With all the pelvic floor content out there (we love to see it!), it’s becoming common knowledge that pelvic floor muscles can get weak — especially during pregnancy, postpartum, and menopause — which leads to symptoms like bladder leaks or postpartum prolapse. Next, we need to spread the word that a pelvic floor can also be “hypertonic” or too tight, which contributes to a host of other uncomfortable issues.

So, grab a cup of coffee, get comfortable, and let us explain how to recognize when your pelvic floor is holding onto tension.

What is a hypertonic pelvic floor?

The pelvic floor describes the layers of muscles and connective tissues that make up the floor of the pelvis. On a regular basis, these muscles need to be very dynamic, with the appropriate strength, flexibility, and coordination needed to help control your bowel, bladder, and sexual functions during your daily routine. 

When the pelvic floor muscles become tight, or overactive, they essentially get stuck in a contraction and can lose the flexibility and strength that is needed to properly do their job, leading to all sorts of bowel, bladder, and sexual symptoms. Tight, overactive muscles will often also have poor blood flow and irritated nerves, making movement or touch to these muscles tender and painful. 

Tightness in the muscles can occur for a number of reasons:

• A response to injury: A fall on your bottom, muscle injury from a vaginal delivery or sexual assault, or surgery in the area for example. After injury, your muscles can tense in response to pain and injury, and if not properly rehabilitated, the tension can persist.
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• Muscle overuse: Yes, you can do too many kegels. Excessive strengthening of the other muscles in the core and glutes — without also focusing on flexibility —may also lead to pelvic floor muscle tightness. 
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• Behavioral habits: If you’re always squeezing your buns together, sucking in your stomach, clenching your jaw as a habit or have TMJ, you may have a habit of holding tension in your body, which is often correlated with pelvic floor tightness.
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• Stress responses: Your pelvic floor is like a guard dog in response to stress and anxiety experienced in your body. This is not so much of a big deal if the stress only happens every once in a while and then goes away, but constant life stressors and anxiety, may leave your pelvic floor locked tight and on guard on a regular basis.
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• Medical conditions: Pelvic tightness and pain can often develop after a pelvic infection, or other medical condition that affect organs in the area. It’s also important to note that with infections or medical conditions that impact your bowel, bladder or reproductive health, you may have symptoms that are similar in ways to those who have a pelvic floor that is too tight, so always check in with your healthcare professional to make sure you have the treatment plan you need. 

10 symptoms of a hypertonic pelvic floor

Symptom #1: You seem to pee a lot

If your grocery store choice is based on the stores which have the cleanest bathrooms, because you cannot make the trip without needing to visit them, your pelvic floor may be too tight. Urinary frequency, meaning you are needing to empty your bladder more often than once every two hours, is a very common symptom of an overactive floor, with muscle tightness and poor blood flow that leads to irritation of your lower urinary system. 

Symptom #2: You have to push to pee

Also known as urinary hesitancy, if you have to push when you pee, notice a weakened urinary stream, or a stream that starts and stops, it could mean that your pelvic floor muscles are too tight to be able to relax fully from supporting your bladder and urethra, and at the right time when you pee.

SYMPTOM #3: IT's Hard to poop (or Pooping hurts)

For normal bowel emptying, your pelvic floor muscles must relax and lengthen to allow for opening of the anus, and easier stool evacuation. Constipation is common in those with a tight pelvic floor, since the muscles have a hard time lengthening and opening. As a result, you may need to strain to empty your bowels, and can it can even lead to pain, especially if constipation leads to large, impacted stool, hemorrhoids or fissures (small cuts in the fragile anal tissues).

SYMPTOM #4: It feels like you have a UTI — but you don’t

Similar to a UTI, tight pelvic floor muscles can lead to symptoms such as vulvar and urethral pain, and also leave you feeling like you have to sprint to the bathroom every few minutes to only push out a few drops. However, if an infection has been ruled out, and these symptoms persist, your pelvic floor may be to blame, and is often referred to as a “phantom UTI”.

SYMPTOM #5: Your orgasms are weak or non-existent

While there are many different reasons why someone could experience sexual dysfunction, pelvic floor muscles that are too tight may be one of them. Your pelvic floor muscles are vital for orgasm and sexual function: They ensure good blood flow to healthy pelvic nerves, along with your hormones they facilitate hydration and natural lubrication to your tissues, and they encourage the sensations needed for arousal and orgasm. However, if your muscles are too tight, you may have trouble experiencing orgasms. 

SYMPTOM #6: Sex hurts

Speaking of sexual function, tight pelvic floor muscles can also contribute to painful sex. Otherwise known as dyspareunia, tight pelvic floor muscles are often painful when touched or stretched during penetrative and non-penetrative sex. Even if the act of sex is comfortable, tight pelvic floor muscles can contribute to pain during an orgasm, or even pain in the moments after sex when overactive muscles cramp from the strong muscle contractions that often automatic occur during sex. 

SYMPTOM #7: Urinary urgency (You Really have to go!)

Things are rolling along just fine, until you get home and start to unlock your door and are struck by a sudden, and uncontrollable urge to pee. You have to drop the groceries and run to the bathroom before you pee your pants. Urinary urgency is another common symptom when your pelvic floor muscles are too tight. 

SYMPTOM #8: Your bladder leaks sometimes

While bladder leakage is a very common symptom of an underactive and weak pelvic floor, you can also experience leakage when your muscles are too tight. When muscles are tightened and overactive, they often don’t have any strength left to give to protect you when you cough or sneeze. Leakage can occur with overactivity or underactivity, so check in with a pelvic floor physical therapist to see which could be causing your symptoms.  

SYmptom #9: Kegels Make bladder leaks (or other pelvic symptoms) worse

Kegels are often touted as the best thing for your pelvic floor health, but when your muscles are tight and overactive, using kegels to “fix” your symptoms will often lead to them worsening instead. If this happens to you, it may be an indicator that your pelvic floor muscles are already too tight. 

SYMPTOM #10: You have tailbone pain

A too-tight pelvic floor can literally be a pain in the butt, or the coccyx to be more specific. From behind, your pelvic floor attaches to your tailbone (aka coccyx), and a tight pelvic floor will pull and strain on said tailbone leading to tailbone pain. When you sit, this pain often becomes more apparent since depending on your posture (slumping back into your chair, or the bucket seat of your car for example) it can increase the pressure on an already strained and tender tailbone. 

If you notice any of the symptoms above, don’t ignore them or explain them away as "normal." Any of these symptoms can indicate that you have pelvic floor dysfunction, which is likely to get worse if left untreated. The good news is that you can take action right away. Let your healthcare provider or, even better, a pelvic floor physical therapist know what's happening with your body so you can get the care you need.