Hypertonic Pelvic Floor

What is hypertonic pelvic floor?

Hypertonic pelvic floor is a condition where the muscles in your lower pelvis are in a spasm or state of constant contraction. This can be temporary or constant. When your pelvic floor muscles are in this state, they can’t relax and coordinate the control of certain bodily functions. This causes pain (either constant or with certain activities), problems with urination (peeing) and bowel movements (pooping) as well as sexual dysfunction and painful intercourse.

These symptoms can greatly impact your quality of life.

What is the pelvic floor?

Your pelvic floor is a group of muscles that supports your pelvic organs. These organs include the following:

• Bladder that holds urine.
• Rectum that stores stool (poop).
• Uterus and vagina (in people assigned female at birth).
• Prostate (in people assigned male at birth).

The muscles of your pelvic floor connect to your pelvic bones to form a strong, yet flexible foundation. They span between the:

• Pubic bone in the front.
• Lower spine (sacrum) in the back.
• Sit bones on each side.

Nerves and muscles in your pelvic floor help control urination, bowel movements and sexual function.

Who does hypertonic pelvic floor affect?

This condition occurs in people of all genders and ages.

How common is hypertonic pelvic floor?

In general, pelvic floor dysfunction is very common. Hypertonic pelvic floor is a type of pelvic floor dysfunction. It’s often undiagnosed and data suggests that it occurs as often as in 1 in 10 people.

What does hypertonic pelvic floor feel like?

A common symptom is pain. You may feel this as general pain or pressure in your pelvic area, low back or hips. Pain can also be specific to a location (like your bladder) or during certain activities (like bowel movements or sex).

Other symptoms include:

Urinary symptoms

• Bladder pain.
• Pain while urinating.
• Frequent urination.
• Difficulty starting or maintaining a urinary stream.

Bowel symptoms

• Difficulty starting a bowel movement (pooping).
• Feeling like you’re unable to empty completely.
• Pain during or after pooping.
• Pain with passing gas.
• Constipation.

Sexual symptoms

• Pain during or after sex.
• Inability to achieve orgasm.
• Erectile dysfunction or pain with erection or ejaculation.

Symptoms of hypertonic pelvic floor usually develop slowly and get worse over time. It’s important to talk to your healthcare provider even if you have mild symptoms.

What causes hypertonic pelvic floor?

The causes of this condition can be complex. Factors that may increase your risk for hypertonic pelvic floor include:

• Habitually holding in your urine or stool. Some people do this as children and continue the practice into adulthood. Others may do it because of their lifestyle or job.
• Injury or trauma to the pelvic muscles during surgery, pregnancy or childbirth or a traumatic accident.
• Muscular dysfunction caused by prolonged sitting, abnormal posture, irregular gait when walking or uneven pelvic bones.
• Other pain-causing conditions such as irritable bowel syndrome, endometriosis, vulvodynia, anal fissures and painful bladder syndrome.
• Sexual or physical abuse.
• Stress, depression and anxiety.

How is hypertonic pelvic floor diagnosed?

Your healthcare provider will ask about your symptoms and medical history. This may include questions about your bowel movements, urination and sexual activity. You may find these topics difficult to talk about, but it’s important to be open about any problems you're having. This will help your provider make an accurate diagnosis.

Your provider will also likely do a physical exam. This may involve:

• Visual inspection of your pelvic area, including a check of how well you contract and relax your pelvic floor muscles.
• Digital rectal exam to check your rectum and anus.
• Pelvic exam to check your vagina.

Other tests your provider may perform include:

• Anorectal manometry: During this test, your provider inserts a thin tube (catheter) with a balloon at the end into your rectum. As the balloon inflates, the muscles in your rectum and anus contract. The catheter is attached to a machine that records these contractions and relaxations and measures pressures in your sphincter.
• Electromyography: This procedure uses surface electrodes to measure the electrical signals of your muscles as they relax and contract. Electrodes are held to your skin with adhesive pads.
• Defecography: This test allows your provider to check your bowel movements. It involves placing a thick barium paste (special contrast that is seen on X-ray) into your rectum. You’ll then be asked to poop on a special toilet while X-ray pictures are taken. This test requires taking some bowel prep similar to colonoscopy to clean out your rectum and colon prior to the test.
• Urodynamic tests: This is a set of tests usually performed together that show how well you urinate (pee) and how your bladder works.

How is hypertonic pelvic floor treated?

The primary treatment is physical therapy to retrain your muscles. Your provider will recommend a therapist with training in pelvic floor dysfunction. Strategies physical therapists use include:

• Biofeedback to teach you how to contract and relax your muscles correctly.
• Relaxation techniques for your pelvis and abdominal wall.
• Massage, muscle stretching and joint movement.

Other treatments your provider may recommend include:

• Acupuncture.
• Medications to manage symptoms such as pain, anxiety, constipation or frequent urination.
• Stimulation of nearby nerves to manage urinary incontinence or bowel incontinence.
• Trigger point injections with corticosteroids or Botox® to ease pain.

Your provider may also seek help from other specialists such as:

• Gastroenterologist to treat constipation and evaluate your pelvic floor.
• Colorectal specialist for pelvic floor disorders related to bowel movements (pooping).
• Gynecologist to treat reproductive health problems in people assigned female at birth.
• Urologist or urogynecologist to help with urinary problems or sexual dysfunction.
• Psychotherapist to address psychological issues.
• Sex therapist to treat sexual dysfunction.

How can I reduce my risk of hypertonic pelvic floor?

You can reduce your risk by understanding the contraction and relaxation of your pelvic muscles. You can also:

• Practice mindfulness and relaxation techniques.
• Do pelvic floor exercises during and after pregnancy.
• Strengthen your pelvic floor by doing yoga.
• Avoid constipation and straining.
• Seek medical care if you’re having pelvic or anal pain.
• Seek psychological support after trauma.
• Avoid prolonged periods of holding poop and pee.

What is the outlook for hypertonic pelvic floor?

Hypertonic pelvic floor is treatable. It may take time and patience, but most people have either partial or complete relief of symptoms with treatment. If your symptoms persist, your provider may refer you to a specialist based on your individual needs.

When should I seek care?

Talk to your healthcare provider if you experience pelvic pain, trouble peeing, and pain when pooping or with sexual activity. These symptoms typically don’t get better on their own, so it’s important to get care.

A note from Cleveland Clinic

Hypertonic pelvic floor causes pain and problems with peeing, pooping and sex that can be uncomfortable and embarrassing. Fortunately, physical therapy and other treatments can be very effective. By talking to your provider about your symptoms early, you can get the treatment you need and improve your quality of life.