Several yoga techniques target the muscles of the pelvic floor, groups of muscles we tend to ignore—but at our peril. In this interview with Eva Norlyk Smith from Yoga U, yoga teacher Leslie Howard, who specializes in women’s health issues pertaining to the pelvic floor, discusses the importance of the pelvic floor for long-term health, as well as for our sense of grounding and security in life.
Eva Norlyk Smith: On your website, you say that stabilizing, stretching, and softening the pelvic floor helps to create the correct foundation for every movement in the body. That’s a pretty bold statement! What exactly do you mean by that?
Leslie Howard: The pelvis floor is really the foundation of the whole body. The pelvic floor is sitting at the bottom of our torso, so it literally forms the floor for all our organs – especially for women, because of the way women’s pelvises are designed. Women are designed to have a baby’s head come through that pelvis. So the interior outlet of the pelvis for women is actually larger than in a man. And that creates instability.
Now instability, interestingly enough, can manifest in different ways. What I found is that the prevailing belief is that if you’re female, you have a weak and loose pelvic floor. Particularly after women have a couple babies they’re weak in the pelvic floor and may become incontinent and develop other long-term issues like prolapse, and so on.
But now that I’ve been teaching and studying this as long as I have, I have found that this is actually not necessarily always true. You can have quite the opposite problem, which can wreak just as much havoc. There are all kinds of other problems that could happen. And when the pelvic floor is not working correctly, then again your foundation – your true foundation – is not supporting you in all of your movements throughout your day. It’s a strong statement, but in my experience, that’s the case.
ENS: In subtle yoga anatomy, the pelvic floor is typically associated with the root chakra, Muladhara. Imbalances in this chakra is said to cause issues around sense of security, grounding, and centering in life. Is this something that you see coming into play when people begin working with the pelvic floor?
LH: Well, you can certainly look at pelvic floor issues from the perspective of blocked prana or issues associated with the muladhara chakra. But which comes first? A tight pelvis or a feeling of insecurity in the world? We all bring karma with us. I prefer to approach my work from the view point that we all need to develop a healthy loving relationship with ourselves and the pelvis is a good place to start! If you heal your pelvis, without a doubt, you will have a more secure place in the world and be more grounded.
ENS: What are some of the symptoms that women might want to look out for that could indicate a pelvic floor issue or pelvic floor weakness?
LH: Well, in the general population, the largest problem is incontinence for women.
After that, I would say the most common problem among women is pelvic pain, which usually denotes too much tone in the pelvis. Those two problems are the most common followed by hysterectomies. There are somewhere between 500-600,000 hysterectomies performed every year in the United States. And the fallout from a woman getting a hysterectomy can be very, very challenging.
ENS: So the hysterectomy would typically occur if there is a prolapse. Is that correct?
LH: That is correct. A prolapse is a very common reason to have a hysterectomy. However, there are a lot of complications for women’s health after a hysterectomy. And often, surgeons don’t talk to you about that. I had really severe fibroids and the doctors said, “Ah, you’re 45. Let’s just take your uterus out.” And I was like, “You know, I think I want to hold on to my uterus.”
I had to go to a couple different doctors to find one that would actually try to save my uterus, and I’m happy to say I have it now. But women aren’t as informed as they could be. Maybe some medical people aren’t as informed as they could be. There are other ways to deal with a person’s problems than just to take out their organs.
ENS: Issues like incontinence and prolapse become much more common as women get older, why is that?
LH: Muscle tone all over the body lessens as we age. We lose 5% of our muscle tone with every decade of our life simply via aging. The number of babies you’ve had can contribute to it as well; it doesn’t matter whether you’ve had your children vaginally or through C-section. Studies have shown that it’s not the labor that makes the pelvic floor weak, it’s carrying the baby on the pelvic floor – especially in the third trimester.
Also, being overweight can contribute to pelvic floor problems. Posture is another huge factor, the way you sit and stand has a big impact on the long-term health of the pelvic floor. That is something I talk about a lot in my workshop. There is a correct way to sit and stand, and if you have any pelvic floor problems, you really need to pay attention to that.
ENS: What does yoga have to offer for pelvic floor health? What is it that you feel makes yoga a useful tool in this respect?
LH: Well, it’s not one thing, it’s not a quick fix. I got a call from a major medical foundation, and they said, “We’ve heard about your work, and we were wondering if you could give us a list of poses that work for the pelvic floor.” And I replied, “It doesn’t work that way. I can’t just give you a list of poses; it’s what you’re doing in the poses.”
It’s cultivating awareness that is healing. That’s number one. It’s not just a pose. It’s how you’re doing the pose, and where your awareness is in the pose. And some poses are more conducive to finding the pelvic floor than others.
Number two, “What does yoga offer to the pelvic floor?” It’s the mind-body connection, the breathing. Another thing I see all the time with women with pelvic floor problems is that they are not breathing well. They’re chest breathers, and they’re not breathing into their abdomens. It’s not that chest breathing is wrong, per se. But diaphragmatic breath has been shown again and again to be the most efficient way to breathe. You get the most oxygen, the most benefits, if you breathe into your abdomen.
And that goes back to our cultural messaging of how women today are told that their belly should be flat and hard. I’m not saying not to tone and exercise, but the abdominal exercises taught at the gym involve doing tons of crunches. Abdominal muscle toning, if not taught mindfully, can actually cause a prolapse or incontinence.
If you’re not even aware that you have a pelvic floor and you’re obsessed with getting a flat belly, you’re putting all this intra abdominal pressure down into your pelvic floor. And if you have a weakness there, then you’re going to get pushed to the limit. That’s another thing to keep in mind when doing abdominal exercises – do them in a particular way so that you’re not putting too much pressure on your pelvic floor.
In my work, my biggest goal is to create awareness – awareness that your pelvis needs attention, how to figure out if you might be on one end of the spectrum or the other end, and then how to identify your muscles. There are three layers, three primary muscle groups of the pelvic floor. And I have a couple different ways to try to access them.
It’s all about awareness – how to find your pelvic floor muscles, how to diagnose if you’re on one end of the spectrum or the other, and then of course, taking into account cultural messaging.
Get a free download with the full interview: Your Body’s True Foundation – An Interview with Leslie Howard
Also check out Leslie Howard’s online course at Yoga U: The Female Pelvic Floor: Keys to Lifelong Health
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Such fantastic information, Leslie! I see so many female clients with pelvic issues that aren’t even aware of until that start training with me. I’m looking forward to absorbing more of your wisdom.
I would say pretty much every client that I have — male and female of all ages — have pelvic floor “issues.”
I find that just educating people on the area — as you say, bringing awareness and attention to the space — is really valuable as a first step. People become more mindful of what is going on in the pelvis — which can be difficult for them to access and take time — but I find that once awareness is developed, things change rapidly without anything specifically prescriptive (i.e., here are the postures that you need to do!).
I have been studying with Leslie for almost as long as she’s been teaching this work. I love this work, I teach this work and I adore this teacher! It’s so valuable to understand that the pelvis is complex, that investigation is the key, and that “kegels” aren’t the panacea they’ve been hailed as.
I have gotten to attend a couple workshops with Leslie. I have enjoyed and benefited from her knowledge.
I’ve nominated your blog for a Versatile Blogger Award. I hope you have fun with it. http://eveyoga.com/2012/03/11/blogging-award-a-kind-of-peer-recognition/
Thanks so much, Eve!
Thank you Leslie for sharing your wisdom! I share your passion for getting this information about pelvic floor health out to the yoga world. I just have a couple of words to add….no tucking! We are a society of tuckers! Many people over tuck. It is important to find, maintain and nourish the lumbar curve! Keep up the good work!
Where did you get your pelvic floor picture? It is great. I am a pelvic health physiotherapist and would love to use it in a presentation I am giving. Who would I need to get permission from?