Motherhood is stressful, and many of our day-to-day postural habits can cause a tight, or hypertonic pelvic floor. This happens when your pelvic muscles do not fully relax when they should, and can lead to a host of uncomfortable symptoms, from chronic pain to constipation.
What Causes a Tight Pelvic Floor?
There are many reasons a pelvic floor might become chronically tight. Often, it is a cumulative effect, and not necessarily one thing alone.
Common causes include:
- Sucking in your belly
- Gripping your butt
- Sexual trauma
- Holding urine for extended periods
- Doing too many kegels
- Fear around prolapse
Tight vs. Weak Pelvic Floors
According to Justine Williams Roper, a pelvic floor physical therapist with InHer Physique, a hypertonic pelvic floor occurs when the pelvic muscles involuntarily spasm or, more commonly, are in a constant state of contraction.
“Think of a person flexing their bicep nonstop. When the muscles are constantly contracted, they won’t work properly,” she says. “Similarly, a tight pelvic floor isn’t a ‘good’ or ‘strong’ pelvic floor.”
On the other hand, a weak pelvic floor means that the muscles are weak and uncoordinated. For example, when you sneeze, a properly functioning pelvic floor will reflexively lift. If yours is weak, it won’t react properly, which can also result in leaking.
“It is possible to have both a weak (hypotonic) AND tight (hypertonic) pelvic floor. I like to use the example of a lady bent over with her shoulders shrugged, typing on a computer all day,” said Dr. Roper. “After years of doing this daily, you ask her to go to the gym and do shoulder shrugs with 50-100 pound dumbbells. She likely won’t be able to because she lives day-to-day with shortened, tight muscles. She can’t grow and build proper strength with such a small range of motion. The same goes for the pelvic floor.”
Signs and Symptoms of Hypertonic Pelvic Floor Muscles
Pelvic floor dysfunction is common.
Signs and symptoms that commonly accompany a hypertonic pelvic floor include:
· Constipation, need to strain, or difficulty evacuating (pooping)
· Hesitancy or delayed start of urine stream
· Urinary urgency or incontinence
· Incomplete emptying the bladder
· Painful sex
· Chronic low back, tailbone, or hip pain
· Pelvic pain
· A history of sexual trauma is common among women with pelvic floor disorders, and while not a symptom, it often results in chronic pelvic pain.
If you have any of these symptoms, you may be dealing with a tight pelvic floor. But the only way you can know for sure is by seeing a pelvic health professional.
“I do not recommend anyone ‘self-diagnose,’” said Dr. Roper. “A pelvic floor PT will perform a pelvic exam to assess pelvic floor muscle tone, reflexes, whether you have a prolapse or not, as well as your ability to voluntarily control pelvic floor muscles, core strength, and much more.”
Recognizing that some people don’t have access to a professional, she noted that because tightness is so common, many people will see even the most subtle change by performing relaxation techniques.
Treatment for Hypertonic Pelvic Floor
So what are these techniques? Is a hypertonic pelvic floor treatable? In short, yes – you can retrain your muscles. Here are key ways to promote pelvic floor muscle relaxation:
Breathwork to Release Your Pelvic Floor
Connect the breath and your pelvic floor. Work daily on deep abdominal breathing techniques:
- Sit comfortably with a hand on your chest and the other on your abdomen.
- Inhale down into your body, expanding your rib cage like an umbrella. Overflow air will flow gently into your tummy. You should feel abdominal muscles move, while the hand on your chest remains still.
- As you exhale, your pelvic floor will naturally recoil and release. Don’t actively lift it.
Kegels Aren’t the Answer
Take it easy on the kegels. These infamous pelvic floor squeezes only work one way. Your muscles tighten. This can worsen an already tight pelvic floor.
Instead, the pelvic floor through its full range of motion – your diaphragm and pelvic floor work together. Deep abdominal breathing promotes optimal muscle function and can help decrease pain.
When we have tension, it becomes important to learn to lengthen and release the pelvic floor.
Break Bad Habits
Stop butt gripping and sucking in your belly. These two common postural habits can create even more tension within pelvic floor muscles. When seated, instead of tucking your butt under, think about sitting evenly on your sit bones.
Learn to Relax and Contract Your Pelvic Floor During Exercises
During exercise, focus on the inhale and exhale. Inhaling and relaxing your pelvic floor is as important as lifting and contracting the pelvic floor when exercising.
For example, during a squat, inhale down into the body as you lower down. Then exhale and lift pelvic floor as you stand.
Strengthen Nearby Muscles
Incorporate moderate stability exercises (functional movement training) to the muscles surrounding the pelvis. When your core and pelvic floor have support from other body parts, it is more likely to let go.
Again, as you work through these treatments and something just doesn’t feel right, if you have back, pelvic, or hip pain that won’t improve, or you’re experiencing incontinence, please reach out to a professional.
How Long Does it Take to Fix?
How long it takes to “fix” a hypertonic pelvic floor is unique to each person, says Dr. Roper. “If a provider of any kind says they can get you better in a certain time, that can be misleading. I have treated a patient for two weeks with successful mitigation of their symptoms, and I have seen a patient with several pelvic conditions for months.”
She makes sure her patients learn something new at each session and improve on previous skills to work on their issues. In her view, physical therapy is “less of a quick fix and more of a way to improve that way you exist in your world by changing habits.”
Is It Ever Too Late to Fix an Overactive Pelvic Floor?
It is never too late to improve a hypertonic pelvic floor. The key is to identify the ‘why.’ What is contributing to the issue?
Taking a whole body approach is key in improving a hypertonic pelvic floor and its symptoms. The SLAM Stretch program has a variety of relaxation & release work that can help.
“Is it a central nervous system response to stress? Are there other muscles in the body that are weak and causing strain to the pelvic floor? Is there a history of trauma that needs to be addressed with collaborative care from another provider?” Dr. Roper asks, “It requires lots of investigative work, but once there is a solid foundation set there are so many innovative ways to conquer hypertonic pelvic floor issues.”