2018, Responses from: Heba Shaheed
“I sometimes have pain after sex and my muscles feel like they are cramping afterward. Are there any exercises I can do so that sex doesn’t hurt so much?”
Heba Shaheed from The Pelvic Expert: Women with endometriosis often experience many different forms of pain including period pain, pelvic pain, ovulation pain, painful sex, painful urination, pain with bowel movements, and nerve pain.
As a pelvic pain physiotherapist, I treat a lot of women with endometriosis. Endometriosis is a condition where the cells, similar to the cells that make up the lining of the uterus, exist in other places too. These cells can be found on the ovaries, the fallopian tubes, the bladder, the bowels, in the vaginal walls, on the pelvic ligaments inside the pelvis, in the Pouch of Douglas (which is the space between the uterus and the bowels) and even on the lungs and diaphragm too! These cells will behave just like the lining during the monthly cycle, except they have nowhere to go, so they build up and cause inflammation and pain.
Because women with endometriosis often spend a lot of time in pain, often curled up in bed, the muscles and connective in their pelvis, abdomen, back and hips can become tight and sore as well. It’s important to keep the body moving to allow the muscles and connective tissue to lengthen, and to allow the nerves to slide and glide freely within the tissues.
Here are a few simple exercises I recommend for women with endometriosis to do at home:
1. Diaphragmatic Breathing
Don’t underestimate the incredible benefits of taking a deep wide breath into your diaphragm. Deep breathing helps to allow for the ribs to expand, easing tension in the back, right up to the neck, and down into the pelvis. Often women with pain will take shallow breaths into their upper chest so their diaphragm doesn’t really get a stretch. The diaphragmatic breath calms the nervous system, which leads to less pain. You can do deep, wide breathing anywhere, but I like to have a yoga strap or band around my lower ribcage, so I can get that feedback of my breath into the band. I suggest taking 5–10 deep wide breaths every hour.
2. Pelvic Floor Drops
Very often women with endometriosis and pelvic pain actually have a tight and tense pelvic floor, so I recommend reverse kegels or pelvic floor relaxation exercises. We want to lengthen and relax the pelvic floor, especially with women who have pain with sex. Imagine the way a pebble drops into a pond, and imagine the ripples it makes outwards. Visualise this in your pelvic floor, and feel the way the pelvic floor muscles let go. Another image is visualizing your pelvic floor as an elevator in a 3 story building, then imagining the elevator at the roof coming down to ground floor and the elevator doors opening. You can combine this with your diaphragmatic breath and as you breathe in feel the elevator dropping to ground floor, and to get more relaxation, as you breathe out, feel the elevator coming down to the basement. Again try to do 5–10 breaths combined with pelvic floor drops every hour.
3. Hip & Buttock Stretch
This is a really great simple hip opening stretch that also allows your buttocks and deep hip rotators to stretch. Simply lay back on your mat or on your bed with your knees bent, then take one ankle onto the opposite knee and use your hand to gently press away at the knee. Because a lot of women with endometriosis and pelvic pain often curl up in pain, we really want to open the hips, but in a gentle way. Hold this stretch for 60 seconds or as long as your feel comfortable and repeat daily.
4. Groin Stretch
This is another effective hip opening stretch that also lengthens the pelvic floor and allows the tailbone to soften away from the hips. You can do this laying back on your mat or in bed. Slowly bring both knees up towards your chest, and then when you are comfortable, slowly take the knees apart towards your shoulders. You can rest here for 60 seconds, and focus on your deep breathing and pelvic floor drops.
5. Hip Flexor Stretch
I love this yoga variation of the hip flexor stretch because you get a lot of lengthening of the muscles and connective tissue along the front of the body. The front of the hips, the pelvis, the belly and the chest all get a deep stretch. Start in kneeling on your knees on a mat (you can have a towel or blanket under your knee), then take a step forwards with one foot. Rest here for a moment before starting to bring bot arms up towards the ceiling. Rest here again and start to lunge forwards and lift your belly to the ceiling. Take a slow deep breath as you move from each position, but only go to a place where you are comfortable. Hold this stretch for 60 seconds as your breathe deeply and feel your pelvic floor melting down.
6. Shell Stretch
Finish off with a shell stretch by sitting back on your heels and curling forwards bringing your forehead to the mat. Reach your arms forward on the mat. If you feel comfortable, you can even take your knees out into a child pose stretch. This is a really great restorative pose that allows you to expand into your diaphragm more as your breathe in, and also lengthens the pelvic floor. Spend some time here whilst you breathe and visualize your pelvic floor muscles softening down, as your chest and breastbone also melt to the mat.