What is an overactive pelvic floor?

Pelvic floor ‘overactivity’ is common, and what this means is a pelvic floor that is tense and tight, and can’t contract and relax through it’s full range like it should. 

Often ‘overactive’ pelvic floor muscles are painful, and this might mean that you experience pain with sex, pain with tampon insertion or pap smears, or referred pain somewhere else in the pelvic or abdominal region. Think of it like having chronically tight muscles in your neck or lower back that could cause pain locally or refer pain to nearby areas. 

Other possible symptoms of having a pelvic floor that doesn’t relax well include difficulty emptying your bladder or bowel (either trouble getting it started, or a feeling that you can’t completely empty), urinary frequency or urgency, or recurrent urinary tract infections. 

Something that I see often in clinical practice is actually stress urinary incontinence (leaking with coughing, sneezing, jumping or other exertion activities) that ends up being due to a tense, tight pelvic floor – not a weak, underactive pelvic floor like the woman might have assumed. Because when a pressure comes down through the pelvis, your pelvic floor needs to be flexible and ready to take that load on. If it’s already chronically tense and contracted (and probably exhausted and fatigued!) it’s unlikely to be able to work well under load, and leakage can occur.

 

Why would this have happened?

Well, sometimes it’s for no apparent reason. But often it’s to do with the pelvic floor responding to stress or pain. 

Some example of this include:

  • After having a tear during childbirth
  • After having pain in the pelvic or lower back joints
  • After experiencing a stressful period of your life
  • After having a painful or traumatic sexual experience

Sometimes it can be a learned thing over time – those who have done a lot of ballet, pilates, horseriding etc can sometimes end up always holding their core on without realising. 

 

What can a physio do to help if they diagnose you with an Overactive Pelvic Floor?

A physio will often put in place a ‘Downtraining’ exercise program for your pelvic floor, with the aim of learning how to fully relax. This often will include visualisation, diaphragm breathing and mindfulness. 

The physio may also introduce the techniques of massage and stretching to the muscles, either done by the therapist or done by the woman on herself. This can sometimes be complemented by the use of Vaginal Dilators, which are very helpful when overactive pelvic floor muscles are preventing pain free penetration with sexual intercourse. 

If you think your pelvic floor may be overactive, we can help you at FitRight HQ. Simply book a Women’s Health Physiotherapist appointment and Taryn, Cat, Veronica or Jess Vanson can help to diagnose and manage this common presentation.