If people are aware of their pelvic floor at all (which is definitely not everyone), they probably are most familiar with the idea of exercising or strengthening it (i.e. Kegels). And that makes sense -- the most common types of pelvic floor dysfunction, like urinary incontinence or pelvic organ prolapse, tend to be associated with weakness in the pelvic floor (which is a kind of hammockconsisting of a group of muscles, ligaments and connective tissue at the base of your pelvis that helps keep your pelvic organs in place and has a key role in various bodily functions and wellness). Plus, the idea of Kegels has accumulated a certain degree of pop culture prominence over the years, from Sex And The City to Cardi B.
However, the pelvic floor muscles are no different than the other muscles in your body: MORE STRENGTH GRRRRRR is not always the answer to your problems, or even a good thing at all. It is not uncommon at all for people (women in particular, although it can also be an issue for men) to have pelvic floor muscles that are what’s called overactive (or hypertonic). This basically means that the pelvic floor is too tense or too tight, and it can cause a number of problems, including painful sex, pelvic and lower back pain more generally, and urine leakage or other continence issues.
We wrote a whole article here looking at what it means to have a pelvic floor that is hypertonic vs. one that is hypotonic (which means too loose / weak). But with this article, we wanted to dig a little more into practical advice to prevent or, if needed, deal with the situation if you have a overactive pelvic floor and need to find a way to relax and reduce the tension in it (this is also often called downtraining).
(First, one note about nomenclature. There are a number of terms that people have used historically to talk about this condition. We mentioned "overactive" and "hypertonic" above, and "high tone" is another one. As the pelvic floor health field evolves, the language evolves too, and some of the vocabulary is taking on more precise / specific meanings; going forward here we will use "overactive" but just know that if you've heard "hypertonic" or "high tone" in the past, any distinctions aren't terribly important for the purposes of this article.)
What are risk factors for an overactive pelvic floor?
First, it’s important to understand that pelvic floor overactivity can have many different causes. So, it’s good to be aware of some common circumstances that can correlate with the development of an overactive pelvic floor -- addressing these risk factors may be a good way to resolve problems at their root cause. (However, you should also be aware that people can develop an overactive pelvic floor for no apparent reason; some people’s bodies just tend towards that direction).- Musculoskeletal: excessive exercise (including Kegel or pelvic floor exercise but also exercise more generally) or any of a variety of injuries (mostly relating to your hips, pelvis and core) can increase the risk of overactivity in the pelvic floor
- Urogynecological: a variety of urogynecological dysfunctions, including endometriosis, pelvic inflammatory disease, certain STDs, interstitial cystitis, or prostatitis (in men) can also increase risk
- Rectal/gastrological: again, any of a variety of problems including but not limited to irritable bowel syndrome, hemorrhoids and ulcerative colitis can increase the risk
How to relax an overactive pelvic floor (or prevent the development of one in the first place)
First of all, a note on prevention vs. treatment. In good news for those of us who like to keep things simple, basically the same things can be helpful for both prevention and treatment, at least in terms of conservative therapies (essentially everything mentioned below except the “Last Resorts”).
Second of all, let’s briefly address what not to do. Although some people are under the impression that pelvic floor muscle training(or Kegel exercise) is the solution to any pelvic floor problem, that is not true. In fact, if your pelvic floor muscles are too tight, strengthening exercises may be useless at best and actively counterproductive at worst. (It is possible for the pelvic floor muscles to be overactive while also being too weak and requiring strengthening eventually, but that’s a scenario you should probably work through with a pelvic floor physical therapist).
More generally, speaking to or ideally working with a pelvic floor physiotherapist is a great place to start, since they will be able to assess your specific situation and provide guidance on physical therapy or other steps to help. But there are a number of tools that you can expect to hear about, as they are often used to help people learn how to relax their pelvic floor muscles (and practice doing so). So, without further ado...
Biofeedback therapy
Biofeedback therapy basically means using some sort of sensor to help you learn to control aspects of your bodily function that you normally struggle to consciously control. It could be something as simple as using a mirror to see when you’re activating the right muscles, in the right way, to wiggle your ears.
Because the pelvic floor muscles are inside your body and it’s hard to visually detect when you contract (or relax) them (technically your perineum will move, but that's not easy to see), biofeedback can be particularly useful for learning how to identify and learn to control them correctly (many people mistakenly activate their glutes, abs, or even inner thighs when they're first trying to identify their pelvic floor muscles).
Examples of the kinds of “sensor” used for pelvic floor biofeedback could range from a finger (a pelvic floor physical therapist’s, or your own) to electronic sensors which can detect the state of your muscles and communicate it to you using a display or other type of interface.
This type of approach can be really helpful in enabling people to understand what it feels like when they do a pelvic floor contractionor when they relax their muscles, and in helping them practice relaxing the muscles regularly.
Stretching
Like all muscles in your body, stretching can be a good way to loosen up the pelvic floor muscles and improve flexibility. And there are a number of stretches / stretching routines that are designed to help you practice releasing or relaxing a tight pelvic floor. The poses at the link are yoga poses, and yoga can be a tremendously valuable and powerful activity for your pelvic floor (and the rest of your body!). But be aware -- many yoga practitioners are very mindful about engaging their pelvic floor (or mulabandha) while doing yoga but less intentional about releasing it. This continued engagement without sufficient release can often actually lead to overactive pelvic floor muscles and pelvic pain. Similarly, Pilates can of course be really good for you, but you’ll need to be very mindful about your pelvic floor when practicing.
Breathing exercises
The diaphragm and pelvic floor are intertwined, making proper breathing a surprisingly powerful tool when you’re looking to practice relaxing your pelvic floor muscles. Diaphragmatic breathing is a good way to be more conscious and intentional about relaxing your pelvic floor muscles, and getting into the habit of doing so consistently (after all, there is not much about your body that is more regular or consistent than breathing!).
Mindfulness techniques
Speaking of being conscious and intentional, that brings us to the next technique: mindfulness and other mental techniques that can help you connect with and better control your body. There are a number of resources out there (like this one) that can help you practice cultivating a conscious connection with your pelvic floor. This can make it easier to recognize when your pelvic floor muscles are tense -- and when you do notice, to try to take a step back, let go of your tension, and relax them.
Posture
Poor posture can contribute to tight pelvic floor muscles, as some positions can force your pelvic floor to work overtime to support your core and pelvic organs. So improving your posture habits can help keep your pelvic floor more relaxed.
And actually working to improve your posture is helpful from a psychological point of view, too -- it’s easy to be distracted by whatever you’re doing and stop paying attention to your posture (or pelvic floor). But if you can get in the habit of checking in with your body regularly in one way, you can piggyback on that to add the other one to your routine.
Last resorts
In some cases (generally AFTER trying conservative therapies like the ones discussed above), medications such as muscle relaxants or even surgery may be part of a treatment plan. However, digging into those options is beyond the scope of this article and definitely something to be explored with your doctor and pelvic floor physical therapist.