In my experience, exercising when you have pelvic pain is controversial - for the people experiencing the pain that is. In one camp, there’s the people who have had to stop doing what they love because of the pain. On the other side, there’s the people who cannot start an exercise program because of their pelvic pain.
As a healthcare provider, I can tell you that the benefits of exercise for health and for pain management are astounding. Improved mood, clearer and more creative thinking, better sleep, better metabolic regulation, improved digestion and colon motility (which means better poops). Basically movement helps your spirit, mind, and body feel good!
Even though I know all this as a healthcare provider, as a woman who has had pelvic pain & IBS for over a decade, I can also tell you that there have been times when I have NOT taken my own medicine.
So what do you do? Where do you start when you have intense pain that stops exercise or that prevents you from starting in the first place?
#1 Find Your Coach
I chose those words carefully because a coach can come in many forms. It could be a pelvic floor physical therapist, a body worker who uses movement, a medical doctor (urogynecologist, urologist, pelvic pain specialist), a life coach, a therapist/counsellor, etc.
A coach is someone who sees your potential, not your problem.
What this means is that while they understand your current problems, they can clearly see you meeting your goal and they will help you reverse engineer the process. This person encourages you and guides you through the healing journey.
To them, you are not IBS or painful sex or SI joint pain. You are a person with pain, who wants to get back to living! And it IS possible. For a long time I defined myself as my IBS and pelvic pain. It held me back from living fully. I wouldn’t ask myself “Do I want to do that?” I would ask “Will my IBS let me eat that? Will my pelvic pain let me sit through that movie comfortably?”
Take back ownership of yourself. You are not defined by the pain that you experience!
Here’s a plot twist: You can be your own coach! Sometimes, the people around us have such a bleak outlook that the only person who believes you can do it is yourself. There are countless stories of people who were written off as never being able to walk/talk/run/etc, who decided they WOULD and overcame those odds. If you are that person for yourself then cool! I challenge you to find your support system because you will need them.
Note: A great coach does not shame you about your current status, meaning they aren’t focused on how “broken, painful, weak, tight” you are. They DO listen to you and collaborate their knowledge with your desires in order to create a plan which is going to take you to the next level. If you feel that the person or people you’ve currently got in this role are not fitting the bill… then you have my most sincere encouragement to go find a better match. This provider or person is not the one YOU need on your journey.
#2 Create Accountability
How are you going to get from your current status to where you want to be? By breaking each step down and taking action. Accountability ensures that something actually happens with all the potential we see. You may have built in accountability, like in the case of regular sessions with your coach. If you talk/see this person once a week then you have accountability each week. You know you’ll have to report in.
You can also create accountability by:
Asking a trustworthy and persistent friend/family member to check in with you
Paying for it
People pay attention to what they pay for. I have to say that if you’re getting free coaching/physical therapy/counselling then it’s much easier to blow it off. Now, if your financial situation requires free services and you are motivated to use them, that’s a different story. But for people who could afford to pay something and instead find the free version - they often do not utilize it fully.
Case in point: I paid $25 for 2 weeks of unlimited yoga classes. I went twice, then stopped going and didn’t really worry about it. A yoga class in my area averages ~$30 so I already got my bargain’s worth. I did not utilize the full potential of this pass! On the flip side, I made sure to get my butt to a pole dancing class I’d signed up for even though I was feeling “meh” because the fee was non-refundable! I got up, shaved my legs, and went because I wasn’t going to lose that money.
Paying for a service keeps you and the provider of that service accountable. You want to get your money’s worth, and the provider wants to be sure they give you what they promised.
#3 Create the space for exercise
Before we get into exercise, I want to be sure you’re set up for success. Many people skip this step, therefore sabotaging themselves. When I say create the space, I’m referring to physical and emotional space for exercise.
Physically, you may have to:
Schedule the time into your work day
Find a gym
Buy exercise equipment (or dig it out of your garage!)
Clean up a part of your home to use for exercise
In my opinion and clinical experience the more important and often ignored of the two is emotional space. Ask yourself: Do you feel ready to start moving your body?
This seems like a no brainer, but it’s not. Many people come to me and say they want to eliminate their pain and reclaim their lives, however when it’s time to take action, they hesitate. In these situations, there is often an internal block that’s stopping them before they can even start. In some cases it’s a fear of movement as many motions/activities aggravate the symptoms of pelvic pain. I want you to know that this is a common and serious concern for many people. If you feel this way, I highly recommend you find a skilled and compassionate movement coach to work with on your journey. In the meantime, I can tell you this with certainty:
Movement is healing for our bodies
The focus is to find what movements feel good or at least neutral to your body. Stay curious and use the stoplight system:
Green light: this movement makes you feel better
Interpretation: do more of this!
Yellow light: this movement doesn’t make you feel better or worse
Interpretation: neutral is a great place to be as you’ll get the benefits of exercise described above, even if it doesn’t provide immediate pain relief
Red light: this movement intensifies your symptoms
Interpretation: Pause and change something about that movement. Your body is trying to cue you in that you may be:
Moving too quickly
Moving too slowly (i.e. clenching everything and thinking a lot!)
Trying to do too much
Require a rest break
Your body craves variety. Just like you don’t eat the same thing every day, your body wants different movements too! Sometimes this variety comes in cycles (i.e. “I’m on a yoga kick”) or they may change from day to day. Respect the signals your body is giving you and try new things.
Besides fear of movement, sometimes there are emotional blocks which prevent self care. Ask yourself this: Do you struggle to start or stick with healthy lifestyle changes? Why?
There are many reasons people start and stop. Most of those reasons boil down to: fear that you aren’t good enough. Shame stops many people from admitting that they have a problem in the first place. Then we guilt ourselves because “I should already know/be doing this!!”
Let those go. Shame & guilt have never helped anyone make more loving choices. You are enough and you are worthy of the life you envision.
I get it. Facing everything we could improve in our lives can feel pretty overwhelming. Maybe you need to clean up your nutrition because the current foods & drinks you consume make you feel bloated, gassy, painful, and lethargic. Maybe you need to maximize sleep so that you are rested and energized enough to exercise. Maybe you need to learn about emotional processing so that you can successfully handle the ups and downs of life without becoming drained and defeated.
If you feel like all of the above apply, know that to start healing you do NOT have to do all of the above at the same time. You only have to be willing to change and to pick one thing to begin on!
Hint: a great coach can help you identify the thing that’s best for you to start with.
Personally, this is the step that kept me from creating a regular exercise program. I’ve had significant pain in my pelvis/tailbone/mid back, Irritable Bowel Syndrome, and on/off urinary urgency and vaginal pain for over a decade. For many years I did not tell anyone about it because initially I didn’t realize these were problems, then because I was ashamed and embarrassed. I got used to the pain and flare ups and accepted that this would always be a part of my life.
To distract myself from this, I shifted my focus to healing others. The more I focused on that, the further I got away from caring for myself. By the time I started a Women’s Health Residency program I was so focused on others, that I put all my client care and academic work ahead of my own needs. I stopped exercising for almost two years. During that time period I would try to rally and go to the gym or a yoga class here and there, sometimes even string a couple classes together. It never stuck. I was inundated with working and taking on waaaayyy too much.
I didn’t have the emotional space for exercise! So of course it kept getting put on the back burner. For me, a bootcamp wasn’t the answer. Like many people, it took a period of emotional desperation for me to ask for help. Slowly I began working on myself. I learned to let go of shame, to care for myself out of love (not guilt) and to learn about my values. It took me over a year before I began to feel the desire to move my body again. It may not take you this long, especially if you are open to the process rather than fighting it!
If this resonates with you, then I give you my blessing to stop trying to force the exercise. All that will do is create more shame/guilt and that will keep you further from the empowered healthy lifestyle you desire. Start by doing the necessary emotional, mental, spiritual work - the exercise will follow. I promise!!
#4 For the love of movement
Now that you’ve got the coach, accountability, and space, it’s time to get started on the actual exercise! The body is beautiful in it’s predictability. We get what we train for. If we train our body not to move, it will adapt to that and movement will feel unnatural. If we train it to sleep better, eat/drink when needed, and exercise, then it will adapt and become stronger.
YOU get to decide what you want to train your body for. Work with your coach to find types of exercise which you genuinely enjoy doing. I always know we’ve hit the sweet spot when my client lights up and says “I like this!” It means they are going to a) remember it and b) actually do it!
If you’ve been in pain for a long time, you may have forgotten what types of movements you like to do. Think back to the ways you loved moving your body in the past, maybe even when you were a kid. One of my clients got excited about starting ballet again as an adult because she loved it growing up. She even got a friend to go with her (hello accountability). It’s never too late to start!
You can also use this time as an opportunity to try new movements. Always been a runner? Try yoga. Always been a yogi? Try weight lifting. Always been a group class kinda person? Try dancing in your living room.
It’s ALL good! Find movement that you get excited about. Something you can do 3-5 times a week without counting down the minutes. What matters most here is consistency. I can’t tell you when, but I do know that one day you are going to do something and think “WOAH! That used to hurt but now it doesn’t!” or you’ll be talking about your weekend and realize that you didn’t stop to think about the pain. That moment when you realize that you just accomplished something that you couldn’t do a few weeks or months ago is INCREDIBLE. It’s the best reminder of how far you’ve come!
#5 Have a plan B, C, D, E, F…
You get the point. Plan A was yoga, but you start it and realize that’s NOT going to happen. Change it up. Stay curious my friend! Your body is ever evolving - that’s the magic of life. You are learning to become in tune with your body’s signals.
This is also the part where we talk about your pain flare up plan. Before we go further into the plan, we’ve got to talk about exercise intensity. This is one of the most common questions I get about exercise:
How do I know if I overdid it?
First let me start by saying that it is highly likely that you will feel discomfort at some point during your journey into exercise. That’s a normal part of trying new movements! If you are training with a specific purpose, like increasing the weight you can lift, the pace you run, or learning a new pose then rest assured that you’ll encounter physical AND mental discomfort in pursuit of that goal.
So how do you know if that amount of soreness (i.e. discomfort) is okay? If it goes away within a day of exercising. It may go away sooner than that! Often it’s gone within a couple hours.
Soreness or pain that lasts for >24 hours after exercise is an indication that you overdid it. Even the best exercise program can be done a bit too intensely and cause this to happen. By the way: exercises aren’t bad. They don’t rob you at gunpoint. Some exercises simply are too difficult or perhaps require your body to move in a way that it’s not capable of - yet. So if something doesn’t feel right, you have two options: adapt or move on. Neither is wrong. It’s a matter of personal preference and goals.
Back to our big point here: if you encounter a flare, have a management strategy ready! Perhaps you even know that you overdid it (I’m looking at you Mr. “Didn’t train for the 5K but still gonna do it”). Start your management program ASAP! Take the hot bath, use the ice pack, foam roll, stretch, meditate, do progressive muscle relaxation, go for a walk outside, etc. Keep in mind that the best thing to reduce muscle soreness is gentle movement of whatever part of the body is sore.
If you do not have a pain management strategy which you can perform on your own, then prioritize creating one with your coach! It’s my goal to help my clients discover their personal pain management strategy which doesn’t involve me treating them. My role is to start their healing journey, guide them, and help them through the bad days, but I want them to be able to take care of themselves without me too! What happens when the flare up is on a Sunday but your appointment isn’t until Thursday?
If you feel that you are entirely reliant on seeing your current provider and have no self management strategy then I would encourage you to try other providers until you find someone who works with you to empower you!
A final word for the folks on the fence…
Indecision is a decision too. Deciding NOT to do anything is a decision for what you don’t want. Avoiding the doctor appointment you need, not signing up for the program you want to do, sitting on FB for 3 hours even though you know you need to sleep… those are all decisions for the life which you say you don’t want.
Let that awareness creep up and see what discomfort it causes. Mindfulness was a game changer for me because it showed me all the indecision and the discomfort I was avoiding. When I began practicing mindfulness I realized that the times I sat on my phone for hours were almost always because there was something on my to do list I didn’t want to tackle.
I believe that pain is a blessing which spurs us into action. The emotional or mental pain of realizing that you’re suffering when in reality you want to be a fun, energetic, passionate person who lives their purpose will make you change. Y’know what doesn’t spur change? Mild discomfort and boredom. See, I explain it like this: If you step on a Lego, you’ll be sure not to do it again. If you have a little soft something in your shoe then you’ll keep walking. I hope that this book helps you realize what Legos you’ve been stepping on.*