Overactive Pelvic Floor
By Lauren Zanelli, Pelvic Health Physiotherapist
What is an overactive pelvic floor?
When we hear about pelvic floor dysfunction, most of us think of weakness or loss of control - however there's another important, and often overlooked, aspect: overactivity.
Understanding the Pelvic Floor
The pelvic floor is a group of muscles and connective tissues that sit like a hammock at the base of your pelvis. These muscles support your pelvic organs (the bladder, uterus, and rectum), help maintain continence, and play a key role in sexual function.
Just like any muscle group, the pelvic floor muscles can experience imbalances. Overactive pelvic floor muscles have difficulty relaxing or may even contract when relaxation is functionally needed, for example when emptying your bladder or opening your bowels (Frawley et al., 2021). This lack of necessary relaxation can disrupt essential functions and lead to symptoms such as pain, urgency or difficulty emptying your bladder or bowels.
What Causes an Overactive Pelvic Floor?
Several factors can contribute to heightened resting tone:
Persistent stress or anxiety, which can lead to muscle tension throughout the body, including the pelvic floor
Holding in urine or bowel movements frequently, causing the muscles to stay contracted for long periods
High-impact exercise or heavy lifting without proper core coordination
Past trauma or injury, including childbirth, pelvic surgery, or sexual trauma
Medical conditions, such as endometriosis, interstitial cystitis, or irritable bowel syndrome (IBS)
Common Symptoms
When the pelvic floor muscles cannot fully relax, it can manifest in a variety of ways. These include:
Pelvic pain or discomfort (including during sex)
A frequent or urgent need to urinate
Difficulty starting or fully emptying the bladder or bowels
Painful bowel movements or constipation
Lower back, hip, or abdominal pain
Muscle spasms or a feeling of tightness in the pelvic region
How Is It Assessed?
Assessment by a pelvic floor physiotherapist may involve:
A detailed history
A physical exam to assess muscle tone, coordination and ability to relax
Possibly imaging or urodynamic studies if further information is needed
Management Options
You can manage overactive pelvic floor muscles and improve your pelvic floor function with the right approach. Effective management options include:
Pelvic floor physiotherapy: Learning techniques to relax, strengthen and coordinate the pelvic floor muscles
Breathing and relaxation techniques: To reduce muscle tension and stress response, and promote full muscle relaxation
Biofeedback: Using sensors to provide feedback, improving awareness and control over time
Lifestyle changes: Including posture, bowel habits, and exercise modifications
Psychological support: Especially beneficial when anxiety, trauma, or stress are contributing to persistent muscle tension
With a comprehensive treatment plan, you can regain control, reduce discomfort, and improve overall pelvic floor function.
If you’re experiencing persistent pelvic symptoms that don’t have a clear cause, it might be worth having your pelvic floor muscles assessed by a pelvic floor physiotherapist. A thorough assessment may help identify any muscle tension or dysfunction and guide you towards an effective, tailored management program.
References:
Frawley, H., Shelly, B., Morin, M., Bernard, S., Bø, K., Digesu, G. A., Dickinson, T., Goonewardene, S., McClurg, D., Rahnama’i, M. S., Schizas, A., Slieker‐ten Hove, M., Takahashi, S., & Voelkl Guevara, J. (2021). An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment. Neurourology and Urodynamics, 40(5), 1217–1260. https://doi.org/10.1002/nau.24785