How to Restore an Imbalanced Pelvic Floor

Pelvic Floor Imbalance: A Condition You Do Not Have To Accept

Ladies, do you ever pee a little when you sneeze, laugh, or jog? Do you suffer low back pain, hip pain, constipation, or urinary incontinence or urgency?

You may have an imbalance in the pelvic floor muscles. The pelvic floor cradles the organs of the lower torso and creates the base for deep-felt strength, balance, and stability. This area supports the load of pregnancy and then relaxes and stretches for a vaginal delivery of the baby. On an energetic level, the pelvic floor corresponds to the first energy center (called a chakra) in the body and creates the foundation for our connection to our family. When the pelvic floor is out of balance, we feel unstable, weak, and disconnected from our essential needs. Once it comes back into balance, we notice how much stronger we feel and more convicted to do what’s right for ourselves and our families.


Anatomy and Function of the Pelvic Floor

Before diving into the particulars of the pelvic floor, first understand how it relates and functions with the rest of the components of the core. With interest in understanding the anatomy of the postnatal body, let’s start with the area that cradled and supported the fetus—the pelvis and the torso—and move onto the trunk of the body where its muscles all connect at a particular point.

The pelvis is made up three main parts: the right side, the left side, and the sacrum. The top of the pelvis is called the “ilium.” The bottom of the pelvis has two knobs commonly called the “sitting bones” or “sitz bones” for short. The bottom of the front of the pelvis is the “pubic bone,” which has a ligament in the center, technically known as the “pubic symphysis.” The back and center of the pelvis is a triangular bone/plate with ridges. It’s called the “sacrum,” which is part of the spine at the back of the pelvis before the spine ends at the “coccyx,” also known as the tailbone.  

The abdominal organs live inside of what’s called the “abdominal sac.” The abdominal sac is like a balloon; it has a natural amount of pressure inside, and its pressure can change based on how you stand, sit, breathe, and move.

The “thoracic diaphragm” is on top of the abdominal sac. Commonly known as the “breathing diaphragm,” it is a muscle shaped like a mushroom cap and nestles inside the ribcage. The diaphragm descends involuntarily to fill your lungs with air, and it ascends as you exhale. We also have voluntary control over the diaphragm and can take a big breath in to fill the lungs, thus, moving the diaphragm more deeply downward. The movement of the diaphragm directly changes the pressure of the abdominal sac, pushing it downward or lengthening it upward as you breathe.

The pelvic floor is a diaphragm at the bottom of the abdominal sac. The muscles of the pelvic floor form a bowl shape and hold the internal organs of the pelvis and lower abdomen. Imbalances in the pelvic floor can lead to improper bladder function and constipation among other complications. Specifically, the pelvic floor can become too tight or too slack due to poor posture, constricted breathing, and/or emotional tension. This can translate into muscular gripping of the two pelvic floor openings, the anus and vagina. It’s possible you may unconsciously tighten the pelvic floor due to a childhood memory, past injury, and/or childbirth trauma and not realize it until you work with awareness and breath control on releasing the pelvic floor. Poor posture of the pelvis comes from either tucking the tailbone or by sticking the tailbone out, which compromises the integrity of the pelvic floor and tightens particular muscles causing an imbalance. As you discover postnatal wellness and balance through the practices in this book, work toward sustaining a neutral pelvis as much as possible (unless specified differently) while sitting, standing, and moving to equalize and balance the tone of the pelvic floor all around.

The pelvic floor diaphragm moves at the same time as the thoracic diaphragm. When you breathe naturally and in a relaxed manner, both descend and ascend together. It is due to this synchronized relationship that relaxed, yet focused, breathing is an optimal way to treat a slack or tight pelvic floor. You can determine whether your pelvic floor is imbalanced by allowing your ob/gyn, midwife, or pelvic floor-trained physical therapist to assess you.

Once you have identified which way your pelvic floor is imbalanced (if you actually have an imbalance), then focus your awareness on either relaxing the muscles or toning them appropriately under the guidance of your pelvic floor physical therapist. A pelvic floor that is too tight needs a bit more focus on the release and relaxation while a pelvic floor that is too loose needs more contraction. Regardless of whether you have a pelvic floor that’s too tight or too loose, pelvic floor contraction and release exercises (described below) will help bring balanced elasticity to these muscles. Over time, the pelvic floor will equalize, and you can spend the same amount of energy and awareness on contracting and releasing.


Pelvic Floor Contraction and Release Exercises

Once your doctor or midwife has cleared you for exercise and yoga, he/she may recommend Kegel exercises to strengthen your pelvic floor. In a perfect world, the doctor or midwife will assess the condition of your pelvic floor and teach you how to properly perform them while also determining whether your muscles are too tight (hypertonic), too weak (hypotonic), or in balance. But in reality, I rarely see mothers in my yoga classes whose doctors or midwives have done this for them. I suggest asking your caregiver to do this for you in your appointment or at least ask how to properly perform the exercises he/she recommends for pelvic floor health. (If the doctor or midwife will not determine the condition of the pelvic floor, seek out a physical therapist who specializes in pelvic floor rehabilitation.)

Kegels are commonly understood as tightening and releasing the pelvic floor muscles. Although this is the inherent action of Kegels, many do not consider the rhythm of the movement and how to perform the exercises with breath awareness. Doing Kegels isn’t the wrong prescription; rather, doing them is often incomplete due to their misunderstood execution.

People commonly describe doing a Kegel as similar to stopping a stream of urine, holding it in, and then releasing it. However, doing a contraction in this area is a very small part of a practice to rehabilitate your pelvic floor and sustain optimal health. If someone recommended you practice pelvic floor contractions by stopping a stream of urine, please know this is not an ideal practice. The pelvic floor needs to relax fully for the bladder to empty appropriately. Intermittently stopping the flow of urine to engage in pelvic floor exercises can prevent your bladder from fully releasing the toxins the body has created. Over time, you can develop bladder infections due to bacteria lingering in the urinary tract. Instead, relax on the toilet and let nature run its course.

It is better to perform Kegels with mindful movement of the body synchronized with breath so your muscles move up and down freely. Because muscles are elastic in nature, they perform best when they can contract and release with the breath and steady movement. Depending on whether your pelvic floor muscles are too tight or too loose, aim to balance these muscles with more focus on either the release or the contraction. That said, following a pelvic floor rehabilitation program is important in postnatal life and beyond.

In lieu of calling this program “Kegels,” I call it “Pelvic Floor Contraction and Release” (PFCR) to affirm the balance of energies of the pelvic floor. I suggest prioritizing your time to investigate the pelvic floor, identify the muscles, and notice how they feel contracted and released. Then use this information for a daily practice of 10 repetitions of long holds, then 10 short pulses three times a day. You will fully relax the pelvic floor after each contraction. The time you reserve for this initial inquiry establishes the awareness you need for your path onward.

            Once you identify how to isolate the pelvic floor muscles to contract and release at will, then create your personal training program. If you are short on time, you can double-up duties by performing pelvic floor contractions and releases during stop lights while running errands. In fact, the couple of minutes you gain to practice each time you stop will add up nicely. You can also practice while nursing, feeding your baby a bottle, or snuggling with your little one. Remember that performing these exercises several times a day—even for one minute at a time—is better than negating them or doing them on the chance you remember.


Pelvic Floor Contraction and Release—Identifying the Pelvic Floor

Now that you have connected with the flow of your breath, let’s carry this over to identifying the pelvic floor and how it contracts and releases with the movement of your breath. Remember that the pelvic floor diaphragm moves in sync with the thoracic diaphragm. As you breathe in, both diaphragms descend; as you breathe out, both rise. It’s important to understand where the pelvic floor is, how to contract it correctly, relax it, and help it properly regain elasticity.

1.     Sit comfortably either in a chair or on the floor. Be sure your head is in line with your hips and, if you’re seated, that you’re not slouching.

2.     Inhale deeply, then exhale the air out hard, as if blowing into a balloon. Notice what you feel. If you have the urge to urinate when blowing, your pelvic floor may be weak due to the change in pressure the forced exhalation caused within. Not to worry; you can correct this with focus, awareness, and an intention to put forth your best work each day.

3.     Remain relaxed yet aware of your breath moving in and out of your body.

To help identify the pelvic floor muscles, I have listed recommendations from anatomy and movement specialist Blandine Calais-Germain and her book The Female Pelvis: Anatomy & Exercises (Seattle, WA: Eastland Press, Inc. 2003). Perform these exercises lying down with your knees bent and feet on the ground hip distance apart, fully reclined with legs straight, squatting, or seated. (Standing is too difficult because of the effect of the gravity on the body.) Feel each instruction during one inhalation and exhalation as you follow these instructions:

1.     Feel like drawing the tailbone and pubic bone together and keep your awareness on the most exterior muscles between these points.

2.     Feel like the two bony knobs at the base of the pelvis (the sitting bones) are drawing together.

3.     Rock the pelvis gently top to bottom five times.

4.     Rock the pelvis side to side five times.

5.     Feel the two lines between the tailbone/public bone and the two sitting bones gently drawing together simultaneously. Feel like you are keeping the pelvic floor flat and not lifting too hard.

6.     Coordinate this movement with several breath cycles. Exhale while making an S consonant and contract the pelvic floor inwards and up. You can either keep the pelvis still in a neutral position or rock the pelvis back so the tailbone points toward your bent knees on the exhalation. Inhale fully and relax the pelvic floor completely.

7.     Hold the pelvic floor contraction and release exercises for these two lengths of time: a short time (2 to 5-second contraction) and a long time (7 to 10-second contraction).

Be sure the relaxed time in between each contraction itself is as long as the contraction so the pelvic floor muscles establish a balance between contracting and expanding.

As part of your daily regimen, begin with long holds and then finish with short contractions. By giving equal awareness to the two lengths of contractions throughout the day, you can create balance in the elasticity of the muscle fibers that make up the pelvic floor. You can explore some of these practices in my You Tube video.

Do not inhale deeply while sustaining a pelvic floor contraction because it places too much pressure on the pelvic organs and pelvic floor. This may be contrary to what you may have learned in prenatal yoga class in which you contracted the pelvic floor on an inhalation and released the pelvic floor on an exhalation. This is because prenatal Kegel exercises focus on connecting the exhalation with releasing the grip of the pelvic floor, which aids in a smoother delivery of the baby. If the pelvic floor is contracted on an exhalation, it would run counter to the energy of the mother pushing the baby out on her breath and through a tight muscular region.) You can feel a shallow yet natural breath while sustaining a long contraction. Follow 10 long contractions and releases with 10 short contractions three to five times a day. A good way to remember to do them three times a day is right before breakfast, lunch, and dinner. If you want to do them five times a day, add one repetition in the morning after you’ve visited the toilet and again in the evening before bedtime.


Semi-Supine Pelvic Tilts with PFCR

1.     Lie on your back with knees bent and feet hip distance apart on the floor (a semi-supine position). Feel the length of your spine from the back of your head all the way to your tailbone.

2.     Inhale, rock the tailbone toward the mat while creating more space between your lower back and the floor. Exhale, contract the pelvic floor while curling the tailbone up toward the knees and bringing the lower back to the mat.

3.     Inhale, relax the pelvic floor and breathe into the lower abdomen while pointing the tailbone toward the mat. Exhale, engage the pelvic floor while tilting your pelvis back so your tailbone points to your knees.

Repeat the pelvic tilts with awareness of pelvic floor contraction and release three to five more times.


            Awareness is power. Now you know about the pelvic floor, how to identify it, and contract and release it at will with your breath. You have the tools you need to restore your pelvic floor to its natural elasticity. Imagine the freedom you will have when you are free from low back and/or pelvic pain and no longer pee when you sneeze, laugh, or jog!  What will your life feel like?  Take care of yourself and enjoy the time you devote to personal enrichment from the pelvic floor up!