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Pose of the Week: What to Do When a Tight Pelvic Floor Causes Pain

What is a tight pelvic floor? In 2012 Dr. Stephanie Faubion from the Mayo Clinic wrote a scientific article on recognition and management of the “nonrelaxing pelvic floor,” at the time and probably still, an under-recognized and under-treated problem in women.

The wonderful thing about this article was that it brought attention to a problem that is common for women, and the fact that PT should be considered a first line of intervention. But a tight pelvic floor should not be considered normal or acceptable. Dr. Faubion states that “women affected by nonrelaxing pelvic floor dysfunction may present with a broad range of nonspecific symptoms” which may include:

  • pain and problems with emptying the bowel
  • pain and problems with urination
  • sexual dysfunction and pain with attempted intercourse

What is a tight pelvic floor?

Several terms such as pelvic floor tension myalgiapiriformis syndrome, and levator ani syndrome and nonrelaxing pelvic floor dysfunction have been used to describe the problem of a tight pelvic floor.

Tight Pelvic Floor? Best Care Practices for Core Health can help with Dr. Ginger Garner
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The female pelvic floor
©2016. Garner, G. Medical Therapeutic Yoga. Image used with kind permission from Handspring Publishing Ltd., UK

How to recognize a tight pelvic floor

  • Do you have bowel, bladder or sexual dysfunction or pain?
  • Do you have bloating, constipation, difficulty evacuating stool, straining with bowel movement, splinting the pelvic floor in order to have a bowel movement, manually evacuating the bowel or relying on enemas or laxatives, sense of incomplete emptying after or during going to the bathroom?
  • Do you have urinary frequency, hesitancy, urgency, bladder pain, or do you lose urine shortly after getting a strong urge to go?
  • Do you have pain with sex, aching in the pelvis after intercourse, or are unable to tolerate penetration?

If so, you may need to find a pelvic PT to help. See below for resources on finding a pelvic PT.

What you may feel if the pelvic floor is too tight

  • ✅Back pain or sacroiliac joint pain
  • ✅Hip pain
  • ✅Snarky Psoas “syndrome” – that’s what I call hip flexors that just won’t quit firing, which can create some of the problems in this list
  • ✅Tight, ropy muscles in the front of the hip – like the rectus femoris, sartorious, or TFL (tensor fascia lata)
  • ✅Tight inner thigh muscles (called adductors – in hip issues, these are the first to cry “wolf” and the last to be quiet)
  • ✅Draggy, heavy, or achy feeling in the pelvic floor
  • ✅Pain with sex
  • ✅Pinching in the groin or front of the hip
  • ✅Lack of hip range of motion 
  • ✅Stiff spine 

What kind of things can cause tightness and/or pelvic floor dysfunction

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While this isn’t an exhaustive list, here are some of the things that can cause tightness and/or pelvic floor dysfunction:

  • ❎Back gripping
  • ❎Butt clenching
  • ❎Poor posture
  • ❎Pelvic organ prolapse
  • ❎Weak pelvic floor
  • ❎Rigidly holding the ab muscles in (as if trying to flatten your stomach)
  • ❎Incorrect breathing
  • ❎Vocal tension
  • ❎Injuries from childbirth or tearing during childbirth
  • ❎Abdominal or back surgery
  • ❎Hip pain or injury
  • ❎Kegels (too many or incorrect form)
  • ❎Diastatsis rectus abdominis (split abdominal muscles)
  • ❎Anxiety, stress, or other external factors

What it looks like to relax the pelvic floor 

Below is an ultrasound image of the bladder, vaginal canal, and pelvic floor. I use rehabilitative ultrasound imaging (RUSI) at my clinic as part of my evaluation and intervention for the pelvic floor and surrounding area. RUSI is incredibly valuable for addressing core and pelvic floor, bladder, and bowel retraining and rehab.

In the image below, the dark area is the bladder and the measurements were taken at rest and with a deep belly or abdominal breath. D1 is a view of the anatomy with the patient at rest. D2 is during a deep belly breath. The difference between D1 and D2 is the patient’s ability to allow the pelvic floor to drop and stretch with an inhalation.

Tight Pelvic Floor? Best Care Practices for Core Health can help with Dr. Ginger Garner
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D1 is the pelvic floor at rest. d2 is the pelvic floor during a deep inhale (belly breath, also known as diaphragmatic or abdomino-diaphragmatic breath). This is what should happen to the pelvic floor during a regular, relaxed deep breath. image: ©2021. Ginger Garner.

What should we see?

Inhalation – We want to see excursion of the pelvic floor or “drop.”

Exhalation – The pelvic floor returns to what is hopefully a resting (not tight or nonrelaxed) state.

For patients who cannot do this, RUSI helps to retrain their breath, use of abdominal and back muscles, and the ability to relax and let go of the tension creating a “tight pelvic floor.” It’s an invaluable tool because it allows a patient to actually see their pelvic floor (and other muscles and organs as well when I do different scans) in real time and get instant feedback on exercises and breathwork we do during therapy.

How can you relax a tight pelvic floor?

I often use yoga, a specific type of yoga called Medical Therapeutic Yoga, to tackle complex pain issues that can come from pelvic floor and hip or back pain. I also use Lifestyle Medicine and other mindfulness practices to help women successfully manage their pain and impairment. However, for this Pose of the Week, I’m just addressing yogic breathwork you can do to help relax a tight pelvic floor. See below to get started!

Deep Belly Breath - Dr. Ginger Garner
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Practicing seated belly breathing (AD breath) Click on the photo to get free access to over 2 dozen MTY practice Videos

What can be done to help

  • Perform a thorough physical examination
  • This exam of the urogenital and pelvic area may be internal and/or external
  • Evaluate musculature of the urogenital triangle
  • Perform palpation of the deep pelvic floor muscles
  • Perform ultrasound imaging (if available) to visualize anatomy and functioning of the pelvic floor and surrounding abdominal wall and/or hip musculature
  • Prescribe appropriate treatment such as bladder or bowel retraining
  • May refer you for anorectal manometry or internal pelvic ultrasonography
  • May have you complete a voiding diary, urinalysis, and possibly refer you for urodynamic study for voiding symptoms or to a gastroenterologist for gut symptoms
  • Provide education about pelvic floor muscles and function and a complete program for addressing your particular issues and pain

Find a pelvic PT near you:

The second step is to learn how to breathe. That will give you a big head start in starting to manage your pain and begin the process of recovery. See the video below to get started on relaxing the pelvic floor.

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the mechanics of Belly breathing (AD Breath) on an inhale.
©2016. Garner, G. Medical Therapeutic Yoga. Image used with kind permission from Handspring Publishing Ltd., UK
The mechanics of relaxed belly breathing

Inhalation – The respiratory diaphragm and pelvic floor should descend and gently expand/stretch, which will inflate or expand the abdomen at the same time.

Exhalation – The respiratory diaphragm and pelvic floor should return to their previous state, and the abdomen will also return to its steady state.

The laryngeal/thoracic/vocal diaphragm should remain open and at ease, with no tension. in the muscles of the face or neck.

An Extra Tip! Guided Relaxation for Toileting



Want More?

PS HERE ARE 3 MORE WAYS I CAN HELP YOU!

1. Free Phone Consult – Not sure if your yoga practice is on target? Struggling with hip pain or rehab? I offer free phone consults to see how I can best help.

2. Take the Trifecta Tuesday Core Health Series with me at Living Well Institute and Yoga U Online!

Get 3 hours of pelvic floor and core retraining PLUS my newly released 2nd edition of Best Care Practices for Core Health, a 110 page full color multi-media (video and illustrations) EBook. This PT-led yoga-based course will help you learn to take control of your core and pelvic floor.

Tight Pelvic Floor? Best Care Practices for Core Health can help with Dr. Ginger Garner
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the core Health 3 week series

3. Take advantage of the Free Medical Therapeutic Yoga Basic Video Library.

Just want the book?

Best Care Practices for Core Health can help with Dr. Ginger Garner
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Dr. Garner’s E-Book – Best Care Practices for Core Health, 2nd ed. comes with the Trifecta Tuesday 3 Diaphragm Core Series for FREE (a $15 value). This 100+ page E-book outlines some of the most important CORE PRACTICES in this series. 

Buy just the EBook

Buy the Trifecta Core Series


DISCLAIMER: These movements are for protection and preservation, as well as maximizing, pelvic girdle function (hip, SIJ, low back, pelvic floor). This and any other videos I instruct do not constitute physical therapy or a patient-provider relationship. User assumes risk in performing this or any video. Finally, you need to get the approval of your healthcare provider before doing this or any instructional movement video. Assessment and evaluation of the hip & knee should only be done by a licensed healthcare provider.

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