How to Listen To Your Pelvic Floor
Lisa came to me with tears in her eyes. A high-stress job (coupled with a high-stress life!) was getting the best of her, especially with the holiday season swirling around her and work deadlines looming.
Over the last few weeks, she had experienced several bouts of intense, irregular, and totally unpredictable sharp pains in her anus — enough to stop her in her tracks. These spasms took Lisa’s breath away, sometimes leaving her doubled over in pain. Not knowing the trigger was driving her crazy, and it wasn’t exactly something she wanted to tell her boss about!
How could she explain that her life had LITERALLY become a pain in the ass?
Ultimately, Lisa was diagnosed with proctalgia fugax, a condition consisting of fleeting rectal pain that is related to excessive pelvic floor tension. To heal, Lisa needed to STOP doing her daily kegel exercises, release her pelvic floor muscles, and make total-body relaxation a priority. Lisa’s pelvic pain story is not uncommon. Many people around the globe live with symptoms of pelvic floor dysfunction (PFD), which is a broad term describing various conditions related to the group of muscles situated at the base of your pelvis. PFD can cause sexual difficulties, pain, and problems with urination. It is often misdiagnosed, misunderstood, and unfortunately, many sufferers of PFD are told that their condition is “all in your head.”
Spoiler alert: PFD is NOT in your head. It’s in your pelvic floor. And if your pelvic floor is “talking to you” with symptoms of PFD, then you need to listen!
Is Your Pelvic Floor Trying to Talk to You?
As a women’s health physical therapist in the online fitness space, I’ve found that people are opening up to pelvic health issues and are more willing to learn about them than ever before! But despite the growing awareness about PFD, the pelvic floor remains shrouded in mystery and taboo. It’s time to bring these subjects into the light!
Let’s begin with the “PF” in the term PFD, or the pelvic floor. The pelvic floor is a group of muscles situated at the base of the pelvis. The pelvic floor muscles are a support system for your abdominal and pelvic organs. They also help close off the orifices they surround, including the urethra, vagina, and anus in women, and the urethra and anus in men. The “D” in the term PFD refers to a lack of — or a change in — function of the pelvic floor muscles. This usually presents as weakness or excessive tension in the pelvic floor, and manifests as:
- Lack of support, causing issues such as pelvic organ prolapse or back pain
- Lack of coordination and closure, causing issues such as bladder leakage, fecal incontinence, or unintentional “slips” of wind
- Too much closure, or an inability to relax the pelvic floor muscles. This can cause painful sex, difficulty initiating the stream of urine, and generalized pelvic pain that is often felt in the buttocks, tailbone, or groin.
Returning to Lisa’s story, too much “closure” (i.e. tension) in her pelvic floor muscles created periodic spasms of rectal pain.
Whether weakness or excessive tension is the primary dysfunction, a lack of coordination and control of the pelvic floor (and surrounding) muscles is usually the ultimate concern. While it is ideal to see a pelvic health physical therapist for individualized evaluation and treatment, there are some things you can do on your own that may be beneficial for anyone with PFD.
1. Core Breathing
Sit tall, with the crown of your head reaching toward the ceiling, back of your neck long and spine straight. Breathe deeply and expansively.
As you inhale, feel your ribs expand out to the sides and to the back, and draw your breath down into your pelvic floor. As you inhale, imagine that you’re pulling a ping pong ball down your central channel (Sushumna nadi) into your pelvic floor. As you exhale the air out of your lungs, feel the ping pong ball travel back UP through your central channel. Continue moving the imaginary ping pong ball up and down as you inhale and exhale for 1-2 minutes. Note: this technique was inspired by author Anodea Judith.
Take 1-2 minute “breath breaks” throughout your day for general relaxation and stress management. Bonus? It’s like an internal massage for your pelvic floor and abdominal and pelvic organs (helpful for anyone with PFD).
Relax and release pelvic tension with this short guided meditation. It’s perfect for individuals with pelvic pain; also ideal for ANYONE who carries stress in their pelvic region (hint: that’s most of us). Use this is as often as DAILY for an easy way to unwind and connect with your core.
3. Daily Stretching
If pelvic tension is your primary concern, hip opening stretches such as Puppy Pose (Uttana Shishosana), Happy Baby (Ananda Balasana), and Bound Angle Pose (Baddha Konasana or Supta Baddha Konasana) should be practiced daily. Avoid kegel exercises if your pelvic floor is talking to you with symptoms of pain, tension, or “holding,” or if you feel like kegel exercises are making your symptoms worse.
4. To Kegel or Not to Kegel?
Kegel exercises are defined as a complete contraction followed by a full release (relaxation) of your pelvic floor muscles. Kegels might be appropriate for you if you have PFD related to lack of support or closure, such as pelvic organ prolapse or incontinence. However, you must be certain that you understand where your pelvic floor muscles are located and that you are doing your kegels correctly. The following video will help:
If pelvic pain and/or tension are your primary concern, or if you find that kegel exercises are making your condition feel WORSE and not better, then skip kegels for now. A consultation with a women’s health physical therapist is advised if you have any questions related to your condition.
Always Listen to Your Pelvic Floor, and Don’t Be Afraid to Talk
If you have any PFD symptoms — from painful sex to bladder leakage to the heaviness and discomfort of pelvic organ prolapse — please know that there is hope and there is help. These under-discussed problems are MORE COMMON than you might think, and if you need help with something, speak up! Talk to your healthcare provider. If he or she doesn’t take you seriously or listen with compassion to your concerns, then talk to someone else. You know your body best. Heed its warnings if it tells you that something is off.
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