Signs of a Tight Pelvic Floor: Understanding the Symptoms and Solutions
Just like any other muscle in your body, having a tight pelvic floor impacts function. Meaning it changes how it responds in it’s roles, which can cause undesirable symptoms. But the pelvic floor is not visible from the outside of the body and can be difficult to know what’s going on with it unless you know what to look for.
I’ve compiled the most common symptoms of a tight pelvic floor. You may have one or multiple of these symptoms, indicating a tight pelvic floor.
Bladder urgency or leakage
Bladder urgency is the strong sensation that you have to pee. This may occur frequently throughout the day, with a specific trigger like hearing running water or arriving home, and can make reaching the toilet difficult.
The tension and possible trigger points in the pelvic floor can refer to the bladder nerves triggering the urgency, can limit the expansion of the bladder triggering the sensory nerves in the bladder to respond sooner than they should OR the pelvic floor tenses up and remains tense in response to the urgency that is caused by another reason.
Urine leakage does not always indicate a weak pelvic floor, but a disruption in how the pelvic floor muscles respond to needing to keep pee in. Whether it’s not being able to control an urge or the pressure from a cough, sneeze or impact force from a running or jumping.
To understand this, let’s first look at how muscles work. A muscle is made up of individual fibers that slide across each other when they are stretched or contracted. These fibers work the best when they are in what I call the “Goldie locks” length, essentially not too stretched or contracted to begin with. That’s because the fibers need to have some overlap to contract with efficient force. If the fibers barely overlap, like the abdominals when stretched in pregnancy, or are super overlapped, like constantly holding a Kegel, the muscles won’t be able to respond optimally.
Back to tension and leaking. If your pelvic floor muscles are tense from say constantly doing Kegels but never relaxing or always needing to brace against downward pressure from gripping the upper abs; they won’t be able to respond even more with a new contraction to keep the pee in, without relaxing first.
Difficulty peeing or pooping
The opposite role of the pelvic floor to keeping pee in is to let pee and poop out. When the pelvic floor is tense, it can be challenging to let go or relax the muscles. Lengthening of the pelvic floor is required to go to the bathroom. When your pelvic floor is unable to do this you may strain to get the pee or poop out, you feel like you didn’t get all all the poop out or leak a little when you stand back up, maybe you can’t even start the urine stream or the poop is pencil thin. Then the straining and pushing to empty can lead to hemorrhoids or fissures (long narrow tear inside the anus).
Vaginal or anal pressure
When muscles are tense they tend to bulk up and take up space. Since the pelvic floor muscle line the lower ring of the pelvis underneath the pelvic organs, if the pelvic floor muscles are tense they are cause the sensation of pressure or like “something is there.” This sensation mimics or contributes to a pelvic organ prolapse, when the bladder, uterus or rectum drop into the vaginal vault.
Vaginal pain or burning
Similar to the pressure sensation, tense pelvic floor muscles can also replicate UTI symptoms and can cause vaginal pain or burning. Wearing tight clothes, peeing and wiping can make it worse.
Pain with penetration
Pelvic floor tension can also make vaginal (or anal) penetration painful. This may be during intimacy with fingers, penis or dildo/vibrator; inserting or removing a period product like a tampon or cup; or with a gynecological exam.
Just like urgency the pelvic floor muscles may already be tense and tight, not allowing relaxation and ease of insertion. Or the muscles may tense up in reaction to the act or inserting, but not stay tense all the time.
Both responses can elicit a pain response in the muscles and tissues that are trying to be stretched. Think of a time you sat in an awkward way then got up and your muscles were tight so it was uncomfortable to stretch your legs. Pain with penetration may be superficial around the perineum or vulva or deeper into the pelvis.
Tailbone pain
Tailbone (or coccyx) pain is typically related to tighter posterior pelvic floor muscles. If you think of the pelvic floor like a diamond, draw a line from sit bone to sit bone across the perineum. This divides the diamond into two triangles, anterior (front) and posterior (back). These fibers are more directly connected to the tailbone and influence the movement and position of the tailbone. When the pelvic floor is tense it can pull the tailbone further under, think of constantly being in a arched cat position or a scared dog tucking it’s tail. Since the tailbone is the base of your spine it will move in response to your spine. So it the tailbone stays tucked, and you go into a movement that tries to untuck it, i.e. straighten or extend your spine like when you stand up, it will elicit pain. The opposite can be true as well, where the tailbone can be stuck out, which can cause the pelvic floor to become tense if it tries without success to pull the tailbone into proper alignment.
A tight pelvic floor has many causes, including scar tissue, trauma, posture/alignment, weakness, muscle clenching or holding, over stimulated or worked, nerve damage. So treating a tight pelvic floor typically requires more than stretching but addressing the underlying cause of why the pelvic floor is tight in the first place.
Here are some questions to consider if you any of the above symptoms and suspect a tight pelvic floor:
Do I sit slouched on my tailbone?
Do I clench my buttock?
Do I reverse breath aka suck your belly in when you inhale?
Do I hold my belly in all the time?
Did I have emotional or physical trauma?
Do I have beliefs around the bladder, bowels or sex that cause me to tense that area or have lead to habits that cause me to tense that area?
You can take these questions one step further by doing a self pelvic floor assessment. Check out my free guide here. In the end if you have any of the above symptoms, answer yes to at least of the questions as have tense pelvic floor muscles during the self assessment, you need to go see a pelvic PT/OT.