Yoga for Pelvic Floor Health: Why Kegels May Do More Harm than Good

In seeking the cause of ailments such as back pain, constipation, or even dysfunctional breathing issues, the pelvic floor rarely shows up on the list of potential suspects. But physical therapist Jessica Reale and yoga educator Patricia Schmidt are on a mission to change that.
 
Jessica and Patty, both specialists in pelvic health, work collaboratively to help their clients with an approach that blends traditional physical therapy with yoga practice to achieve a greater long-term outcome.  
 
In this interview, Jessica and Patty start by dispelling the common misunderstanding that the pelvic floor muscles are akin to a simple hammock or sling sitting at the bottom of the “pelvic bowl.” In fact, a healthy pelvis is integral to overall health and wellness. And toward that end, yoga can play a key role.
  
Jessica explains how the traditional notion that pelvic floor problems such as incontinence are best addressed by working with the pelvic floor in isolation (think 50 Kegels a day) is changing. “What we’ve learned about the pelvic floor is that it’s a system that does not work in isolation,” she says. “Yoga offers a great alternative to working with pelvic floor balance, she notes because it’s so much more holistic and comprehensive.  

“I love the way yoga philosophy views the body and the way the yoga movements are tied into the breath and the nervous system. It was a really natural pairing with how I work with my patients,” she adds.

 “The pelvic floor is absolutely fundamental to a well-functioning sense of self,” notes Patty when describing what brought her to this work.

Jessica goes on to cite studies that have shown how the pelvic floor coordinates synergistically and neurologically with the respiratory diaphragm. 
 
“When we inhale the pelvic floor descends. And when we exhale both the pelvic floor and the respiratory diaphragm elevate,” she says. Those muscles partner with the deep abdominal and low back muscles and together they modulate pressure in the pelvis and the abdomen. They also act as anticipatory muscles, cueing the core muscles to adjust to any type of movement based on the task at hand.
 
Taking the bigger picture, Jessica and Patty show how the movement of the ribcage and even the vocal folds, along with movements of the feet, can be tied to the pelvic floor.  And they point out that pelvic floor health is not just about how strong the pelvic floor muscles are. Rather it’s about developing a strong, flexible, healthy system that functions well in a healthy system within the body.
 
While issues around fertility and postnatal fitness may be the first time some clients consider the role of the pelvic floor in overall health, Patty points out that the pelvic floor has a much greater impact. “We are born with a pelvic floor that takes on our family of origin, our movement patterns, repetitive movements in our childhood,” she says. 
 
In fact, Patty says it’s not unusual for her to start working on pelvic floor issues from the shoulders.  “When we are in the shoulders we’re in the pelvic floor; when we are in the thoracic space we are in the pelvic floor,” she states, “because the girdles and diaphragms of the body mirror one another. Sometimes these systems are at odds, they don’t work optimally; this is often what inspires clients to seek ways to enhance wellness.”
 
This is where the collaboration between physical therapy and yoga excels. “When people go to [pelvic physical therapy] they need to be in the pelvis,” Patty continues. “But one of the things that yoga can do is help them access the pelvis with different entry points—like coming to the shoulder girdle and finding an entry there.”  This is especially relevant to people living with trauma or in situations where discomfort around approaching the pelvis directly may be uncomfortable. 
 
Jessica concurs and elaborates on the efficacy of yoga in long-term pelvic health. “I can help my patients negotiate the activities of daily living, such as lifting a child or sitting at a desk, with manual therapy that improves their soft tissue mobility or with prescriptive exercises, working with them once a week in the office.” 

“But my long-term goal is to help them more globally with their movement, and with fitting their pelvic floor into their body.  My ultimate goal is to find a long-term practice for them that fits with their goals, and that’s where yoga fits in so nicely.”
 
Want to learn how to work with yoga to enhance the health and balance of the pelvic floor? Study online with Jessica Reale and Patty Schmidt in their comprehensive online course on pelvic floor health:

Click here to learn more and see Sneak Peeks! 

About Dr. Jessica Reale and Patricia Schmidt    

Dr. Jessica Reale, PT, DPT, WCS

Dr. Jessica Reale is a Doctor of Physical Therapy (DPT) and Board-Certified Specialist in Women’s Health (WCS). She has specialized for over 10 years in working with all people with pelvic floor dysfunctions, and owns a private practice, Southern Pelvic Health, in the metro Atlanta area. Jessica has advanced training in the evaluation and treatment of urinary and bowel problems, sexual dysfunction, prenatal and postpartum concerns, complex pelvic pain disorders, and much more. She is a faculty member and curriculum developer with the Herman & Wallace Pelvic Rehabilitation Institute, and teaches within the Pelvic Floor Series and Perinatal Series to other health care providers across the country.

Additionally, she authors a blog on pelvic health topics at www.jessicarealept.com and is a regular contributor to the blog at YogaU. Jessica is a student of Yoga and has a deep appreciation of the benefit that a yoga practice can have in helping people find healing from their pelvic health challenges. She is also passionate about educating people in the community, and partners with Dr. Sara Reardon of “The Vagina Whisperer” to provide regular online classes and workshops. For additional information about Jessica, view her personal website at www.jessicarealept.com or her clinic website at www.southernpelvichealth.com.

Patricia Schmidt, E-RYT 500hr, IAYT Level 1, YACEP

Patricia Schmidt (E-RYT 500hr, IAYT Level 1, YACEP) is the founder of PLS Yoga, a private yoga practice that specializes in yoga for pelvic health and wellness. She teaches large general classes for all levels at Vista Yoga (Atlanta, GA), as well as adaptive and chair practices for those living with specific concerns and conditions. In her private practice, she helps people living with pelvic floor dysfunctions, including pelvic organ prolapse, incontinence, cancers, and pain conditions. She also helps those with issues related to the pelvis, but who are feeling it elsewhere: hips, knees, lower back (up and down the chain…). 

In addition to 23 years of yoga practice with wonderfully inspiring instructors, Patricia has trained with internationally-recognized teachers, including Nubia Teixeira, Christy Brown, Kaya Mindlin, Robin Gueth, Lynn Weinberger, and Jane Austin. She currently studies with Marti Yura, Tias Little, and Kaya Mindlin. She holds further certifications in yoga for hypermobility (and its related conditions), yoga for cancer survivors, yin and restorative practices, and prenatal/postpartum yoga. Patricia is a faculty member on the Vista Yoga 300hr Advanced Teacher Training and holds regular workshops and community education outreach on pelvic health and yoga. Her full training, education, and upcoming teaching schedule may be found at www.plsyoga.com