Could your pelvic floor be TOO tight or TOO strong?

Having pelvic floor muscles that are TOO strong is not necessarily a good thing and can lead to problems…

It is important that during pregnancy and in the post-natal period (aka. the rest of your life) your pelvic floor muscles stay strong.

This will help to maintain great bladder control, reduce your risk of prolapse, improve your sexual sensations and keep your pelvis strong and happy.

However can they be TOO strong?

Absolutely!

More and more these days I am seeing women in the clinic with overactive pelvic floor muscles.

What exactly does an overactive pelvic floor mean?

This means that the pelvic floor muscles have difficulty relaxing and therefore are constantly held in a slightly contracted state. Now this may sound like a good thing. Doesn’t that make them stronger?

Well actually, no.

If the pelvic floor is already tense or switched on… then when we need it to work (ie. when we cough, sneeze or lift something) then not only is it fatigued (because it hasn’t been relaxing) but it only has a small amplitude of movement in which it can contract (and therefore when it does contract, it will be weaker).

Imagine walking around on your tip toes all day. Sounds silly right? It would be inefficient, and would fatigue your calf muscles quite a bit! Then if you needed to jump, your calf muscles would be so tired and weak that they wouldn’t be able to do that activity correctly.

This is what happens when you over-activate a muscle… it cannot perform it’s job correctly.

Overactive and strong or overactive and weak?

Answer: Overactive and weak.

It is normal for muscles to both CONTRACT and RELAX. Both actions are equally important for a muscle to be STRONG.

You cannot contract properly if you cannot relax fully. A muscle should work in it’s full range of movement.

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

Symptoms of an overactive pelvic floor may include…

Painful sex
Pain with inserting tampons
Pain with papsmears or any internal examinations
Difficulty emptying your bladder or bowels
Constipation or pain when opening your bowels
Bladder leakage
Needing to rush to the toilet all the time
Lower abdominal, pelvic or back pain

Why do pelvic floor muscles become overactive?

There are many different reasons but in my clinical experience I have found a few common issues…

Stress/anxiety. This can cause muscles in the body to tense in response to emotional stress or trauma.
Overactive bladder. If you have a grumpy bladder that is always telling you to go to the toilet, your pelvic floor may try to protect you by gently holding on to help suppress the urge. Too much of this can be detrimental.
Rock hard abs. If you are “super strong” in your core, ie. you never let you belly hang out and you are always tensing/sucking in… this can create overactivity in your abdominals which likely encourages the pelvic floor to do the same. LET YOUR BELLY HANG OUT AND RELAX LADIES!
Poor posture. Sitting on your bottom a lot, or slouching your pelvis can create tension in the pelvic floor as it is in a shortened position. Try to change postures every 1-2 hours, add some walking into your day, stretch your gluteal muscles and untuck your bottom a little more! You should always have a small curve in your lower back.
Too much bum tuck!

How can I fix this?

It is often hard for my client’s to firstly recognise that their muscles are holding on too tight.

An easier way to start is by practicing belly breathing (or diaphragmatic breathing).

Generally when your pelvic floor is overactive, so too are your abdominals.

It is difficult to know whether your pelvic floor is in a relaxed state or not. So I find that by starting with relaxing the abdominals, it is easier to then relax the pelvic floor.

Try this flow to relax the abdominals and pelvic floor…

Lie down in a comfortable position, free from noise and distractions.
Close your eyes.
Start by slowly inhaling through your nose.
Imagine your breath travelling down, into your belly and your belly slowly starting to rise.
Place your hands on your belly so you can feel this rise.
Initially it may feel like there is resistance to this.
Thats OK. Your belly might not be used to stretching, give it time.
Exhale and feel your belly fall.
Continue this slow inhale and exhale- feeling the belly rise and fall.
As you find it gets easier, try to inhale for 3 seconds and exhale for 3 seconds.
Do this for at least 2 minutes.
Now once you’ve relaxed…think about gentle contracting your pelvic floor muscles on the exhale.
On the inhale, completely relax the pelvic floor muscles.
For as much as you pull your pelvic floor up, you need to let it go all the way back down.
Imagine your pelvic floor like an elevator.
Lift the elevator to level 3, then completely relax it back down to the basement.
Continue this for 1-2 minutes with the coordination of your breath, nice and slow.
Practice at least once/day.

Round up of what you should start trying TODAY

Relaxation/belly breathing 5 minutes every day
Practice good posture, don’t bum tuck!
Let your belly hang out, don’t suck in!
Relax and don’t rush on the toilet

If you continue to experience symptoms or pain associated with overactive pelvic floor muscles, or are not quite sure and need some more feedback.. then get in touch with your local women’s health physiotherapist and book in for a thorough assessment and treatment.