Hypertonic pelvic floor symptoms: What you need to know
Have you ever been told that you have a hypertonic pelvic floor (and probably "pelvic floor dysfunction" alongside that) from a medical provider but then were sent on your way before you could ask many follow-up questions or begin to comprehend what hypertonic even means?
Well then keep reading!
Hypertonic pelvic floors are something I commonly see in my clinic and in this blog, I’m going to discuss everything you need to know about the condition, including how to recognize if your pelvic floor may be hypertonic, common causes, some strategies you can try on your own if you suspect you have hypertonicity, and formal treatment options (including how pelvic floor physical therapy and a pelvic exam can help, of course!)
What is a hypertonic pelvic floor?
Before we dive in though, let’s cover some terminology. I mean what the heck even is a hypertonic pelvic floor!? Let’s look at the word hypertonic, which stems from the prefix ‘hyper-’ meaning ‘excess’ and the root word ‘tonic’ which refers to muscular tone. So put together, hypertonic simply means ‘excess tone’ or in layman’s terms, a tight muscle (or muscles). (The medical field always finds ways to complicate terms. I still remember in PT school when I learned of a condition called coryza, otherwise known as…a runny nose! But I digress.)
A lot of patients initially find it strange to hear that the pelvic floor can be too tight, but just like any other muscle, the pelvic floor can indeed hold too much tension. When this happens in our neck, we end up with a neck ache, but when it happens in our pelvic floor, we can experience not only aches & pains, but also problems with other bodily functions.
You see, the pelvic floor is a very special muscle group. And I promise I’m not biased at all! I just think it’s special because unlike most muscles, whose primary function is to help us move our bodies, the pelvic floor has much more important jobs that it’s responsible for. (Again, not biased at all…)
Because our pelvic floor muscles surround our pelvic organs, they aid in bowel, bladder, and sexual functions. They also act as an important crossroads between our lower body and our torso so they are quite literally the floor of the core!
Symptoms associated with hypertonic pelvic floors
If your pelvic floor muscles are too tense/if you have overactive pelvic floor muscles, they won’t function optimally and can cause a variety of symptoms. Many people with a hypertonic pelvic floor will often experience one or more of the following:
Pelvic pain (which can include pain with sexual intercourse, tailbone pain, pain with urination or pain with bowel movements)
Lower back or hip pain
Frequent urination
Urinary incontinence
Slow urine flows or a delayed ability to initiate urination
Constipation (this can actually be a root cause of a hypertonic pelvic floor, but we’ll come back around to that!)
Straining to empty bowels
If you’ve been experiencing any of the above symptoms, you may be thinking “yep that’s me, I must have a hypertonic pelvic floor”, but don’t make assumptions just yet. Unfortunately, there are many reasons a person might experience pelvic floor symptoms so just because two people share a common symptom doesn’t necessarily mean that they have the same cause.
How to test if you have a hypertonic pelvic floor
The best way to know if hypertonicity is at the root of your symptoms is by undergoing a full pelvic floor physical therapy assessment. However, there is a quick test that you can try by yourself at home to see if it’s likely that you have a hypertonic pelvic floor.
First, lay on your back or sit reclined in a comfortable position.
Place one hand on your chest and one on your belly.
Take a few deep, slow breaths and notice which hand moves more.
Finally, check in with your pelvic floor and see if you notice any changes. If you’ve never checked in with your pelvic floor before, it might take a few tries before you’re even able to sense that part of your body. But give it a try!
In a perfect world, you would find that:
Both your hands move together as you inhale and exhale.
Your pelvic floor gently relaxes on your inhale and resets to a starting position on your exhale (if this is difficult to imagine, just picture how a belly gently rises & falls with a deep breath…your pelvic floor should do the same!)
If you have trouble sensing any movement in your pelvic floor, it could be because your pelvic floor muscles are indeed hypertonic and as such, cannot “stretch” very far. (Here, picture someone with tight hamstrings not being able to lift their leg up very far…same idea!)
Okay, so what should you do if you have some of the symptoms listed above, have a hard time taking a deep breath, and it’s looking like you may have a hypertonic pelvic floor?
Coincidentally, that deep breathing exercise can also be a treatment for pelvic floor hypertonicity! Convenient, huh? Many treatments for pelvic floor hypertonicity center around relaxation - hypertonicity is a too tense pelvic floor or a pelvic floor that can’t relax so treatment involves teaching the body how to relax! And honestly, we live in such a rushed society, that most of my patients (and myself!) can benefit from taking a few moments per day to intentionally slow ourselves and our breath down.
Causes for hypertonic pelvic floor
Which brings me to my next point. A major cause of pelvic floor hypertonicity is stress. Or to be more specific, excess stress. We all experience stress, but when you’re under too much stress for too long, your body tends to hold onto that stress by increasing muscular tension, and such a hypertonic pelvic floor occurs. To use the neck as an example again, this is why some people get tension headaches when there’s too much tension in the neck muscles.
Stress can refer to emotional stress, but it can also refer to physical stresses, such as:
Physical abuse (which is especially difficult given that this is a combination of emotional and physical stress)
Pelvic surgeries
Injuries (for example, a lower back injury or a traumatic birth injury)
Constipation (told you I was going to come back around to this! Having extra stool backed up in your colon adds weight and therefore stress to the pelvic floor.)
Chronic holding of the bladder
Chronic coughing
Treatments for hypertonic pelvic floor
In pelvic floor physical therapy, I use a variety of treatments to encourage my patients to relax both their pelvic floor and in general. These include things like:
Soft tissue work to both the pelvic floor and other tense areas such as the lower back or neck
Gentle movements
Mobility exercises
Reverse kegels (which are exactly as they sound - teaching the pelvic floor how to relax rather than contract as in a kegel)
Guided meditation
And more to encourage full body relaxation.
I love being able to help a patient find their calm in the clinic, but if you’re struggling with a hypertonic pelvic floor, you can certainly try some of these techniques on your own! And like I wrote before, we could all benefit from more self-love, whether we have pelvic floor symptoms or not.
If you’ve tried all the deep breathing and stretches but haven’t yet made headway on your symptoms, then I’d encourage you to seek out care with a pelvic floor physical therapist like me! We can individualize treatment to you so that you’re really addressing the root cause of your symptoms.
There are also other treatments available for a hypertonic pelvic floor, including medications and medical procedures, but I always recommend starting with pelvic floor physical therapy because it’s the most conservative treatment and we can recommend other treatments if we see that you might not improve with therapy alone.
But more often than not, patients do resolve their symptoms with individualized pelvic floor physical therapy. So if you’re feeling hopeless, I promise you that you do not have to live with uncomfortable symptoms forever. And I’d love to help you feel better! If you'd like to schedule a complimentary 15-minute discovery call to ask any questions you have, please feel free to click here to schedule. I'd love to chat.
💜 Dr. Rachel J
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