Pelvic Floor Tightness

What is a hypertonic pelvic floor?

A hypertonic pelvic floor occurs when the muscles of the pelvic floor become too tight, tense and are unable to lengthen.

What causes a hypertonic pelvic floor?

There can be many causes of a hypertonic pelvic floor.  People who spend a lot of time working out and holding onto their core muscles can develop tension in their pelvic floor because they force the muscles to consistently be under tension.

People who have a history of holding on to their urine and/or bowels can also develop tension in their pelvic floor muscles. Usually a good amount of nurses can develop this do to prolonged delay in urination. The act of holding on means the pelvic floor muscles are tightening to prevent the loss of control.

Stress 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. Coincidently, those who also tighten their jaw and grind their teeth are also usually tightening their pelvic floor.

Tight pelvic floor muscles can also be a response to pain, either post-surgical pain or chronic pain. 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 are at higher risk for pelvic floor dysfunction in general. 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. A pelvic floor physical therapist is best equipped to do this.

What are the signs and symptoms of a hypertonic pelvic floor?

  • constipation
  • incomplete emptying of the bowels
  • straining when emptying the bowels
  • pelvic pain
  • low back pain
  • hip pain
  • coccyx pain
  • painful sex
  • vaginismus
  • urinary incontinence
  • incomplete emptying of the bladder
  • slow flow of urine
  • hesitancy or delayed start of urine stream
  • urinary urgency
  • urinary frequency
  • painful urination

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