By Nicole Guappone

If you’ve experienced pelvic tension, painful sex, needing to pee often or suddenly (otherwise known as urinary frequency and urgency), you may have pelvic floor muscle dysfunction! It sounds scarier than it is: pelvic floor muscle dysfunction (PFMD) just means that your pelvic floor muscles aren’t working optimally. Oftentimes they are too tight, which can cause all of those not-so-fun symptoms.

No matter where you are in your journey, we’ve put together a list of things you can do for pelvic floor health that can help soothe symptoms of PFMD. We will always encourage you to seek individualized professional care when necessary and available, but the following suggestions can help you whether you’ve got tension, overstretched muscles, or even just period pain.

Learn to relax your pelvic floor

It sounds so simple! Relax your pelvic floor. But if you’ve ever tried to consciously relax a muscle (like a tight knot in your neck), you may know it’s easier said than done. Relaxing the pelvic floor is truly the best first step in caring for your pelvic floor, especially if you carry extra tension. If those muscles are weak, they may have led to prolapse(s), and many people need to learn to relax before rebuilding strength. 

How to relax your pelvic floor

We won’t sugarcoat it. This takes practice. I remember lying in bed one night doing my pelvic floor physical therapy exercises when all of a sudden, “I think I did one!” I yelled to my partner. At that point, I’d been in PT for a couple of weeks. I personally describe relaxing my pelvic floor (or doing a pelvic floor “drop”/”reverse Kegel”) as breathing depth into my pelvic bowl. 

Imagine you have to pee and you’re holding it until you get to a bathroom. Once you sit down and release, that “ahhhh” is your pelvic floor relaxing. If you focus on it next time this happens, you may even notice the “drop.” 

Other ways to imagine or visualize relaxing your pelvic floor

• Imagine that your anus or vulva is a blooming flower when you take a deep breath
• Pretend you are starting a bowel movement (this is a release, not a push)
• Sometimes, contracting a muscle before relaxing can make the release come easier. Imagine your pelvic floor is an elevator. Do a gentle Kegel contraction, lifting your perineum up, and then as you relax it, the elevator is going down. Once you think you hit the first floor, try to get to the basement, just a little bit further.

For more info about how to relax your pelvic floor, check out Pelvic Gym!

Your prolapses won’t fall out

Prolapses are incredibly common, especially with folks who’ve carried a pregnancy to term and given birth. A prolapse happens when one of the pelvic organs (bladder, uterus, rectum) shifts out of place due to laxity or pelvic floor weakness. The pelvic floor is put through a lot during a pregnancy so it is understandable why it might need some TLC after giving birth. A lot of folks with prolapses tend to guard against the prolapse or squeeze their pelvic floors to keep everything where it belongs. 

The good news is that there are so many interconnecting muscles, fascia, and structures within the pelvis that a prolapsed organ can’t fall all the way out! “Relaxing the pelvic floor is not the same as pushing or bearing down,” says Rachel Gelman, DPT. “Bearing down, which increases pressure on the pelvic floor, is typically what can contribute to issues with a prolapse, versus relaxing the muscles back to neutral.”

In order to build the strength in your pelvic floor back up, you must first release it. A tight muscle is not necessarily a strong muscle. Think about the example we’ve used before: imagine doing a biceps curl to contract and show off your bicep muscle. If you held that contraction for a really long time, that muscle would get tired. It wouldn’t want to work anymore. When you are doing biceps curl exercises, you contract then release the muscle. 

The same should go for your pelvic floor. 

Eating well can help your pelvic floor 

It’s true! Eating well can keep your pelvic floor healthy. A lot of folks are constipated when they have pelvic tension OR their pelvic tension leads to constipation. “Having good bowel movements that are free of pushing or straining is important for pelvic floor health. Constipation is often a cause of pelvic floor muscle dysfunction, so maintaining a healthy diet is important for gut health and bowel function,” Dr. Gelman says.

Fiber is the go-to for many when they are constipated, but make sure you are getting the right kind of fiber. 

Insoluble vs soluble fiber

If you are constipated, make sure you are getting insoluble fiber. Insoluble fiber holds onto water, making harder stools easier to pass. Good sources of insoluble fiber include brown rice, whole grains, and dark leafy greens. Soluble fiber (from fruit, beans, nuts, and seeds) bulks up your stool, which is better for those who tend to have loose stool/diarrhea. Chia seeds have both soluble and insoluble fiber, so you can’t go wrong with them! 

Magnesium

Magnesium glycinate is a supplement commonly recommended by pelvic floor therapists for constipation as well. Not only does it help with bowel regularity, but magnesium is a natural muscle relaxer! We love a supplement that does double duty. 

Even if you aren’t noticeably constipated, keeping digestion regular and easy is so much more gentle on your pelvic floor. Straining to poop or feeling unable to hold your stool in are both signs that your pelvic floor may need some attention. 

Keep your body moving

Your pelvic floor loves movement. Your hips, thighs, abs, glutes—all of these muscles are connected to your pelvic floor, so if you are able to keep them moving in all sorts of juicy ways, your pelvic floor will thank you. 

More than Kegels

We’re not going to recommend Kegels at all! Not because Kegels are bad, but because they are not for everyone and in fact, they could even be contraindicated for some folks. We are The Pelvic People, but the pelvis is in the middle of the whole body! Our surrounding systems need some love, too. 

Multiplanar movement 

Oftentimes, we do a lot of up-and-down and side-to-side exercises, but “multiplanar movement” is important. Our bodies are meant to move between three planes: sagittal (forward/backward), lateral (side-to-side), and transverse (rotational). So don’t be afraid to swirl your hips, throw your arms up, and have fun. (Laughing is great exercise for your pelvic floor!) Here’re a few ideas to get your wheels turning: 

• Dancing, including ecstatic dance or belly dancing 
• Pilates or yoga with a pelvic floor-informed instructor
• Hiking 
• Gardening
• Strength training 
• Singing 

Find something that you enjoy, and know that even if it isn’t “focusing” on your pelvic floor, your pelvic floor is getting in on the action! We want the muscles surrounding our pelvic floor to be strong, supple, and flexible, too. 

Mindfulness/meditate

You probably hate us by now. Relax, eat well, exercise. What kind of nonsense is this? I thought you were The Pelvic People! you might be saying to yourself. But everything is connected. Not just literally, like our muscles and fascia, but our minds and bodies, too. In order to be able to truly relax the pelvic floor, it needs to feel safe. It’s hard to do that if you’re constantly in guarding/fight/flight mode. Studies show that our pelvic floor muscles are just as reactive, if not more reactive, than our shoulders when responding to stress, fear, or anxiety. 

Meditation doesn’t have to look like meditation

If meditation just isn’t your jam (or maybe you’re neurodivergent and it never really worked for you no matter how hard you tried), you don’t have to sit cross-legged with your eyes closed and grit your teeth.

• Put on some music, close your eyes, and move in any way your body wants. Getting into your body is one of the most potent ways to switch off your “thinking” brain.
• Guided meditation via an app, YouTube channel, or write and record your own meditation for yourself!
• Quietly walk by yourself with no audio input (no music, podcasts, etc.) 
• Journal or draw 
• Do anything that brings you peace and comfort

Moving through stress

Sometimes when we’re in an actively stressful situation, calming the mind and body can be difficult. One of the easiest ways to move through stress is to literally “shake it off.” Shake your arms and legs, bounce gently by lifting your heels up and down off the floor. And if you can, vocalize while you’re doing this. The lower your vocal register, the more relaxing it is to your pelvic floor! 

If you’re in public and can’t shake and make noise, tense up your muscles and then release them. Squeeze your shoulders up towards your ears, make fists, scrunch up your face, and then let it all go. 

Connect with your body

Connecting with your body may feel difficult right now if you’re experiencing symptoms of pelvic floor muscle dysfunction, but everything we’ve recommended so far—relaxing your pelvic floor, eating well, movement, meditation—they are all different ways of doing just that. But if you’re looking for a little more fun than just eating your greens, consider an…

Orgasm

Really, truly! Not only a great exercise for your pelvic floor, it can help with period cramps, tension (the squeeze and relax can help you get closer to that “ahhh” relaxed feeling), or your mood. Talk about mind-body medicine. Self pleasure, mutually masturbate, have penetrative sex! There are no rules here. For some folks with pelvic pain, orgasm can actually be painful, so if this is you, please feel free to skip this suggestion. Orgasm doesn’t even have to be the goal!

Pleasure in general

If orgasm feels overwhelming or scary, any type of pleasure can help you connect with yourself, which is why we really recommend finding a movement type you LOVE. If orgasms are uncomfortable, difficult to reach, or just not your jam, genital pleasure without the goal of orgasm can still help you create a more positive relationship with that particular part of your body. 

When we talk about pelvic health, we often stay in the realm of the pelvis. If you’re in a place where heading directly to the source of your pain (the pelvis/pelvic floor) is scary or you’re not quite ready to go there, there are so many other ways to help ease your pain and work on your pelvic health—and they can all help your general health, too!

“The pelvic floor muscles are like any muscle of the body,” Dr. Gelman says. “They contract, relax, and lengthen. A tense or guarded [pelvic floor] can cause things like pain, urinary urgency, frequency, pain with urination, pain with sex, and constipation. Knowing how to relax the pelvic floor can help decrease or potentially eliminate those symptoms.”