A Guide to Pelvic Floor Dysfunctions and Herbs That Can Help

The pelvic floor is the core of the human body – it is there and working from crawling, to walking, to experiencing sexual pleasure, and giving birth to children. The pelvic floor is the root of the body, running deep and interweaving, making a hammock that gently sways and supports the digestive and reproductive organs. So why don’t we talk about the pelvic floor? Because it is also the sexual part of our body, and social norms don’t allow public discourse about sex. In some countries, like France, people are immediately referred to a pelvic floor physical therapist right after childbirth to address obstetric trauma and prevent pelvic floor disorders.

When we think of the pelvic floor and conditions that hinder its function, we usually talk about uterine or bladder prolapse and incontinence - but there is so much more. The world of pelvic floor conditions is vast, ranging from a hyper toned pelvic floor that causes painful sexual intercourse to a prolapsed bladder that causes incontinence. According to the National Institute of Health, Pelvic floor dysfunction affects women more frequently than men - 1 in 3 women are affected by a pelvic floor condition during their life.

Pelvic floor physical therapy is a holistic medical treatment that, for years, was rarely used in the United States. These days, especially in places with progressive medical care, pelvic floor physical therapy is becoming more well known. Pelvic floor physical therapists use therapies like breath work, diet, stress reduction, and manual manipulation of the body and tissues. This essay provides an overview of what pelvic floor dysfunction is, with a focus on over-active pelvic floors; what therapies are used to address it; and which herbs may be used in addition to other therapies. As much as possible, this essay uses gender-neutral terms, except when referring to published clinical studies.

So what is the pelvic floor?

The pelvic floor is located at the base of the pelvis. It is made up of nerves, muscles, and ligaments; the nerves control the muscles and the fascia, which connect everything together. The muscles act like a hammock to support the reproductive organs, urinary tract, prostate, and digestive tract. When these muscles aren’t working effectively, the impact can be huge. People who have pelvic floor dysfunction may also suffer from interstitial cystitis, IBS, and endometriosis.

During pregnancy, pelvic floor dysfunction can cause hip, back, and deep groin pain, and, it may make vaginal delivery difficult and more painful. Aggressive forms of interventions during childbirth like forceps, directive pushing, birth trauma, and episiotomies can cause structural damage, and - C-sections can also cause pelvic floor dysfunctions.

Other root causes of pelvic floor dysfunction are:

  • Misalignment of the pelvis, due to trauma and poor posture

  • Sitting for to long on a daily basis

  • Pelvic tilt

  • Muscular asymmetry

  • Excessive athletics

  • Working out improperly

  • Spinal misalignment

  • Chronic inflammation

  • A previous or existing infection, including yeast infections and urinary tract infections.

  • Surgery such as a hysterectomy

  • Childbirth

  • Menopause due to the loss of estrogen, and lubrication.

  • Endometriosis that causes tightening of the pelvic floor due to chronic pain.

  • Caesarean section

  • TMJ

  • Tight hip flexors

  • Leep Procedure (trauma)

  • Cone Biopsy (shortening of the cervix which affects the surrounding connective tissue and structure)

  • Sexual Trauma

  • Range of muscular mechanisms not communicating properly.

  • There may not be an identifiable trigger to pelvic floor dysfunction

As mentioned above, the pelvic floor acts as a “hammock” for the reproductive and digestive organs. Another element that is very structurally important to the pelvic floor (and the body as a whole) is called fascia. Fascia is a long band of fibrous connective tissue that attaches, stabilizes, and separates muscles and internal organs. Fascia runs from head to toe, covering every muscle, every organ, and every nerve, all the way down to the cellular level. Fascia also produces fluid that provides support and mobility throughout the body. This fluid medium, the extracellular matrix­­­­­­­­ ­facilitates cell- to- cell communication. When fascia becomes shortened due to accidents, injury, and, daily repetitive stress, it can become dehydrated and lose its fluid medium. This manifests as tightness, tension, and pain throughout the body. The mobility and resilience of the body’s structures are now compromised, and cellular communication is altered - which can affect the pelvic floor. So why not just drink water to rehydrate? Physical therapist Jody Hendryx compares dehydrated fascia to a root-bound plant: "If you have a root-bound plant and you pour water in it, the water will just run through without hydrating the dry, brittle roots. You have to give those roots space so they can absorb water. The same thing applies to our body." Because fascia is such an important structure in the body, and also so neglected, people can end up with a lot of pain related disorders that health care professionals and patients struggle to treat. Finding a body worker who ­specifically works on facial release, psoas muscle release, and trigger points can be extremely beneficial for people who have a pelvic floor disorder.

This is one of my favorite videos on fascia. It shows how interconnected our fascia is to our whole body.

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There are several symptoms of pelvic floor dysfunction. Some symptoms are shared between pelvic floor dysfunction and other conditions, so going to a general physician to get an exam is important. There are medications that can cause symptoms of pelvic floor dysfunction, so patients should be sure to review their medications with a doctor. Patients may need to advocate for themselves to get referred to a physical therapist.

Symptoms of pelvic floor dysfunction include:

  • Pain during intercourse, including sharp and ongoing pain in the clitoris, vulva, or rectum. Pain during sex is not normal. Besides pelvic floor dysfunction, pain during sex may be due to one or more parties’ unwillingness to engage in sexual activity, insufficient lubrication, or infection.

  • Pain in the pelvic floor when sitting

  • Pain during a vaginal exam

  • Not being able to fully empty your bladder

  • Pain in the lower back and hips that can’t be explained by other causes

  • Painful urination. (This includes people who have had recurring urinary tract infections and people whose urine screening tests were negative).

  • Vulvodynia (chronic pain or irritation of the vulva)

  • Vaginismus (involuntary contraction of vaginal muscles, often painful)

  • Urinary incontinence

  • A frequent need to urinate

  • Irritable bowel syndrome

  • Constipation or incomplete bowel movements

  • Lowered libido

  • Interstitial cystitis (inflammation of the bladder)

  • Polycystic ovarian syndrome

  • Rectal spasming and pain

  • Lower back pain

  • Erectile dysfunction

  • Premature ejaculation

What is pelvic floor physical therapy? How long does it take to see results? Pelvic floor physical therapy can look like a lot of different things, depending on the individual and what the therapist thinks will help. The physical therapist will usually conduct an evaluation by looking at the patient’s posture, the pelvis, hips, spine, and sacrum, and flexibility and mobility of muscles. An internal exam may also be conducted. This may be vaginal or, anal, and the therapist may use manual palpitation or biofeedback technology. This kind of internal exam usually looks a lot different from a conventional gynecological exam. There usually aren’t any speculums or stir-rups. During the exam, the therapist will use their hand or a dilator to put gentle pressure on tender spots along the vaginal walls until tension is released. Biofeedback techniques using computer imaging can help therapists evaluate pelvic floor muscles and retrain them to address dysfunction. In some cases, such as when vaginal or anal penetration is too painful for the patient, physical therapists will only do external therapy. External pelvic floor trigger points, also known as myofascial points, can feel like a lump or nodule in the muscles. In addition to external and internal work, therapists work on exercises to build muscles, core strength, and mobility. Physical therapy may include 6 to 12 weekly visits, or more depending on the individual. There are different institutions that offer pelvic floor physical therapy, including some hospitals, and also free- standing physical therapy offices.

Physical therapy is not cheap in the United States, and it is also time consuming; I will discuss other therapies below. These are two directories that can help you find a pelvic floor physical therapist ( https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/), (http://aptaapps.apta.org/findapt/default.aspx?navID=10737422525&UniqueKey=).

Physical manipulation: dilators

Pelvic floor physical therapy puts health care back into the client’s hands with a series of self-applied routines. There are tools that can be inserted vaginally or rectally to release trigger points. Hands are always an option, but for deeper trigger points that are hard to reach, or if you just don’t want to use your hands, many people use dilators. The best dilator on the market is called TheraWand (https://www.therawand.com or on Amazon). There are two different sizes; the smaller size can be used anally to relieve prostate, anal, and lower back pain or for when the larger size isn't tolerated because of painful vaginal penetration. Never force anything inside your anus or vagina if it is too painful. A pelvic floor physical therapist can show you how to use a dilator properly, but if you can’t see a physical therapist, there are instructional videos available on TheraWands website. When using a dilator for pelvic floor dysfunction, the dilator is inserted into the vagina and used to put gentle pressure on each tender site until there is release or a sense of relief. This is repeated on all sides of the vaginal wall. If using a dilator causes too much pain, take it slow, and take breaks. It can take time. There are lots of other non-invasive techniques to release tension in the pelvic floor including; pelvic floor release stretches, at home hip adjustments with certain motions, strengthening the core, and lots of other techniques.

Looking at nerve pain Physical manipulation techniques like massage, trigger release, and movement can help sciatic nerve pain, just as physical manipulation can relieve nerve pain in the pelvic floor. Let’s talk about nerve pain and interstitial cystitis for a moment. Interstitial cystitis causes- urinary frequency, urinary urgency, and horrible recurring pain that can affect the genital area, back, and abdomen; many people mistake it for a urinary tract infection. What is really going on with interstitial cystitis? The lining of the bladder becomes irritated and is in a constant state of inflammation. The muscles around the bladder begin to tighten and shorten due to spasms of the bladder. These repetitive spasms condition the pelvic floor to continue with these motions, irritating the lining of the bladder. Certain techniques like muscular bio-feedback tools can release trigger points and relax the muscle or nerve that is causing irritation in the pelvic floor.

Gender reconstruction surgery can also cause pelvic floor disorders and nerve pain. Pelvic floor physical therapists are starting to discuss transgender health and what role pelvic floor physical therapists have in trans-specific health care. Transgender patients are historically underserved, research isn’t being done, and there is little follow up for patients after genital reconstruction surgery. Patients who undergo vaginoplasty (the construction or reconstruction of a vagina) tend to have pelvic pain and painful intercourse because of over-activity or a hyper-toned pelvic floor. During vaginoplasty, the sensory nerves in the genitals are completely rearranged, and some frayed nerves are put into muscle tissue to re-sprout. Pelvic pain patients, and especially transgender people, are often reluctant to seek help out of the (justified) fear that practitioners may be judgmental and un-supportive. (The website http://mytranshealth.com/ has peer-supplied recommendations for trans-friendly practitioners in some major cities.)

Herbs for Nerve Pain

  • Saint Johns wort (Hypericum perforatum). Often thought of as an anti-depressive or anti-viral herb, it works well for nerve damage when used as a tincture internally or as a fresh oil externally. Clinical trials indicate that the action of hyperforin antinociception involves an opioid-dependent pathway, and that prolonged treatment with St. Johns wort does help with neuropathic pain. I’ve used it for sciatica with mixed results, but most people do feel relief when it is used topically for pain. I like to use St. Johns wort in combination with other oils topically like- arnica (Arnica spp), poplar bud (Poplar spp), birch (Betula spp), and calendula (Calendula spp). I also like to use St. Johns wort internally for nerve damage. Practitioners vary in their recommended internal dosage for St. Johns wort, though I am usually heavy- handed with my tinctures. Internal use of St. Johns wort can interfere with the p450 pathway, which can inhibit drug metabolism and make birth control and other drugs ineffective. Selective serotonin reuptake inhibitor (SSRI) drugs like Prozac should not be used with St. Johns wort, as there is a possibility of serotonin syndrome due to- too much serotonin in the body. If you are on any medication, please talk to a qualified practitioner before taking St. Johns wort internally.

  • Skullcap (Scutellaria lateriflora). ­ Another great herb for nerve pain. Skullcap is used for spasms that are caused by nerve damage, including trigeminal neuralgia, epilepsy, and tremors. It helps relax frazzled nerves that might be triggering sharp pain along with numbness and tingling sensations. Herbalist CoreyPine Shane says skullcap relaxes muscles by “dimming the amount of nerve signals being sent.”

  • Valerian (Valeriana officinalis). Sedative; can help when pain is severe and interferes with sleep. Valerian is a great herb for pain management in general, and can be used in combination with other herbs to help with nerve and muscular pain. People who have interstitial cystitis have found valerian helpful, (possibly because it stops the bladder from spasming). Dosage needs to be tailored to the individual. Some people can handle a lot of valerian, while others may just need a little. Valerian can cause a person to develop a dependency for pain management and sleep. If you are taking a lot of it and waking up feeling like there is a heavy blanket on you, or still feeling groggy, then reduce the dosage. I like to add kava to my formulas for interstitial cystitis. However, both kava and valerian are sedatives, so use caution when taking them together.

  • Willow (Salix spp). Another herbal ally for pain and inflammation. Willow contains salicin, the original source of salicylic acid that is found in aspirin. Other salicylate containing herbs include poplar (Poplar spp), birch (Betula spp), and meadowsweet (Filipendula ulmaria), just to name a few. You have to take a good amount of willow to feel relief from pain: 2-5 ml of tincture as needed, or a strong decoction made from fresh bark. The decoction is very bitter so be ready.

  • Motherwort (Leonurus cardiaca). Not really thought of as an herb for muscle or nerve pain, but Coreypine Shane reports good results using motherwort for muscle tightness, and more specifically for shingles and chickenpox spots.

  • Cayenne (Capsicum spp). Hot and stimulating, cayenne is also effective for pain. Cayenne peppers and other hot peppers contain capsicum. Doctors tend to use capsaicin cream or patches, while herbalists make oil or salve from the whole pepper. It is believed to cause temporary neurolysis (nerve degeneration) making the nerves insensitive to pain.

  • Alpha-lipoic acid (ALA). A potent antioxidant that has been shown to help with pain and numbness associated with diabetic neuropathy. In a study called the SYDNEY 2 trial, 181 patients with diabetes and systemic polyneuropathy were given three doses of ALA or placebo for five weeks. All three doses of ALA (600, 1200, and 1800 mg) helped reduce stabbing pain, numbness, and paresthesia and the effect did not differ by dose size. Other studies show positive results when ALA is used for other nerve damage as well.

  • Acetyl-L-carnitine. Studies show mixed results when acetyl-L-carnitine is used to reduce neuropathy in diabetic patients. However, a dose of 1000 mg was associated with lower pain scores than a dose of 500 mg.

Pain and pain management is a huge subject. There are great articles written about pain and herbs by a lot of other herbalists. A good article about back pain written by my friend and herbalist Jim McDonald can be found at http://herbcraft.org/backpain.html.

Working with muscle spasms

Pelvic floor trigger release can be painful and may result in spastic muscles. This happens because pelvic floor trigger release is basically re-training these muscles to work properly again. Over- tightened muscles will try to retract back to where they were, sometimes resulting in painful spasms. Sexual penetration can also trigger these muscle spasms. Taking anti-spasmodic herbs throughout the day or before having sex can be helpful to reduce spasms. Herbs that relax skeletal and smooth muscles and thus help with muscle spasms and pain, include:

  • Black haw (Viburnum prunifolium). A uterine tonic, and traditionally used as a relaxant to all smooth muscles. Useful anti-spasmodic for menstrual cramps and spasms or excitability in other smooth muscles. Eric Yarnell (ND) talks about using black haw for severe low back pain accompanied by “a feeling of bearing down in the pelvis.”

  • Crampbark (Viburnum opulus). Used interchangeably with black haw. Traditionally used as a uterine relaxant to help painful menstrual cramps, and ease spasm of smooth muscles. Both Viburnums can be used for irritable bowel syndrome that is accompanied with digestive spasms and diarrhea. Eric Yarnell (ND) uses crampbark for pain radiating into the thighs.”

  • Jamaican dogwood (Piscidia piscipula). Pain killing and slightly sedative. In vitro and in vivo studies show that Jamaican dogwood is effective as a spasmolytic. It can also help with sleep, nerve pain, trauma due to injury, and dysmenorrhea. I like to add Jamaica dogwood into formulas for painful menses.

  • Pedicularis (Pedicularis canadensis, P. spp). I use the local pedicularis here in Michigan, which is P. canadensis. There are lots of different species that can be used. I have also used P. groenlandica and P. contorta. It is usually used as a skeletal muscle relaxant rather than as a smooth muscle relaxant, but I think it can still help with both. For pelvic floor spasms, pedicularis can help relax general muscle tension. Some relaxants, including pedicularis, can cause people to feel drowsy and lethargic; start with a half dropper and increase to a dropper or two as needed.

  • Lobelia (Lobelia inflata). Lobeila is more useful for an acute situation than for chronic pain. It is great for spasming or tension in the body and for severe tension headaches, and is an amazing herb for asthma attacks. The fresh above ground parts are used. Lobelia is usually used in drop doses, starting with 1-5 drops, although I have seen larger doses used.

  • Betony (Stachys officinalis). Long history of being used and associated with magic and lore. Betony helps with headaches, a busy mind, and muscle tension.

  • Solomon’s seal (Polygonatum spp). Solomon’s seal is unique: It is excellent for muscles, but mostly because it supports the connective tissue, fascia, and synovial fluid. It is indicated for people who are dry, creaky, and in pain. You can make an oil or tincture out of the rhizome. (Please harvest responsibly, or get from someone who cultivates the plant).

  • Horsetail (Equisetum arvense). Also falls under the connective tissue support category. It is, high in minerals like silica and boron, — that can help with pain associated with degrading connective tissue.

  • Willow (Salix spp). See entry above in (herbs for nerve pain). Anti-inflammatory and pain relieving— I find higher doses of willow to be most effective; 2-5 ml of the tincture as needed.

  • Wild lettuce (Lactuca spp). Pain reliever, best used in combination with other herbs like Jamaica dogwood and Valerian. It can make some people a little sleepy, so start with a low dose and increase as needed.

  • Black cohosh (Actea racemosa). Works great for both skeletal and smooth muscles and helps with pain management. Jim Mcdonald uses black cohosh for “significant stiffness and a dull, achy, tender sensation,” and mixes black cohosh with arnica in small frequent doses for what he calls muscle reactivity. Start with drop doses (1-5 drops), as large doses of black cohosh can cause headaches in some.

  • Arnica (Arnica montana or A. spp). Great herb often used for first aid for blunt trauma. Arnica is also used for muscle or nerve injury as needed. I use the herbal tincture of arnica, not the homeopathic, in a low dose (5-10 drops). Arnica oil is really nice to massage in topically, but do not use it on broken skin- it can cause heart problems when absorbed into the bloodstream.

  • Birch (Betula spp). Also contains salicylates, and therefore helps alleviate inflammation and pain. Also very tasty medicine. I use black or yellow birch bark.

  • Kava kava (Piper methysticum). Relaxant for smooth muscles, and an analgesic for urinary tract problems like interstitial cystitis. Kava is a mood elevator and is relaxing, both physically and mentally; it relaxes tense muscles. Fresh root or rhizome is used.

  • California poppy (Eschscholzia spp). Slightly sedative. Calming for anxiety and for nervousness with tension. Helpful for spasms and pain.

  • Motherwort (Leonurus cardiaca). CoreyPine Shane has used motherwort for muscle pain with good results, mostly as a specific for shingles and chickenpox spots.

  • Silk tassel (Garrya spp). My teacher 7Song’s favorite uterine anti-spasmodic (at least, it was in 2013). Great for smooth muscle spasms.Great pain reliever and anti-spasmodic herb – maybe one of the best ones we have. Michael Moore writes, “In proper doses it has little effect on the central nervous system but slows down the impulses of the vagus nerve, myenteric plexus nerves, and the sacral ganglia of the parasympathetics. This makes it useful pain reliever and antispasmodic for diarrhea, dysentery, gallbladder attacks, and menstrual cramps.”

Other therapies for pelvic floor dysfunction

I have pondered (but never tried) herbal suppositories for acute flare ups that cause severe spasms down along the vaginal walls or anus.It could be useful to have an emergency stash in the freezer for acute episodes of pain and spasms. Herbal suppositories should never be used long term— when applied vaginally, because leaving material in the vagina provides a breeding ground for infections. Also vaginal herbal suppositories should never contain essential oils.

Making your own herbal suppositories is pretty easy. I like to use shea or cocoa butter as my base, warm it up in a pan on the stove, and add herbal oils or tinctures (possibly from the herbs listed above). Mix it all together until its melted. Freeze in aluminum foil molds, silicone suppository molds, or ice cube trays. These suppositories can be used vaginally or inserted rectally.

Castor oil and muscle spasms

People have found relief from pelvic floor muscle spasms by using castor oil topically. You can mix other herbal oils or liniments with castor oil to enhance the effectiveness. Soak a cotton rag or old t-shirt in warm castor oil and apply the cloth to the painful area. Most people who use castor oil for pelvic floor dysfunction use it for rectal spasms, though I love using castor oil compresses for uterine cramping as well. The oil is rubbed around the rectum, up the tailbone, and around the sacrum, and left for 10-20 minutes before removal.

At home relaxation techniques

A technique called a reverse kegel helps to relax muscle tension in the pelvic floor as opposed to a regular kegel. Avoid kegels if you have an over toned pelvic floor, as well as sitting or standing for too long, and heavy lifting. Yoga poses that focus on hip and pelvic floor muscle stretching are also helpful. Release of the PSOAS muscle is really important when balancing the ligaments of the pelvic floor. Hot baths and hot packs or heating pads are also beneficial. You can add Epsom salts to the bath water, this helps with muscle spasms and relaxation. Muscle relaxing herbs can be added to the bath as well. You can find many youtube videos on pelvic floor relaxation stretches and techniques. Working with a physical therapist is also really helpful to gain knowledge on how to do things at home on your own.

Magnesium and muscle spasms

Magnesium is needed for more than 400 biochemical reactions in the body, and it is important for proper nerve and muscle function. It is really important to supplement when working with any kind of muscle spasm. Due to conventional agricultural practices, the soil that most food is grown in is depleted of magnesium, so no matter how good your diet is, you’re not getting enough from your food. My favorite supplements come in capsules. Two brands are Pure Encapsulation and Jigsaw; you can find these online. Whole food magnesium supplements are great; brands that make them include MegaFood and New Chapter. If you prefer to take magnesium in powder form, look for Calm or Pure Essence brands. These supplements can be found in most health food stores or online. If you experience loose stool from taking magnesium it is best to reduce the amount your taking until you find a comfortable range.

TMJ and the connection to our pelvic floor

There is now no doubt that what body workers observed for a long time with tmj and pelvic floor dysfunctions is now studied and shown to correlate. Misalignment of the jaw causes misalignment of the pelvic floor. There is now TMJ physical therapists that can help release tension in the jaw thus giving relief of a tight pelvic floor. Body workers, PT's and chiropractors can especially be beneficial when working with TMJ.

Herbs and supplements work differently on different people, and can be used differently depending on pain and symptoms. Don’t mask the root of the problem by only using herbs that help with pain: Pain relief may cause a person to overexert because they feel fine, and ultimately cause more injury to themselves. Herbs and supplements need to be used in conjunction to physical manipulation for pelvic floor disorders.

Thinking about trauma

Treating people "holistically" means that, as practitioners, we have to take into account emotional and psychological factors when creating a plan of healing. People with chronic pain, like that caused by pelvic floor dysfunction, often have to deal with anxiety and depression because of the pain. Psychological support can be helpful for people, and there are online and local support groups for people with chronic pain and for survivors of abuse that can also help. A referral to a therapist may provide a person with more tools to deal with depression and anxiety. Although therapy tends to be expensive if it is not covered by insurance, there are a lot of practitioners that provide services on a sliding scale, depending on a person’s ability to pay. If you are seeing clients, consider compiling a good resource list with local providers as holding space for trauma work might not be best suited for you.

Fear may be held in the pelvic floor muscles, albeit subconsciously, and affect pelvic floor health. Physical therapist Anthoy Lo told me that sexual abuse and an over-active pelvic floor is very much on their radar, and they do believe the two are connected. People hold tension in their shoulders and other muscles with or without knowing it, and can do the same in the pelvic floor. Every event in our life is stored either in our brain or somewhere else. Sometimes the trauma is too much for our brain and is stored in our soft tissues, ligaments, or muscles. I can't stress trauma work enough when dealing with pelvic floor disorders, we can not separate the two when working with someone. I could write a whole other paper on just this subject alone.

The list of herbs that help with trauma recovery is vast. Herbs need to be picked for the individual person, rather than according to the symptoms alone. Nervine herbs can help a lot here, as they work by toning and nourishing the nervous system and can be effective in treating mild pain.

  • Tulsi (Ocimum tenuflorium). Warming, stimulates the immune system; High in flavonoids. Used as a nervine tonic, or adaptogen; It helps balance cortisol (stress hormone) levels and normalizes the size of the adrenal gland. Highly aromatic; it makes a nice tea or tincture, alone or in a formula, and is a safe herb.

  • Milky oats (Avena sativa). Nourishing milky oat tops are full of trace minerals. It makes a nice tasting tea. The bright green tincture is what I like to use; it is great for frazzled nervous systems, over- sensitive types, and people who feel exhausted and overstimulated by the world and everything that needs to get done (which applies to pretty much all of us). Can be taken for a long period of time- and in fact, the longer the better. I generally add milky oats to any of my nervine blends as a base to offer nourishing and relaxing support.

  • Anemone- a low dose botanical, that can help with panic attacks, and pain associated with interstitial cystitis. A herb that is also used in low doses to move through trauma.

  • Rose (Rosa spp). Rose petals are well known to help with emotional trauma and encourage a person to let go. It is a great herb that helps facilitate forgiveness and helps ease sorrow. I like to make rose glycerin extract and add that to my formulas for a more aromatic and tasty delivery. I tend to use the wild roses here in Michigan that can be found bordering farmlands and woods. I also grow Rosa rugosa bushes and make glycerin with their petals.

  • Skullcap (Scutellaria lateriflora). Amazing nervous system tonic and one of my favorite herbs. Helps with anxiety and insomnia, and is pain reducing. It is relaxing and great for pain management, — specifically tension headaches and muscle spasms. Skullcap has been used traditionally for twitches and ticks. It can help people with emotional outbursts and anger that seems to come out of nowhere. It’s nice in formulas for people who need support coming off of opioids. Studies support skullcap’s role in treating nervous system disorders and anxiety, and show that skullcap help raise GABA levels in the brain.

  • Nettle (Urtica diocia). The above- ground parts of nettles are packed full of nourishing vitamins and minerals. Nettles can nourish the adrenal glands, helping people deal with depression and anxiety. Nettles are a food herb, which makes nettles very safe to eat or take. Nettles can be used as a substitute for spinach in any recipe.

  • Lavender (Lavendula officinalis). Anxiolytic and calming herb. Shown to reduce anxiety just through smell. Clinical trials with lavender support the use of lavender for reducing anxiety and depression. I like to start with lower doses of lavender, as it can be bothersome to people. Start with 5-20 drops in a formula.

  • Hops (Humulus lupulus). The hops strobile is what is used medicinally traditionally (though I had a friend smoke the leaf of hops, to stop a panic attack). Hops is slightly sedative, which can be helpful if a person is having trouble with sleep. Hops helps with anxiety and nervousness, and reduces brain activity.

  • Catnip (Nepeta cataria). Relaxing, and aromatic. It is beneficial for nervousness, tension headaches, and people who hold emotional tension in the gut. If someone is upset and feeling nauseous, or bloated or has any other gastrointestinal distress along with anxiety catnip tea, tincture, or glycerin extract is nice to use.

  • Chamomile (Matricaria chamomilla, Chamaemelum nobile). Calming and familiar. Chamomile is great for people who get an upset stomach when they are anxious. A randomized, double-blind, placebo-controlled study concluded that chamomile had a significant impact on treating moderate anxiety compared to placebo.

  • Lemon balm (Melissa officinalis). Uplifting and a great nervous system tonic. Lemon balm is an anti-depressant herb. I like to mix oat tincture with lemon balm for those days or weeks of feeling down and discouraged. Clinical trials done with rats support the traditional use of using lemon balm as a -mood elevator.

  • Ashwagandha (Withania somniferia). Also called -winter cherry- or -Indian ginseng-. It is a well-known Ayurveda herb. It is used as an adaptogen and immune modulator. Ashwagandha is also anti-inflammatory, and rich in iron. Ashwagandha is traditionally taken in a powder form with ghee and honey. Black pepper and cinnamon are also used synergistically to increase efficacy; most herbs high in volatile oil will have the same effect. Extensive studies of ashwagandha have shown it to be effective against stress and for increasing stamina. Studies support the traditional use of ashwagandha in the prevention of many stress —induced diseases like arthritis, diabetes, hypertension, and arteriosclerosis. “Ashwagandha induced a calming anxiolytic effect that was comparable to the drug Lorazepam in all three standard Anxiety tests”

  • Rhodiola (Rhodiola rosea). Rhodiola is considered an adatptogenic herb. It helps strengthen the nervous system and the ability to deal with environmental stressors, and enhances immunity. In animal studies rhodiola enhanced the transport of serotonin precursors. I find rhodiola stimulating. It can cause hyperactivity in some people, but can also help people focus better if their excitement usually interferes with their ability to focus.

  • Blue vervain (Verbena hastata). Bitter, cooling, and calming. Because of it bitter action it helps depression when there is liver stagnation. It is an anti-spasmodic that works well in combination with skullcap for tremors and twitches. Great for those type A list makers who are busy, busy, busy.

  • Linden (Tillia spp). Linden flower is cooling and aromatic. It makes a tasty tea. It is used as a relaxing nervine, anxiolytic, vasodilator and demulcent. It was “historically used to soothe nerves and treat health problems associated with anxiety.” (McIntyre, n.d.)

  • Hawthorn (Crataegus spp). Traditionally used for heart problems, and for support of the cardiovascular system. Hawthorn is high in flavonoids that support the blood vessels, and reduce, hypertension. Hawthorn is a cardiovascular tonic and also a nervine. It is usually given to people who experience heart palpitations when anxious. It is used for, emotional support when someone has experienced trauma or heartbreak. Hawthorn works best when taken over a long period of time.

  • Passionflower (Passiflora incarnata). Passionflower is helpful for someone with an active mind- who makes a lot of lists and wakes up in the middle of night thinking about everything that needs to get done. Passionflower is a safe herb that does better in higher doses; 4-5 dropperfuls per dose.

  • Motherwort (Leonurus cardiacia). Motherwort is a cardiotonic. It is well known for helping with anxiety accompanied by heart palpitations. Motherwort can reduce tachycardia that is caused by anxiety and it helps calm the nervous system. It is nice in a blend with hawthorn.Motherwort is great for women who get really emotional, or irritable during their menstrual cycle, and for people who experience PMS. It is traditionally used for women from childbearing to menopause.

  • Ocotillo bark- This is a beautiful desert plant that is used specifically for pelvic floor issues, trauma, suppression and more. If interested I advise you to research more about this plant remedy. Rebecca Altman a herbalist in L.A. has a fantastic write up on pelvic floor health and using this plant.

  • Vitamin B- is essential for serotonin production. Vitamin B deficiency has been linked to depression. There are lots of good Vitamin B supplements to choose from in most health food stores some are; Jarrow Methyl B-12, Megafood B-complex, Garden of Life, Vitamin Code B-12.

  • Magnesium- is responsible for over 400 biochemical controls in our body. Magnesium deficiency is associated with increased anxiety and HPA (hypothalamus-pituitary-adrenocortical) dysregulation. Case studies show that magnesium supplementation improves the treatment of depression and anxiety.

  • L-lysine is an essential amino acid that, has been shown to reduce anxiety and stress hormones.

  • Zinc is not commonly talked about in mental health treatment, but studies have shown that it is helpful for obsessive compulsive disorder that it influences GABA (and thus is believed to help anxiety disorders). Too much zinc can interfere with copper absorption. To avoid problems, take low doses of zinc (15mg) and also take breaks every two weeks.

Nourishing, toning, and, relaxing the nervous system promotes emotional and physical healing. The nervous system affects the nerves, muscles, posture, breathing, and sleeping, all of which affect healing. By supporting the nervous system, practitioners address one of the root elements of pelvic floor dysfunction.

Blood flow

Pelvic pain and poor blood flow can manifest together. When blood flow is restricted, a dull ache may occur in the pelvic region after standing for a long period of time. The Stony Brook School of Medicine considers pelvic congestion syndrome (PCS) to be one of the causes of chronic pelvic pain. The pain that accompanies pelvic congestion often gets worse when standing or sitting, but feels better when lying down. Other signs include hemorrhoids, and varicose veins on the thighs, buttocks, and vagina. Sometimes, ultrasound imagery or CAT scans are used to detect pelvic varicosities that don’t display external signs. It isn’t clear what causes pelvic congestion syndrome, but some medical providers suggest hormones play a part. Estrogen can weaken vein walls, leading to enlarged pelvic veins that cause pressure and pain. Other causes include hysterectomy, C-sections, and pregnancy; veins being stretched beyond their normal capacity in the ovaries and pelvic region; and injury to the structural tissue (ligaments, nerves, and muscles). When blood flow is normal, blood flows up from the pelvis region to the heart through the ovarian vein. The valves within the veins prevent blood from flowing backwards. In people with PCS, the valves don’t close properly, so blood flows backwards; this is called reflux. Reflux causes pooling of blood in the pelvis region and can give a sensation of heaviness and cause pain.

Herbs that have been traditionally used for pelvic congestion include:

  • Stoneroot (Collinsonia canadensis). Traditionally specifically indicated for pelvic congestion; helpful when there is pressure and constriction in the pelvic region. Seems to work on the vagus nerve, and helps with irritation. Stoneroot can be used for uterine fibroids and ovarian cysts. It is used as a venous tonic for dilated veins or vessels.

  • Horse chestnut (Aesculus hippocastanum). Helps tone vessels. Known to strengthen veins and- reduce fluid accumulation (edema). Indicated for hemorrhoids, and rectal complaints. Horse chestnut should be avoided by anyone with liver or kidney disease, taking anti-coagulant therapy or who is pregnant or breast-feeding. Not advised to use on broken or ulcerated skin. Saponins from the plant can cause irritation.

  • Prickly ash bark (Zanthoxylum americanum). Circulatory stimulant. Promotes proper blood flow throughout the body and helps disperse congestion. Helpful for poor peripheral circulation. Jim Mcdonald uses Prickly ash for “very severe, agonizing nerve pain.”

  • Yarrow (Achilleia millefolium). Used for hemorrhoids and also to stop excess bleeding. Yarrow is useful for moving stagnant blood. Can be used to either as an oil or tincture.

  • Ginger (Zingiber officinale). Warming, anti-inflammatory, helps get blood moving.

  • Gotu Kola (Centella asiatica). Gotu kola is helpful for building and repairing connective tissue around weakened veins. Gotu kola has shown impressive clinical results in the treatment of varicose veins.

  • Butchers broom (Ruscus aculeatus). Vasoconstrictor; eases inflammation

  • Cinnamon (Cinnamomum verum). Warming circulatory stimulant that can ease pelvic stagnation.

  • Ladies Mantle- astringent, aromatic, it is specifically indicated for pelvic congestion or fibroids, cysts, endometriosis.

  • Hawthorn (Crataegus spp). Helps with insufficiency of the heart or blood flow. Hawthorn is an antioxidant herb, high in flavonoids. It is a heart tonic and slow working, so must be used long term. It can relieve venous insufficiency.

  • Gingko (Gingko biloba). Gingko is a circulatory and cerebral stimulant. It relieves brain fog and increases clarity of thought. Do not take gingko if you are also taking blood thinners.

  • Rosemary (Rosmarinus officinalis). Circulatory stimulant, anti- inflammatory. Used for weak circulation, cold hands and feet, and for, people who get tired easy. It is also a venous tonic for long term use

  • Cayenne (Capsicum anuum).Moves blood, strengthens capillary walls.

  • Flavonoid- rich berries.Berries like blueberries, bilberry, blackberries, and hawthorn improve vein integrity.

Inflammation

Inflammation is another component of pelvic floor dysfunctions. Determining why inflammation is occurring, and using herbs appropriately to address it, is something to consider. However, let’s not forget that inflammation plays a key role in the body’s immune system, and is usually a beneficial mechanism of protection and healing. The problem happens when there is a constant state of inflammation, which, can happen for multiple reasons. Someone who is experiencing chronic pain may be in a chronic state of inflammation. Reducing inflammation can reduce pain. Chronic inflammation can be reduced through diet. A good anti-inflammatory diet includes lots of dark leafy greens, fruit, and a limited intake of refined sugars, simple carbs, and alcohol. Some foods trigger haptens, small molecules that trigger an allergic response; food sensitivities should be identified and eliminated (remove suspect food you’re your diet for a month, then reintroduce it and pay attention to any symptoms that manifest). As much as possible, buy local organically raised, and grass fed meat. Mushroom teas and bone broth are absolutely amazing for addressing gut and musculoskeletal issues. Bone broth is high in collagen, which is part of what fascia is made of. And, of course, we can’t forget the importance of omega 3s. Omega 6s and omega 3s should be consumed at a ratio of 1:1. Most people consume omega 6s at a ratio of 16:1, frequently from fried and processed food. High omega 3 foods come from cold water fatty fish like salmon and sardines. High quality omega 3 supplements include fish or cod liver oil products made by Nordic Naturals, Barleans, and Carlson. The recommended dosage is 2 grams a day. Vegetarian sources for omega 3 supplementation are evening primrose oil, and flax seed oil. Inflammation may be associated with sleep issues and constant stress. It can be hard to reduce stress, especially when stress is caused by factors that are necessary for survival like working multiple jobs and finding (and keeping) affordable housing. Avoiding stressors and eating well are privileges that a lot of people can’t afford, or that they may not have access to. This is where client education comes in. Practitioners need to educate people about good food choices, but most importantly they should provide resources such as where clients can get financial assistance like food stamps or WIC (Women, Infants, and Children) benefits. Most herbs reduce inflammation to some degree. Herbs work differently than pharmaceutical anti-inflammatories; rather than inhibiting the body’s natural response, herbs nourish and support the body’s response. It’s not well understood how most anti-inflammatory herbs work, but we do know that certain constituents help with inflammation. Those constituents include saponins, resins, salicin, volatile oils, essential fatty acids, and mucilage.

Herbs that are commonly used for inflammation include:

  • Tumeric (Curcuma longa). Turmeric is a hot topic right now. Lots of clinical trials are being done on curcumin, the main chemical constituent in turmeric root. Curcumin shows anti-oxidant properties, and seems to be useful in addressing inflammatory diseases like Crohn’s, cancer, psoriasis, IBS, and AIDS.I like to use the whole plant rather than an isolated constituent. Tumeric root is hot and drying, and is best formulated with a demulcent like marshmallow, or Solomon’s seal root to balance it out so that it doesn’t irritate an already dry and hot condition. Whole food capsules containing tumeric can be found in most health food stores. These supplements often contain black pepper to increase turmeric’s bioavailability.

  • Willow (Salix spp). Useful for chronic inflammation. Works best in higher doses. Willow is high in tannins, so if you are taking the tea or tincture long term, mix it with a demulcent herb so it doesn’t dry out and irritate the gut or other tissues.

  • Marshmallow (Althaea officinalis). A demulcent, cooling herb that is soothing to tissue and mucus membranes. It can help reduce burning pain in the urinary tract. Other demulcent herbs that reduce inflammation and help coat tissues are plantain, licorice, and mullein.

  • Meadowsweet (Filipendula ulmaria). Meadowsweet is a salicylate containing herb, like willow and birch. It is specific for gut inflammation, but is also great for general pain and inflammation.

  • Devils club (Oplopanax horridus). Devil’s club is traditionally used for a variety of health issues including pain, rheumatic arthritis, and other states of chronic inflammation.

  • Licorice (Glycyrrhiza glabra). Licorice contains compounds that are similar in structure to steroid hormones.Licorice is anti-inflammatory and demulcent. It helps reduce, inflammation of internal organs, like that which occurs in Crohn’s disease. It is also useful for general inflammation and pain, as in arthritis. People with high blood pressure should not take licorice root.

  • Solomon’s seal (Polygonatum multiflorum). Used for connective tissue disorders and pain. One theory is it helps produce more synovial fluid in the body, reducing friction and pain. Jim Mcdonald says its indicated when someone is creaky and dry.

  • Goldenrod (Solidago spp). Goldenrod reduces histamine reactions like seasonal allergies and sinusitis, but it is also a great anti-inflammatory herb that help heal damaged muscles and injuries. The fresh flowering tops can be used as tincture, tea or even an oil.

  • Mullein (Verbascum thapsus). Mullein root was historically used for structural issues and pain, and that use is starting to be rediscovered. Kiva Rose writes that it is “a perfect herb for use where delicate, complex bones such as in the hand or feet have been broken and cannot be set, or where there are complicated alignment issues in the spine (even in the lower spine and hips).

  • ​Shatavari (Asparagus racemosus) nourishing ​tonic herb that is safe to take for a long period of time. This herb is indicated for dry and tense tissue states. Helps calm inflammation in the body and rebuild tissues. Tea or tincture can be used.

How can we make sure the ropes in our pelvic hammock stay strong and inter-weaved after years of use? How can we can make sure that the hammock isn’t too taut, causing stiffness and discomfort? We need to start discussing pelvic floor health with young people. The common aversion to talking about the genitals and pelvic area is causing miseducation and even harm in lots of people. It can affect not only their pelvic floor but digestion, pain, sex, and overall well-being. We also need to get people MOVING, lymphatic and overall stagnation plays a role in our pelvic floor. By being stagnant we aren't allowing our body to have proper blood and lymph circulation. It’s important that, as herbalists, we don’t dissect people into parts like mechanics, but instead synergistically match herbs with people. Although in this paper I have separated the different body systems, it is important to remember that all these overlap. When making a formula for a client, you will probably mix herbs that are listed in each one of these categories. And we always need to try to figure out why symptoms are appearing, not how can we just treat them. I’m hoping that this paper will get the wheels spinning for herbalists and other health care providers. I truly believe that pelvic floor physical therapy is a revolutionary tool and should be used for the prevention of pelvic floor disorders, and in all cases of pelvic floor dysfunctions. Herbs are just an adjunct therapy here. In order for pelvic floor disorders to improve, clients will need some physical manipulation, whether its external or internal and sometimes psychological treatment as well. Physical therapy unearths and examines the root of a person’s problem; this unearthing brings the root cause to light, and spreads out that tightly root-bound plant. Sometimes just holding space for clients and letting people know that there are physical therapists who address pelvic floor dysfunction can give people hope, or help break the stigma that physical therapy is only for the elderly and severely injured. Advocating for someone’s health, giving them resources, affirming that what they are going through is real, and letting them know that there is help for their pain can be more helpful than just giving herbs.

A (Brief) Case study

A 20-year-old woman had been experiencing pelvic pain for 5 years. She was diagnosed with dysmenorrhea at the age of 18. She had never been pregnant. Doctors suspected she had endometriosis; they performed a laparoscopic surgery to look for endometrial tissue, and they found nothing. At the time of her visit, she was taking Norco, ketorolac, and ibuprofen to control her pain and to enable her to function daily. Her pain was so severe that any kind of vaginal penetration caused her “screaming pain.” During menstruation, she had pain so severe that it caused vomiting and fainting and often immobilized her. After five years and five doctors, she was referred to a pelvic floor physical therapist. The physical therapist worked with her on posture, stretching, and core strengthening techniques. After seeing her physical therapist, she was able to get off all medication. Some pain still occurred during menstruation but nothing like it was before. It has been about a year and her pain level remained low.

Alex Rea is a clinical herbalist and herb farmer located outside of Ann Arbor, Michigan. She is currently pursuing nursing school, and plans, to go on to be a nurse practitioner.

Authors note: *Research studies for some herbs were limited, so only certain studies are used. Some studies did not use the gold standard which is randomized, double –blind, placebo control trials in humans. Included are some studies that used rats or mice to evaluate the effect of herbs. There is still a lot of work that needs to be done in research to make it possible to evaluate herbal medicine in relationship to humans.

Disclaimer:

*This article is not intended to cure, prevent, or diagnosis any medical conditions. I am not a medical practitioner. This article is for educational purposes only. If you are experiencing any of the symptoms discussed in this article, please seek medical advice from a licensed practitioner.

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