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Pelvic Floor Conditions: The Hypertonic Pelvic Floor

Like any muscle, your pelvic floor muscles can become tense and/or unable to relax. A hypertonic pelvic floor occurs when your pelvic floor muscles are contracting at higher levels at rest or are unable to completely relax.

What does a hypertonic pelvic floor cause or feel like?

Individuals with a hypertonic floor may experience

  • Constipation

  • Urinary urgency or frequency

  • Incomplete emptying of bladder/bowels

  • A weak stream of urine

  • Hesitancy or delayed start of urine flow

  • Pain with intercourse

  • Pain with urination

  • Pelvic pain that can also present as hip, low back, and/or coccyx pain

Why is my pelvic floor “tight”?

There are many reasons why your pelvic floor muscles may be overactive. Sometimes there are no clear direct causes but below are a few common causes of a hypertonic pelvic floor:

  • Bathroom habits that cause you to hold in urine and stool when your body is signaling that you need to void. I see this in patients that works jobs that do not allow them to use the bathroom easily (teachers that can not leave their classroom, a surgeon performing hours long surgeries, people who work retail… just to name a few)

  • High amounts of stress. When you experience high levels of stress, your body activates your fight or flight nervous system. This fight or flight response causes a contraction/shortening of your pelvic floor muscles.

  • Trauma to the pelvic floor either from birth or other causes. This puts you at higher risk of pelvic pain and possible scar tissue which can result in a protective over-activity of the pelvic floor.

  • Conditions that cause pelvic inflammation (chronic UTI, endometriosis, IBS, etc)

I think I might have a hypertonic pelvic floor, what should I do?

If this sounds like you, you may benefit from an evaluation from a pelvic floor therapist or gynecologist that is trained in the evaluation/treatment of pelvic floor musculature and function. Below are a few exercises that can assist with a hypertonic pelvic floor

Lie on your back, place your feet on a chair so your knees are bent at 90 °.

Adjust the feet position to achieve the most comfortable position.

Breathe in through your nose filling your rib cage front to back and side to side

Exhale with pursed lips slowly breathing out

Sit back on your heels and lean forward, place pillow or half foam roller on your knees for comfort

Rest your elbows on the floor or on a slightly elevated surface if you can't reach the floor comfortably.

Staying in this static position, breathe slowly through the back of your rib cage.

Exhale slowly with pursed lips

Begin lying flat on your back. Bend both knees and hold the outside edges of your flexed feet with your hands.

Allow the weight of your arms to gently bring your knees toward the floor

Try not to tense your shoulders or chest: keep everything relaxed.

Breathe normally.

Hold onto something sturdy in front of you

Slowly lower your body into a squat position

Keep your heels in contact with the ground

Relax and breathe normally

Do not perform this type of stretch if it produces discomfort in your knees.

Kneel with one leg straight out to the side.

Sit your bottom back towards your heels

Relax and breathe normally

Hold the position when you feel a stretch on the inside part of your thigh.

Stand in front of a bed or other surface

Rotate the leg and place the lower leg on the table.

Keeping your spine straight and tall, bend the trunk forward from your hips until you feel a comfortable stretch in the outer part of your glutes.

Hold for 30-90 seconds and breathe normally

A pillow can be placed under the thigh and knee/lower leg of the flexed leg to decrease pressure


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