When people think of pelvic-floor muscles, it’s usually in the context of pregnancy (or post-pregnancy), urinary incontinence, and the well-known pelvic floor exercise kegels. But, believe it or not, the pelvic floor has a very important job for all genders, regardless of whether you’ve given birth before. “The pelvic floor is a thin, bowl-shaped group of muscles that makes up the bottom-most portion of the abdomino-pelvic cavity,” explained Dr. Sarah Collins, urogynaecologist at Northwestern Medicine Central DuPage Hospital in Illinois. “It supports your pelvic organs, including your vagina, uterus, rectum, bladder, and urethra. The pelvic floor is so important for a number of reasons. First, your urethra, vagina, and rectum pass through it, and the function of those structures is affected by your pelvic floor.”
If all of this is new to you, you’re definitely not alone. The conversation around pelvic floor dysfunction has predominantly centred around having a weak pelvic floor, with the most common symptoms people present with being urinary or stool incontinence, or a heavy or bulging sensation in the vagina. But, it turns out that having overly tight, or “hypertonic,” pelvic floor muscles is an issue spoken about a lot less often, even though it’s equally important and comes with a whole other set of symptoms.
“The pelvic floor is so important for a number of reasons. First, your urethra, vagina, and rectum pass through it, and the function of those structures is affected by your pelvic floor.”
All the experts who spoke to POPSUGAR agreed that common symptoms of hypertonic pelvic floor muscles are: back pain, difficulty controlling your bladder or bowels, and pain or unpleasant sensations in the bowel or bladder during penetrative sex. On the last point, Dr. Helen Bernie, a urologist at Indiana University Health, added that “sex should never be painful. Pelvic floor dysfunction can cause painful sex, vaginismus, decreased or painful orgasms, as well as positional pain.”
Historically, the only thing we’ve been taught about our pelvic floor muscles is that tighter equals better, and weak is disastrous — but it turns out, that’s not strictly true. “Believe it or not, the focus on ‘strengthening’ and ‘tightening’ the pelvic floor muscles is usually misplaced,” Dr. Collins told POPSUGAR. “In most women with pelvic floor muscle dysfunction, the muscles are not weak but actually too tight, so they can become chronically contracted, losing their range of motion. Muscles that are chronically contracted do not work properly because they are unable to relax or squeeze well.” Dr. Bernie agreed, explaining that “our goal is to have a strong pelvic floor that can lengthen, elongate, relax, and contract as it needs to for normal body functions and support.”
“There are many causes of hypertonic (overly contractile, tight pelvic floor muscles), including emotional states such as high stress, anxiety, or fear,” Dr. Bernie said. “Many people carry their emotions in the pelvic floor, which can cause overly contractile, hypertonic states, leading to weakened pelvic floor muscles and dysfunction.” She explained that there are many causes for this, such as overusing the pelvic muscles (for example, going to the bathroom too frequently or pushing and straining too hard when you do), which eventually leads to poor muscle coordination.
Dr. Bernie also noted that overtraining your pelvic floor muscles with repetitive exercises such as kegels, which focus only on tightening the muscles, can also result in an imbalance in the pelvic floor. Dr. Collins seconded this point, explaining that “kegels actually are not right for most women as a form of exercise because, while it is important to be able to perform a pelvic floor muscle contraction (or kegel squeeze), it is at least as important to be able to relax the pelvic floor.”
“Our goal is to have a strong pelvic floor that can lengthen, elongate, relax, and contract as it needs to for normal body functions and support.”
Dr. Karyn Eilber, MD, a urologist at Cedars-Sinai Medical Center in California, who has a subspecialty board certification in female pelvic medicine and reconstructive surgery, said that a common scenario is a woman who has recurrent bladder infections eventually developing hypertonic pelvic floor muscles. “Every time she urinates, she contracts her pelvic floor in anticipation of pain, and over time, her muscles can stay tight. Another situation is chronic pelvic pain due to conditions such as endometriosis. Similar to the woman with recurrent infections, because she is in pain, she clenches her pelvic muscles to help ease the pain, which actually makes her situation worse,” thus, resulting in muscles that are overly tight.
Unfortunately, the deeper you dive, the clearer it is that pelvic floor dysfunction is extremely common, so seeing a specialist if you suspect pelvic floor dysfunction is the best way forward. The first step is booking to see your general practitioner, who can then refer you to a urologist, urogynaecologist, or a specialist physical therapist. Dr. Bernie also recommended ISSWSH.org (The International Society For the Study of Women’s Sexual Health), which she said is a wonderful website full of information for women with sexual dysfunctions or pelvic floor dysfunctions.