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A photo of a woman in plank position, shot from behind to highlight her tight or hypertonic pelvic floor

10 Signs You Have a Tight Pelvic Floor

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 does it mean to have a hypertonic pelvic floor?

The pelvic floor is made up of muscles and connective tissues that span across the base of the pelvis. These muscles need to have the strength, flexibility, and coordination necessary to help support healthy bowel, bladder, and sexual function.

When the pelvic floor muscles are tight, or overactive, they essentially get stuck in a contraction, which leads to poor blood flow and irritated nerves. Moving or touching a tight pelvic floor can be painful.

Tightness in the pelvic floor muscles can occur for several reasons:

  • Injury or surgery: A fall on your tailbone, muscle injury from a vaginal delivery or sexual assault, or surgery in the area can all lead to a tight pelvic floor.
  • Muscle overuse: Yes, you can do too many kegels. And excessive strengthening of the muscles surrounding the pelvic floor, like the hips, low back, and deep abdominals can also lead to pelvic floor muscle tightness.
  • Behavioral habits: If you’re always squeezing your glutes together, sucking in your stomach, clenching your jaw, you may have a habit of holding tension in your p
  • Stress responses: Your pelvic floor is like a guard dog in response to stress and anxiety — it contracts to protect you from perceived threats. If this happens too often or continually, it can lock up your pelvic floor.
  • Medical conditions: Pelvic tightness and pain can often develop after one or more pelvic infections (chronic UTIs for example) or other medical conditions that impact the pelvis.

10 Symptoms of Tight Pelvic Floor in Women

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 need 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 have to relax and lengthen to allow the anus to open and stool to exit your body. 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, which can be painful. Large, impacted stool, hemorrhoids, or fissures (small cuts in the fragile anal tissues) can worsen the pain.

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”.

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Pelvic Anatomy

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 automatically 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.

Ashley Rawlins Headshot
Dr. Ashley Rawlins, PT, DPT

Dr. Rawlins is a physical therapist at Origin who specializes in the treatment of pelvic floor muscle dysfunctions including pelvic pain, sexual dysfunction, pregnancy related pain, postpartum recovery, and bowel and bladder dysfunction. In addition to being a practicing clinician, she is a passionate educator and author.

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