Abdominal & Pelvic Massage and Women’s Health Issues

deeper pressure addresses physiological aspects of the abdomen

deeper pressure addresses physiological aspects of the abdomen

Massage Therapists are trained to do abdominal and pelvic massage – this type of massage on the area of the torso can be physiological or energetic in nature. A therapist can assist in the movement of blood, toxins, muscle tissue, and visceral structures physiologically, and move energies related to the Hara, kidneys (Jing), and aura.

the Hara is believed to exist 3 finger-widths below & deep to the navel

the Hara is believed to exist 3 finger-widths below & deep to the navel

Several structures in the lower female pelvis are the apparatus that allows a woman to bear another human being. The ovaries produce and release eggs that travel down the uterine (Fallopian) tubes monthly, taking a 5-day journey to attempt to attach to the tissue nest of greatly-available blood and nutrients, the endometrium lining that the uterus has prepared all month (approximately every 28 days). The eggs are most likely to be fertilized in that journey down the uterine (Fallopian) tube. If the eggs are not fertilized within a certain amount of time, hormones communicate that the nest of blood and nutrients needs to be shed in the menses and the cycle starts at the beginning again.
No matter the reason for a massage therapist to choose to work on the abdominal and pelvic area, there are some conditions a therapist and their client need to be aware of when addressing the female reproductive system. Several conditions that women regularly and/or naturally experience in the pelvic area and that are of concern in the area of massage therapy include: use of birth control, dysmenorrhea, spontaneous and elective abortion, endometriosis, and fibroid tumors.
Birth control pills are used to tell the brain that the body is pregnant, thereby stopping the flow of hormones that prepare the body for fertilization and pregnancy. Massage in the pelvic area is appropriate when considering this form of health affectation.
Dysmenorrhea, referred to more commonly as a painful menstrual period, is defined by the woman’s experience of limiting activities for at least 1 day every month because of symptoms of dull aching or sharp severe lower abdominal pain – accompanying nausea and vomiting are also signs of dysmenorrhea. It is not advisable for massage to be done on the area of localized pain within the first two days that symptoms show – it is advisable to use reflexive techniques and massage all other indicated areas of the body.
Spontaneous Abortion, an unintentional termination of a pregnancy, can happen in many stages of pregnancy and for many reasons, many having to do with the overall & systemic health of the mother and the ability of the egg or fetus to survive in the health of the mother’s uterus. Elective Abortion, an intentional termination of a pregnancy, can also happen for many health-related reasons. In either the case of spontaneous or elective abortion, the lining of the uterus is disrupted and needs time to heal. Massage in the pelvic region is not appropriate after a spontaneous or elective abortion until after bleeding has stopped and there is no sign of infection. Client and therapist should be aware of doctor recommendations for massage therapy if an abortion occurred less than 6 weeks ago.
Endometriosis is a resultant condition of the non-exiting (in menstruation) tissue fragments of the endometrium (of the uterus) attaching to other cells and structure in the body. Circulation and implantation of the endometrial cells produces “blood blisters” or clear vesicles in early years – in later years, the implanted cells will grow over, appearing black and scarred. Massage therapy is not advised in the area of the diagnosis of endometriosis, especially during menstruation. Diagnoses have been known to displace structures in the area of endometriosis (usually in the pelvic region), so care in providing and receiving pelvic work is suggested for locally diagnosed endometriosis.
Fibroid Tumors grow in or around the uterus, mostly undetected (because of their small size) and exist in a postulated 20-30% of women between 30 and 50 years old¹. Symptoms of small fibroids are unrealized while in diagnosed cases of larger fibroids can reveal symptoms of mechanical pressure on other structures (including nerves) in the pelvic area and increased menstrual bleeding. Massage is suggested in pelvic areas other than the uterus if there is a diagnosis of fibroid tumors – as large fibroids can displace other structures in the pelvic area, massage is not appropriate in the area of the uterus.

finger-tip massage done at the transverse abdominal wall

finger-tip massage done at the transverse abdominal wall

Here are some points to consider when going for your therapeutic massage and your therapist does pelvic work:

  1. Deep work in the pelvic area is not generally practiced in massage therapy, although a few modalities address the pelvic region using deep tissue techniques. A client should always ask and the therapist should always explain what the intent of their work is deep in the pelvis.
  2. Deep work in the pelvic or abdominal area is generally not advised on days of heavy menstrual flow. Many other massage therapy techniques can be used by a therapist to alleviate symptomatic experiences of pain and discomfort.
  3. Let your massage therapist know if you’ve been experiencing conditions related to your health as a woman, so your therapist may best serve you and deliver the most appropriate method to improve your health and well-being.
  4. Your therapist may also let you know about structures s/he feels (literally) may be abnormal or out of place; the therapist may also refer you to a qualified health care provider that s/he knows personally in order to assist you in achieving a level of wellness or “peace of mind” – listen, and visit that doctor or qualified practitioner who can help you determine what the issue is and how to improve your overall health.
  5. As with all other areas of the body, the pressure should be delivered by the therapist and experienced by the client at a level that is comfortable and expected. Any level of discomfort beyond acceptable standards of the client needs to be recognized and addressed by the client so the therapist can respond appropriately.
  6. Most of all, enjoy your pelvic massage! It increases the internal health of the abdomen, strengthening, circulating, and stimulating movement in the organs and musculature, making your entire body healthier!
¹”A Massage Therapist’s Guide to Pathology,” Ruth Werner, 1998, p. 331

Bodies on the Table: Blood Circulation

The second article in this series addresses another way your body responds to bodywork, massage therapy specifically – it is the aspect of circulation.  Increasing circulation of many of the body’s fluids is a benefit that is innate to the pushing, pulling, and stretching that accompanies most massage strokes – blood transport is the focus of this segment.

In Swedish-style massages, effleurage, petrissage, compression, and muscle stripping all share the goal of moving fluids.  Fluids can be defined as blood, lymph, water, or extra-cellular fluid; all forms transport nutrients, bacteria (good and bad), and waste in and out of the body.  Effective transport indicates good health – the cells are healthier and cellular-aging and -death is reduced.


virtual arterial flow (no surrounding cells)

Massage enlivens the theory that moving blood, specifically, toward the heart increases vasodilation (venous circumference) which increases the volume of the vein which means transport of nutrients and waste in the blood will increase.  Movement is life, so moving the fluids is important for the health of the surrounding and affected cells.  Also, moving fluids toward the heart increases waste production, since the kidneys are in line to the return blood flow to the heart – needing to urinate after a bodywork session is a normal and healthy response to the work you just received.

Another aspect of blood circulation that is an important feature of healthy, comfortable, and safe bodywork is the direction of the stroke.  Since veins occur mostly toward the most-surface areas of the body, they are the most directly affected structures during a massage.  Although the direction of energy strokes is dependent on the theory in use, tissue-manipulative strokes are most effectively and safely delivered when applied toward the heart.

The reason for this is that veins have structures inside that prevent backflow of blood and fluid.  The heart is not able to effectively assist the blood return through the veins, just the blood delivery through the arteries, which is strongest at the point of origin – the pumping heart muscle.  In blood return to the heart, the body is designed to assist through contraction of muscle surrounding the veins to move the blood back toward the heart and lungs for recirculation.

Another function of and safety mechanism for preventing the back flow of blood (especially during sedentary states) is the pockets or valves on the interior of the veins.  If pressure is applied in the direction of backflow (against the direction of flow), the structure of the pockets and valves is compromised and the veins stretch and strain under the pressure.  If there is too much stress on the vein in one application or over time, damage can occur to the vein, causing it to weaken or break.  Varicosities can occur or, at worst, bruising of the area where the vein was compromised.

As we get older, the elastin is depleted and not easily replaced in our entire body.  Veins are an important place to have elastin, as they expand and contract based on our environment and state of physical exertion and health.  If undue pressure is applied in the opposite direction of blood flow, permanent damage can be caused by which it becomes more difficult to recover.

massageface01110x110What’s most important is that you feel good during and after your massage.  The old adage “If it feels good, do it” is most applicable when considering the direction of the massage stroke you are receiving.  If it is irritating or annoying, there is a reason it feels that way – talk to your therapist and ask why you may be experiencing that feeling or sensation.  Trust your body to tell you what is good for it – safe, effective massage “feels good.”  The circulatory system plays a major role in how you feel during or after your massage, so make it an important goal, whether it’s to invigorate or relax it, for your overall health and well-being.

In the next article, we’ll talk about another circulatory system that is affected by bodywork and massage – the lymphatic system.  We’ll see how edema, lymph nodes, and the liver, kidneys, and your tonsils all play a part in the physical response and benefits of receiving bodywork!