Currently I am treating many strong women. One lovely patient has a history of sexual abuse and PTSD; another patient has recently suffered the loss of her mother while another is amidst a breakup. Multiple with traumatic birth stories and others with personal struggles at work. A few are young girls feeling the pressure and stress of teenage social dilemmas and school anxiety. And others healing from bullying and mental health disorders.

So many different individuals, with so many different stories yet all presenting with similar symptoms. Similar pelvic floors, pains, constipations and leaks.

Could the events that occurred or are currently occurring in their life possibly be the cause of such physical symptoms? Is that possible?

Yes! Absolutely! But how? How could these emotional and mental-health related events be the cause?

I love this poem written by Elizabeth Noble, an obstetric physiotherapist who has been called the mother of pelvic floor physiotherapy in America.  She describes the pelvis this way:

The center of gravity.

Centre of pleasure. Centre of reproduction. Centre of creativity.

A bony basin to cradle a baby.

Our first home, the primordial cave of bliss or terror? Wounds are stored here.

Survival, relationships, power and money.

A bony bridge between trunk and legs.

Muscular floor pulsing and pumping.

Architecture of containment.

Keystone of good posture.

Base of emotional security.

Love’s portals.

Your pelvis is so much more

This poem accurately explains that a pelvis is not just a bony cavity in our body. It is so much more. It contains memories and experiences. It allows for the greatest forms of vulnerability, intimacy, and therefore potential pain.  It has the ability to bring forth life. It is linked to relationships and connected to our very breath. It is the stable foundation for all our upper and lower body movements. It truly is our center. We can do without our arms or legs, but we can’t function without a pelvis.

Proof

A study was performed on a multitude of different aged females. They all sat in a movie theatre, attached to electrodes on all muscles of their body. They then were exposed to scary scenes such as zombies and ghosts. Can you guess the first muscles to contract when experiencing fear? You know it, their pelvic floor muscles. The first set of muscles to tense in response to fear, anxiety, worry or distress are your pelvic floor muscles.

Stress and our pelvis

One of our helpful coping strategies for mental or physical stress is a subtle contraction of our pelvic floor muscles. This contraction helps prevent urinary or fecal leakage and co-contracts with our abdominal muscles to protect our spine. If we experience long-term stress, our pelvic floor stays contracted and eventually can have difficulty relaxing. You may have heard terms like hyper-active pelvic floor, non-relaxing pelvic floor, or tight pelvic floor muscles which are often used to describe this phenomenon. When our pelvic floor learns to stay in a semi-contracted state, we lose the functional strength needed to hold in urine and feces, the mobility needed for pain-free intercourse, and the stability needed to prevent pelvic organ prolapse. We also lose the ability to positively cope with pain, even if our body is no longer in danger.

Is this you?

So all my patients with previous or current traumas… Maybe its 20 years ago or maybe it’s last month, maybe its assault and maybe it’s a fight with your partner. Trauma is trauma no matter how small and our body reacts. And my new moms, hopefully you had a wonderful and happy birth but regardless birth is a trauma and can have major effects on our pelvic floors.

So now?

How can we take better care of our pelvic floors? How can we heal from our previous trauma that has affected our pelvises?

The best and quickest way to start connecting and relaxing our pelvic floors is diaphragmatic breathing. Such a simple, free, accessible treatment to relieve tension and restore our pelvic floor and core.

The Benefits of Diaphragmatic Breathing

• Calms & centres the mind
• Reduces stress & anxiety
• Improves sleep patterns
• Improves circulation
• Reduces muscle tension & overactivity
• Relaxes the pelvic floor
• Helps prepare for labour
• Assists recovery after childbirth
• Returns the body to a state of equilibrium
• Teaches your body to naturally breathe deeper during the day
• Increases energy levels
• Promotes mindfulness
• Allows us to respond more positively to challenges in life

How to Diaphragmatically Breathe

Follow these simple steps to learn Diaphragmatic Breathing

1. Lie on your side with your head on a pillow & your knees bent. You can be on a bed, the couch or a mat on the ground. Just make sure you are comfortable.
2. Place one hand on your chest & the other on your upper stomach, under your breasts.
3. Close your eyes & bring your awareness to the breath in & out through your nose.
4. When you next breathe in, keep your top hand (on your chest) as still as possible, directing the air you breathe in to your bottom hand (on your stomach). Feel your stomach & hand rise with the breath in.
5. On the breath out through your nose, let your hand & stomach gently sink back in towards your spine. Let the breath out be natural, not forced.
6. Continue focusing on the breath in & out, keeping your chest & shoulders as still as possible, letting your belly rise & fall slowly.
7. Maintain a slow, regular pace with deep, quiet breaths.
8. Now move your bottom hand down to the middle of your belly, directing the air in through your nose, allowing your whole belly to expand. This may feel somewhat uneasy, as there is a feeling of letting the belly hang out.
9. Feel the belly gently retract as you breathe out through your nose.
10. Take a few slow deep breaths with your hand in this position.
11. Now move your hand down to your lower torso, pelvic region. As you breathe in through your nose feel your lower belly/pelvis fill with air, softening & expanding under your hand.
12. Take a few slow deep breaths with your hand in this position.
13. Finally move your hand to your bottom near your pelvic floor. Focus on the air you breathe in flowing all the way through your body, filling your entire pelvis, bottom & to your pelvic floor. As you continue to do this, you will feel your hand subtly rise & fall with the breath in & out. This is indicative of your pelvic floor relaxing.
14. Take a few slow deep breaths with your hand in this position.
15. You can remain in this position for as long as it serves you. When you are ready to finish, slowly crack open your eyes & make your way to a sitting position before getting up.

You can do Diaphragmatic Breathing for as long as you like. I recommend at least 10minutes to allow your nervous system to calm down. Do this daily if you are stressed, have pelvic floor over activity, or are experiencing pelvic pain or incontinence or painful intercourse.

What else?

• See your pelvic floor therapist, they can assess and see and feel what is going on and provide treatment. I treat women every day with overactive pelvic floors and we see wonderful results!
• Be more mindful. Practicing mindfulness is so powerful.
• See a therapist. Trauma requires a multidisciplinary approach to heal.
• Yoga and stretching.
• Be true to yourself and set your boundaries to limit further trauma.
• Love yourself. You are strong and you are brave and you will get through this.
• Give yourself time. Healing is a lifelong process.

With you in all pee, poop, pleasure and pain,

Written By: Talya Chemel

Talya is a physiotherapist running her own practice in Melrose North. She has special interest in neuromusculoskeletal and women's health pelvic floor conditions. She is further specialising in sexology in the physiotherapy context to ensure pain-free and pleasurable living. You can contact her on talya@fizzeeoh.com and find her on instagram @talyachemelphysio