Do you have overactive pelvic floor muscles?
By Dr. Lauren Earles, Physiotherapist/Owner — PhysioPod Co.
When we talk about pelvic floor muscle dysfunction, most people think of leakage (incontinence) when you cough, sneeze or lift anything due to weakness of the muscles. Did you know the pelvic floor muscles can also be overactive (hypertonic)? They can!
The pelvic floor is a complex web of muscle, fascia and fibrous tissue that helps support the pelvic organs. There are 3 layers of pelvic floor muscles and their collective role is to provide support to our pelvic organs (bladder, bowel and uterus in females) so as prolapse does not occur, provide bladder and bowel continence (and allow us to go to the toilet when they relax), as well as provide pleasure during sexual intercourse.
The three layers of the pelvic floor muscles are as follows:
Layer 1 - Superficial layer consisting of the urogenital triangle and external anal sphincter.
Layer 2- Deep perineal pouch consisting of the deep transverse perineii, external urethral sphincter and perineal membrane.
Layer 3- Pelvic Diaphragm consisting of the levator ani and coccygeus.
Weakness or tearing of any of these muscles may cause urinary, faecal or flatal incontinence. A pelvic organ prolapse (where one of the pelvic organs descends) may be related to weak pelvic floor muscles, as well as damage to the pelvic fascia which can occur during labour.
Overactive or tight pelvic floor muscles can also occur. This can lead to and be associated with pelvic pain, dyspareunia (painful sexual intercourse) and constipation. There are many different causes for overactivity of the pelvic floor and it can be seen in the following populations:
1. Pelvic pain (eg. Endometriosis, PCOS, bladder pain syndrome)
2. Dyspareunia (painful intercourse)
3. Anxiety and panic disorder
4. Previous trauma (psychological or physical)
5. Chronic constipation
Overactive (hypertonic) Pelvic Floor muscles require specialised assessment and treatment from a Pelvic Health or Women’s Health Physiotherapist. Those not trained adequately in this area may prescribe Pelvic Floor muscle retraining/strengthening exercises, however this will further tighten the already hypertonic muscles in people listed above and cause more issues with pain and discomfort.
Physiotherapy for hypertonic Pelvic Floor muscles can involve the following;
1. Myofascial release (a massage technique) of the internal and external pelvic muscles
2. Relaxation techniques (eg. Deep breathing, visualisation, mindfulness and meditation)
3. Stretching (eg. ‘Child’s pose’ and ‘happy baby pose’ in yoga)
4. Myofascial release with a Pelvic Wand
5. Vaginal dilators
A thorough and specialised Women’s Health Physiotherapy assessment needs to be performed first before any treatment is prescribed. The good news is that Physiotherapy for pelvic pain and overactive pelvic floor muscles is very effective and can greatly reduce your symptoms!
Contact your local Women’s Health or Pelvic Health Physiotherapist to gain an accurate diagnosis and individualised treatment plan.
Dr. Lauren Earles
Musculoskeletal and Women’s Health Physiotherapist
Winter Olympic Physiotherapist (Sochi 2014)