What is an overactive pelvic floor? And why won’t Kegels work?

An overactive, or hypertonic, pelvic floor is when the pelvic floor muscles are constantly switched on and don’t relax (and switch off). Have you ever had someone tell you to relax your shoulders and let them drop down away from your ears? When you’re tense or stressed and your shoulders slowly raise up towards your ears your muscles (the upper trapezius muscle) is switched on and hence pulls your shoulders up towards your ears. If you relax, roll your shoulders and let the muscle switch off your shoulders will drop back down where they should be. The exact same thing can happen with your pelvic floor muscles (except they don’t pull your shoulders to your ears!). So you might be thinking that a pelvic floor that’s always switched on should be a good thing, right? Most women are concerned about a pelvic floor that doesn’t switch on and is weak, right? Unfortunately an overactive/hypertonic pelvic floor is not a strong pelvic floor. It is usually also a weak pelvic floor.

How can a pelvic floor that is always switched on be weak?

I often explain this in terms of another muscle to help people make sense of what is going on with a hypertonic/overactive muscle. So imagine you are doing a bicep curl. A bicep curl is literally having a weight in your hand, with your hand down by your side, and then bending your elbow to lift the weight until you can’t bend your elbow any further. Your hand, or the weight, would touch your bicep area at the end of the movement. This is full range of movement for the bicep muscle. Now imagine you started that bicep curl from the halfway point (your elbow already bent to about 90 degrees). You’d still be able to lift a decent amount of weight from here, the halfway point. But now imagine you are just going to lift the weight almost at the end point of your movement (from your elbow almost fully bent and the weight almost touching your bicep) – you wouldn’t have much room to move – the muscle doesn’t have much room to move. So if you suddenly needed to try and lift something heavy and this was all the movement you had, it would be pretty difficult to move. And if you kept your elbow in this position all day long, every day, then your muscle (and your elbow joint) would actually get very sore and weak – as it is not moving through it’s full range of movement. So the same is true for the pelvic floor muscles. If they are constantly contracted and switched on, the muscle can get sore and painful – hello pelvic pain! And also the muscle gets weak, as it is not moving through it’s full range of movement anymore. So if your pelvic floor muscles are constantly switched on and at their end range of movement – if you then suddenly exert yourself – let’s say a sneeze, or a jump on the trampoline – then this shortened, weak muscle hasn’t got enough movement or strength to do it’s job properly and ‘hold on’ for you – hence the leaking that occurs in these situations.

Woman doing a bicep curl
Bicep curl

Will Kegels help?

No – definitely not. Kegels, or pelvic floor exercises, are a switching on and then off of your pelvic floor muscles. A hypertonic and overactive pelvic floor often does not know how to switch off and relax. So essentially you would just be doing your pelvic floor exercises in your small range of movement and wouldn’t therefore gain any useful strength. What you need to focus on initially is relaxation of the pelvic floor. We need to get this pelvic floor relaxed and back to it’s normal resting state – switched off. So your treatment with a womens health physiotherapist will usually focus on pelvic floor relaxation techniques and pelvic floor stretches.

How would I know if I have an overactive/hypertonic pelvic floor?

Certain symptoms could mean you have a hypertonic pelvic floor – but a lot of these symptoms can also indicate other pelvic floor issues. Therefore if you have any pelvic floor symptoms it is best to see a trained womens health physio for a thorough assessment so that they can work out what your pelvic floor is doing and treat you appropriately.

Symptoms of a hypertonic pelvic floor can include:

Pain – this can be in the pelvis, groin, hips, back or rectum

Urinary leakage (with cough/sneeze/running/jumping etc)

Urinary frequency (going for a wee a lot!)

Slow flow of urine or stopping and starting when urinating

Painful urination

Constipation (as the pelvic floor needs to relax in order to defecate (go for a poo) so a hypertonic pelvic floor can also cause constipation)

Pain with intercourse

Why have I got a hypertonic pelvic floor?

There are many different reasons that your pelvic floor can become hypertonic. Some examples include women who have done a lot of dancing/ballet and therefore spent a lot of their early years constantly switching on their pelvic floor and not knowing how to relax their pelvic floor. Other examples include people who have a history of ‘holding on’ and not going to the toilet when they need to. This might be associated with not wanting to use public toilets and hence waiting until they get home to go to the toilet. In these cases the pelvic floor muscles will be switched on to help them ‘hold on’ and can then have trouble relaxing and switching off. Also if someone has experienced a lot of stress this can also be a cause for an overactive/hypertonic pelvic floor as the pelvic floor muscles can switch on when we are tense and stressed.

If you think you may have a hypertonic pelvic floor or if you are experiencing any pelvic floor symptoms, see your GP who can refer you to a women’s health physiotherapist for a thorough assessment and you can get on the road to recovery.

If you have any comments or questions about anything in the blog feel free to leave a comment below.

Have a great day.

References:

Faubion, S. S., Shuster, L. T and Bharucha, A., E 2012). ‘Recognition and management of nonrelaxing pelvic floor dysfunction.’ Mayo Clin Proc 2012, 87 (2), 187-193. 10.1016/j.mayocp.2011.09.004

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.