The Pelvic Floor: A Foundation for Female Health & Wellbeing

If you are reading this, you are almost certainly female; ranging in age from 30-65; you may well be a mother but not necessarily, (I attract plenty of mothers mothers pre and post natal) and you will almost certainly be interested in embodied health & female wellbeing.

I am 52 years old; perimenopausal; a mother of 4 (1 C-Section, 3 VBACS),  physically fit and with a leaning towards a tight pelvic floor – especially on my right side. Three decades of mulabanda, postpartum strengthening yoga; a hypersensitive nervous system response and some old issues around safety in sex have all contributed to a tendency towards tightness – despite three vaginal births. The good news is that I have done a fair bit of holistic pelvic healing and, although I err on the side of tightness, I know too my pelvic health is pretty good – something I am hugely grateful for as I edge towards menopause.

So how do you identify your pelvic floor health?

Where you fall on the pelvic floor spectrum is a consequence of the experiences you have had in your body;  your pelvic health history, your childbirth and postpartum experience; (if relevant) your nervous system disposition, genetics and lifestyle. I have worked with women who have experienced the challenging consequences of both excessively tight, or hypertonic pelvic floors, and also those with excessively weak, or hypotonic pelvic floors. But how do you know into which category you fall?

Before we explore the two broad categories, it is important to say that this is not a simple polarisation exercise. Tight and weak pelvic floors exists on a spectrum but, generally speaking, you will identify behaviour patterns that will suggest you lean more towards one way or the other – although it is also possible to be taught and weak simultaneously. Let’s break down the two broad categories

Pregnancy & childbirth have a huge impact on the pelvic floor. As a birth doula, I have witnessed with my own eyes many times a tight and rigid pelvic floor obstruct a baby’s passage in the second stage. This presents a deeply frustrating outcome for those women who may well end up with episiotomies, instrumental deliveries and sometimes even c-sections – all of which have additional consequences for their pelvic floor health and recovery.

Women with tight pelvic floors may experience a range of symptoms including:

• Pain with penetration and/or tampon insertion
• Pain during or after sex
• Difficulty with peeing – stream is slow to start
• Dribbling after peeing or needing to pee again immediately afterwards
• A long history of repeated UTIs
• Constipation
• Feeling like you can’t relax your pelvic floor
• Difficulty with taking a full breath in  or a pelvic breath
• Shallow breathing pattern
• SI joint pain, tailbone (coccyx) pain and/or hip pain

Stress, fear and anxiety and trauma also contribute to pelvic floor overactivity. This stress or anxiety may be current or you may have longstanding holding patterns that date back as far as childhood and which form the basis of your unconscious pelvic floor response. This is especially true where there are issues around hygiene, elimination, menstruation and sexual pleasure.

Is Your Pelvic Floor Too Tight? Too Weak? Or Both?

At the other end of the continuum is the weak pelvic floor; categorised most obviously by incontinence. This is a very common late pregnancy and post partum experience – especially for those women who have had a few children. Where there has been damage to the pelvic floor during childbirth,- perhaps an episiotomy or instrumental birth – pelvic floor weakness can be the consequence. Other common consequences of childbirth and a weak pelvic floor are prolapse (of any of the three organs), haemorrhoids and ongoing incontinence issues. Weak tissue, especially if not rehabilitated after birth, potentially does not recover its original tone.

Women with weak or lax pelvic floors may experience a range of symptoms including:

• Difficulty achieving the required lift in the pelvic floor when practising
• Inability to isolate the pelvic muscles and contract other muscles instead (glutes, abductors or abs instead)
• Leaking urine when coughing, sneezing or exercising
• Leaking wind
• Decreased sensation during sex
• Decreased or inability to orgasm – this can be psychosexual as well

Menopause is another key driver for weakness in the pelvic floor – the consequence of a reduction in oestrogen which leads to decreased muscle mass and elasticity in the pelvic floor.

A recent poll published by the The Royal College of Obstetricians and Gynaecologists (RCOG) , a staggering 60% of women were found to be experiencing at least one symptom of poor pelvic health.

A survey of 2,000 women* revealed one in five (21%) experienced urinary incontinence and a quarter (25%) experienced a frequent urge to wee. Despite symptoms being common, over half (55%) did not currently do, or have ever done pelvic floor exercises, with nearly a quarter (23%) not knowing how to do them.

Now is the time to start tending your precious feminine terrain. I feel strongly about this as I saw my own mother struggle with the ignominy of a weak pelvic floor the result of spinal surgery ten years earlier and poor rehabilitation afterwards.

Lifestyle can also contribute; a sedentary lifestyle with a lot of sitting around – especially slumping – will lead to a weaker pelvic floor.

The pelvic floor needs a balance between strength and flexibility. When you create this thoughtfully and consciously you create an elastic trampoline effect. The dynamism and elasticity of this trampoline is resilience and receptivity in broadly equal measure.

The good news is that poor pelvic health is treatable, preventable and radiant pelvic health is possible for everyone. It doesn’t happen overnight, but changing your relationship with your female pelvis is the best investment you can make in a happy healthy embodied future.

It is not just a matter of mechanical stretching and contracting but inhabiting your pelvis with curiosity, free-flowing and full breaths, and plenty of loving embodied attention ; learning to move your pelvis and body in a variety off ways to stimulate the supporting joints and muscles, create strong neural pathways; embodied receptivity and that all important elasticity that responds as well as supports.

My own experience on this journey has been profoundly that pelvic health is a holistic matter and that radiant pelvic health necessarily requires you to explore your emotional, sexual and psychological relationship with your pelvis as well as your physical experience. If you are a yoga practitioner, you will know that the gross physical is the end point expression of the subtle or energetic.

Want to Learn More?

On the 8-week Live Online Holistic Pelvic Health Course, we practice a number of explorative exercises to help us uncover our holistic pelvic health profile including internal massage, in depth questionnaires and mat-based explorative work.

As you travel through the course, you will slowly be able to identify your own pelvic health needs and build your own programme of support.

Whether you lean towards tightness or weakness, investing time and attention  in your pelvic floor health will bear you many fruits; not just a healthy, energised and functional pelvis but also a healthy relationship with your female centre; its structures, organs and functions.  Now is the time to claim it fully free from shame and guilt.

The Holistic Pelvic Health Course  Starts on Thursday February 22, 7pm-9pm UK

(This course runs once per year)

All sessions are recorded. Group size is kept small to maintain intimacy and drop-ins are not permitted to ensure a safe space is maintained at all times.

**It is important to add that if you are experiencing pelvic issues, seek professional and personalised guidance from a specialist women’s health physiotherapist for a thorough evaluation and personalised treatment plan.