The hypertonic pelvic floor
What is a hypertonic pelvic floor?
A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.
What causes a hypertonic pelvic floor?
There is no one defining cause of a hypertonic pelvic floor; however, there are several activities which can lead to the muscles tightening up. As an example, many people who spend a lot of time working out and holding onto their core muscles can develop tension in their pelvic floor because they keep these muscles switched ‘on’ without giving the muscles times to relax and let go.
People who have a history of holding on to their bladder and/or bowels can also develop tension in their pelvic floor muscles. For instance, some people feel uncomfortable using public toilets so may hold on to their bladders for hours until they come back home from school, work or social activities. The act of holding on means the pelvic floor muscles are tightening to prevent the loss of control.
As high levels of stress, fear or anxiety can cause muscles to reflexively tighten, these factors can lead to a hypertonic pelvic floor. Consider how a puppy behaves when it is afraid—it runs away with its tail between its legs. Similarly, humans have a primitive response during fight or flight where the tailbone tucks under. The pelvic floor muscles are attached to the tailbone and this causes the muscles to shorten.
Pelvic health and abdominal health conditions can also result in hypertonicity of the pelvic floor. For example, many women with endometriosis can develop tense pelvic floor muscles due to the chronic pain and inflammation in the pelvis. Similarly, a history of irritable bowel syndrome with abdominal pain and cramping can result in pelvic floor muscle pain and cramping. Other conditions linked to a hypertonic pelvic floor include interstitial cystitis, pudendal neuralgia and vulvodynia.
Birth trauma and scar tissue is another cause of tightness in the pelvic floor muscles. Women who experience perineal tearing or vaginal tearing may be at a higher risk, as the pain and scarring can cause the pelvic floor muscles to tighten protectively. One-sided pelvic floor tears can cause the opposite side of the pelvic floor to tighten due to overactivity.
It is crucial to identify the cause of the pelvic floor hypertonicity in each individual. A continence physiotherapist will be best equipped to do this.
What are the signs and symptoms of a hypertonic pelvic floor?
The typical sign of a hypertonic or non-relaxing pelvic floor is pelvic muscle pain; however, there are a variety of signs and symptoms, including:
- incomplete emptying of the bowels
- straining when emptying the bowels
- pelvic pain
- low back pain
- hip pain
- coccyx pain
- painful sex
- urinary incontinence
- incomplete emptying of the bladder
- slow flow of urine
- hesitancy or delayed start of urine stream
- urinary urgency
- urinary frequency, and
- painful urination.
What to do if you think you or your client has a hypertonic pelvic floor?
If you have any of the signs or symptoms of a hypertonic pelvic floor, or you have a client that communicates any of these signs or symptoms, seeing a continence physiotherapist is essential. The physiotherapist will be able to identify the root cause of the hypertonicity and provide tools to help overcome this.
A continence physiotherapy session may involve a combination of the following:
- pelvic floor muscle relaxation techniques
- breathing techniques
- advice on bladder and bowel habits
- pelvic floor and abdominal massage techniques
- the use of vaginal dilators for women, to stretch the pelvic floor muscles
- pelvic and hip stretches, and
- scar tissue massage techniques.
Written by Heba Shaheed – physiotherapist, nutritionist and exercise specialist and co-founder and CEO of The Pelvic Expert thepelvicexpert.com.