How to Exercise with Pelvic Floor Pain

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When we think of exercises that would benefit the body’s core, we usually think of ways to strengthen the back and abdomen. Oftentimes, another crucial part of the core—the pelvic floor—is overlooked. Made up of tendons, ligaments, and muscles, the pelvic floor acts as a hammock that holds up the bladder, uterus, and abdominal organs. When strong and toned, the pelvic floor surrounds and strengthens the opening of the urethra, vagina (in women), and anus. It is easy to understand why we need our pelvic floor muscles to be strong and functional, but sometimes, the pelvic floor’s functions are compromised by factors such as childbirth, surgery, aging, chronic tension, or injury. Pelvic floor dysfunction is defined as a wide range of abnormalities in the pelvic floor, such as a weak or tight pelvic floor or an underlying musculoskeletal issue that manifests as pelvic pain. Additionally, both women and men can suffer from pelvic floor pain.

Clinical conditions linked to pelvic floor pain may include vulvodynia, vestibulitis, pudendal neuralgia, interstitial cystitis, non-bacterial prostatitis, lichens sclerosis, and endometriosis. Physical therapy can be an effective treatment for pelvic floor dysfunction to help relax, retrain, and strengthen the pelvic floor muscles. Patients frequently ask their pelvic floor physical therapists if they can continue with their regular exercise routine or if it will interfere negatively with the healing of their pelvic floor. With regard to this question, it’s important to note that each person struggling with pelvic floor pain and dysfunction has a unique case and so, there is no one-size-fits-all answer! Some exercises will enhance the pelvic floor’s functionality and alleviate pain, but others may only worsen pain or cause further pelvic floor dysfunction. However, there are some general types of exercise that should be avoided to support the healing process of the pelvic floor.

People who have overly tight or overactive pelvic floor muscles should approach core-strengthening exercises such as abdominal workouts, planks, boot camps, and Pilates with caution! These types of workouts and exercises will further tighten the pelvic floor muscles and may lead to greater dysfunction—possibly increasing pelvic pain. For patients will overly tight muscles, it is best to consult with a pelvic floor therapist, such as those at Rebalance Physical Therapy, to help modify their Pilates class or coordinate with their Pilates instructor to modify their programs. Typically stretching, yoga, deep breathing, and more gentle exercises are recommended to help relax the pelvic floor muscles but again, even these exercises may need to be modified based on each person’s individual needs. For people with weak or lax pelvic floor muscles, there are specific exercises that can strengthen the pelvic floor such as Kegels, which involve consciously contracting and relaxing the pelvic floor. There are also more global strengthening exercises that target larger muscles of the body, in addition to the pelvic floor muscles, which include glute bridges, squats, and bird dogs. However, it’s important to be aware of any precautions before adding these exercises into your routine and we recommend you consult with your pelvic floor physical therapist before beginning a pelvic floor strengthening program.  In cases where there may be an underlying musculoskeletal or other medical diagnosis causing pelvic floor dysfunction, it is best to consult with a pelvic floor physical therapist before beginning to exercise. A pelvic floor physical therapist will recommend an exercise regimen most suitable for each patient’s specific diagnosis.

Are you struggling with pelvic floor dysfunction but are unsure what is causing it? Do you need help discovering which pain-relieving exercises are best for your body? Contact Rebalance physical therapists, who will assess your body, suggest lifestyle changes, and prescribe a plan to restore your pelvic floor!

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