A common misconception about tight pelvic floor muscles, also known as hypertonic or overactive pelvic floor muscles, is how in the world could that cause so much pain? We think a tight muscle feels just like your hamstrings you overstretch at the gym and nothing more. Once a tight muscle becomes a continuous spasm, however, the blood flow becomes restricted, the nerves get irritated, and then all you can think about is how miserable it is.
Pelvic Floor Discomfort: Common Causes
Not all pelvic floor discomfort arises from hypertonic pelvic floor muscles, although it is a very common reason. Listed below are other reasons why pain can persist.
Muscle Tension or Tightness: Similar to other muscles in the body, the pelvic floor muscles can become tense or tight due to stress, anxiety, poor posture, or a sedentary lifestyle. This tension can lead to discomfort or pain. Jump to this section to read more about muscle tension or hypertonicity.
Muscle Weakness: On the other hand, weak pelvic floor muscles might also cause discomfort. Weak muscles can contribute to instability and insufficient support for the pelvic organs, leading to discomfort and potential issues like incontinence.
Pelvic Floor Dysfunction: Pelvic floor dysfunction occurs when the pelvic floor muscles do not function properly. This can involve issues with muscle coordination, relaxation, and contraction, which can lead to discomfort, pain, or problems like urinary or fecal incontinence.
Childbirth: The process of childbirth, especially vaginal delivery, can stretch and potentially damage the pelvic floor muscles, leading to discomfort or pain. This is more common in women who have experienced difficult or traumatic deliveries.
Surgery: Surgical procedures involving the pelvic area, such as pelvic organ prolapse repair, hysterectomy, or prostate surgery, can impact the pelvic floor muscles and cause discomfort during the healing process.
Chronic Constipation: Straining during bowel movements due to chronic constipation can put stress on the pelvic floor muscles and lead to discomfort.
Chronic Pain Conditions: Conditions like endometriosis, interstitial cystitis, and pelvic inflammatory disease can cause chronic pelvic pain that involves the pelvic floor muscles.
Overactive Bladder: Conditions like overactive bladder can lead to frequent and urgent urination, causing strain on the pelvic floor muscles and resulting in discomfort.
High-Impact Activities: Activities that involve frequent or heavy impact on the pelvic area, such as running or certain types of exercise, can sometimes lead to discomfort if the pelvic floor muscles are not properly conditioned or if there's an underlying issue.
Sexual Dysfunction: Discomfort or pain during sexual activity can also be related to pelvic floor muscle dysfunction. Conditions like vaginismus or vulvodynia can cause these symptoms.
Psychological Factors: Emotional stress, anxiety, and trauma can manifest as physical tension in the pelvic floor muscles, leading to discomfort.
Postural Habits: Poor posture can contribute to pelvic floor muscle discomfort by putting undue pressure on the pelvic area.
It's important to note that pelvic floor discomfort can vary widely and may be caused by a combination of factors. If you're experiencing persistent pelvic floor muscle discomfort, it's recommended to consult a healthcare professional, such as a gynecologist, urologist, or pelvic floor physical therapist, who can provide a proper diagnosis and recommend appropriate treatment options.
What causes tight pelvic floor muscles?
There are many different causes of tight pelvic floor muscles. Some of the most common are:
Your standing posture: If you are always sucking in your stomach, or tucking your pelvis to flatten your butt, then you are tensing your pelvic floor.
Your sitting posture: Proper sitting should be weight-bearing through your sit bones and femurs, but as soon as you rock back off your sit-bones you're now fully on your tailbone. All of the nerves and muscles that have soft tissue attachments there can become affected.
You 'kegel' all of the time: This happens a lot when people feel like they are leaking or unsupported. This can also happen subconsciously with a lot of stress.
You are always stressed out, or always anxious, and you don't have a way to let that go at the end of the day. The muscles of the pelvic floor are controlled by our fight or flight nervous system, so if you are always hanging out in a fight / flight / freeze panic, then you are always tensing your pelvic floor.
Weakness elsewhere: You've heard of muscles compensating for other areas of weakness. The same can happen here where the pelvic floor has to engage more than it usually would to help stabilize and support your trunk.
How to relax pelvic floor muscles:
This is definitely a delicate balance based off of why your muscles are tight, as every intervention doesn't work for every body. Some easy things to try at home:
Stretching: It is important to keep all stretches very gentle to not irritate the painful tissue. Since a lot of stretching for the pelvic floor is also indirect, going slowly and deep breathing into the pelvic floor can help make sure you target the tissue you want. Some of my favorite stretches are:
Deep squat with deep breathing
Happy baby
Sphinx
Child's pose
Piriformis / glute stretch
Nerve mobilizations: This is different from static stretching, as that is dealing with soft tissue length and pliability. Nerves like movement, and they like to not be trapped underneath tight tissue. Doing some gentle nerve mobilizations can help them slide and glide along their pathway.
Deep breathing focusing on prolonged exhaling. Prolonged exhalation triggers a shift into a parasympathetic state to help your nervous system calm down a bit, which can help the pelvic floor tension also release. I recommend at least 5 minutes with a 3 second inhale and a 7 second exhale.
Check in regularly with your posture. Are you like some of my clients that constantly contract their core to 'protect their back'? Stop! You'll be okay, I promise.
If anxiety and / or stress is a huge driver of nervous system tension for you, and it is for most of us, finding ways to regulate your nervous system is huge. Some great ways to shift into more of a parasympathetic state at least once a day are:
Cold water for 3 minutes on the hands, neck, and face.
Deep breathing with prolonged exhale
Mindfulness: distraction of all 5 senses (vision, touch, taste, smell, hearing) for at least 15 minutes. This can work just as well as meditation, and has been shown in research to be equivalent for anxiety.
Exercise, especially if you get that "ahhh" feeling afterwards. Some describe it in running like a runner's high. I highly recommend swimming as it encompasses the cold water pressure on your face combined with exercise for a double dose of soothing.
Singing and use of your voice-box, like humming.
The importance of exercise for pelvic floor health
It is really easy to shift into fear of movement when we are in pain, but finding a form of movement that not only relieves pain but brings joy is huge. There is a balance, you don't want to try to PR in the gym when a core contraction causes pain. However a lot of the time muscle tension and hypertonic pelvic floor muscles come down to nerve tension and chronic over-firing of the nerves coming from your spinal cord. Because movement helps to expel a lot of the tension that can build up over-time, it can help you let go of muscle overactivity that was hanging around.
When it comes to getting back into exercise, it is important to prioritize stretching the muscles you strengthen and prioritizing form quality over repetition quantity. If you're getting back into yoga, know that just because you think you could move deeper into a stretch doesn't always mean you should.
There are no wrong exercises, just bad form mixed with a little bit of ego.
TLDR:
Pelvic pain is more common than you think, and a huge underlying reason is usually hypertonic pelvic floor muscles / overactive pelvic floor muscles. These muscles can become tight due to nerve tension, posture, and stress. The best way to find relief long term, besides seeing a pelvic floor PT, is to work on gentle stretching, stress-management, and nervous system down-regulation (cold showers anyone?).
Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Pelvic Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things pelvic health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her strongest passions lie with helping others conquer their chronic pain and achieve their intimacy goals.