Relaxing Your Pelvic Floor

The pelvic floor muscles span from your pubic bone to coccyx, and sit bones on both sides. Overactive muscles create pain and irritation leading to increased muscle tone. You also can have tension in your pelvic floor without knowing it. Many women have a difficult time relaxing their pelvic floors. The muscle tension has been there so long that your brain thinks it is normal. Because of this, it can be difficult to know when these muscles are actually relaxed. A pelvic physical therapist can be very helpful with identifying when these muscles are relaxed and with instruction in techniques to assist with this training. 

When someone develops pelvic floor pain, this can cause more involuntary tightening or guarding of these muscles, leading to more pain and dysfunction. Relaxation of these muscles can interrupt the pain cycle and promote healing. 

Signs of Pelvic Floor Tightness

• Difficulty with starting peeing

• Dribbling after you pee or feeling like you have to pee again right after you go

• Constipation

• Pain with penetration and/or tampon insertion

• Increased UTI risk— due to retention and irritation of urethra

• Leaking with sneezing, coughing or lifting heavy things

• Feeling like you can’t get a good contraction or have a weak contraction

• Difficulty with taking a full breath in (shallow breathing pattern)

• SI joint pain and/or hip pain

Stress, fear and anxiety also can contribute to pelvic floor overactivity. Taking steps to minimize stress and learning to respond to stress in a healthy way can assist with pelvic floor relaxation and pain reduction.

General Relaxation Techniques

1. Set aside time for yourself. Make yourself a priority and take the time.

2. Go to a quiet environment where you feel safe, with minimal distractions. Don’t bring your phone or turn on the TV, etc. Dim the lights and find a comfortable position for yourself.

3. Take moments throughout the day to be mindful. Be mindful of how your body feels, how you are breathing, or holding tension in your body. Take these moments to relax, improve your posture, and breathe deeply. Try to keep your mind focused on relaxation and do not think about other tasks or stresses. You can think “inhale” and “exhale” with your breath or count during the inhale and exhale while slowly lengthening the duration or count of the breath. 

4. Stretch and change positions frequently throughout the day to avoid being in one position too long. Set a timer if needed.

5. Try various relaxation techniques to see what works best for you. Practice 20 minutes or more once per day or smaller moments several times per day. Falling asleep is not the same as practicing relaxation.

Visualization

Visualization can assist some people with relaxation. Picture the pelvis and pelvic floor muscles in your mind. Now, picture what these muscles look like relaxed with good blood flow, the muscles releasing and the “bowl” deepening. We can coordinate this same image with proper breath. Imagine that when you inhale, the vagina opens and your sit bones separate. Breathe into one side of your pelvic floor, and then the other.

Other visualizations that may work:

• You can also visualize your pelvic floor as a flower. A tight pelvic floor is like a tight flower bud, while a relaxed pelvic floor is like when the flower opens up and blossoms.

• Think of your pelvic floor as an elevator. A Kegel would be like going up to the second floor. Relaxing the pelvic floor is like going back to the main level, and bulging/bearing down would be like going down to the basement.

• Think about a color that is calming and relaxing (for me, green) and then pour that color into your pelvis like you are pouring it into a bowl, letting go of the tension in your muscles as that color spreads throughout your pelvic bowl. Pour the color into the left side of the bowl (tilt towards left hip), the right side of bowl (tilt towards right hip), the front of your pelvis (towards pubic bone), and then the back (towards your coccyx or rectum).

• Pelvic floor “bulging” is a relaxation beyond what normal resting position.  Resting tone is the low-level of tension any muscle holds when it is relaxed.  Your pelvic floor is always “on” to some extent, but you should not be actively contracting it at all times.  

  To review:

  contraction= lift and tighten

  relaxation= let the pelvic floor come back down to resting position

  bulge= pelvic floor gently lengthens and descends down further than where it typically rests 

  Bulging is what the pelvic floor should be doing ideally to help with emptying during pooping and during vaginal childbirth.  For people who have had very tight pelvic floors for a long time may need to incorporate this into their daily habits to reset their pelvic floor resting position.

Body Scan

Tension in other parts of the body can also contribute to tight pelvic floor muscles. Do you tend to pull your belly in or tighten it down? Do you hold your legs together? Is your jaw tensed? Are your brows furrowed or shoulders raised in tension? If you are a teeth grinder or hold a lot of tension in your jaw, learning how to relax your jaw also takes tension off of your pelvic floor. Periodically through the day, stop and bring your attention to the various parts of your body and notice tension. Then, try to release this tension as you exhale, imagining the tension leaving the body with each exhale.

Here is a link to listen to Krystle help sooth you into deep full body relaxation.

Exercises to Help

Wide Leg Child’s Pose: Start in a kneeling position with knees spread wider than shoulder width to accommodate your bump. Place your hands with palms facing down on the ground, arms straight. Pull your chest toward the ground. Hold this position for 10 seconds. Slowly move your hands over to one side, bending your trunk in that direction. Pull chest toward ground. Hold this position for 10 seconds. Repeat to the other side.

Happy Baby: Lay on your back and bring your knees up to your chest. Grab the pinky toe side of your feet and draw your knees out wide and towards your armpits. Hold there, rocking side to side. You should feel a stretch in your hamstrings. We are trying to lengthen the tissues around the pelvis with this stretch.

Side Lying Pelvic Lift: Lay on one side. use your top hand to grab your top butt cheek and hold for 5 seconds. Think about lifting up the bottom side of your pelvis to open it up. Repeat on other side.

Static Squat at Counter with Block under Butt: Begin with your feet wider than shoulder width apart. Place a yoga block or low chair or stool behind you as a target. Squat, holding on to a railing or counter. Squat all the way down until you touch your butt to the block. You should feel a good stretch in your hamstrings and focus on opening up your pelvis with this stretch. Practice the visualization techniques described above as you do this.

Deep Squat with Block: Stand with your feet wider than shoulder width apart. Place a yoga block or low chair or stool behind you as a target. Squat all the way down until you touch your butt to the block/chair. You should feel a good stretch in your hamstrings and focus on opening up your pelvis with this stretch. Practice the visualization techniques described above as you do this.

Downward Dog: Move to an inverted V position with your elbows and knees straight. Get your heels as close to the ground as possible, shifting weight into your feet. Set your shoulders by pretending to rotate your hands outward through the ground. A good visual: pretend you are pushing your hands into the ground and rotating the whole arm outward like a screwdriver, but your hands stay in the same place. This should allow you to feel your shoulders turn on. Hold this position, feeling a stretch through your back and legs. Come back onto all fours and then shift your weight forward into your hands and then backward onto legs. Repeat.

Diaphragmatic Breathing: Start by lying on your back. Place your hands on your bottom ribs with your fingers facing forward underneath your bust and your thumb wrapped around the back. Take a deep breath in. When you inhale, your pelvic floor relaxes. To achieve excursion of your diaphragm, try to minimize the movement of your chest and breathe into your lower ribs. This is NOT simply belly breathing. Breathing forcefully into the belly can create extra pressure on the front side of the abdominal wall. During this we are trying to coordinate your diaphragm with your pelvic floor. Take a deep breath in and allow your pelvic floor to relax. When you exhale your pelvic floor should activate automatically. Practice for two minutes.

Stretching the Vagina

This only applies to women who had a traumatic birth- so if you had an episiotomy or any natural tearing, or if you have pain with penetration, thrusting and/or tampon insertion or pelvic floor pain in general. This is because your pelvic floor gets stretched to its max and then seizes up and gets really tight again. You can start this around 12 weeks postpartum. Here are some instructions and tips for stretching your vagina after birth:

1. USE YOUR FINGER.

   You can insert your pointer finger or thumbs into your vagina. Wash your hands before and make sure your fingernails are short so you don’t scratch anything. Lubricate the finger(s) you are going to use with a water based lube- my favorite is slippery stuff.

   Insert your finger 1-1.5 inches inside your vagina. Imagine your vagina as a clock (6 is down toward the anus and 12 is up tossed the clitoris). Slowly massage the lower half of the vagina using a U shaped motion. Press down toward 6 o’clock and back and forth from 3 to 9 o’clock until you feel a slight burning, stretching sensation. Do this for 2-3 minutes max. Focus on relaxing your muscles while you do this and practice using your diaphragmatic breathing.

2. VAGINAL DILATOR

   Just like with the finger, you can imagine your vagina as a clock. Push the dilator down towards six o’clock and work it from 3 to 9. Push and hold for a few seconds at 3, 6 and 9 oclock.

3. PARTNER HELP

   You can also have your partner help you with this wink wink ;). Have them use their index finger and follow the same instructions above, using their index finger and lubrication. Make sure you have good communication if you are going to do this and let them know if it is hurting anything. Again, you should just feel a slight stretching/burning sensation but shouldn’t be painful. Sometimes you are so tight in your pelvic floor sex is painful and your last thought.

4. FIND A PELVIC FLOOR PT

   As always, if you are uncomfortable with stretching out your own vagina we recommend that you find a pelvic floor PT to help do this for you. You can look up a PT here: http://www.apta.org. Click find a PT and filter it to Women’s Health.