Posture and the Pelvic Floor
Can Posture Influence Your Pelvic Floor Muscle Function?
A general trend that I hear with a lot of my clients entails the following repetitive weekday cycle: long meetings at the office, hours behind the desk working on the computer, long commutes home whether in cars or on public transit, and by the end of the day, they are flopped on the couch with a lap top or phone in hand. Did you know that the positions and postures you assume every day can directly affect the muscular function of your pelvic floor (1)? It is important to consider that the alignment of our spine and pelvis when standing or sitting can work for us or against us when trying to optimize and normalize our pelvic floor function. If we become more aware of how we hold our bodies throughout the day, this allows us to maximize the efficiency of our pelvic floor muscles at all times, as opposed to only when we are doing our prescribed pelvic floor exercises.
Consider your posture when you are standing or sitting. The slumped body position commonly involves your head jutting forward, rounded shoulders, a flat, low back, hips displaced forward, and/or a protruding abdomen. This posture places prolonged and excessive pressure on our internal organs and pelvic floor which can worsen urinary incontinence, pelvic pain, and symptoms related to prolapse and rectus diastasis.
Research has shown that when we sit in a slumped posture, our pelvic floor muscle activity is significantly less than when we are sitting tall (1). It was also found within the study that, asymptomatic women had increased curves in their lower back compared to those suffering with stress urinary incontinence. Additionally, slouched sitting postures decrease the activity of your transverse abdominal muscles (1,2). This is relevant as co-contraction of the transverse abdominals and the pelvic floor muscles play a key role in enhancing bladder control (3). Furthermore, slumped postures and the tendency to “suck in” the abdomen to evoke a flatter looking stomach, inhibit the body’s ability to diaphragmatically breath. The respiratory diaphragm moves in coordination with the pelvic floor muscles (5). That is to say, as the diaphragm descends during inspiration, the pelvic floor muscles lower as well. Likewise, during exhalation, the diaphragm rises up underneath the rib cage to expel air and the pelvic floor muscles lift as well. This breathing pattern encourages the pelvic floor to move more dynamically. Dysfunctional breathing patterns inhibit this dynamic movement of the pelvic floor (4) (stiff pelvic floor muscles are weak and inefficient thereby contributing to conditions such as pelvic organ prolapse, pelvic pain, rectus diastasis and bowel and bladder dysfunction).
Here are some tips to optimize your sitting posture throughout the day and during your pelvic floor exercises:
When unsupported, maintain a slight inward curve of your low back. If sitting supported, put your buttocks up against the back of the chair and the place a small roll or cushion in the small of your back to maintain a comfortable inward curve.
Sit with your weight evenly balanced between both sitz bones (no crossing of your legs).
Place your feet hip width apart and your hips and knees should be at a 90 degree angle.
Pretend there is a string attached to the crown of your head lengthening your spine up towards the ceiling
Tuck your chin in slightly.
Pull your shoulders back so that they are in line with your hip bones (keep the top of our shoulders relaxed so that they do not elevate toward your ears.
Here are some tips to optimize your standing posture throughout the day and during your pelvic floor exercises.
Stand with your weight evenly distributed between both legs.
Maintain a slight inward and comfortable curve of the low back.
Place your feet hip width apart.
Pull your shoulders back and in line with your hip bones (keep the top of your shoulders relaxed and don’t pull them up toward your ears).
Pretend there is a string attached to the crown of your head, lengthening your spine.
Tuck your chin in slightly.
Avoid wearing heels, as this pushes your center of gravity forwards on to the balls of your feet which will throw off your pelvic alignment (and we already know how important neutral pelvic position is for pelvic floor muscle activity.)
With these corrections in mind, I think an important concept to consider is “move often”. Although these postural positions are considered ideal, any position in which the muscles of your body are static or sustained for a long period of time is not recommended. Try to change your position from sitting to standing to lying down to walking as frequent as you can. The term “motion is lotion” applies to all of the muscles of your body including your pelvic floor muscles.
An assessment by a pelvic health physiotherapist includes a thorough postural examination. Your pelvic health physiotherapist will be able to identify your unique postural compensations and can help guide you on the road to improved body positional awareness.
1. Sapsford, RR. et al (2006) Sitting posture affects pelvic floor muscle activity in parous women: an observation study. Aust L Physiother. 52(3):219-22
2. Reeve, A., Dilley, A., (2009) Effects of posture on the thickness of Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises for Stress Urinary Incontinence: A Randomized controlled Trial. J Phys Ther Sci. 26(8): 1161-1163.
3. Kimiko T. et al (2014) Effects of Co-contraction of Both Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises For Stress Urinary Incontinence: A Randomized Controlled Trial. J Phys Ther Sci, 26(8):1161-1163
4. O’Sullivan, PB, Beales, DJ. (2007). Changes in Pelvic Floor and Diaphragm Kinematics and Intervention: a Case Series. Man Ther. 12(3):209-218
5. Hodges et al., (2007). Postural and Respiratory Functions of the Pelvic Floor Muscles. Neurourol Urodyn. 2007;26(3):362-71