Anatomy Of Pregnancy

Please note – if you are looking for recommendations for additional reading / resources / illustrations to support your learning, here are our recommendations:

• Recommended reference for muscles: ‘The Key Muscles of Yoga’ by Ray Long
• Recommended reference for basic anatomy: ‘Yoga Anatomy’ by Leslie Kaminoff
• Recommended resource for understanding joints: ‘Anatomy for Yoga’ DVD by Paul Grilley

Chakras

This lesson will give you a overview of pre and postnatal anatomy medically and holistically.  In yogic terms the body is modeled on the chakras and on energy.  This section will look at the first three chakras as these relate to the pelvis and the muscles surrounding. Yogic philosophy believes the imbalance of the chakras can cause diseases.

Here is a reminder of the chakras:

The first chakra Muladhara relates directly to the pelvic floor area.

• Unconscious until conscious- women don’t come to yoga until pregnant and don’t even know the pelvic floor.\n• Fight or Flight origin
• The base from which the 3 main nadis emerge, ida, pingala and shushumna nadi
• Seat of kundalini awakening
• Unites shakti to shiva (SHIVA symbolises consciousness, the masculine principle and SHAKTI symbolises the feminine principle, the activating power and energy)
• Associated with element earth, sense of smell, nose, action of excretion
• Any history of trauma can show in the muscles dis-function of this area

The second chakra Svadhishthana sits right in the bowl or centre of the pelvis.

• Swadhisthana (Sanskrit) – ‘one’s own abode’
• Supports the pelvis but also supports us knowing what we desire for our lives and for our babies lives
• Water element, silver crescent moon, sense of taste, tongue, cocreation
• 6 petals represent vrittis of affection, pitilessness, feelings of all destructiveness (addiction), delusion, disdain, suspicion.
• Associated with unconscious and emotions (water element)
• Similar to muladhara where the potential karmas lie dormant –our ability to co-create, manifest in the physical world

The third chakra Manipura right up in the solar plexes.

• Power chakra – ‘solar plexus’ between the ribs and pelvis
• Element – fire
• Self definition and ego identity, self will, personal power, autonomy,
  metabolism – ‘I am’
•  When balanced this chakra brings energy, effectiveness, non-dominating power

Knowing these chakras where they sit and how when pregnant we can be rewired essentially.  This is particularly helpful when in classes so we can create a safe environment for women to get in touch with these energy points and prepare her for motherhood by being more self aware.  We want to create non judgmental safe spaces for women where they can really get in touch with the dynamic energy changes and understand and feel comfortable with this.

Shakti is the feminine energy referring to multiple ideas. Its general definition is dynamic energy that is responsible for creation, maintenance, and destruction of the universe. It is identified as female energy because shakti is responsible for creation, as mothers are responsible for birth.

A quick explanation of fertilisation!

Ova are produced in a female during the pregnancy of their mother. By the seventh month all of the 400,000 ova are developing. ‘Ovulation’ refers to the release of an ovum from the ovary and this begins to occur after puberty as each ova becomes fully developed. This happens once a month, usually in the middle of a woman’s menstrual cycle. If the ovum is not fertilised, it dies and is expelled along with the lining of the uterus, which forms a period. Approximately one thousand sperm are formed per second in the testicles, this is a continuous process. Each sperm will be fully mature in two months. The sperm will travel 40cm through the sex ducts to reach the ovum (a lot further than the 2.5cm the ovum travels to the site of fertilisation).

When the ovum is fertilised by the sperm it becomes an embryo. This process takes 24 hours and occurs two thirds of the way along the fallopian tube and it then takes approximately six to seven days to travel to reach the uterus. Throughout this time, development is occurring and the cells are dividing. This is the beginning of the miracle of life.

From now on, pregnancy is split into 3 sections called trimesters.

 The change in the size of the uterus throughout pregnancy:

Pregnancy Trimesters- First Trimester (weeks 1-12)

During the first trimester, it is common to suffer from morning sickness and fatigue. At around 12 weeks, the mother will have an ultrasound scan to check the growth and give an estimated due date based on size. KalmaMamas classes can begin after this.

 

Second Trimester (weeks 13-28)

In the second trimester, a lot of mothers gain some energy back and the sickness subsides. However, as the baby gets bigger they may start to experience issues such as shortness of breath or frequent urination as the baby takes up more room and the bladder, bowels and lungs are displaced. This also when they will feel their babies first movements. This can be right at the end of the second trimester for first time mums and for second time mums it can be right at the beginning. This is usually when mothers start to ‘feel pregnant’ and it feels more real. They’ll also be offered a second ultrasound at 20 weeks to check for any abnormalities and they can find out the sex if they want to (this can be found out as early as around 16 weeks in a private scan).

12 week ultrasound    

    20 week ultrasound

Third Trimester (weeks 29-40)

The third trimester is the final stage of pregnancy. The problems experienced are similar to those in the second trimester, but they may be increased in severity as the abdomen grows further. For example, urination can become even more frequent, breathing becomes shorter still, heartburn can continue and get worse. These are due to the internal organs shifting and becoming more squashed as the baby grows. These will all cease after birth. Also due to this some mothers may also experience swelling, if this is severe medical attention should be sought as this could be a sign of pre-eclampsia (raised blood pressure in pregnancy, also called toxaemia). The breasts swell in anticipation of breastfeeding and may be tender. The movements and kicks of the baby can also seem to be lessened due to them having less room. This is normal, but as with any changes in movement, if the mother is concerned at all she should report it and get checked.

During this final stage of pregnancy, the body is flooded with relaxin. This is a hormone that prepares the body for childbirth, allowing the pelvic girdle to move and birth canal to stretch for the baby to pass through. Because of the high levels of relaxin it is very important to remind the mothers not to overstretch as they will be more prone to injury and it is much easier to overstretch without realising.

Labour and Birth

During the first stage of labour, the cervix dilates until it reaches 10cm, fully dilated. There are three phases:

1. The Latent Phase – longest phase and least painful. The cervix begins to thin, for some mothers this can take weeks, for others just hours. They may experience mild regular or irregular contractions, some mothers don’t even notice them.
2. The Active Phase – The beginning of strong and painful contractions, 3-4 minutes apart lasting for up to a minute each. The cervix dilates to 7cm.
3. The Transition Phase – Contractions become more painful and intense and as they become more frequent they may feel as if there is no break in between. The cervix dilates fully to 10cm and this last 3cm can take up to an hour. The baby’s head now pushes against the rectum, giving a feeling like an urge to go to the toilet.

The second stage of labour (also called ‘the pushing stage’) starts when the cervix is fully open (10cm dilated) and ends when baby is born. At this stage, baby is moving from the uterus into the vagina and then out into the world.

A caesarean section is delivering the baby through an incision made through the abdomen and the uterus. Some C-sections are planned but most are carried out in an emergency when there is an issue with birthing the baby vaginally. There are many reasons why a mother may need or opt for a C section including: labour failing to progress, the health of the mother that means a vaginal delivery would not be advised such as heart disease and foetal distress.

Pelvic Girdle

The pelvis is a balanced and structured part of the body.  Fused by three  bones: the ischium, the ilium, and the pubis it is fairly symmetrical.  The sacro-iliac joint is formed in the area where the tow bones the sacrum and Ilium meet.  The area is a synovial joint.  A synovial joint is the type of joint found between bones that move against each other, such as the joints of the limbs (e.g. shoulder, hip, elbow and knee). Characteristically it is a cavity filled with fluid. Together with the ligaments, tendons and muscles in the area, the capsule keeps the bones of the joint in place.  Although this joint does not have a huge amount of movement its got limited mobility.

Sacrum means sacred from the Latin.  Yogis believe this is where our untapped potential lies dormant. It is where the seat of kundili where we engage in yoga to access the areas energy to harness and resource the creative energy to create our world around us.  When we stand up it locks in position as it is designed to give a firm base of support to the spine and trunk.  When we sit it unlocks and can be come unstable and irritated.  When we are young its smooth but as we age it becomes bones and suffers from more interlocking challenges.  It moves in a gliding, rotation and tilting movement.

Sacroiliac Joint

Sacroiliac Joint (SIJ) instability and pain affects 15-25% of people with axial low back pain. Approx 20% of women in pregnancy suffer lower back pain due to SIJ.  It is often misdiagnosed as sciatica or lower lumbar spine issues.  There are tell tale issues which will point to this issue.  The SIJ is the largest axial joint in the body designed for stability not movement.  Common issue in pregnancy due to hormonal changes to ligaments. This compromises our stability.  It is a strong weight-bearing joint prone to issues due to strong weight-bearing and load-bearing responsibilities.  There is less resilience due to more weight bearing in pregnancy due to ligament softening form hormones.

SIJ joint surfaces become rougher, duller, coated with plaques as the body ages. In the 30s and 40s the surface irregularities,
crevice formations and bony clumps start to appear in the cartilage of the ilium surface. By 60-80 years old there is a marked
restriction in mobility.

The role of ligaments plays an important part in keeping stability and symmetry in this area.  Ligaments are the inflexible structures that connect bone to bone. They have a poor bloody supply so once damaged or stretched its difficult for them to recover.  This is why we produced relaxin in order to allow the birthing process.  Oestrogen and progesterone hormone levels increase steadily during pregnancy and reach their peak in the third trimester.  The changes in progesterone and the presence of the hormone relaxin cause a laxity or loosening of ligaments and joints to prepare the body (especially the pelvis) for labour. This can remain for up to 6 months postpartum.  This is why we must reduce impact to the area and build up gentle exercise until the return to normal.  The SIJ is heavily dependent upon ligaments for stability.

There is a round ligament that connects the front part of the womb to the groin.  It stretches as the baby and uterus grows.  A sharp, sudden and temporary spasm in the belly can be a symptom of round ligament strain.  Especially as the pregnancy progresses.  Sneezing, coughing, laughing and rolling over in bed can cause a sudden sharp pain in the round ligament, which quickly subsides.  There are lots more ligaments helping to reinforce the pelvis around the iliac and sacrum.  We have our iliopsoas muscle which covers part of these ligaments.

If you look at the dimples of Venus on our back (Greek goddess of beauty).  You will notice they are hollow and if there is a problem with the SIJ joint then the side which the problem correlates to is where you will often see a swollen dimple.

Signs of SIJ

• Sharp stabbing pain in lower back or hip esp during weight bearing
• Often causes a limp if been on feet longer than 20-30 min
• Turns into dull ache when stationary
• Worsens as day progresses (stairs slopes etc niggle)
• Pain radiates into hip socket, outside of hip (if its anterior ligaments) or deep inside belly, or localised to the SIJ  If you palpate the venus dimples this is sore.

It is important to have stability in the SIJ because a comfortable and stable SIJ is linked to a natural birth.  An asymmetrical pelvis with instability, because one joint is swollen than the other this may be associated with greater likelihood of birth intervention.

We can treat the joint with physiotherapy and gentle mobilistaion and massage.  In yoga we use gentle mobilisation and asanas.  Cat/cow and varjarasana can help sooth the joint.  Correcting asymmetrical aggravating factors for example carrying a toddler on one side of the hip, feeding one side, couches and lounge chairs-one of the simplest ways to help prevent and correct the joint.

• Avoid stairs
• Sit with feet flat, hips level not crossed
• Walk slowly and smoothly (avoid uneven ground or jogging jarring like running)
• Step in and out of car with legs together
• Sleep with pillow between knees
• Never bend and twist at same time keep hips and shoulders in line keep the body symmetrical so the muscles stay optimised on both sides in SIJ
• Avoid sustained postures (change at 30 minute intervals) get up and walk or stretch
• Bring shortened length and wider stance to asana practice
• Maintain lumbar lordosis in seated postures (avoid posterior pelvic tilt). The inward curve in the lumbar.

In your Pre and Postnatal classes:

• Be aware that the SIJ is most vulnerable in seated position
• Use a blanket under the hips in sitting postures if hamstrings are tight and ensure lumbar lordosis (inward facing curve of the lower back) is maintained especially in forward folding
• Reduce distance between feet in wide legged poses act conservative in poses.
• Reduce length and width of stance in standing pose
•  Pull back rather than deepen if there is any sign of pain or discomfort
• When standing in tadasana take a wider stance than usual
• Keep a microbend in the knees with forward folds and down dog to maintain lumbar
  lordosis
• When doing asymmetrical postures, make sure you allow the hips to move naturally with the posture, and don’t ever force the joint to move against its natural line of movement. For example, in trikonasana allow the top hip to move down and forward.

One way to think of this in classes when teaching is If you move in such a way that you separate the sacrum from the vertebral column or from the pelvis there will be stress on the joint. So focus on bending from the hip joints in all sitting poses
so that the pelvis, sacrum, and lumbar spines are moving forward and together in harmony!

SPD

Symphysis Pubis Diastasis 2 halves of pelvis are connected by a fibro cartilaginous joint known as SP.  SPD is caused when gap widens due to softening hormone relaxin.  The gap can be as much as 5mm – 10mm increased and can even increase to 3cm.   Usually occurs mid pregnancy, but can start earlier with multiple pregnancy.  You will know this happens by clicking, grinding pubic pain with pain radiating to inner thighs.

It is cartilaginous so it is a problem if it separates because its usually fixed and rigid.  Sometimes one can move up down or back in relation to the other.  This can be linked to a SIJ issue.

SPD advice:

• Don’t move legs apart – keep hips and shoulders in line, maintain lumbar lordosis Poses like Padottanasana are a no
• Avoid heavy lifting and pushing
• Climb stairs with best leg leading, one step at a time
• Sit down to put knickers on
• Avoid breast-stroke and wide legged postures with asanas
• Work with block between knees in asanas engages thighs and makes muscles work in harmony bridge, down dog
• SPD serola belts lift the belly and help stability holds the two surfaces together and the SIJ joint

Lumbar issues in pregnancy

True sciatica is rare during pregnancy UNLESS there has been previous history of it before pregnancy.  Often SIJ is mistaken for sciatica because it presents itself with similar sharp pain in the buttock radiating down the thigh and in similar areas. If someone comes to class with this issue its helpful to ask how it it was diagnosed was it a health professional by xray etc or is it a presumption.  It can often also be a muscular issue so ruling out these things help.

Possible causes of LBP in pregnancy are-

• SIJ instability-the pelvis is well supported but they soften in pregnancy and insatiability is a side affect its often over looked as a cause of pain
• SPD mainly pubic in location so easy to diagnose
• Sciatica if its true sciatica it can be caused by disc issue of priformus muscles
• Muscle strain of quadratus lumborum or erector spinae easier to treat as muscles can repair well having good blood supply
• ligament pain (intervertebral joint pain) difficult to treat low blood and longer healing times.

With true disc pain – extension of lumbar spine a gentle back bend is a position of ease and forward flexion will aggravates it.  Where the cushion like structure between the lumbar is compromised.  It bulges placing pressure on the nerves and ligaments which causes pain.

With ligament or joint pain – flexion forward bending brings relief and extension aggravates it.  You will find people struggle to straighten from a seated position.   In classes its important we can find positions to relieve the pain!  Gently incorporate into class the postilions of ease.  Lumbar issues can  increase with aggregation the further on they get in the pregnancy.  Your aim should be to do no harm.  Warning signs of Lumbar issues include: loss of bladder control or bowel control, progressive weakness of any kind, severe constant pain which you can usually see in their faces.

It is important to recognise the lumbar lower back doesn’t operate by itself.  The lower back operates as a cylinder.  We know this as the cylinder of control.  The muscles responsible for supporting the lumbar spine which are of the cylinder are:

• Erector spinae-three long muscles running parallel to spine create extension in spine and keep us right.  The erector spinae is then supported around the lumbar spine by the multifidus and quadratus lumborum which sits beneath the lowest rib and the pelvis on the left and right sides these help us in back bends in the lower spine (back wall)
• Respiratory diaphragm (top/lid cylinder control)  On the inhale the muscles draws down and increases the lordorsis (lumbar curve)  slightly and on the exhale the lumbar curve flattens. Pregnancy puts upward pressure on the diaphragm which stops the action of the decent
•  4 abdominals (front wall) The deepest layer is the transverse abdominis-like an air bag drawing the navel to the spine, this is then supported by the internal abdominal oblique and then the external abdominal oblique both these muscles help with rotation of the spine (side flexion and opposite arm to leg action) The final layer is the rectus abdominis its the 6 pack muscle containing bands of fascia which segment it.  it the muscle Diastasis Recti where it separates due to the goring uterus.  All of these muscles get stretched and become weak in pregnancy.  These all support the lumbar spine by 50%.
• Pelvic floor (bottom/seal) Small but many muscles create integrity in base of body.
• Pelvic stability and reinforcement – iliopsoas and adductors, gluteals, piriformis

Iliopsoas is another supporting muscle of the spine pelvis and thigh bones.  Its two muscles the illiacus (between pelvis and inserts into femur) and the soas (lumbar spine origin and inserts into femur) this muscle is responsible for drawing the knee to chest and truck to thighs in forward bends.   This muscle can be tight because of sitting.

Gluteus maximus, medius and minimus are the buttocks muscles and crucial for stability around pelvis. The maximus is the largest muscle reinforcement in the sacriacrial joint area.  This muscle extends the hip.  Often the muscle can be over active and then this creates pressure on the sacrial area.  in a class situation remind mum’s to be to activate thighs and not tense the buttocks so much.  A block between the knees can help train the maximus to support the area.

Adductors are the muscles of the inner thigh which run on the inside seam of trouser leg up to the pubic bone.  There are 5 muscles which hold the femur bones parallel and stabilise the bones in relation to the pelvis they can get tight if we don’t do wide leg stretches. These muscles can have a direct effect on SPD as connect to the pubic bone.

Pelvic tilt

Pelvis means base or bowl.  Think of this as where we hold water in the bowel in a neutral position.  In pregnancy we usually move to an Anterior tilt because the weight of the belly moves it forward its gravity.  This shortens the soas muscles at the front.   An anterior tilt increases lumbar lordosis –rectum tips forward toward the vagina. Pregnancy open exacerbates this, shortened iliopsoas.  If we can imagine the water tips backwards in a Posterior tilt.  This give a flattened lumbar lordosis –where the bladder tips backwards towards the vagina. A sign of this is tight and short hamstrings and it impacts on the pelvic floor.  Pelvic floor in neutral is a very sound position for organs within the bony encasement of the pelvis. The cylinder of control and muscles are optimised here like in mountain pose.  Using this visual in class will help relay standing positions to mums to be.  Good alignment will also help bone density, posture, balance and muscular support.

Support structure of spine are listed below.  Be mindful although these offer support they can also be contributing factors to problems within the area too.

• Ligaments-Ligaments are the inflexible structures that connect bone to bone. The SIJ is heavily dependent upon ligaments for stability as is the lumbar spine.  Oestrogen and progesterone hormone levels increase steadily during pregnancy and reach their peak in the third trimester. The changes in progesterone and the presence of the hormone relaxin cause a laxity or loosening of ligaments and joints to prepare the body (especially the pelvis) for labour
• Cartilage-present in all synovial joints.  Smooth white substance that sits at the end of each bone and forms the gliding surface.  Once we damage it we can suffer long term damage.  Poor blood supply which means that it also has a poor healing time. Relies upon slow movement in order for diffusion for nutrient access. Cartilage is usually fine so long as we have joint and ligament support.  Yoga stretches can stretch these  joints so much they loose a little stability.  Then in pregnancy the relaxin softens them so much they can become hyper mobile therefore prone to cartilage damage.  We must be careful on the depth of the asanas in pregnancy which we do inside of classes because of this.
• Muscles offer support to the joints which is protective.  There is lots of reflexive action to help protect joints.  Active stretching is key for muscle support and they need to be switched on to protect joints and ligaments. This is why in postures for example seated forward bends our feet are active and not passive flopping to the side.
• Bones
• Nerve
• Joint Capsule
• Skin

Sciatica

The sciatic nerve is the largest nerve in the body.  It roots at the base of the lumbar and they forma long trunk down the thigh splitting into two at the knee.

True sciatica-is a result of nerve root impingement (see disc issue below) mainly due to disc injury

Piriformus sciatica-The piriformis is a small muscle located deep in the buttock, behind the gluteus maximus. It runs diagonally from the lower spine to the upper surface of the femur, with the sciatic nerve running underneath or through the muscle. The piriformis muscle helps the hip rotate, turning the leg and foot outward.  Where the piriformus muscle which sits on top of the sciatic nerve it presses on the nerve.  The prirformus muscle can be really tight and painful.  Stretching and deep tissue massage can help.

Disc issues

Fibrous cartilaginous discs which sit in between the vertabrae in the spine.  If the discs become damaged they can bulge into the wall of the spine and put pressure on the roots of the sciatic nerve.  A Herniated disc is where the gel inside is expelled due to a trauma.  This then puts pressure n the nerve roots.  The lumbar spine is most prone area to disc issues.

The whole point of our pre and post natal classes is to create comfort at each stage of pregnancy.  Safe postures generally are Cat, Downdog modified (at wall), back extension (in thunderbolt hands behind leaning back length in the front)

Diastasis Recti

This is specially common in multiple pregnancy and can get worse. It is the separation between the left and right side of rectus abdominus.  It can be a few cm’s and even bigger. This can make back pain worse as there is less support given to the back.  Common in newborns and in pregnant women (2/3 according to webMD) because of increased tension on the abdominal wall.  There is an increased risk with multiple births and multiple pregnancies, women who have had it in previous pregnancies, very petite women, women with poor abdominal muscle tone and women with hyperlordosis (anterior tilt the pelvis).  Ridge-like appearance, can stretch from bottom of xiphoid (breastbone) to belly button.

We must be careful with Diastasis Recti:

• Do take care with exercise – sit ups, navasana (boat pose), push-ups/planks, can make it worse.
• Don’t strain – avoid cons/pa/on and heavy lifting
• Do distinguish between DR and a hernia (hernias need surgical repair)
• DR generally resolves on its own
• Check out Julie Tupler (RN) – Lose Your Mummy Tummy – a 4 step diastasis recovery process.

Pelvic Floor

The area of the pelvic floor is in yogic terms the area of the shakti energy.  Yogis believe that this is the area of the kundilini energy and yoga can ignite this energy and support this energy to ascend. This area not only has significance for physical support but also supports our generally spiritual wellbeing.

Lets start by looking at Mulabandha the root chakra and area of the pelvic foor.  MULA in sanskrit has the meanings of beginning, foundation, root, base, source, origin or cause.  Whilst BHANDA in sanskrit means bondage, joining together, catching hold of, fetter.  Awareness is essential to complete mind-body connection.  This is the energy seal at the base of the body or root lock.  An awareness of this area is essential to the mind and body especially in pregnancy.  

Pelvic floor muscles are muscles of longevity.  It is the layer of sling shaped muscles that support the pelvic organs and span the bottom of the pelvis. The pelvic organs are the bladder and bowel in men and in women it’s the bladder bowel and uterus. The diagram above shows the pelvic organs.  Having strong pelvic floor muscles gives us control over the bladder and bowel. Weakened pelvic floor muscles mean the internal organs are not fully supported and you may have difficulty controlling the release of urine, faeces (poo) or flatus (wind).  Common causes of a weakened pelvic floor include childbirth, obesity and the associated straining of chronic constipation. Pelvic floor exercises are designed to improve muscle tone and prevent the need for corrective surgery.

The pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side). These muscles are normally firm and thick.  Imagine the pelvic floor muscles as a round mini-trampoline made of firm muscle. Just like a trampoline, the pelvic floor is able to move down and up. The bladder, uterus and bowel lie on the pelvic floor muscle layer.  Diamond shaped perineum – bounded by the
pubic bone (front), tailbone (back) and both sitting bones (ischial tuberosiCes).  Primary muscle of importance – pubococcygeus muscle (pc) – runs from pubic bone to coccyx.

The pelvic floor muscle layer has hole for passages to pass through.  There are three passages in women (the urethra, vagina and anus). The pelvic floor muscles normally wrap quite firmly around these holes to help keep the passages shut. There is also an extra circular muscle around the anus (the anal sphincter) and around the urethra (the urethral sphincter).  Although the pelvic floor is hidden from view, it can be consciously controlled and therefore trained, much like our arm, leg or abdominal muscles.

Pelvic floor muscles provide support to the organs that lie on it. The sphincters give us conscious control over the bladder and bowel so that we can control the release of urine, faeces (poo) and flatus (wind) and allow us to delay emptying until it is convenient. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.

Pelvic floor muscles are also important for sexual function in both men and women. In men, it is important for erectile function and ejaculation. In women, voluntary contractions (squeezing) of the pelvic floor contribute to sexual sensation and arousal.  The pelvic floor muscles in women also provide support for the baby during pregnancy and assist in the birthing process. The muscles of the pelvic floor work with the abdominal and back muscles to stabilise and support the spine.  Pelvic floor muscles heavily influenced by –emotions, self-image, culture, religion, trauma and prior abuse.

Knowing where they are can help during labour so they can be relaxed.  To help prevent the uterus from prolapsing and protect the perineum from tearing during labour it is important to help strengthen it through the use of pelvic exercise.  The pelvic floor muscles change through pregnancy, exercise, childbirth, ageing. In women these muscles are important muscles for incontinence, sex life, they prevent organ prolapse, shakti- life force, vitality and vigour, they protects the lumbar spine, supports elimination (apana) and prevents sagging.  In men they are important for erectile function, urinary and faecal
incontinence as well as prostate cancer.  These muscles are often compromised by the following – heavy labour work, chronic constipation, chronic cough and obesity, low collagen (menopause and Caucasian races), pregnancy and complicated childbirth. Diets high in saturated fat and refined carbohydrates increase inflamm change in the body – increase pf dysfunction of them.

How KalmaMamas helps strengthen Pelvic floor

Firstly it is important for us to understand the health issues women may have with the pelvic floor.  1 in 3 women have issues with incontinence.  A normal pattern for going to the toilet is 4-6 times per day and 1-2 times at night.  If women start to notice a pattern off to this and or including painful sex and passing less wee painfully these could also be signs of pelvic floor issues.

It is very important to correctly identify the pelvic floor muscles, and you can easily do.  You can locate the muscle by stopping your urine flow mid-stream.  It is not recommended you do this all the time as can harm the bladder.

There are ways in which you can suggest to test the muscles.  what happens to the floor when you cough strongly. Women can use a mirror to check when the central muscles draw up when adopting the squeeze.  It should lift rather than bulging out or being slow to respond.  The muscles must lift on cough.  When we are lifting heavy things and
exercise the muscles need to be engaged.  

Always encourage women to engage the muscles before coughing, sneezing and lifting.  Adopt a tall posture (cylinder of control needs to be not compromised as the muscles of the pelvic floor may not have as much support to the organs).  You can advise of a good diet, this may also help with constipation.  Tech them to learn where the pelvic floor muscles are with our techniques below and transversus abdominus connection – these will both RELAX on an inhale and CONTRACT OR RECOIL on an exhale.  Adopt an abdominal breathing pattern and relax the abdomen (esp) when releasing the bladder and bowel

The exercises which we do each week will help strengthen the pelvic floor during pregnancy, these should continue after birth.  To strengthen your pelvic floor muscles, sit comfortably and squeeze the muscles 10-15 times in a row.  Reminding students that the breath, stomach, buttock or thigh muscles shouldn’t be held at the same time.  Once students are used to the muscles they can be held for a few seconds during the stretch each week, and then more squeezes can be added.  Again advise to the students not to overdo it and always rest between sets of squeezes.  See stretches and warm up for more pelvic floor exercises.

Pelvic floor stretches can be done anywhere and very discreetly.  Its important to keep the practice up after birth to strengthen the area of the vagina and back passage.  It will help incontinence, with sex and treat prolapse.   Women should be advised to work at their own pace.

We have a few different pelvic floor exercises, and there are more within the lesson plans too. Always discuss how to locate the muscles first and stress the importance of practicing daily. Teaching this in different ways will help all the Mamas to access this and find a way that makes sense to them.  Use the below in reps of ten slow contractions and ten fast.

The hissy lift – Place your hands firmly into your waist.  Take a breath in and hiss to feel waist action.  take another breath in and this time hiss out to feel what Pelvic Floor does.  On the next breath in lift the Pelvic Floor before next hiss out.
Ask yourself does the waist expand? Does the pelvic floor descend?  The pelvic floor should naturally lift on the exhale (hiss). 

Elevator – Starting from Floor 0, when muscles are relaxed. Squeezing the pelvic floor you move through levels 1, 2 and 3 squeezing a bit more each time to the top. Then the most important part is to reverse this releasing the muscles bit by bit to train them. Repeat this 3 times. Then you can practice squeezing all the way in, bringing the lift to floor 3 before coming down stopping at each floor.

Lacing Up the Trainer – Imagine the muscles of your pelvic floor are the laces on a training shoe. Start off with the laces loose and then pull them to tighten.

Alternating the speed – Doing fast twitches and slow squeezes helps to strengthen different areas of the pelvic floor.

Prolapse

Some women maybe at a higher risk of pelvic organ prolapse.  Which is decent of the organs.  We should avoid intense core abdominal Yoga exercises or they modified with a prolapse.  Strong activation of the upper abdominal muscles increases downward pressure on the pelvic floor (and prolapse). If the pelvic floor cannot withstand this downward pressure it is forced downwards. If repeated with intense force or repeated open this can result in weakening of the pelvic floor muscles and connective tissues. This is why prolapse symptoms can feel worse after performing intense core abdominal Yoga poses.  

The following are conditions and proceedures as a reuslt of a prolapse:

• Vulvodynia – pain of the vulva open involving symptoms of burning and irritation. Also referred to as vulva vestibulitis
• Vaginimus – painful spasmodic contraction of the vagina in response to physical contact or pressure, especially sexual intercourse
• Vaginoplasty – tightening the muscles with surgery
• Femili2 – laser, non-surgical, rebuilding of collagen
• Labiaplasty – surgery to labia majora
• Pelvic organ prolapse (POP) – the descent of the abdominal organs
• Cystocele – bladder pushes forward on the wall of the vagina
• Uterocele – the uterus migrates. Normal vaginal depth is 5-6cm
• Rectocele – colon and rectum unsupported by the ligaments or the pelvic floor, sags inwards towards the vagina causing a bulge on the posterior vaginal wall

How do we know its a Prolapse?

• Vaginal bulging: Complaint of a “bulge” or “something coming down” through the vaginal opening. The woman may state that she can either feel the bulge by direct palpitation or see it aided with a mirror.
• Pelvic pressure: Complaint of increased heaviness or dragging in the perineum and/or pelvis.
• Bleeding, discharge, infection: Complaint of vaginal bleeding, discharge or infection related to dependent ulceration of the prolapse.
• The need to apply manual pressure to the vagina or perineum or rectally to assist voiding or defecation.
• Low backache: Complaint of low, sacral (or “period-like”) backache
• Other symptoms: urinary hesitancy, slow urine stream, history of recurrent urinary tract infections (UTIs), faecal incontinence

Poses to modify or avoid

• Boat Poses/Navasana (modify by raising one leg only or hold thighs and keep knees bent);
• Plank (modify by weight bearing through knees rather than through feet)
• Deep squat poses – avoid poses involving deep squats 6-12 months post partum or stop completely
• Forward bends with wide legs – avoid or modify wide leg forward bends which increase downward pressure in a vulnerable wide leg position such as Forward Bend with V-Legs.
• Upper body weight bearing – weight bearing through the upper limbs increases downward pressure on the pelvic floor with poses such as Crane Pose and plank. Down dog may be ok as gravity assists pelvic floor position. Ensure no breath holding occurs.
• Uddiyana bandha (“belly lock”) – this bandha should be avoided by women seeking to avoid increasing pressure on their prolapse. The action of drawing the abdomen in strongly and simulating an in breath increases pressure within the abdomen which is transferred directly down onto the pelvic floor.
• Double Leg Lift