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REVIEW ARTICLE
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Year
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2014 | Volume : 46 | Issue :
3 | Page : 59-63
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Exploring the significance of "Mudra and Bandha" in pelvic floor dysfunction
Mrithunjay Rathore1, Sarita Agrawal2, Prasanta Kumar Nayak2, Manisha Sinha1, Dhanyesh Kumar Sharma1, Subarna Mitra2
1 Department of Anatomy, All India Institute of Medical Sciences, Raipur, India
2 Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Raipur, India
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Date of Web Publication
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1-Jul-2015
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Correspondence Address:
Dr. Mrithunjay Rathore
Kabir Nagar, AIIMS Residential Complex, Type 4 Quarters, Flat No: 201, Raipur, Chhattisgarh - 492 099
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0044-0507.159737
Pelvic floor dysfunction (PFD) is commonly associated with
the weakness of pelvic floor muscles and the supporting connective tissue
structures, which may lead to prolapse of the pelvic organs. There are
various researches which have shown the significance of pelvic floor
exercise (PFE) on the PFD. The last few years have seen a growing interest
in the field of yoga. "Mudra" and "Bandha" are reported
as pelvic floor yogic exercises (PFYEs) in the ancient Indian texts. These
yogic exercises involve the coordination of breath, maintain the structural
integrity of the pelvic floor, and thereby prevent PFD. It is recognized
that all the female patients of PFD can be benefited from education on
PFYE. So, in this article, we have tried to highlight the significance of
PFYE in the preventive and therapeutic aspects of PFD.
Keywords: Bandha, Mudra, pelvic floor
dysfunction, pelvic floor exercise, pelvic floor yogic exercise
How to cite this article:
Rathore M, Agrawal S, Nayak PK, Sinha M, Sharma DK, Mitra S. Exploring the significance of "Mudra and Bandha" in pelvic floor dysfunction. Yoga Mimamsa 2014;46:59-63 |
How to cite this URL:
Rathore M, Agrawal S, Nayak PK, Sinha M, Sharma DK, Mitra S. Exploring the significance of "Mudra and Bandha" in pelvic floor dysfunction. Yoga Mimamsa [serial online] 2014 [cited 2023 Apr 1];46:59-63. Available from: https://www.ym-kdham.in/text.asp?2014/46/3/59/159737 |
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Introduction
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Pelvic floor dysfunction (PFD) is often associated with weakness of the
pelvic muscles as well as failure of supporting connective tissue
structures, leading to urinary and fecal incontinence, prolapse of the
pelvic organs, defecation problems, and sexual difficulties (Russell and
Brubaker, 2008; Sung & Hampton, 2009). Moreover, women are more
vulnerable to PFD due to several reasons, and they suffer silently due to
lack of knowledge of preventive and therapeutic strategies directed toward
the problem.
The Kegel exercise is a well-known pelvic floor exercise (PFE) as described
by Arthur Kegel, Professor of Obstetrics and Gynecology in the USA. There
are various researches showing the significance of PFE on PFD. Kegel
(1948), in his historical paper "Progressive resistance exercise in
the functional restoration of the perineal muscle," has reported the
successful treatment of 64 patients with urinary stress incontinence with
this exercise. Balmforth, Mantle, Ashton-Miller, Bidemead, and Cardozo
(2006) reported increased urethral stability at rest and during effort
following 14 weeks of supervised pelvic floor (PF) muscle training.
Practicing PFE is an important element in the prevention and rehabilitation
process (Messer et al., 2007; Geoffrion et al., 2009). Meanwhile, Geoffrion
et al. (2009) showed an improvement in symptoms and quality of life by PFE.
The last few years have seen a growing interest in the field of yoga, as
well as, in the practice of pelvic floor yogic exercise (PFYE) as a very
effective method for restoring PFD. Ancient Indian texts report similar
exercises as the "Mudra" and "Bandha" practiced by the
yogis. In Yoga texts, Moola bandha is usually defined as the activation of
the perineum, i.e. the soft tissue area between the anus and the genitals
(Saraswati, 1999). There are two Mudras that are closely related to Moola
bandha. One is the Ashwini Mudra, activated by contracting the sphincter
muscles of the anus. The second is the Sahajoli Mudra for females or the
Vajroli Mudra for males, either of which are activated by contracting the
sphincter of urethra, i.e. action of stopping the flow, midstream, when
urinating (Saraswati, 1999). The practice of PFYE improves the strength of
PF muscles and helps in increasing their tone. The parturient mothers can
be trained with these exercises, thereby improving their ability to release
these muscles at the time of child birth. It is important to learn how to
release these muscles and how to tighten them as well. In PFYE, the simple
Kegel exercises practiced are associated with breathing exercises. The
proper work of strengthening and stabilizing the PF with PFYE helps to
create the correct foundation of each movement of the pelvis. PFYE helps in
three ways: a) the yoga posture isolates and strengthens the PF muscles, as
well as stretches and lengthens them; b) breathing can release tension and
direct healthy, oxygenated blood to the pelvis; and c) the yogic posture
helps in strengthening the core postural muscles which are directly linked
to the PF muscles. A healthy relationship between core muscles and PF
muscles is very important to the overall health of the pelvis.
In this article, we have explored the significance of "Bandha and
Mudra" in PFD. Particular attention is paid to the anatomical
association of Bandha and Mudra. It has been recognized that all the female
patients with PFD can benefit from education on PFYE. Specialized
therapeutic PFYE has been discussed, which actually can improve the quality
of life of women experiencing incontinence, pelvic organ prolapse, and
variety of pelvic pain syndromes.
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PF Anatomy,
Function, and Dysfunction
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The PF strength is maintained by the synergistic action of the ligaments,
fascia, and muscles of the pelvis. The normal function of the pelvic organs
depends upon the PF structure. Peschers, Schaer, DeLancey, and Schuessler
(1997) evaluated the function of levator ani (LA) before and after
childbirth, and found that muscle strength was much reduced for 3-8 days
postpartum following vaginal birth, but not after cesarean delivery, and
returned to ante-partum status within 2 months for most women. Allen,
Hosker, Smith and Warrell (1990) demonstrated a persistent reduction in
muscle contraction strength after child birth.
The following changes weaken the PF structures and reduce the LA strength:
- Stretching and
relaxation of the PF muscle, ligaments, and fascia during child birth
and pregnancy. Vaginal delivery is known to be associated with damage
to the PF innervation, direct trauma to the LA muscle and endopelvic
fascia by way of stretching
- Perineal damage
during child birth
- Trauma or congenital
defect in the PF musculature that allows the bladder neck and base to
descend outside the anatomical PF
- Previous surgical
procedures that weaken surrounding musculature or fascia.
The women's PF is traditionally defined as a ligament-muscular apparatus
that provides a dynamic support to the urethra, bladder, vagina, and
rectum. It is divided into supporting and suspensory parts. The supporting
part of PF is formed of muscles (the levator ani), while the suspensory
part is formed by fascia and ligaments. The supporting element of PF is a
gutter-shaped thin sheet of muscular partition which is slung like a hammock
around the mid-line pelvic effluents (urethra, vagina, and anal canal). The
basic foundation of female pelvic support consists of the paired LA
providing an active floor to support the weight of the abdomino-pelvic
contents against the forces of intra-abdominal pressure (DeLancey, 1993;
Wall, 1993). This muscular plate extends from the pubic symphysis to the
side wall of the ileum toward the coccyx [Figure 1] and [Figure 3]. The suspensory ligaments form the middle
support of the PF whereas, the pubo-urethral ligaments form the main
support of the bladder neck. The pubo-urethral ligaments are attached to
either side of the posterior third of the urethra and provide vaginal
support for proper elevation of the uretrovesical junction. The presence of
the nerve, smooth muscle, and blood vessels indicates that ligaments are an
active contractile structure. Laxity in the pubo-urethal ligament can
contribute to urinary incontinence in women (DeLancey, 1993), while laxity
in the cardinal ligaments gives rise to utero-vaginal descend.
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Figure
1: Pelvic floor anatomy showing the components of levator ani muscle
Click here to view
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Primarily the PF dysfunction involves the pelvic diaphragm or LA muscle.
Therefore, the purpose of exercise is to increase the LA muscle volume and
strength, which will increase the maximum urethral closure pressure and
stronger reflex contraction following rise in intra-abdominal pressure. It
was also suggested by DeLancey in 1988 that contraction of the LA muscle
moves the vesicle neck anteriorly, compressing it against the precervical
arc, favoring the closure. The objective of PFYE is to improve, the
contraction time of the PF muscle, and also its strength. Strength training
of the PF muscle will build muscle bulk and, thereby, provide structural
support to the PF by permanently elevating the muscle plate to a higher
position in the pelvis.
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Anatomical
Corelation of Pfye
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Sahajoli Mudra (for women) (Saraswati, 1999)
The term "Sahajoli" is derived from the root word
"Sahaj," meaning "spontaneous". It regulates and tones
the entire urogenital system.
sahajoliriyaṃ proktā śraddheyā yoghibhiḥ
sadā ǀ
ayaṃ śubhakaro yogho bhogha-yuktoapi muktidaḥ ǀǀ
94 ǀǀ
Meaning: This is called Sahajoli, and should be relied on by yogis. It does
good and gives Moksa (Sinh, 1914, p. 133).
How to perform
Sit in any comfortable meditation posture with the head and spine straight
and place the hands on the knee in Jnana Mudra. In the Jnana Mudra, fold
the index fingers so that they touch the inside root of the thumbs.
Straighten the other three fingers of each hand so that they are relaxed
and slightly apart. Place the hands on the knees with palms of both hands
facing upward.
- Relax the hands and
arms. Close the eyes and relax the whole body. Take the awareness to
the urethra [Figure 1] and [Figure 3]. Inhale, hold the breath inside, and
draw the urethra upward by contraction of the muscles. This action is
similar to holding back an urge to urinate. The labia in a woman
should move slightly upward during the contraction. Hold the
contraction for a comfortable duration as long as possible, starting
with a few seconds and gradually increase to as much as you can.
Exhale while releasing the contraction and relax. Repeat the same
steps three times to begin with and gradually increase it to 10 times
- Awareness- Physical
awareness on the urethra
- Contraindication-
Sahajoli Mudra should not be practiced by people suffering from
urethritis.
Anatomical correlation of Sahajoli Mudra
The LA muscle is a complex unit that consists of several muscle components
with different origins and insertions and, therefore, perform different
functions. Knowing the precise attachments, the function of each LA
component allows better understanding of PF anatomy and its correlation
with Mudra and Bandha. LA consists of pubococcygeus (PC), iliococcygeus,
and ischiococcygeus muscles from before backward. PC is further divided
into the pubovaginalis, puboanalis, and puboperineal muscles, according to
the attachments [Figure 1].
The muscle which is primarily strengthened in the practice of the Sahajoli
Mudra is pubovaginalis. The pubovaginalis refers to the medial fibers of PC
that attach to the lateral walls of the vagina. Although there are no
direct attachments of the LA muscles to the urethra in females, those
fibers of the muscle that attach to the vagina are responsible for
elevating the urethra during a pelvic muscle contraction. In the Sahajoli
Mudra, our awareness is toward the urethra. It involves inhaling, then
holding the breath inside and drawing the urethra upward by contraction of
the muscle. It helps in lifting up of the urethra while inhaling and
contraction of the pubovaginalis parts of LA muscle while holding of
breath. So, the practices of Sahajoli Mudra give strength to the
pubovaginalis part of PF and prevent PFD, especially bladder neck
dysfunction.
Vajroli Mudra (for men) (Saraswati, 1999)
The word "Vajroli" is derived from the Sanskrit root
"vajra," which means "thunderbolt,"
"lightning," or "mighty one." It is a unique procedure
of yoga which is very useful in conditions like premature ejaculation,
urinary incontinence (Muktibodhananda, 2005).
karaṇï viparïtākhyā vajrolï śakti-chālanam ǀ
idaṃ hi mudrā-daśakaṃ jarā-maraṇa-nāśanam
ǀǀ 7 ǀǀ
Meaning: Viparξta Karanξ, Vajroli, and Śakti Chβlana.
These are the 10 Mudrβs which annihilate old age and death (Sinh,
1914, p. 137).
How to perform
Sit in any comfortable meditation posture with the head and spine straight.
Place the hands on the knees in Jnana Mudra. Close the eyes and relax the
whole body. Take the awareness to the urethra [Figure 4]. Inhale, hold the breath inside, and draw
the urethra upward. This action is similar to holding back an intense urge
to urinate. The testes should move slightly upward during this contraction.
Confine the contraction to the urethra. Hold the contraction for as long as
comfortable, starting with a few seconds and gradually increasing. Exhale,
releasing the contraction, and relax.
Duration: Begin with 3 contractions and slowly increase to 10.
Awareness: Physical- on isolating the point of contraction, avoiding
generalized contraction of the pelvic floor
Contraindications: Vajroli should not be practiced by people suffering from
urethritis as the irritation and pain may increase.
Benefits: Vajroli/Sahajoli Mudra regulates and tones the entire urogenital
system. It helps overcome psycho-sexual conflicts and unwanted sexual
thoughts. It conserves and redirects energy, enhancing meditative states.
Anatomical correlation of Vajroli Mudra
The coordinated activity between the urinary bladder and brain controls the
urinary function. The bladder stores urine because the smooth muscle of the
bladder (detrusor muscle) relaxes and the bladder neck and urethral
sphincter mechanism is closed. The urethral sphincter is a circular muscle
that wraps around the urethra. During urination, the bladder neck opens,
sphincter relaxes, and bladder muscle contracts. Incontinence occurs if the
closure of the bladder neck is inadequate. The bladder neck and membranous
parts of urethra are innervated by pudendal nerve (S2, S3, S4) [Figure 2] and this innervation is responsible for
voluntary control of micturition. The muscle which is mainly strengthened
in the practice of Vajroli Mudra is an external sphincter (sphincter
urethrae) [Figure 4]. The external sphincter surrounds the
membranous parts of the urethra and is derived from sphincter urethrae
muscle [Figure 4]. The practice of Vajorli Mudra can fortify
the sphincter muscle and improve the urinary control.
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Figure
2: Innervations of uninary bladder and external urethra sphincter
Click here to view
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Figure
3: Sagittal section of female pelvis, showing relation with mudra
Click here to view
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Figure
4: Male urethra (sagittal view) relation of external urethral sphincter
and vajroli mudra
Click here to view
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Ashwini mudra (Saraswati, 1999)
"Ashwini" means 'horse'. The practice resembles, the movement a
horse makes with its sphincter, immediately after evacuation of the bowels.
Technique 1: Rapid contraction
Sit in any comfortable meditative posture (asana). Close the eyes and relax
the whole body. Become aware of the natural breathing process. Take the
awareness to the anus. Rapidly contract the anal sphincter muscle for a few
seconds without straining [Figure 1] and [Figure 4] and then relax it. Contraction and
relaxation should be performed 10-20 times smoothly and rhythmically.
Gradually make contractions more rapidly.
Technique 2: Contraction with kumbhaka (holding of breath inside)
Sit in any comfortable meditation posture. Close the eye and relax the
whole body. Inhale slowly and deeply while simultaneously contracting the
anal sphincter muscle, mainly puboanalis and puborectalis. Practice
internal breath retention (antar kumbhaka) while holding contraction of the
anal sphincter muscle as tightly as possible without strain. Exhale while
releasing contraction of the anal sphincter. Perform it for 5-10 rounds.
Contraindication- People with high blood pressure or heart disease should
not practice Ashwini Mudra with antar kumbhaka.
Benefits- This practice strengthens the anal muscle.
Anatomical correlation of Ashwini Mudra
The muscles which are mainly strengthened in the practice of the Ashwini
Mudra are puboanalis and puborectalis. The puboanalis refers to the fibers
attached to the anus at the inter-sphincteric groove between the internal
and external anal sphincters [Figure 3]. These fibers elevate the anus. The
puborectalis fibers of PC wind around the posterior aspect of the
ano-rectal junction and continue with similar fibers of the opposite
muscle, forming U-shaped loop known as the puborectal sling. The practice
of Aswini Mudra provides strength to the puboanalis and puborectalis parts
of the PC.
Moola Bandha
In Sanskrit, "Moola" means "root." In this context, it
refers to the perineum. Moola Bandha (the root lock) is a gentle contraction
of the pelvic diaphragm and the muscles of the urogenital triangle which
include the muscles associated with the genitals and the urethra.
Meaning: The person who desires to cross the ocean of Existence, let him go
to a retired place and practice in secrecy this Mudra. By the practice of
it, the vayu (prana) is controlled; let one silently practice this, without
laziness and with care (Vasu, 1979).
How to perform Moola Bandha (perineum contraction) (Satynanda, 1999)
Stage 1- Sit in a comfortable meditative posture. Close your eyes and
relax the whole body. Be aware of the natural breath. Focus the awareness
in the perineal region. Contract this region by pulling on the muscles of
the pelvic floor and then relax them. Continue to briefly contract and
relax the perineal region as rhythmically and evenly as possible. Breath normally
during the practice of this yogic exercise and you should not hold the
contraction any time.
Stage 2- Continue to breathe normally without holding it. Slowly
contract the perineal region and hold the contraction. Contract it a little
tighter, but keep the rest of the body relaxed. Contract only those muscles
related to the mooladhara (perineal) region.
Stage 3- As you breathe in, lift the perineum upward. Breathe out
and slowly down the lower back.
Anatomical correlation of Moola Bandha
The muscle which is mainly strengthened in the practice of the Moola Bandha
is puboperinealis muscle. Puboperinealis refers to the fibers that attach
to the perineal body (PB). The PB is the central tendon of the perineum [Figure 1] and [Figure 3] which is located at the dividing line
between the anal and urogenital triangles, and it is the central body mass
of dense connective tissue found between the distal third of posterior
vaginal wall and the anus below the pelvic floor. It is formed by the
midline connection between the halves of the perineal membrane, which is
known as urogenital diaphragm (UGD) and provides support to the distal
vagina and urethra by attaching these structures to the bony pelvis
(DeLancey, 1999). The PB supports the distal vagina and rectum.
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Conclusion
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The anatomical correlation of the yogic exercise with PFD is quite
convincing as it enhances the tone and integrity of the PF muscles by
providing the strength to various components of the PF muscles and
ligaments. It can be used to formulate preventive and therapeutic
strategies toward the PFD. Group instructions supplemented with brief
individual instruction can be an effective method to improve PF strength.
Research work is very scanty on this subject. So, more number of randomized
controlled trials (RCTs) and cohort studies are required in this field.
Future research could concentrate on assessment of PF function before and
after the PFYEs.
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References
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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