Tight (Overactive) Pelvic Muscles
Having a strong pelvic floor is essential for the support and functionality of your pelvic organs. Like any other muscle, the muscles of the pelvic floor can tighten when they are overworked. This can be quite painful, and lead to the muscles weakening. As a result you can develop multiple pelvic floor disorders such as an overactive bladder and orgasmic dysfunction. Learn more about the role of the pelvic floor and why you need to keep your pelvic floor strong.
When your pelvic muscles are overworked, you will feel a tenderness and deep ache in your pelvis as they tighten. If you repeatedly overload your pelvic floor, trigger points in the muscle can activate. These points become more sensitive and experience severe sharp pain. Specific activities and movements may aggravate this pain by putting pressure on these trigger points.
If your muscles are frequently overloaded, they can experience long term fatigue from being contracted for long periods. This leads to them weakening, and as a result they become unable to react when you need them to. This can lead to the development of pelvic floor disorders, such as incontinence and even pelvic organ prolapses (POP).
Therefore it is important that you seek treatment as soon as possible, and begin exercising your pelvic floor correctly to correct any damage and maintain your muscles for the future.
How are Tight Pelvic Muscles Diagnosed?
Anyone, of any age, can experience a tight pelvic floor. The group that most often suffers is young women. Before treatment for pelvic pain can begin, your doctor will need to exclude other potential causes of the pain. To do so, they will:
- Complete an observational pelvic examination - To see any obvious causes for your pelvic pain, such as infection or injury.
- Complete a biofeedback method - Using a vaginal or anal probe to measure the strength of your pelvic floor as you squeeze against it. If your pelvic floor muscles are very tight, it may not even be possible to insert a probe.
- Discuss areas of particular sensitivity
- Discuss postures you have found that relieve your pain the most
- Discuss other conditions you are suffering from - Which may be symptoms or causes of a tight pelvic floor.
What are the Symptoms of Tight Pelvic Muscles?
The symptoms associated with tight pelvic floor muscles often appear gradually. They can begin in early childhood as a general discomfort and, as the condition develops, the symptoms intensify into more severe pain and incontinence issues. This is often the stage where treatment is sought.
- Pelvic pain and tenderness - A tenderness and aching feeling is usually localised to the perineum and anterior wall (front) of the vagina in women. It may be accompanied by single trigger points of more intense pain, that are aggravated by certain movements and postures where they are under greater pressure.
- Involuntary muscle spasms - Muscle spasms often occur in skeletal muscles when they are overused and fatigued. They can be quite painful, but are often short lived and relieved by stretching the area.
- Bladder and bowel issues - For the bladder and bowel to function correctly, the muscles of the pelvis and digestive system need to coordinate, with some contracting whilst others relax. The pelvic muscles must be able to rest for the sphincter muscles to relax. This is not possible when you have a tight pelvic floor that is unable to fully relax.
- Bladder / urinary incontinence - You may have difficulty in urinating, and slowing the flow of urine once you begin. Urge incontinence and an overactive bladder (OAB) are common as the bladder may never fully be emptied.
- Constipation - If you are very tense, you may be unable to have a bowel movement without immense straining.
- Bowel incontinence - If you have suffered from constipation for a long period of time, straining to defecate will have put pressure on your pelvic floor, causing it to weaken. As a result, you may no longer have the strength to prevent bowel movements from occurring.
- Recurring urinary tract infections (UTI's) - If you are struggling to fully empty your bladder, you are more prone to developing UTI's as bacteria often remains around the urethra and bladder.
- Abdominal bloating and tenderness - If you are unable to empty your bowel fully, you can have a build up of wind.
- Intimacy issues - You may experience discomfort or pain during and after sexual intercourse. This pain can radiate into your lower back and thighs.
- Painful sex due to vaginismus (in women) - Vaginismus is when your pelvic floor acts as a defence mechanism, involuntarily contracting to prevent anything from penetrating your vagina. This may make it difficult or impossible to have sex. You may not even be able to use a tampon or menstrual cup. You can read more about vaginismus here.
- Erectile dysfunction (in men) - The anatomy and function of the muscles for penile erectile hardness is complicated. It is clear, however, that the muscles need to be able to contract and relax for the function to be successfully.
- Ejaculatory and orgasmic dysfunction - The muscles must successfully coordinate, with some contracting whilst others relax, for a successful orgasm and male ejaculation. If the pelvic floor muscles are weak or tight, this cannot happen.
Conditions with similar symptoms include lower urinary tract issues and an overactive bladder. Therefore a tight pelvic floor is often misdiagnosed as such, which can delay appropriate treatment.
What Causes Tight Pelvic Muscles?
Overactive, tight pelvic floor muscles often develop over a long period from a combination of these factors:
- Too much pelvic floor exercise - Exercising your pelvic floor too often can prevent your muscles from having time to heal. The Bladder and Bowel Foundation recommend you limit your exercises to 3-4 times a day. Within an exercise, rest your pelvic floor for as long as it is contracted for, and make sure it is a full relax and you breath normally throughout.
- Incorrectly exercising your pelvic floor - Exercising your pelvic floor incorrectly can cause areas of muscle tension and weakness. Learn how to contract the correct muscles here.
- Pelvic surgery - Undergoing any surgery in the pelvis can lead to nerve and muscle damage.
- Pelvic infection - If you have an infection, the inflamed tissue will tighten and swell.
Emotional or mental factors - You may tense your pelvic floor as response to abuse. This can result in anxiety around relaxing these muscles, leaving them consistently contracted.
- Poor posture - The human skeleton is reliant on each of its components to support and move your body. This means that if you have a poor posture, some parts become overworked to compensate for others. Read more about how poor posture can cause pelvic pain here.
- Habit - You may not have learned how to correctly fully empty your bladder and bowel when you where younger, meaning you never fully relax your pelvic floor. Or your current lifestyle or occupation may prevent you from accessing a toilet often so you frequently suppress the urge, and rarely relax your sphincter muscles to prevent leaks. This can cause pelvic floor dyssynergia.
- Painful sex (dyspareunia) - As well as being a symptom of a tight pelvic floor, if you continue to have sex when it is painful, you can inadvertently cause your muscles to tighten more as they attempt to involuntarily prevent you from continuing.
To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.
How to Relax the Pelvic Floor
To stop muscle spasms and relieve your pain, you need to relax your pelvic floor.
Biofeedback therapy - Squeezing against a vaginal or anal probe, the contractions and relaxations of your pelvic floor will be scored to show their efficiency. This technique can help teach you to fully relax and contract your muscles most effectively.
- Exercise your pelvic floor correctly - Don't over do it. Use an electronic pelvic toner with set programmes. These do the work for you, giving your muscles appropriate rest time in between the contractions.
- Relax your pelvic floor - The Kegel8 Ultra 20 electronic pelvic toner features a 20 minute relaxation programme, which helps relax tense pelvic floor muscles with NMES. Once your muscles are soothed, you can continue to use the toners other programmes as pelvic floor maintenance, and to deal with any other pelvic floor disorders you are suffering from, such as incontinence or a pelvic organ prolapse (POP).
- Avoid heavy lifting - Which puts extra pressure on the pelvic floor, causing it to weaken.
- Avoid intense core/abdominal exercises - Exercising your abdominal muscles puts pressure on your pelvic floor, as they press down when they are contracted.
- Take time to relax - Just like any other muscle in the body, if you are stressed or tense, your pelvic floor muscles will get tense too. You should find taking a warm bath can help.
- Take things slowly in the bedroom - Make sure intercourse is slow and gentle, to avoid trauma to the pelvic area. If you have suffered with a tight pelvic floor for a long time, consider speaking to a sex therapist to reduce any anxiety you may be feeling.
- Myofascial trigger point release - Following these three techniques, with a Physiotherapist, can relax the trigger points of your pain.
- Manual therapy - The points are temporarily put under pressure and stretched out.
- Dry needling - A needle is quickly and repeatedly inserted into the trigger points.
- Wet needling - Lidocaine or botulinum toxin (commonly referred to as Botox) is injected to numb the trigger points.
If your muscles have shortened as result of tightening, relaxing your pelvic floor may not be enough to treat your pelvic pain. Your muscles will need to be stretched for you to regain normal function. You will need to:
- Retrain your muscles - Therapy to retrain your muscles to effectively relax when you use the bathroom, can prevent recurrence.
- Decrease sensitivity - If you have suffered for a long time, you may be unable to stand the sensation of vaginal penetration or bowel movements. To decrease the sensitivity of these areas, you can retrain the areas with probes increasing in size.
To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.
Aw, H. C. Ranasinghe, W. Tan, P. H. M. O’Connell, H. E. (2017). Translational Andrology and Urology.Overactive pelvic floor muscles (OPFM): improving diagnostic accuracy with clinical examination and functional studies. [online] 6(Suppl 2), pS64-S67. [viewed 15/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5522794/
Bladder and Bowel Foundation. (2008). Pelvic Floor Exercises For Women. [online] Bladder and Bowel Foundation, 2008 [viewed 15/05/18]. Available from: https://www.nhs.uk/Planners/pregnancycareplanner/Documents/BandBF_pelvic_floor_women.pdf
Butrick, C. W. (2009). Obstetrics & Gynecology Clinics of North America. Pathophysiology of pelvic floor hypertonic disorders.[online] 36(3), p699-705. [viewed 15/05/18]. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0889-8545(09)00063-1
Cohen, D. Gonzalez, J. Goldstein, I. (2016). Sexual Medicine Reviews. The Role of Pelvic Floor Muscles in Male Sexual Dysfunction and Pelvic Pain. [online] 4, p53-62. [viewed 15/05/18]. Available from: https://www.smr.jsexmed.org/article/S2050-0521(15)00002-5/pdf
De Paepe, H. Hoebeke, P. Renson, C. Van Laecke, E. Raes, A. Van Hoecke, E. Van Daele, J. Vande Walle, J. (1998). British Journal of Urology. Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. [online] 81(Suppl.3), p109-113. [viewed 15/05/18]. Available from: https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1464-410x.1998.00021.x
Engeler, D. Baranowski, A. P. Borovicka, J. Cottrell, A. Dinis-Oliveira, P. Elneil, S. Hughes, J. Messelink, E. J. van Ophoven, A. Reisman, Y. Williams, A. C. D. C. (2014). Guidelines on Chronic Pelvic Pain. [online] European Association of Urology, 2014. [viewed 15/05/18]. Available from: https://uroweb.org/wp-content/uploads/26-Chronic-Pelvic-Pain_LR.pdf
Faubion, S. S. Shuster, L. T. Bharuchac, A. E. (2012). Mayo Clinic Proceedings. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction. [online] 87(2), p 187-193. [viewed 15/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498251/
Loving, S. Thomsen, T. Jaszczak, P. Nordling, J. (2014). European Journal of Pain. Pelvic floor muscle dysfunctions are prevalent in female chronic pelvic pain: A cross‐sectional population‐based study. [online] 18(9), p1259-1270. [viewed 15/05/18]. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/j.1532-2149.2014.485.x
Lucas, N. Macaskill, P. Irwig, L. Moran, R. Bogduk, N. (2009). The Clinical Journal of Pain. Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. [online] 25(1), p80-89. [viewed 15/05/18]. Available from: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0027220/
Montenegro, M. L. Mateus-Vasconcelos, E. C. Rosa e Silva, J. C. Nogueira, A. A. Dos Reis, F. J. Poli Neto, O. B. (2010). Pain Medicine. Importance of Pelvic Muscle Tenderness Evaluation in Women with Chronic Pelvic Pain. [online] 11(2), p224-228. [viewed 15/05/18]. Available from: https://academic.oup.com/painmedicine/article/11/2/224/1807291
Simons, D. G. Mense, S. (1998). Pain. Understanding and measurement of muscle tone as related to clinical muscle pain. [online] 75(1), p1-17. [viewed 15/05/18]. Available from: http://insights.ovid.com/pubmed?pmid=9539669
Wedro, B. (2017). Muscle Spasms. [online] MedicineNet.com, 2017 [viewed 15/05/18]. Available from: https://www.medicinenet.com/muscle_spasms/article.htm#muscle_spasm_facts