Ultra Yoga and Exercises for Pelvic Floor Muscles

Today’s guest arti­cle, cour­tesy of Marisa Sul­li­van, con­sists of an inter­view she gave to Sal­ly M. River­tones of the Williams­burg-Green­point News.

Ultra Yoga  

The importance of the female pelvic floor (men not excluded) explained through a Yoga perspective

By Sal­ly M. River­tones

Marisa Sul­li­van has been teach­ing yoga for over 19 years. She was a stu­dent of pio­neer­ing yoga duo David Life and Sharon Gan­non in New York City 21 years ago. She holds to many tenets of Jiva­muk­ti method and includes spir­i­tu­al teach­ings in all her class­es that range from Alzheimer’s res­i­dences to tra­di­tion­al gyms, “but the phys­i­cal asana prac­tice I teach is much slow­er, has many more ‘anatom­i­cal’ teach­ing points.”


WG—How did you get into pelvic health from your yoga work?

Marisa Sul­li­van—My class­es boil down to mind­ful­ness in body, mind, and spir­it; deep lis­ten­ing to Spir­it and Inner Wis­dom; Love, for life, Self, and the world around us. These con­cepts nat­u­ral­ly lead to and unfold from phys­i­cal prac­tices that encour­age breath­ing, some­times sweat­ing, unearthing strength, releas­ing, stretch­ing, and relax­ing.

As I got into my prac­tice, after sev­en years or so, I dis­cov­ered that my sex­u­al life was huge­ly expand­ed. There was much more going on that I was direct­ly par­tic­i­pat­ing in—I had more pelvic aware­ness. That moved me to explore the his­to­ry of both female sex­u­al anato­my and var­i­ous spir­i­tu­al sex­u­al prac­tices through­out his­to­ry. I start­ed teach­ing work­shops and coach­ing women on their sex­u­al anato­my and yoga and ener­getic aware­ness prac­tices that lead to greater sex­u­al self-empow­er­ment, and some­times greater orgas­mic poten­tial. About five years ago I found Leslie Howard, an incred­i­ble pelvic floor and Iyen­gar yoga teacher based in San Fran­sis­co. Her teach­ing has great­ly expand­ed and deep­ened my pelvic health work. Now the work I am doing is about the pelvic anato­my as a whole, not so much cen­tered on the sex­u­al piece.

Marisa Sullivan

Marisa Sul­li­van

Pelvic health is not a com­mon sub­ject, it might even be con­sid­ered too adult for pub­lic con­sump­tion. What do you think?

It is and it isn’t com­mon. Women qui­et­ly joke about it fre­quent­ly and wide­spread through­out var­i­ous ages and com­mu­ni­ties. There is the con­stant refer­ral to women los­ing a bit of pee when they laugh or sneeze, but then the real knowl­edge of what is hap­pen­ing as we age, give birth, and prac­tice try­ing to “get a flat stom­ach and tight butt” in ways that affect the long term health of our pelvic floor is not so well under­stood and less so the fact that we can so eas­i­ly help our own pelvic floor sys­tems through very spe­cif­ic exer­cis­es that teach anatom­i­cal aware­ness. One prob­lem is that many of our med­ical prac­ti­tion­ers have become so com­part­men­tal­ized, we go to one doc­tor for this organ and anoth­er for that organ, but the body is much more inter­con­nect­ed.  And of course the pelvic floor has these holes—where we pee, poop and have sex—places that cul­tur­al­ly, sad­ly, many have con­sid­ered ‘dirty.” We shut out the sex­u­al organs into a dark­er, more pri­vate, sec­tor, when they are just too con­nect­ed to all our parts to do that, and by doing that we suf­fer need­less­ly. I remem­ber some use­less phys­i­cal ther­a­py I was get­ting for my ham­strings, I said to my phys­i­cal ther­a­pist, “I think this has much more to do with my lev­a­tor ani, (a deep pelvic floor mus­cle, in under the sacrum and the glutes).” She laughed and said, “I don’t go to those dirty places, you must go to a spe­cial­ist for that.” There are extra­or­di­nary pelvic floor phys­i­cal ther­a­pists, but it is hard to get a pre­scrip­tion to see one, they rarely are in net­work, take few insur­ances, and so women (and men) who could use one can’t always afford or even ever find one.  In most coun­tries in Europe, women get six weeks of pelvic floor phys­i­cal ther­a­py and recon­di­tion­ing [after they give birth]. In this coun­try we get noth­ing. Even the major­i­ty of women who have real post-birth issues are rarely informed about the pos­si­bil­i­ty of get­ting pelvic floor phys­i­cal ther­a­py

Why is pelvic health impor­tant, and for whom?

Pelvic health is impor­tant because our pelvic floor is the bot­tom of the bag, so to speak, the floor of our organs, with­out a vital healthy pelvic floor there is lit­tle chance for our low­er abdom­i­nal organs, or our diaphragm, to have any chance of being their fullest health and great­est effi­cien­cy. Pelvic health is impor­tant to everyone—I do believe many men suf­fer from poor pelvic floor health, most notably relat­ing to prostate health, sex­u­al issues, and low back pain, but women are more sus­cep­ti­ble to pelvic floor issues because, while men have only one hole at the bot­tom of the bag, women have three. Pelvic floor health is espe­cial­ly impor­tant for women with fer­til­i­ty issues, post par­tum heal­ing, and men and women who have any his­to­ry of sex­u­al abuse. It is impor­tant for peo­ple who sit all day—as sit­ting in a chair is the worst posi­tion for our pelvic floor. It is impor­tant for New York­ers, because we have such a ten­den­cy to live stress­ful, striv­ing, lives and have to hold it all in and live so close to one anoth­er. Many mys­te­ri­ous, mis­un­der­stood prob­lems in the pelvic floor come from not a weak pelvic floor, but an over­ly tight pelvic floor. And many work­outs and incor­rect­ly taught Kegels that have women just ran­dom­ly “squeez­ing and tight­en­ing” “down in there” lead to exces­sive ten­sion and hold­ing that is just as harm­ful and can cause incon­ti­nence as much as a weak pelvic floor.

You once spoke about how men sit with their legs wide open and let every­thing “hang out,” why is this an advan­tage over women?  And what can women learn from this?

That is fun­ny that you remem­ber that image so well. I think it is incred­i­bly empow­er­ing and heal­ing for women to rec­og­nize that our sex­u­al organ is as big and potent as the male organ. The cul­tur­al con­serve car­ries lan­guage and imagery that the female sex­u­al organ is infe­ri­or and small com­pared to the male. I love to imag­ine a lit­tle embryo with all the cells to make up all he or she will be, and as male and female embryos dif­fer­en­ti­ate the female erec­tile tis­sue doesn’t get small­er, or get thrown away, it is just hid­den and spread around inside in all sorts of smart and healthy help­ful places. As one of my favorite sex­u­al anato­my writ­ers, Rebec­ca Chalk­er says, “The cli­toris is just the tip of the ice­berg.” I tell women to think of those men who sit on the sub­way with their legs spread as if their male organ is so big that they have to take up more space and to own that sense of big­ness inside of them­selves. I have observed much heal­ing in women under­stand­ing this con­cept. Con­nect­ing to that image dur­ing sex brings greater orgas­mic poten­tial and that in hand does won­ders for uri­nary health as much of the erec­tile tis­sue is a padded bar­ri­er to pro­tect the ure­thra and ure­thra open­ing dur­ing sex and if a woman engages in cer­tain activ­i­ties before she is ful­ly aroused in all her tis­sues then her uri­nary organs are sus­cep­ti­ble to infec­tion.

The pelvic area includes a com­plex set of mus­cles, would you describe them.

There are a bunch of mus­cles and some have big com­pli­cat­ed names, but there are a few sim­ple images that open many doors to under­stand­ing. I do high­ly sug­gest read­ing some books on the pelvic floor anato­my and get­ting a clear­er pic­ture for one­self as a path to heal­ing for any­one who is hav­ing issues. For the rest of us just hav­ing a few images will go a long way to bet­ter under­stand­ing. One thing that is help­ful is to have a pic­ture of the pelvic dia­mond, the area of the two belts of pelvic floor mus­cles that make up the bot­tom of our bag, and where they inter­sect. Mus­cles must attach to bone, so from sit­ting bone to sit­ting bone is one set of mus­cle that runs left to right, then the sec­ond set of mus­cle runs from pub­lic bone to tail­bone, front to back.  Pic­tur­ing the space between those four bones as a dia­mond and then work­ing with that area being able to release and lift even­ly is very good start to a healthy pelvic floor.

What are the most impor­tant things women can learn from pelvic work?  

The most impor­tant thing women can learn is that we must take an active part in our pelvic floor health. The ben­e­fit is that when we do we can avoid many surg­eries and exter­nal med­i­cine.  There is much inter­nal med­i­cine we can unearth in becom­ing ful­ly aware of our pelvic floor anato­my and our ten­den­cy to hold ten­sion in one place or anoth­er and have weak­ness in one place but be crazy strong in anoth­er. It is equal­ly fas­ci­nat­ing and depress­ing to learn that uri­nary doc­tors used to teach women how to cor­rect­ly do Kegels many decades ago. Then they dis­cov­ered that when women could care for them­selves they lost mon­ey in surg­eries that were no longer need­ed.  So the doc­tors stopped teach­ing the exer­cis­es. Now there is a big recall on the net­ting used in surg­eries giv­en to women to hold up their blad­ders and hold back incon­ti­nence.  The net­ting cuts into the organs and caus­es far worse dam­age than was there before.

What are some books that would be good know about?

The Female Pelvis Anato­my & Exer­cis­esby Blan­dine Calais-Ger­maine
End Pelvic Pain by Isa Her­rera
The Cli­toral Truth by Rebec­ca Chalk­er

What’s the most sur­pris­ing thing you’ve learned from this work?

I still can’t get over that most women I talk to don’t know the dou­ble anatom­i­cal func­tion of the G-spot and its great impor­tance to our uri­nary health. The first func­tion is the erec­tile tis­sue that sur­rounds the ure­thra and the ure­thral open­ing, pro­tect­ing it from bang­ing, and flu­ids from enter­ing the ure­thral open­ing. Sec­ond func­tion is female ejac­u­la­tion, expand­ing orgas­mic hori­zons!

Thank you, Marisa! Is there any­thing you would like to add before we con­clude our inter­view?

I love the work I do, and I love shar­ing it with peo­ple. I run work­shops, teach pri­vates on a slid­ing scale and will be start­ing “clin­ic” after­noons once a month or so where I do low fee 30-minute con­sul­ta­tions as well as full hour ses­sions. Keep in touch through my web­site at www.marisasullivan.org


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About Ronald Lavine, D.C.

Dr. Lavine has more than thirty five years' experience helping patients alleviate pain and restore health using diverse, scientifically-based manual therapy and therapeutic exercise and alignment methods. His website, askdrlavine.com, provides more information about his approach. Please contact him at drlavine@yourbodyofknowledge.com or at 212-400-9663.
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