Hypertonic Pelvic Floor: Common Issues in Moms and How to Address Them

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hypertonic pelvic floor

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What is a hypertonic pelvic floor and can it happen in pregnancy? What are the symptoms and possible causes of a hypertonic pelvic floor and what exercises can I do if I have it?  Read on for all the answers to your most asked questions.

Hypertonic Pelvic Floor: What is it and how can it affect moms

Having a hypertonic pelvic floor means that the muscles low in your pelvis are in a state of contraction or spasm. It means they’re kinda ‘always switched on’.

It is sometimes also called non-relaxing pelvic floor dysfunction. If your pelvic floor muscles are ‘tight’ or always contracted or spasming in this way, they aren’t able to properly coordinate the control of certain bodily functions. Urination and defecation can be affected by a hypertonic pelvic floor, as can sexual function and sexual pleasure. 

Even though pelvic floor conditions are common and awareness is increasing, this condition is likely underdiagnosed. The Cleveland Clinic suggests it might occur as commonly as in 1 out of 10 people. 

Learn more about the pelvic floor after childbirth here.

Recognizing the symptoms: Overtight pelvic floor muscles in moms

The sensations of having a hypertonic pelvic floor can manifest in the bladder, bowels, or genitalia. 

Bowel symptoms:

  • Constipation and difficulty pooping.
  • Feeling like you can’t empty your bowels completely.
  • Pain during or after pooping.
  • Pain when passing gas or feeling like you can’t pass gas.

Urinary symptoms:

  • Pain when peeing and peeing frequently. 
  • Bladder pain.
  • Struggling to start peeing or maintain a steady urinary stream.

Sexual symptoms:

  • Difficulty achieving orgasm.
  • Pain during or after sex.

Can pregnancy or birth cause pelvic floor hypertonicity?

In some cases, yes. Pregnancy can contribute to pelvic floor problems due to the added weight of a growing baby on your pelvic floor muscles and surrounding organs.

It may be more likely you might experience pelvic floor injuries with surgical vaginal births than other birthing experiences. However, injury or trauma to this area can occur in any method of delivery including cesarean birth and uncomplicated vaginal birth. 

In all cases, it is likely a variety of factors that can contribute to a higher risk of pelvic floor injury or hypertonic pelvic floor than just pregnancy or birthing alone. 

Uncovering the Underlying Causes

Let’s take a look at some of the other possible causes of hypertonic pelvic floor:

  • Habitually holding in pee or poop. 
  • Trauma or injury to the pelvic muscles caused by an accident or surgery. 
  • Other prolonged conditions related to the reproductive organs, pelvic bones or tissues, anal/rectal disorders, or bladder disorders affecting the pelvic floor. 
  • Muscular dysfunction caused by posture issues, an abnormal gait, or prolonged sitting.
  • Mental health concerns can cause high levels of stress, anxiety, and/or depression.
  • Sexual or physical abuse. Please go here for resources and expert help with trauma and PTSD.

For causes related to a generally weak pelvic floor or other pelvic floor issues see our

Who can be affected?

Anybody of any age or sex can experience a hypertonic pelvic floor. 

Men / Male assigned at birth can also experience pelvic floor disorders and all/any of the above pelvic floor disorder symptoms. They may also struggle to have or maintain an erection or ejaculation from this issue.

Hypertonic Pelvic Floor: How to Self-diagnose and Seek Help

If you have some or all of the symptoms above, it is possible that you are experiencing this type of pelvic floor dysfunction.

It’s something to bring up at your next OB, midwife or doctor’s appointment. They might run some tests and/or send you to a specialist. We recommend you seek care from a pelvic floor Physical Therapist who could help diagnose this issue.

Can it cause sex to be painful?

Yes. Painful sex may be a symptom of a hypertonic pelvic floor.

Pain can occur during or after penetrative sex for women, or cause there to be painful or difficult sexual function in men.

How to relax the pelvic floor muscles: Tips for moms

What exercises can you do to help with having a hypertonic pelvic floor?

Walking, stretching, and yoga are fantastic exercises for hypertonic pelvic floor dysfunction. Butterflies, child’s pose, and hip stretches are the best exercises for this condition. Squatting can be a great exercise as well, especially if you can work into a deep, full squat. 

MUTU’s gradual and grounded approach to postpartum exercise for pelvic floor health is rooted in functional movement meant to help strengthen and stabilize your core and pelvic floor muscles. Beyond building back strength in postpartum, the MUTU workouts help with the component that can sometimes contribute to a tense pelvic floor. These guided, expert-driven exercises can help teach you how to ease hypertonic pelvic floor spasms.

Is yoga good for hypertonic pelvic floor disorder?

Yoga can be great for relaxing your pelvic floor muscles.

This is thanks to the gentle stretching in yoga as well as in helping you gain skills for relaxation. That combination can go a long way in addressing hypertonic pelvic floor symptoms. 

Are there any exercises to avoid if you have overtight pelvic floor muscles?

Traditional kegels – that focus purely on the contract or ‘squeeze’ cue – may not recommended for a hypertonic pelvic floor.

There is such a thing as a “reverse kegel” or allowing your pelvic floor muscles relax and release rather than pulling them up forcefully, or holding them tight. 

Traditional crunches, sit-ups, and planks might not be a good idea for someone with hypertonic pelvic floor spasms. Hypertonicity weakens pelvic floor muscles, but it’s best to address the tightness and spasms that happen with this condition before going back to many straightforward ab exercises. 

In some cases, high-impact or ab workouts can be okay with this condition, but in a modified form. For example, a modified plank or push-up with your knees on the ground might be better than a fully prone position from your toes. Cycling and running might make the spasms worse, or combined with lighter workouts and stretching, may be fine for you. Listen to your own body around this! 

Keep in mind that stretching and relaxing your muscles to avoid further injury can help you return safely to high-intensity sport and exercise with more strength and ease than trying just to fight through it. Hypertonic Pelvic Floor disorder is treatable and you can build back strong and less painful muscles.

Is there a medical treatment?

Your care provider (please consult with a pelvic floor Physical Therapist) can make a diagnosis of hypertonic pelvic floor through a combination of verbal, visual, and physical assessment.

There are several treatment options available for this condition. Some plans of treatment are more intimate, extensive, or medical than others. Medications for mental health are effective in helping some cases of hypertonic pelvic floor disorder, too. 

Some women have benefitted from botox injections to treat hypertonic pelvic floor disorders, though the treatment is not yet widespread. This treatment is usually tried only after less invasive options have been tried.  

Your care provider might want to have your care co-managed by other specialists like a gastroenterologist, sex therapist, psychologist, or pelvic floor physical therapist. 

Non-Medical Treatments: What You Need To Know

In some cases, injections or medication may be advised, but this issue is usually treated non-medically. Physical therapy, dilators (managed in consultation with your PT), self-massage, stretching, meditation, yoga, etc. are usually the recommended care. 

A technique called biofeedback is a very effective treatment for this condition. Biofeedback involves working with a pelvic floor therapist using sensory cues to retrain your pelvic floor muscles. This will be guided at first, and then you will be able to do them on your own till your symptoms improve.

Taking Control: Strategies for Preventing Hypertonic Pelvic Floor

With the right support, you can be proactive with your own pelvic health. You can employ some simple yet effective methods today, to prevent issues and feel more in control.

  • Avoid holding in your pee or poop for long periods. 
  • Practice pelvic floor exercises in pregnancy.
  • Seek treatment soon after any injury to your pelvic floor.
  • Seek emotional support from a trained provider around any stress, anxiety, fears, etc. which may be contributing to your pelvic floor tension. 
  • Bring mindful awareness to the tension in your pelvic floor then focus on trying to release that tension through breath and movement. 

These strategies may not feel easy at first, but awareness is the start, and your pelvic Physical Therapist alongside MUTU will support you.

Emily Flynn
Emily Flynn
Emily Flynn is a birth and postpartum doula, author, and researcher based in California, USA. She writes about reproductive technologies, maternal mental health, infant sleep, and postpartum fitness. You can find her writing through MUTU System and her substack, Doula Thinking.

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