Overactive Pelvic Floor

Can the Pelvic Floor be too tight?

In one word - Yes! Pelvic floor muscles, like any muscle in the body, can become “tight” or overactive due to stress, overuse and other factors. This can lead to pain and other symptoms, just like pelvic floor weakness can!

You may hear pelvic floor overactivity referred to as having a “hypertonic”, “tight” or “dyssynergic” pelvic floor. 

What are the signs of an overactive pelvic floor?

  • Pain with insertion of tampon or during sex
  • Urinary frequency (needing to go often)
  • Feeling like you never fully empty your bladder
  • Frequent urinary tract infections
  • Constipation 
  • Sometimes also lower back, hip, groin or abdominal pain and tightness 
  • Sometimes stress urinary incontinence 

While these symptoms may indicate that you have an overactive pelvic floor, the best way to diagnose is through assessment with a Pelvic Floor Physiotherapist. They will also help determine the cause of tight pelvic floor muscles. 

What causes pelvic floor overactivity?

Pelvic floor muscles can become overactive or tight as a result of a number of factors. Generally it occurs when the muscles are being held when they should be relaxed. 

Some possible contributing factors include:

  • Stress - the pelvic floor can hold tension, similar to holding stress in the neck or jaw 
  • Trauma - like an injury to the back, hip or pelvis, or sexual trauma
  • Infection or inflammation of the pelvic organs 
  • Bladder or bowel dysfunction 
  • Hypermobility – some people who lack hip and pelvic stability may compensate with pelvic floor muscles 
  • Chronic holding patterns – constantly tensing through the abdominals, pelvic floor and/or glutes as learnt behaviours and postures
  • Too many Kegels! (Yes, there is such thing)

What can be done to help a “tight” pelvic floor?

Learning to properly relax the pelvic floor is the main way to decrease muscle tension and reduce the associated symptoms. This can be done through:

  • Belly breathing and relaxation techniques
  • Reducing nervous system stress, eg. mindfulness, yoga
  • Good bladder and bowel habits 

As well as relaxation, some treatments and exercises can further reduce pelvic floor activity:

  • Manual therapy release (internal or external) by a Physiotherapist 
  • Perineal massage 
  • Stretches for the hips and pelvis 
  • Sometimes strengthening gluteal muscles can help reduce the load on the pelvic floor 

Can you still do Kegels if you have an overactive pelvic floor?

It depends but we would recommend not.

With a heavy focus on relaxation during the Kegels, it won't do harm. However, if the Kegels are centered around contraction with too little attention to fully letting go after the contraction, it may result in further tightening of the pelvic area.

A pelvic floor Physiotherapist can give you specific exercises suited to your pelvic floor. 

Article written by
Laura Justin
Qualified and Registered Australian Physiotherapist
Women's and Children's Health
@thefamilyphysio 

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