Friday Q&A: Organ Prolapse and Intra-Abdominal Pressure

White Rose by Melina Meza

Today’s question was left as a comment on our post Organ Prolapse and Yoga, which was written by guest contributor Shelly Prosko. Rather than just leaving a short answer in the comments section, Shelly decided to write long, more thorough answer that we could share with all our readers. Thank you, Shelly!

Q: Thanks for the more nuanced understanding of this issue. Could you help me understand why uddiyana bandha increases IAP (intra-abdominal pressure)? My experience and theoretical understanding suggest that is would decrease pressure because a) the diaphragm is rising, thus relieving pressure on the abdomen, b) the pelvic floor will slightly life if it is relaxed during uddiyana, a sign of decreased pressure, c) the lungs are at less than atmospheric pressure, which should drop general fluid pressure in the torso. Am I missing something?

A: Thanks for your thoughtful and wonderful observation, insight, and question. It gives me an opportunity to more thoroughly explore this topic, and gives me a chance to better explain my perspective about re-evaluating the use of uddiyana bandha for prolapse.

You said, "the diaphragm is rising, thus relieving pressure on the abdomen". Well, yes, the diaphragm ascends on exhalation, but that doesn't automatically decrease intra-abdominal pressure (IAP). If abdominal muscles are engaging such that it increases pressure in the system (the abdominal cavity being the hydraulic part of the piston system), the intra-abdominal pressure may not necessarily be reduced at the end of exhalation, when the diaphragm is elevated.

You also said, "the pelvic floor will slightly life (lift) if it is relaxed during uddiyana, a sign of decreased pressure." I agree for the most part. If the pelvic floor and abdominals are truly relaxed and they draw upward/inwards during uddiyana bandha, one would assume the intra-abdominal pressure has reduced, resulting in a passive lifting effect of the abdominal and pelvic organs. However, it's a challenge to know if the pelvic floor is completely passively lifting or actually actively lifting without EMG, US, or internal manual palpation.

This is where I feel I need to clarify my perspective and explain my experience (personal and clinical) with uddiyana bandha. I am by no means a bandha expert. I understand there are different interpretations and teachings of uddiyana bandha, depending on lineage. Some of these may potentially increase intra-abdominal pressure, others may decrease intra-abdominal pressure, depending on how it is taught and understood.

Here is my translation and understanding of how uddiyana bandha is supposed to be performed (please feel free to add/clarify from your knowledge): After a full exhalation, breath is retained. The intercostals and perhaps even some accessory muscles of respiration are supposed to then be engaged to expand the rib cage, therefore increasing volume in the thoracic cavity which will create reduced intra-thoracic pressure. This, in turn, is supposed to pull up the respiratory diaphragm because of the vacuum created, which in turn is supposed to passively “suck” the abdominal organs up higher. One would assume the same for pelvic organs.

Although even though the “abdominal lock” is supposed to be a passive indrawing/lifting of the abdomen, I believe it is rarely taught or performed (in our western mainstream yoga culture) this way. Even the way we've translated it as the “abdominal lift” can be confusing. To me—and I know many others—this implies that the primary action is to “lift or pull in the abdomen” Instead, maybe we should call it “rib cage vacuum.”

But I've seen videos, books, and teachers give instructions to "pull the abdomen in." If that is the case, then potential is there to incorrectly use surrounding trunk/abdominal muscles to move the abdomen, increasing intra-abdominal pressure, which may be unfavorable for someone with prolapse. (I sure would love to do a study though!)

So, I do feel that people suffering from organ prolapse should re-evaluate their use of uddiyana bandha if they are performing it, particularly if they are performing this bandha regularly, thinking it should help, but they are getting worse (which I've witnessed). In retrospect, I would have re-worded my statement: "precaution with advanced yoga methods such as uddiyana bandha, as this could potentially increase intra-abdominal pressure if not performed correctly."

Finally, reader, I think you're onto something. There is actually a relatively new approach to treating reproductive organ prolapse that is gaining popularity in the pelvic health world called hypopressives. From photos/videos, it looks interestingly similar to uddiyana bandha. Research is still in its infancy, but perhaps there is actually some therapeutic value in uddiyana bandha for reproductive organ prolapse! 

Thanks for opening up this conversation and providing me with this opportunity to expand on this topic. Hope this helps clarify my article.

—Shelly

Disclaimer: This article is not meant to diagnose, treat or act as medical advice. Please consult your health care provider for clearance and guidance before following or participating in these activities. 

Shelly Prosko is a Physical Therapist, Yoga Therapist and a Certified Pilates Instructor. She received her Physical Therapy degree at the University of Saskatchewan, Canada in 1998, her Yoga Therapist training through Professional Yoga Therapy Studies in North Carolina and her Pilates certification through Professional Health and Fitness Institute in Maryland. 

Since 1998, Shelly has been integrating yoga principles and methods into her physical therapy treatments. She has treated a wide variety of musculoskeletal, neurological and cardiorespiratory  conditions while working in private orthopaedic clinics and long term care facilities across Canada and the United States.


Currently, Shelly resides in Sylvan Lake, AB and travels across Canada and the United States offering specialty Physio-Yoga Therapy workshops, classes, private sessions, lecturing at University and College programs as adjunct faculty of Professional Yoga Therapy Studies, teaching at YTT’s and actively promoting the integration of medical therapeutic yoga into our current healthcare system. She believes that bridging the gap between Western and Eastern healthcare philosophies is essential in order to achieve optimal health. Her treatments are individually based and are a unique blend of both approaches. Please visit www.physioyoga.ca for more information about Shelly’s mission and services, and to read a variety of testimonials of how PYT has profoundly influenced many people’s lives.

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