Identifying Pelvic Floor Tightness
So we all know to do our kegels to help strengthen weak pelvic floor muscles, especially after pregnancy. But did you know that it is possible to have pelvic floor muscles that are too tight? This tightness or ‘hypertonicity’ can also cause pelvic floor dysfunction and is more common than you think. It is possible to have tight AND weak pelvic floor muscles, which can lead to postpartum issues such as incontinence and pelvic pain.
What causes tight pelvic floor muscles?
Some contributing factors include
- Pelvic joint instability
- Improper back and pelvic alignment
- Core and pelvic floor exercise (too many kegels!)
- Repetitive daily activities
- Poor posture
Any of this sounds familiar?
Pelvic Floor Anatomy
Your pelvic floor muscles are a group of muscles that act like a hammock to support the bladder, uterus, prostate, rectum, and vagina. These muscles ensure that every time you breathe deeply you don’t have to change your underwear! Although they must be able to contract in order to prevent incontinence, they also must be able to relax to allow for activities such as urination, bowel movements and sex.
According to pelvichealthsolutions.ca, If these muscles have too much tension they can cause pelvic pain, urgency, and frequency of urination, as well as low back pain and other dysfunction.
So how do you know?
If you are having issues down there, how do you know if it’s due to weakness, tightness, or both?! The easiest solution is to be seen by a therapist who specializes in working with pelvic floor dysfunction. They will be able to evaluate the different muscles and identify where the problem lies. See below for some common symptoms that may indicate pelvic floor tightness and prompt a referral to therapy!
Pelvic Health Solutions identifies the following as reasons to seek therapy.
- Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying
- Constipation, straining, pain during or after bowel movements
- Unexplained pain in your low back, pelvic region, hips, genital area, or rectum
- Pain during or after intercourse, orgasm, or sexual stimulation
- Uncoordinated muscle contractions causing the pelvic floor muscles to spasm
An obvious sign of someone who may have hypertonic pelvic floor muscles is what therapists refer to as a ‘butt gripper’. Some people have the tendency to stand with their glute muscles engaged, therefore causing a backwards tilt of the hips. This can shorten the pelvic floor muscles over time. If someone gets into the habit of standing like this often it is likely that they will have a muscular imbalance, which can lead to pelvic floor dysfunction and back pain.
Increased muscle tension is also commonly seen in women who have had unstable sacro-iliac (SI) joints (often due to pregnancy) as they make up for this instability by over contracting the muscles of the pelvic floor during activities
What to do about it?
A physical therapist can teach you how to increase your awareness of your pelvic floor muscles and focus on relaxing them just as much as you contract them.
Try this exercise at home…sitting at the side of the bed in a neutral posture (sitting up tall, tailbone un-tucked, and back with a neutral curve) contract your pelvic floor (visualize closing the openings of the urethra and vagina and then lifting up) focus on lifting up slowly like an elevator. Take a deep breathe at the top and exhale releasing the tension letting your pelvic floor return to its starting position. Once in the starting position, let your stomach fill with air and then relax your stomach muscles letting this air settle lower and lower in your abdomen until you feel your pelvic floor completely relax. You don’t want to feel like you are straining to go to the bathroom, but rather a feeling of bulging out at the pelvic floor. Unsure if you are doing this correctly? Use your hand to feel the pelvic floor muscles (the area between your two sit bones) and you should feel a bulge while relaxing.
By doing these bulging exercises or ‘reverse kegels’ you are teaching the pelvic floor muscles how to relax so they are not always in a state of constant contraction. You can also try stretching these muscles.
Bottom line.
If you have tight pelvic floor muscles causing dysfunction kegels will not help you, but rather make the condition worse! Pay attention to your posture, try to maintain a neutral alignment in your lower back as much as possible, and avoid engaging your butt muscles all the time! Also avoid tucking your tailbone under when sitting at your desk or in the car. Feel free to ask questions in the comments below!
Thank you to the Herman & Wallace Pelvic Rehabilitation Institute for your excellent continuing education courses on pelvic floor dysfunction. I learned a lot and I am glad to be able to share this knowledge with my followers and clients!
Resources
https://www.medbridgeeducation.com/courses/details/functional-applications-pelvic-rehabilitation-b
http://www.pelvichealthsolutions.ca/for-the-patient/pelvic-floor-muscle-tightness/