Leslie Howard is a Bay Area-based yoga teacher who runs workshops nationally that teach women about the muscles and potential dysfunctions of the pelvic floor. She talked to The Sacred Cow this month about misconceptions and realities of the pelvic floor and whether or not modern yogis should be practicing mula bandha at all.

Sacred Cow: How did you first become interested in exploring the pelvic floor through yoga?

Leslie Howard: I had been a yoga teacher for years, and had started studying with a teacher who believes that, as women age, their pelvic floor gets weaker. She gave me strengthening exercises for my pelvic floor. Being a good yogini, I practiced those exercises every day. Then, two years later, I started having pelvic pain. Intercourse was painful or not even possible. I was also diagnosed with a condition called vulvodynia, which was pain of the vulva. I started to see a physical therapist for the problems, and she told me I had a hypertonic pelvic floor. Doing all of these “yogic” exercises had made my pelvic floor too tight.  This realization shifted my teaching profoundly.

SC: Was it just the exercises that caused the problem?

LH: No, there were other factors contributing to it. I had a good asana practice, but I realized that outside of yoga I would go into Shlumpasana, sitting with a rounded back and tail forward which contracts the pelvic floor. I would stand like most women in America: on one leg, hip to one side, pelvis forward. That also makes your pelvic floor tight. But I definitely think the pelvic floor exercises made it worse. It took me a year of physical therapy and different exercises to get my pelvic floor to relax.

SC: Is a hypertonic pelvic floor common in women?

LH: The official stats for women with pelvic pain is about 20 percent in the US. But as I teach my workshop, I am finding that in the yoga community, it seems to be more like 40 percent of women who are suffering from a gripped pelvic floor.

SC: Why do you think this is?

LH: For one, I think people who have anxiety come to yoga for relief and a lot of women who have hypertonic pelvic floor are anxious people. But it could also be a result of people being taught to improperly engage the pelvic floor in yogic practices like mula bandha without knowing that they already have too much tension in that area.

SC: How might women know if they have a problem with the pelvic floor?

LH: If you have too much pelvic floor tension, then sex, pelvic exams, and tampons may be uncomfortable or painful.  You might have redness, irritation, itching, white spots, red spots—a lot of the skin conditions of the vulva are associated with hypertonic pelvic floor. Urgency and bladder infections are also indications of an issue.  Women who have lack of tone in their pelvis may have stress incontinence (urine leakage from sneezing, coughing, or jumping) and prolapsed organs. And some people don’t have any major symptoms.

SC: How can yoga help people who have too much tension in the pelvic floor?

LH: Yoga brings more space to your physical body and it also just gets you moving. We sit so much in society. We are the most sedentary we have ever been historically, and yoga gets your blood and oxygen moving. On the psychological level, if your hypertonic pelvic floor is caused from anxiety, yoga asana and pranayama calm your nervous system.

SC: What yoga poses do you recommend for pelvic floor issues?

LH: For women who are tight, I recommend diaphragmatic breathing lying down with sandbags on the thighs. This helps move the breath down into the abdomen, which helps to release their pelvic floor. Also, things like bent-leg Urdhva Mukha Savasana, Prasarita Padotonasana, bent leg Utanasana – all of this will encourage your tail to lift and your sitting bones to spread. Front of the groin quad and psoas stretches are also helpful, like Supta Virasana, Ardha Supta Virasana, and Natarajasana.  Viparita karani is a great restorative for hypertonic pelvic floor.

For those with a loose pelvic floor, it’s important to learn to engage the pelvic floor. Backbends, and arm balances are good for creating tone in the pelvic floor. The most important thing for women who have lack of tone, though, is that they understand the nuance of engaging their pelvic floor as opposed to engaging their butt or their hamstrings, lifting their anus, or grabbing their tailbone.

SC: You now teach pelvic floor workshops all over the country. What do you teach in those?

LH: We look at a 3d model that has a female pelvis that you can take apart. This is important because the more specific your mind can be about where the muscle is in your body, the better you’ll be able to release or engage it. We also work with exercises that teach you how to know if your pelvic floor is too gripped, and practices that both engage and release the pelvic floor. A strong muscle is one that can both engage and relax.

And I talk about cultural messaging. Look at any magazine, and all you see are women who throw their pelvises forward, suck their bellies in, put themselves in high heels and jut to one side—all really bad for the pelvis. The other message in these ads is that women are primarily sexual creatures. This makes it very difficult for women to talk about problems with their pelvic floors. It’s just not sexy or acceptable.

SC: So what about mula bandha? Do you discourage the practice?

LH: Let’s talk about what mula bandha is. It’s first lifting your perineum. Then, the anus lifts and you draw it diagonally back toward your sacrum, encouraging the energies toward the front of the spine. As you get more advanced in your practice, it becomes more of an energetic lift and then it becomes only an energetic lift, not a physically gross action. It comes in stages. So it’s very complex. Many of the texts that talk about mula bandha were written for serious yogis who were living in caves, not the dilettante yogi who goes to Ashtanga a few times a week. It’s a sacred practice working on subtle energies but most people can’t truly feel what it’s supposed to be about, or even distinguish their anus from their perineum.

It may be helpful to people who have lack of tone, but I would first teach someone how to simply engage their pelvic floor muscles. If you’re already starting with a hypertonic pelvic floor, you’re probably going to make it worse.

SC: What about uddiyana bandha?

LH: If you do uddiyana bandha without doing mula bandha, you are putting a lot of pressure on your pelvic organs and hence pelvic floor.  This can contribute to organ prolapse, stress incontinence and other issues, so I wouldn’t recommend that either.

SC: Can men also have pelvic floor issues?

LH: Yes. They might feel pain or discomfort more in the anus or sitting bones, and similar techniques can help.

SC: What do you recommend women do if they have issues with their pelvic floor?

LH: Most importantly, they should see a physical therapist who works with the pelvic floor muscles, and the yoga can complement the therapy. But also women need to start a relationship with their pelvis, looking at the outside of it, touching the inside of it, talking and listening to it, and loving it. If you are having problems with your pelvic floor, it’s telling you, “Hey, I am here and you’ve been ignoring me and something has to change.”

For Leslie Howards podcast interview on the pelvic floor click here https://pranamaya.com/blog/regular-posts/podcast-pelvic-floor-health-and-yoga-with-leslie-howard/
To learn more about Leslie Howard, visit her website at www.lesliehowardyoga.com, and check out her online course here at Pranamaya.

For more of Karen Macklin’s work, visit her website at www.karenmacklin.com.