How do I relax my pelvic floor?

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How do I relax my pelvic floor?

How do I relax my pelvic floor? This is a question I receive from clients quite frequently. It is an important question, as the ability to relax the pelvic floor is vital to healthy tissues, and vital to the return of continence and intimate function, as well as with regards to control of pevic pain or pressure complaints.

Spoiler Alert: MOST pelvic floor disorders are due to pelvic muscles being too short and stiff (thus weak), and NOT due to them being too long and loose and weak..

You: “Nope. That’s not me, Dr. Kelly. I KNOW I’m too weak because when I go to try to stop my pee, the muscles don’t work. They are clearly too long, loose and weak.”

Me: “It’s certainly possible. BUT, based on my 16+ years experience in the pelvic floor field, I find that hypertonicity is a much more common cause of dysfunction. I know it’s hard to picture sometimes, so try this: Make a fist. Now hold it for 8 hours. Now try to make dinner, or write a letter with a pen. How does your hand work? Does that help you see how something being stiff and tight can cause weakness and dysfunction?”

Why can’t I just tell my muscles to relax?
I’m doing it right now. … … I think? …

The reason we can’t just ‘tell’ our pelvic muscles to relax, is that often, our amazing brains have NO connection to be able to reliably sense the resting position of these pelvic muscles.

Often, in cases of incontinence and prolapse pressure, and especially after trauma or pain (AHEM childbirth), our brain gets nervous and tries to protect us by attempting to ‘ignore’ the problematic body part–in this case, the pelvic floor and core region.

Here’s the problem. Our brain, while able to block out pain signals for a certain finite amount of time (think of if you sprain your ankle while trying to save a child from being hit by a car. Your ankle won’t hurt until the adreneline has worn off later). In the case of pelvic pain, low back pain, or other dysfunction, the brain isn’t smart or strong enough to inhibit that pain signal forever.

Did you know that the same nerves that carry the sensation for pain, also report the sensation for touch, and temperature, and other information?

So now, the brain is trying to protect you, and trying to ignore pain in this ‘general vicinity’, but what it ends up ignoring is something called proprioception, or our body’s ability to sense its position in space.

Our body, in an attempt to reduce the pain we feel, actually reduces our ability to sense WHERE our core and pelvic floor muscles are in space. So we ‘think’ they are relaxed, but we actually have NO IDEA if they are relaxed or contracted. This now reduces our ability to use them properly…at rest, and with activities, and sets us up for additional pain and dysfunction. Bummer, huh?

image of pelvic floor muscles, showing their resting position at the bottom of the pelvis, like a hammock. The muscles should rest at about 3/4 range relaxed, then be able to contract up and in when needed, relax easily back down, then gently buldge down and out (like a flower opening) the bottom 1/4 of range, before again returning to resting position.
The pelvic floor muscles should rest at about 3/4 range relaxed, then be able to contract up and in when needed, relax easily back down, then gently buldge down and out (like a flower opening) the bottom 1/4 of range, before again returning to resting position.

So how do I relax my pelvic floor?
Or, how to I find out if it IS relaxed?

Great question! I would, of course, recommend purchasing my entire Signature Series Course for all the amazing lectures, including the Self Pelvic Floor Muscle Assessment, or at minimum, the a la carte Self Exam Package. BUT, if this isn’t in your budget right now, I’ve made a quick tutorial for you:

https://vimeo.com/628542418/546d1b8dd9

This 10-minute video guides you through a series of breathing and stretching exercises to improve your proprioception to WHERE your pelvic floor is in space, and how it should move during both relaxed breathing, supportive breathing, and with active, purposeful efforts to move it.

Wait. The pelvic floor can move in more than one way?

You bet! Would you like some exercises to teach you about the different ways it can move?

5 Exercises to Improve Pelvic Floor Health

  1. Relaxed Breathing. Here, as you inhale, your abdomen and pelvic floor should elongate with each passive inhale, and then passively reboud back inwards with each exhale. All motion in relaxed breathing is in belly and pelvic floor. No movement is in chest or neck. This is also called diaphragmatic breathing. Often when we are hypertonic in pelvic floor, we can’t sense this passive movement…because it’s not happening! Our brains often hold pelvic floor rigid, which contributes to all sorts of wonkiness (see fist analogy earlier in this post).
  2. Supported Breathing. Now, we try to engage the deep abdomen, to unload the organ pressure off of our pelvic floor. Can you do this and NOT clench pelvic floor? Now, your stomach is gently supported, so it can’t move freely. The motion here is now in our lower ribcage. Neck is still relaxed. This pattern is VITAL in recovering function post injury, as we often loose ability to differentiate abdomen from diaphragm from pelvic floor. This exercise helps you recover that individual control.
  3. If you’re able to master #2, then, from a supported breathing position, add a kegel, squeezing and lifting rectum up and in; squeezing and lifting perineum up and in; squeezing around urethra in front; pulling pubic bone towards tail bone. Hold 5-seconds. Then, keeping abs engaged, drop and open the pelvic floor back to it’s resting position. After 5-10seconds of working to keep abs tight and relax the PFM, go ahead and relax your abs, too. Did you find any parts of the pelvic floor that were ‘coupled’ to the abs? If this is too hard, just do the pelvic floor part for now, without the ab coordination.
  4. After the kegel to and from relaxed position, now try bearing down. Drop and open JUST THE PELVIC FLOOR MUSCLES further than their rest position. This is not a tummy movement, folks, just the pelvic muscles. You should feel a heaviness and opening in the rectum. Hold this 5-10 seconds, then relax. With ‘relax’, the pelvic floor springs back up and in.
  5. Wow. Now, in #1, as we did our relaxed (diaphragmatic) inhale, our pelvic floor elongated slighty. WIth #4, we are actively bearing down. As physios love exhaling with exertion, whenever I have you bear down actively, I want you to coordinate it with your exhale. Hold for 5-10 sec while breathing, then relax.

During the 10-min video, I guide you in a variety of mobilization techniques that utilize BOTH the relaxed breathing in #1, as well as the active bearing down in #4.

Wow. I’m overwhelmed.

I know. It’s a lot. But we all need to start somewhere

  • Even if we just focus on the relaxed breathing, a few times a day, in a seated position, this will start the brain thinking about these pelvic floor muscles.
  • Even if we JUST try the relaxed breathing before bed, this reduces our excessive tone and allows the pelvic floor to move more naturally as we sleep, improving tissue health and function.
  • If just sitting on a chair isn’t enough, try a Cooch Ball or Gooch Ball, which is a special ball for pelvic floor health (more on that later this month!), or just a rolled towel, for 5-10 minutes a few times a week.

How do I know if it is working?

  • You will generally become more aware of your body position in space. Often, you will feel more relaxed, as tension in the pelvic floor is associated with anxiety (and vice versa), so relaxing the pelvic floor (and neck), allow the sympathetic nervous system to chill out, and we typically feel a bit more centered.
  • Your urgency, frequency, leakage, pain, or sexual dysfunction might not be so bad as before. We start seeing these changes almost immediately after beginning to relax the muscles. It’s really great!

What if I don’t feel better?
Or have NO CLUE what I’m doing?

Then head to see a Pelvic Floor PT in person, buy my Signature Series, or a la carte Self Muscle Exam Course. We’ll get you headed in the right direction.

Thanks for Reading!

Check out my Pelvic Floored Signature Lecture Series for a much more in depth training of how your current pelvic floor musce status could be contributing to your pain, incontinence, constipation, pelvic organ pressure, or sexual dysfunction complaints.

And, if you haven’t already, please join my mailing list to be kept up to date on other AMAZING blog posts with practical tips for improving your pelvic (and overall) health prenatally, postpartum and beyond! Mailing list subscribers also get exclusive discounts to Pelvic Floored products, and access to subscriber only events!  Don’t miss out!  Sign up Today! 

Thanks for reading!

xoxo, Dr. Kelly

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How do I relax my pelvic floor?
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