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Your pelvis and pelvic muscles
Your pelvis is made up of several structures including the bones and muscles of your skeleton, your pelvic floor muscles, as well as your reproductive and urinary organs, rectum, and perineum (the skin around your anus and genitals).
Your pelvic muscles move things by contracting and then relaxing. All muscles work in tandem with other nearby structures, with them all coordinating various stages of contraction and relaxation to achieve organised movement. Some of this movement is conscious, for example when you choose to cross your legs, and some of it is involuntary, for example when your bladder relaxes and expands so that it can fill with urine.
Your pelvic floor muscles are a specialised set of muscles, positioned at the base of your pelvis, which help keep your pelvic organs in the correct place and control your bladder, bowel, and sexual functions.
Pelvic muscle overactivity
Like all muscles, your pelvic muscles can become hypertonic (overactive), which means the muscle may become painful, weaker, less responsive and move out of time with other nearby structures, leading to a loss of the coordinated movement.
You won’t necessarily “feel” pelvic muscle overactivity because some of the muscles, such as those in your pelvic floor, are involuntary so you are not conscious of whether they are contracting, relaxing or hypertonic.
As well as pain, the loss of the coordinated movement may cause changes in your bladder and bowel habit and effect your sex life. Any and all of these symptoms can be very distressing, which in itself can make things worse.
Bladder symptoms include:
Going to the toilet a lot
Needing to rush to the toilet
Finding it difficult to “hold on”
Finding it difficult to pass urine
Passing only small amounts of urine
Bowel symptoms include:
Feeling bloated and/or constipated
Going to the toilet a lot
Needing to rush to the toilet
Finding it difficult to “hold on”
Straining and difficulty passing stool
Sexual symptoms include:
Pain before/during/after sexual intercourse
Deep pain worsened by menstruation
Loss of libido
Erectile dysfunction
Testicular pain
Pelvic muscle relaxation and physiotherapy
The mainstay of treatment for pelvic muscle overactivity is targeted relaxation and physiotherapy.
We would like you to spend 3 weeks learning: 1) How to relax properly; 2) How to relax your pelvic floor muscles and 3) How to stretch your pelvic skeletal muscles. Then we would like you combine all of these activities into a single exercise regimen and build this into your daily routine.
We hope you quickly notice that your symptoms improve with these changes, and that you will learn over time how much, when and what exercises you need to do to control and manage your symptoms.
Week 1: How to relax properly
Start by reading this booklet entitled "The Mitchell Method of Physiological Relaxation".
Week 2: Relax your pelvic floor muscles
Next visit the Pelvic Physiotherapy website and read through the pelvic floor release webpage.
Try to practice each of these exercises for 5-10 minutes, once per day, every day, for one week or until you become comfortable with the process.
Week 3: Stretch your pelvic skeletal muscles
Click here to view a handout entitled: "Easy Stretches to Relax the Pelvis" produced by the Pelvic Pain Foundation of Australia.
Week 4: Combine it all together
Now try to combine all three exercises, by first using the “Mitchell” relaxation routine to relax your whole body, then work though “Sniff, flop and drop” to relax your pelvic floor and then finishing with the easy stretches to relax your pelvis.
You should aim to do the combined exercises regularly each week until you will learn over time how much, when and what exercises you need to do to control and manage your symptoms.
Further information
Further information
Specialist pelvic floor physiotherapist
If you find it difficult to understand or perform these self-directed exercises, or would simply prefer to be seen in person, you may benefit from seeing a specialist pelvic floor physiotherapist. Please contact your GP about it. You may need to arrange this privately depending on what services are available in your area.
Pelvic floor injection therapy
If your pelvic floor muscles are so painful that you cannot complete any physiotherapy, you may benefit from seeing a gynaecologist with a specialist interest in this area, who may be able to perform injection to relax some of the overactive muscles in your pelvis. Please contact your GP about it. You may need to arrange this privately depending on what services are available in your area.
Information for patients
Patient information leaflets
Patient resources
Pelvic muscle pain
Opioid medication
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