What a lot of women don't know about relaxing the pelvic floor

There’s so much talk about the contraction part of “working” our pelvic floor muscles.

That we should be doing this every day.

That we should focus on squeezing “longer” and more “firmly”.

And in between these we are given the instructions "relax” - whatever that means. 

Except that there's a growing problem for women that this advice is making worse: hypertonicity of the pelvic floor muscles. 

This is where the muscles are over-contracting, getting too tight and tense, and working too hard. 

When this happens, the muscles aren’t returning to their full length at rest.

Symptoms of a hypertonic pelvic floor can include:

- Feelings of irritation, especially when trying to do pelvic floor exercises

- Increased frequency or urgency for the toilet

- Bladder leakage

- Pain or discomfort during sex, particularly in changing positions

- Pelvic Pain

- Constipation

How does hypertonicity occur?

There are a number of causes, all usually resulting in an over-contraction of the pelvic floor muscles. Typically things such as:

- Doing too many isolated pelvic floor exercises (like kegels) with no progressions into integrated exercise 

- Clenching for fear of pelvic organ prolapse or bladder leakage symptoms

- The tendency to brace our abdominals or clench our butt muscles through low intensity activities, instead of connecting to our deep inner core muscles 

- Dealing with a pre-existing injury that increases the need for stability - like back pain, a hip, knee or ankle injury or hypermobility syndrome.

How to enhance relaxation of the pelvic floor:

- Relax when you inhale

  A lot of women try to relax on the exhalation, sucking everything in as they breathe in.  

When we inhale, deep into our belly, our diaphragm moves downward, facilitating a downward movement for the deep abdominals and pelvic floor. 

- Aim for a feeling of no effort rather than consciously pushing down on the pelvic floor in order to release it 

Sometimes we can think that working harder on a problem will do a better job of fixing it, but in this case, relaxation involves tuning in to the natural rhythm of the inner core muscles and letting the breath cue the pelvic floor to release as it's designed to.

- Unless you have a specific assessment and prescription of kegels from a health professional, move on to integrated exercises.

The pelvic floor muscles are not designed to work in isolation. They are supposed to work with the deep abdominal and back muscles, and the diaphragm.

When we have a knee injury we don’t squeeze the muscles around the knee many times a day, for the rest of our lives.  We slowly make progress through methodical exercises that teach the area how to co-ordinate with the rest of the body. 

The pelvic floor is no different. 

- Avoid exercises that cause you to bear down or brace your abdominals until you know how to fully integrate and co-ordinate your pelvic floor.

The deepest abdominal muscles are designed to lift everything up and in through our torso, rather than push everything out and down. This group of muscles, known as our inner unit, needs to know how to work fully first, in every movement. 

The inner unit of the core

If you have an underlying condition that has caused symptoms of hypertonicity, it can be worth it examined by a professional.

 Kristy Ahale is an Exercise Scientist specialising in rehabilitation, joint pathologies and women's health.

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