If you find yourself the butt of irritating “mom always has to pee” jokes, tell those jokers to can it. For one thing, having children is a common cause of those symptoms later in life—frequent urination or incontinence affects more than half of all post-menopausal women. For another, those symptoms are no joke: Incontinence can contribute to serious health issues if left untreated.
“It’s accepted as status quo, like this is just normal,” says Leslee Subak, MD, a gynecologist at Stanford who researches urinary incontinence in women. In fact, “it’s not normal. It is common, but it’s not normal. And it’s a problem.”
Incontinence can contribute to fall and fracture risk and can cause people to become less physically and socially active. That can lead to myriad health problems from depression to cardiovascular issues and beyond. Incontinence is also a leading reason that people become nursing home residents, which can be difficult for individuals and balloon healthcare costs.
“Bladder problems are a big problem for an individual, the family, and for our national healthcare budget,” Dr. Subak says. “We haven’t actually worked it into our social and medical systems to take care of urinary problems and incontinence.”
For all of those reasons, Dr. Subak has been studying behavioral interventions to improve bladder control. Typically, doctors will recommend doing things like learning to engage your pelvic floor before you have to sneeze, and strengthening that pelvic floor with exercises like kegels. But recently, Dr. Subak learned something else was helping people: Iyengar yoga.
Iyengar is a more restorative form of yoga. Over the past few years, yoga teacher Leslie Howard saw her clients’ bladder problems were improving, so she started specifically offering yoga for pelvic floor health. She told Dr. Subak that the proof was in the pudding, but, as a researcher, Dr. Subak needed to know for sure.
“[Howard] had been a pelvic floor yoga practitioner for years, and she was like, ‘this stuff works,’” Dr. Subak says. She asked Howard “‘How do you know, it works, you haven’t actually tested it?’ And that’s when we started doing our small trials, that turned into a bigger trial to see if yoga was actually effective.”
In August, Dr. Subak and her co-authors published a study of 240 women over the age of 45 who experience bladder urgency daily. Half of the group did “pelvic floor yoga” 3 times per week for 12 weeks to see if it would improve incontinence, while the other half did general strength and conditioning. Women in both groups experienced about one third the amount of urgency and incontinence that they did before.
“If we can get between a 50 and 70 percent improvement in the number of incontinent episodes or incontinent frequency, that’s considered very effective, because that’s the point at which patients and participants say, I feel much better, I’m much better off,” Dr. Subak explains. “It turned out that both of the interventions met that criteria. So they both had a very good reduction in incontinence.”
The most surprising aspect of the study to Dr. Subak was that neither type of exercise actually targeted the pelvic floor specifically. The strength and flexibility regimen included moves like bicep curls. And the “pelvic floor yoga” moves were just common poses in an Iyengar practice that were accessible to people of all ages.
“We were just kind of intrigued about why this might work,” Dr. Subak says. “We didn’t specifically say we want moves that focus on the pelvic floor or the core. We went with what she had been doing.”
Dr. Subak and her co-authors aren’t exactly sure why yoga, and fitness overall, improve incontinence, but they have a theory.
“Our hypothesis is that it works not only by possibly strengthening the pelvic floor, but by also changing the nervous system balance so that you’re a little bit more parasympathetic, which is a more relaxed state which can help the bladder be calm,” she says.
It’s also possible that connecting with the breath plays a role, but Dr. Subak has not tested that specifically. Another factor includes just being more physically active.
“No matter what, being physically active is great for your health,” Dr. Subak says. “If it happens to improve your incontinence, that’s fantastic.”
10 yoga poses for incontinence
Want to give yoga that’s scientifically linked to improved bladder control a shot? The women in the study did 16 poses three times a week. These are 10 of our favorites. Don’t forget to breathe!
1. Parsvakonasana: Side angle pose
Want to open up your lower body and upper body at once? Side angle hits your hips, groin, chest, shoulders, and back all at once, while also delivering an isometric challenge to your core, quads, and hamstrings.
Your browser does not support the video tag.
Begin in a lunge, with your front knee bent and your other leg straight back behind you.
Place your back foot down so that it’s perpendicular to your front foot. This should open your hips and upper body to the side.
Lean over the front leg and place your arm on your thigh or on the floor. Hold.
2. Salabhasana: Locust pose
Activating the stabilizer muscles along your spine, and working the upper back, is crucial to maintaining good posture. Locust pose does just that.
Photo: Rachel Hirsch, RYT
Lie on your stomach with your arms by your sides.
Simultaneously lift your legs and chest off the floor.
If you can, grasp your hands together behind your back.
3. Salamba Setu Bandhasana: Supported bridge pose
Bridge pose is a classic glute and hamstring building pose that also sneakily works your core and opens up your chest.
Photo: Katherine Englishman, RYT-500
Lie face up with your knees bent and feet flat on the floor.
Place your hands at the small of your back.
Lift your hips up into the air using your glutes, but continue to support your hips with your arms by keeping your elbows on the floor.
Alternatively, you can place a yoga block under your lower back to support your bridge.
4. Supta Baddha Konasana: Reclined cobbler’s pose
The longer you stay in cobbler’s pose, the more you’ll feel your hips start to fall open little by little. Where your knees start is not where they’ll end up.
Photo: Katherine Englishman, RYT-500
If you have a bolster, set it lengthwise in the middle of your mat and sit up against the short edge at the bottom.
Inhale to elongate your spine and lie back onto the mat or the bolster, then bring the soles of your feet together.
Use any other props, like a blanket or eye pillow to make the adjustments you need.
Relax your arms alongside you or place them on your heart or belly (or place one hand on your heart and the other on your belly).
5. Tadasana: Mountain pose
Mountain pose is so much more than just standing up straight. Check in with your different body parts, and turn the pose “active” by engaging your muscles throughout the body.
Your browser does not support the video tag.
Stand up straight with your feet hip width apart and arms down by your sides.
Open your chest and breathe.
To extend, lift your arms above your head, then bring your hands together at your chest.
6. Trikonasana: Triangle pose
Triangle pose is all about tuning into your form. Are your hips facing to the side, or are you twisting? Is the side of your body closest to your leg scrunched up or elongated? Done correctly, triangle will help give a great stretch in your side and hips while also activating your muscles throughout the body to maintain that balance.
Photo: Katherine Englishman, RYT-500
Stand in a staggered position, with one foot in front of the other.
Turn your back foot so that it is flat on the ground (this will open your hips and torso to the side).
Lift your arms in line with your shoulders, parallel to the floor.
Shift your hips back toward your back leg, while still keeping them open to the side.
Simultaneously shift your torso and front arm to the front, equal and opposite to the hip.
Place your front arm where it naturally lands on your front leg and lift your back arm straight up to the sky.
7. Utkatasana: Chair pose
The yoga class burner is a classic for a reason. In chair pose, make sure to tuck your pelvis so that you’re not over arching in your lower back. This will also turn on your hamstrings for an even more intense leg workout.
Your browser does not support the video tag.
Begin standing with your feet touching each other.
Shift your hips back into a seated position and bend your knees to lower.
Raise your arms.
8. Viparita Karani: Variation Legs up the wall pose
Reversing your blood flow in legs up the wall can help send blood and oxygen to muscles throughout your body, which aids in recovery.
Photo: Nicole Vincent/YogaSix North Carlsbad
Place a blanket on the floor where it meets the wall.
Scoot up towards the wall so that your bottom is on the blanket, and your torso is resting on the floor.
Lift your legs up so that your heels are touching the wall.
Rest and breathe.
9. Virabhadrasana 2: Warrior 2 pose
You’ll have to engage those quads and hamstrings, not to mention those shoulders and triceps, if you want to stay balanced and in warrior 2 pose.
Your browser does not support the video tag.
Begin in a lunge, with the knee of your front leg bent, and your back leg straight.
Twist your torso and hips open to the side as you flatten your back foot onto the ground.
Send your arms up to shoulder height, with one in front of you and one behind you, parallel with the floor.
Look out over your front arm and hold.
10. Savasana: Corpse pose
If you worked up a sweat, savasana is amazing for helping return your nervous system to that parasympathetic state. Who couldn’t use a moment to lie down?
Your browser does not support the video tag.
Lie on your back on your yoga mat. Extend your legs out long on the mat, allowing your feet to fall open naturally.
Place your arms alongside your body, palms facing up and fingers curled naturally.
Close your eyes gently and allow your entire body to relax.
Let go of any tension in your muscles, starting from your feet and working your way up to your head.
Bring your awareness to your breath, observing the natural rhythm of your inhales and exhales.
Remain here for as long as you’d like.
When you’re ready to transition out of savasana, begin to deepen your breath and gently wiggle your fingers and toes to bring movement back to your body.
