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.

My Top 3 Postnatal Yoga Poses

My Top 3 Postnatal Yoga Poses

What yoga poses are safe to do after baby? This question comes up a lot for new parents. The biggest rule of thumb for all poses and movement - can your breath continuously? If the breath is shallow or labored, it is an indication that your body might not be ready for pose or movement.

Rib Cage Breathing

Do not underestimate the power of your breath! Before starting a movement practice, you want to practice rib cage breathing. Mastering this breath practice is essential to healing your core and pelvic floor.

I choose the following 3 poses because:

• Great beginner poses but has lots variations to increase challenge

• Strengthens your true core (diaphragm, transverse abdominals, multifidus, and pelvic floor)

• Strengthen your glutei

• Does not compromise your linea alba

1. Bridge Pose

Lie on your back with your feet hip width distance apart. Shoulders relax away from your ears and arms down along your sides. On the exhale, lift your hips. Your shoulders, hands and feet are your foundation in this pose. Using a block between the thighs to help keep legs parallel.

Daily practice: 3x, holding for pose through 3 breaths. Gradually increase to longer holds and more rounds.

2. Balancing Table

Come into tabletop. Wrists are shoulder width distance and knees hip width distance (knees maybe slightly wider if pregnant). Spread the finger evenly into your mat, curl your toes under. Gaze in between the hands. Draw the navel toward the back of the body. Breath comfortable.

On the exhale extend one leg hip height and opposite arm in line with the ear. To read more about this pose and variations.

Daily practice: 3x, holding for pose through 3 breaths. Gradually increase to longer holds and more rounds.

3. Chair Pose

From standing, lift the toes and spread evenly on your mat. On the exhale, bend the knees and sit back into an imaginary chair. On the next exhale, extend the arms in line with the ears. Breath comfortably for 3 breaths and gradually increase.

Add a block between the thighs to add challenge to the posture. If newer to the practice, start with hands at heart center until breath is comfortable. Try this pose standing behind a wall for challenge and support.

Daily practice: 3x, holding for pose through 3 breaths. Gradually increase to longer holds and more rounds.

Consideration for movement before getting back to your mat or exercise routine:

• It took 10 months to grow baby, give your body and self the same time and grace to heal

• How did your birth and healing go? Every birth and healing is going to look very different.

• Bleeding has completed stopped.

• Do you notice any doming, bulging or invagination at the midline?

• Do you feel any pelvic pressure?

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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Balancing Table Pose

Balancing table pose has a few different names, depending on who you have taken the class with and their trainings. Also known as Sunbird pose, Bird Dog pose or Sanskrit name, Dandayamana Bharmanasana. This is one of my must practice poses for both my prenatal and postnatal students. Working your core during pregnancy is tricky, since you baby is growing in belly, traditional exercises like crunches and planks are not ideal. Postnatally, crunches and planks can add additional pressure toward inner unit function. Balancing table is great no matter where you are on your journey. This pose can be very challenging but it’s also really nice because you can ease into the posture.

Why I love this pose: this pose works on strengthening your deep inner core muscles and is appropriate for pregnancy and postpartum.

Benefits: Strengthens core four (core four: diaphragm, transverse abdominus, pelvic floor and multifidus.), specifically the multifidus, and stabilizes low back and pelvis.

Tips for practicing this pose:

• Align wrists under shoulders

• Align knees under hips

• Curl the toes under for additional stability

• Use a towel or blanket under the knees if practicing on a hard surface or knees are sensitive

• Maintain continuous breath

• Move slowly

Balancing Table Prep

1. AVOID Tabletop with belly sinking - Draw the belly toward the back of the body. Maintain a neutral spine. Keeping the spine neutral gets more challenging once you extend the legs and arm, so be mindful and move slowly.

2. Tabletop - Spine is neutral. Press the mat away from you with your hands. Find a comfortable breath pattern.

3. Tabletop with arm extension - Start by extending one arm forward, palm is open. Keep the arm in line with the ear. Gaze in-between the hands.

4. Tabletop with calf stretch - With both hands rooted on your mat, extend one leg back at a time. This is a great calf stretch. Can be done as it’s own pose or preparation for balancing tabletop.

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Balancing Table Variations

1. Tabletop with knee lifted - Start with a strong tabletop foundation. Extended one arm forward. Exhale and lift the opposite knee two inches off your mat. Maintain continuous breath.

2. Balancing table - From tabletop, move slowly extending the leg and then opposite arm. (I like to switch this up, if started I with the legs first, second round start with the arms then leg). Notice your breathing pattern. Try to extend without moving low back.

3. Balancing table with wall - Using a wall to press your heel into helps to keep the pelvis neutral. The tendency in this pose is to lift the leg higher than the hip. You may also choose to extend the opposite arm.

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

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.