Significance of Mula Bandha for Urinary Incontinence in Women

Pratima Maurya *, Prof H H Awasthi**

Abstract
Mula Bandha is the most important part of the Hatha yoga tradition. It is known
as the ‘perineal lock’, contraction of the muscles around the perineal body in the
male and the cervix in the female, in order to release and control energy
generated by the mooladhara chakra. This lock affects the physical and psychic
body.

Leakage of urine is called urinary incontinence. Urinary incontinence is more

common in women than in men and affects women of all ages. The underlying
cause of urinary incontinence is pelvic floor weakness. In yoga, the pelvic floor
exercise, or mula bandha, is one of the fundamentals of core body strength. The
practice of mula bandha tones and strengthens the muscles of the pelvic region.
Pregnancy and vaginal delivery are considered to be the main risk factors for the
development of urinary incontinence in women because pregnancy and
childbirth may cause damage to the fascias, ligaments, pelvic floor muscles, and
nerves supporting and controlling the bladder neck and urethra. To prevent
urinary incontinence, women have been encouraged to conduct pelvic floor
exercises during pregnancy and after childbirth. Many research studies have
found that the pelvic floor exercises were very effective in improving symptoms
of Stress Urinary Incontinence.

Keywords: Mula bandha, Perineal body, Urinary incontinence, Pelvic floor,

Pregnancy, Childbirth.

Introduction
Mula Bandha is the most important part of the
Hatha yoga tradition, and it is the base of
Pranayama and meditation. It helps to increase our
pranic energy upward, which Patanjali tells us, is
where the mind “becomes fit for concentration”,
then only, says the great yogic sage, is meditation
possible (PYS 2,53). Additionally, if we practice
Mula Bandha properly, the contraction at the base
(mula) of our bodies will, according to the Hatha
Yoga Pradipika, allow the apana vayu, the
downward force of energy within our body, and
change the direction and move upwards to unite with
the prana vayu. When these two energies (vital
breaths) meet certainly we will achieve success in
yoga (HathYogPradipika 3, 60-68).1
Definition
The Sanskrit word Mula means ‘root, firmly fixed,
source or cause, basis, the foot, the lowest part or
bottom, foundation’. Bandha means ‘lock, restrain,
shut or close’. Together the word mula and bandha
refer to the contraction of mooladhara chakra, the
seat of kundalini. This contraction is triggered at the
‘root’ of the spine or the trunk of the body, the
perineum. Mula bandha is known as the ‘perineal
lock’, contraction of the muscles around the perineal
body in the male and the cervix in the female, in
order to release and control energy generated by the
mooladhara chakra.2
According to Hatha Yoga Pradipika “Press the heel
against the perineum and contract it firmly. Draw
the apana upwards. This is known as mula bandha”
(3/61).
This lock affects the physical and psychic body.
Scientists found by locking or contracting certain
muscles on the physical level, a subtle process of
unlocking goes on simultaneously on the mental and
pranic level. Mula bandha associate with energy
centers in the spine and brain. Using these locks

*
Ph.D. Scholar, Department of Rachana Sharir, Faculty of Ayurveda, IMS, BHU.
**
Professor & Head, Department of Rachana Sharir, Faculty of Ayurveda, IMS, BHU.
Correspondence to: Ms Pratima Maurya, Ph.D. Scholar, Department of Rachana Sharir, Faculty of Ayurveda, IMS, BHU.
E-mail Id: pratima.maurya08@gmail.com

© ADR Journals 2015. All Rights Reserved.

21
helps the endocrine and nervous systems to function
more properly, stimulating positive responses
throughout the whole body. The root of the nervous
system begins from the pelvic floor and ends in the
crown, so we can understand that Mula bandha
work as a starter and promotes energy downward to
upward. By practicing mula bandha, our nervous
system is stimulated positively and modifies the way
the brain receives information by balancing out
mental and physical function-(Sheri Cherokee).1
Procedure of Mula Bandha
This Bandha involves contraction of the muscles of
the perineum and specially the muscles of pelvic
floor. This contraction is important and
characteristic.
 Sit in siddhasana or siddha yoni asana so that
pressure is applied to the perineal/ vaginal
region. The area to be contracted is the physical
location of mooladhara chakra.
 For men, this is located in the perineum,
between the anus and the sexual organ.
 For women, the trigger-point is located behind
the cervix where the uterus and vagina meet.
 Close the eyes and relax the whole body.
 Inhale deeply, retain the breath inside and
contract the perineal/ vaginal muscles as tightly
as possible, without strain.
 Hold the final position for as long as possible.
 Slowly release the Moola bandha, by rising the
head to the upright position, and exhale
gradually.
 Repeat the practice 10 times with maximum
contraction and total relaxation.
 At first, practice short contractions and as
control improves increase the duration of the
contraction.3
Urinary Incontinence
Leakage of urine is called urinary incontinence.
Urinary Incontinence is defined by the International
Continence Society as “the complaint of any
involuntary leakage of urine.” Urinary incontinence
is more common in women than in men and affects
women of all ages.4 Pregnancy and childbirth,
menopause, and the structure of the female urinary
tract account for this difference.5 Prevalence rates in
J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(1): 20-23.
Maurya P et al.
women between 15 and 64 years of age vary from
10% to 30%. However, prevalence estimates of
urinary incontinence during pregnancy and after
childbirth are even higher, varying between 20% and
67%, and 0.3% and 44%, respectively.4 Some
women may lose a few drops of urine while running
or coughing. Others may feel a strong, sudden urge
to urinate just before losing a large amount of urine.
Many women experience both symptoms.5
Types of Urinary Incontinence
1. Stress Incontinence: Leakage of small amounts
of urine during physical movement (coughing,
sneezing, and exercising).
2. Urge Incontinence: Leakage of large amounts of
urine at unexpected times, including during
sleep.
3. Overactive Bladder: Urinary frequency and
urgency, with or without urge incontinence.
4. Functional Incontinence: Untimely urination
because of physical disability, external
obstacles, or problems in thinking or
communicating that prevents a person from
reaching a toilet.
5. Overflow Incontinence: Unexpected leakage of
small amounts of urine because of a full
bladder.
6. Mixed Incontinence: Usually the occurrence of
stress and urge incontinence together.
7. Transient Incontinence: Leakage that occurs
temporarily because of a situation that will pass
(infection, taking a new medication, colds with
coughing).5
Symptoms of Urinary Incontinence
In addition to leaking urine, women with
incontinence also may have other symptoms:
 Urgency-A strong urge to urinate whether or not
the bladder is full, often with pelvic pressure.
 Frequency-Voiding more often than she
considers usual.
 Nocturia-The need to void during hours of
sleep.
 Dysuria-Painful Voiding.
 Enuresis-Bed-wetting or leaking while
sleeping.6
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Maurya P et al. 22

Causes of Urinary Incontinence

Short-term Causes Long-term Causes
 Urinary Tract Infection- Loss of bladder control  Pelvic Support Problems- The pelvic organs are
may be caused by an infection of the urinary held in place by supportive tissues and muscles.
tract. These supporting tissues may become torn or
stretched, or they may weaken because of aging,
pregnancy and childbirth (vaginal delivery). If
the tissue and muscles that support the urethra,
bladder, uterus, or rectum become weak, these
organs may drop down, causing urine leakage or
making it hard to pass urine.
 Medications- Loss of bladder control may be a  Urinary tract abnormalities- A fistula is an
side effect of medications, such as diuretics. abnormal opening from the urinary tract into
another part of the body, such as the vagina. It
can allow urine to leak out through the vagina.
 Abnormal growths- Polyps, bladder stones can  Neuromuscular problems- These disorders can
cause urinary incontinence. Abnormal growth interfere with the transmission of signals from the
often causes urge incontinence and may be brain and spinal cord to the bladder and urethra.
associated with blood in the urine.
Table 1.Causes of Urinary Incontinence
Prevention of Urinary Incontinence via increases with parity and, in primiparas who deliver
Mula Bandha (Pelvic Floor Exercise) vaginally, it has been associated with decreases in
pelvic muscle strength of 22–35% between
The underlying cause of urinary incontinence is pregnancy and the postpartum period (Wilson PD,
pelvic floor weakness. In yoga, the pelvic floor Herbison RM, Herbison JP, 1996). Pregnancy and
exercise, or mula bandha, is one of the fundamentals vaginal delivery are known to be associated with
of core body strength.7 The practice of mula bandha damage to the pelvic floor innervations, direct
tones and strengthens the muscles of the pelvic trauma to the levator ani muscles and the endopelvic
region.8 Pelvic floor muscles are known to assist in fascia by way of stretching or tearing. It has been
the control of continence through stabilization of the observed that bladder neck mobility is worsened
bladder neck and increase of the intra-urethral following vaginal births and this is postulated to be
pressure.9 The urethra and bladder are supported by the cause of urinary stress incontinence secondary to
the pelvic floor muscles, which contract during parturition. A study by van Brummen et al. (2007)
coughing, sneezing and exercise to prevent leakage. showed that the antenatal development of stress
Weakness in the muscles or damage to the bladder incontinence lead to an 18-times higher risk of
neck support can result in leakage.10 Pelvic floor developing stress incontinence during the year
muscle training (PFMT) can be an effective way to following child birth, and that this was most
help treat people who experience reduced bladder prevalent in the group that delivered vaginally.12
control or other pelvic health issues.11 Apart from
the above said factors, life events having major To prevent urinary incontinence, women have been
implications for urinary incontinence are pregnancy, encouraged to conduct pelvic floor exercises during
child birth and menopause in women. Pregnancy and pregnancy and after childbirth. Pelvic floor exercises
vaginal delivery are considered to be the main risk can be a very effective way of improving symptoms
factors for the development of urinary incontinence of Stress Urinary Incontinence. In a study, it was
in women because pregnancy and childbirth may found that up to 75% of women show an
cause damage to the fascias, ligaments, pelvic floor improvement in leakage after Pelvic floor exercises
muscles, and nerves supporting and controlling the (PFE) training. The benefits of PFE are maximized
bladder neck and urethra. It seems that the if practice is carried out regularly over a period of
prevalence of urinary incontinence increases during time. Maximum benefit usually occurs after 3 to 6
pregnancy and decreases following delivery, months of regular exercising.13 Several studies have
although postpartum prevalence still remains higher demonstrated the potential efficacy of postpartum
than before pregnancy. Estimates of the prevalence pelvic floor exercises in preventing incontinence and
of stress urinary incontinence during pregnancy vary other pelvic floor symptoms. A study by Cammu et
between 6% and 67%, and from 3% to 38% two to al., comprising a 10-year follow-up of women after
three months after delivery. Urinary incontinence pelvic floor muscle exercise for stress incontinence,

ISSN: 2394-6547 J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(1): 20-23.
23
concluded that when pelvic floor muscle training is
initially successful there is a 66% chance that the
favorable results will persist for at least 10 years.12
Reilly et al. conducted a study on Two hundred and
sixty-eight primigravidae attending an antenatal
clinic at approximately 20 weeks of gestation with
bladder neck mobility. Of the 268 women enrolled,
information on the main outcome variable was
available for 110 in the control group and 120 in the
study group. Fewer women in the supervised pelvic
floor exercise group reported postpartum stress
incontinence, 19.2% compared with 32.7% in the
control group. The findings suggest that supervised
pelvic floor exercises resulted in a lower incidence
of postpartum stress incontinence in the intervention
subjects compared with controls.13 Morkved and Bo
et al. conducted a single-blind randomized
controlled trial at Trondheim university hospital and
three outpatient physiotherapy clinics in a primary
care setting.4 301 healthy nulliparous women were
randomly allocated to a training (n=148) or a control
group (n=153). The training group attended a 12
weeks intensive pelvic floor muscle training
program during pregnancy. Result was found that at
follow-up, significantly fewer women in the training
group reported urinary incontinence: 48 of 148
(32%) versus 74 of 153 (48%) at 36 weeks’
pregnancy (p=.007) and 29 of 148 (20%) versus 49
of 153 (32%) 3 months after delivery. According to
numbers needed to treat urinary incontinence
intensive pelvic floor muscle training during
pregnancy prevented urinary incontinence in about
one in six women and one in eight women after
delivery. Pelvic floor muscle strength was
significant higher in the training group at 36 weeks
pregnancy and 3 months after delivery.4
Conclusion
In conclusion, as we know Moola bandha is the root
or perineal lock, it is the contraction of certain
muscles in the pelvic floor. Pregnancy and childbirth
are the leading causes of a weak pelvic floor and its
consequences. Pelvic floor exercises are important
because during pregnancy the increased weight of
the uterus puts pressure on pelvic floor. Plus, the
connective tissues of muscles are less resistant
during pregnancy due to hormonal changes. Some
women have faced urine and gas leakage during
pregnancy. This problem may continue during the
postnatal period in a number of cases. More
importantly, mula bandha (pelvic floor exercise) is
helpful for women to become aware of this area and
also it helps to preserve a perfect tone in the pelvic
area. It is beneficial and has no significant adverse
effects. Substantial and durable improvements in
continence can be achieved, when the mula bandha
J. Adv. Res. Ayur. Yoga Unani Sidd. Homeo. 2015; 2(1): 20-23.
Maurya P et al.
is adequately performed. It has been demonstrated
by different studies that the performance of pelvic
floor exercises had an improvement in muscle
strength and found a protective effect against the
development of urinary incontinence and significant
improvement in symptoms of urinary loss in women.
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