Hypertonic (High Tone) Pelvic floor

Written By Ciara Devery

I’ve had so many clients recently with issues associated with a high tone pelvic floor - some of whom have been suffering for years with pain, incontinence, bladder urgency and frequency!

What is a hypertonic pelvic floor?

A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.

What causes a hypertonic pelvic floor?

There is no one defining cause of a hypertonic pelvic floor; however, there are several activities which can lead to the muscles tightening up.

Examples include:

  • Many people who spend a lot of time working keep these muscles switched ‘on’ without giving the muscles time to relax and let go.

  • People who have a history of holding on to their bladder and/or bowels can also develop tension in their pelvic floor muscles. For instance, some people feel uncomfortable using public toilets so may hold on to their bladders for hours until they come back home from school/work.

  • High levels of stress, fear or anxiety can cause muscles to reflexively tighten, these factors can lead to a hypertonic pelvic floor.

  • Pelvic health and abdominal health conditions can also result in hypertonicity of the pelvic floor. For example, many women with endometriosis can develop tense pelvic floor muscles due to the chronic pain and inflammation in the pelvis. Similarly, a history of irritable bowel syndrome with abdominal pain and cramping can result in pelvic floor muscle pain and cramping. Other conditions linked to a hypertonic pelvic floor include interstitial cystitis, pudendal neuralgia and vulvodynia.

  • Birth trauma and scar tissue is another cause of tightness in the pelvic floor muscles. Women who experience perineal tearing or vaginal tearing may be at a higher risk, as the pain and scarring can cause the pelvic floor muscles to tighten protectively. One-sided pelvic floor tears can cause the opposite side of the pelvic floor to tighten due to overactivity.

It is crucial to identify the cause of the pelvic floor hypertonicity in each individual. A pelvic health physiotherapist will be best equipped to do this.

What are the signs and symptoms of a hypertonic pelvic floor?

The typical sign of a hypertonic or non-relaxing pelvic floor is pelvic muscle pain; however, there are a variety of signs and symptoms, including:

  • constipation

  • incomplete emptying of the bowels

  • straining when emptying the bowels

  • low back pain

  • hip pain

  • coccyx pain

  • painful sex

  • vaginismus

  • urinary incontinence

  • incomplete emptying of the bladder

  • slow flow of urine

  • hesitancy or delayed start of urine stream

  • urinary urgency

  • urinary frequency, and

  • painful urination.

What to do if you think you have a hypertonic pelvic floor?

If you have any of the signs or symptoms of a hypertonic pelvic floor, seeing a pelvic health physiotherapist is essential. The physiotherapist will be able to identify the root cause of the hypertonicity and provide tools to help overcome this.

A continence physiotherapy session may involve a combination of the following:

  • pelvic floor muscle relaxation techniques

  • breathing techniques

  • advice on bladder and bowel habits

  • pelvic floor and abdominal massage techniques

  • pelvic and hip stretches, and

  • scar tissue massage techniques.

“I have to share just how amazing Ciara is in helping ladies of all ages with pelvic health care.
I was being treated for constant kidney infections ( or that is what I thought I had) but it wasn’t that at all.. it was hyper tonic pelvic floor.
I discovered this after my first appointment with Ciara and after 6 treatments I was back to my old self and no pain. This all began after the birth of my children.
Ciara is absolutely wonderful, she puts you at ease right away and is so professional. I can not recommend Ciara enough for all you mummy’s out there.
I never knew the importance of pelvic health checks until now.
Anyone in constant pelvic health pain please go and see Ciara, it will be the best thing you do.
Thank you Ciara! xx”
Ciara Devery
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