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Pelvic-Pain-Relaxation vs. Strengthening

Home » Pelvic-Pain-Relaxation vs. Strengthening

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This guide is designed to help you navigate the often-confusing world of pelvic health. When you are in pain, the natural instinct is to “squeeze” or protect the area, but for chronic pelvic pain, that is often the opposite of what your body needs.

Below is a step-by-step breakdown of how to use Down-Training (Relaxation) versus Up-Training (Kegels), and how to perform the essential movements for relief.

“Summery (TL;DR):

Pelvic floor health is about balance — muscles should be strong, but also able to fully relax. Chronic pelvic pain is often caused by overly tight pelvic muscles, so relaxation exercises like diaphragmatic breathing, Child’s Pose, Happy Baby Pose, and deep squats should come before strengthening exercises. Kegels are helpful mainly for weakness, leaking, or loss of support, but doing them on an already tight pelvic floor can worsen pain. The goal is to restore normal muscle function, flexibility, and control without increasing tension. “

The pelvic floor is a muscular hammock. To function correctly, it must be a “Goldilocks” muscle: not too weak, but not too tight.

When to “Down-Train” (Relaxation):If you have deep pelvic pain, pain during intimacy, or a frequent “urge” to go, your muscles are likely hypertonic (overactive). You need to lengthen the hammock.
When to “Up-Train” (Kegels):If you experience leaking when sneezing or a heavy “sagging” sensation (prolapse), your muscles may be hypotonic (weak). You need to strengthen the hammock.
Pain Specialist Note: If you have chronic pain, start with relaxation. Doing Kegels on an already tight pelvic floor is like trying to lift weights with a muscle that is already cramping—it will likely increase your pain.

Before you move, you must breathe. Your diaphragm and pelvic floor move together like a piston.

How to do it:Lie on your back. As you inhale, let your belly rise. Visualize your pelvic floor dropping and opening like a blooming flower.
Why it works:This is the primary way to “stretch” the pelvic floor from the inside out using your own breath.

Once you’ve mastered the breath, add a gentle external stretch.

How to do it:Lay on your back and bring your knees to your armpits, holding your feet.
The Goal:Do not pull hard. Simply hold the position and send your “belly breath” down into the pelvic space to release deep-seated tension.

This pose allows the pelvic floor to relax completely without having to fight gravity.

How to do it:Kneel with knees wide and big toes touching. Fold forward. Use a bolster or pillow under your chest if the stretch feels too intense.
The Goal:Deep relaxation. Feel the space between your “sit bones” widen as you breathe.

This is the most advanced relaxation pose, using gravity to help the muscles drop.

How to do it:Stand wide and squat down low. If your heels lift, put a rolled-up towel under them. Use your elbows to nudge your knees open.
The Goal:Hold for 30 seconds. This “resets” the pelvic floor to its natural, resting length.

Only once your pain is managed and your muscles can relax should you focus on isolated strengthening.

Feature	Kegel Exercises	General Pelvic Exercises
Focus	Isolated contraction (squeezing).	Integration of hips, glutes, and core.
Goal	Raw muscle strength.	Flexibility and "functional" movement.
Example	Squeezing to stop urine flow.	Squats, Happy Baby, or Child's Pose.

If your pain has subsided but you feel a lack of support or control, you can begin gentle “Up-Training.”

The Squeeze : Imagine lifting a marble with your pelvic muscles.
The Most Important Part:You must be able to feel the muscle fully let go after the squeeze. If you can’t feel the “drop,” stop doing Kegels and return to the relaxation exercises above.

If you feel...	Use this Method	Primary Exercise
Sharp or Deep Pelvic Pain	Down-Training (Relaxation)	Diaphragmatic Breathing / Child's Pose
Heaviness / Pressure	Down-Training (Length)	Deep Squat / Happy Baby
Leaking / Incontinence	Up-Training (Strength)	Isolated Kegels (with full release)

All content is authored, clinically reviewed, and approved by Dr. Vijay Bhaskar Bandikatla. Advanced AI assistance is utilised solely to ensure comprehensive medical literature coverage and structural clarity.

Founder IBAP Clinics, Pain Physician

MBBS, DA, FRCA (UK), FFPMRCA (Pain Medicine, RCOA, UK)
CCT (Anesthesiology And Pain Management)
Neuromodulation & Advanced Pain Research Fellowship (London), MBA (HM)

Founder IBAP Clinics, Pain Physician

MBBS, DA, FRCA (UK), FFPMRCA (Pain Medicine, RCOA, UK)
CCT (Anesthesiology And Pain Management)
Neuromodulation & Advanced Pain Research Fellowship (London), MBA (HM)