“What’s Going On Down There?”: Understanding the Perineum and Perineal Descent
Let’s talk about something rarely discussed but deeply important—especially if you’re dealing with pelvic heaviness, discomfort during movement, or that sinking feeling like “everything’s dropping.”
We’re talking about your perineum—that small but mighty diamond-shaped patch of tissue between your vagina and anus (or scrotum and anus, for the gents). It’s not just “extra skin” or a forgotten gap. It’s a central hub for fascia, muscles, nerves, and blood vessels. It forms the floor of your pelvic floor and plays a vital role in support, sensation, and function.
But what happens when that support system gives way?
That’s where perineal descent comes in.
What Is Perineal Descent?
In simple terms, perineal descent means the perineum drops lower than it should—either during bearing down (like when you poop or lift something heavy) or even just at rest. It’s often a sign of pelvic floor dysfunction or excessive strain on the pelvic structures.
For many, it feels like:
A bulging or dragging sensation
A feeling like you’re sitting on a golf ball
Pressure or fullness in the perineum, especially after standing or exertion
Trouble with complete bowel movements
Leaking, heaviness, or difficulty fully relaxing the pelvic floor
It’s commonly under diagnosed or misunderstood—partly because many women are told these sensations are “just normal” after childbirth or with age. They’re not.
Let’s Get Anatomical: What’s Connected to the Perineum?
The perineum might look like a small area of tissue, but underneath, it’s prime real estate for some of the most essential muscles and fascial lines in your body.
Here’s what connects to or influences it:
Pubococcygeus and Iliococcygeus: These two make up the levator ani, your primary pelvic floor muscles. They run like a supportive hammock from your pubic bone to your tailbone. Their fibres help lift the pelvic organs, close the vaginal and anal openings, and maintain tone and continence. When these are weak, tight, or out of sync with breath, the perineum can start to drop under pressure.
Anal sphincters (internal and external): These surround the anus and are closely tied to perineal function. If the perineum descends, the tension and positioning of the sphincters can be thrown off, leading to issues with bowel movements or a feeling of incomplete emptying.
Obturator internus: This deep hip rotator attaches on the inner surface of the pelvis and creates a fascial “sling” near the pelvic floor. If it's tight or underactive, it can contribute to pelvic asymmetry and pulling on the perineal tissues.
Gluteus maximus and pelvic ligaments: Your glutes don’t just power your stride—they influence the sacrotuberous ligament, which connects to the perineum and pelvic floor. Weak or underactive glutes = less fascial support from below.
Fascia of the urogenital triangle: The superficial and deep layers of perineal fascia anchor various structures like the clitoral body, perineal body, and transverse perineal muscles. This fascial network is incredibly responsive to load, breath, and posture. When tension builds up (especially from scar tissue or posture), descent becomes more likely.
In short: the perineum is not an island. It’s a crossroads—where the pelvic floor, hips, breath, and posture converge.
This is why Hypopressives, which address full-body posture, fascial decompression, breath mechanics, and reflexive pelvic floor lift, are such a game-changer for managing and reversing perineal descent.
What Causes Perineal Descent?
It’s rarely one single cause. Think of it like a load-bearing bridge whose supports have been weakened or overstretched. Here’s what might be contributing:
Chronic straining (constipation, breath-holding, pushing during exercise)
Pregnancy and birth trauma, especially prolonged second stage or use of forceps
Connective tissue disorders or hypermobility
Poor pressure management from posture, weak diaphragm mechanics, or gripping in the wrong places (hello, upper abs and jaw)
Hysterectomy or pelvic surgery, which can disrupt fascial continuity and nerve signalling
Increased intra-abdominal pressure without proper counterbalance—think heavy lifting, high-impact workouts, or even coughing fits
Hormonal shifts that affect tissue tone, especially during menopause
How Hypopressives Can Help
Now, here’s the hopeful bit. While perineal descent can feel disheartening, your body isn’t broken—it just needs a new kind of support. And that’s exactly where Hypopressives come in.
This isn’t your average “squeeze and lift” pelvic floor exercise. Hypopressives work on a whole-body level by:
Rebalancing intra-abdominal pressure so your pelvic organs aren’t constantly pushed down
Lifting the pelvic contents reflexively via postural shifts, apnoeas, and the vacuum effect
Lengthening and decompressing the pelvic floor muscles instead of gripping or over-tightening them
Re-establishing coordination between the diaphragm, core, and pelvic floor
Improving posture and fascial tension lines, helping bring the perineum back into alignment from the feet up
In my clients, I’ve seen incredible shifts—literally and figuratively. From less pressure and improved bowel movements to more confidence standing tall and moving freely.
You’re Not Alone (and You’re Not Doomed)
Let’s break the taboo. Your perineum deserves just as much attention as your abs, your glutes, or your heart. If you’ve been feeling like something’s “off” or like your body isn’t responding how it used to, you’re not imagining it—and you’re not alone.
The great news? Your perineum is responsive. With the right tools—like Hypopressives, gentle release work, and postural awareness—it can heal, lift, and reclaim its place in your pelvic puzzle.
Want to Learn How?
Join me for a workshop or a beginner’s course and discover how Hypopressives can help you reconnect to your core and bring that beautiful base of support back online.
Your body’s not letting you down. It’s just asking for a different kind of help. Let’s answer that call—together.
