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Hypertonic Pelvic Floor: What it is and How to Treat it

Pelvic Floor Doctor

Medically Reviewed By Dr. Amanda Olson,DPT, PRPC

Receiving a diagnosis of hypertonic pelvic floor can be disheartening at best, especially if other conditions are present as well. Hypertonic pelvic floor is a condition wherein the muscles of the pelvic floor are overactive, contracting or maintaining tension and tightness when they should relax.

Activation of the pelvic floor muscles is normal to maintain continence, such as when coughing, sneezing, or exercising. Hypertonic pelvic floor disorder results from excessive contracting or clenching of the pelvic floor muscles.

Hypertonic Muscles in Men and Women

This condition can be present in men, women, and transgendered people. It is commonly present in people who have experienced trauma, stress, or who have other medical conditions.

Hypertonic pelvic floor can result in issues such as constipation, issues emptying the bladder, pelvic pain, pain with sex, and even low back and hip problems as well as other symptoms.

The good news is that it is a reversible and fixable issue. Often with the help of health care providers and dedication to a home program for learning coordination of the pelvic floor, and pelvic health tools, hypertonic pelvic floor can be conquered.

Why Does Hypertonic Pelvic Floor Occur?

Hypertonic pelvic floor is often an involuntary response to an environmental stimuli, or a change in health status. Sometimes it is present as long as one can remember.

This is often noted in young females who have difficulty using a tampon, cannot tolerate a gynecology examination, or have penetrative sex. Others may notice pain in the tailbone, or a throbbing sensation in the pelvis that is difficult to describe or trace.

Men may report a feeling of pressure in the rectum, testicles, or pain with erection or ejaculation as a result of hypertonic pelvic floor.

Hypertonic pelvic floor is a result of overactivity of the pelvic floor often as a guarding response. This maybe in response to a threatening situation, abuse, a traumatic event, or after surgery or other medical conditions.

It is often thought of as a protective response, and occurs unintentionally.

How is Hypertonic Pelvic Floor Treated?

  1. Pelvic physical therapy: Pelvic floor physical therapy is the front-line treatment for hypertonic or overactive pelvic floor syndrome. A pelvic physical therapist is trained in evaluation and treatment of pelvic floor issues such as pelvic pain, incontinence, bowel issues, post-partum issues, and abdominal issues as well.

    Treatment involves an thorough examination of posture, muscle strength, and coordination of the body and specifically the pelvic floor. Manual therapy, biofeedback, ultrasound imaging, and exercises are common components of hypertonic pelvic floor treatment and can help manage pelvic floor issues.

  2. Exercises for pelvic floor release. Exercises for home programming include learning to sense when the pelvic floor is contracted and controlling the muscles to relax them.

    Often this is best learned visually, by watching the muscles contract in a mirror, and using gentle breathing techniques to relax the muscles from clenching.

    Stretches including child’s pose, deep squat, and happy baby can be utilized in addition to hip and back stretches to help restore mobility in the pelvic floor muscles, and to allow for focused relaxation.

    Additionally, tools such as a pelvic wand or dilators may be used to stretch the tight pelvic floor muscles to reduce pain and improve flexibility. This is helpful to reduce pain and assist in improving the elasticity that is necessary for bowel movements and pain free penetration.

  3. Medications for pelvic muscle overactivity. A medical doctor or nurse practitioner who specializes in pain may prescribe medications such as muscle relaxants, specialized valium, or anti-inflammatory medications to help reduce pain and reduce spams while the patient is in pelvic physical therapy addressing the root causes of the hyperactivity.

    Additionally, Botox injections may be performed to inhibit the pelvic floor muscles from over activating.

  4. Counseling or Cognitive Behavioral Therapy to address trauma. Counseling, Cognitive Behavioral Therapy, EMDR, and Sex therapy are all helpful in addressing emotional distress associated with hypertonic pelvic floor.

    Additionally these forms of therapy are helpful in addressing trauma and learning new coping skills.

While hypertonic pelvic floor does not resolve overnight, by addressing the issue and seeking help from qualified health care providers, it can be resolved.

Results can take time; it is well worth it to reclaim your life and achieve your personal goals.