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. As an example, many people who spend a lot of time working out and holding onto their core muscles can develop tension in their pelvic floor because they keep these muscles switched ‘on’ without giving the muscles times 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 or social activities. The act of holding on means the pelvic floor muscles are tightening to prevent the loss of control.
As high levels of stress, fear or anxiety can cause muscles to reflexively tighten, these factors can lead to a hypertonic pelvic floor. Consider how a puppy behaves when it is afraid—it runs away with its tail between its legs. Similarly, humans have a primitive response during fight or flight where the tailbone tucks under. The pelvic floor muscles are attached to the tailbone and this causes the muscles to shorten.
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 continence 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
pelvic pain
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.
Hope this is of interest
PMx
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