We focus so much attention on getting a strong, tight pelvic floor (for good reason—it’s important), we often overlook that there is such a thing as a too-tight pelvic floor. Our minds were actually kind of blown when we learned this.
Have we Kegel-ed ourselves into this scenario? What does it mean to have a pelvic floor that’s too tight? And how can we even tell if this is something we have?
So. Many. Questions.
To help make sense of it all, we enlisted the help of Aleece Fosnight, urologist and Medical Advisor at Aeroflow Urology.
What is a too-tight pelvic floor?
“High-tone or tight pelvic floor muscles means that the muscles are continuously in a contracted state as opposed to being at rest,” Aleece says. “Think of it as an elevator. Your pelvic floor muscles should be resting on the ground floor, ready to engage at any time. With tight pelvic floor muscles, the elevator is hanging out at the first or second floors. And think the opposite with pelvic organ prolapse or weak pelvic floor muscles, where the elevator hangs out at the basement or lower levels.”
What are the common symptoms?
Aleece says some common symptoms include (but are not limited to):
- Pelvic pain
- Dyspareunia (or pelvic pain with insertive sexual activity)
- Pain with tampon insertion
- Urinary symptoms (urgency, frequency, weak urinary stream, retained urine, urinary incontinence)
- Lower back pain
- Pain radiating down the legs.
“Some AFAB individuals will even complain of ovarian pain when it is actually their pelvic floor,” she adds.
“Overall, we see that fear, stress, and anxiety are overarching themes that create a reactionary pelvic floor and therefore, tight muscles,” Aleece says.
(Of course those three are involved.)
“Specifically, we see behaviors that cause tight pelvic floor muscles including having to ‘hold’ their urine or stool longer than needed and forced sexual activity,” she says. “Some conditions that cause a high-tone pelvic floor include endometriosis, interstitial cystitis, irritable bowel syndrome, pregnancy and delivery (both vaginal and cesarean delivery), genitourinary syndrome of menopause, performance anxiety with premature ejaculation, and poor posture.”
The answer is an emphatic “pelvic floor physical therapy.” That’s because you need a specialist to pinpoint exactly which pelvic floor muscles are contributing to your symptoms.
“Modalities are very specific to the individual in order to isolate the muscles involved and guide the patient to their overall goals,” Aleece explains. “Diaphragmatic breathing and stretching exercises are good starting points. There needs to be decreased tightness in those muscles first before strengthening can be implemented.”
As for kegels, “No kegels! This will only perpetuate the problem and worsen the pain,” she says.
“Pelvic floor PTs may also use vaginal dilator therapy to perform biofeedback and help train those muscles. Vaginal dilator therapy should be performed alongside a pelvic floor PT that understands the model and plan for the dilator therapy,” she says.
“Other things that may help include dry needling and trigger point injections with lidocaine or Botox/Dysport,” she says. (Obvs these should also be done by a doctor!)
She leaves us with these final thoughts:
“You are not alone. Many people are suffering from high-tone pelvic floor muscles, and there are healthcare professionals out there who want to help you have a pleasurable life full of joy and happiness, not pain. Visit APTA to find a pelvic floor PT near you. Visit SMSNA and ISSWSH to find a healthcare provider near you.”
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