Pelvic floor muscle tension
Pelvic floor muscle tension or pelvic floor muscle spasm can be a debilitating condition that may have far reaching effects upon a woman’s life including her intimate relationships.
Physiotherapists are now treating increasing numbers of women with pelvic pain caused by pelvic floor muscle tension or overactive pelvic floor muscles.
Read on now for expert physiotherapist answers to the following:
- What is pelvic floor muscle tension?
- What causes pelvic floor muscle tension or pelvic floor muscle spasm?
- What problems can result from overactive pelvic floor muscles?
- Activities to avoid if you have a overactive pelvic floor muscles and pelvic pain
- The key steps for pelvic floor relaxation with “Down Training”
- How improved pelvic support, therapy and vaginal dilator therapy can help overcome increased pelvic floor tension.
What is pelvic floor muscle tension?
Pelvic floor muscles can become taut with spasm and overactive just like other skeletal muscles in the body. Overactive pelvic floor muscles have increased tension and or an inability to fully relax, a little like having very tight and painful neck muscles that will not relax. When a woman experiences pelvic floor pain, this may actually cause her to involuntarily tighten her pelvic floor muscles even more, and so a cycle of ongoing pelvic pain and increased pelvic floor muscle tension or pelvic floor muscle spasm develops.
Gynaecologists and physical therapists are seeing increasing numbers of women with pelvic pain associated with the inability to relax the pelvic floor muscles. Because of the complexity of pelvic pain, this condition often goes undiagnosed.
What causes increased pelvic floor muscle spasm?
Possible causes include the following:
- Overloading the pelvic floor muscles with too much pelvic floor exercise and insufficient relaxation. Women who regularly perform pelvic floor exercises or kegel exercises need to take the time to relax their pelvic floor muscles too.
- Overloading the pelvic floor with potentially unsafe intense abdominal core exercises
- Pelvic surgery including prolapse surgery and hysterectomy
- Pelvic infection or inflammation
- Recurrent infection such as cystitis
- Pelvic trauma
- Postural problems
- Mental/emotional factors.
It currently remains unclear whether pelvic pain causes pelvic floor muscle spasm, or whether the pelvic floor muscle spasm causes the pain – it’s a bit of a chicken or the egg story. What is known is they are both very much interrelated.
What problems can result from overactive pelvic floor muscles?
Overactive pelvic floor muscles can cause a range of bladder, bowel and sexual problems in addition to pain, emotional issues and progressive pelvic floor muscle weakness. These problems include:
- Bladder issues such as; slow urine flow, difficulty commencing urination, inability to completely empty the bladder, interrupted urine flow and even urinary urgency. These can result from the lack of pelvic floor muscle relaxation.
- Bowel issues such as; constipation, incomplete emptying of the stool, difficulty commencing bowel movement and straining throughout emptying. The straining associated with constipation can then cause increased pelvic floor muscle pain and increased tension. Furthermore additional problems may develop such as rectal prolapse, haemorrhoids and anal fissures.
- Sexual problems associated with intercourse and penetration. Vaginismus is the term used to describe the condition where the pelvic floor muscles spasm involuntarily with the threat of vaginal penetration which can prevent sexual intercourse, insertion of tampons and gynaecological examination. Sexual problems that result from overactive pelvic floor muscles can cause considerable emotional difficulty with stress, anxiety and relationship difficulties.
- Ongoing pain floor pain and discomfort caused by pelvic floor muscle overactivity or pelvic floor muscle spasm can be very stressful and anxiety provoking which often makes the condition worse. The physical discomfort associated with pelvic floor muscle tension presents differently in different women; it may present as pain, ache or discomfort in the low abdominal, low back and/or in and around the vagina and anus.
- Pelvic floor muscle weakness results from the pelvic floor muscles contracting too much and tiring out. As a result when they are required to work they are not able to, contributing to problems such as stress incontinence (involuntary leakage of urine with exercise or activity). The supportive function of the pelvic floor muscles may also be compromised, increasing the vulnerability to other pelvic floor problems such as vaginal prolapse.
What to avoid with pelvic floor muscle tension 
- Pelvic floor exercises or kegel exercises
- Intense core abdominal exercises
- Painful intercourse/ painful vaginal penetration
- Prolonged sitting
- Heavy lifting or heavy activity
- High impact exercise e.g. running
- Stress
How to promote pelvic floor relaxation using “Down Training” Methods
Treatment for pelvic floor muscle spasm is multifaceted.
The following Down Training steps (Shelly 2002) can encourage the pelvic floor relaxation when performed regularly.
- Relax – lie down with a pillow under the knees for 20-30 minutes daily to relax the pelvic floor muscles. Sometimes a warm pack placed over the pubic area or lower abdomen can assist pelvic floor relaxation.
- Employ diaphragmatic breathing – this means breathing into your diaphragm. Slow diaphragmatic breathing (like yoga breathing) is very important for relaxing the pelvic floor muscles.
- Visualise your pelvic floor muscles relaxing and a warmth in the pelvic floor region
- Gentle perineal bulging – this is very gentle bulging of the pelvic floor and should be taught by a pelvic floor physiotherapist. Bearing down too strongly can actually increase spasm so this must be done gently.
- Choose a relaxed environment is important e.g. soft music, surrounding warmth.
- Total body relaxation – relax the muscles of the whole body, this may involve progressive relaxation of the different muscles from the face and neck through to the feet.
- Employ body scanning for any areas of increased muscle tension and aim for complete physical relaxation.
Pelvic Floor Relaxation CD by Dr Patricia Neumann, specialist Women's Health Physiotherapist has produced this outstanding CD to help in the treatment of women with pelvic floor muscle tension. Relaxation CD guides the user through progressive pelvic floor muscle relaxation exercises and is an excellent guide to pelvic floor muscle relaxation. It is specifically for use with pelvic floor retrainer also known as vaginal dilator in the privacy of the home setting.
Vaginal Dilator Therapy
Vaginal dilator therapy can also be used to treat overactive pelvic floor muscles and Vaginismus. Vaginal dilators such as FemmaxTM (shown right) are designed with progressively increasing length and diameter, and are used to help a woman become accustomed to vaginal penetration and to help train pelvic floor muscle relaxation. Vaginal dilators are usually used initialy by the woman in the comfort and privacy of her home. When used to manage sexual dysfunction dilator therapy may progress to the partner assisting with dilator use at a later stage when the woman feels ready for this management.
Vaginal dilators are also used by women following radiation therapy and following some forms pelvic surgery such as hysterectomy where the vaginal tissues have become inelastic and require some gentle stretching for the woman to resume sexual activity with comfort. Sometimes the length of the vagina can become shortened during hysterectomy surgery and in cases such as these, vaginal dilators can assist with gentle elongation of the vaginal tissues.
Sitting Support
- Try to minimise prolonged sitting by taking frequent rest breaks where you stand and walk around
- Avoid round rubber rings which can increase pressure on the pelvic floor
- Choose appropriate pelvic pain relief cushion support (pictured right) to alleviate pelvic pressure and pain. A quality pelvic pain cushion will reduce pressure on the pelvic flor muscles, reduce associated pelvic pain and increase sitting tolerance.
- Sit with good posture avoiding slumped posture which is known to increase pelvic tension. This means maintaining the curve in your low back when sitting.
Manual therapy
A trained pelvic floor physiotherapist may use specific methods to promote pelvic floor relaxation and to re-educate the correct activation of these muscles. Pelvic floor physiotherapists are highly trained and skilled in manual therapy techniques for the pelvic floor. These methods are usually progressed gradually over time and may involve:
- Desensitising painful areas to touch (using physical touch or vaginal dilators)
- Pelvic floor stretches using digital resistance against these muscles
- Massage techniques
- Identifying areas of pelvic tension
- Postural re-education
- Biofeedback instruments which tell you about the activity of the pelvic floor muscles
- Treating concurrent conditions which may present along with pelvic floor spasm such as problems with pelvic joints (SIJ joints), tailbone problems and low back problems.
- Progressive strengthening of the pelvic floor muscles.
Complimentary therapies
Pelvic floor rehabilitation may be just one component of addressing pelvic floor muscle tension. Other practitioners may also be involved in managing overactive pelvic floor muscles including counsellors and/or couple therapy depending upon the woman’s associated problems.
For more reading on therapeutic management of pelvic pain refer to:
Shelly B., Knight, S. et al. (2002) Pelvic Pain, ch 23-27. Therapeutic Management of Incontinence and Pelvic Pain, J. Laycok and J Haslam. London, Springer-Verlag: 156-189.
Please read our disclaimer regarding this information
This information is provided for general information only and should in no way be considered as a substitute for medical advice and information about your particular condition.
While every effort has been made to ensure that the information is accurate, the author accepts no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation.
Copyright © Pelvic Exercises.com.au
i have had over 2 years of pain.. can a locked up kegal..pelvic floor etc.. and any of the ligaments and tendons being tight around anywhere and then the bladder cause bladder infections… ?
Hi Tracy
If tight pelvic floor muscles contribute to incomplete emptying of the bladder, then this could potentially increase the likelihood of recurrent bladder infection. When emptying the bladder it is very important to; lean forward, support the upper body with forearms or hands on thighs, maintain an inward curve in the low back and allow the lower abdominal wall to completely relax forward (this helps the pelvic floor muscles to relax). There is also a technique called double void which involves emtying the bladder, standing and rotating the hips a little like a hoola hoop action and the sitting to empty again. This technique helps to remove any residual urine that can contribute to infection. Michelle
i will add I am a core specialist fitness trainer who refers to kegals often in workouts.. so the theory of too much pelvic floor work and or intense abdominal core work… that would be what I have done for several years….
Hi Tracy
Yes this is a huge problem. Many women are exercising their core muscles too much, so much so that their core muscles are then unable to relax (including their abdominal and pelvic floor muscles). Intense core training and Kegel exercises without relaxing the muscles fully are increasingly contributing to pelvic pain and pelvic floor muscle tension among women. It is really important tha women are made aware to contract and fully relax their pelvic floor muscles. Furthermore women with pelvic pain associated with pelvic floor muscle tension need to avoid intense core workouts to alleviate the pressure on the pelvic floor until the musles fully relax and recover. Michelle
Michelle that is hard for me to do. For the past year I have done a workout called T-Tapp and this was a main focus. I am always tucking my butt and keeping my abs tight. I am going through menopause so I now have the lower tummy that I have never had. I am determined to teach myself to relax so that when I get the urge to move my bowels my muscles will relax and allow me to empty. I am excited as I read your book and start to use your exercises.
Peg
Hi Peg
Keep practicing learning to relax your abdominals. It can take some time to learn to relax abdominal and pelvic floor muscles. Many women are so accustomed to walking around with them braced all the time to flatten the appearance of their stomach. Not to mention the intense core work and abdominal muscle exercises women unknowingly do in gyms and exercise classes. The abdominal muscles increase the pressure in the abdomen which is transmitted directly down onto the pelvic floor resulting in stretch and strain of weakened pelvic floor muscles and tissues. Good luck Peg, Michelle
I just purchased your book because I am interested in returning to a healthy pelvic floor exercise program. I am 6 days post op hysterectomy with vaginal vault, and rectocele and cystocele repair. I am interested in knowing if you have had any experience with post op sciatic nerve pain and numbness after this type of surgery? How long does it last, and what can I do to help it subside?
Debbie
Hi Debbie
First of all best to clear things with your specialist if you experience altered sensation post operatively. Numbness can occur post op if the sensory nerves are for some reason compromised – stretched or nicked during surgery, compressed with swelling, problems in the low back or pelvis from the position in which the surgery is performed (lithotomy or the old childbirth position) which can be unkind to the spine and or pelvis. To help relax pelvic floor muscles post op, pelvic floor muscle downtraining strategies can help greatly in the first six weeks see this article for details. Then if the numbness persists post op longer physiotherapists may start manual therapy techniques for the pelvic floor muscles (massage, trigger point release, stretching and retraining of the pelvic floor muscles). Also check out the source of the sciatic pain, and that it’s not SIJ/lumbar spine related. Back and pelvic joint problems can also increase pelvic floor muscle tension. Also supported sitting can help using make a foam wedge not a rubber ring which will make swelling accumulate in the pelvic floor region. A good idea to rest frequently and elevate the pelvis with knees over a pillow when lying down – this also relieves the back and helps to reduce swelling. Best of luck Debbie, Michelle.
I was so excited to find your web page and all the information it
> provides. I have learned more from your web page then from the four
> doctors I have saught treatment from.
>
> I had a cystocele repair and bladder neck suspension three years ago. I
> had a hysterectomy, rectocele, enterocele repair with sacrospinios
> ligament fixation with a prolift mesh kit ten months ago. Two months ago I
> had a urethra sling placed as the previous surgery left me leaking badly
> as the cystocele and my urethra reprolapsed. I chose not to repair the
> cystocele as I was advised it would make sex more painful.
>
> Currently I have been diagnosed with damaged nerves which causes a burning
> tearing pain in my vagina and perineal area and muscle atrophy which
> causes an achy pain and a feeling that something is falling. I will be
> starting pelvic floor therapy soon. Do you have any helpful information on
> this condition?
>
> Thank you
Hi Lianne
Thanks so much for this honest and useful contribution. I think it helps other women to read about your experiences so thank you for your generosity in relating them here.
It sounds as though you have been referred in a good direction to receive pelvic floor therapy. It is not uncommon that after multiple surgeries to the pelvic floor that pelvic pain conditions can arise. There are many possible individual causes of pelvic pain and it may well be that other factors in your life are contributing to this painful situation also. Your physiotherapist will assess other potential contributing factors as well as treat the underlying condition.
Essentially therapy for pelvic pain is multidimensional. Some strategies that may be employed by a treating pelvic floor physiotherapist include relaxation strategies for the pelvic floor muscles and for the whole body, soft tissue massage of tight painful muscles, diet assessment to ensure good bowel movements and to decrease bladder irritants, education about the causes and factors perpetuating that person’s pain, breathing awareness training, advice regarding sexual intercourse, advice regarding the need to avoid using soap and irritants on the vulval area, use of dilators to desensitize painful regions to touch and advice regarding appropriate and inappropriate exercise. Your doctor may also have recommended that you commence specific antidepressant medication that has been shown when taken in small doses to help manage and alleviate pelvic pain.
The down training strategies listed in this article on how to overcome pelvic floor muscle tension and reduce pelvic pain are also extremely helpful to employ to assist in managing pelvic pain. Alyssa Tait is an Australian Physiotherapist who works extensively with pelvic pain and lectures to University Physiotherapy students on this issue. She has created an excellent CD called Free Your Pelvis to guide women through many of the techniques listed above which may also be of assistance to you.
Best of luck and trusting this information helps you in overcoming your condition Lianne.
Hello,
I am twenty-one. From the age of two I have suffered from chronic constipation. All through my childhood my parents forced healthy, fibre-full foods into my diet in order to relieve me from this problem. My doctor and my parents always thought that the problem I had was due to my diet as constipation is most commonly associated with diet and exercise.
When I was seventeen I started having sex with my boyfriend. My constipation subsided until a trip I took about a year after we had been together. Throughout the week long trip I hadn’t been eating the best foods, and was anxious as I was meeting his family for the first time and I never had a bowel movement. When I returned from the trip I had terrible constipation. We tried to have sex but every time we tried it was unbearably painful for me. Sometimes I felt so bad about it that I would try to endure the pain but it was just too hard and I couldn’t help moving away from him as he tried to penetrate.
We didn’t have sex for an entire year during which I had visited the doctor three times. First she told me I wasn’t lubricated enough and that is why sex hurt. Then she told me to massage and stretch the walls of my vagina. The third time I came back I asked her if my problem could be associated with constipation, she told me that the anus and vagina are two separate passageways, she acted as if I was a hypochondriac and referred me to a gynaecologist. I asked the gynaecologist the same thing and she prescribed estrogen cream to me and told me to stretch the walls of my vagina. I did this. I started to be able to have sex, even though it was still painful—I wanted so badly to show my boyfriend I was progressing after he had not had sex with me for an entire year and only tried to help and encourage me.
After about three years of my own research, this month I found a book at the library called “the g spot.” There was a story in the book about a woman with “chronic pelvic tension.” It was too painful for her to have sex. As a child her authoritarian father told her not to urinate in public washrooms because of germs. She would hold in her pee for hours until she came home and could urinate. Her pc muscle was always tightened, thus leading to her involuntary contractions at the approach of a penis.
One day I was talking to my mom about this, trying to find out why I had constipation my whole life and how it could be linked to my sex problem. I just knew it was linked but nobody believed me! My mom finally came out and told me that when I was two my authoritarian father had yelled at me for pooping in my bathing suit at the beach. They had never told me this because my dad felt awful about it but also because they didn’t know it was the reason for my constipation—they always associated it with my diet.
Well that explains the trauma that triggered my constipation. From the day I got in trouble I began to hold in my waste. When I felt the urge to release I would run to the bathroom or even go behind the couch or somewhere private and clench my PC muscle as hard as I could in order to make the feeling go away and it would go away for a few hours. Sometimes I would go like this for two weeks at a time—to the point where I would be sick and dizzy, I would have to stay home from school and spend hours on the toilet trying to go to the washroom. It sounds absolutely crazy but it’s true. By the time my body actually forced me to go to the washroom it was terribly painful because of the stool would be hard as rock and larger than normal. This would start a new cycle of being scared to release my bowel.
Now after 19 years of having chronic constipation, I can finally learn how to control it, and how to have sex without pain. I just need to learn how to relax the muscles in my pelvic floor. The really awful thing is that constipation is something so embarrassing no one wants to talk about, especially when you are a teenager. I never told my boyfriend until we had been together for three and a half years, because I was so embarrassed. I just want so badly to get this story out and show other women that it is not a taboo subject and it should be researched further! Not enough people and not enough health practitioners know about this type of thing and it could have saved me a whole lot of pain and embarrassment if I knew about it earlier.
Now I’m scared because I have been doing kegel excersises, running, abb workouts, thinking that this would help to strengthen and thus relax my muscle.
I am having pelvic muscle tension and spasms. My psoas, abdomen and diaphraghm are also in a chronic state of tension. I had a tummy tuck seven years ago. However, last year I had two miscarriages, heavy bleeding from uterine polyps and then a polypectomy and d&c. Since I had that surgery my Internstitial cystits flared up and then i started having severe tension in spasms in groin, pelvis, abdomen, psoas and diaphraghm. it feels uncomfrotable to sit. I am most comfortable lying down or standing up. has anybody had similar symptoms
Thank you Lena and Jen. Me too! Doctors treat me as if I'm just drug-seeking, but I'm in horrible pain … increasing for 16 years to the point I've been considering suicide to avoid more pain or degradation from a doctor. Sounds drastic, yet this is where I am emotionally now.
My problem probably started in childhood, holding waste up to 2 weeks unless I could go at home. I've not coped well with some tragedies, and anxiety has always been an issue. I was put on medication that gave me chronic diarrhoea for years, and I tried to hold that. The same drug caused massive weight gain. That impact, a car wreck, years of stress and then over-exercising to loose the fat …have created huge pelvic floor muscles that are constantly contracted, and sporatically tighten more to excruciating extreme. My periods intensify the cramps, but the flow has nearly stopped (or squeezed off). I often can't even insert a tampon, and if I do, the "fit" vaginal muscles bend it u-shaped or flip it upside down in less than an hour. What talent, huh?
Uterine pollyps 7 years ago could have been a sign. In the last year, I've finally seen some specialists (a challenge in itself since "women's health" in Ireland is limited to child-bearing concerns only). I was refered to a pelvic floor therapist who sent me to a gynaecologist, who sent me to a gastroenterologist, who sent me to a surgeon, who sent me to a back pain specialist. Surgery to correct the rectocele and tummy tuck the baggy skin is still being discussed. The first test brought on bad memories and so they postponed the next invasion. Endometriosis and colon cancer have been ruled out.
Next stop is a facet joint block in 3 weeks. I'll discuss my pelvic floor theory again, with more vigour this time! Thanks ladies.