What is an overactive pelvic floor?

An overactive pelvic floor is a condition where there may be increased pelvic floor muscle tension at rest and/or a decreased ability to fully relax these muscles. So basically the pelvic floor muscles become tense and are unable to relax.

We often get the message that we need to squeeze and strengthen the pelvic floor muscles, but for those with an overactive pelvic floor this can be the wrong advice.

Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. An overactive pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the glutes, inner thighs and hamstrings.

What are the causes?

There is no one defining cause of an overactive pelvic floor; however, there are several activities which can lead to the muscles tightening up.

Chronic holding patterns – 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’ and don’t give them the chance to relax.
Stress- high levels of stress, fear or anxiety can cause these muscles to reflexively tighten, leading to an overactive pelvic floor. Consider how a puppy tucks his tail between its legs when it is afraid. Humans have a similar primitive response when stressed, where the pelvic floor muscles tighten and shorten, pulling on the tailbone.
Bladder or bowel dysfunction- people with a history of holding on to their bladder and/or bowels can develop tension in their pelvic floor muscles. For example if there is a frequent sensation of urgency or chronic constipation. The act of holding on causes the pelvic floor muscles to tighten to prevent the loss of control.
Trauma- such as a fall onto the buttocks or tail bone or trauma like sexual abuse, cause the pelvic floor muscles to tighten protectively.
Birth trauma and scar tissue- women who experience perineal 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 to compensate for weakness.
Injury – pelvic floor muscles can tighten as a compensation strategy, for example, following a hip, knee or ankle injury/surgery that was never fully rehabilitated.
Hypermobility – excessive hip and pelvic mobility can cause tension in the pelvic floor in an attempt to create more stability through these joints.
Infection, chronic inflammation and pain– eg. endometriosis, irritable bowel, chronic urinary tract infections or chronic thrush can lead to tension in the pelvic floor muscles.
Pelvic surgery- this can cause scar tissue or irritation of the pelvic structures including ligaments, nerves and muscles, eg. post-hysterectomy or post-prostatectomy pain.

It is crucial to identify the cause of the pelvic floor over activity in each individual. A pelvic floor physiotherapist is able to do this.

What are the signs and symptoms?

The typical sign of a non-relaxing pelvic floor is pelvic pain; however, there are a variety of signs and symptoms, including:

Incomplete emptying of the bladder
Slower urinary flow or the feeling of incomplete emptying
Hesitancy or delayed start of urine stream
Urinary urgency and sometimes leakage
Urinary frequency
Not being able to feel a PFM contraction or release
Pelvic pain that can include urethral, vaginal, rectal, lower abdominal pain, lower back pain, coccyx pain
Vaginismus or pain with sex, either with initial or deep penetration
Difficulty or pain with emptying the bowels or passing ‘skinny stools’
Constipation
Incomplete emptying of the bowels

Why see a pelvic floor physiotherapist?

If you have any of the signs or symptoms of an overactive pelvic floor, seeing a women’s health physiotherapist is essential. The physiotherapist will be able to identify the root cause of the overactivity and provide tools to help overcome it.

A pelvic floor physiotherapy session may involve:

pelvic floor muscle relaxation techniques
breathing and mindfulness 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.

What can you do straight away to help your pelvic floor relax?

You can get started straight away with some breathing, meditation and gentle stretches. While doing these exercises focus on releasing and relaxing the pelvic floor.