Do you experience pain during sex, leaking, or unexplained pelvic discomfort? These symptoms might be connected to a hypertonic pelvic floor, a condition where your pelvic floor muscles become overly tense.
As a pelvic floor physical therapist who has treated hundreds of women (and a mom of three myself!), I can tell you that this condition is both common and treatable with physical therapy. Here’s everything you need to know!
What Is a Hypertonic Pelvic Floor?
Your pelvic floor is a group of muscles that form a hammock-like structure at the base of your pelvis. These muscles support your bladder, uterus, and bowel, and they’re very important for continence, sexual function, and core stability.
A hypertonic pelvic floor means that your pelvic muscles are constantly contracted or tightened.
Many women, especially after childbirth, believe that tight pelvic floor muscles = strength, but this isn’t accurate! Tight doesn’t always mean good. When your pelvic floor muscles stay contracted all the time, they actually become weaker and less functional.
Most of the moms I work with have only heard about Kegels and the importance of tightening their pelvic floor muscles. They’re surprised when I explain that relaxation is equally – if not more – essential for pelvic floor health.
For example, if you flexed your quads all day long, what would happen? They would fatigue, become painful, and ultimately fail to work properly. AKA, you wouldn’t be able to walk or you’d trip because you can’t bend or straighten your knee.
Your pelvic floor works the same way. When these muscles stay tight all the time, they become weak and can’t do what they’re supposed to, like hold your pee in when you sneeze or cough! Over time, this can lead to issues like chronic pelvic pain.
Hypertonic pelvic floor is common both during pregnancy (because you have the baby sitting on the pelvic floor, so it has to work harder) and after birth.
It can present years and even decades after birth.
Hypertonic Pelvic Floor Symptoms
Living with a hypertonic pelvic floor can be very uncomfortable. As a mom, you might dismiss these symptoms as “just part of motherhood,” but they’re signs that your pelvic floor needs attention.
Common hypertonic pelvic floor symptoms include:
- Chronic pain: Ongoing discomfort in your pelvic region that never fully goes away
- Painful sex: Discomfort or sharp pain during penetration or lingering soreness after sex
- Urinary issues: Always needing to pee, urgency (that “gotta go right now” feeling), painful urination, and incomplete emptying of your bladder
- Bowel problems: Constipation, straining during bowel movements, or pain
- Persistent pelvic pain: Discomfort in your lower abdomen, groin, or between your sit bones that doesn’t seem connected to your menstrual cycle
- Lower back pain: Aching or tension that doesn’t resolve with typical stretching or rest
- Tailbone pain: Discomfort when sitting, especially on hard surfaces
- Pain in surrounding areas: Hip pain, groin discomfort, or pain that radiates down your thighs
- Feeling of heaviness or pressure in your pelvic region
These symptoms usually start mild and get worse slowly over time without proper pelvic floor rehabilitation.
Unfortunately, I’ve seen many moms who thought that pelvic floor hypertonicity symptoms like peeing a little when you cough were normal and just something that they should accept.
Hypertonic pelvic floor is a real pelvic floor dysfunction, and it’s very common. Studies show that 60-90% of women who have ongoing pelvic pain might have hypertonic pelvic floor muscles.
Hypertonic Pelvic Floor Causes
There is no one defining cause of a hypertonic pelvic floor. Often, hypertonic pelvic floor occurs from a combination of factors, including:
- Pregnancy and childbirth experiences: The physical demands of carrying a baby and delivering can create tension patterns in your pelvic floor
- Birth trauma or tearing: Vaginal tears during delivery can cause protective muscle tightening, with one-sided tears sometimes causing the opposite side to overcompensate
- C-section scar tissue or trauma: Surgical scars can restrict movement and create tension in connected muscles (there are connections between pelvic floor muscles and the muscles that are cut into during a C-section)
- Chronic stress and anxiety: Your body’s stress response can cause pelvic muscles to tighten reflexively. If you have tension in the neck, upper shoulders and jaw OR if you always clench your butt, you most likely have chronic stress response!
- Holding in urine or stool: Maybe you avoid public restrooms or have a busy schedule that prevents regular bathroom breaks
- Core muscle overengagement: Always “sucking in” your stomach or constantly activating your core during workouts without proper relaxation
- Clenching your butt: This may sound silly, but this habit often contributes to weakened pelvic floor muscles
- Pelvic health conditions: Such as endometriosis, irritable bowel syndrome, interstitial cystitis, pudendal neuralgia, or vulvodynia
- History of sexual abuse or physical trauma: Past traumatic experiences can manifest as physical tension and trigger pelvic floor muscle dysfunction
- Emotional trauma after birth: Sometimes, your pelvic floor can become hypertonic as a result of a neurological response to a traumatic birth
Anyone can have hypertonic pelvic floor muscles, but it’s common in moms because pregnancy and childbirth expose them to multiple risk factors at once.
You go through physical changes, potential trauma during delivery, postpartum stress, and lifestyle adjustments that may affect your posture and bathroom habits.
This is why taking care of your pelvic floor after birth is so important.
How Is Hypertonic Pelvic Floor Diagnosed?
To get diagnosed, you’ll usually need to see a pelvic floor physical therapist or a special doctor called a urogynecologist. During your visit, they’ll ask about your pelvic health concerns and medical history.
The main part of the diagnosis is a physical pelvic exam. The therapist will look at how you stand and move, then do an internal exam by gently feeling your pelvic floor muscles through the vagina or rectum. They check for:
- Sore spots in the muscles
- Tight knots (called trigger points)
- Whether you can tighten and relax your muscles properly
This exam helps them know if your pelvic floor muscles are too tight and what kind of treatment will help you best.
That said, you don’t HAVE to get diagnosed to start doing pelvic floor exercises and physical therapy.
Some women find the internal exam to be too invasive, or they just don’t feel comfortable with it. You may also not have access to a pelvic floor PT because of your location or financial circumstances.
Hypertonic Pelvic Floor Treatment
The main treatment for hypertonic pelvic floor is pelvic floor physical therapy. You won’t typically need any medication or surgery, only specialized physical therapy techniques and exercises.
You can see a pelvic floor therapist in person or follow my evidence-based online program, Strong Core Mama!
Hypertonic Pelvic Floor Exercises
When treating a hypertonic pelvic floor, the focus isn’t on strengthening but on relaxation. This surprises many of the mamas I work with! They expect to be given Kegel exercises, which would often make things worse by creating more tension.
Pelvic floor relaxation exercises teach your hypertonic muscles how to properly lengthen and release. You can find them in Strong Core Mama.
This is important because your deep pelvic floor muscles have essentially “forgotten” how to relax. With consistent practice, these exercises help retrain your brain-muscle connection and restore normal muscle function.
Breathing Techniques
Breathing techniques might sound too simple to make a difference, but they are fundamental to pelvic floor healing. Your breath and your pelvic floor are intimately connected!
When you breathe deeply into your diaphragm (360-degree breathing), your pelvic floor should naturally move in coordination, expanding slightly on the inhale and returning on the exhale.
This movement helps reduce tension and retrain your muscles to function properly.
I know this may sound boring or too basic compared to more active exercises, but it’s VERY important. Many moms want to skip ahead to what they consider “real” exercises, like running postpartum.
But diaphragmatic breathing can make a huge difference for your pelvic pain symptoms (and everywhere else in your body where you’re holding tension!).
Addressing Bladder and Bowel Habits
Some women with hypertonic pelvic floor have developed bladder and bowel habits that contribute to their hypertonic pelvic floor dysfunction.
For bladder health, avoid “just in case” peeing and give yourself enough time to fully empty your bladder without straining (I often tell my clients, “Don’t push your pee out!”).
It’s also important to stay hydrated throughout the day. I often see women try to drink less to leak less, but being dehydrated actually makes you want to pee more often because your bladder is aggravated.
For bowel health, don’t ignore the urge to go when you feel it and use proper positioning on the toilet (knees higher than hips, leaning slightly forward).
Try to avoid straining on the toilet. Using diaphragmatic breathing strategies can REALLY help with this! Plus, prioritize fiber in your meals.
Making these changes can help reduce the stress on your pelvic organs and muscles, but it’s important to combine them with physical therapy exercises for best results.
Using a Pelvic Floor Wand
A pelvic floor wand is a special tool that can help release trigger points in your pelvic floor muscles.
These S-shaped tools function similarly to the trigger point canes people often use for neck and back tension, but are specifically designed for the pelvic region. They can reach areas that might be difficult to access otherwise.
I recommend the Intimate Rose Pelvic Wand. You can use it to identify tender or tight spots in your pelvic floor muscles and apply gentle pressure to them.
Scar Tissue Massage
If you have scars from childbirth (either from a C-section or perineal tearing), scar tissue can create pulling and tension that affects your pelvic floor muscles.
Gentle scar massage improves the flexibility of the scarred area and reduces adhesions where tissue is stuck together.
Learn more about taking care of your pelvic floor after a C-section.
Should I Only Focus on My Pelvic Floor?
No! Pelvic floor relaxation is very important for treating a hypertonic pelvic floor, but focusing solely on these muscles isn’t enough.
Your pelvic floor doesn’t work in isolation. It’s part of a complex system where all muscles attaching to the pelvis work together.
When surrounding muscles like your glute medius, glute maximus, obliques, transverse abdominis, hamstrings, and inner thighs are weak, your pelvic floor has no choice but to pick up the slack.
This contributes to chronic tension and tightness.
For best results, you need to strengthen all the muscles that connect to your pelvis. By building strength in these supporting muscles, you help your pelvic floor relax because it’s no longer being asked to do everyone else’s job!
Should You Do Kegels with a Hypertonic Pelvic Floor?
Short answer: You shouldn’t do Kegels with a hypertonic pelvic floor, but you can make them a part of your routine after your pelvic muscles return to normal tone.
I can’t tell you how many times I had moms come into the PT clinic and tell me, “I was having some pelvic floor symptoms, so I started doing Kegels, but my symptoms got WORSE!”
If you have a hypertonic pelvic floor, doing Kegels is like adding fuel to a fire. Kegels are contracting exercises, and your muscles are already stuck in a contracted state. You’re essentially tightening muscles that desperately need to relax.
Instead of just doing strengthening exercises like Kegels, you need to learn how to fully relax your pelvic floor to contract it properly. A healthy pelvic floor can both contract AND relax fully.
I remember one mom who came in with leaking symptoms. She was surprised when I sent her home with only ONE exercise that focused on relaxing her pelvic floor muscles.
Many moms are nervous that their symptoms will get worse since relaxing your pelvic floor seems so contradictory to what they’d heard about “tightening up” with Kegels.
But when that mama client returned for her next appointment, she was completely symptom-free! This approach may seem counterintuitive, but it works because we’re addressing the root problem.
So, How Do You Fix a Hypertonic Pelvic Floor?
The best way to fix a hypertonic pelvic floor is through pelvic floor physical therapy. Specifically, through physical therapy exercises that help you learn how to relax your hip and pelvic muscles.
I share evidence-based exercises and techniques like scar tissue massage and pelvic floor relaxation in my online program, Strong Core Mama.
You can do the program at home, and each class only takes 15-20 minutes!
How Long Does It Take to Heal a Hypertonic Pelvic Floor?
It depends. Sometimes it’s as quick as just one week!
There are different factors at play, such as how long you’ve had symptoms, how tight your muscles are, whether you have other issues like scar tissue, how often you do your exercises, and your stress levels. Some symptoms might get better faster than others.
The most important thing to remember is that it’s never too late to improve your core and pelvic floor.
It doesn’t matter if you had your kids 6 months or 6+ years ago. You can ALWAYS make positive changes, get rid of hypertonic pelvic floor symptoms like chronic pain and leaking, and feel more confident.
FAQs
What Worsens Hypertonic Pelvic Floor?
There are a few things that can make a hypertonic pelvic floor worse. Stress is a big one, because when you’re stressed, your muscles tense up, including your pelvic floor. Doing too many Kegel exercises when your muscles are already too tight can increase tension. Poor posture, especially slouching and butt clenching, puts pressure on your pelvic area. Holding in your pee for too long trains your muscles to stay tight. Heavy lifting with improper technique, constipation, and not drinking enough water can all add to the problem, too.
Is Sitting Bad for a Hypertonic Pelvic Floor?
Sitting for long periods can make a hypertonic pelvic floor worse, but it largely depends on how you sit. Slouching or sitting with your pelvis tucked under puts extra pressure on your pelvic floor muscles. If you must sit for long periods for work, try using a cushion that takes pressure off your sit bones, sit on a stability ball sometimes, take frequent standing breaks, and focus on sitting with good posture (feet flat on the floor, sit bones pointing down, and spine tall). If you have tailbone pain, sitting on a donut can be helpful.
Can a Hypertonic Pelvic Floor Feel Like a Prolapse?
Yes, a hypertonic pelvic floor can sometimes feel like pelvic organ prolapse. Both conditions can create feelings of heaviness, pressure, or fullness in the vagina. That said, hypertonic pelvic floor and prolapse are two very different conditions. Prolapse causes your organs to drop down, and a hypertonic pelvic floor means that your pelvic muscles are too tight.
These conditions can also co-exist. If you have prolapse, you may also develop a hypertonic pelvic floor from trying to “hold” everything in. In turn, your prolapse symptoms can get worse. But if you work on decreasing the tension and tightness, then you’ll likely also experience less heaviness. This is a common scenario I see with mamas in the PT clinic!
How Do You Fix a Hypertonic Pelvic Floor At Home?
You can do pelvic floor physical therapy exercises at home, but it’s important to follow an evidence-based program like Strong Core Mama. You’ll need to focus on learning how to relax your pelvic floor muscles instead of doing strengthening exercises like Kegels, which is what many women typically associate with pelvic floor exercises. You can also supplement PT exercises with techniques like scar tissue massage and using a pelvic wand to release tension. It’s also important to strengthen the muscles surrounding your pelvis, such as your glutes.
Heal Your Pelvic Floor with Strong Core Mama
If you’re struggling with a hypertonic pelvic floor or dealing with uncomfortable symptoms like pelvic pain, leaking, or feelings of heaviness and pressure, physical therapy can make a big difference. You don’t have to settle for living with symptoms that can be treated.
Strong Core Mama is a pelvic floor rehab program full of evidence-based exercises and techniques that can help. You can also ask me questions as you go through the content!
