Hypertonic Pelvic Floor: Causes, Symptoms, and Exercises for Tight Pelvic Floor Muscles

You feel like you have to pee all the time — but the flow is more like a dribble than a whoosh. Pooping has its own problems: You can go days being constipated and when the urge finally arrives, it’s tough to get things moving and an effort to complete. You might wonder why you’re blessed with both issues and what you can do to fix it. The culprit might be hypertonic pelvic floor — a mouthful of a name for when pelvic floor muscles are too tight. When pelvic floor muscles stay tense or contracted, they can’t properly coordinate certain bodily functions. That can lead to problems with urination and bowel movements, pelvic pain, painful sex or even pain while using a tampon or during an ob-gyn exam. Read on to learn about hypertonic pelvic floor muscles, symptoms and causes, the benefits of pelvic floor physical therapy for too-tense muscles and the best exercises and other treatments to relax tight pelvic floor muscles.

What Is Hypertonic Pelvic Floor?

First, a little refresher on your pelvic floor: This group of muscles and tissues is shaped like a bowl at the bottom of your torso. Your pelvic floor stretches from your pubic bone in front to your tailbone in the back. It helps support and hold pelvic organs in place and plays a role in bladder and bowel control and sexual response.

Just like other muscles in your body, your pelvic floor muscles can get too tight. Hypertonic means excessive tone. The muscles may stay contracted, spasm, or have difficulty relaxing. An overly tight pelvic floor can lead to pain, bowel and urinary symptoms, and sexual dysfunction.

Hypertonic Pelvic Floor Symptoms

One common symptom is persistent pelvic pain. You may also feel pain or pressure in your lower back or hips. Pain can come from a specific spot, like your bladder, or with specific activities, such as during urination or bowel movements. Other signs your pelvic floor muscles are too tight include: 

• Urinary urgency and frequency (needing to pee urgently, often, or right after you go)

• Urinary incontinence (a sudden urge to urinate, followed by leaking pee)

• Difficulty starting to urinate

• Slow urine flow

• Difficulty starting a bowel movement

• Straining when pooping, or being unable to empty completely

• Constipation

• Painful intercourse, or dyspareunia

• Pain while inserting a tampon or during a gynecological exam

Symptoms of a tight pelvic floor tend to develop slowly and get worse over time. 

Causes of Hypertonic Pelvic Floor

Pelvic floor tightness may be due to many different factors. Some potential causes include:

• Frequently delaying urination or bowel movements

• Injury to your pelvic floor from surgery or childbirth

• Certain pain-causing conditions, such as irritable bowel syndrome, painful bladder syndrome or endometriosis

• Carrying tension due to stress or anxiety in your pelvic floor muscles (just as you might hold tension in your neck, shoulders, or back muscles) 

• A habit of “hover-peeing” (squatting above the toilet to urinate, which can make it difficult for your pelvic floor muscles to relax)

• Breathing patterns (a habit of shallow or chest-breathing that reduces the normal movement of the pelvic floor during breathing)

• Weakness in nearby muscles (e.g., hips, glutes) that causes pelvic floor muscles to compensate

• Sexual trauma

Physical Therapy for Hypertonic Pelvic Floor

The primary treatment for hypertonic pelvic floor muscle dysfunction is physical therapy to retrain your muscles. Muscles are designed to contract and relax. For a healthy pelvic floor, you need to be able to tighten (contract) the muscles and fully release (relax) them so they function properly. When pelvic floor muscles are constantly contracted, it can lead to painful symptoms. Pelvic floor physical therapists (PTs) can provide relaxation exercises to help stretch and relax tense muscles to relieve many different pelvic symptoms. Relaxation exercises can:

• Reduce pelvic, low back, and bladder pain  

• Reduce pain while urinating or during bowel movements

• Improve sexual function

• Improve bladder control and reduce urgency and frequency 

• Improve bowel control and reduce constipation

Can Pelvic Floor Muscles Be Both Tight and Weak?

Yes. Pelvic floor muscles are often both tight and weak. When that’s the case, PTs will focus on exercises to release tension in the muscles first. Trying to strengthen overly tight muscles can make symptoms worse, explains Jacquelyn White, PT, DPT, a Hinge Health pelvic floor physical therapist. Instead, you need to relax and stretch, or lengthen, the muscles before you strengthen them. 

Pelvic floor physical therapy is a comprehensive treatment that may include education, behavioral and lifestyle strategies, movement and exercise, and manual therapy. 

You can see a physical therapist in person or use a program like Hinge Health to access a PT who specializes in pelvic health via telehealth video visit.

Diaphragmatic Breathing for Hypertonic Pelvic Floor

Diaphragmatic breathing may be a key part of your pelvic floor physical therapy treatment for hypertonic pelvic floor. Here’s why: With each breath you take, your diaphragm (the muscle that sits at the bottom of your ribcage) moves. When your diaphragm moves, your pelvic floor moves. Think of these two as dance partners.

When you inhale, your diaphragm moves down. This causes your pelvic floor to lower slightly, giving it a nice stretch. When you exhale, your diaphragm rises up, which allows your pelvic floor to move upward with a gentle contraction.

Slow, deep breathing (aka diaphragmatic breathing) allows your pelvic floor to rest periodically so your muscles can relax and remain strong and flexible.

More Ways to Treat Hypertonic Pelvic Floor

Depending on your symptoms, your healthcare provider or pelvic floor physical therapist may also recommend additional techniques and lifestyle changes as part of your treatment plan. Some strategies may include:

• Relaxation techniques. Deep diaphragmatic breathing and progressive muscle relaxation can help reduce muscle tension and promote pelvic floor relaxation, says Dr. White.

• Biofeedback. This can help you identify your pelvic floor muscles and contract and relax them correctly.

• Pelvic myofascial release therapy. Also known as trigger point therapy, myofascial release is a type of gentle, constant massage that helps release tightness or restrictions in the fascia, or connective tissue that surrounds and supports the muscles, explains Dr. White. Applying sustained pressure to trigger points, or knots, in the perineum (the area between your rectum and vagina) with a small yoga or tennis ball can release tension in a tight pelvic floor. By targeting areas of tightness and trigger points, myofascial release helps restore flexibility and mobility to the pelvic area.

• A pelvic wand. Used for internal massage, this tool can help stretch and release tight muscles and improve blood flow to the area, which can help reduce pain.

To help relax your pelvic floor muscles, your pelvic floor physical therapist may recommend exercises including:

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Tips to Prevent Hypertonic Pelvic Floor

You can take steps to help keep your pelvic floor healthy and prevent hypertonic pelvic floor. Some strategies include:

• Modify bathroom habits (Bladder retraining and avoiding straining during bowel movements, for example, can alleviate pelvic floor strain)

• Practice mindfulness and stress management techniques

• Incorporate regular movement into your daily routines

• Stay hydrated and maintain a balanced diet to prevent constipation

• Seek prompt treatment for pelvic pain or symptoms to prevent chronic issues

PT Tip: Pelvic Floor Health Is About Balance

“Kegel exercises can be beneficial for some pelvic floor conditions, but they're not always the solution,” says Dr. White. “Balancing strengthening with relaxation is important, so make sure your pelvic floor muscles are relaxed before attempting strengthening exercises.” Coordinating your breathing with exercises can make them more effective and promote relaxation, she adds. “And remember that consistency and patience are key for better pelvic health.” 

How Hinge Health Can Help You

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Grimes, W. R., & Stratton, M. (2021). Pelvic Floor Dysfunction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559246/

3. Huang, Y. C., & Chang, K. V. (2022). Kegel Exercises. In StatPearls. StatPearls Publishing. 

4. Shaheed, H. (2019, June 13). The hypertonic pelvic floor. Continence Foundation of Australia. https://www.continence.org.au/news/hypertonic-pelvic-floor

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