Yoga for Hypertonic Pelvic Floor: A Path to Greater Comfort and Mobility

While yoga is well-known to many people as an exercise modality, it can, when used appropriately, be an effective tool for managing the hypertonic pelvic floor, offering a path to greater comfort, mobility, and overall well-being.

Why try yoga for a hypertonic pelvic floor?

Yoga, with its unique combination of specific poses, mindfulness, and relaxation techniques, can help release tension in the pelvic floor muscles. For movement teachers, physical therapists, and other body professionals, incorporating yoga into a comprehensive treatment plan offers a holistic approach to addressing both the physical and emotional dimensions of a hypertonic pelvic floor.

Hypertonic pelvic floor: definition and symptoms 

Ideally, the pelvic floor muscles react reflexively to the activities we engage in by relaxing and tightening in response to the loads placed on them. However, many people have pelvic floor muscles that are hypertonic or “too tight,” even when they’re not performing any activity at all. It’s like having the volume on your TV just a little bit too loud all the time–maybe it’s tolerable for a while, but eventually, the symptoms can become intolerable.

Common issues related to tight pelvic floor muscles often include:

• Leaking urine, especially under higher load, such as sneezing, jumping, or running (stress incontinence). 
• Pain during or after intercourse
• Constipation
• Low back pain

Hypertonic pelvic floor muscles can also make engaging the rest of the core muscles more difficult, leading to unnecessary strain on other muscles, and compensation patterns that cause pain. A hypertonic pelvic floor often coincides with pelvic floor weakness, as the persistent muscle tension can lead to challenges when these already overactive muscles are required to handle an increase in stress, such as during sneezing or coughing.  

Causes and common triggers. 

Several factors can play a part in the development of hypertonic pelvic floor. Chronic stress, anxiety, and unresolved emotional issues can lead to increased muscle tension, and trauma such as childbirth or surgery can also contribute to pelvic floor tension.

Other physical triggers for hypertonic pelvic floor include prolonged sitting, poor posture, and excessive straining during bowel movements. These factors can exacerbate muscle tension and contribute to the persistence of symptoms. Lifestyle modifications, such as incorporating regular breaks during prolonged sitting,maintaining good posture, and eating a diet rich in fiber can help with the symptoms of a hypertonic pelvic floor.

A comprehensive treatment plan for hypertonic pelvic floor should address both physiological and mental/emotional causes of the problem. While on the surface it seems that the answer to an overactive pelvic floor is to learn how to relax, stress and emotional tension are equally important to address, and are not quite so simple as telling the muscles to relax.

Impact on daily life and mobility. 

The pelvic floor muscles are connected to the bones of the pelvis; they also connect to the muscle systems above and below the pelvis.

Because the pelvic floor forms the base of the core, it is affected by everything else in the body–foot tension, jaw tension, tight hamstrings, respiration. As a result, the effect of a hypertonic pelvic floor can’t be overstated. From back pain, to incontinence or constipation, to decreased mobility, to difficulty enjoying sexual activities, to a loss of confidence in the body, hypertonic pelvic floors are often the culprit. This is, of course, contrary to common beliefs about the pelvic floor–Kegels are not the answer to all pelvic floor dysfunction. 

The goal with exercises for hypertonic pelvic floor is to help your client find a sense of connection with their body, and eventually with their pelvic floor. From there, building mobility and strength becomes much easier. It’s possible to be strong and have a pelvic floor that is hypertonic (in fact the highest incidence of stress incontinence is in athletes), but it’s even better to be strong and have a responsive pelvic floor that can yield when needed.

How Yoga Can Play a Role in Managing Hypertonic Pelvic Floor

Exploring yoga as a therapeutic approach

When we’re working with clients with a hypertonic pelvic floor, combining a mind-body connection with physical exercises can be much more helpful than either modality alone. Yoga has a long history of bringing people into a deeper connection with their bodies, and has demonstrable physical benefits such as improved balance and proprioception, lowered blood pressure, and lowered stress. If you have the ability to offer yoga to your clients, you may find that they make more progress than with exercise alone. And if you are already a yoga teacher yourself, adding a few cues and specific poses to your classes may benefit anyone attending who has pelvic floor issues–and everyone else, too.

Specific benefits of yoga for hypertonic pelvic floor include:

• Muscle relaxation and reduced tension: Yoga poses often involve stretching and strengthening the muscles that attach to the pelvic floor. This helps in reducing tension in the pelvic floor muscles themselves. Remember that a responsive pelvic floor is both strong and relaxed. Yoga poses can help with both.
• Improved mobility: Yoga involves a variety of poses that promote flexibility and mobility in the body. Improved flexibility in the hips, pelvis, and surrounding muscles can alleviate stiffness and pain associated with pelvic floor dysfunction.
• Increased bodily awareness: By fostering a heightened awareness of the body, hypertonic pelvic floor yoga may help your clients better understand and connect with their pelvic floor muscles. This awareness is essential for recognizing tension and making conscious efforts to release it. Eventually, that release becomes unconscious.
• Stress reduction and emotional well-being: Chronic stress and emotional tension can contribute to hypertonic pelvic floor by keeping the body in a constant state of hypervigilance. Yoga, with its focus on relaxation and stress reduction through breathing, mindfulness and meditation, helps manage stress levels, which can then positively impact pelvic health.

As a practice that is at its heart a holistic approach to the mind and body, yoga addresses both the physical symptoms and the emotional factors contributing to hypertonic pelvic floor. Yoga can be a powerful tool for anyone working with clients suffering from symptoms of excessive pelvic floor tension, especially when combined with more conventional corrective exercises and an emotionally supportive, therapeutic environment.

There are numerous styles of yoga that your clients may have tried. While this article cannot provide an exhaustive list, some of the more common styles are:

• Hatha
• Iyengar
• Hot/Bikram
• Flow/Vinyasa (including ashtanga)
• YinRestorative

Please note not all styles are recommended for those with non-relaxing (hypertonic) pelvic floor muscles.

Preparing for Yoga Practice

Before beginning to integrate yoga into their movement program, please have your clients check in with their medical providers. It’s important to note that introducing new activities or small changes in movement habits can sometimes trigger symptom flare-ups. If your client encounters a sustained increase in symptoms lasting more than a few days, it is advisable for them to speak to their doctor. Any unexplained bleeding or severe pain is an indicator to stop the yoga practice and seek immediate medical attention.

Creating a safe and comfortable yoga space

It is of paramount importance to create an environment that feels safe and comfortable for yoga practice. Here are a few tips:

• In a group setting, make sure that everyone present feels seen and welcome to the space. 
• In a 1-1 situation, check in on your client’s emotional well-being before beginning physical practice. 
• Keep the space you’re in as free from visual distractions and sudden loud noises as you can in order to put your clients’ nervous systems at ease. 
• Make sure that you have time at the end of your session or class for quiet rest. Rest is when the body integrates what it has done, and is an opportunity to help your client tune into their body.

5 Yoga Poses for Hypertonic Pelvic Floor

Here’s a detailed overview of five specific yoga poses that can be beneficial for the hypertonic pelvic floor. Many similar poses are in my online program, Restore Your Core®. When cuing your clients in these poses, use words that invite them to explore and be curious about how their body feels rather than telling them how they should feel. 

1. Child’s Pose (Balasana)

• Have your client come onto all fours with the tops of the feet on the mat.
• Palms are placed down on the mat in front of their body with arms straight.
• Shift the pelvis back toward the heels, allowing the knees to widen if needed. 
• Keep big toes close together
• Rest here comfortably for several breaths

Modifications to make the pose more comfortable or accessible:

• Move hands closer to the body
• Tuck toes under if the tops of the feet are sensitive
• Place a bolster or block under their forehead
• Offer them a block or bolster to place under their butt
• Place a rolled-up towel behind the knees

2. Happy Baby Pose (Ananda Balasana)

• Have your client begin by lying down on their back with their knees bent
• Bring the knees in toward the chest
• Hold onto the lower legs, ankles, or feet to help the body relax into this position
• Bring some attention to the pelvic floor, and invite them to observe how it feels as they inhale and exhale.

Safety precautions: be cautious about assigning this pose to clients with have any disc conditions that require them not to put pressure on their spine.

Modifications:

• Offer a strap for them to use over the soles of the feet instead (hold one end in each hand and have them adjust the amount of force they’re exerting on the strap to their comfort level.
• Invite them to let their body gently rock side to side, front to back, and in a circle, if it feels good.

3. Reclined Bound Angle Pose (Supta Baddha Konasana)

• Have your client begin by lying on their back with their knees bent, and pelvis neutral.
• Have them place the soles of the feet together 
• Invite them to let their knees gently move away from each other and let gravity do the work.

Adjustments and modifications:

• Support the knees with blocks or blankets or bolsters
• Offer them support to the back of the head with a folded up towel or blanket
• Slide feet farther away from the body, or bring them closer to the body.
• Remind them not to strain to press their knees in to the floor
• If this movement is available to them, pressing their hands into the inner thighs and resisting the press for a few moments, then releasing that resistance can help their knees relax toward the floor. You can also provide that resistance, but be mindful of how much pressure you’re using.

4. Garland Pose (Malasana)

Malasana is essentially a deep squat. You may wish to offer one of the variations below if your client has pelvic organ prolapse symptoms, knee pain, or other mobility restrictions that make it difficult to sit in a low squat.

• Have your client begin by standing with the feet a little wider than pelvis-width
• Ask them to lower the body toward the floor by bending the knees
• Have them bring the palms together in front of the chest, with the elbows touching the shins.
• Encourage them to keep the spine relatively neutral as they relax into the squat.
• Have them slowly come up by pressing down with the feet.

Modifications and variations:

• If downward pressure isn’t an issue, but hip/knee/ankle mobility is: Use a door handle or sturdy piece of furniture to help them support their weight as they lower down and come back up. Only lower down as far as the joints will let them go.
• Chair squat: Instead of sitting down toward the floor, have them sit onto a chair with legs comfortably wide apart. Press the feet into the ground to come up; repeat several times.
• Supported squat: Follow the same instructions as for Malasana, but let the stibones land on a block, stack of blocks, or bolster.
• Supine Malasana: Lie on the back and draw the knees toward the chest, as if squatting in the air. 

5. Pigeon Pose (Eka Pada Rajakapotasana)

Pigeon pose can feel wonderful for tight hips, but is often challenging. We’re offering three variations: the traditional seated version, a figure 4 stretch, which can be more accessible to many people, and a standing variation that is great for anyone who struggles with both getting up and down from the floor and hip mobility. 

Variation 1: Eka Pada Rajakapotasana

• Have your client begin from a downward-facing dog position. 
• Step one leg forward as if into a lunge, but place the side of the shin on the mat, so that the front shin is roughly parallel to the front of the mat. (If this angle is too much for the hips, bring the front foot closer to the body. 
• Let the back knee come to the floor, and place the top of the foot on the mat. (it’s ok to tuck the toes under instead, if this is the preference)
• Make sure that the front foot is lined up with the shin, not twisted.
• The pelvis should be relatively even, not dropping off to the side.
• Support some of the weight with the hands alongside the body, or use blocks under the hands to help. 
• A good cue can be to encourage them to imagine drawing the legs toward each other.
• After a few breaths in this upright position, have them slowly walk the hands forward and let the weight sink a bit more toward the floor.
• Slowly come out of the stretch in any way that feels good to the body.
• Repeat on the other side.
• Note: your client can support their pelvis on a block or folded blanket if the mat is too far away, or try one of the variations below.

Variation 2: Supine figure 4 stretch

• Have your client lie on their back with both legs bent, feet on the floor, spine neutral. Bolster the head if needed.
• Cross the right ankle over the left knee. 
• For some people, this is enough of a stretch! If this is your client, let them stop here.
• Otherwise, ask them to draw the left leg toward the body by holding on behind the thigh. They can also use a strap if needed.
• Gently press the right knee away from the body.
• For some extra input, add a tiny twist by allowing the sole of the right foot to move toward the floor by a couple of inches.
• Come back to neutral and lower the legs.
• Repeat on the other side.

Variation 3: Standing pigeon

• Have your client begin by standing in front of a step, bench, or chair.
• Step one foot onto the bench and rotate the bent leg from the hip so that the side of the foot rests on the bench. 
• Mindfully allow the stretching knee to move toward the ground–don’t collapse into the stretch. Keep the standing leg steady.

Integrating Yoga into Daily Life

Establishing a regular yoga routine can be challenging for many people, and your clients may need your help to do so. One place to start is by brainstorming with them what already works in terms of routines. Where can they add something new easily? What works for their lifestyle in terms of length of time and consistency?

I often help my clients to just pick a time to get on the mat. How much time they actually spend there is less important than making time for themselves. Particularly with excessive pelvic floor tension, the simple act of taking intentional time to focus on themselves can kickstart their progress. Adding a few poses at a time becomes easier the more they build the habit of moving at all. You could teach a regular class that incorporates hypertonic pelvic floor exercises, so that they get the benefits of practicing in community. Or you could recommend a program for them to push “play” on, like Restore Your Core®. What matters most is helping them make it doable and consistent. Five minutes in the morning and/or evening is better than not at all.

Reminders 

Bringing an integrated mind-body approach to your clients with yoga-based hypertonic pelvic floor exercises is a powerful way to help people feel better. We’d like to close with a few final thoughts:

Seek professional medical advice when needed. 

Encourage your clients to seek the advice of a physician when necessary–in general, acute pain, sudden worsening in symptoms that persists, or unexplained bleeding are all good reasons to check in with their doctor. Individual responses to yoga exercises for hypertonic pelvic floor can vary, and consulting with a healthcare provider or a certified instructor with expertise in therapeutic practices is a good idea before beginning to practice. If you’d like to book an assessment with a certified RYC® Teacher, you can do so here.

At the same time, let’s take a holistic approach to managing a hypertonic pelvic floor.

Because of the effect that pelvic floor dysfunction can have on mental health, it is essential to bring a holistic focus to our work with hypertonic pelvic floor clients. Remember to set the stage for healing by creating a calm environment. Spend time listening compassionately to your clients’ experiences. Healing isn’t linear, and knowing that they have a care team that sees them as more than just parts is invaluable.

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