DEBBIE DRESLER - Genital prolapses and yoga fo woman(benefits and asanas)

 

  Genital prolapses and yoga fo woman(benefits and asanas)       11/2015   

              

Definition:         A prolapse is a structural problem. Genital prolapse is defined as the descent of one or more pelvic organs(Bladder,urethra,uterus,small bowel or rectum) into or through the vagina –happens due to lack of support or elastisity of the ligaments or fascia attaching the organ to the area above (peritoneum) or around the organ in the pelvis. It is also  a result of overstretching of the vaginal tissues and the endopelvic fascia that supports the female pelvic organs.                         

 The main feature of the condition is a descent of the vaginal walls with/without one of the organs. Genital prolapse  includes a cystocele(bladder ), urethrocele, rectocele or enterocele (descent of the small bowel)–one of them or combined. The descent=prolapse  is classified by the anatomic structure involved and severity of descent-graded between 1-4. 4=meaning most severe descent-when the organ is completely beyond the vaginal opening. 

                                               

 Risk factors for prolapses are vaginal delivery,instrumental delivery(mainly forceps),prolonged labor, big baby(above 4k"g),menopause-estrogen deficiency,heavy lifting, chronic respiratory disease or allergy causing coughing,  smoking,chronic constipation and straining on defaecation.     

                                   

Symptoms:  vaginal pressure,feeling of heaviness/bulging  in the vagina or lower abdomen, "pulling down  in the pelvis" which worsens as the day progresses, low back pain: relieved when lying down, urinary frequency, difficulty with bowel  movements-lack of complete emptying of the bowel or bladder(urinary retention),difficulty or painful intercourse, urinary tract infections –due to urine residual in the bladder. Vaginal flatus: air  is drawn into  a dilated upper vagina,  above the pelvic floor –and air escapes noisily ,causing embarrassment. many woman are unaware that they have minor prolapses.

 

Treatment: kegel exercises(pelvic floor contractions –mainly for endurance:10-25 seconds at once) can solve 1-2 degree prolapses,questionable for more severe prolapses-depending on the elasticity and recovery of elasticity of the various structures involved.

 Pessary insertion: a  prosthetic  device-ring or cube(rubbery) can prop up in place  the uterus or bladder(more difficult for severe prolapses) with this device the pelvic floor can strengthen better and relieve symptoms(woman inserts device daily).  Defaecation retraining can limit pelvic floor organ descent on defaecation, avoiding constipation, quit smoking (which weakens connective tissues) avoid heavy lifting –above 2k"gs and try to avoid birth canal trauma.

 

Surgery:  repairing/shortening  of the pelvic floor structures to replace  organs back in correct position and diminish symptoms. surgery can be done vaginally or abdominally or combined depending on the damage and operation chosen by the surgeon (urogynecologist)-sometimes surgery involves a hysterectomy(preferably  avoided). 

The approach to improve a prolapse  or avoid worsening  with exercise is based on the fact that any "prolapse" is due to weakness of muscles and/or stretching of connectives tissue ligaments/ fascia. Yoga practice combines breathing techniques with activity of the various  abdominal muscles(especially the tansverse abdominus that attaches to the pelvic floor)and pelvic floor muscles"moola banda"-working altogether in yoga asanas.  This activity  can be effective to improve a prolapse when   exercised patiently/regularly  for at least 3 months .

 

"Mira yoga - women's health" Asanas for pelvic floor prolapse.(to improve  condition /prevent deterioration) :

Basic Positions  recommended to practice with  a prolapsed organ:positions neutralizing gravity: supine and pelvis lifting,legs up in the air ,upside down asanas –like headstand,shoulder stand,standing on hands and knees,plank position,adhumukha-shvanasa with awareness of working the "moola banda"(=pelvic floor)with  coordinative breathing and gradually adding core  and abdominal muscles in various positions.

1.supine-moola banda work+breathing:.lie on your back knees bent-breath out through your nose,feel your stomach harden slightly  and lift up your pelvic floor closing your vagina as long as possible(5-25seconds)continue breathing normally.

2.supine/knees bent feet on floor/arms close to body –breath out with moola banda contraction and lift pelvis "bridging position" (setubanda)holding thighs parellell actively to each other keep pelvic floor contraction –3-4 breathes in the chest –breath in with  pelvis to floor . can move arms above your head and back down 2-3 times-in this position.

3.same as2.-while pelvis up and pelvic floor active straighten 1 leg up in the air keeping pelvis stable –breath out when changing legs –then relax pelvis down and relax completely.-repeat .

4.Cat stretch pose –marjari-asana:from sitting on ankles stretch arms forward on the floor hands pulling body forward /up and bring shoulders above /slightly behind hands-buttocks a bit behind knees –(apart) and exhale-contract moolabanda –tummy hardening  stretching spine upwards-head down –inhale try holding pelvic floor relax down stomach and spine and lift head. Inhale/exhale at least 5seconds.

5.Cat position –weight on hands knees and feet,spine long :contract moola banda, breathing out tummy in keep spine straight and log –straighten in the  air opposite arm and leg –continuing breathing cycle 3-5 times  and relax.

6.boat pose-navasana:sit slightly back leaning on hands near buttocks –fingers forward ,knees bent –exhale with moolabanda contraction-then lifting feet up from the  floor trying to straighten knees –holding in pelvic floor –and breathing .can be done with support of a stool under legs.(advanced asana).

7.cat position-exhale with holding pelvic floor in  lifting knees off the floor and moving from side to side.continue breathing –still holding pelvic floor moving knees in the air up to 25 seconds.

8.supine –legs bent to stomach (90 degrees at hips)exhale with pwlvic floor contraction and straighten knees up holding(pelvic floor in with legs up) and breathing.repeat 5-10 times.(hands  on the floor supporting to the sides)

 

Debbie Dresler

Physiotherapist(BPT)-Continence specialist

Yoga for woman instructor (Mira Artzi-Padan's method)