Pelvic floor muscles are very protective. When we experience something uncomfortable, they can tighten to protect you. Unfortunately, this can cause them to ‘grip’ or hold on all the time and become too tight, which can make us feel more uncomfortable. This may be happening in a child or young person who has pelvic pain.

Another way to try and understand this is to think about your hand.

Your hand is naturally quite relaxed and open, but at times throughout the day it squeezes or grips and releases as needed – just like pelvic floor muscles.

When we squeeze our fingers or hands shut and hold them tightly, we begin to feel some discomfort after a while. Imagine you keep this held tightly for several minutes or even a few hours.

Even after letting go, your hand may still feel sensitive and would continue to feel this way if you did this every day. Pelvic floor muscles can be the same.

If you use your hand muscles a lot, you might get cramps in your hand. These will feel like very sudden, quite severe pain. Pelvic floor muscles can do this as well. When they cramp, it’s often a severe sudden pain that may feel like it’s in the vagina.

How does pelvic pain affect the pelvic floor muscles?

When we experience pelvic pain, our body tries to protect us by tightening the muscles around this area, including the pelvic floor.

This is normal. However, if the pain continues, the tightening of the pelvis can become a habit.

Over time, the pelvic floor muscles can stay constantly switched ‘on’, even when they should relax (just like your hand).

If pelvic pain affects pelvic floor muscles, a young person might also:

• Have trouble going to the toilet including holding on to wee and poo
• Need to go to the toilet more often
• Have trouble relaxing when they sit on the toilet
• Have trouble inserting a tampon
• Experience difficulties with sex
• Have sudden sharp pains that feel like they are coming from the vagina.

How to reduce pelvic floor muscle related pain

Pelvic floor exercises

To reduce pain, we generally focus on belly breathing and exercises that release or ‘down train’ the pelvic floor muscles, rather than strengthening them.

Pelvic pain doesn’t mean pelvic floor muscles are weak. They’re actually tired from being activated and alert all day. These exercises aim to down train the pelvic floor to help those muscles relax.

Belly breathing

Belly breathing is one way to help restore coordination between the diaphragm (the muscle between the lungs and stomach) and the pelvic floor muscles. It can balance the pressure in this area, improve circulation and calm the nervous system by stimulating the vagus nerve. You can encourage your young person to try belly breathing when they’re having a pain flare-up or to do it every day as part of their usual routine.

Encourage your young person to try lying on their back or sitting with their feet flat on the floor:

• Get them to place one hand on their upper chest and the other on their belly
• The hand on their chest should remain fairly still throughout this exercise
• Get them to imagine that their belly is like a balloon
• As they breathe in, get them to imagine the balloon filling with air and expanding
• As they exhale, ask them to imagine that the balloon is deflating and their belly should gently relax back down.

They could practise their belly breathing each night before sleep. This will help them be able to use this breathing technique when they are experiencing pain. They can also practise this breathing each time they’re doing a wee or a poo.

Support options

You can start by talking to a doctor (GP) about getting a Chronic Disease Management plan (GPCDMP) for your young person.

Pelvic health physiotherapy

A pelvic health physiotherapist is a qualified health professional who specialises in managing pelvic pain conditions. They might be part of the pain support team for your young person. They can help design a treatment plan to reduce the intensity of your young person's pain, anxiety, and pain-related worries. They can also help them overcome fear of movement and help them get back to doing the things they enjoy.

A pelvic health physiotherapist can help with:

• Understanding pelvic pain through assessment and education
• Exercises for the pelvic floor and whole body
• Belly breathing
• Going to the bathroom
• Pain management through electrotherapy like a TENS machine.

Pelvic health physiotherapists should have additional, specialist training and be registered with AHPRA (Australian Health Practitioner Regulation Agency). There are some pelvic health physiotherapists who specialise in helping young people with their pain.