How do you fix a hypertonic pelvic floor?
What is a hypertonic pelvic floor?
A hypertonic muscle is one that is too tight and therefore difficult to move. The pelvic floor is made of many small muscles working together; when one or more of these muscles become hypertonic, problems can start to occur. In this condition, the muscles of the lower pelvis stay contracted or are in a state of spasm. Because of the inability of these muscles to relax, the pelvic floor doesn’t function as it should in the coordination of daily bodily functions (Cleveland Clinic).
Because of the positive connotation associated with a “tight body” (typically referring to someone who is fit and strong), there’s often some confusion when talking about muscle tightness. From a functional standpoint, a tight muscle is a WEAK muscle and needs rehabilitation to regain strength to work properly.
What are common symptoms of a hypertonic pelvic floor?
- Inner thigh/groin pain (and/or front/side of hip pain) - comes and goes, often times worse with prolonged periods of standing, and with activity that involves lunge-like positions or anything that pulls in opposite directions on the pubic joint
- Struggle to start the flow of urine - feel like you need to bend forward and move around to get started
- Dribble of urine when you stand up after peeing
- Feel a tightening of vaginal opening during sex, which may cause pain - find it hard to relax, and notice an increase in feelings of anxiousness
- May also have urinary urgency (gotta-go-now), frequency (peeing more than 10 times per day), and constipation.
- Flat glutes
Please note: if you’ve been diagnosed with pelvic organ prolapse, it is very likely that you are also dealing with a hypertonic pelvic floor.
What causes a hypertonic pelvic floor?
It can be difficult to pinpoint the exact cause of a weakened pelvic floor. After working with us, many women with a hypertonic pelvic floor come to suspect kegels (or kegel-like exercises performed with intravaginal devices) are to blame for worsening symptoms. For this reason, Tighten Your Tinkler has been publicly opposed to the use of kegels (except in extreme circumstances overseen by a specialist) since Jenn’s prolapse diagnosis in 2014. If you have to lean forward to start peeing, dribble when you stand back up, or feel pain with insertion during sex, kegels might be to blame.
Along similar lines, trigger point therapy (common in Women’s Health Physical Therapy) may make a hypertonic pelvic floor worse. If you’ve experienced this type of therapy and noticed that your symptoms recur as soon as you stop sessions, consider pausing sessions and following the steps outlined below.
Pubic symphysis joint dysfunction can also play a role in causing a hypertonic pelvic floor. This joint is at the front/bottom of the pelvis, where the left and right sides meet just above the genitalia. Increases in the relaxin hormone during pregnancy and breastfeeding can make this (and other) joints looser, causing it to come out of alignment. Women with hypermobility or other musculoskeletal disorders have increased risk for pubic symphysis joint dysfunction.
Other possible causes for a hypertonic pelvic floor include scarring from an abdominal surgery, such as a C-Section or appendectomy. Scar tissue extends well below the surface of the skin and can interfere with normal function. It can be helpful to assess your scar (after you’ve completely healed) to see if you might benefit from desensitizing and loosening the tissue. This short video can help you get started; if you’re a Signature Program member, be sure to watch the “Softening Scar Tissue” training in the Recovery Tools section.
I have a hypertonic pelvic floor. What should I do first?
If you suspect or have been formally diagnosed with a hypertonic pelvic floor, there are a number of steps you can take today. It’s important to note that while some of the band-aid solutions outlined below should provide partial relief, true healing will require consistent efforts over time.
To address a hypertonic pelvic floor at its root, you’ll need to:
- Correct alignment issues.
- Train your pelvic muscles to fully relax.
- Rebuild strength.
This is not a quick fix – but it is the path to healing. Many women who find Tighten Your Tinkler do so after years of living with their symptoms. They’ve often tried pelvic floor PT or other programs with little success. If that’s you, please know that healing IS possible.
Step 1: Address alignment issues.
The first step is to check your pubic joint alignment, which you can do yourself (clothes stay on!) using this quick tutorial. The majority of the women we’ve worked with who are experiencing a hypertonic pelvic floor have a misaligned pubic joint. Because it’s not visible and only sometimes painful itself, this misalignment often goes unnoticed - but it’s impact is similar to what happens with a subluxed shoulder (when a shoulder partially slides out of the socket).
When that happens, you don’t expect your hand and fingers to function normally; your pubic joint coming apart causes malfunctioning in your pelvis, leading to the symptoms mentioned earlier. If you complete the self assessment and discover you ARE out of alignment, the next step is to schedule an appointment with a Webster-certified chiropractor. They’ll be able to help you get back into alignment, gently and fully clothed. If you’re opposed to chiropractic care, have known hypermobility, or have been diagnosed with a connective tissues disorder like Ehlers Danlos Syndrome, please seek care from an Upledger craniosacral therapist (CST) or Osteopathic manual medicine (OMT or OMM).
Please note: Once adjusted, it’s unlikely your pubic joint will STAY in alignment until you take further steps to strengthen the muscles around it. Similar to the shoulder issue, getting things back into place is a necessary first step. It’s important to address the root cause of misalignment (muscle weakness) to stop it from happening. While you’re rebuilding strength, continue to assess your pubic joint regularly and expect to need monthly visits with your practitioner for 6 months to a year depending on severity.
Step 2: Practice relaxation.
Hypertonic muscles are in a sort of permanent contraction. The next step after realigning your pelvis is to help the muscles in your pelvic bowl relax. We’ve found that a combination of diaphragmatic breath work and resting postures to be the most beneficial. Signature Program members, please utilize the Breath work, 90/90 Decompression, and Pelvic Organ Decompression teachings in the Recovery Tools section. Non members can access the 90/90 Decompression training for free here. Daily use of breath work and decompression over the course of 2-4 weeks will lead to the best results (they can be done simultaneously!). Ideally this would be done early in the morning or before bed, but Tighten Your Tinkler is a big believer in “done is better than perfect” – so make it fit your schedule!
Step 3: Rebuild Strength.
The pelvic floor is made up of over a dozen small muscles. Once these muscles have begun to relax, they’ll need to build strength to regain optimal function. As an Exercise Physiologist and Physical Therapist, we’ve helped hundreds of in-person clients do this work. If seeking in-person support, be sure to find a practitioner who utilizes strength building techniques outside of kegels and internal devices.
You can learn more about our online, movement-based approach to pelvic floor health here. The Tighten Your Tinkler program can be customized to support women with hypertonic pelvic floors by following our included Symptom Relief Map.
Other helpful tips
While they won’t address the root cause of a hypertonic pelvic floor, the following tips may help relieve some of the symptoms.
Hum while you pee.
If you struggle to start a urine stream, try creating a low vocalization (like a hum or moan). This can help relax the muscles and allow the flow to start. Avoid pushing your pee out, as this causes incomplete emptying (which in turn can cause issues with frequency and UTIs).
Stay hydrated.
Dehydration is a bladder irritant and can make urinary symptoms worse. Use electrolytes (we prefer this sugar-free, tasteless option) to get a bigger bang for your buck.
Avoid tight clothing (anything that leaves a mark on your skin).
Shapewear, compressive leggings, and other restrictive garments apply pressure to your pelvic muscles and organs. Avoid these – and order a size up if your jeans (or heck, your undies!) are leaving marks on your hips.
A note for Signature Program members: the Happy Bladder Habits bonus teaching in the “Extra Support and Resources” section explains these tips in more detail. The video also shows “proper pee posture” which might be especially beneficial for you.
How will I know if my hypertonic pelvic floor is getting better?
It might be helpful to document your symptoms. We invite all Signature Program members to complete a self-assessment at the beginning of their healing journey so they have benchmarks (found in the “Let’s Get Started” section). If you’re not a member, you may consider journaling your symptoms and creating pee/poop logs. We recommend tracking how often you pee over the course of a day and monitoring your bowel movements for a week. These data points are more objective and easier to quantify than the following.
Signs your hypertonic pelvic floor is getting better:
- Your glutes feel stronger.
- Your neutral posture improves.
- You experience less pain with intimacy.
- It becomes easier to start the flow of urine.
- You feel less anxious.
- Your pubic symphysis joint is not out as badly (or at all) when you visit your practitioner.
- Thigh/groin/hip pain improves or goes away.
- Your pee problems improve, including leaks, urgency, and/or frequency
How long will it take to fix my hypertonic pelvic floor?
Healing a hypertonic pelvic floor IS possible – the process will require effort and time. The length of time required depends on your specific goal, severity of symptoms, how long you’ve been living with this, and your consistency. You don’t have to show up perfectly (no one does!); small actions over time lead to better results. Think of yourself as the Tortoise in the Tortoise and the Hare, and continue taking one step after another.
We offer a one-year guarantee for our Signature Program so women can relax and proceed at their own pace. Most start to feel a difference quickly – within 30-60 days – and continue to see improvements compound over the following months.
This is real.
Many women we speak with have been dismissed by the healthcare system, told their issues have improved “enough” or “aren’t that bad.” We’re so sorry if that’s part of your story. We know firsthand how pelvic floor symptoms interrupt relationships and negatively impact quality of life. We also know that “mild” symptoms seldom stay that way – and it’s much easier to treat hypertonicity and other pelvic floor issues in the earlier stages. If you’re questioning whether your issues are “bad enough” to seek care, we invite you to take our Symptoms Quiz. It can help connect the dots between related issues that modern medicine often separates into different buckets. It’s fast (and free), and you can retake it any time. Click here to take the quiz.