5:49 pm - 04/18/2010

Leslie Howard & Demystifying "Down There"

When I first saw the notice for this workshop on the female pelvic floor at my local yoga studio, I'll admit that my first reaction was, "I hope it's not some power-of-positive-thinking, banish-bad-energy, connect-with-your-inner-more-beautiful-spiritual-self crap." Not that there isn't a time and a place for those ideas, but too often I've seen them used as ways to dismiss and divert attention from the very physical pelvic problems female-bodied people sometimes face.

But since it mentioned a connection to menstrual pain, I went. At the very least, I figured a workshop on the pelvic floor would mean an afternoon talking vaginas, which for me = fun times.



Which turned out to be very true. What struck me most was how very full the workshop was. I don't remember this workshop being especially heavily advertised, yet I have never seen the studio as full as it was that day.

And every person there, I'm sure, had a story to tell. Leslie, the yogi running the workshop, asked some of us to introduce ourselves and volunteer reasons why we were here. There were folks who'd had hysterectomies, epistiotomies, pelvic organ prolapse; folks who had long-running battles with incontinence, interstitial cystitis, painful sex; people reclaiming parts of themselves after sexual and/or medical trauma. What got to me was the repeated sentiment that the speakers' issues were "strange" or "embarrassing."

Which, between what I heard there and what I read everyday on VP, I know that's not the case. Without devaluing the validity of those emotions, I think it's because society does not allow for open discussion of these issues that makes people feel freakish or alone. (Oh, and yes, before anybody asks, I absolutely took advantage of the opportunity to evangelize about VP.) ;)

Also, it turns out, I did not need to worry about the workshop being insufficiently physical. The next thing we did was learn about the anatomy of the pelvic floor muscles. Yes, there was an actual 3-D model whose name was Ruby. Yes, I got to touch the inside of Ruby's pelvis. ;)

I'm not sure about the rest of you, but I'm used to diagrams of pelvic floor muscles that look like this or this:
pelvic_floor


Or this:

si-pelvic-floor_default


Where I'm still left wondering, "WTF do the muscles actually look like?"

Now I know they look like this or this:

pf390.

There are layers that are deeper and more superficial, but basically, they form a sort of diamond shape that attaches to the pubic bone (at the front), the "sit bones" (at each side), and the tailbone (at the back). Because this diamond encompasses so much -- in terms of how far forward, sideways, back, and deep it extends -- it influences a lot more than just the vagina. And because kegel exercises mostly work on the more external layers of the pelvic floor, kegels by themselves aren't really strengthening pelvic floor muscles completely.

But. Google "pelvic floor exercises" and try to find some that are not kegels. Not easy. I wanted to try to find some diagrams that depicted the pelvic floor locating (because figuring out what it feels like when each "layer" of muscle is activated is Step 1) and strengthening (which includes both voluntarily contracting and relaxing/stretching the muscles) exercises we did. However, after 45 minutes of searching, the best I found was this page that covers some of the same material. (I do know that Leslie Howard recommends the books she links to and sells here, and they do have pelvic floor exercises -- but that's not the same as me being able to show you.)

We did talk about some things, though, that people can do to improve pelvic floor health:

1) Get to know your pelvic floor. -- First, imagine your vulvovaginal area as a clock, with 12 up by the pubic bone and 6 toward the perineum, like this:

Vulva_labeled

Insert a thumb (trimmed nails recommended) its full length into your vagina; by doing this, you're accessing the deeper pelvic floor muscles. Going from 3, back to 6, and around to 9, gently press outward on the vaginal canal. (You're actually pressing into your pelvic floor muscles.) You may feel the muscles relax and move pliantly; you may feel some pain at the site of your pressing, especially if those muscles are "clenching" when they shouldn't be. Or, you may be like me and feel pain in more distant places. When I press back to my perineum, there's a sharp pain at the front of each hip bone; when I press either side, there's a sharp pain in my sacrum. (My personal hypothesis is that years of spending menstrual periods clenched in the fetal position have made portions of my pelvic floor hyper-vigilant. I am currently working on getting set up with a pelvic floor physical therapist to get a professional opinion on this.)

2) Check your sitting posture. -- If you're familiar with yoga or pilates, the idea of moving the flesh from under your seat so you're sitting on your sit bones is probably also familiar. If not, the analogy Leslie used was to imagine you're a cat (or a dog) and never sit on your tail. Basically, the difference looks like this: When you're sitting on your sit bones, your spine is at its neutral point (whether it's 100% straight or not), the back and abdominal muscles are lightly engaged, and the pelvic floor can relax. When you're sitting on your tail, it's harder to engage the rest of your core, and so the pelvic floor is crunching and contracting when it maybe shouldn't have to.

3) Get a poo stool and/or squat to shit. -- Okay, this was maybe not the advice with the biggest impact, but it was far and away my favorite. The idea is that squatting "straightens the path" for poo elimination and reduces the need for straining. Less straining, in turn, means less downward pressure on the pelvic floor. Yes, squatting really was recommended if you could do it safely on your toilet. Looking at my toilet, I knew that trying to squat was just begging for an embarrassing 911 phone call, so I tried the alternate suggestion: a poo stool. It raises the thighs to approximately the same angle they'd be in a squat, also achieving the corresponding rectum straightness.

Anyone who knows me, I'm sure, recognizes that I was overcome with fecal fascination and could not wait to try this out. Fortunately, I poop a lot, so I didn't have to wait long. (Though I didn't purchase a stool since our bathroom garbage is about the right height.) And you know, I have a high fiber diet and didn't think I really had elimination problems before. But let me tell you -- even with that, this is So. Much. Better. I have not been this excited about a "down there" development since... menstrual cups. No shit. ;)



So that is my long and arduous tale in learning about the pelvic floor. If it's convenient for you to check out one of Leslie Howard's pelvic floor workshops, I definitely recommend them. And if you're in the Tucson, Arizona, area, I ♥ Tucson Yoga for hosting events like this.
frolicnaked 19th-Apr-2010 01:29 am (UTC)
I don't remember us talking about orgasms specifically, but my thought is that it couldn't hurt.

I mean, the prominent organs involved in most female orgasms are the brain and the clitoris. Since the clitoris is on the anterior end of the pelvic floor muscles, I don't know how directly they affect the experience of orgasm for female-bodied people.
acetank 19th-Apr-2010 01:11 am (UTC)
You misspelled Tucson. :( But this is awesome!
frolicnaked 19th-Apr-2010 02:06 am (UTC)
Fixed, though I originally spelled it right once too! ;) Can you tell it's taken me over a week to write this?
hairballsplat 19th-Apr-2010 01:11 am (UTC)
*sniff*...Tucson. I miss it. lived there for 5 1/2 years...left 4 years ago Wednesday. Can't wait for my husband to retire so we can move back out there. Thanks for all the info.
madraykin 19th-Apr-2010 01:27 am (UTC)
I live in Tucson too!
It's interesting about the pooping position, I will have to try that.
ktnzgtklws 19th-Apr-2010 01:32 am (UTC)
I have heard about the benefits of squatting for bowel movements before. Considering the issues I have with IBS, I may have to seriously consider getting one of those stools! (Why am I WAY too amused about using a stool to pass... stools? LOL! Yes, I'm a dork.)
I'm not normally a big fan of yoga, but this is something I'm going to check out! :-)
acetank 19th-Apr-2010 01:45 am (UTC)
This maybe kinda off-topic, but if you don't want to buy one of the stools, if you're slender enough to put your feet on the front of the toilet seat when you make a BM (yes, it looks/feels kind of silly) it really helped with my IBS and hemorrhoids.
ktnzgtklws 19th-Apr-2010 02:07 am (UTC)
I think that I could get away with that, although as the OP said, it does seem that it's kind of asking for an embarassing 911 call! :->
Regardless, I'll try it with my next BM and see how truely difficult it is/isn't. Thanks for the tip! :-)
frolicnaked 19th-Apr-2010 04:10 am (UTC)
Why am I WAY too amused about using a stool to pass... stools?

I know! I kept wanting to call it a stool stool in the post, but I restrained and un-dorkified myself.

Yes, "poo stool" is as un-dorky as I get. ;)
acetank 19th-Apr-2010 01:50 am (UTC)
Also, I'm excited that so many Tucson people are in VP.
aeryn 19th-Apr-2010 02:06 am (UTC)
Informative! Thank you! I'm going to try that squatting position - I've heard of it before but never tried it!
kaowolfie 19th-Apr-2010 02:33 am (UTC)
I am a big fan of something to put my feet up on when I'm having a difficult bowel movement or menstrual cramps. Before the minipill killed my cramps, I could be found once a month in the bathroom completely naked, with my head between my knees (to lessen the risk of fainting) and my feet raised up about 8-12" on whatever the nearest object of that height was.

When I was younger, my parents had stools in both bathrooms specifically for putting feets on, even after my two brothers and I could sit on the toilet with our feet on the ground. They stayed primarily because my mom has IBS issues, as do I when I don't eat a 'clean' soy protein-free diet.
pinkdagger 19th-Apr-2010 02:52 am (UTC)
Really neat! Parts of Asia still have squat toilets, but some people have trouble squatting flat-footed for long enough periods of time to have BMs, I've heard. I was too uncomfortable to use one for pooping in China several years back though, haha. :<<
mijakai 19th-Apr-2010 06:20 am (UTC)
Ahhh yes...I had the unfortunate experience of falling backwards into my own pee in one of them while I was in Japan. Wasn't something I'd like to repeat any time soon.
jbyrdski 19th-Apr-2010 02:57 am (UTC)
This sounds amazing! And there's one in NYC next month. I'm signing up right now...
altorogue 19th-Apr-2010 03:10 am (UTC)
Huh. I tend to lean forward so my torso is almost horizontal whilst I'm pooping- and now that I look at those squatting pics, it makes sense! I think I was reading a blog a year or so ago, and the pregnant writer was saying that leaning over whilst peeing and pooping was the ONLY way she could get anything out.
hairballsplat 19th-Apr-2010 06:26 pm (UTC)
i think i read somewhere that you should lean forward for peeing while pregnant to help the flattened bladder empty out.
j_m_m 19th-Apr-2010 08:42 am (UTC)
Thank-you for posting this.
missusmona 19th-Apr-2010 12:37 pm (UTC)
great post! i always had a feeling putting your feet up on something while on the loo was a good idea. my bathroom was rebuilt and now there is a bidet right across from the toilet i put my feet up on, get everything moving along quite nicely! hehehe
misspaigeb 19th-Apr-2010 04:15 pm (UTC)
The squatting-to-poop thing is sooo true. I can't remember where I read about it, but whenever I'm having issues pooping (pretty often because I have bowel issues) I always put my feet up on the toilet seat, while still sitting on the pot, and it solves the problem.
glasspumpkin 19th-Apr-2010 07:59 pm (UTC)
This is so awesome!! Glad you could share. One of the biggest things I've learned this semester has been the invaluable resource a good pelvic floor physical therapist can be - we had an awesome seminar from one here in Atlanta at school and I was so amazed. I have referred at least 3 people to her since then. More people need to know about the value of pelvic floor work/PT!
littlemissalien 19th-Apr-2010 11:56 pm (UTC)
Man, I wish we had stuff like this in the UK. I'd definitely go to one of those workshops.
so_much_udder 20th-Apr-2010 06:47 pm (UTC)
Oh man! My bathtub is in front of the toilet at the right height to put my feet up on, so I tried it...and I totally thought you were exaggerating when you said that it was so much better...but it so is! Apparently my boyfriend knew this and didn't tell me! Sheesh!
katrina_splat 9th-Jun-2010 02:39 am (UTC)
Thanks heaps, I've been so confused about pelvic floor exercises for a long time :)
corvidophil3 4th-Mar-2011 10:19 pm (UTC)
Gonna have to try this while relaxing! I have thighs of steel because I pee without sitting whenever at a public restroom. Silly, I know, but I just don't want to sit on public toilet seats. So I pee standing in a partial squat, and I've pooped standing a few times in a leaned-forward partial squat. I think the best thigh workout I've ever had was trying to poop standing up on a moving train that kept going around turns through the mountains. Felt like I ran up several flights of stairs after, haha.
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