Overactive (Tight) Pelvic Floor: Causes, Symptoms & When to Seek Support
What is an overactive pelvic floor?
An overactive pelvic floor — sometimes called a tight or high-tone pelvic floor — occurs when the pelvic floor muscles are unable to fully relax. While many women are told to strengthen their pelvic floor during pregnancy and after birth, fewer realise that these muscles must also be able to lengthen and release.
When the pelvic floor remains tense or poorly coordinated, it can contribute to:
Difficulty emptying the bladder or bowel
Pain with intercourse
Pelvic pain or pressure
Tailbone discomfort
Difficulty relaxing during labour
A feeling of “tightness” or tension internally
Pelvic floor health is not just about strength — it’s about coordination, timing and relaxation.
Why Pelvic Floor Assessment Matters in Pregnancy
Pregnancy places increasing load and pressure on the pelvic floor. While strengthening exercises are often encouraged, it is equally important to ensure that the muscles are functioning optimally — meaning they can both contract and relax effectively.
A women’s health physiotherapist (WHP) can perform a pelvic floor assessment, including internal examination where appropriate, to determine:
Whether the muscles are weak, tight, or uncoordinated
Whether there is a higher risk of postpartum incontinence or prolapse
Whether relaxation training is needed before strengthening
How the pelvic floor is responding to pregnancy-related changes
Early assessment allows personalised strategies to be implemented well before birth, rather than waiting until symptoms develop postpartum.
Pelvic Floor Relaxation and Birth Preparation
Many women are familiar with Kegels. However, fewer are taught how to fully relax the pelvic floor between contractions.
If the pelvic floor is unable to release effectively, this can make stretching during labour more challenging.
A WHP may guide you through:
Pelvic Floor Down-Training
Learning to:
soften the pelvic floor
lengthen the muscles with breath
release tension consciously
This may involve breathwork, positioning strategies and specific exercises tailored to your presentation.
Perineal Preparation
For women planning a vaginal birth, a WHP can also guide:
Perineal massage technique
Timing (usually from 34 weeks)
Tissue awareness
Appropriate pressure
Read our Perineal Massage & Epi-No blog
Pushing Coordination
Rather than prescribing a rigid pushing method, physiotherapy support focuses on helping women understand:
How to coordinate breath and pelvic floor relaxation
How to avoid excessive straining
How to protect the pelvic floor during the pushing stage
Pelvic Girdle Pain and Muscle Tension
Pelvic floor tension often coexists with pelvic girdle pain (PGP), including:
Symphysis pubis dysfunction (SPD)
Sacroiliac joint (SIJ) pain
“Lightning crotch”
Up to 1 in 5 women experience pelvic girdle pain during pregnancy. When not managed appropriately, it can affect mobility, sleep, exercise tolerance and birth positioning.
A WHP can assess movement patterns, load management and muscle coordination to reduce pain and support continued activity throughout pregnancy.
When to Seek Support
Symptoms such as:
Ongoing pelvic pain
Difficulty emptying your bladder
Pain with intercourse
A sense of heaviness or vaginal tension
Leakage during pregnancy
are not things you should ignore.
While some changes are common in pregnancy, persistent symptoms warrant assessment. Early management often improves outcomes both during pregnancy and postpartum.
Bub & Me prenatal and postnatal programs are now delivered through Together Strong Physio in Canberra, providing women with a seamless pathway from pregnancy and early postnatal recovery into safe, strength-focused physiotherapy and long-term exercise support.
The Importance of Postnatal Follow-Up
Building a relationship with a women’s health physiotherapist during pregnancy makes it far more likely that you will attend a postpartum assessment.
A 6-week postnatal pelvic floor review can identify and manage:
Incontinence
Prolapse risk
Ongoing pelvic girdle pain
Abdominal separation
Return-to-exercise readiness
Early assessment helps prevent minor issues from becoming long-term dysfunction.
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.
Belly breathing
Place one hand on your chest and another hand on your belly, just below your rib cage. Take a deep breath in to the count of three, and then exhale to the count of four. When you inhale, your pelvic floor relaxes, and as you exhale, your pelvic floor returns to its resting state
Childs pose
Start on your hands and knees. Spread your knees wide apart while keeping your big toes touching. Gently bow forward, moving your torso downwards, between your thighs. Keep your arms stretched out long and in front of you.
Frog pose
Kneel down on the floor then rest on your elbows and forearms. Gently start to move your legs apart with your feet out behind you until you feel a stretch in the inner thighs. Hold this position for 30 seconds and focus on relaxing your pelvic floor. Remember to breathe.
Happy Baby
Lie on your back. Open your knees wider than your chest and bring them up towards your armpits. You may hold your legs with your arms behind your knees or at your ankles, but try to keep your ankles over your knees. You can either hold this position or gently rock on your back from side to side.
Butterfly stretch
Sit on the floor, bend your knees and bring your heels together. Lengthen through the spine and gently lower your knees towards the floor as you breathe out. Hold the stretch for 30 seconds and make sure to focus on relaxing your pelvic floor at the same time
Piriformis stretch
Lie on your back with your knees bent. Place your left ankle on your right knee, like a figure four. Pull your right thigh toward your chest to feel a stretch on the outside of your left hip. Hold for 30 seconds, and then repeat on the other side.