Have you ever noticed how much tension your body can hold without you even realising it?
You clench your jaw. Your shoulders creep towards your ears. You hold your breath when you lift the washing basket, pick up your child or rush through another busy day. Perhaps you pull your stomach in so often that you no longer notice you are doing it.
But have you ever wondered what your pelvic floor might be doing at the same time?
For many women, the pelvic floor only becomes part of the conversation when something changes. You leak when you cough, laugh or jump. You feel pressure or heaviness. Sex becomes uncomfortable. You notice urgency, constipation, lower abdominal tension, or an ache that seems to move between your pelvis, hips, buttocks and lower back.
You may have been told to do more Kegels. So you squeeze harder and more often, hoping that will fix it.
But what if your pelvic floor is not simply weak? What if it has been working overtime and has forgotten how to soften?
This is where the conversation becomes much more interesting, because the pelvic floor rarely tells its story on its own.
Your pelvic floor is part of a bigger conversation
Your pelvic floor forms a supportive base beneath your pelvis. It helps support the bladder, bowel and reproductive organs and plays a role in continence, sexual function and the way your body manages pressure.
Yet it does not work in isolation. It responds alongside your diaphragm, abdominal wall, lower back, hips, sacrum and nervous system. It reacts when you breathe, cough, lift, walk, exercise and change position.
This is why two women can have similar symptoms for very different reasons. One may need to build strength and endurance. Another may already be gripping too much. Someone else may have good strength but poor coordination, meaning the muscles do not contract or relax at the right time.
A healthy pelvic floor needs to do more than squeeze. It needs to respond.
What if the problem is not weakness
Pelvic floor exercises can be very helpful when weakness contributes to leaking or reduced support. But they are not automatically the answer for every woman.
An overactive or non-relaxing pelvic floor may be linked with pelvic pressure or pain, difficulty emptying the bladder or bowel, constipation, pain during or after sex, and a feeling that the lower abdomen or pelvis is always switched on.
If this sounds familiar, you are not imagining it. And you are certainly not alone.
Sometimes a woman can feel both weak and tight. The muscles may be working hard, yet still not coordinating well when she coughs, lifts or needs to relax. This is why doing more squeezes without first understanding the pattern may be unhelpful for some women.
The goal is not a pelvic floor that is tense all day. It is one that can contract when needed, lengthen when needed and soften when it is safe to let go.
Why your lower abdomen may be part of the story
Take a moment and notice your belly as you read this. Is it relaxed, or are you holding it in? Are you breathing comfortably into your lower ribs and abdomen, or is your breath sitting high in your chest?
The lower abdomen and pelvic floor work together through breath, movement and pressure. When the abdomen remains braced, the pelvic floor may have less opportunity to move comfortably. Pain, abdominal or pelvic surgery, scar sensitivity, fear of movement and long periods of guarding may also change the way you use this area.
We often describe this as helping the body feel safe enough to soften. I think that is an important way to look at it.
We do not need to claim that emotions are literally stored inside the pelvic floor to recognise that life experiences can shape the nervous system. Stress can change our breath. Pain can make us guard. Pregnancy, birth, surgery, distressing sexual experiences and periods of feeling unsafe may all influence the way a woman holds her abdomen and pelvis.
That does not make the symptoms imagined. It simply reminds us that the physical and emotional parts of our experience do not always operate in separate boxes.
How Chiropractic and Massage come together
When you are having chiropractic care alongside massage for support with pelvic or lower abdominal concerns, we are not dividing your body into separate parts. We are looking at the same body through different lenses and asking what may be contributing to the pattern you are experiencing.
From a chiropractic perspective, we look at how the lower back, sacrum, pelvic joints, pubic symphysis region and hips are moving together. We assess muscle tension around the hips, buttocks, pelvis and lower back, and whether certain positions or movements bring on the symptoms.
When we talk about pelvic alignment, we are not suggesting that the pelvis has simply popped out of place. We are looking at symmetry, movement, comfort and how the body transfers load through the pelvis. Where appropriate, gentle hands-on care may be used to support movement and ease surrounding musculoskeletal discomfort.
If there is burning, tingling, altered sensation or pain travelling into the leg, we also check neurological function and neural or dural tension. These findings can give us useful clues, but no single finding explains the whole pelvic floor picture.
If stress appears to be influencing how the body is holding, we may also incorporate Neuro Emotional Technique as an optional part of care. NET does not treat pelvic floor dysfunction, and it does not replace pelvic health physiotherapy, medical assessment or psychological support. It is simply another way we may explore the relationship between stress and the body’s physical responses.
Massage and bodywork may complement this by gently working with the areas surrounding the pelvis. This may include external work through the lower abdomen, diaphragm region, hips, gluteal muscles, lower back and sacrum.
When we take a holisitc approach in working with women with pelvic floor dysfunction, some women become more aware of their breathing, feel more comfortable through the surrounding tissues and notice where they have been unconsciously bracing. It is not an internal pelvic floor assessment, and it does not replace one when it is needed.
This is where collaboration matters. One appointment may reveal a movement or neurological component. Another may show how much the abdomen and surrounding muscles have been guarding. A pelvic health physiotherapist may then identify whether the pelvic floor itself needs strengthening, relaxation or coordination work.
Sometimes the best care involves more than one practitioner
We are sometimes asked which approach is best. In reality, that may be the wrong question.
A woman with leaking and lower back discomfort may need a pelvic health physiotherapist to assess pelvic floor function while we look at relevant lumbopelvic movement and supporting the surrounding abdomen, hips and lower back. Another woman with new pelvic pain, unusual bleeding or significant urinary symptoms may need to see her GP before hands-on care is considered.
The aim is not to send you from practitioner to practitioner. It is to recognise when one pair of hands cannot reasonably address every part of a complex concern.
Depending on your symptoms, your care team may include:
- a pelvic health physiotherapist to assess strength, relaxation, coordination, prolapse symptoms and bladder or bowel function
- a GP or medical specialist to investigate pelvic or lower abdominal symptoms that may have a medical cause
- chiropractic care for relevant lower back, pelvic, hip, muscle or neurological factors
- external massage and bodywork to support comfort, breathing awareness and surrounding muscle relaxation
- an appropriately qualified mental health or sexual health professional when trauma, distress or sexual pain is part of the story
Good collaborative care means knowing what we can help with, recognising what sits outside our scope and helping you find the right next step.
When to speak with a medical or pelvic health professional
Please speak with a GP or pelvic health clinician if you have ongoing pelvic or lower abdominal pain, urinary leakage or urgency, constipation or difficulty emptying, pain with sex, vaginal heaviness or a bulge, or symptoms that are changing or affecting daily life.
Seek urgent medical care for sudden or severe pelvic or abdominal pain, heavy or unexpected bleeding, fever or vomiting with pelvic pain, inability to pass urine, a pregnancy-related concern, new numbness around the groin or saddle area, new leg weakness, or sudden loss of bladder or bowel control.
Start by noticing rather than judging
Pelvic floor symptoms can leave you feeling frustrated with your body, especially when you have tried to do the right things and nothing seems to change.
Before you tell yourself that you are weak or that you simply need to try harder, pause and become curious.
Do you hold your breath when you lift? Is your belly always braced? Can you relax your pelvic floor as easily as you can contract it? Did your symptoms begin after pregnancy, birth, surgery, pain or a particularly stressful season?
You do not need to know which practitioner you need before contacting us. Tell us what you have been noticing, and we can help you work out whether the most appropriate starting point is a chiropractic assessment, massage or bodywork appointment, pelvic health physiotherapy or medical care.
Sometimes the most useful first step is not doing more. It is finally asking why your body feels it needs to keep holding on.
