What Causes a Tight Pelvic Floor?
A tight pelvic floor, also called a hypertonic pelvic floor, is a condition where the pelvic floor muscles hold excess tension and have difficulty relaxing even when they should. This affects the muscles' ability to coordinate with the diaphragm, core, and hips, contributing to symptoms like pelvic pain, bladder urgency, and discomfort during sexual activity.
Common contributors include chronic stress, poor breathing patterns, exercise habits, hormonal changes, and past injuries. Tightness does not respond to the same approaches used for weakness, which is why understanding the root cause matters.
Pelvic floor therapy addresses hypertonic pelvic floors through a whole-body approach that includes manual therapy, breathwork, nervous system support, and movement training. Evaluations look at posture, breathing, strength, and daily habits to identify what is driving tension and build a plan from there.
What exactly causes a tight pelvic floor, where does this start, is it a ‘bad’ thing? If something feels off, or even painful, it could be a tight or hypertonic pelvic floor.
At Bloom Pelvic Therapy, many clients we see are not dealing with a weak pelvic floor, many of their pelvic floors are holding tension, tight and resisting natural essential movement. Pelvic floor muscles need to be relax, to perform essential functions comfortably.
Not every pelvic floor needs strength, many pelvic floors need length and movement of the muscles instead. Too often the advice to fix anything with the pelvic floor is “do your Kegels”, although seldom the correct answer and never ever the answer in isolation. If you have been doing Kegels- here is your sign to stop.
If your pelvic floor or body feels tense- there is help, and many ways to address your concerns. A tight pelvic floor is not about something being “wrong:” or “broken”, more about understanding and correcting the patterns that are contributing.
What is a Tight Pelvic Floor?
The pelvic floor is a group of muscles that sit within your pelvis. These muscles are essential to support the pelvic organs- the bladder, rectum, and uterus.
These muscles need to be reactive and move throughout the functions of our day. The pelvic floor needs to contract well to support organs during movement or something like coughing, keep urine or bowels in- but also need to lengthen to allow for sexual function, use of a tampon, or to eliminate urine or bowels. A well-functioning pelvic floor moves in tandem with the diaphragm or large muscle that facilitates breathing.
A tight pelvic floor, or otherwise referred to as a hypertonic pelvic floor holds a lot of tension throughout the day, even at rest. A tight pelvic floor gets so used to holding tension that it has a hard time letting go, even in times it would be beneficial. This tension holding pattern often causes difficulty in its power struggle and coordination with the abdominals, back, hips, and diaphragm- resulting in a lot of the difficulties we see clients for.
An optimally functioning pelvic floor is not always holding tension or “stuck on”, instead it can both contract and relax when needed in response to activities we engage in throughout our days.
Common Causes of Pelvic Floor Tension
A tight pelvic floor can happen for a number of reasons. At times it's responding to perceived danger, pain, or trying to help support a weaker muscle nearby. A stressful event, or series of events can contribute to pelvic floor tension. An illness or infection, change in hormones, or poor habits can also contribute in part to a hypertonic pelvic floor. The good news is there is so much that can be done with pelvic floor therapy to get a tight pelvic floor back to optimal state.
Stress & Anxiety
Stress and anxiety directly connect to pelvic floor function. Ask yourself- When stressed do you hold tension in your shoulders or hold your jaw tight? Your pelvic floor is directly related to this tension you are holding elsewhere- if you are holding your jaw or upper body tight- it is very likely your pelvic floor is also held tight up and in. This isn’t an issue in an isolated incidence when we are able to let the stress, anxiety and tension go from our bodies and mind. However it often becomes an issue when stress is chronic, and make that tension holding pattern the default.
Breathing & Core
The diaphragm is directly related to the pelvic floor. The diaphragm is designed to move downward to take air into the lungs when you inhale, and then recoils to rest with exhale. The pelvic floor ideally mirrors this movement with each breath, lengthening with inhale and then with exhale the muscles recoil to rest.
We find that most clients are not breathing well, or have adopted some habits along the way that impact the ability for the diaphragm and pelvic floor to work together. Often this presents as holding tension in the upper abs, breathing into shoulders rather than stomach, or constantly sucking in and bracing your core. Over time the pelvic floor gets used to moving less and less with each breath.
Exercise
How you warm up, move and stretch matter! Your pelvic floor is designed to support you in movement of any nature. Allowing time to warm up and then allowed time and space to lengthen and relax after exercise is essential.
Often we see resting pelvic floor tension in:
Runners who are not warming up or cooling down
Weightlifters that are pushing the boundaries, doing more and more
People who do pilates or barre without taking time to stretch and move through the full range of motion and diaphragmatic breathing post class
Former soccer players, dancers, horseback riders or gymnasts that are used to holding positions and patterns of movement that in time work against the pelvic floor moving in its full range.
Pain, Injuries, Illness
When your body experiences pain in the pelvis or anywhere it often responds with the muscle tightening to protect. This muscle guarding can be helpful initially, however with longstanding pain or pain that re-occurs the hypertonicity can become persistent.
During the first visit at Bloom Pelvic Therapy we ask about past injuries, even those we forgot about “or couldn’t possibly be related”. These may include:
A fall on your tailbone as a child
A slip on the ice in your teens
An injured knee, ankle or hip- even if it was minor
All of these have the potential to impact the pelvic floor at the time of injury or illness, or years later.
Bowel and Bladder
Your pelvic floor may get accustomed to holding tension and creates a new pattern if you are in a habit of:
Always holding tight in hopes of keeping the urine from leaking
Didn’t trust our GI system and were experiencing frequent loose stools due to IBS-D
Had anxiety about the bathroom on the commute to work where bathrooms were not available
Your brain recognizes that the pattern of holding tension in the pelvic floor makes you feel safe, creating this new pattern of holding tension to your normal status.
Hormones
Pregnancy, postpartum, and perimenopause change hormones in your body, impacting the muscles, supportive structures, and function. Our bodies are amazing, built for these transitions, and can often overcome without long standing issues. However, at times we need a bit more support from pelvic therapy or the medical team to support hormones and resultant function.
During menopause it's common for vaginal tissues and muscles to decrease bulk and moisture. This can impact the support of pelvic organs, comfort of vaginal penetration, and continence possibly causing the muscles to guard and hold tension. Working with a team of professionals is essential to management- because “oh you're menopausal” isn’t the answer!
Pregnancy and postpartum is another time of great change, hormones fluctuate, there is increased weight on the pelvic floor, and often a relaxation of supportive structures. We tend to see many people that start holding tension during this time due to the rapid changes. Many of the apps and general reconditions are “do your Kegels and get stronger during this time”- however strength isn’t the only answer, you also need the muscles to relax and lengthen to allow for a comfortable pregnancy and to facilitate comfortable labor.
Signs Your Pelvic Floor May Be Too Tight
A tight pelvic floor isn’t always a good thing it can also bring a lot of symptoms:
Pain with penetration
Pain with insertion of tampon or pelvic exams
Deep vaginal, rectal, or tailbone pain
Pain in your hips, pelvis, or low back
Needing to get to the bathroom to urinate quickly
Needing to pee more often than every 2 hours
Leaking urine (not always a strength problem)
Difficulty getting the pee to start flowing, having to give a push to start the flow or get the last bit out
Constipation and painful bowel movements
Pain with sitting
Pain in movement and exercise
Feeling like you are holding your pelvic floor up and in tightly, unable to relax the muscles even with trying
Why “Just Do Your Kegels” Isn’t the Answer
The age-old recommendation anytime someone asks about the pelvic floor or complains of issues related to sexual, bladder, bowel or pregnancy is “just do your kegels” by well meaning, but incorrectparties.
Kegels are not for people with tight pelvic floors.
Doing kegels is never the answer in isolation, and honestly still rarely beneficial in a larger plan.
Kegels, done well, are isolated contractions and relaxations of the pelvic floor- like picking it up, pulling up and in, and then relaxing fully. Most clients are unable to fully relax their pelvic floor with each repetition, therefore increasing tension with each.
Doing kegels with a tight pelvic floor can increase pain, make constipation worse, cause you to need to use the bathroom to pee more often or quicker, and cause more leaking or pressure.
How Pelvic Floor Therapy Can Help
Pelvic floor therapy is not all created equal, lasting results from a tight pelvic floor requires a look head to toe about what contributes, changing daily habits and movements, nervous system and breath work allowing the pelvic floor muscles to relax and lengthen, and strength & endurance training.
At Bloom Pelvic Therapy we take a whole-body approach and time to listen & understand. During the evaluation we will look at posture, breathing, strength, movement patterns, pelvic floor function and day to day contributors to begin understanding the root cause of your symptoms.
Pelvic Floor Therapy Sessions with Bloom are all 1 hour, focusing on:
Hands on manual therapy done external to abdomen, legs, back, hips or internal to the pelvic floor to address muscle tension. Manual therapy is a part of discussion about benefits, technique and always consent-based. Manual therapy should never be painful!
Nervous system & breath work- helping you to breathe well, let go of tension, manage inevitable stress without increasing unnecessary tension in the pelvic floor.
Diaphragmatic breathing and core coordination training- correcting patterns in the core, getting the correct muscles to activate well, restoring the connection between the diaphragm and pelvic floor.
Movement & strength-Our goal is to keep you doing the things you love. Addressing strength and movement is essential to a well-balanced system that supports the pelvic floor in all activities.
Education- understanding what’s going on, how to identify it in our bodies, and learning the tools to address it yourself.
Where to Find a Pelvic Floor Therapist in Tampa Bay
If you are local to Tampa Bay, Bloom Pelvic Therapy has locations in:
Lutz
St. Petersburg
South Tampa
Please call our office at 813-515-9008 to schedule an appointment or click the button below to submit our contact form.
If you are not local, begin your search by looking for a pelvic therapist that specializes in the pelvic floor, not a clinic that treats the pelvis as an offering, spends one-on-one time to understand the deeper cause, and prioritizes your experience, expertise in your own body, and comfort- helping you return to the activities you love.
Some databases to search include:
Pelvic Rising Map — https://www.pelvicptrising.com/mappelv
PelvicRehab.com — https://pelvicrehab.com
Pelvic Global Directory — https://directory.pelvicglobal.com
APTA Pelvic Health Locator — https://www.aptapelvichealth.org/ptlocator
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