What is Hypertonic Pelvic Floor?

Today’s topic is a little bit of a departure from my typical fashion, beauty and running content, but the pelvic floor actually has a lot to do with running. And I first learned about hypertonic pelvic floor when I was having pain on almost every run, even 2.5 years after having my son. I would often complain (and yes, even cry at times) to my husband and tell him that I didn’t think I’d ever be able to run normally again. That my days of marathons were behind me. That having Thomas was worth it, but I missed feeling like myself while running.

Turns out, so many of my running woes the last few years were related to my pelvic floor. If you’re not familiar with this group of muscles, they form a sling-like structure located at the base of the pelvis. This area serves as a foundation for essential organs like the bladder, uterus, and rectum. The pelvic floor muscles help control bowel and bladder function, support the pelvic region, and aid sexual function.

Unfortunately, several factors like pregnancy, childbirth, aging, and injury can impact pelvic health. One condition that specifically affects the pelvic floor muscles is hypertonic pelvic floor. This can have a big effect on the physical activities you perform, especially if you’re a runner like me.

If you’ve been following along my pelvic floor journey, then you know the struggle has been real. My return to running after pregnancy was not an easy one. I had a lot of pain even just walking. Back then, it was obvious I needed to see a pelvic floor PT. But when I was 2.5 years out from birth and struggling with hamstring and hip pain while running, it didn’t cross my mind that it was still pelvic floor related.

It took getting desperate to go back to pelvic floor PT (after seeing countless other health care providers) and I’m kicking myself for not going in sooner. (I shared a bit about my new pelvic floor therapist here.)

Most people think that pelvic floor health is related to kegels to help strengthen muscles, but for many women — particularly runners — issues can be related to muscles that are too tight, aka hypertonic. (So, yes, kegels worsen the problems.)

What is Hypertonic Pelvic Floor?

Hypertonic pelvic floor occurs when your pelvic floor muscles become too tight and don’t relax as they should. It’s also commonly known as an overactive pelvic floor. This can lead to several symptoms, including pelvic pain, constipation, sexual function disorder, pain during intercourse and difficulty with bowel or bladder function. It can also cause pelvic floor muscles to overreact. This can lead to feeling like you need to go to the bathroom all the time.

Don’t worry, though; you’re not alone. Female pelvic floor disorders are common, with up to 25% of women having one or more symptoms such as urinary incontinence, pelvic organ prolapse, or genitourinary fistulae. (If you struggle with urinary incontinence, check out this post I shared on how to stop stress incontinence when running.)

To know if you have hypertonic pelvic floor, a visit to your doctor can help diagnose what is going on. This assessment will review symptoms and evaluate your pelvic floor muscles’ strength and tension. It may include a pelvic floor physical, which can sound intimidating, but getting an accurate diagnosis is essential.

I first saw a pelvic floor PT about 6 months after giving birth. The reason I went back to pelvic floor PT was that I having problems with my hamstring for months and no one could tell me what was causing it. I’d seen multiple massage therapists, two chiropractor and two sports PTs, but no one could get to the root cause. They helped manage the symptoms but the symptoms always came back shortly after treatment.

I finally saw a new pelvic floor PT with a background in orthopedics. She explained that my hamstring issue was related to my hypertonic pelvic floor which I never would have connected.

Hypertonic Pelvic Floor Causes

Let’s dive a little deeper into hypertonic pelvic floor and its possible causes. There is no definitive cause of a hypertonic pelvic floor; however, several activities can contribute to this tension.

• Strenuous exercise like running or core strengthening has been known to tighten the pelvic floor muscles, especially if you condition for long periods without allowing time for relaxation.

• Holding the bladder or bowels to avoid using public restrooms (or for any reason) can also result in tension in the affected area since the muscles must stay contracted to prevent any leakage.

• Emotional causes can also manifest as physical tension. Fear or anxiety can make muscle tightening possible with real ramifications. All of these can contribute to a higher level of muscle tightness which can easily lead to hypertonic pelvic floor.

• Chronic stress, trauma to the pelvic area, surgery, or radiation therapy in the pelvic region are some of the most common causes of hypertonic pelvic floor.

• Chronic constipation or straining during bowel movements can also lead to this condition.

I feel that it’s important to emphasize that everyone’s experience with hypertonic pelvic floor will differ, and the underlying causes can vary.

My issues very likely came from running and starting pilates about 6 months after having my son. Running and pilates are not bad, obviously, but I wasn’t balancing the work with proper recovery, stretching and muscle relaxation. I also struggled with postpartum anxiety, which no doubt contributed to the problem as well.

Hypertonic Pelvic Floor Symptoms

Symptoms of hypertonic pelvic floor can appear in various ways, and the severity of the symptoms can differ from woman to woman. Here are some signs and symptoms to look for:

Pelvic pain:

You may experience discomfort or severe pain in the pelvic area. It can feel like a dull ache, sharp pain, or pressure that comes and goes. My initial symptom was a dull ache; I felt like I had been kicked in the pubic bone… like it was bruised.

Bowel symptoms:

Hypertonic pelvic floor can lead to chronic constipation or difficulty passing stools. You may feel like you need to go, but nothing comes out, or you may have infrequent bowel movements. Also, having difficulty passing stools or experiencing pain in the rectum during bowel movements can be another sign.

Difficulty with bladder function:

You may have trouble starting or stopping urination or feel like you can’t fully empty your bladder. You may also feel like you haven’t fully emptied your bladder after going to the restroom or have a sudden intense urge to urinate that’s difficult to control. And you may wet your pants without meaning to. Even if this is something you’ve been struggling with for years (and are considering surgery), you should still see a pelvic floor PT. They can do so much to help without surgery.

Pain during sexual intercourse:

Hypertonic pelvic floor can cause pain during sexual intercourse, which can be distressing and affect your quality of life. Sexual symptoms can vary greatly, but they often include pain during or after sex and the inability to orgasm. This tension can develop slowly over time and become more pronounced with time.

Unexplained injuries:

If you have other injuries that you just can’t seem to pinpoint why they’re happening, try seeing a pelvic floor PT. The pelvic floor muscles impact how your entire body functions, even if it doesn’t seem related.

Hypertonic Pelvic Floor Treatment

When it comes to treating hypertonic pelvic floor, several options are available, depending on the severity of your condition. Treatment plans may involve a combination of medication, surgery, therapies, and exercises to help alleviate your symptoms and improve your pelvic floor health. Treatment options available for hypertonic pelvic floor may include:

Medications

Your doctor could prescribe muscle relaxants or other medications to help manage the symptoms of hypertonic pelvic floor.

Surgical Interventions

In some cases, surgery may be necessary to treat hypertonic pelvic floor. For example, some women may require surgery to repair pelvic organ prolapse, which can contribute to hypertonic pelvic floor.

Therapies

Pelvic floor physical therapy can be an effective treatment option for hypertonic pelvic floor. A physical therapist trained in pelvic health can teach you relaxation and strengthening exercises to help you manage your symptoms. (When I was newly postpartum, I used Recore Fitness online classes. Many of the exercises in that are the same ones my PT now prescribes so it’s a great option if you like having an online program to guide you through exercises at home. Ask your therapist if he/she is okay with that first though.)

Dry Needling

Dry needling can be done on areas surrounding the pelvic floor. My hip flexors were extremely tight which led to my pelvis being shifted and that pulled on other muscles. By loosening the muscles around the pelvic floor, it can allow some of the stress on the pelvic floor to relax. You can read about my experience with dry needling here.

Botox Injections

Botox injections can relax your pelvic floor muscles and alleviate symptoms. This treatment is typically reserved for cases that do not respond to other treatments.

Hypertonic Pelvic Floor Exercises

Pelvic floor exercises can be beneficial in managing overactive pelvic floor muscles. The following exercises are effective in helping relax your pelvic floor:

Diaphragmatic Breathing

This technique involves breathing deeply into your belly, which can help to relax your pelvic floor muscles. This was the very first exercise my PT gave me to do. Just 4 diaphragmatic breaths, 3x a day.

Pelvic Drops

This exercise involves standing with your feet shoulder-width apart and dropping your pelvic floor muscles as you exhale. One of my favorite pelvic floor PTs explained this as lifting and lowering a blueberry in your pelvic floor, like it’s going up and down a slow elevator.

Kegels

Kegel exercises are beneficial in strengthening your pelvic floor muscles. Whether it’s bladder incontinence, hypertonic pelvic floor (or the desire for better sex!), kegels can be your go to exercise for overall pelvic floor health.

However, performing them correctly is important, as doing them incorrectly can worsen the condition. A physical therapist trained in pelvic health can teach you how to perform Kegels correctly. They may also tell you to STOP doing kegels.

Reverse Kegels

Reverse Kegels are another exercise that can help to relax the pelvic floor muscles. They involve contracting the muscles used to push urine out instead of the ones used to stop the flow of urine.

Yoga

Certain yoga poses, such as child’s pose and happy baby, can help to release tension in the pelvic floor muscles and improve overall pelvic health.

Remember, you’re not alone in this!

These symptoms don’t typically get better on their own, so it’s crucial to recognize the signs, so that you can get help. And if you feel like you don’t know where to start with pain, discomfort or injuries, try a pelvic floor PT. It’s been the most holistic care I’ve ever received. My pelvic floor PT has helped me with pain all the way from my ankles to my neck.

By working with a team of healthcare professionals Rather than suffering through, thinking that this is just your new normal after having kids, find a good team of health care professionals so you have an action plan. You deserve to feel your best!

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