Is Your Pelvic Floor Too Tight, Too Weak, or Both?
When it comes to pelvic floor dysfunction (PFD), the muscles of the pelvic floor will develop a variety of different characteristics and qualities — a pelvic floor personality, if you will — that can show up as weakness or tightness, or even both! No matter the personality of your pelvic floor, when PFD is present, it often leads to inconvenient and unwelcome pelvic floor symptoms that impact your bowel, bladder, and sexual health.
While these symptoms are often the first thing to signal you may have pelvic floor dysfunction, they are not always a reliable source of information to explain what is actually going on in the muscles. To the untrained eye, it can be tricky to tell if your muscles are weak, tight, or both — don’t worry, a pelvic floor physical therapist can easily get to the bottom of your pelvic floor dysfunction for you! In the meantime, let’s break down PFD a bit more for you, and learn a few self assessment tools that you can use to investigate your own pelvic floor health, and give you some insight into how to get the conversation rolling when you get in to see your pelvic PT.
Types of Pelvic Floor Dysfunction
The pelvic floor muscles—which refer to the multitasking layers of muscles that stabilize your pelvis from below, and help to support and control your bowel, bladder, and sexual functions—play a crucial role in supporting so many of your body's movement and bowel, bladder, and sexual functions. Ideally, your pelvic floor muscles should be simultaneously strong, flexible, and coordinated.
When the pelvic floor muscles are not working in the way they should, it is known as pelvic floor muscle dysfunction (PFD), and this can develop for a whole variety of reasons including:
- Change in hormones, particularly estrogen (like during pregnancy or menopause for example)
- Trauma or injury (psychological or physical)
- Chronic increased pelvic floor pressure (like if you have a chronic lung disease such as COPD, or have chronic constipation for example)
Pelvic floor muscle dysfunction can be further classified into two categories depending on the characteristics of the muscles:
- Overactive pelvic floor muscle dysfunction: Aka, you have tight pelvic floor muscles. Muscles in this category typically have poor flexibility, difficulty relaxing, and are tender to the touch. Because muscle tightness restricts a muscle’s ability to produce force, tight muscles can also be weak and unsupportive.
- Underactive pelvic floor muscle dysfunction: This explains the classic weak pelvic floor muscles. Muscles in this category typically have low tone, are unsupportive, and are weak. Treatment for pelvic floor muscle dysfunction is not one-size-fits-all, and depending on the type of your PFD, the details of your treatment plan can look entirely different. For example, a devout routine of kegels may have helped your bestie with their bladder leakage, but your bladder leakage may require you to focus more on adjusting your diet, and tuning into your body instead. It is important to get a better understanding of your pelvic floor health, so that you can get the most out of your treatment.
Treatment for pelvic floor muscle dysfunction is not one-size-fits-all, and depending on the type of your PFD, the details of your treatment plan can look entirely different. For example, a devout routine of kegels may have helped your bestie with their bladder leakage, but your bladder leakage may require you to focus more on adjusting your diet, and tuning into your body instead. It is important to get a better understanding of your pelvic floor health, so that you can get the most out of your treatment.
How to Check for Signs of Pelvic Floor Dysfunction
If you think you may have PFD, it is best to see a pelvic floor physical therapist who can assess your pelvic floor muscles and determine whether they are too tight, too weak, or somewhere in between. With a full understanding of your symptoms and pelvic floor muscle dysfunction, they will work with you to find the best treatment options for your symptoms.
In the meantime, try these 3 easy self-checks to help you better understand your pelvic floor muscles.
#1. Tune into your symptoms.
As mentioned before, your symptoms alone are rarely enough to understand the full picture of your pelvic floor health. However, they are a helpful place to start when wondering about the details of your pelvic floor muscle dysfunction.
If you experience any of the following, you may have tight pelvic floor muscles:
- Chronic constipation
- Pain during sex (inner course, outercourse, or orgasm)
- Difficulty starting or stopping urine flow
- Painful urination or urinary urgency and/or frequency
- Low back, pelvic, or tailbone pain
If you experience any of the following, you may have underactive and weak pelvic floor muscles:
- Bladder or bowel leakage
- Difficulties holding back gas
- Pelvic heaviness or prolapse
- Low back, pelvic, or tailbone pain
- Decreased sensation during sex, or delayed or absent orgasms
#2. Decode your kegel.
Sit down on a chair with a firm flat surface. Make sure your feet are flat on the floor, and you are sitting up straight on your sit bones so that you can feel your vulva pressed gently into the chair.
Contract or squeeze your pelvic floor muscles to lift your vulva up and away from the chair. This should feel like the movement you make when you are trying to hold back gas or stop the flow of urine. How does this feel?
- What contraction?
Hold it for a few seconds if you are able, and then release your contraction. Pay attention to the way it feels when you release your pelvic floor. How did it feel?
- It was easy and fast-ish to relax
- It felt slow and awkward. It's kind of had to force myself to relax
- It’s still contracted
If it felt difficult or impossible to contract your pelvic floor muscles, or if you could contract but it was too hard to hold and they quickly released, you may have pelvic floor muscles that are weak.
Alternatively, you may have pelvic floor tightness if you notice that the contraction felt difficult or weak, and/or releasing the contraction was difficult. Tight pelvic floor muscles can be so used to being held tight, that it can be difficult to release after a contraction.
#3. Take a deeper dive.
A self pelvic floor muscle assessment is a gold mine when it comes to understanding your body. Check out this blog for a full explanation of this assessment, but here are a couple of things to pay attention to in order to help you better understand if your pelvic floor muscles are tight, weak, or a combination of both:
If your muscles are underactive and weak, you might notice the following during the pelvic floor self assessment:
- Minimal to no perineal movement when observing your perineal mobility in the mirror. Or you may find yourself substituting other muscles such as your inner thighs or glutes to help you accomplish this movement.
- When you cough and/or bear down, you may notice a little bladder leakage, or tissue drooping down from your vaginal opening.
- When pushing on your muscles, they are pain-free and feel a bit softer than expected (you can compare it to how it feels to push on your thigh muscles — they should feel like they have about the same tone).
If your muscles are tight, you might notice the following during the pelvic floor self-assessment:
- It may feel difficult or weak to contract the pelvic floor muscles if there is tightness and weakness.
- It feels difficult or impossible to release your muscles from a pelvic floor contraction, and when you lengthen/bulge your muscles it is also difficult or impossible.
When pushing on your pelvic floor muscles internally or externally, they feel tight, you notice muscle knots, and/or they are uncomfortable or painful to push on.