Pelvic Floor Dysfunction can cause debilitating pelvic pain. This pain can be described as constant, intermittent, random, sharp, shooting, dull, achy, burning, pulling, pressure, and/or cramping. When pain is present pelvic floor muscle contractions (Kegels) should not be performed. Instead the focus will be on ‘down-training’ the pelvic floor muscles. The first part of treatment is to remove any aggravating factors, meaning if it increases or starts your pain do not do it. The pain is a signal letting you know that your body does not want you to do that activity. Typically with patients who have Pelvic Floor Dysfunction the following rules will apply until the pain has decreased or resolved:
No intercourse or self-stimulation (if pain is present during or after this activity)
No Kegel exercises. Remember we are trying to ‘down-train’ the pelvic floor muscles (decrease tone and spasm) not strengthen or increase tone.
No abdominal or ‘core’ exercises. This will cause a co-contraction of your pelvic floor muscles resulting in up-training of the pelvic floor muscles.
No high impact activity. During high impact activities such as running or jumping, the pelvic floor muscles are subject to a high amount of force that they are not functionally able to absorb at this point due to the shortened position of the muscles. High impact activities will slow down the healing process or potentially exacerbate the dysfunction and overall weaken the pelvic floor muscles.
When pain is present during an activity, first modify the activity. If you cannot modify the activity safely without developing compensatory patterns and pain is still present then do not do it. Listen to your body.
What can you do? Walk everyday!! This will bring blood flow to the pelvis and pelvic floor muscles facilitating healing. If walking is painful start with short bouts of walking stopping prior to onset of pain.
If you suffer from pelvic pain and also have abnormal bowel and bladder function then Bowel and Bladder Retraining will also be a significant part of treatment. Think of the pelvic floor, bowel, and bladder as a family that need to be in counseling. One member of the family cannot be seen by a counselor and expect to fix the problems for the whole family. Therefore, you cannot treat the pelvic floor muscles only and ignore what is happening to the bowel and bladder. Do not overlook the fact that the bowel and/or bladder could also be the reason for your pelvic pain.
Down-training the pelvic floor muscles is accomplished through diaphragm breathing. The diaphragm is a dome shaped muscle that forms the floor of the rib cage. It is the most efficient muscle for breathing and using this muscle aides in relaxation reducing spasm and pain. Diaphragmatic breathing is an important technique to learn because it helps settle the autonomic nervous system. The correct use of diaphragmatic breathing can help to quiet brain activity resulting in the relaxation of all the muscles and organs of the body especially the pelvic floor muscles. This is accomplished by slow rhythmic breathing concentrated in the diaphragm muscle rather than the upper chest.
HOW TO BREATH WITH YOUR DIAPHRAGM
The key with diaphragm breathing is Belly Rise, Belly Fall. As you inhale your belly should rise, and as you exhale your belly will fall. You should also feel a outward expansion of your ribcage. You should not see or feel your chest rise and fall. Inhale through your nose and exhale through your mouth. The inhale is a deliberate slow, deep breath and the exhale is passive.
- Lay on your back and place your hands on your stomach
- Relax your jaw by placing your tongue on the roof of your mouth and keeping your teeth slightly apart.
- Take a deep breath in through your nose allowing your rib cage to expand out and your belly rise. Keep your upper chest, neck and shoulders relaxed as you breathe in. Think about breathing into your hand.
- Instead of trying to forcibly blow all the air out, simply open your mouth and allow the air to come out naturally. DO NOT HOLD YOUR BREATH.
- Remember to breathe slowly. Do not force your breathing.
Diaphragm breathing should be performed as often as possible. You can train your body to breath this way naturally again as it was originally designed. Over the years we develop compensatory breathing patterns and become chest breathers–taking quick, shallow breaths not efficiently using the diaphragm. When the diaphragm contracts and relaxes at its full potential it will physiologically relax and lengthen the pelvic floor muscles reducing spasm and pain. Changing your breathing pattern will reduce your pain and bring down anxiety levels.
Initially when my patients start practicing diaphragm breathing they will state that they feel pain on the exhale. This is due from using the abdominal muscles to force the air out which results in a co-contraction of the pelvic floor muscles. Make sure the exhale is passive and you are not tightening your stomach muscles to blow the air all the way out. Often I will cue patients to simply open your mouth during the exhale and just let the air naturally expel.