Pelvic pain and dysfunction part 3: 7 tips to nip that pain in the butt

In part 1 and part 2, we discussed the symptoms and causes of chronic pain and the basics of an effective treatment and management plan. Let’s discuss what you can do NOW to help improve your situation.

Many structures are in the pelvis, underneath the bladder, bowel and uterus. All these structures can irritate each other if inflamed, enlarged, irritable or tight. Gaining improvement can be as simple as reducing irritability to just 1 of these structures, or it may require addressing all of them.

While effective treatment and management requires a multi-faceted approach, there are a number of lifestyle modifications that can be easily implemented to start reducing triggers, allowing the nerves more mobility and reducing the nervous system tension in order to directly impact the negative cycle and start increasing comfort now.

Tip # 1:

Minimise activities that tend to trigger and aggravate pudendal and perineal nerve irritation such as:

  • riding a bicycle (especially for long periods)
  • horse riding
  • jumping (for example, on a trampoline)
  • intense exercise
  • lifting weights (anything over 5 kg is too much)
  • anything that causes intense pain (if 0 is no pain and 10 is the worst pain imaginable, do not go over a pain scale of 7/10).

Tip # 2:

For any activity where you know pain comes on after a certain period of time (for example sitting for more than 5 minutes):

  • Ensure that you set an alarm and only sit for 4 minutes at any one time.
  • When the alarm goes off – get up!
    • go to the toilet or get a drink or stretch before continuing to sit
    • when sitting again, ensure the alarm is set for another 4 minutes.

Tip # 3:

Ensure you have good posture in any activities you perform for a prolonged time (more than a few minutes). Get ergonomic advice if required.

For sitting:

  • ensure that your knees sit at the same level or slightly lower than your hip joints.
  • allow your pelvis to rotate forward slightly, keeping a slight extension in your lower back – this happens naturally when your knees are lower than your hips, helping to keep the natural spinal curves.

This ensures your back is “straight” with your head sitting directly over your pelvis.

It also helps your shoulders to sit in a good position, not rounded forward or held up high towards your ears.

  • Make sure that you don’t lean on your elbows or put too much pressure on your wrists (or you will get elbow or wrist strain injuries) (it also pushes your shoulders up and tends to make you lean to one side).
  • ensure that your feet are flat on the floor (use a floor stool if required for comfort)
  • ensure the seat is cushioned a little (especially if you have pudendal nerve pain) – you can use a doughnut ring if pain is more severe.

Tip # 4:

Lie with your legs up the wall for 5-10 minutes in the evenings

  • lie on your back, on the floor with your shoulders relaxed and rotated backwards
  • get your bottom as close to the wall as possible. Adding a cushion underneath your bottom to raise the angle of your pelvis.
  • place your legs up the wall and relax (you could use a meditation or relaxation app at the same time)
  • only stay for 5 minutes initially, but if it gets painful, stop. Aim to get to 10 minutes per night.

This exercise

  • allows pain relief in the pelvic area – for vaginal issues, haemorrhoids, pudendal nerve pain, period pain and also assists with reducing pressure associated with incontinence issues
  • increases blood return to heart, therefore helps with venous return in general and varicose veins/haemorrhoids etc
  • allows the spine to relax and lengthen after a day of compression forces from standing and sitting.

Tip # 5:

Avoid straining on the toilet

  • To avoid constipation, it’s important to keep hydrated, eat healthy fruit and vegetable fibre, exercise regularly and use a natural laxative if necessary (avoid stimulant laxatives).
  • Don’t sit for extended periods as this stretches the ligaments and increases the pressure in the wrong spots increasing likelihood of pain around the buttock (inferior cluneal nerve) or haemorrhoids. If it’s not coming, stop and go for a little walk and come back when you feel more ready.
  • Aim to sit correctly on the toilet (not squat over it) as this tends to constrict rather than relax the area, increasing downward pressure and reducing ease of toileting.

Tip # 6:

Perform a relaxation and strengthening program for the pelvic floor muscles daily.

  1. Start by massaging the perineum to help relax the pelvic floor muscles, relax the nervous system and improve circulation in the area
  2. In the bathroom or a private area, use a small amount of unscented, natural oil (coconut, olive or jojoba are best)
  3. Locate the area right in the middle – between your anus and your vagina in women or base of the penis in men
  4. Use 2 fingers with the oil and gently rub that central area in a clockwise motion for 20 rotations
  5. Then gently rub in a counter clockwise motion for another 20 rotations.

Use a simplified Kegel-reverse Kegel pelvic floor exercise to help your pelvic floor re-learn to strengthen its contraction as well as relax when contraction is not needed (many issues are due to an over-tense pelvic floor).

  1. Sit or stand with good posture, feeling your head being pulled up in the centre, your shoulders relaxed and back a little, your chest “out”, your natural back curves present and not accentuated and equal pressure either through both sit bones or through the front and back of both feet.
  2. As you breathe in, allow your pelvic floor to relax – feeling that centre point (located in the previous exercise) drop, and breath in for a count of 4-5.
  3. As you breathe out, allow your pelvic floor to gently contract and pull together – feeling that centre point gently squeeze together and up towards your pelvic organs and breathe out holding that squeeze for a count of 6-7.

Tip # 7:

Alter sexual activities. Some people find that sex is painful or that afterwards, symptoms seem to worsen.

  • Always use a gentle lubricant (that works for you – jojoba oil is great)
  • Using a relaxation technique may be of benefit
  • Play around with positions to find what is most comfortable for you.

If you would like to chat about your situation, drop us an email, call, or book an appointment with Alexis.


 [JH1]Link to previous articles on website