Totum Experts: Pelvic Floor Demystified
by Lauren Spahn
Yoga Teacher, Birth Doula, Writer
Vagina. Privates. Yoni. Lady bits. Flower. Noony.
The list of words we use to refer to the pelvis goes on and on. Take a moment to consider the word you use in your vernacular. Now what exactly do you mean when using that word? Are you referring to the external genital organs such as the labia, mons pubis, and clitoral hood (the vulva)? Or are you referring to the elastic muscular canal that extends from the cervix to the vulva (the vagina)? What about the uterus, which has the remarkable capacity to double in size during menstruation? Or the 16 different layered muscles that make up the pelvic floor?
If we consider the true anatomy of the female reproductive system, none of these terms alone effectively encapsulates the beautiful complexity. Which is why, despite its lack of sexiness and pizazz, I have consciously shifted – in my life and work - from using the term “vagina” to embracing the term “pelvis.” For, the pelvis is the sacred home of all the elements that make us women. *That is NOT to say that if you were born with extra or without certain anatomy, have had the surgical removal of organs, or identify as transgender that you are not a woman. You are a woman. Real. Whole. You.
I’ve come to observe in my time as a doula and yoga instructor, that while many elements of our bodies feel foreign, the pelvic floor seems to take the cake. Yet it is also the root of so many conditions that ail women, particularly as we cross the threshold into motherhood. Incontinence – check. Prolapse – check. Vulvodynia – check. Vaginismus – check. Irritable Bowel Syndrome (IBS) – check. And the list goes on! If you’ve suffered from any of these, I want to assert that 1) you are not alone and 2) there is support available on all levels. If you don’t know what any of those strange words mean and don’t care to become acquainted, I encourage you to get to know your pelvic floor!
So exactly is the pelvic floor?
The pelvic floor is comprised of 16 muscles in three different layers:
Bulbocavernosus (known as the bulbospongiosis in males)
Levator Ani (also known as the “Pelvic Diaphragm”)
You certainly don’t need to memorize those names, but what you do need to know is that each layer runs a different direction, creating a woven hammock in which the organs of the pelvis sit. Just as the diaphragm of our lungs billows wide and expands downward as we inhale, so does the pelvic floor. Upon exhalation, a healthy pelvic floor and diaphragm return to a neutral state almost parallel to the ground. Inviting this visualization with breath is a beautiful exercise to practice. Not only does it enhance our awareness of and connection to the pelvic floor, but it also serves to maintain a healthy range of motion for the muscles. Which leads me to my next point:
What makes a healthy pelvic floor?
To answer that question, we need to challenge the status quo of what defines a healthy muscle. Our culture often misinterprets strength and health. We assume that if our muscles are big and defined, that means we are strong and therefore healthy. Or, alternatively, we strive to elongate our muscles enough to be able to contort our legs into a pretzel, assuming that to be the epitome of health. But the reality is that those “big” muscles are simply short and contracted, while those “lean” muscles are elongated and lengthened. If all our muscles were only one or the other, our bodies would be in serious trouble. Just imagine your six pack abdominal muscles as short and contracted. Now think about how limited your breathing would be if those muscles couldn’t expand as you inhaled. Or consider how those shorter muscles create less space between your ribs and hips, thus rounding your spine and rolling your shoulders forward (think hunchback).
Muscle health is, actually, elasticity. In other words, it’s the ability of a muscle to exert its full range of motion, from short and contracted to elongated and lengthened, according to use.
Let’s apply this to the muscles of the pelvic floor. When too toned or overly tight, those short and contracted (known as hypertonic) muscles can cause complications such as the constant need to urinate, irritable bowel syndrome, and painful intercourse. On the flip side, pelvic floor muscles that have no or low tone (known as hypotonic) remain lengthened and can result in the lack of urinary control with impact (like jumping or sneezing), prolapse of pelvic organs, or the passage of air through the vagina during intercourse. The reality is that many of us experience an array of these complications over the course of our lives, particularly during pregnancy and postpartum. Just as our bodies change over time, so do the muscles of our pelvic floor. In fact, sometimes the transverse perineal will be too toned while the levator ani has low tone - even though they’re woven together, they each have their own conditioning and, therefore, their own levels of elasticity.
Which leads us to our answer: A healthy pelvic floor is when each of the three layers of muscle can exert a full range of motion in accordance with the action of the body.
So how do you attain a healthy pelvic floor?
The first step is acquainting yourself with your pelvis and those ever-so-important pelvic floor muscles. Here are a few exercises for you to familiarize yourself with the vast world of your pelvis:
Write the story of your pelvis - Documenting the journey of your pelvis to date is a beautiful tool of exploration and understanding. I invite you to write free form or answer any of the following questions as a prompt:
What is one word that you would use to describe your pelvis?
Is your pelvis a source of power, a source of vulnerability, or both?
What delights your pelvis (i.e. touch, a bubble bath, candles, music)? What frightens it (i.e. touch, strangers, childbirth, the mirror)?
When did you first touch your pelvis? When did you first see your pelvis? How did those experiences make you feel in the moment and how do they make you feel in retrospect?
Breath work - As mentioned above, breath work helps to inform us about the health of many of our core muscles, including the pelvic floor. So here is an exercise for you to do once or daily:
Recline on your spine and find a comfortable position.
Place your left hand on your chest and your right hand on your belly.
Concentrate your breath in your chest; observe how your chest and left hand rise with each inhale and fall with each exhale.
Once you’ve found a rhythm to your breath in your chest, expand that breath from the chest into the belly; observe how both hands rise along with the chest and belly as you inhale and fall as you exhale.
Once you’ve found a rhythm to your breath in both your chest and belly, send each inhale into the chest, belly and pelvis. Just as the hands rise, feel the full expansion of your pelvis with each inhale. As you exhale, left the breath exit the pelvis, then the belly then the chest.
Posture evaluation - Our posture tells us a lot about the natural resting state of the pelvic floor muscles, so I invite you to take inventory of your posture:
Stand with your feet hip width distance apart.
Place your hands on your hips, with all four fingers on the front side and your thumbs pointed towards the back. Now press your fingers down toward the earth and notice the tilt in your pelvis. In this position, the belly protrudes forward and the curve in the low back is exaggerated. In this position, the pelvic floor muscles are lengthened.
Place your hands on your hips, with the thumbs on the front side and all four fingers around back. Now press your fingers down toward the earth and notice the tilt in your pelvis. The belly is drawn in and the curve in the low back is neutralized. Just as the core and glut muscles are contracted, so are the muscles of the pelvic floor.
Apply these observations to your posture at different points throughout the day (i.e. when you’re standing in the kitchen, when you’re driving in the car, when you’re carrying a child on your hip, when you’re lounging on the couch) to understand the natural resting state of your pelvic floor muscles.
Whether you’re overwhelmed, excited, fearful, angry, or in awe by this information and/or by practicing these exercises, please don’t hesitate to share your experiences and reactions with me. I’m here as a part of Totum Women to hold space for you to feel heard, supported, and strong in all that you are: firstname.lastname@example.org.