Like many women, I’ve had a complicated relationship with my pelvic floor. I hold stress in my lower abdomen, which means that’s where my body keeps score of what’s going on in my brain. It’s like how some people clench their jaws in their sleep or hunch their shoulders, leading to migraines and other agonies. Put simply, my pelvic muscles are taut when I am in a tizz.

I used to get frequent UTIs in my early 20s, so initially assumed my crippling need to pee (when my bladder was near empty) and aching discomfort to be symptomatic of yet another infection. But in January last year, this sensation became insufferable and I reached breaking point. After multiple ED stints, emotional outbursts, fear of the pain propelling the pain, misdiagnoses and doctors being bamboozled by my negative dip-stick results, I eventually went to a Urologist who put a treatment plan in place.

I was on three obscure medications daily in early 2024, when it was at its most severe stage. At last, I felt some relief. I stopped crying and crashing out all the time and I felt validated. But my Urologist adamant that these hardcore muscular relaxation patches and nerve-calming pills were just bandaids on an underlying issue: my very tight pelvic floor. Turns out, I was holding my tension there — a manifestation of a personally challenging time, coupled with the physical trauma of those UTIs on my body. I was also later diagnosed with anxiety, which felt like a big ‘ah-ha’ moment.

"I thought I was making it all up, or had something so terribly wrong with me that the ultrasounds, Cystoscopy and physical examinations were missing."

Alas, the Urologist explained to me that a pelvic floor physio was going to be crucial in helping me. I was apprehensive and incredibly cynical, because medicine was doing its thing and a pain so intense could not possibly have been managed by some cat-and-cow stretches or deep breaths. Reluctantly, I went to a few sessions, and in time, slowly came off all the medications. I'm basically symptom-free now and doing all the things that make me happy — it’s a major personal achievement.

Reflecting on when I felt peak pain, it was so debilitating and maddening. I thought I was making it all up, or had something so terribly wrong with me that the ultrasounds, Cystoscopy and physical examinations were missing. A real medical enigma! I didn’t feel comfortable telling my work clients or acquaintances, so I just pushed through the internal anguish and tried to show up for everything in life with a brave face. If I said I needed to pee all the time, I didn’t think anybody would get how heinous it was.

Jodi Pullar is the founder of Soma Practice, an embodied Pilates and somatic movement community. Her work lies in the balance between functional fitness and a holistic perspective — both of which are integral when addressing pelvic floor tension and associated pain. “Functional fitness focuses on strengthening and releasing the muscles,” she tells me, “while somatic movement allows for a deeper exploration of the mind-body connection.”

I asked Pullar to give us a proper breakdown as to what happens physiologically when women have tight pelvic floors. “When our nervous system is in an activated state (fight or flight), our body responds with increased muscular and fascial tension. Fascia is the connective tissue that surrounds and supports our organs, muscles, bones, ligaments, and tendons.”

“This tension isn’t limited to abdominal and pelvic floor tension but can affect the entire body. We may hold onto tension due to factors like trauma, stress, pregnancy, childbirth, or poor posture…”

Confession: I shamefully ghosted my first pelvic physio to find another one that worked for me better. The latter explained things in a way I could connect with, and I think finding what suits you is half the battle in finding reprieve. I had to visualise my vulva releasing and melting down into the chair beneath me ‘like chocolate’ — totally bizarre, but it clicked. And in any free moment I had, I was to check in and see what I was doing with my tummy muscles.

When I caught myself holding on to my abdominals internally for dear life, I employed breathing techniques and quite literally pushed my belly forwards instead of sucking it in. It was always happening subconsciously during busy days, in traffic taking work calls, or while furiously tapping away at my desk and throwing back coffees (aka, more cortisol-spiking).

The antidote for this clenching is unzipping my jeans, letting it ‘all hang out’ if the setting allows, and just genuinely pressing my pooch outwards to Homer Simpson status. Making sure I was going to therapy, breathing deeply and doing these weird stomach protrusions all added up to get me to a place where I could wean off each medication, one at a time.

“One common response to an activated nervous system is shallow or restricted breathing. The diaphragm,” Jodi shares, “which is one of the deep abdominal muscles, works closely with the pelvic floor to support our body.” This makes so much sense to me now.

Even now as I write this, looking out onto the water from a local beach café, I have to repeatedly check in, release my lower belly and take moments to exhale. I always catch myself forgetting to breathe.

"It was always happening subconsciously during busy days, in traffic taking work calls, or while furiously tapping away at my desk and throwing back coffees (aka, more cortisol-spiking)."

“When we breathe, the diaphragm moves down, and the pelvic floor gently lowers as well. On exhale, the diaphragm moves up, and the pelvic floor contracts. If this natural rhythm is disrupted, both the diaphragm and pelvic floor can hold onto tension, leading to discomfort and imbalances.”

Through practising somatic body-based techniques like breathwork, grounding exercises, self-massage, and mindful movement, we can help regulate the nervous system. This allows the body to release muscular tension, expand our breath capacity and achieve the ultimate end-goal: no discomfort.

I spent an egregious amount of time and money on doctors, those emergency department day trips and subsequent specialist referrals. But I feel proud for continuously standing up for myself. I rarely suffer from that hellish feeling anymore, and If I do, I know how to relieve it. I think the issue lies in that ‘first line’ assessment (be it at a GP or a hospital), due to a lack of specialised education (or maybe awareness?) among generalised healthcare professionals for relatively niche women’s health concerns. Even once you figure out what’s happening, it takes experimentation to find a management plan that works for your body — we are all wired differently.

Pilates exercise with breath

Jodi has generously shared some techniques to help alleviate pelvic floor tension and pain, so I thought I’d drop them here for you to screenshot and revert back to as needed as a parting piece of actionable advice. It can all seem very futile at first, I totally get it. But perseverance and an open mind is key — healing is not linear, but it is absolutely possible. You’ve got this.

1. Sit on a chair, and if comfortable, roll up a small towel or pillow to place lengthwise under your pelvis. This tactile feedback can help you engage and release the pelvic floor.
2. Begin by noticing your breath. On your inhale, tilt your pelvis so your tailbone extends back (anterior tilt). Allow your pelvic floor to fully relax.
3. On your exhale, tilt your pelvis so your tailbone tucks under (posterior tilt). As you exhale, feel the deep abdominal muscles (including the pelvic floor) engage, as if you’re trying to lift the towel/pillow between your pubic bone and tailbone.
4. On your next inhale, relax and let the towel/pillow drop back down.

Breathwork Exercise: for releasing pelvic floor tension and nervous system regulation

1. Inhale for four counts. Focus on filling your lungs fully, expanding your belly as you breathe in.
2. Hold your breath for four counts, keeping your body relaxed.
3. Exhale slowly for four counts, letting the breath release gently.
4. Hold again for four counts, keeping the pause comfortable.
5. Repeat.

Feature images: one, two, three, four.