As a pregnant woman, prenatal yoga teacher, and birth doula, I spend a lot more time than most people thinking about pelvic floors. Imagine my disappointment when I started to scour the internet for more information about one of the pelvic floor muscles—the pubococcygeus—and found a few dry medical encyclopedia entries, a bunch of articles about Kegels, and not much else.
All men and women have the pubococcygeal muscles, often referred to as the PC muscle. They’re part of the three levator ani muscles, which, along with the coccygeus, make up that sling of muscles that are the pelvic floor and support the pelvic organs like a hammock. The pubococcygei are two muscles that originate at the posterior side of the pubic bone and insert at the back of the pelvis into the anococcygeal raphe (a rigid fibrous median) just in front of the coccyx; they wrap around either side of the urethral and anal sphincters, as well as around the vaginal sphincter in women. I’ll focus specifically on these muscles as they pertain to the female pelvic floor here, but it’s important to remember that they exist in males and can be equally tight or underused.
Pelvic floor muscles become a topic of much discussion for women particularly around childbirth. Many pregnant women are instructed to do Kegels (a contraction of the pelvic floor muscles, specifically the pubococcygeal muscles), sometimes hundreds daily, in preparation for childbirth, in an effort to strengthen them. In fact, a much more apt preparation for childbirth would be to learn to relax these muscles on demand. Hypertonicity in the pelvic floor can actually impede the process of childbirth. Although many women have learned that they’ll need to actively engage these muscles in the pushing stage of delivery, in fact they need to learn how to let them release to let the baby out. Women who have a very lax pubococcygeus and be experiencing incontinence may indeed need to strengthen these muscles via this very concentrated contraction, but it’s not always a beneficial action to imprint into these muscles leading up to delivery.
Post-childbirth, it’s true that all the muscles of the pelvic floor may be overstretched, and it’s perhaps then that it makes sense to revisit the Kegel, to put that muscular sling back together so that it can adequately support the organs of the pelvis. However, as Katy Bowman points out in Jill’s recent pregnancy webinar, Healthy Pregnancy, Healthy Baby: Dispelling Myths of Pre-Natal Exercise, Diet and Self-Care, it’s good to question why we need Kegels in the first place. Hundreds and thousands of years ago, women weren’t doing Kegels post-birth to put their pelvic floors back together, but they also weren’t sitting all day long, weakening their pubococcygeal muscles along with all the other muscles of the pelvic floor. Perhaps a better approach is to incorporate regular movement into our days both before and after childbirth to engage and stretch these tissues without assuming that isolated contractions of one small muscle can really create pelvic health.
Tune in on Friday for some Yoga Tune Up® exercises targeted for your pubococcygeal muscles!