The Over-Active Pelvic Floor

When you stumble across the topic of pelvic floor in everyday life, the take home message is usually one that promotes squeezing, lifting, tightening  and strengthening or some variation of these commands. For the majority of people this advice is useful and can go towards addressing common bladder and bowel dysfunctions. 

There are however a group of people for whom squeezing and tightening of the pelvic floor can be unhelpful and even harmful! SO, how do you know if you are one of them?

Having an over-active pelvic floor means that the pelvic floor muscles are unable to relax or switch off. They might be held tightly for long periods of time without rest and therefore can become tender, painful and tired. 

Some of the signs that you may have over-active pelvic floor muscles are the presence of pain with intercourse or attempted intercourse, pain when using tampons or an inability to feel the pelvic floor muscles either tighten or relax. 

Just to confuse matters, some of the symptoms of an over-active pelvic floor may be similar to those of a weak pelvic floor. Leakage of urine with coughing or exercise may also be caused by an over-active pelvic floor. Although an over-active pelvic floor is 'tight', the muscle can be fatigued from holding excess tension and when it needs to produce a strong effort to support the bladder neck during these activities its strength reserve is depleted and it cannot perform. 

If you are suspicious that this sounds like you, the only way to find out for sure if you have an overactive pelvic floor muscle is via internal pelvic floor examination. 

So what causes an overactive pelvic floor?

For some people there is no clear reason why they have an over-active pelvic floor. For others there may have been a precipitating event which has caused the muscles to 'spasm'. This might be the presence of painful conditions like endometriosis or perhaps a perineal tear sustained during childbirth. Anecdotally, overactive muscles can be prevalent in those who perform excessive abdominal exercises, have highly stressful lifestyles and high level athletes (especially runners, dancers and gymnasts) as these factors can promote habitual or situational tensing of the muscles. 

What can I do about it?

The first part of your treatment will be to create a better awareness around your muscle so you learn how to relax it completely and turn it 'off'. This can be taught during the internal assessment and other therapies like visualisation, mirror biofeedback or EMG biofeedback may be used. General relaxation strategies that target all the muscles in the body may also be used and mindfulness practice may also be incorporated as a useful tool to create better body awareness. 

Other issues such as leaking, painful sex or difficulty emptying the bladder or bowel may need other specific treatments to be fully addressed. 

If you have questions about over active pelvic floor and how physiotherapy can help you, please get in touch!