Yoga to Help with a Tight Pelvic Floor

When it comes to postpartum issues, it is common to hear about urinary incontinence and diastasis recti. Oftentimes, kegals are the go-to recommendation for strengthening the pelvic floor after having a baby. One issue that is less frequently in conversation is hypertonicity of the pelvic floor. What about those who have dysfunction that would be made worse by these suggestions? An evaluation by a pelvic floor physical therapist is a good idea, whenever you have problems with pain, urinary incontinence or bowel dysfunction. You want to make sure you are getting to the root of your problem. If you are someone who has tightness in the pelvic floor or hypertonicity, this blog post is for you!

Signs of a Tight Pelvic Floor

• Frequent or painful urination
• Difficulty starting urination, maintaining stream, or spraying urine in an unpredictable stream
• Constipation, hard stool, and hemorrhoids
• Pain with penetration during sex, vaginal exams or inserting a tampon
• Low back pain, tailbone pain, and/or hip and pelvic pain
• Prolonged pushing phase of labor
• Shallow breathing pattern or difficulty taking a full breath

If you have any of these issues, it would be beneficial to get a referral to a physical therapist with a specialty in pelvic health, as not all exercises are suitable for everyone. Some people have a mixture of weakness and tightness, but it is important to address the tightness before the strengthening.

Breathing for Hypertonicity

Deep breathing helps to stretch the pelvic floor on the inhale and contracts on the exhale. It is important to work on whole body breathing to help with the stretching and relaxation of the pelvic floor. Starting in Shavasana (reclined or side lying if you are currently pregnant), place a bolster or pillow under the knees and under the head for comfort.

1. Lie on your back with your legs extended and arms by your side letting the body relax into the floor beneath you. Close your eyes.
2. On an inhale, breath the air into the belly and lower back and slowly exhale out of the nose or mouth.
3. Release all tension of the muscles starting at the crown of the head to the soles of the feet.
4. Relax all the muscles of the face and mouth. Continue deeply breathing for 5-20 minutes.
5. To come out of the pose, start wiggling your fingers and toes, roll onto your side and return to seated when you feel ready.

6 Daily Yoga Poses for Hypertonicity

Reclining Big Toe Pose 2: This pose is done laying on the back and stretches the hamstrings and adductors, which can contribute to tight pelvic floor muscles. It is important to maintain a neutral pelvis to stretch the second layer of the pelvic floor.

1. Lie supine on the floor with knees bent and feet on the floor. Try to be aware of a neutral pelvis.
2. Place a yoga block or bolster against outer side of the right hip.
3. Draw the right knee toward the torso and hug it in towards your chest.
4. Place a strap around the sole of the foot and push the foot up into the strap to straighten the leg.
5. Push the left leg into the ground below you.
6. Slowly allow the right leg to rotate out to the side toward the ground supporting the outer thigh on the yoga block or bolster.
7. Remain in the position for 1-2 minutes.

Low Lunge: Lunges help to open the hip joint, stretching the groin of the front leg and the hip flexors of the back leg. Both of these may be tight in people with pelvic pain.

1. Starting on hands and knees step the right foot forward to the outside of the right hand. The right foot is slightly turned out.
2. Shift weight forward and move the pelvis in a circular motion keeping the pelvis neutral. Change directions of the circular motion after 1 minute.
3. Another variation is to raise arms overhead for a deeper stretch of the psoas of the back leg.
4. Repeat on the opposite side and notices if the two sides feel different.

Downward Facing Dog: Stretches the hamstrings, which attach to the sit bones. When the hamstrings are tight it pulls the tailbone into a posterior tilt and causes tightness in the pelvic floor. It is important to do this pose with bent knees to slacken the hamstrings and allow the pelvis to untuck.

1. Starting on the hands and knee place the hands about 6 inches in front of the shoulder joint with the knees directly below the hips and the pelvis neutral.
2. Tuck the toes under and lift the hips up toward the ceiling extending the legs by engaging the quadriceps.
3. Avoid sticking the ribs out.
4. Bend the knees to allow the tailbone and sit bones to move away from the shoulders toward the ceiling.
5. Keep the ears in line with the inner arms.
6. Rotate the thighs inward and push the hips away from the arms toward the ceiling.
7. Stay in position for 20 seconds to 2 minutes.

Yoga Squat: If done correctly and with modifications to keep pelvis from tucking under, this pose helps to increase awareness of the pelvic floor muscles.

1. Starting in mountain pose standing with feet hip distance apart and hands by your side, slowly bend the knees dropping the weight into the heels. If you do not have the flexibility to do this, you can modify by putting a rolled up yoga mat under your heels or sit on a yoga block. The support should help to maintain a neutral pelvis.
2. Coming into a squat position, there should be equal weight on the inner and outer heel and the knees should be wider than the torso.
3. Bring the palms together and press the elbows into the inner thighs.
4. Practice deep breathing and completely relaxing the pelvic floor muscles.
5. Remain in this pose for 30 seconds to 2 minutes.

Cat-Cow: In cat-cow, you will experience both shortening and lengthening of the pelvic floor muscles and when combined with breathing exercises it creates an exaggeration of what occurs during the normal breathing cycle.

1. Starting in tabletop: Hands and knees position with the pelvis in a neutral position and hands directly under the shoulder joints and knees below the hip joints.
2. Cow: On an inhale, lift the head and tailbone toward the ceiling arching the lower back and expanding the chest and lengthening abdomen. The pelvic floor is lengthening.
3. Cat: On and exhale, round the back toward the ceiling and tuck the tail underneath you while drawing the navel toward the spine. The pelvic floor is shortening.
4. Move between the two postures for 3-5 rounds linking the breath to the movement.
5. Return to tabletop position with a neutral pelvis.

Reclining Bound Angle: This pose opens up the hips, stretching the pelvic floor and the abdomen. It can be beneficial to practice deep breathing to relax the pelvic floor and perineum.

1. Placing a bolster lengthwise across the back or additional pillows for a more reclined position, if pregnant. Place a folded blanket or small pillow to support the head and neck.
2. Place folded blankets or yoga blocks under each thigh close to the hip joint.
3. Start seated in bound angle pose- soles of the feet together and knees bent.
4. Using a yoga strap, loop it around your torso near the sacrum, over the groin and around the outer edges of the feet.
5. Lean back into the bolster and focus on deeply breathing down into the pelvic floor relaxing your muscles.
6. Remain in this position for 5-20 minutes.