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 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 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.
Gentle pelvic floor bulging is taught by Pelvic Floor Physiotherapists. Bearing down too strongly can actually increase spasm so this must be done gently.
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
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 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.
These exercises and activities can increase pelvic floor muscle tension:
- Pelvic floor exercises (Kegel exercises)
- Intense core abdominal exercises
- Heavy lifting or heavy activity
- High impact exercise such as running
- Painful intercourse or painful vaginal penetration
- Prolonged sitting or standing
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.
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.
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
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.