Tight pelvic floor muscles are just as problematic as weak ones but much less is written about them.
We regularly hear the call to action strengthen your pelvic floor, do your exercises every day, squeeze, squeeze and squeeze again ………but there is a significant group of people who SHOULD NOT STRENGTHEN THEIR PELVIC FLOOR yes I said SHOULD NOT.
This is the group of men and women whose pelvic floors are so tight and over-tensed that doing pelvic exercises will get them nowhere and in fact will make matters worse.
How can doing pelvic floor exercises be bad for me? How do I tell if that is the case with me …and if so, what do I do instead?
Think of your pelvic floor as a lift in a building . At rest it is on the 1st floor – a small degree of natural tension in the muscles just like all the other postural muscles in your body. You don’t feel your neck muscles working when sitting upright but they are, so they can help hold your head up. You only feel them when the tension increases beyond normal, as in sitting at the computer in poor posture, head forwards, the neck muscles have to work harder to hold your head , they fatigue and get sore – often leading to headaches and neck pain. Over time this can develop into chronically tight neck muscles.
When you do a pelvic floor squeeze – think of your pelvic muscles closing and lifting to the 3rd or 4th floor, you can hold a while then have to release them back to resting. A cough or sneeze will create very forceful pressure downwards on your pelvic floor- they may rise to the top 5th floor and then relax back down afterwards. When you go to the toilet, your pelvic floor muscles relax down to ground or basement to totally relax and allow your bladder or bowel to empty correctly.
Up and down, in and up, squeeze and relax.
Now, what if your pelvic floor were- like your tight neck muscles- overworking all the time? They wouldn’t be sitting on 1st floor waiting for action up to the 3rd, 4th or 5th floor as they may be already sitting at the 4th floor - so when you try to squeeze them up there is nowhere for them to go. . Now this will be felt on palpation internally, or by you, to be no activity – they can’t go anywhere because they are already there!!
Constant tension in these muscles put pressure on the bladder and bowel.
This is how they work: Pelvic floor muscles tighten, which tightens the fascial or elastic tissue they attach to which in turn lifts the bladder neck and closes it off, much like stepping on a hose. The elastic tissue is tensioned by the pelvic floor muscles tightening and acts like the hard concrete driveway . If the fascial/ elastic tissue is stretched or torn, then it is more like stepping on the hose on soft grass – you get some closure but not completely.
This is why we tighten to close the urethral and anal openings and relax to release or open them – in other words stop or go to the toilet.
Tighten to hold , relax to go.
So if they are already tight, can’t relax and let go ….then how are you going to “GO”?
So – tight pelvic floor muscles not only affect the ability for you to go to the toilet , they can also cause pain , much like muscle tension in the neck.
Signs to look for:
- difficulty initiating or starting flow of urine.
- thin pencil like bowel motions
- pain during or after using bladder or bowel
- urgency of bladder
- feeling like you haven’t emptied properly
- painful sex especially pain or difficulty on penetration
- combined with some of these symptoms you are unable to effectively tighten or squeeze your pelvic floor
This list is an indication only and may mean that you have overtight pelvic floor muscles , but they are all symptoms from other causes as well. If you suspect you may have this problem please consult your doctor or physiotherapist who specialises in pelvic floor treatments.
In cases where the pelvic floor muscles are already over working / too tight or hypertonic to use the medical term, initial treatment consists of learning how to relax the muscles back to their normal resting tone. It may also involve muscle releasing techniques just like when you have treatment with your physiotherapist for neck pain. The only difference is that these muscles are internal – it is a very specialised area of treatment so you need to see a physiotherapist trained in this area.
Treatment may also involve relaxation techniques:
The use of dilators
Once the muscles have been released and you are able to relax them, then treatment will progress to a strengthening program if appropriate.
Here’s to pelvic health