Excess tension in the pelvic floor muscles may cause or perpetuate pain in the
coccyx, vagina, or perineum. Tense muscles restrict good blood flow resulting in a build
up of metabolites which can irritate the muscle causing pain and more muscle tension.
Relaxing the muscle helps to break the pain pattern and will assist in your recovery.
Relaxing the pelvic floor does not always result in immediate pain relief but this
relaxation is necessary for full recovery.
Stress is a part of life. Manifestations of stress are very individual. You may not
even know you are under stress. This is partly due to the fact that we get used to a certain
level of stress and perceive it to be normal. The same thing happens with muscle tension.
Many people today have excess muscle tension and do not perceive it. The tension has
been there for so long, the body accepts it as normal. This makes it very difficult to
determine if the muscle is relaxed or tense. You may need additional information about
the muscle to tell if you are truly relaxed. Surface EMG can provide this information.
Ask your health care provider about this modality.
In attempting to relax the pelvic floor muscles it is best to try to determine the
difference between relaxed and contracted. This is not a big difference and is very hard
to describe. Be persistent and pay close attention to how the muscles feel. The following
is a list of helpful hints in learning to relax the pelvic floor.
1. Not every medication helps every person. Medications have side effects. It is best not
to rely on chemicals for pain relief. Empower yourself to be an active partner in your
2. Rely on yourself, not others, to be the manager of your care. You have a
responsibility to follow the instructions of the people caring for you and to participate in
your care to the best of your ability.
3. Seek consultation when you are aware of unmanageable stress. Social workers,
psychologists, relaxation therapists, self help groups, clergy, books and tapes can help
you learn how to manage stress effectively.
4. Stretch frequently during the day to avoid being in one position for too long.
5. Do not over exert yourself or over tire yourself.
Try several different relaxation techniques to determine the one that works best
for you. Then practice relaxation for at least 20 to 30 minutes twice per day. Relaxing is
a skill that takes lots of practice. You may not feel very relaxed the first time you try it.
Be persistent and keep trying till you can relax quickly, and easily and totally. Relax
frequently during the day.
Specific relaxation techniques
Start with a quiet environment: low lights, comfortable position, comfortable
temperature. Take the phone off the hook. Do not fall asleep. Later you should practice
relaxing in a less quiet environment.
Diaphragmatic breathing : Take a slow breath in through your nose allowing your
abdomen to expand. Exhale slowly through your mouth allowing your belly to fall. This
type of breathing should be relaxed and gentle not forced.
Visualization: Imagine you are in a quiet relaxing place (meadow, beach, mountains).
Make the image as real as possible imagining what you would see, hear, feel and sme ll in
this quiet place.
Visualize the muscle:
Picture the muscle in your mind.
See the muscle relaxed with good blood flow.
Picture the muscle contracting and relaxing normally.
Imagine what the muscle would feel like without pain or problems.
Imagine the muscle sagging down.
Imagine a circle (the vagina) getting larger.
Imagine the sit bones separating.
Pretend you are passing gas, urinating, or moving the bowels.
Body scanning: Periodically throughout the day stop and bring your attention to the
various parts of the body (eyes, cheeks, jaw, head, neck, shoulders, arms, hands, ribs,
belly, buttock, legs, feet). Check each area for tension and pause to allow the tension to
leave the body. Tension in other areas of the body may contribute to tension of the pelvic
Strengthening the muscle: In many cases painful muscles are weak. Strengthening the
muscle can help to decrease pain. Follow the pelvic floor exercise program prescribed by
your health care provider.
Perineal bulging : Place your hand over the cleft in your buttock resting your index
finger near the anus. Gently push as if expelling gas. Feel the tissue bulge outward.
This is relaxation. Practice reproducing this sensation without your finger in place.
Over all fitness: Many patients have found that walking or swimming helps to relax the
pelvic floor muscles. These types of rhythmic alternating movements enhance circulation
Written by Beth Shelly, PT, DPT, BCIA-PMDB