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Can your pelvic floor muscles be TOO strong?!

Woman holding stomach
Woman holding stomach

Did you know if your pelvic floor muscles are too strong or tight it can cause you problems?

Hypertonic (or overactive) pelvic floor is where the muscles in your lower pelvis are in a state of constant contraction and aren’t able to fully relax. It affects people of all genders and ages.

When your pelvic floor muscles can’t relax they can’t coordinate the control of certain bodily functions. This can cause pain, problems with urination or bowel movements, and problems with sex.


How do I know if my pelvic floor muscles are overactive?

A common symptom is pain. This may be general pain or pressure in your pelvic area, lower back or hips. Pain can also be specific to a location, like your bladder, or during certain activities such as bowel movements, inserting a tampon, having a pap smear or cervical exam.

You may have pain while urinating, feel the urge to wee frequently, or feel like you’re unable to fully empty your bladder. You might have pain during or after penetrative sex, or be unable to achieve orgasm. You might have constipation, or pain passing gas.

You might notice that you can’t feel a pelvic floor contraction or release at all.

Symptoms of overactive or hypertonic pelvic floor usually develop slowly and get worse over time. It’s important to talk to your healthcare provider even if your symptoms are mild as they usually don’t get better on their own.


How common is this?

More common than we think. Research suggests it occurs as often as 1 in 4 women and 1 in 10 men – andit is probably under-reported.


Why are my pelvic floor muscles overactive? Too much coffee?!

It’s not the coffee! But there can be many different contributing factors:

  • Infection or inflammation – like chronic urinary tract infections or chronic thrush
  • Pelvic surgery - such as post-hysterectomy pain. This can cause scar tissue or irritate pelvic structures including ligaments, nerves and muscles
  • Chronic pain from pelvic health and abdominal health conditions – endometriosis, for example, can develop a tense pelvic floor 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. Vaginismus, vulvodynia, and painful bladder syndrome can also contribute.
  • Hypermobility – some people with excessive hip and pelvic mobility can compensate through pelvic floor tightness
  • Muscular dysfunction - caused by prolonged sitting, abnormal posture, irregular gait when walking or uneven pelvic bones.
  • Bladder or bowel dysfunction -  if there is a frequent urgency to wee or chronic constipation, the pelvic floor muscles often have to work hard to hold the bladder or bowel motions in.
  • Injury or trauma – due to surgery on your hip, knee or ankle where rehabilitation wasn’t completed; due to pregnancy or childbirth trauma or scarring; caused by an accident that results in a fall or traumatic impact onto your buttocks; a tailbone injury in childhood; or sexual abuse or assault.
  • Chronic holding patterns – some people may constantly grip through their abdominals, pelvic floor muscles and/or buttocks as learnt behaviours and postures. (Eg, children taught to hold in urine or feces, workers who have difficulty getting to toilets, people who do exercise or sports where you hold your core muscles tight for long periods.)
  • Stress, depression and anxiety - tension can be stored in the pelvic floor in response to stress.


Wow, that’s a lot. So, my pelvic floor muscles are overactive – what can I do about it?

Overactive pelvic floor muscles are treatable. There is no overnight result, but there are a variety of approaches that will make a significant difference over time. The primary treatment is physical therapy to retrain your muscles to fully relax. Your health provider can recommend a therapist with training in pelvic floors. A physiotherapist can help you address overactive pelvic floors through:

  • Belly breathing and relaxation techniques
  • Education and biofeedback (to teach you how to contract and relax your muscles correctly, eg using real-time ultrasound)
  • Work on calming the sympathetic nervous system, eg. mindfulness, yoga
  • Vaginal or rectal dilator (a wand designed with input by pelvic floor therapists, for therapeutic internal massage and trigger point release)
  • Massage, muscle stretching and joint movement  
  • Strengthening gluteal (bottom) muscles


Other treatments and specialists that can help:

  • Acupuncture
  • Medications to manage symptoms such as pain, anxiety, constipation, or frequent urination.
  • Stimulation of nearby nerves to manage urinary or bowel incontinence.
  • Trigger point injections with corticosteroids or Botox® to ease pain.
  • Gastroenterologist to treat constipation and evaluate your pelvic floor
  • Colorectal specialist for pelvic floor disorders related to bowel movements.
  • Gynecologist to treat reproductive health problems in people assigned female at birth
  • Urologist or urogynecologist to help with urinary problems or sexual dysfunction
  • Therapist to address psychological issues
  • Sex therapist to treat sexual issues.


Can I prevent, or reduce the risk of developing, overactive pelvic floor muscles?

Understanding the contraction and relaxation of your pelvic muscles is key, and you can do this by tuning into your body and mind. Being aware of your body, noticing how you are feeling emotionally and physically, and seeking support if you notice something is not right will help you look after your pelvic floor. Practice mindfulness and relaxation techniques, and seek psychological support after trauma.

Avoid prolonged periods of holding on before going to the toilet. Notice if you are straining on the toilet and experiencing constipation, or if you are having pelvic or anal pain, and see your GP if that is happening for you.


So remember!

If you are getting recurrent Urinary Tract Infections or thrush – don’t just keep taking antibiotics or creams. It could be your pelvic floor.