The Art of Letting Go: Pelvic floor muscle down-training and relaxation

“Just relax” must rank as one of the most infuriating phrases in modern life. Relaxation sounds easy and does not require money or advanced degrees. And yet, when someone kindly tells us to “just relax,” our minds and bodies often ramp up, alerting even the highest achiever that not doing can be harder than doing.

The pelvic floor relaxation addressed in this blog post relates to the treatment of overactive pelvic floor muscles. The goal is better described as pelvic floor down training, which helps alleviate pain and tension while restoring normal coordination. This post does not address pelvic floor relaxation related to insufficient muscle activity or prolapse, which is discussed elsewhere.

Pelvic floor relaxation is the conscious or unconscious downregulation of nerves, muscles, and surrounding structures. Nerves decrease signaling and muscles lengthen with less activity.

Like other muscles in the body, the pelvic floor can be trained to relax. However, these muscles are often less familiar, have multiple roles, and carry more emotional associations. Down training can occur locally or in coordination with the whole body.

Why Do Pelvic Floor Muscles Become Overactive?

Understanding pelvic floor relaxation starts with understanding why overactivity develops.

Overactive pelvic floor muscles, also referred to as pelvic floor tension myalgia, levator ani syndrome, or non-relaxing pelvic floor dysfunction, are driven primarily by neural overactivity and sometimes by adaptive muscle shortening.

Symptoms of an Overactive Pelvic Floor

• Pain with penetration including sexual activity, medical exams, or tampon use

• Incomplete emptying of the bladder or bowels

• Difficulty initiating urination or bowel movements

• Urinary or bowel urgency

• Pain or tension in the pelvic floor with activity or at rest

Pelvic floor overactivity often reflects dysfunction in surrounding systems. Because these muscles have multiple roles, contributing factors can include:

• Direct pelvic trauma such as childbirth, surgery, infections, or medical procedures

• Indirect injury including low back pain, hernias, or hip dysfunction

• Overtraining or exercise with inefficient form

• Nerve sensitivity or irritation

• Gastrointestinal conditions such as IBS, bloating, diarrhea, or constipation

• Urinary habits such as delaying voiding or frequent “just in case” urination

• Hormonal changes across the lifespan

• Pelvic floor strengthening without adequate relaxation

• Lack of foundational health factors such as sleep, movement, and nutrition

• Emotional or mental stress contributing to a persistent stress response

What Is Normal Pelvic Floor Muscle Activity?

When the pelvic floor works efficiently, it functions as a coordinated system that turns on and off with activity and rest. The pelvic floor is not one muscle. It is a group of muscles with different roles, layers, and neural control. These muscles coordinate to:

• Support pelvic organs

• Allow urination and bowel movements

• Adapt to movement, pressure, and load

This coordination happens across the front and back of the pelvis, the right and left sides, and in connection with breathing and movement.

Pelvic floor activity is necessary and helpful. The goal is not less activity, but better timing, coordination, and variability.

How to Relax Pelvic Floor Muscles

Relaxation of the pelvic floor is marked by a passive opening and dropping. It is not pushing or bearing down. Because nerves drive muscle activity, relaxing the pelvic floor requires quieting the nervous system locally, systemically, or both. You cannot force relaxation by trying harder. Pelvic floor down training happens when the body experiences safety, ease, and new movement options.

1. Movement

Changing positions regularly or walking allows natural movement of the rib cage and arms while keeping effort low. Patients often ask what exercises help the pelvic floor. The best answer is movement that:

• Feels enjoyable

• Can be done consistently

• Promotes a sense of ease

Walking, yoga, Pilates, swimming, and tai chi can all be helpful.

The key is how you move. The pelvic floor should turn on and off with activity. In overactivity, this rhythm is lost. Gentle movement helps restore it.

2. Stretching with Diaphragmatic Breathing

Breathing that expands the belly and rib cage reduces demand on the pelvic floor.

When muscles change length with breath, the nervous system receives new input that can reduce pain signals. Guidelines:

• Stretch to the point of sensation, not pain

• Hold for about six breaths

• Inhale into the lower ribs

• Fully exhale and pause for three to six seconds

Helpful stretches include:

• Happy baby

• Hip flexor stretch

• Hip external rotator stretch

• Cat-camel

3. Mindfulness and Nervous System Regulation

An overactive pelvic floor often reflects an overactive nervous system. Mindfulness and bilateral stimulation techniques can help shift this state. One example is mindful journaling from Hello Down There by Dr. Alex Milspaw. Alternating between labeling thoughts and physical sensations can help regulate brain activity and reduce tension.

Local Techniques to Relax the Pelvic Floor

When systemic approaches are not enough, local techniques can support pelvic floor down training.

Position and Imagery

The easiest position for relaxation is often lying on your back or side with full support.

Check for:

• Even expansion of ribs and belly with breathing

• Reduced tension in jaw, shoulders, hands, and feet

Helpful imagery includes:

• A rose opening and softening

• A jellyfish floating downward

• An elevator descending

Ball Release

Using a soft ball near the sit bone can provide gentle pressure to the pelvic floor.

• Breathe into the lower belly

• Fully exhale

• Stay up to 90 seconds

• Stop if painful

Pelvic Wands and Dilators

These tools can help introduce new, non-threatening input to the nervous system and reduce muscle overactivity. They are best used with guidance from a pelvic floor physical therapist.

When to See a Pelvic Floor Physical Therapist in Philadelphia

P

elvic floor overactivity is not the same for everyone. The cause of your symptoms matters.

You may benefit from pelvic floor physical therapy if you have:

• Persistent pelvic pain

• Difficulty relaxing pelvic floor muscles

• Ongoing bladder or bowel symptoms

• Pain with intimacy or exams

At Hazel Physical Therapy, we provide pelvic floor physical therapy in Philadelphia with a whole-person approach that addresses both local and systemic contributors.

How Pelvic Floor Physical Therapy Helps

Awareness and Coordination

• Biofeedback

• Visual and tactile feedback

• Learning to grade muscle tension

Manual Therapy

• Soft tissue mobilization

• Myofascial release

• Trigger point techniques

• Joint mobilization

Movement and Strength

• Improving pelvic mobility

• Strengthening supportive muscles

• Restoring coordination with breath and movement

Whole-Body Integration

• Breathing retraining

• Addressing posture and movement patterns

• Nervous system regulation

Pelvic floor physical therapy focuses on helping the body learn new strategies, not just reducing symptoms.

Final Thoughts on Pelvic Floor Relaxation

Relaxing the pelvic floor is not about trying harder or thinking your way into change. It is about creating the right conditions for your body to shift. With the right support, including pelvic floor physical therapy in Philadelphia, many people experience meaningful improvements in pain, function, and confidence.

References

• Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic Proceedings. 2012 Feb 1 (Vol. 87, No. 2, pp. 187-193). Elsevier.

• FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor. International Urogynecology Journal. 2003 Oct;14(4):269-75.

• Klein MC et al. Relationship of episiotomy to pelvic floor outcomes. American Journal of Obstetrics and Gynecology. 1994 Sep 1;171(3):591-8.

• Milspaw A. Hello Down There. Hellertown, PA: Bright Communications. 2022.

• Wickham S et al. The Big Three Health Behaviors and Mental Health and Well-Being Among Young Adults. Frontiers in Psychology. 2020 Dec.

Looking for Pelvic Floor Physical Therapy in Philadelphia?

If you are experiencing pelvic girdle pain during pregnancy or postpartum pelvic pain, individualized care can make a meaningful difference.  At Hazel Physical Therapy, we provide pelvic floor physical therapy, prenatal physical therapy, and postpartum care in Philadelphia to help you move with less pain and more confidence. Schedule an evaluation to get started.

This post has been adapted from the original post written by Joanna Hess and published on the Beyond Basics Blog.