10 Expert Physio Techniques that Relieve Pelvic Floor Muscle Tension and Pelvic Pain Fast

Pelvic Pain Symptoms

10 treatment techniques that relieve pelvic floor muscle tension

  • Physical Therapist pelvic floor relaxation video
  • Exercises and activities to avoid with pelvic floor spasm
  • About pelvic floor muscle tension
  • What causes pelvic floor muscle tension
  • Typical signs and symptoms of pelvic floor spasm
  • Where to access professional treatment

Treatment Techniques for Relieving Pelvic Floor Muscle Tension

Pelvic floor muscle tension is also known as pelvic floor spasm. Treatment techniques including home management strategies are outlined below.

1. Pelvic Floor Relaxation

Start by watching this pelvic floor relaxation video then read on below.

Physical Therapist Pelvic Floor Relaxation Video

Daily pelvic floor relaxation practice is imprtant for relaxing tight, painful pelvic floor muscles. Pelvic floor relaxation exercises can provide immediate relief from pain and spasm.

Pelvic Pain and Pelvic Floor Relaxation Training (Download)

Pelvic Relaxation Therapy for Women

Pelvic Floor Physiotherapist guided pelvic pain and pelvic floor relaxation training audio.

Learn how to relax your pelvic floor muscles, manage and treat chronic pelvic pain in the privacy of your home.

2. Lying Down

Lying down with a pillow under your knees or lying on your side with a pillow between your legs will relieve the weight of your abdomen off your pelvic floor. When you are upright, your pelvic floor is under load.

Take the load off your pelvic floor to reduce pelvic discomfort by avoiding prolonged standing or sitting.

Unloading your pelvic floor muscles can give you immediate pain relief especially when combined with a warm pack

3. Applying Heat

Immediate pain relief is often by applying a warm pack over the pelvic floor. Research has demonstrated that heat treatment can relieve pelvic floor pain1.

Mild heat applied over the outer pelvic floor may also relax pelvic floor muscles. Use a warm pack or mild heating pad over the pelvic floor (outside your briefs). The warm pack can be applied for 15 to 20 minutes at a time. The best position to apply the warm pack is lying down with a pillow under both knees.

The pelvic floor muscle relaxation methods outlined in this Down Training Routine (next) can provide immediate relief when combined with a warm pack.

Pelvic Floor Down Training Relaxation Routine

This pelvic floor muscle relaxation method known as Down Training2 helps the pelvic floor muscles to relax and release.


Lay down with a pillow under both knees for 20-30 minutes daily to relax the pelvic floor muscles. Positioning a warm pack over the pubic area or lower abdomen can assist pelvic floor relaxation.

Diaphragmatic Breathing

Diaphragmatic breathing involves slow and deep breathing into the belly. Slow diaphragmatic breathing (like yoga breathing) is very important for relaxing the pelvic floor muscles.


Imagine or picture in your mind’s eye your pelvic floor muscles relaxing and a sensation of warmth in the pelvic floor region.

Perineal Bulging

Gentle pelvic floor bulging is taught by Pelvic Floor Physiotherapists. Bearing down too strongly can actually increase spasm so this must be done gently.

Relaxing Environment

Choosing a relaxed environment can assist overall whole body relaxation for example soft music and surrounding warmth or a light cover over the body.

Whole Body Relaxation

Whole body relaxation is often used in conjunction with pelvic floor relaxation. This process may involve progressive relaxation of the different muscles of the body from the face and neck through to the feet

Body Scanning

Whole body scanning for areas of increased muscle tension is part of learning the process of pelvic floor muscle relaxation.

4. Vaginal Dilator Therapy

Vaginal dilator therapy is often used in the clinic and by women at home to treat pelvic floor muscle tension.

vaginal dilator

Vaginal dilators (shown right) are used inside the vagina to improve the comfort with the feeling of vaginal penetration and to train pelvic floor relaxation with penetration. 

Vaginal dilators are also used by women following radiation therapy and following some forms of pelvic surgery such as hysterectomy where the vaginal tissues have become inelastic and require gentle stretching for the woman to resume sexual activity with comfort.

Sometimes the length of the vagina can become shortened during hysterectomy surgery and in these cases vaginal dilators can assist with gentle elongation of the vaginal tissues.

Vaginal dilators should be used with non toxic lubricants for pelvic floor health.

5. Stress Reduction and Cognitive Behavioural Therapy

Living with chronic pain can be very stressful indeed. Stress can make chronic pelvic pain much worse.

Reducing stress and changing thinking and behaviours related to pelvic pain can assist in treating pelvic pain.

Techniques to reduce stress and change unhelpful thoughts and behaviours include:

  • Breathing and relaxation exercises
  • Mindfulness training
  • Counselling and training in cognitive behaviour therapy
  • Prioritizing rest and sleep routines

If you live in Australia and have a chronic health condition you can access government subsidized treatment for psychology and counselling through an EPC (Enhanced Primary Care Program). This requires a referral from your doctor.

6. Bowel Management

Bladder and bowel problems commonly occur with pelvic floor muscle tension. Good bowel management is important for reducing muscle spasm associated with pain and straining.

Avoid straining to use your bowels and aim for the correct stool consistency which is a soft well formed stool.

Use the correct bowel emptying technique (shown below) to avoid straining and achieve a comfortable bowel movement.

Keep your stool soft and well formed so that it is easy to pass. Choose stool softener foods if your stool is too firm and causes you discomfort and straining.

Drink plenty of water to promote bowel movement and reduce the risk of constipation. Most women should aim for approximately 2 litres/day (67 ounces).

7. Correct Sitting Posture 

  • Minimize prolonged sitting by taking frequent rest breaks where you stand up and walk.
  • Sit with good posture avoiding slumped posture which is known to increase pelvic tension. Good sitting posture involves maintaining the normal inward curve in the low back when sitting.
  • Avoid sitting on round rubber rings which can increase pelvic floor strain.
  • Use a quality pelvic support cushion can help to alleviate pelvic pressure and pain.

8. Manual Physiotherapy Treatment

A trained Pelvic Floor Physiotherapist may use specific methods to promote pelvic floor relaxation and to re-educate the correct activation of these muscles. Pelvic floor physiotherapists are usually highly trained and skilled in manual therapy techniques for the pelvic floor.

Treatment techniques are usually progressed gradually over time and may include:

  • Desensitizing painful areas to touch (using physical touch or vaginal dilators)
  • Pelvic floor stretches using digital resistance against these muscles
  • Massage techniques
  • Postural re education
  • Biofeedback instruments which tell you about the activity of the pelvic floor muscles
  • Treating coexisting conditions which may present along with pelvic floor spasm such as problems with pelvic joints, tailbone problems and/or lower back problems.
  • Progressive strengthening of the pelvic floor muscles only when appropriate.

If you live in Australia and have a chronic health condition you may be able access government subsidized treatment for pelvic floor physiotherapy through an EPC (Enhanced Primary Care Program). This requires a referral from your doctor to a pelvic floor physiotherapist.

9. General Exercise

Overall strength and fitness can become decreased when living with chronic pain including pelvic pain.

It’s only natural that general exercise becomes low on the list of priorities when living with chronic pelvic pain and spasm through fear of exacerbating pain and fatigue.

Some researchers have suggested that some specific general exercises may play an important role in recovery from pelvic pain 4.

Appropriate pelvic floor friendly exercises may assist overall recovery by improving strength and fitness while avoiding exacerbation of pelvic floor conditions.

Exercises when living with pelvic floor spasm may include:

  • Posture exercises
  • Gentle muscle stretching of tight thigh and buttock muscles
  • Progressive low impact fitness exercise such as gentle water walking

10. Multidisciplinary Team Approach

Pelvic floor physiotherapy rehabilitation is only one component of treating pelvic floor muscle tension.

A multidisciplinary team approach may be required in managing overactive pelvic floor muscles and pelvic pain including general practitioner, psychologist, pelvic floor physiotherapist, gynaecologist and dietician.

Some medical practices and hospitals offer a multidisciplinary team approach to managing pelvic spasm and pain.

Exercises to Avoid with Pelvic Floor Muscle Tension

Exercises and activities that load the pelvic floor can increase pelvic floor muscle tension and exacerbate pelvic pain.

Avoid Kegel exercises (pelvic floor exercises) when first diagnosed with pelvic floor spasm. Kegel exercises involve contracting the pelvic floor muscles and can exacerbate pelvic pain and muscle spasm.

Intense core exercise

These exercises and activities can increase pelvic floor muscle tension

What is Pelvic Floor Muscle Tension?

Pelvic floor muscles contract and relax in the same way all skeletal muscles contract and relax.

The muscles of the pelvic floor can become taut with spasm and overactive. Overactive pelvic floor muscles have increased tension and can’t fully relax, just like having very tight and painful neck muscles that won’t relax.

Pelvic pain associated with pelvic conditions such as endometriosis can cause involuntarily tightening of the pelvic floor muscles. This pattern often causes a cycle of ongoing pelvic pain and increased pelvic floor muscle tension or pelvic floor muscle spasm.

Gynecologists and physical therapists are seeing increasing numbers of women with pelvic pain associated with the inability to relax the pelvic floor muscles. Pelvic pain is often undiagnosed and inappropriately managed owing to the continued lack of understanding about this condition.

Causes of Pelvic Floor Muscle Spasm

Possible causes of pelvic floor spasm include:

  • Overloading the pelvic floor muscles with too much pelvic floor exercise (Kegel exercise) and insufficient relaxation.
  • Overtraining the abdominal muscles with potentially unsafe intense abdominal core exercises
  • Pelvic surgery including prolapse surgery and hysterectomy
  • Pelvic infection or inflammation
  • Recurrent infection for example cystitis
  • Pelvic pain conditions including interstitial cystitis or endometriosis
  • Pelvic trauma
  • Postural problems
  • Mental and emotional factors including anxiety, catastrophizing and hyper vigilance3

Pain and pelvic floor muscle tension are interrelated however it currently remains unclear whether pelvic pain causes pelvic floor muscle spasm, or whether the spasm causes pain.

Signs and Symptoms of Pelvic Floor Muscle Tension

Pelvic floor muscle spasm can be associated with a wide range of possible signs and symptoms.


Bladder signs and symptoms associated with pelvic floor spasm can include slow urine flow, difficulty commencing urination, inability to completely empty the bladder, interrupted urine flow and urinary urgency. These signs and symptoms can result from insufficient pelvic floor muscle relaxation.


Bowel signs and symptoms can include constipation, incomplete emptying of the stool, difficulty commencing bowel movement and straining throughout emptying. The straining associated with constipation can further increase pelvic floor pain and muscle tension. Additional bowel problems may develop with pelvic floor spasm for example rectal prolapse, hemorrhoids or anal fissure.

Sexual Dysfunction

Pelvic floor muscle tension can be associated with signs and symptoms during intercourse and penetration. Vaginismus is the term used to describe involunatary pelvic floor muscle spasm with the suggestion of vaginal penetration. This can can prevent sexual intercourse, insertion of tampons and gynecological examinations.

Sexual problems associated with overactive pelvic floor muscles can cause considerable emotional difficulty with stress, anxiety and relationship difficulties.

Chronic Pain

Physical discomfort associated with pelvic floor muscle tension presents differently in different women. Pain, ache or physical discomfort with pelvic spasm may present in any the following areas:

  • low abdomen
  • low back
  • vagina
  • anus

Ongoing pain can create added stress and anxiety further increasing muscle spasm and discomfort. This can establish a an ongoing cycle of increasing pain, spasm and pelvic floor dysfunction.

Pelvic Floor Muscle Weakness

Pelvic floor muscle weakness results from the pelvic floor muscles contracting constantly and becomeing fatigued as a result. Pelvic floor weakness then contributes to problems such as stress incontinence (involuntary leakage of urine with exercise or activity). The supportive function of the pelvic floor muscles may also be compromised, increasing the vulnerability to other pelvic floor problems such as vaginal prolapse.

Where to Access Treatment for Pelvic Floor Muscle Tension

If you suffer from pelvic floor muscle tension and pelvic pain, you can access professional treatment by speaking with a gynecologist or a qualified Pelvic Floor Physiotherapist. Urogynaecologists who are specialised in both bladder and vaginal problems are highly qualified to diagnose and manage pelvic floor muscle tension.


1. Dodi, G. Bogoni, F. et al. (1986) Hot or cold in anal pain? A study of the changes in internal anal sphincter pressure profiles. Diseases of the Colon and Rectum 29(4):248-251.

2. Shelly B, Knight, S. et. al. (2002) Pelvic Pain ch 23-27. Therapeutic Management of Incontinence and Pelvic Pain, J. Laycok and J Haslam. London, Springer-Verlag: 156-189.

3. Bergeron, S. Morin, M. and Lord, M. (2010) Integrating pelvic floor rehabilitation and cognitive-behavioural therapy for sexual pain: What have we learned and were do we go from here? Sexual and Relationship Therapy. Vol 25(3):289-298.

4. Fitzgerald M. and Kotarinos R. (2003) Rehabilitation of the short pelvic floor. II: treatment of the patient with the short pelvic floor. International Urogynaecology Journal and Pelvic Floor Dysfunction 14 (4): 269-275.

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  1. Hi
    I will be 60 in a couple weeks. I am post menopausal. I have lower rating back pain. Off and on for a year, I have the spasms on one side of the pelvic area. No UTI. Does happen to older women too?

  2. Hi Michelle,

    Thanks for everything you do! I’ve had pelvic tension for years and am figuring it out only now, and that’s thanks in part to your website and youtube channel.

    I’m wondering if you think the Pelvic Pain and Pelvic Relaxation Therapy for Women download would be helpful for me. I have almost every bowel symptom you list on this page but no direct pain from my pelvic floor muscles (only pain from the resulting hemorrhoids). I see a PF physiotherapist once a month for a manual release session but it’s not enough! I will go through your suggestions here thoroughly but would like to follow a step-by-step program if I can. I’m just not sure if this one is the most appropriate, since it covers desensitization, which I don’t think applies to me.

    Many thanks! I’m feeling hopeful now that I’m finally on the right track.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Katie
      I’m so sorry to hear that you’ve suffered for so long. This condition unfortunately continues to be poorly diagnosed. Manual release can be assisted by following up daily with practicing pelvic floor relaxation otherwise by the time you return to see your physio the muscles may have tightened again which is likely what you are experiencing. From this perspective practicing daily guided daily floor relaxation can indeed be most beneficial.

      All the best to you Katie

  3. Hi my daughter had a bad UTI two years ago and has been in chronic pain every since. Most PTs say breathing will help but she has spent hours doing every kind of breathing exercises and it has never given her a moments relief.
    Does this mean she has something Else wrong with her? I have tried this breathing and I don’t have any tightness but still can’t feel anything. There has to more help help out there. My daughter used to be a professional singer she knows how to belly breath. I think if this were going to help it would have done so by now.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Gina
      Breathing is definitely not the only treatment for pelvic pain and is usually used in combination with other treatments particulalry if pelvic floor muscle spasm is involved. I wonder if your daughter has been given other treatment modalities to assist with her pain management too?

  4. Hi Michelle,
    I’m 22, and I am pretty sure I have an overactive pelvic floor. I pee frequently (sometimes 3 times during a 30 minute time span), and often don’t feel as though I have emptied my bladder every time I pee. I have also come to notice that it stings if I try to insert a tampon for example, however, I feel confused because if I am (aroused), I don’t seem to have the same issue? I can insert things with more ease. Also, I feel as though I have chronic constipation. I wake up in the mornings with strong stomach pain, but if I go to the restroom, I can’t really relieve myself. Do you have any tips/ guidance for me?

    • Theresa, your symptoms sound very similar to mine except I have trouble with peeing only once in a while but almost every day I can’t fully empty my bowels and then sometimes just 10 minutes later I have to come back to the toilet. So frustrating!

  5. Hello Michelle,
    I was diagnosed with Hypotonic pelvic floor dysfunction 10 years ago, I’ve had little flare ups between now a d than, would last a couple of weeks. Well, I’ve had a flare up for almost two months now, the pain comes in waves. I took a hot bath, my PT said warm bath however the water was in the hotter side, I use to take hot baths for my fissure, they never bothered my vagina area, however this hot bath I took a couple days ago, well it left me in tears, now I’m really irritated down there and I feel red and swollen and dry. I feel like I ruined my tissue down there. Any advice, I’m in so much pain, I’ve lost weight over this. I healed 10 years ago and I’m praying I heal again.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Rosie
      This will settle and you will heal – you’ve possibly burnt your sensitive tissues or they feel burnt because they are so sensitive at the moment. I suggest you speak with your doctor or specialist to get some appropriate pain relief to start with. Obviously steer away from heat until this settles down. Focus on your relaxation practice for your pelvic floor and whole body (both will help). When this settles return to your PT and continue treatment too. All the best

      • Thank you very much Michelle, I will do that.
        It’s been a few days since my hot bath and I still feel horrible, I know I need to give it time. I need to be patient. I see my therapist on Monday, I’ll see what she says.
        Relaxing techniques? I just know the diaphragmatic breathing, you have a book on this?

        Thank you again, you truly are a wonderful woman, for helping us women in pain. Not a lot of people understand this pain. Not even some doctors.

        • Author: Michelle Kenway Pelvic Floor Physiotherapist says

          Yes Rosie this condition is not well understood and I feel for you. Yes I do have a pelvic floor relaxation download – designed to teach how to relax the pelvic floor and to be practiced daily. I do hope your condition is starting to settle down a little bit. All the best to you

          • Hello Michelle,
            I do feel somewhat better from the hot bath experience. Do you know why some days I’m almost pain free than others I’m not. I was diagnosed with this 10 years ago and haven’t really had a bad flare up till now. I don’t remember my pain coming and going. I am somewhat constipated now, so maybe that’s why? After I have a bowel movement I feel irritated. Also after, I use my dilator, I feel some discomfort, it discourages me from wanting to do it again. I don’t remember if it did that before. My doctor put me on Amitriptyline because I’m getting anxiety she said it might also help with my pelvic pain, gonna start it tonight. I stopped going to PT, I feel like what we are doing in my session, I can do here at home. With Covid going on, I just feel it’s better to stay home and do it. I wanna get your audio and do that daily and dilator daily as well. I’ve also noticed besides the burning I feel in my vagina, now outside my vagina sometimes is itchy, I put a little aquaphor on it and it kinda sting, wasn’t expecting that. Please Michelle any thoughts?

  6. Jacqueline says

    I was fused from L2 to L5 about 5 years ago and recently had a caudal epidural along with injection at L3 and L4 on the left. I’ve had injections for 20 years, but no caudals. I have been having pelvic floor problems. At first, I recovered quickly. After the caudal, the obturator internus muscles never seem to stay relaxed in spite of PT. This causes many symptoms in the bladder and pelvic floor. Could the caudal injection have caused weakness in these muscles and extra tension? This is a complicated matter, so I don’t expect a diagnosis, only your best guess.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Jacqueline
      You seem to connect the caudal injection to the spasm from your description of events. Do you think the injection was so painful that you may have tightened your muscles involuntarily in anticipation? AS you’re well aware lumbar issues can cause pelvic floor issues too. Are you doing any stretches or self trigger pointing these muscles?

  7. How can you tell if your pelvic floor is too tight and you should be doing relaxation tips or too lose and you should do kegels

  8. Hi I’m in my 20s and I Injured my hip a year ago and due to the pain from it and also the pain I began to feel in my lower back and bottom I started seeing a physio. She said that the muscles in my glute and lower back were abnormally tight and gave me stretches to do. However I’ve started to expiernce lbl, Vaginal flatulence during everyday chores, urination problems as well as the pain in my lower back, hip and gluteus, All of which I’ve never had. Due to this I thought I had a weak pelvic floor but after reading your website im resonating with a lot it it and think that your relaxation techniques would be beneficial and have started to do them. I’m wondering if the muscles are instead too tight and if so can you shed some light or your thoughts. Thankyou

  9. I also have this issue. After seeing this post couldn’t resist. Doctor has told me that my vagina is too tight I need a vaginal loosing surgery. But I m really worried. Help me out please. I DONT WANT TO HAVE A SURGERY PLEASE.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      I agree! What country are you located in Lakshmi? There is plenty of non surgical treatment for this condition available and surgery may make the condition worse depending on the cause. Please let me know and we can go from there.

  10. hi,
    i am 32 yrs old ,recently i had a pelvic exam, where i did feel some discomfort when doctor tested with 2fingers, and she also said the vagina is normal anatomically and you are contracting fine but try to relax the muscles.
    is this vaginismus?
    does this inhalation techniques help me and what would be the duration to overcome this and relax my muscles

  11. I’m so grateful to have found this website. I’ve learned more about my bladder issues in the short while I’ve browsed this site than all the hours of research and Dr visits in the passed couple years. I’ve been diagnosed with urinary retention which is something I’ve dealt with for years. The most frustrating of symptoms is having to get up 5+ times a night to use the bathroom! I’d love to purchase any of your products that could be helpful with these issues. From what I understand I should be working on relaxing my pelvic floor, correct? Should I be avoiding exercises that will strengthen my pelvic floor? I am currently working on losing weight so I want to be sure the workouts I’m doing aren’t doing more damage than good. I’d love it if you could recommend which of your products would be most beneficial for me. Thank you so much

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Belinda yes you’re correct, the place to start is pelvic floor relaxation definitely not active strengthening which can worsen the condition. Here is the link for the Pelvic Floor Relaxation training to start with. The Inside Out book/eBook helps you understand the exercises to choose and avoid long term I hope this information helps you move forward with your pelvic floor and weight management, all the best

  12. Michelle Hi, you say in your article 10 Physiotherapy techniques to reduce pelvic pain , not to sit on round rubber rings as this can increase the pressure on the pelvic floor. I have been using an oval shaped cushion with a hole in the centre trying to take the pressure off. I’m not sure if this qualifies as Round Rubber Ring or not but looks to me like it would be a similar effect.

    You mention that instead we should use a quality “pelvic support cushion”. Do you have a particular one that you would recommend ?


    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Andy I prefer to use foam wedges – a wedge under each buttock to avoid contact with the supporting surface. If you search coccygeal wedge you’ll see what I mean, hope this helps

      • Hi Michelle, I have to sit a lot due to my work and you say – ‘use foam wedges – a wedge under each buttock to avoid contact with the supporting surface.’ Would this wedge support be OK? https://www.amazon.co.uk/Medipaq-MEMORY-Cushion-CUT-OUT-Support/dp/B00BTD1X76/
        Also, when using a stationary bike should I use cycling support undershorts?

        • Author: Michelle Kenway Pelvic Floor Physiotherapist says

          Cara you can use whatever you like to pad the seat. Gel seat covers can help on the bike or shorts with padding too. In the past I have simply bought 2 pieces of foam and placed each one separately under each thigh to keep the pelvis from contacting the support. If you can find a local foam seller, they are often happy to give or cheaply offload a couple of foam offcuts (approx 20-30cm length and 15 cm width thick foam pieces) I hope this helps!

  13. Anonymous says

    Hi Michelle,
    Is it possible for the pain area to keep changing when you have pelvic floor muscle tension? Sometimes i have urethra pain and sometimes i just have a tight sensation in either my rectum/vagina. It depends on the position I’m in (e.g. sitting, lying down). And sometimes I can feel the tightness slowly move from my rectum to vagina and vice versa.

  14. How can i buy pelvic Floor Muscle Relaxation Combo Pack in Indian curreny. Is there any link.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Aravind
      Before you checkout your order should appear in your local currency on the checkout page. Please email us if you need further assistance with checkout.

  15. How long can it take relealisticly to relax pelvic floor doing exercise day in and day out what’s the outcome after a week and two? I understand it veries but it would help for motivation what happens on week one week two and so on:)

    • Michelle Kenway Physiotherapist says

      Unfortunately this is too different for women to say, some women notice improvements within a week of appropriate training, others take much longer. There are so many different factors that can cause the issue, and it also depends upon the treatment regime, individual stressors, technique etc The best thing is to commit to regular PF relaxation practice to get your best results, all the best

      • Hi i have nerve pain in the pelvic area and down the back of both legs. I am under a pelvic floor physiotherapist who has given me relaxation techniques. I also went to a euroligist who referred me to the physio . I’m just wondering whether walking 2 kms a day is good for the nerve pain . I have been told i have a tight pelvic floor . I had prolapse surgery in 2005 with mesh repair. Looking forward for your advice . Thanks Jeanette

        • Michelle Kenway Pelvic Floor Physiotherapist says

          Hi Jeanette
          At this stage I would be inclined to keep walking to a gentle stroll and probably less than 2km especially continuously. Short walks will feel more comfortable and gentle walking in water will be even more so as the pelvic floor is supported. Avoid walking at the end of the day when your pelvic fooor is fatigued and more inclined to discomfort and strain. All the best, Michelle

        • Hi Michelle,

          My name is Pinelopi I’m 34 years old and had a laparoscopic myomectomy this past July 2020 they removed a very large degenerating penduclated fibroid that was causing me lots of pain.After the surgery I am still experiencing pelvic pain Ei pressure very painful periods muscle spasms stomach pain and I started seeing a PFT she recommenced some exercises to do at home but am still experiencing the same amount of pain.I feel very hopeless at this point I thought my surgery was supposed to help me with all my problems but just seem to be the same.I don’t know what to do anymore.

  16. So many things people say here resonate with what has been happening with me and everything comes up “normal” with doctors! Chronic, *obsessive* abdominal core exercises, being an overly anxious person in general, and excessive stair climbing followed by sitting (I work on the 15th floor of my building, would only take the stairs, maybe 4-5 times a day and then sit at a desk – – keeping that psoas and hips damn tight!)– that went on for maybe 5 years previously. Now it’s been another 5 years since I have stopped all that because I started suffering from horrible abdominal/gastrointestinal distress, pain, cramping, constipation. I cannot tolerate sitting for any longer than 5 min or my abdomen tightens and constricts. Driving in a car is unbearable, and prevents me from being able to move my bowels for a day or two even if it is *urgently* pushing from above, sometimes heaving. I have to sleep on my stomach with my chest and head propped up on 3 pillows so that my back is arched backward and abdomen extended, otherwise I awake with horrible constricted abs and cramps and cannot move my bowels. I also have pain with intercourse. And my uterus is tilted funny so the gyno couldn’t see what she wanted to see. There’s more but you get the picture :)
    My question is if “pelvic floor pt” is enough to resolve this, or if there needs to be other therapy directed specifically at the tight psoas and abdomen? I have done pelvic floor pt for pelvic pain, which was mainly manual releasing of trigger points both vaginally and anally, but my constipation issues and abdominal pain were not really helped because that tension is so much higher up. Do you know of other bodywork modalities which might be useful for this?
    Help. My life is so miserable, I can’t even say I have a life. I can’t work a real job because of the pain, inability to sit, and ridiculous struggle and length of time in the bathroom.

    • Michelle Kenway Physiotherapist says

      Hi Dandy
      Reading through your story and your symptoms I would really suggest that the best course of action is to find an experienced pelvic floor physiotherapist. Pelvic floor spasm often doesn’t exist in isolation from other muscle groups. This is why treating all the areas affected will be very important. Do your homework and find a physio to help you. This may involve phoning various practices to ensure they work holistically rather than focusing just on the pelvic floor. I understand your distress and discomfort. Don’t underestimate the effect of stress on your condition as well. It goes without saying that pelvic floor relaxation is a vital part of this type of treatment and I would suggest committing to this on a daily basis. It’s also important to consider your stool consistency to reduce the effect your bowels may be having on your overall presentation. This might involve discussing appropriate stool softener medication with your doctor too. Don’t forget that when pain ramps up everything can become increasingly sensitised too so addressing this from all possible avenues may help too. I hope this gives you some starters Dandy …

  17. Donna c says

    Hi, I have had treatment for a hyper tonic pelvic floor – dilator therapy and gynae physio with some effects – was able to enjoy cuddles again, result of which, I’m due to give birth in four weeks!! am very worried how the pelvic floor distinction might effect things.. Mentioned to midwives who just look baffled and say they sure I’ll be fine. Also have nasty scars from previous (20 year old) episiotomy. Everything been very uncomfortable for quite some time hence the gap between labours!! Any advice/anecdotes received.

    • Michelle Kenway Physiotherapist says

      Hi Donna

      This is a tricky question, it will be worthwhile practising pelvic floor relaxation techniques such as those shown in this pelvic floor relaxation video. If you can make contact with your Pelvic Floor Physio this will be very helpful too (for assistance before and after delivery). Some women try perineal massage to prepare for birth however I would suggest that your Physio oversees this. Wish I could help more with this question, all the best with your new bub!


  18. Mrshappy2 says

    Hi Michelle, My 18 year old daughter was a competitive swimmer (16 hours training a week) and ballet dancer (4 hours a week) when 13 months ago she started getting abdominal pain. This was accompanied by constipation, bloating, reflux and urinary problems. After many trips to the doctor and a very high calprotectin test they thought she suffered from Crohns disease and she was given a colonoscopy/gastroscopy – the results were all clear. Her gastroenterologist felt that she was suffing from IBS brought on by a severe bowel infection.

    My daughter always felt that the problem was not with her bowel and was more with her uterus (her words although she didn’t know why). Her doctor referred her to a gynaecologist suspecting she may have endometriosis as she also suffered from period pain a week before her period was due. She had a laparoscopy and again the test results were clear.

    Her gynaecologist referred her to a Holistic Physio who said her abdominal muscles were all extremely tight and so she did work (all external) to release them. Since then the pain has reduced and she has had a couple of pain free days but the pain is ongoing and some days is severe. She has constant abdominal pain and it is making her life unbearable. She started at University this year and is struggling. On top of everything else she is constantly tired, no matter how much sleep she gets.

    She has also been seeing a pilates instructor (who is an ex nurse) who was the first person to suggest she was hypertonic. I have never heard of it before, after 13 months of googling and speaking to specialists.

    We are in NZ is there anyone here that could help her?

    • Michelle Kenway Physiotherapist says


      I’m sorry to hear about the ordeal your daughter is going through.

      Mrs H I’m glad you’ve commented having read this article on pelvic floor muscle tension – you may be on the right track. Your daughter needs to be assessed by a Pelvic Floor Physio for pelvic floor muscle tension which can occur in athletes who have developed particularly high tone in their pelvic floor muscles, especially through ballet and swimming. I think a good place to start would be to contact The New Zealand Physiotherapy Association and ask for names of Pelvic Floor Physiotherapists who are experienced in treating pelvic pain.

      I would also suggest immediately ceasing all Pilates and pelvic floor exercises until she has been assessed. Any core exercise has the potential to worsen pelvic floor tension – the focus should be on relaxation until a diagnosis is provided.

      If you require further assistance in accessing help for your daughter please feel most welcome to email me via the contact page at this website and I can make some enquiries for you with my NZ contacts.

      Mrs H this may or may not be the cause of your daughter’s problem – pelvic floor tension is still often not recognised and poorly diagnosed and sometimes women have many years of running around trying to get help which unfortunately just exacerbates the problem through stress.

      I hope this gives you some direction

      • Mrshappy2 says

        Hi Michelle, thank you so much for your quick reply. I have googled Pelvic Floor Physios in Auckland (why didn’t I think of that before!!) and found a physio that specialises in pelvic treatment. I have contacted them via email today and will make an appointment as soon as they reply. Thank you again.

        • Michelle Kenway Physiotherapist says

          That sounds like a really good way to proceed, all the best and always keen to hear how things go if you have time

          • Mrshappy2 says

            Hi Michelle, I have an appointment for the 11th May so I will update you after that.

          • Hi Michelle,

            I took my daughter to the specialist pelvic physio in Auckland and she has been diagnosed with a hypertonic pelvic floor. The therapist is confident she can cure her of all her symptoms. I am keeping everything crossed that this is true it would be such a relief. She has her first therapy appointment this afternoon. Thank you for your help.

            • Michelle Kenway Physiotherapist says

              I am really glad to hear that this has now been correctly diagnosed and can be managed from here on. I think that once you have the right diagnosis with this condition the pieces of the puzzle fall into place. All the best for her long-term management.

              Kindest regards

            • Hi was your daughter able to get help? How is she doing. I think i may have that issue. Anything would help.

  19. Can PFD cause a urinary frequency issue with no other symptoms? I have had the feeling of needing to urinate that seems to be constant. I may get 10-15 minute break after going and then the feeling comes back. I have no pain, burning or leakage. Sometimes I have a good urinary flow and sometimes very little with a pause before I can even get it started. Have had multiple negative urinalysis and a clear lower abdominal CT scan, pelvis exam and bladder scan. He did a quick cath in the office and I believe he said the flow was good. Seeing a urogynocologist who want to do a cystoscopy next week. I had foot surgery on one foot in Sept 2015 and the other foot in Dec 2015 so have had a lot of sitting around. I have been up and moving well for a month before this started. Any ideas would be appreciated. Thank you.

    • Michelle Kenway Physiotherapist says

      Hi Betsy

      Many different things can cause urinary frequency, not just bladder infection. It can be related to pelvic floor muscle dysfunction. Your Urogynae will take a look inside the bladder and this will give him/her a much better idea of what’s happening inside the walls of the bladder which also tells a lot. You’re on the right track with your investigations and working with a Urgynaecologist in this matter. This is unlikely to have anything to do with sitting while recovering from foot surgery.

      All the best

      • Thank you for your reply. I also was doing some extensive tile work on our shower floor and were in many awkward positions for several days right before this problem popped up? Do you think that might have anything to do with it or my PF muscles or maybe even something in my back?
        Thank you- Betsy

        • Michelle Kenway Physiotherapist says

          Hi Betsy
          It could be one or a combination of a number of things – there’s no real way of knowing unfortunately

  20. Hi Michelle,
    Thanks for the great info provided on your site. After years of (what I thought was) tailbone pain I’ve had a recent breakthrough with a pelvic physio and have been diagnosed with hypertonic pelvic floor muscles. Do you have any information about the impact this can have on giving birth? Or perhaps tactics to assist natural birth when a hypertonic pelvic floor is at play?

    • Michelle Kenway Physiotherapist says

      Hi Emma

      Great question. Hypertonic pelvic floor muscles are often associated with coccyx issues too – especially in women that have had coccyx injury so the two can become confused. If the pelvic floor muscles are very tight during birth it makes them more likely to tear as they can’t stretch as they might otherwise. I believe this is why some ballet dancers/athletes sustain pelvic floor muscles tears during natural vaginal delivery, I don’t know the exact stats on this however. I think it’s beneficial to have pelvic floor therapy to really address the issue well prior to pregnancy if possible and know how to relax the pelvic floor muscles especially with breathing (specifically exhaling). During pregnancy the weight of the baby stretches the pelvic floor muscles and this can cause discomfort if the pelvic floor is hypertonic. Regular practice is also vital when it comes to pelvic floor relaxation. I recall reading about perineal stretching prior to delivery some years ago however I’m not sure if this technique is being used currently prior to childbirth. Anyway some thoughts for you here to start with.

      All the best

  21. I am 2 yrs post menopause. I have done 12 weeks of pelvic floor physical therapy with a pelvic floor PT. She got rid of all my trigger points. The first day evaluation was painful! The last day evaluation for discharge of service was amazing..not one painful area or trigger point. My PT suggested I use dilators as part of my maintenance program. My problem is that they slowly slide back out while using them. Is there any suggestions on how to get the dilator to stay inside? I have the kind that have a handle that attaches and are hallow in the center so I could put something inside as a weight but wasn’t sure if that was ever suggested. Thank you for any ideas. Otherwise, I just have to keep putting it back in through out the session.

    • Michelle Kenway Physiotherapist says

      Hi Lynn
      Try using a rolled towel against the end of the dilator once inserted – it’s difficult for you to relax with your treatment if you’re having to worry about the dilator sliding out of position. Let me know how you go.

  22. Hi Michelle, I have been attending pilates classes for the past two years to strengthen my core and pelvic floor.
    I have had irritable bowel for many years and over the past 10 months I have had pain in my left lower abdomen and hips and sacrum, which also feels numb. My bowels have become dysfunctional. After a colonoscopy which showed nothing and increased bouts of severe pain I have been sent to a bowel Physio. After some treatment with them they put me into a pilates class again which seemed to trigger more pain. I also have Ankylosing Spondelitis with pain in my sacroiliac joints, neck and shoulders and have had two visits to emergency recently with pain and tetany due to a drop in my calcium levels. I am now taking Endep, Resotran, anti inflammatories and other medications. I think I have been having pelvic floor spasm, I am finding your site very helpful and I was thinking of purchasing the relaxation video and I wanted to know if there is anything else I can do. I just want to get on with my life and it is so confusing when you feel you are doing something that is beneficial for your health and it turns out to be otherwise. I feel I need to find a new way to be in my body and the pathway is not clear. Regards Alice

    • Michelle Kenway Physiotherapist says

      Hi Alice

      Yes this is very challenging for you indeed. Obviously something about the Pilates that you started didn’t agree with your body for some reason, were/are you in a position to discuss this with the practitioner that recommended Pilates for you based upon your assessment and progress? Did your bowel Physio assess your pelvic floor and diagnose pelvic floor spasm? Some of your symptoms are consistent with spasm along with your history of IBS.

      In your situation I would seek an assessment from a Pelvic Floor Physio or Gynaecologist who is experienced in treating pelvic pain conditions so that you know what you’re dealing with. Yes the pelvic floor relaxation CD is an excellent resource for helping women manage pelvic floor pain and spasm. I would start with a thorough assessment, daily relaxation and breathing exercises and cease Pilates, pelvic floor and core exercises until advised otherwise.

      I hope this helps you on your journey Alice, stay in touch

  23. Hello i though i would leave a comment as i need help and someone might be able to help me
    I have a had a back surgery and been having no friction during sex it effect me and my partner hugely where now we are not physical, from my gyne and spinal surgeons there is no spinal nerve damage and gyne says there is nothing wrong in the vagina but i did suffer with pcos and endomitiotis that is a low level, But my physio says i have tight pelvic floor and given me a thera wand and now I’m using a probe, i also have seen urology as i have overacive bladder,
    with pelvic floor tightness can it cause no friction as when using diazepam it dose change me back to normal after doing this and the wand? has anyone has this issue with intercourse and found an ongoing solution i believe I’m going through this as back pain from my spinal surgery but just would like tome information to help, Kindest regards

  24. hi michelle, i am yet another frustrated male with a spasm in my pf. it has been there since childhood. i am now aware of the tightness, which seems to protect me from the pain. i saw a doctor a while ago who suggested a epidural block may block the pain so that i can ‘relax thru’ the spasm a little more easily. another doctor suggested it was from loose tendons and wanted to do prolotherapy on my pelvic floor area to tighten the tendons which would allow the muscles to relax. i went thru several sessions of pt which seemed to aggravate the spasm and would cause it to tighten up even more. is it unusual that i dont ‘feel’ the pain, i think somehow it is below the surface, i do believe it is why i have such a serious somber personality. have you ever heard of botox in the spasm’d muslce to make it relax? one urologist gave me flowmax as it would help the muscles of the prostate and other muscles in the area. it helped at first, but gradually lost out. finally, i was in an vehicle accident in 2000 where my knee went into the dash, since then my problem has steadily become worse to the point of having to start self cathing in about 2009. seldom at first, now it is much of the time. any thoughts

    • Michelle Kenway Physiotherapist says

      Hi Toby

      Thank you for sending through your comment/question. It sounds as though this has indeed been a very challenging issue for you for a very long time. I read that you have seen many professional who have offered various advice. Toby have you ever been prescribed medication to promote pelvic floor muscle relaxation? Interesting that the PT aggravated spasm – what sort of therapy was involved? Regarding the car accident and worsening issue, there is a neurological phenomenon that involves extra inputs into the CNS winding up pain and spasm – it may well be that the additional inputs to your CNS from the knee injury have heightened the CNS output to your pelvic floor muscles.

      From a PT perspective my focus would be teaching whole body and PF relaxation as a priority even before manual therapy. I am not sure if you’ve seen this PF relaxation video with techniques to help you start. Toby I can highly recommend Patricia Neumann’s pelvic floor relaxation CD for men I am not sure of you are aware of this CD? I would suggest using this daily to help whole body and PF relaxation which can only help. Finally I am not sure if you are in Australia or US – I would suggest finding a very experienced Pelvic Floor Physio who specialises in treatment for men. I am not aware of US practitioners however there are some in Australia.

      I hope this helps you just a little Toby, always keen to hear back Michelle

      • Yes, i was prescribed flowmax under the idea that it would relax smooth muscles. i know flomax is for bph. and during the dre and cystoscopy the doctor didnt see significant bph. and the flomax helped at first. but the effect diminished, and with the doctors aporoval i doubled the dose. first time on the higher dose was amazing, for some reason my pelvic floor loosened up and i could relax it with great ease, but it was short lived. that effect from the higher dose lasted a day or two. after that, i would try to limit intake to 1 dose a day just to limit i intake of pharmaceutical. i finally stopped it because the effect had diminished. been off flow for about one and a half year. is there other medication people are using for cns to relax the pf?
        the pt was doing internal trigger point work. even if i am stretching out, i can sometimes aggravate the muscle to some extent where i can tell when i attempt to urinate next. it is a peculiar thing. for a while it will loosen up enough to where i can urinate but it will take several tries at relaxation but atleast i did it and didnt have to self cath. but then for a while, like a month or so, i will not even be able to do that, and will need to self cath all the time.
        is there anyway to stop the additional CNS inputs ?
        there are some good pf pt here in the states, i dont know of any off hand.

        • Michelle Kenway Physiotherapist says

          Hi Toby

          The pelvic floor muscles are not smooth muscle, they are skeletal muscles just like the other muscles that you have voluntary control over. If you think of tight pelvic floor muscles as though they are tight neck muscles… How do we treat tight neck muscles? treatment options include massage, heat, trigger point therapy, postural reeducation to stop the spasm recurring, treatment of the causes of the tightness everything to help the pelvic floor muscles relax. Skeletal muscle relaxants are used by some specialists to treat chronic pelvic floor spasm. The fact that trigger point therapy aggravated your pelvic floor tension tends to suggest that your pelvic floor muscles may be involved. To decrease CNS output to muscles in spasm? learn to relax the muscles and practice this repeatedly.

          Smooth muscles are not under our voluntary control. The pelvic floor muscles are not smooth muscle. Smooth muscle contracts our hollow organs such as the bladder. We cannot control smooth muscle and this is not the type of muscle involved in pelvic floor muscle tension.

          Hope this helps you understand a little more about pelvic floor spasm.

          • thanks Michelle, yes, i follow what you are saying about smooth muscle and skeletal muscle. yet, for whatever reason it has helped. tell me, what muscle relaxants do you see that works the best on patients with the chronic pelvic floor problems ? for me, there seems to be an involutary response to the pain of spasm when i relax to the point that the spasm is reached… really i work on this every day. do you have any experience of using an epidural block to block the pain and perhaps finally stop the involuntary reflex of the muscles that protect from the pain of the spasm.. thanks,

            • Michelle Kenway Physiotherapist says

              Hi Toby

              Different specialists have their own preferences according to that patient, their general health, contraindications etc so there’s no one right medication. Sometimes local muscle relaxants are used and sometimes general muscle relaxants or some antidepressants. I think this is something to discuss with your specialist if you haven’t already. My apologies Toby I haven’t seen epidural block used for pelvic spasm so I can’t comment. I can’t emphasise enough the importance of whole body relaxation and distraction techniques as well for pelvic floor muscle tension. If there is an intense focus on any area of spasm this is bound to increase the intensity of the physical response. I hope this makes sense too. I will be interested to hear how you go with this Toby, my best wishes to you.

  25. I m a 40 year old male and started doing kegel after i found i have some post urine dribble. I only did kegels for a week and now think that i have damaged my anal sphincters or weakened my pelvic floor muscles. Now i cannot control by bowel urgency (only in the mornings) and also cannot tighten my anal sphincters much like before, this was not a problem before. Does doing kegel weaken your anal sphincter muscles?

  26. Hi Michelle, thank goodness I found your site – I hope it’s not too late to add a comment.
    I may be in the minority here being male but I’m convinced that I’m suffering due to pelvic floor problems. I’m 48 and for the past 5 years have been battling cancer (myeloma). I used to be very fit, exercising and walking daily but for the past year I’ve been forced to spend more time sitting (whilst recovering from fractures) and I started suffering pain after peeing or sex and noticed that I had a slight dribble of urine even after I thought I was finished. My doctor assumed it was a UTI from lowered immunity following chemo but several urine tests have been clear. Nevertheless he has prescribed various antibiotics over the past 8 months, all to no avail. Unfortunately he won’t accept that pelvic floor tension is a possible cause. It makes sense to me given all the stress, drugs and enforced sedentary lifestyle.
    To be honest I could do with a few less problems. Your recommendations are really helpful but I would love to find a pelvic floor physio in the UK (North/Midlands) who could help me address this issue without more drugs.
    Any suggestions gratefully received.
    Thank you, Mark

  27. Hi Michelle,

    I am a 21 year old female. Last May I was diagnosed with IC after a series of urinary tract infections. I previously had completely pain free sex. A main symptom of my IC is intense urethral burning, and when I was first diagnosed, I spent months tightening my pelvic floor unknowingly in pain. When I tried to have intercourse with my boyfriend for the first time 3 months after my IC diagnosis…my pelvic floor was too tight and wouldn’t allow it. I have been in physical therapy doing dialators and internal massage for 2 months now and my resting rate is still around a 9. I can’t get it to relax. I feel it tight all throughout the day. Any advice? I am miserable. Haven’t been able to have sex with my BF since all of this started. Will this continue on like this as long as I am in IC pain?


  28. Rosemary Wissen says

    Hi After nearly four years of pain and urinary retention and endless trips to GP and women’s health physio and two gynaecologist have been told by a Urologist that bladder problems caused by tight pelvic floor. I suggested this to physio more than a year ago and she examined me and said I was fine. So really on my own now as NHS in the UK don’t know about this sort of thing and certainly can’t treat it. I wonder Michelle if you have any contacts in the UK that know about this. Also bit worried as I think from various symptoms over the last 20 years that this problem has been brewing for a long time and the final straw was some gyne surgery so in your opinion at this last stage do you think it could be treated. Also think I may have a problem with joint hypermobility so wonder if this is the root cause of all of my pelvis and hips seeming to just not stay in the right position. Lots of tight muscles and trigger points all over this area. Getting so bad now that I can’t walk very far and last couple of months got pain in my ankle as well.

  29. Hi Michelle,
    So happy to find this site. I too would like to find a female pelvic floor specialist (Madison, WI area) for my 21 year-old daughter who has been suffering for over a year. This has gone on too long and it’s negatively impacting this young vibrant college student.
    After many tests for many things, including abdominal wall pain treatments, it appears she may have pelvic floor muscular/vaginal issues. After several MD visits, pain meds, etc… We sought out a homeopath that specialized in laser treatments. The laser treatments have not solved or stopped the pain, but moved it…. but he (the homeopath) believes her pelvic area is in such spasms and is so tight that is causing pelvic floor/vagina area problems. However, for various reasons she is NOT comfortable with his next suggested steps of ‘digital’ treatments. I’m hoping a PF specialist in more of a clinical, professional setting can help her with whatever treatments are needed.
    It’s so sad, as a mom, to see your child, this young woman, in so much pain and not be able to help… other than be there for her and attend medical appt, etc… with her. She has a high pain tollerence… but the pain is increasing.

    Any comments would be apprecated.

  30. USA, specifically the state of Louisiana and the city of New Orleans. Your site has been very helpful and informative!

  31. Hi Michelle,
    How do I find a Pelvic Floor Physiotherapist? I am a 53 y/o female having low back pain and pelvic floor spasms of unknown etiology. Pain just started one month ago, but I am miserable. Going for colonoscopy, as most pain is in rectal area. Initial exam by colon/rectal surgeon (I thought I had hemmorhoids) was all good / normal tissue. His dx is pelvic floor spasms and he gave muscle relaxer and NSAID for pain. After 2 weeks, no relief. Do you think color/rectal provider or gyn provider is best source for care?

    • Michelle Kenway says

      Hi Sharon

      What country do you live in and I can direct you from there. I think you are correct in sourcing a Pelvic Floor Physio review, NSAIDS alone don’t always resolve pelvic floor spasms.

      I look forward to hearing back from you

      Kindest regards

  32. Hi Michelle

    I have been diagnosed with Hight Tone Pelvic Floor Dysfunction where my muscles will not relax, this is causing Frequency, Urgency. I have been suffering with this for the past 7 months now. I am trying everything internal external PT, stretching, Warm Baths, Deep Breathing. I just wanted to ask you what is the best type of Yoga for Hight tone Pelvic Floor Dysfunction and also what supplements others than Magnesium would help assist this condition ? Any Assistance would be greatly appreciated as I feel like I dont have any other options.

    • Michelle Kenway says

      Hi James

      You will need to be cautious with the Yoga poses you choose as some of them will increase pressure on the pelvic floor, particularly those involving intense abdominal activation. Many of these poses to modify are listed here in this article on Yoga poses to choose and avoid

      I am very much in favor of daily pelvic floor muscle relaxation or down training of the pelvic floor to assist. The best down training pelvic floor relaxation CD for men I have come across for men is this one linked here. Practicing the techniques on this CD would be a great way to help you recognise when your pelvic floor is relaxed and tense and use the strategies to keep it relaxed.

      Magnesium may provide a small amount of relief for some but not usually with excessive muscle tension. Has your doctor prescribed you any medication for this? I am not sure which country you are writing from however there are Physiotherapists in Australia that treat this condition in men.

      I really hope this helps you a little James, please feel welcome to reply further

      • Thanks Michelle for getting back to me. I’m based in Sydney and I have been seeing Angela James for the past 7 months in Bondi Junction. She has been very helpful in my recovery process. The symptoms seemed to calm down after months of treamtment in June, however in July I had a Cystoscopy procedure from my Urologist and bladder distillation and the symptoms afgter the procedure got worse. I’m actually considering botox injections as a last resort.

        If you have any other alternative treatments that you would recommend I would be greatly appreciated if you could let me know.

        Thanks James

  33. Hi, Im wondering if squats in exercise class or chair pose in yoga should be avoided if hypertonic in PVF?

    • Michelle Kenway says

      Hi Margaux

      I don’t think chair pose poses a problem at all – it is a nice safe squat position, just try to avoid drawing your abdomen in ant the same time.

      As for deep squats in exercise classes – avoid them, this article teaches you how to modify squats (and other exercises) in the gym. You will see the heading is for women with prolapse however these principles will also apply to women with pelvic floor muscle tension.

      All the best

  34. I experienced a running injury 9 months ago. I have completed 6 months of PT, seen orthopedic doctors, back specialist, gynecologist, had 2 MRI’s, trigger point injection and a ProloTherapy injection into my Right glute. I have also been diagnosed with Pelvic Floor Dysfunction (too tight). I am awaiting my PT Evaluation (in 1week). I also have PCOS and I suspect Endometriosis. Since my IT Band injury, I have had pain in my pelvic region, specifically the ischial tuberosity and pubic bone. Could having tight pelvic floor muscles be the root cause of my pain? I really want to run again.

  35. I have chronic lower back pain and I think my pelvic pain has been around the same time the back pain started but I only have pain during intercourse and when I use a tampon (though for much of that I had an IUD and no menstruation). My chiropractor has been having me focus on my core to help my back a lot over the last year and now I’m concerned that my back could get worse again. Do you think the back and pelvic issue could be connected?

    • Michelle Kenway says

      Hi Robin

      Pelvic pain and low back pain can be interconnected. Low back pain and pelvic pain will often have an impact on the pelvic floor muscles. You also describe symptoms consistent with a condition called Vaginismus which involves spasm of the pelvic floor muscles or pelvic floor muscle tension. This can cause pain with intercourse, inserting a tampon, gynae examination. Unfortunately intense core exercise with insufficient relaxation can worsen pelvic floor muscle tension since in some ladies the core (abdominal) and pelvic floor muscles work together. It is unlikely that treating the lower back alone will alleviate the pelvic floor spasm.

      This article on pelvic floor muscle tension will give you more information on this condition. It would be great if you could access treatment with a Pelvic Floor Physiotherapist however I am not sure which country you reside in and this isn’t always a feasible option for women.

      I hope this gives you a bit more information to help you along
      Best wishes

  36. I have recently been diagnosed with PFD related to too much pelvic muscle tension. It has been over a yr that my abdominal muscles and gut have been hurting. When I poo I cannot get everything with taking marilax daily. I will then take a dalcilax (sorry about the spelling) and feel like I finally get it all out. The problem here is that I have been in way more pain then I think I should be and the pain is worse after I get myself cleaned out. I don’t have pain in my pelvis only my abdomen. I have been out of work all week and wanting to go to the ER for the pain but know I will get drugged and sent home. Is the amount of pain normal for this or is there more going on?
    I go back to the Mayo tomorrow to meet a PT and get abdominal wall injections. I have only had 1 meeting with the dr there. They seem to not be answering me on the amount of pain that is normal. Maybe cuz I have only been once and have not started treatment. Am I just being paranoid? I don’t know what is normal and it took me so long to get diagnosed.

    • Michelle Kenway says

      Hi Mayday
      The pain with pelvic muscle tension differs in intensity and location one woman to the next. Pelvic muscle tension can cause great discomfort as well as difficulty with bowel emptying. Often when emptying the bowels and straining to empty pain is worse following this as thre pelvic floor muscles will be stretched during the process. Pelvic floor tension is usually treated with techniques to relax the pelvic floor muscles – you will have read about these techniques in this pelvic floor tension article. Warmth over the lower abdomen and pelvic floor can provide some good relief but often only temporary. Yes it can take a very long time to get diagnosed with this problem as unfortunately it is still not widely recognised or well understood.

  37. Hi,

    I exercise very regularly and was having problems with my bladder (constantly feel like I had a UTI) and went to see a gynaecologist who informed me I had an overactive pelvic floor.
    I have tried the relaxation exercises mentioned in this blog but want to know if there is something that I can do that will allow me to continue to exercise frequently!!
    Is Pilates a no-go?

    • Michelle Kenway says

      Hi CS
      Thanks for your question. Yes I understand your frustration and desire to exercise. I have a couple of throughts regarding your exercise and management with overactive pelvic floor muscles I will just list briefly.
      – Unfortunately Pilates is not the best exercise with overactive pelvic floor muscles, this is because Pilates involves a considerable amount of core abdominal work which can actually increase pelvic floor muscle tension. Water-based exercise can allow some women with overactive pelvic floor muscles to exercise (swimming/water walking) and short land-based walks can sometimes be tolerated. It is important to avoid high impact exercises such as running, and bike riding can be very uncomfortable with pelvic floor tension, low impact is the most preferable form of exercise while the pelvic floor is in spasm.
      – Women will usually benefit from Pelvic Floor Physiotherapy manual release techniques for the pelvic floor muscles. If you imagine very tight taut neck muscles, just trying to voluntarily relax them won’t always make a huge impact, for the pelvic floor relaxation is part of an overall management approach which often includes tissue therapy to stretch and relax the pelvic floor muscles, just as you would treat tight neck muscles. I hope this makes sense and gives you a little direction too.
      Best of luck CS

  38. I done physical therapy with good results. However I’ve just lost 15 pounds and would like to tone us my stomach. I’m afraid to do ANY ab exercise. Are there any exercises you would recommend as safe, that won’t tighten the pelvic floor muscles?

  39. Hello, I enjoy reading all of your article post. I
    like to write a little comment to support you.

  40. I don’t know how to relax my pelvic floor muscles when they tense up. I drink to manage the pain and rarely can make love to my husband. I was in physical theraphy for half a yr, I have all the yoga moves and the dilators, but my progress is turtle slow its months between each dilalator step and It makes me worse to do any of those stretches but the squat. I’ve been dealing with this for two yrs and I’m bout to lose my mind.

  41. Thank you Lena and Jen. Me too! Doctors treat me as if I'm just drug-seeking, but I'm in horrible pain … increasing for 16 years to the point I've been considering suicide to avoid more pain or degradation from a doctor.  Sounds drastic, yet this is where I am emotionally now. 
    My problem probably started in childhood, holding waste up to 2 weeks unless I could go at home. I've not coped well with some tragedies, and anxiety has always been an issue. I was put on medication that gave me chronic diarrhoea for years, and I tried to hold that. The same drug caused massive weight gain. That impact, a car wreck, years of stress and then over-exercising to loose the fat …have created huge pelvic floor muscles that are constantly contracted, and sporatically tighten more to excruciating extreme. My periods intensify the cramps, but the flow has nearly stopped (or squeezed off). I often can't even insert a tampon, and if I do, the "fit" vaginal muscles bend it u-shaped or flip it upside down in less than an hour. What talent, huh? 
    Uterine pollyps 7 years ago could have been a sign. In the last year, I've finally seen some specialists (a challenge in itself since "women's health" in Ireland is limited to child-bearing concerns only). I was refered to a pelvic floor therapist who sent me to a gynaecologist, who sent me to a gastroenterologist, who sent me to a surgeon, who sent me to a back pain specialist. Surgery to correct the rectocele and tummy tuck the baggy skin is still being discussed. The first test brought on bad memories and so they postponed the next invasion. Endometriosis and colon cancer have been ruled out. 
    Next stop is a facet joint block in 3 weeks. I'll discuss my pelvic floor theory again, with more vigour this time! Thanks ladies. 

  42. I am having pelvic muscle tension and spasms. My psoas, abdomen and diaphraghm are also in a chronic state of tension. I had a tummy tuck seven years ago. However, last year I had two miscarriages, heavy bleeding from uterine polyps and then a polypectomy and d&c. Since I had that surgery my Internstitial cystits flared up and then i started having severe tension in spasms in groin, pelvis, abdomen, psoas and diaphraghm. it feels uncomfrotable to sit. I am most comfortable lying down or standing up. has anybody had similar symptoms

  43. Now I’m scared because I have been doing kegel excersises, running, abb workouts, thinking that this would help to strengthen and thus relax my muscle.

  44. Hello,
    I am twenty-one. From the age of two I have suffered from chronic constipation. All through my childhood my parents forced healthy, fibre-full foods into my diet in order to relieve me from this problem. My doctor and my parents always thought that the problem I had was due to my diet as constipation is most commonly associated with diet and exercise.
    When I was seventeen I started having sex with my boyfriend. My constipation subsided until a trip I took about a year after we had been together. Throughout the week long trip I hadn’t been eating the best foods, and was anxious as I was meeting his family for the first time and I never had a bowel movement. When I returned from the trip I had terrible constipation. We tried to have sex but every time we tried it was unbearably painful for me. Sometimes I felt so bad about it that I would try to endure the pain but it was just too hard and I couldn’t help moving away from him as he tried to penetrate.
    We didn’t have sex for an entire year during which I had visited the doctor three times. First she told me I wasn’t lubricated enough and that is why sex hurt. Then she told me to massage and stretch the walls of my vagina. The third time I came back I asked her if my problem could be associated with constipation, she told me that the anus and vagina are two separate passageways, she acted as if I was a hypochondriac and referred me to a gynaecologist. I asked the gynaecologist the same thing and she prescribed estrogen cream to me and told me to stretch the walls of my vagina. I did this. I started to be able to have sex, even though it was still painful—I wanted so badly to show my boyfriend I was progressing after he had not had sex with me for an entire year and only tried to help and encourage me.
    After about three years of my own research, this month I found a book at the library called “the g spot.” There was a story in the book about a woman with “chronic pelvic tension.” It was too painful for her to have sex. As a child her authoritarian father told her not to urinate in public washrooms because of germs. She would hold in her pee for hours until she came home and could urinate. Her pc muscle was always tightened, thus leading to her involuntary contractions at the approach of a penis.
    One day I was talking to my mom about this, trying to find out why I had constipation my whole life and how it could be linked to my sex problem. I just knew it was linked but nobody believed me! My mom finally came out and told me that when I was two my authoritarian father had yelled at me for pooping in my bathing suit at the beach. They had never told me this because my dad felt awful about it but also because they didn’t know it was the reason for my constipation—they always associated it with my diet.
    Well that explains the trauma that triggered my constipation. From the day I got in trouble I began to hold in my waste. When I felt the urge to release I would run to the bathroom or even go behind the couch or somewhere private and clench my PC muscle as hard as I could in order to make the feeling go away and it would go away for a few hours. Sometimes I would go like this for two weeks at a time—to the point where I would be sick and dizzy, I would have to stay home from school and spend hours on the toilet trying to go to the washroom. It sounds absolutely crazy but it’s true. By the time my body actually forced me to go to the washroom it was terribly painful because of the stool would be hard as rock and larger than normal. This would start a new cycle of being scared to release my bowel.
    Now after 19 years of having chronic constipation, I can finally learn how to control it, and how to have sex without pain. I just need to learn how to relax the muscles in my pelvic floor. The really awful thing is that constipation is something so embarrassing no one wants to talk about, especially when you are a teenager. I never told my boyfriend until we had been together for three and a half years, because I was so embarrassed. I just want so badly to get this story out and show other women that it is not a taboo subject and it should be researched further! Not enough people and not enough health practitioners know about this type of thing and it could have saved me a whole lot of pain and embarrassment if I knew about it earlier.

    • Lena, you just described my life, almost! Constipation my whole life which started from a very young age when I punished for pooping my pants and I began to fear going to the bathroom… I have never heard anybody else talk about this, but I knew most people weren;t dealing with the problems I had. I would have the same, hard giant bowl movements that sometimes were several days apart, an area of huge embarrassment and shame. I never made the link from constipation and painful sex (im 26 and sex has always been extremely painful so I start to avoid in relationships). I made the connection between this pain and my posture… I completely know what you mean about KNOWING there is a connection and nobody else (especially doctors..) believe you. I have dealt with this a lot with my posture issues and all the different areas of my body/life it has affected, sex being one of them. I’m curious about your posture and the posture of the ladies talking about this problem. I have an “anterior pelvic tilt” but it sounds like you are talking more about the tailbone being tucked under, which is the reverse tilt (im forgetting the term). I feel like my “down there” kegel area isnt flexed ENOUGH.. but maybe it is overly tight? but If have the anterior pelvic tilt, would that mean that I have the opposite problem? Because I feel like I have the beginnings of prolapse, possibly.. im not sure, but it feels like my insides are going to be “pulled out” during sex …at the same time i’m told that i know im “clenching” during sex so maybe the tightness of the muscles is causing that pulling feeling??? I also have a weak core (common of anterior pelvic tilt) so maybe I do need to work on my core and kegel, I definitely want to avoid prolapse. I know there is a connection between all this and posture–ladies if you havent, research the crap out of posture! No pun intended! It affects everything. I guess maybe what Im trying to find out is if both weak and tight pelvic floors can contribute to prolapse and painful sex.. or maybe thats not even whats going on with me… but anyways any info is helpful! I just want to be healthy and discomfort-free.

  45. I was so excited to find your web page and all the information it
    > provides. I have learned more from your web page then from the four
    > doctors I have saught treatment from.
    > I had a cystocele repair and bladder neck suspension three years ago. I
    > had a hysterectomy, rectocele, enterocele repair with sacrospinios
    > ligament fixation with a prolift mesh kit ten months ago. Two months ago I
    > had a urethra sling placed as the previous surgery left me leaking badly
    > as the cystocele and my urethra reprolapsed. I chose not to repair the
    > cystocele as I was advised it would make sex more painful.
    > Currently I have been diagnosed with damaged nerves which causes a burning
    > tearing pain in my vagina and perineal area and muscle atrophy which
    > causes an achy pain and a feeling that something is falling. I will be
    > starting pelvic floor therapy soon. Do you have any helpful information on
    > this condition?
    > Thank you

    • Hi Lianne
      Thanks so much for this honest and useful contribution. I think it helps other women to read about your experiences so thank you for your generosity in relating them here.
      It sounds as though you have been referred in a good direction to receive pelvic floor therapy. It is not uncommon that after multiple surgeries to the pelvic floor that pelvic pain conditions can arise. There are many possible individual causes of pelvic pain and it may well be that other factors in your life are contributing to this painful situation also. Your physiotherapist will assess other potential contributing factors as well as treat the underlying condition.

      Essentially therapy for pelvic pain is multidimensional. Some strategies that may be employed by a treating pelvic floor physiotherapist include relaxation strategies for the pelvic floor muscles and for the whole body, soft tissue massage of tight painful muscles, diet assessment to ensure good bowel movements and to decrease bladder irritants, education about the causes and factors perpetuating that person’s pain, breathing awareness training, advice regarding sexual intercourse, advice regarding the need to avoid using soap and irritants on the vulval area, use of dilators to desensitize painful regions to touch and advice regarding appropriate and inappropriate exercise. Your doctor may also have recommended that you commence specific antidepressant medication that has been shown when taken in small doses to help manage and alleviate pelvic pain.

      The down training strategies listed in this article on how to overcome pelvic floor muscle tension and reduce pelvic pain are also extremely helpful to employ to assist in managing pelvic pain. Alyssa Tait is an Australian Physiotherapist who works extensively with pelvic pain and lectures to University Physiotherapy students on this issue. She has created an excellent CD called Free Your Pelvis to guide women through many of the techniques listed above which may also be of assistance to you.

      Best of luck and trusting this information helps you in overcoming your condition Lianne.

      • Hi Michelle,
        Which specific anti-depressants help manage pelvic pain? Thanks!

        • Michelle Kenway says

          Hi Jeanne
          The use of antidepressants for pelvic pain depends upon your gynaecologist’s preferences, your own general health and the actual cause of the pelvic pain. Antidepressants for pelvic pain are usually lower dose Tricyclic antidepressants (higher doses are used for depression/anxiety). There has been some evidence to suggest that antidepressants have some benefit in alleviating the intensity and duration of pelvic pain in some women but ideally this is incorproated as part of a multidisciplinary approach including physiotherapy and psychotherapy. Some examples of the types of antidepressants used in treatment of pelvic pain include Nortriptyline (Pamelor), Amitriptyline (Elavil) and Imipramine (Tofranil).

  46. I just purchased your book because I am interested in returning to a healthy pelvic floor exercise program. I am 6 days post op hysterectomy with vaginal vault, and rectocele and cystocele repair. I am interested in knowing if you have had any experience with post op sciatic nerve pain and numbness after this type of surgery? How long does it last, and what can I do to help it subside?

    • Pelvic Exercises says

      Hi Debbie
      First of all best to clear things with your specialist if you experience altered sensation post operatively. Numbness can occur post op if the sensory nerves are for some reason compromised – stretched or nicked during surgery, compressed with swelling, problems in the low back or pelvis from the position in which the surgery is performed (lithotomy or the old childbirth position) which can be unkind to the spine and or pelvis. To help relax pelvic floor muscles post op, pelvic floor muscle downtraining strategies can help greatly in the first six weeks see this article for details. Then if the numbness persists post op longer physiotherapists may start manual therapy techniques for the pelvic floor muscles (massage, trigger point release, stretching and retraining of the pelvic floor muscles). Also check out the source of the sciatic pain, and that it’s not SIJ/lumbar spine related. Back and pelvic joint problems can also increase pelvic floor muscle tension. Also supported sitting can help using make a foam wedge not a rubber ring which will make swelling accumulate in the pelvic floor region. A good idea to rest frequently and elevate the pelvis with knees over a pillow when lying down – this also relieves the back and helps to reduce swelling. Best of luck Debbie, Michelle.

  47. i will add I am a core specialist fitness trainer who refers to kegals often in workouts.. so the theory of too much pelvic floor work and or intense abdominal core work… that would be what I have done for several years….

    • Pelvic Exercises says

      Hi Tracy
      Yes this is a huge problem. Many women are exercising their core muscles too much, so much so that their core muscles are then unable to relax (including their abdominal and pelvic floor muscles). Intense core training and Kegel exercises without relaxing the muscles fully are increasingly contributing to pelvic pain and pelvic floor muscle tension among women. It is really important tha women are made aware to contract and fully relax their pelvic floor muscles. Furthermore women with pelvic pain associated with pelvic floor muscle tension need to avoid intense core workouts to alleviate the pressure on the pelvic floor until the musles fully relax and recover. Michelle

      • Michelle that is hard for me to do. For the past year I have done a workout called T-Tapp and this was a main focus. I am always tucking my butt and keeping my abs tight. I am going through menopause so I now have the lower tummy that I have never had. I am determined to teach myself to relax so that when I get the urge to move my bowels my muscles will relax and allow me to empty. I am excited as I read your book and start to use your exercises.

        • Pelvic Exercises says

          Hi Peg
          Keep practicing learning to relax your abdominals. It can take some time to learn to relax abdominal and pelvic floor muscles. Many women are so accustomed to walking around with them braced all the time to flatten the appearance of their stomach. Not to mention the intense core work and abdominal muscle exercises women unknowingly do in gyms and exercise classes. The abdominal muscles increase the pressure in the abdomen which is transmitted directly down onto the pelvic floor resulting in stretch and strain of weakened pelvic floor muscles and tissues. Good luck Peg, Michelle

  48. i have had over 2 years of pain.. can a locked up kegal..pelvic floor etc.. and any of the ligaments and tendons being tight around anywhere and then the bladder cause bladder infections… ?

    • Pelvic Exercises says

      Hi Tracy
      If tight pelvic floor muscles contribute to incomplete emptying of the bladder, then this could potentially increase the likelihood of recurrent bladder infection. When emptying the bladder it is very important to; lean forward, support the upper body with forearms or hands on thighs, maintain an inward curve in the low back and allow the lower abdominal wall to completely relax forward (this helps the pelvic floor muscles to relax). There is also a technique called double void which involves emtying the bladder, standing and rotating the hips a little like a hoola hoop action and the sitting to empty again. This technique helps to remove any residual urine that can contribute to infection. Michelle