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Date issued: March 2023

Review date: March 2025

Ref: C-452/RE/Physiotherapy/Pelvic floor relaxation v2

PDF:  Pelvic Floor Relaxation final March 2021.pdf[pdf] 543KB

Pelvic Floor Relaxation

There are a number of reasons why both women and men may be advised to learn pelvic floor muscle relaxation techniques. Like all muscles in the body, the pelvic floor
muscle needs to have a good balance between length and strength. A muscle needs to be able to contract when called upon and then be able to relax back to its resting position.
The pelvic floor muscle is no exception, being able to relax your pelvic floor muscle is a normal and necessary thing to be able to do. However, sometimes we ‘learn’ to overuse
these and other muscles, such as the abdominals, which can create tension and reduced pelvic floor movement. It may then not be able to do its job of supporting your pelvic organs (bladder, bowel and in females, the uterus) and allowing them to function normally.

An inability to relax the pelvic floor may also lead to one or more of the following symptoms:

• Difficulty starting the flow of urine.

• Sudden urge to urinate, even when bladder not full.

• Feeling of not being able to completely empty the bladder.

• Urinary incontinence.

• Difficulty emptying the bowels, including the need to strain.

• Bowel incontinence.

• Pelvic pain.

• Painful intercourse.

• Difficulty inserting tampon or undergoing vaginal/rectal examinations.

If these symptoms persist, this can be very stressful and increase anxiety, which in turn, can increase any tension within the muscles, further provoking the situation and make
symptoms worse. A vicious cycle is therefore created. However, learning to relax your pelvic floor muscles and then ‘relearning’ how to regain control can improve your
symptoms. It is likely that for whatever reason, if you have held your pelvic floor muscle ‘tight’ for any period of time, your brain will have learnt that this is ‘normal’ for you.
Therefore, the first important step is to become aware of this and allow your brain to recognise this feeling is ‘not normal’, and that you can change it.

What is the pelvic floor?

It is useful to understand where the pelvic floor is and how big it is. The following diagrams of both the female (on the left) and in males (right) show how the pelvic floor ‘spans’between the bony parts of your pelvis, creating a ‘supportive floor’. There are various layers of muscle and fascia that form a ‘bowl’ shape of muscular support at the base of your pelvis.

It is also useful to know that how you breathe, affects the tummy and pelvic floor muscles. If you think of your trunk like a ‘cylinder’ made of muscles that all work together. Your diaphragm sits at the top, the abdominals and spinal muscles create the walls, and your pelvic floor muscle, forms the base of this cylinder.

All these muscles work together, and in particular, the diaphragm and pelvic floor ‘mirror’ their move ments. As you inhale, the diaphragm descends, and likewise
the pelvic floor lengthens downwards, to allow ‘space’ for the breath. However, stress and anxiety can play havoc with our breathing, which impacts on the ability of our pelvic floor to move freely. When we are stressed, we tend to breathe differently, more into our chest, shallower and faster; rather than letting the diaphragm descend slowly and fully. Our pelvic floor can also then get a bit stuck too! It is really helpful to use breathing techniques to help relax our breath and in turn, our pelvic floor.

Our posture also plays an important role in affecting our ability to breathe effectively and maintain a healthy pelvic floor. We may find ourselves slouching, ‘holding’ our
tummies in, tucking our bottoms under, and rounding our shoulders. Take time to become aware of how you tend to stand and sit. Having a strong, stable foundation from your feet is very important. Imagine your head lightly lifting upwards, like a helium balloon.

Relaxation techniques

The exercises are very simple, but need time and dedication
to maximise their benefit.

In a quiet environment

• You may want to dim the lights and switch off any possible distractions, such as your phone and television.

• Take time to find a comfortable position, such as sitting or lying with your knees bent up and apart or resting against each other.

• Adopt a good posture by lengthening your spine and  slightly tucking your chin so that your neck feels comfortable.

• ‘Scan’ your body for any areas that hold tension/tightness and allow them to soften and let go.  For example, we can often clench our jaw without even realising, and this can be linked with tension within the pelvic floor. Try releasing your jaw and allow your tongue to rest gently on the roof of your mouth. Go through each part of the body, identifying any areas you can ‘soften and release’.

• You may also like to try the ‘Mitchell Method of Relaxation’; the leaflet can be found in the references at the back of this booklet.

• Once you have mastered relaxing in a quiet environment, try learning how to relax in less quiet surroundings.

Diaphragmatic breathing

• This is a relaxing type of breathing and optimal for relaxing and lengthening the pelvic floor. 

• Place one hand on your chest and the other on your tummy.

• Slowly breathe in through your nose, allow your tummy to soften and gently rise into your hand. As you continue to breathe in, you may also feel your ribs gently widening and move upwards to allow space for your  lungs to inflate.

• As you slowly breathe out, allow the ribs and tummy to gently fall back to their original resting position. Try not to ‘force’ either the breath in or out.

• If you are comfortable and able to, try lengthening the inhale to a count of 4 and similarly, breathe out for 4.

Release & relax the pelvic floor muscles

As you continue with your slow breaths, bring your attention to your pelvic floor to encourage relaxing and lengthening. There are various  visualisations that can be helpful in allow you to fully ‘relax’. Imagine:

Inhale: Rose bud petals softly open; exhale, petals draw back together.

Inhale: Your sit bones gently spreading apart and your tailbone floats back; exhale: sit bones and tail bone slowly come towards each other.

Inhale: Our back passage and/or vagina relaxing and opening and allowing your pelvic floor to descend downwards (it may help to place your hand over this areas to ‘direct’ your relaxation). Be careful not to force
or bear down these muscles.

The 1-minute seated pelvic floor down-training exercise
(Pelvic Pain Foundation, Australia)

• Uncross your knees and place your feet apart on the floor.
• Let your jaw hang loose and your teeth separate
• Let the belly relax and take your breath down to expand your waist.
•  Let the belly muscles hang loose and your buttocks spread wide.
• Let the inner thigh muscles go loose as your knees hang apart.
• Focus on letting the pelvic floor muscles soften and loosen inside your bottom.
• Breathe down into your belly, expanding your waist,

    Repeat.

You can do this exercise on the bus, your office chair or at home. Try doing regularly throughout the day to improve what we call ‘muscle memory’.

Sniff, flop, & drop exercise

(Adapted from M. Whelen, Pelvic physiotherapy.com)

Find a comfortable sitting position and gently rest your hands on your lower tummy. This exercise works on the principle that when your diaphragm goes down, so does your pelvic floor.
Sniff: Breathe in through your nose for 3 seconds, your diaphragm will go down, (try to keep your shoulders down and relaxed)
Flop: Allow your tummy to ‘flop’ outwards and into your hands.
Drop: Let the muscles of your pelvic floor go, the back passage will go towards your coccyx, the vagina will feel it is opening, your penis will drop.

This can be difficult to feel initially, but draw your thoughts to your anatomy and keep practising. When you are able to do all 3 parts (sniff, flop, drop) together your sensation of the movement will be better.

These exercises can take a lot of concentration to master but can really help to improve the overall function of your pelvic floor. Some techniques may work for you and others may not - have a go at all of them and find which style suits you. Be patient, once mastered you can adopt the exercise and use it during the day at various times.

There may also be other activities that you enjoy, such as going for a walk in nature, a long soak in a bath, that help you to relax and unwind. These will also positively impact on your pelvic floor too. 

The role of other muscles

Sometimes other muscles around the pelvis can have an effect on the function and discomfort in your pelvic floor muscle. Other muscles around the pelvis, back and hips can become tight and painful or weak, this can have a ‘knock on’ effect to your pelvic floor. Common muscles associated with pelvic pain are your hip flexors (front of hip), adductors (groin), gluteals (buttocks) your quadratus lumborum (lower back) and abdominals (tummy). Below are some examples of stretches that target these muscles.

Stretches should always be done slowly, and only to a comfortable level of stretch. Don’t bounce the stretch or force it. You shouldn’t feel pain. As you hold the stretch take
at least 2 deep breaths to help promote relaxation. Spending 5 to 10 minutes a day stretching can really help to release any tight structures.

Some gentle yoga postures have been found to be beneficial in relaxing your pelvic floor muscle and other key muscles around the pelvis. Taking time to regularly practice these postures, breathe slowly, unclench the jaw and imagine the pelvic floor ‘open and lengthening’. Hold the postures for as long as feels comfortable, perhaps beginning with a couple of minutes. Try not to ‘force’ any movement, but allow your exhale to soften and release tension.

Child’s pose

In kneeling, allow your chest to rest on knees together or between parted knees. Support your head with your hands or a pillow. Aim to relax your pelvis back towards your heals.

Happy baby pose

Lie on your back, open your knees wider than your chest and bring them up towards your armpits. You may hold your legs, ankles or feet, face soles of the feet upwards. You can either hold this positon or gently rock on your back side to side.

Butterfly pose

Place a cushion under your pelvis and rest your legs up a wall. Allow your hips to open by bringing the soles of your feet together and resting your arms by your side. This restful pose can also be achieved in lying with cushions to support under the thighs.

Forward fold

In standing, bend your knees to allow you to fold forward at the hips. You may support your arms on a pillow or allow your head and arms to gently hang downwards.

The above pelvic floor relaxation techniques often require lots of practice and concentration to begin with. Once you are able to do this consistently, incorporate it into your pelvic floor muscle training by relaxing your pelvic floor on the inhale and contracting them on the outbreath.

Myofascial release/trigger point release

As part of your treatment your physiotherapist may use some manual techniques to help release any tight muscle or soft tissue. This is called myofascial release or trigger point release; they may treat muscles around the pelvis, abdomen, hips or thighs. If the restrictions and tightness are within the pelvic floor muscle the treatment (with your consent) will take place internally via the vagina. Your physiotherapist may teach you how to do this yourself at home.

Vaginal dilators

As part of your treatment, it may be recommended that you try vaginal dilators. These are silicone devices that can be used at home, alongside the rest of your exercises and advice. They can help with releasing tension in the pelvic floor muscle and in desensitising the area. They are available on prescription from your GP or can be bought online.

Reference & links

• Michelle Kenway, Physiotherapist www.pelvicexercises.com.au A short video on pelvic floor release exercises.
• Maeve Whelan www.pelvicphysiotherapy.com/releaseexercisesfurther info on the sniff, flop, drop technique.
• POGP website www.pogp.org.uk The Mitchell method of Physiological Relaxation. Please see their website for Free downloadable leaflets on relaxation and various pelvic floor conditions.
• Jilly Bond www.jillybond.com lots of information and videos on various pelvic floor conditions.