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Yes, Your Pelvic Floor Muscles Can Spasm

It’s easy to brush off the random cramp in your foot when you first wake up in the morning or the charley horse you get in your calf during a run. But when you experience a muscle spasm somewhere in the vicinity of your vagina or rectum, it can make you stop and wonder what the heck is going on. We get it. The pelvic area can feel like a mystery wrapped in an enigma, and a new, unpleasant sensation can bring up fears ranging from UTIs to STIs.

First thing to know: a muscle spasm can impact any muscle in your body, even the muscles you don’t think about. Take your respiratory muscle, aka the diaphragm — another term for a diaphragmatic muscle spasm is a hiccup, and (as long as it isn't chronic) it's totally benign. So the odd pelvic floor muscle spasm isn't necessarily worrisome, but if they bother you on a regular basis, it's a sign of pelvic floor muscle dysfunction and worth treating.

Keep reading to learn more about pelvic floor muscle spasms and when it might be time to see a pelvic floor physical therapist.

Understanding your pelvic floor muscles

Located at the base of your pelvis, your pelvic floor is a complex group of muscles, ligaments, and tissues. Together, they form a kind of a hammock that supports your pelvic organs, including your uterus, vagina, bladder, and rectum.

Working in sync with your abdominal and hip muscles, your pelvic floor muscles have several important functions:

  1. Supporting normal bowel and bladder function
  2. Allowing for pain-free penetrative sex and satisfying orgasm
  3. Providing stability to the low back and pelvis for pain-free movement and balance
  4. Promoting healthy blood flow and circulation in the pelvic area
  5. Regulating intra-abdominal pressure and helping you breathe normally

When the pelvic floor muscles are in working order, they're strong, flexible, and able to contract or relax as needed. But sometimes pelvic floor muscles can become tight, weak, and/or uncoordinated, which can bring on spasms as well as uncomfortable bowel, bladder, and sexual symptoms.

What do pelvic floor spasms feel like?

Since your pelvic floor is made up of several smaller muscles, the sensations you feel during a spasm can vary depending on which muscle is contracting. If the muscle that surrounds your vaginal or anal opening spasms, you may feel the sensation in one or both of these areas. If the muscles near the outer edges of the pelvic floor spasm, it may feel deeper in your pelvis.

A spasm can be so intense, it may feel like a stabbing sensation. Or it may be more like a gentle throbbing or a fast tremor (kind of like an eye twitch). What you feel can also vary depending on how long the spasm lasts.

The unique sensations you feel can give a pelvic floor physical therapist clues to what's happening in your body. So whatever you feel, make a note of where you feel it, how strong the feeling is, and when it tends to happen. If it's too hard to describe or seems to happen at random, that's good information to share, too.

What causes a pelvic floor muscle spasm?

A muscle spasm (which is a kind of muscle cramp) is an involuntary, tightening or contraction of your muscle, which can cause pain and muscle dysfunction. It is usually temporary and can be resolved by stretching the affected muscle, or gently massaging it.

Spasms are more common in muscles that are:

  • Tight and under-stretched
  • Overused and fatigued
  • Impacted by poor circulation and nerve irritability
  • Stressed and over-exercised

When pelvic floor muscles are stressed and overused — yes, it's possible to overdo kegel exercises — then they can also become tight and more likely to spasm.

Some other factors that can contribute to a so-called vag twitch:

  • In response to injury: Whether it's a fall impacting the pelvic area, muscle trauma from a vaginal birth, or surgical procedures in the region, injuries can cause the muscles to tense in reaction to pain and trauma. Without proper rehabilitation, this tension may persist.
  • Behavioral habits: Constantly clenching your glutes, consistently holding in your stomach, or clenching your jaw/grinding your teeth at night are all ways that we hold tension in the body. You can also hold tension in your pelvic floor, though the symptoms may not be as obvious.
  • Stress responses: Like a guard dog, your pelvic floor can react to stress and anxiety by gripping, protecting, and holding tension. A little stress here and there is not a significant concern, but persistent life stressors and anxiety may keep your pelvic floor in a perpetually tense and guarded state.
  • Medical conditions: Pelvic tightness and muscle spasms can develop following a pelvic infection or other medical conditions affecting organs in the pelvic and abdominal areas. It's important to understand that infections or medical issues that impact your bowel, bladder, or reproductive system can cause symptoms similar to those coming from tight pelvic floor muscles. It’s important to always consult with your healthcare provider first when new symptoms pop up.
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What are the symptoms of pelvic muscle spasm

When your pelvic floor muscles are in a spasm, it may not feel quite as painful and obvious as a charley horse. But when examined, a pelvic floor muscle spasm will feel like a tight band of muscle, or even a trigger point. Pushing on or stretching the affected muscle(s) can sometimes be painful or reproduce your symptoms.

The most common symptoms of pelvic floor muscle spasm include:

  • Pain during vaginal penetration of any kind (with a tampon, speculum, finger, or toy, for example)
  • Vulvar pain or itching (the pain may be provoked — for example by sitting for too long — or present all the time)
  • Bladder urgency (for example, the sudden, uncontrollable urge to rush to the bathroom as soon as you put your keys in the front door) that may or may not cause leaking.
  • Bladder frequency (having to empty your bladder more frequently than once every two hours)
  • Constipation (constantly needing to strain to have a bowel movement)
  • Anal pain during bowel movements
  • Pelvic or low back pain that does not improve (or even worsens) with strengthening exercises

Treating pelvic floor muscle spasm

Just like when you have a charley horse, the goal of treatment is to help ease your muscle spasm by restoring the flexibility and function in your pelvic floor.

A pelvic floor physical therapist may incorporate any or all of the following into your treatment:

  • Mindful Dilator Training: Vaginal dilators are an extremely helpful tool that physical therapists often use to help improve restore normal muscle range of motion by gently and progressively teaching the pelvic floor muscles pain free stretch and pressure.
  • Hands-On Manual Therapy: Skilled manual therapy techniques including myofascial and trigger point massage. These can relieve pain and restore muscle function by dialing down muscle activity, releasing neural tension, boosting blood flow, and normalizing tissue flexibility and joint mobility.
  • Movement Reeducation Exercises: Individualized exercises can be used to retrain the body to move without pain, while also encouraging strength and stability throughout the pelvis and spine.
  • Biofeedback: Biofeedback therapies are a great way to help reconnect your body and mind to help you increase your awareness of your pelvic floor and its coordinated motion. Biofeedback comes in many forms, and can be as sophisticated as displaying your muscle function on a computer, and as simple as watching your body movements in the mirror — all of which are super helpful in learning and recovery.
  • Lifestyle and Behavior Adjustments: Holistic physical therapy care includes helping you replace habits that may be contributing to your symptoms on a regular basis, and using motivational strategies to keep you on track.

While a single muscle spasm is not a reason to worry, you should always check in with your healthcare provider if spasms become chronic, are accompanied by any of the symptoms mentioned above, or if you suspect injury or infection in the area. Be sure to ask if a referral to a pelvic floor physical therapist is right for you — PT is proven to be a highly effective treatment option for muscle spasm.

At Origin, our physical therapists are experts in helping to manage pelvic floor muscle spasms, and will use evidence-based treatment options to help you feel your best. Don't hesitate to book a visit with one of our virtual pelvic floor PTs who can evaluate your symptoms on the spot.

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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