The pelvic floor is an area of the body you probably haven’t paid much attention to unless you’re pregnant or have had a baby. That’s because pregnancy places extra demands on your pelvic floor muscles and can result in changes that greatly affect your quality of life.
But people are beginning to realize that it pays to have a strong pelvic floor, no matter your sex or whether or not you've given birth, with more than 62,000 posts with the tag #pelvicfloor on TikTok.
A lot of these videos are focused on how to strengthen a weak pelvic floor, but according to Leanne O’Brien, specialist pelvic health physical therapist at Ten Health, there’s another issue that could be causing similar symptoms but is often ignored—a tight pelvic floor.
What is the pelvic floor?
The pelvic floor refers to a group of muscles that sit at the base of the pelvis. “This group of muscles supports our internal organs,” says O’Brien.
“It assists with our bladder and bowel function. It also assists with sexual function, and it’s a stabilizer of our pelvis.
“It works with the other muscle groups around our pelvis when we’re sitting and standing. When we’re doing any form of movement, the pelvic floor is active.”
What are the symptoms of a weak pelvic floor?
“One of the most common signs of pelvic floor weakness is urinary incontinence,” says O’Brien.
“Prolapse is a common symptom as well, where there is additional movement of the front or the back vaginal wall.”
A weak pelvic floor can often cause something called stress incontinence. “So if you cough, sneeze, laugh, jump up and down, do something that challenges your body, then you’ll get some leaking from the bladder or a real sense of urgency,” says O’Brien.
What are the symptoms of a tight pelvic floor?
“A lot of the symptoms that we associate with a weak pelvic floor can also be a tight pelvic floor,” says O'Brien.
“If someone has urgency, and they find that they’re going to the toilet very frequently, the pelvic floor could be weak or it could be tight," she explains.
According to O’Brien, some of the symptoms that are more common with a tight pelvic floor include pain during sexual intercourse or when inserting a tampon.
“They’re also more likely to have pain in the lower abdomen, vulval region or the clitoris region,” she adds. “They’ll often have constipation and difficulty emptying their bowels.”
If you’re experiencing any of the above symptoms, as well as bladder symptoms, your pelvic floor might be tight, not weak.
What causes a tight pelvic floor?
“There could be a little bit of underlying weakness that means the pelvic floor has tightened,” says O’Brien.
“Stress and high levels of anxiety will naturally tighten the pelvic floor.
“If you’re hypermobile, the pelvic floor has a bit more mobility and movement to it. Sometimes the body’s response is to try and gain a level of control over those muscle groups by shortening and tightening them, which is really counterproductive, but it’s what the pelvic floor does.”
Pregnancy can also lead you to develop a tight pelvic floor, as can changes in the menstrual cycle. “It can get tighter the week before your period,” says O’Brien.
Finally, it can be a result of surgery. “If you’ve had abdominal or gynecological surgery, often the pelvic floor will grow shorter and tighter,” says O’Brien.
How to treat a tight pelvic floor
If you think a tight pelvic floor may be responsible for some of your symptoms, the first thing you should do is consult your doctor, particularly if you’re not sure whether you’re dealing with weakness or tightness. “The symptoms could often be the same, but the treatment is very, very different,” says O’Brien.
Kegel exercises—which involve squeezing and relaxing the pelvic floor—are a common way of strengthening a weak pelvic floor, but they’re not an effective treatment for tightness.
“They will make those symptoms worse, because quite often they will just increase the tone and the tension of their pelvic floor by doing those exercises,” says O’Brien.
Instead of doing Kegels in the traditional way, O’Brien encourages people with a tight pelvic floor to focus on the relaxation phase and breathwork.
“Do 10 seconds of pelvic floor contraction followed by 10 seconds of relaxing and focusing on that deep diaphragmatic breath to ensure that the pelvic floor has come back down to a resting level and it’s not stuck in that tighter position,” says O’Brien.
Make sure not to hold your breath, even when you’re squeezing. “Take a deep inward breath, allowing the diaphragm to lower,” says O’Brien.
If you can, do this lying on your back with your knees bent and feet flat. “That’s a relaxed position for the pelvic floor,” says O’Brien.
Try doing that a few times a week for three to four weeks. “You’ll teach the pelvic floor contraction and relaxation, moving between the two effectively,” says O’Brien.
