What is a tight pelvic floor?
The pelvic floor is the group of muscles that support the pelvic organs. These muscles also help control urination, bowel movements, and sexual function. When the muscles of the pelvic floor constantly stay in a state of contraction and are unable to relax, it is known as a tense, tight or hypertonic pelvic floor. For a muscle to generate power sufficiently, it should have an optimum level of length and tension.
For example, an already bent elbow cannot do a powerful biceps curl! We need to first straighten the elbow. Similarly a tight pelvic floor cannot function optimally and can result in pelvic floor dysfunction.
Typical signs of a tight pelvic floor
- Pain - A person with a tight pelvic floor may experience a generalised pain or pressure in the pelvic area, low back, hips or the tail bone. Pain can also be felt during or after certain activities like urination, bowel movements, or sexual intercourse.
- Urinary symptoms - A sudden, strong need to urinate may be felt, which is difficult to delay. This may result in involuntary loss of urine (leakage) if the person does not reach the bathroom in time. This condition is referred to as urge incontinence. Frequency of urination may be increased. There can be difficulty in starting or maintaining the urinary stream. Urinary leakage while coughing, sneezing, laughing or during exercise may occur as well. This type of incontinence is known as stress urinary incontinence.
- Bowel symptoms - This can include constipation, difficulty initiating a bowel movement, pain during or after passing stools or gas, and feeling like you’ve had an incomplete emptying of your bowel.
- Challenges with penetration - Inserting a tampon or menstrual cup, a gynaecology exam, and sexual penetrative intercourse can all feel impossible or painful for those who have tension in their pelvic floor.
A tight pelvic floor can be a result of habitually contracting the muscles or ignoring the urge to urinate or defecate which leads to prolonged periods of holding tension. It can also present as a protective response to pain in the pelvic or abdominal area, inability to relax due to constant stress or fear, compensation for weak hip muscles. Direct pelvic trauma like fall on the buttocks or sexual abuse can also cause a tight pelvic floor.
Causes of urinary incontinence
Urinary incontinence is defined as involuntary loss of urine or urinary leakage.
This can occur in women in the following conditions-
- When the pelvic floor muscles are not functioning adequately. They may be underactive or overactive.
- Various neurological disorders like stroke, Alzheimer’s disease, Parkinson’s disease
- Pelvic and or abdominal surgeries like hysterectomy (removal of uterus)
- Obesity
- Pregnancy and childbirth
- Menopause
- Conditions like urinary tract infections, endometriosis, interstitial cystitis
- Radiation to the pelvis
- Pelvic organ prolapse
- Chronic coughing
- Certain medications
When the leakage happens during coughing, sneezing, laughing, running, jumping, lifting or any other movements it is known as stress incontinence. This happens when the pelvic floor muscles are underactive, or are not strong enough to handle the stress placed on them. The muscles are unable to keep the urethral opening (from where the urine comes out) closed when pressure is placed on the bladder. This can happen when the pelvic floor muscles are tight, because when muscles are held in a tense state for a long period of time, they aren’t flexible enough to create the force needed to contract, making them weak. This makes it hard for the muscles to act when we need them to (for example reacting quickly when we sneeze) and can lead to urinary leakage.
Tension in the pelvic floor can cause symptoms of urge incontinence as well. Too much tension in the pelvic floor can cause pressure on the bladder and hence a sudden urge to urinate is felt even before the bladder is full. When this urgency is felt, and the person is unable to reach the bathroom in time, the tight muscles may not respond accurately to hold the urine in, and accidental leakage may occur.
Do vaginismus patients face incontinence?
Vaginismus patients can have urinary incontinence as well. Women having issues with penetration are found to hold tension in their pelvic floor muscles. Prolonged tension can lead to dysfunction and hence incontinence.
Tips on relaxing the pelvic floor muscles:
If you’re reading this and feel like you or someone you know might have incontinence or tight pelvic floor muscles, it’s important to consult a pelvic health physiotherapist. At Proactive for Her, we have experts who can help find the root cause of the tension, and then treat the symptoms, including incontinence. Here are some tips on how to get started with relaxing the tension in your pelvic floor muscles:
- Breathing plays a crucial role in relaxing the pelvic floor muscles. Relaxing and lengthening with every inhale and returning to normal resting state with every exhale should be ensured.
- Various stretching exercises can help with improving the flexibility of the pelvic floor.
- Identifying the weak muscles surrounding the pelvic floor (hip muscles) and strengthening them can reduce the tension in pelvic floor muscles.
- Calming down the nervous system through meditation and guided relaxation techniques.
- Addressing the psychological causes like stress and fear which are leading to tightness in the pelvic floor.
- Taking frequent breaks from prolonged sitting and moving around helps to improve circulation through the muscles and hence reduces the tension.
- Tight muscles can develop tension points/ knots. Manual therapy both internally and externally by a pelvic floor therapist can help release them. The therapist can also teach you how to release the tension points themselves.
Conclusion
People with a tight pelvic floor can face challenges with bladder, bowel control, and sexual function. Urinary incontinence can lead to people restricting their physical and social activities like exercising, lifting, going out to meet friends, or shopping.This leads to a decreased quality of life. Many women feel embarrassed to disclose this issue and seek help. They may experience low self esteem, body negativity, and even depression. A pelvic floor physiotherapist plays an important role in identifying the type and cause of incontinence and providing solutions. If you are experiencing urinary incontinence or any other symptoms of a tight pelvic floor, make an appointment to see one of our expert pelvic floor physiotherapists at Proactive for Her.