yourself off from pelvic health altogether. However, pelvic health is so much more than that!

Pelvic health encompasses your “true core'“ or your “core four”. This muscle group includes:

• Transverse abdominus (TVA) - deepest layer of abdominal muscles

• Multifidus - muscle that run along the spine

• Diaphragm - dome shaped muscles located under the lungs

• Pelvic floor - muscles inside the pelvis

How you breath and move throughout the day is critical aspects to pelvic health. The culture in the United States breeds habits detrimental to pelvic health. Long periods of sitting, poor posture, shallow breathing, high heels, leg crossing, and driving all contribute to pelvic health dysfunction.

Pelvic health is related to how we move, sit, stand and breathe.

Pelvic health is responsible for all the input and output of pelvic function. (Urine, bowel and sexual health)

It is common, but not normal:

• Leak when you cough, laugh, jump.

• Frequent urination (peeing every hour or having the urge to pee related to certain activities)

• Painful intercourse

• Back pain

Many people suffer from pelvic health dysfunction but never receive the proper treatment and support. Pelvic health is more than leaking. If you would like to learn more about how to support your pelvic floor, join our next Yoga for Pelvic Health workshop.

Yoga for Pelvic Girdle Pain

Pelvic girdle pain (PGP) is one of the most common complaints I hear from my prenatal students. PGP varies in severity and areas of pain. PGP maybe a persistent on-going pain or triggered by certain movements, or a combination of both.

Symptoms of pelvic girdle pain

• Pain felt in the front, back or sides of the pelvis

• Symphysis pubis dysfunction (SPD)

• Low back pain

• Inability to stand on or lift one leg

• Pain when walking, sitting or standing

• Pain when getting out of bed

Severe cases of PGP can greatly affect the person’s lifestyle. Daily and regular activities that were once enjoyed maybe stopped or put on pause. Pain may contribute to perinatal mood disorders, including depression and anxiety.

Possible causes of pelvic girdle pain

• Asymmetry in the pelvis

• Hypermobile pelvis

• Weak or tense muscle tone

• Poor postural alignment

• Trauma

Treatment and Tips for Pelvic Girdle Pain

If you are experiencing pelvic girdle pain, it is important that you seek treatment from a qualified Physical Therapist in your area. Specifically one that specializes in pelvic health. Physical therapists can work with you during pregnancy and postpartum. Don’t wait until the pain is debilitating, seek help early.

Be mindful of your daily posture. Your postural alignment and how you move throughout your day is critical. Pain comes one of two ways: a specific incident or trauma -or- through daily habits.

Helpful tips for Postural Alignment:

STANDING

• Feet hip width distance apart, weight equal in both feet

• Soft/slight bend in the knees, engaging the muscles in the legs and glutei

SITTING

• Sit on sitz bones

• Sit tall, lengthen through spine

• Legs 90 degrees, use support if feet don’t touch the floor

BREATHING

When you are sitting and standing in optimal alignment, this gives the breath room for full expansion and oxygenation. This is especially important during pregnancy when the internal organs are shifted and baby is growing.

• Practice rib cage breathing

• Inhale breath into sides, back, and front of rib cage

• Exhale sides, back, and front of rib cage draw in

Yoga Postures

Mountain Pose

• Foundation of all poses

• Practice with a block between the thighs and calves

• Maintain equal weight in the feet

• Head over heart, heart over hips

• Pelvis is neutral

Bird Dog

• Start with knees under hips and wrists under shoulders

• Notice if the weight is sinking in the belly

• Try extending only legs, then arms

• Maintain a continuous breath

Chair Pose with Block

• Use a block and/or wall

• You can also practice without either

• Strengthens lower body, including transverse abdominis

Pelvic Symmetry Sequence

This pelvic symmetry sequence is adapted from Cecile Röst, PT and Dr. Sinead Dufour, PT, PhD. The purpose of the Pelvic Symmetry Sequence is to bring the pelvis back into symmetrical alignment and to keep it strong and mobile.

Practice this sequence daily.

Prenatal Yoga Flow to Relieve SPD/PGP

This is an hour long practice aimed to strengthen inner core muscles and relieve PGP.

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Learn more about pelvic health at our: Yoga for Pelvic Health Workshop

Book a private 1:1 online yoga session: contact us

Breathing During Labor and Pushing

How should I breathe during labor?

This is the number one question I get asked as a prenatal yoga teacher and doula, how should I breath during labor? I know there a lot of birthing classes and techniques that teach specific methods to use during labor. While I don’t discount their methods, my issues with prescribed methods is most people don’t practice them regularly enough for it to be effective or they forget them completely.

First, why is breathing so important?

• Breathing is intimately related to your core.

• Your breathing pattern tells me if you are stressed or relaxed.

• Shallow breathing means that you are not getting maximum of oxygen. If you are not getting the maximum amount of oxygen, then neither is baby.

What to do Instead:

• Keep it simple! During labor: maintain continuous breathing. Deep breath in, deep breath out.

• During class we practice rib cage breathing or lateral breathing. This allows maximum expansion of the breath and does not put stress on pelvic floor.

What about holding your breath during pushing?

Unfortunately, I still see this routinely practiced in hospitals, “coached pushing” or “purple pushing”. This is where the breath is held/retained and the birthing person is asked to blow/exhale and push at the same time. This practice maybe appropriate if there is a true emergency and baby needs to get out quickly. However, in normal circumstance this practice is not recommend because it can cause damage to the pelvic floor. Instead pushing should be done on their own urges with a continuous breathing pattern.

The Truth About Diastasis Recti And What You Can Do About It

When you hear the term diastasis recti is sounds ominous and that surgery or another intense solution is the cure. However, I am here to tell you that it is far from true!

Diastasis recti (dahy-as-tuh-sis rek-tahy) is the displacement of the abdominal wall muscles. Diastasis recti is the partial or complete displacement of the rectus abdominis, or “six-pack” muscles, which meet at the midline of your stomach. Diastasis recti is very common during and following pregnancy. This is because the uterus stretches the muscles in the abdomen to accommodate your growing baby.

Diastasis Recti  is a result of excessive intra-abdominal pressure. Pressure that the muscles of your abdomen and pelvic floor can’t withstand as they should. Your core (abdominal muscles, along with your pelvic floor and the muscles of your lower back) are not working optimally in conjunction, your pelvis not aligned properly. Your core is not doing its job quite right – containing the natural pressure.
 

Key Facts:

• 100% of women have some level of diastasis recti in the third trimester

• 66% of women with diastasis recti have some level of pelvic floor dysfunction

• Men can also get diastasis recti!

Factors that increase risk:

• Advance maternal age

• High weight gain during pregnancy

• Repeated or “back-to-back” pregnancies

• Pregnancy with multiples

How to preform a self-check

1. Lie on your back with your knees bent and feet on the floor.

2. Place one hand on your belly, with your fingers on your midline at your navel.

3. Press your fingertips down gently, and bring your head (shoulders stay on the ground) up into a mini crunch-like position.

4. Feel for the sides of your rectus abdominis muscles, and see if and how far they are separated.

5. Separation is commonly discussed in terms of finger widths -- for instance, two or three (or more) fingers' separation.

Movements to avoid

1. Abdominal exercises that flex the upper spine off the floor (such as crunches, oblique curls, bicycles, roll ups/roll downs, etc.)

2. Movements that stretch or stress the midline (cat/cow and plank)

3. Movements that twist the upper body while expanding the arm out on that side (as in triangle pose)

4. Front extension poses (as in Fish, Up dog, Wheel and Camel pose)

5. Any exercise that causes a bulge in the abdominal wall upon exertion (plank, boat)

6. Lifting and carrying heavy objects

Healing your core

Properly engage your core. The core includes transversus abdominis (TA), multifidus (MF), pelvic floor and diaphragm.

1. Rib cage breathing - breathing to expand the sides and back of the ribcage. Try visualizing the breath as an umbrella opening and closing. Your breath is one of the most important core exercises!

2. Connect with your core - draw in low belly. This is not the same action as sucking in. Breath should be natural. Shoulders relaxed and tailbone neutral.

3. Optimal alignment - Ensure that while sitting and standing you're in optimal alignment.

4. Strengthening transversus abdominis (TA) - chair pose, bridge, bird dog.

Seeking professional help

If you are experiencing pain, discomfort, or dysfunction it is highly recommend you seek professional help from a physical therapist who specializes in pelvic health. If you are local to the Las Vegas area, I would be more than happy to connect you to a local pt.

For more information about local pt or to book a private postnatal yoga session, email me at angela@prenatalyogalv.com.