Pelvic Pain, Posture and the Pelvic Floor Muscles

Did you know that the way you sit or stand affects your pelvic floor and in turn can affect your pelvic pain? Read on if you want to learn more.

The "trunk" part of the body is like a muscular cylinder.

The sides of the muscular cylinder

Put your hands around your waist and feel the side walls of your muscular trunk cylinder - the abdominal muscles - which wrap all around to the front and to your spine at the back. It's common for people to work hard to have strong abdominal muscles, to develop "the core" or a 6-pack. Read on and you will find out how the "core" and the pelvic floor work together. A lot of people hold their abdominal muscles in tight to look smarter in their clothes but this could be affecting the pelvic floor.

The top and the bottom of the muscular cylinder.

At the top is the big muscular diaphragm which is like a pump, drawing air into the lungs. If you breathe deeply and expand your waist, it's the diaphragm at work - filling your tummy with air, like a balloon filling with air. Some people are more "chest breathers" and their diaphragm doesn't move much. When we are anxious or afraid, we breathe more shallowly with our chests.

Try it out for yourself and see what you naturally do. Are you a chest breather or a diaphragmatic breather? Does your chest move up and down or does you belly/tummy expand – or a bit of both?

At the bottom of the cylinder are the pelvic floor muscles, like a mini-trampoline. To find your pelvic floor muscles sit on your hands with the palms up and feel your sitting bones. And now feel the pubic bone at the front and the coccyx at the back. Your pelvic floor fits in between these bones and has the important job of holding your insides up (your bladder and bowel for men and women, and the uterus and vagina, if you are a woman). Squeeze in your pelvic floor as if stopping your urine flow midstream or holding in gas and you may feel these muscles tighten. This tightening may cause pain in some people if the muscles are already tight, so try it gently. Then feel how you can let them go and make them as loose as you can.

Did you notice?

There are some interesting things about these muscles. They all work together. So when you pull your tummy in, the pelvic floor muscles are pulled in too. When you talk or yell or sing a song (ie use your diaphragm), your pelvic floor muscles are switched on and tighten too. In fact they are always in action. Women who watch violent or threatening movies even tighten their pelvic floor muscles as they get tense!

Try it out

Put your hands on the low soft part of your abdominal wall, just above the pubic hair line. Squeeze in your pelvic floor muscles – ie your vagina (or testicles) and feel what happens to your tummy muscles. Yes, they flatten and tighten. It works the other way round too. Let everything in your pelvis go as soft as you can. Now flatten in your low belly like you are doing up the zip on your jeans. Feel what your vagina or testicles do? Yes they have tightened in too. Let your tummy go soft and your vagina will go softer too. Let the testicles hang loose.

The challenge of the pelvic floor

We can’t see them, we can’t compare them with anyone else’s (as you can with a biceps muscle or a six-pack), we are told that they should be tight if you want to have good sex, but no-one much is aware that they can be too tight. Learning to let them go is also important, especially if you are a man or woman with pelvic pain.

The “friendly neighbours” of the pelvic floor.

There are other muscles that are part of the local scene, creating tension.

The buttock muscles (gluteals) are on the outside of the pelvis but they are connected with the pelvic floor muscles inside. When the buttocks tighten, the pelvic floor muscles tighten. Try it out. Sit on the palms of your hands and squeeze your bum-cheeks together. Think about what your vagina or your testicles are doing – yes they tighten and draw in too. Now let your buttocks soften and relax and think about your vagina or testicles and how they soften too.

The muscles on the insides of your thighs (the adductor muscles) are the “guardians of the vagina” in women and women spend a lot of time with these muscles tight, sitting with their legs crossed, for example. Try squeezing your thighs together and think about what happens to your vagina (or your testicles) or anus. Yes, they tighten.

So if all the friendly neighbours are tight and switched on – the abdominal muscles, the buttock muscles and the adductors – then the pelvic floor has only one option and that is to be switched on and tight too. Often when something in the pelvis hurts or aches, we tense up and even curl up. That’s a natural protective reaction to hold everything tight and not to move. Moving might hurt. Pain posture is hunched and tense and breathing is shallow. Nothing much moves around the muscular cylinder of the body. But tight muscles mean trouble as they can start to ache as well. Clench your hand to make a fist and hold it for two minutes and you will see how tense and uncomfortable your hand and arm become. There's nothing wrong with your hand - just tight, tense muscles.

Relax the pelvic floor and the friendly neighbours to reduce pelvic muscle pain

Here are some tips about relaxing the pelvic floor muscles. Uncross your legs and let your thighs separate, let your tummy bulge softly and let the buttocks spread out. Breathe into your belly – even into your pelvis – and feel how the pelvic floor muscles have a chance to relax and soften too.

Become aware of tight muscles and learn to loosen them.

My relaxation recordings (specially designed for women and for men) will guide you through how to do this.

Learn to breathe deeply into your belly and your pelvis. Moving the diaphragm and the abdominal muscles will give the pelvic floor muscles a chance to move and loosen as well.

Learn to scan the body for tension, become aware of your tight areas and practise letting them loosen.

Practise sitting, leaning back in your chair with your legs uncrossed and loosely apart, your spine supported and tall. Think about your breastbone and lift it up, freeing up your diaphragm so that it can expand down into your belly. Let your neck lengthen and your shoulders drop loosely. Notice how your breath can now flow down into your belly. Scan through your body and feel where you are still holding tension.

Practise standing tall. Imagine a golden thread pulling you up to the ceiling as you stand and walk. Your breast bone is lifted as if showing a badge on your chest. Walk mindfully and let your arms hang loosely and swing. Breathe – and notice how your breath goes down into your belly.

If you need more help, seeing a pelvic floor physiotherapist for an individual assessment and management program is recommended. 

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