A tense pelvic floor can happen when the muscles of the pelvic floor have trouble fully relaxing or letting go.
Signs Your Pelvic Floor May Need to Relax
The signs and symptoms below may mean it is time to work on relaxing your pelvic floor:
- Constipation, pain when passing stools, or a feeling that your bowels have not fully emptied
- Low back, pelvic, hip or buttock pain
- Painful sex
- Urinary or bowel urge incontinence (leaking on the way to the bathroom)
- Not fully emptying your bladder, a slow flow of urine, or a stream that stops and starts
- Hesitancy, or a delay before your urine stream starts
- Urinary or bowel urgency and frequency: feeling like you need to go to the bathroom all the time, and only passing small amounts
- Painful urination
Why Relaxing Comes Before Strengthening
It is important to be able to fully and consciously relax your pelvic floor muscles, as well as contract them. If the muscles of your pelvic floor are already stiff and tense, it can be hard to contract them well and build strength. A tense pelvic floor can also be a weak pelvic floor.
For the muscles of your pelvic floor to work well and be pain free, it often helps to first learn how to relax them. Relaxing your pelvic floor is often called down-training, and it is also known as a reverse kegel. Physiotherapists from Pelvic Health Solutions liken the feeling of releasing your pelvic floor to the moment of relief you feel when you reach the bathroom and urinate or have a bowel movement.
Using Your Breath to Let Go
One way to release your pelvic floor is through visualization and deep diaphragmatic (belly) breathing. Start by picturing the hammock of muscles that make up your pelvic floor. As you breathe in, imagine them descending, widening and releasing.
When you breathe in deeply, your diaphragm flattens and lowers, and the muscles of the pelvic floor open, lengthen and stretch. When you breathe out, your pelvic floor recoils like a piston and your diaphragm rises to push the air out. This is sometimes called your pelvic floor rhythm, pelvic floor breath or core breath. If you can find this rhythm of breathing, with the pelvic floor muscles releasing and contracting, reverse kegels will be much easier to do.
How to Do a Reverse Kegel
Start by lying on your back with your knees resting open on pillows. As you breathe out, gently contract the muscles of your pelvic floor to feel what tightening them is like. Then relax, and let that tension release completely as you take a big breath in. Notice the difference between tension and relaxation.
Next, without moving your pelvis or your spine, picture the muscles between your pubic bone and tailbone lengthening away from each other. Imagine your pubic bone gently moving toward the ceiling and your tailbone gently moving toward the surface you are lying on. Picture the pelvic floor muscles getting longer as this happens, creating more space in your pelvic floor. Do this at the same time as you take a deep breath in.
Be patient. It can take some time to feel the letting go, or lengthening, of these muscles. You can also practise this sitting and standing. Once relaxing feels easier, you can begin gentle pelvic floor strengthening exercises.
Don't forget to check in with your pelvic floor throughout the day, and let go of any tension you notice.
The symptoms listed above can have many causes, so if any of them are bothering you, it is worth talking with your healthcare provider. An assessment with a pelvic health physiotherapist is one option available to you.