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REVIEW ARTICLE

Year : 2014  |  Volume : 46  |  Issue : 3  |  Page : 59-63

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

Date of Web Publication

1-Jul-2015

 

Correspondence Address:
Dr. Mrithunjay Rathore
Kabir Nagar, AIIMS Residential Complex, Type 4 Quarters, Flat No: 201, Raipur, Chhattisgarh - 492 099
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DOI: 10.4103/0044-0507.159737

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  Abstract

 

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 2019 Apr 18];46:59-63. Available from: http://www.ym-kdham.in/text.asp?2014/46/3/59/159737

  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.

  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.

Figure 1: Pelvic floor anatomy showing the components of levator ani muscle

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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.

  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).

karaṇī viparītākhyā vajrolī 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.

Figure 2: Innervations of uninary bladder and external urethra sphincter

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Figure 3: Sagittal section of female pelvis, showing relation with mudra

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Figure 4: Male urethra (sagittal view) relation of external urethral sphincter and vajroli mudra

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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.

  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.

 

  References

 

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1.

Allen, R. E., Hosker, G. L., Smith, A. R., & Warrell, D. W. (1990). Pelvic floor damage in childbirth: A neurophysiological study. British Journal of Obstetrics and Gynaecology, 97 (9), 770-779.  Back to cited text no. 1
    

2.

Balmforth, J., Mantle, J., Ashton-Miller, J. A., Bidemead, J., & Cardozo, L. (2006). A prospective observational trial of pelvic floor muscle training for female stress urinary incontinence. BJU International, 98 (4), 811-817.  Back to cited text no. 2
    

3.

DeLancey, J. O. (1993). Anatomy and biomechanics of genital prolapse. Clinical Obstetrics and Gynecology, 36, 976-983.  Back to cited text no. 3
    

4.

DeLancey, J. O. (1999). Structural anatomy of the posterior pelvic compartment as itrelates to rectocele. American Journal of Obstetrics and Gynecology, 180 (4), 815-23.  Back to cited text no. 4
    

5.

Geoffrion, R., Robert, M., Ross, S., van Heerden, D., Neustaedter, G., Tang S.,… Milne, J. (2009). Evaluating patient learning after an educational program for women with incontinence and pelvic organ prolapse. International Urogynecology Journal and Pelvic Floor Dysfunction, 20 (10), 1243-1252.  Back to cited text no. 5
    

6.

Kegel, A. H. (1948). Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology, 56 (2), 238-49.  Back to cited text no. 6
    

7.

Messer, K. L., Hines, S. H., Raghunathan, T. E., Seng, J. S., Diokno, A. C., & Sampselle, C. M. (2007). Self-efficacy as a predictor to PFMT adherence in a prevention of urinary incontinence clinical trial. Health Education and Behavior, 34 (6), 942-952.  Back to cited text no. 7
    

8.

Peschers, U. M., Schaer, G. N., DeLancey, J. O., & Schuessler, B. (1997). Levator ani function before and after childbirth. British Journal of Obstetrics and Gynaecology, 104 (9), 1004-1008.  Back to cited text no. 8
    

9.

Russell, B., & Brubaker, L., (2008). Muscle function and ageing. In K. Baussler, B. Shussler, K. L. Burgio, K. H. Moore, P. A. Norton, & S. Stanton (Eds.), Pelvic Floor Re-education (2nd ed.). London, UK: Springer.  Back to cited text no. 9
    

10.

Saraswati, S. S. (1999). Asana Pranyama Mudra Bandha. (pp. 466-467, p. 476). Munger, Bihar: Yoga Publicataions Trust.  Back to cited text no. 10
    

11.

Sung, V. W., & Hampton, B.S. (2009). Epidemiology of pelvic floor dysfunction. Obstetrics and Gynecology Clinics of North America, 36(3), 421-443.  Back to cited text no. 11
    

12.

Muktibodhananda, S. (2005). Hatha Yoga Pradipika (2nd ed.). Munger, Bihar: Yoga Publications Trust.  Back to cited text no. 12
    

13.

Gheranda (1979). The Gheranda Samhita (p. 22). (R. Bahadur & S. C. Vasu, Trans.). New Delhi, ND: Shi Satguru Publicataions. (Original work published 1914-15).  Back to cited text no. 13
    

14.

Wall, L. L. (1993). The muscles of the pelvic floor. Clinical Obstetrics and Gynecology, 36, 910-925. 897-909).  Back to cited text no. 14
    

15.

Sinh, P. (1914). Hatha Yoga Pradipika. Retrieved from http://sacred--texts.com/hin/hyp/index.htm.  Back to cited text no. 15
    

 

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