So many people talk about the need to tighten and strengthen the pelvic floor that it might seem strange to consider that muscles can be too tight.
When muscles stay tight, they get painful. Maybe with an ache at first, but then with sudden spasms (cramps) when they tighten even more. You will need to learn to relax and ‘down train’ the muscles to help your pain.
What is the normal function of pelvic floor muscles?
The pelvic floor muscles tighten to control the bladder or bowel and for pain-free erections. They relax when you urinate or defaecate (open your bowels).
Pelvic pain often makes these muscles tense up sub-consciously. You probably won’t realise that it’s happening. Muscles that are constantly tensed, become tight and shortened – then they start hurting.
Exercises to tighten the pelvic floor are called ‘Kegel Exercises’. These are the ones you should avoid.
Exercises to relax the pelvic floor are sometimes called ‘Reverse Kegels’.
How to find your Pelvic Floor Muscles
You may never have been quite sure where your pelvic muscles are. The pelvic muscles lie across the bottom of your pelvis. They are the muscles you tighten up if you want to stop passing urine. You can find them using the following steps:
- With one hand, find the pubic bone at the front (the hard thing under your pubic hair) and with the other, find the coccyx at the back (the pointy bit at the bottom of the spine just above the back passage).
- Now sit on both hands, one under each buttock with your fingers facing up, to find the ‘sitting bones’ on each side.
- The pelvic floor muscles are like a round ‘trampoline’ of muscle at the bottom of the pelvis that lies between these four bones. The trampoline sags and moves down when it relaxes – and tightens and moves up as it contracts.
- On top of the muscular trampoline lie the bladder and the rectum (bottom part of the bowel). The pelvic floor muscles tighten to stop the flow of urine from the bladder and to control wind from the back passage. They relax to pass urine or a bowel motion. They contract as the testicles are lifted in towards the body and relax as they hang loosely.
How to start moving your pelvic floor muscles normally
Relaxing and loosening the pelvic muscles regularly will teach the muscles how to move normally again and reduce muscle tension (and pain). You can teach yourself to do this by:
- Standing in front of a mirror without your underwear and lifting your testicles gently up towards your body by tightening your pelvic muscles.
- Now relax your pelvic floor and let the testicles hang loose again. You may notice your penis retract as you tighten.
- Think about your anus and how it moves – in and closed or down and loose.
- Letting your belly hang loose will help your pelvic floor muscles relax too.
It is the relaxing and loosening part of this exercise that is important for you. Regular practice will make it easier to do.
Remember that in men with chronic pelvic pain, where the muscles are already tight, excessive muscle tightening may worsen pain so be gentle when you first start this. We recommend only very gentle tightening and no tightening at all if it worsens your pain. Just concentrate on loosening and softening the muscles in and around your pelvis.
The 1 minute – seated – pelvic floor down training exercise
You can do this sitting back in a chair, on the bus to work or during meetings. If you can do this exercise every hour or so, you will make good progress.
- Uncross your knees and place your feet apart on the floor
- Let your lower 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 let the buttocks spread wide
- Let the inner thigh muscles go loose as your your knees hang apart.
- Focus on letting the pelvic floor muscles soften and loosen inside your bottom
- Breathe down into your belly, 1-2-3-4-5 times, expanding your waist
Using a pelvic muscle relaxation CD or audio file to help you relax your pelvic floor
You may find that using an audio-tape is an even more effective way of learning about and exercising your pelvic floor. A suitable audio MP3 file can be downloaded from www.thepelvicfloorclinic.com.au and there is a CD if you prefer. Ideally these exercises should be done with professional guidance from a pelvic floor physiotherapist, but if you don’t have one nearby, this brief guide and the exercises on the CD or download are a good start.
A useful program would include:
- Listening to the 30 minute track each day in combination with learning some relaxation skills
- Putting relaxation into practice at moments throughout the day
- Noticing when tension creeps into areas of your body, such as your shoulders, jaw or pelvic floor muscles and letting it go.
By lowering the ‘default setting’ in your pelvic floor muscles, they will become looser. We call this ‘down-training’
Please note that if you have had painful or bad experiences because of physical or sexual abuse, which make it especially difficult to work with your pelvic floor, we recommend you seek professional help from an appropriately trained psychologist.
A word of advice about other exercise
It’s good to keep fit but some of the exercises you do could be making your pain worse. Exercises such as core strengthening, heavy weights from a deep squat, high impact exercise or cycling can all make the pelvic floor muscles tighter – and more painful. It may be helpful to stop these types of exercises for a while. Instead, you could use a cross trainer, walk on a treadmill, swim and add stretches to your program.
This site has a page of yoga stretches for men, which can help.
A pelvic floor physiotherapist, experienced in pelvic pain can advise you on exercise suited to your needs.