Tight Pelvic Floor Symptoms

Written by Dr. Karah Charette, PT, DPT, RYT

Are you wondering what the signs of a tight pelvic floor are?

Would you like to learn how to relax pelvic floor muscles?

This blog is for anyone experiencing pelvic floor dysfunction, pain with sex, or is curious about how the pelvic floor affects your overall health. 

What is the Pelvic Floor?

The pelvic floor is a set of muscles at the base of your pelvis that is shaped like a hammock or a sling. These muscles are an essential part of your core. They also help support the bladder, uterus (for those who have one), and rectum. Therefore, any issues with your bowel, bladder, or sexual health may be connected to your pelvic floor muscles. You can read more about this in our comprehensive guide to the pelvic floor here. 

In order to have healthy muscles and healthy function in your body, you must have a good length tension relationship with your muscles. This means that every muscle, including the ones in your pelvic floor, have an ideal resting length. If muscles are too short or too long, they can have a harder time contracting and generating force. This is why in pelvic floor therapy we care not just about strength, but also about length. If your pelvic floor muscles are too tight, this can be a reason why you actually feel weakness and symptoms in this part of your body. 

Common Symptoms of a Tight Pelvic Floor

There can be many symptoms of a tight pelvic floor. One major symptom is painful sex, also known as dyspareunia. Pain with penetration can occur both superficially and deep, and tight pelvic floor muscles can contribute or cause this pain. When muscles are too tight, they do not get enough blood flow. Our nerves and nervous system dictate our pain experience, and nerves love and need blood flow. When there is a non-optimal environment due to tight pelvic floor muscles, symptoms such as raw, aching, or burning sensations at the vulva and deeper in the vagina can occur. 

Another way tight pelvic floor muscles can express is through urinary symptoms. If you are experiencing urinary urgency, increased frequency, or difficulty starting urination (or feelings of incomplete emptying), these can all be a result of tight pelvic floor muscles. You have certain muscles at the front of the pelvic floor that connect to structures like your urethra. When these muscles are too tight, they can actually pull on and irritate the urethra giving you false sensations of urination, urgency to urinate, or even the feeling of a false UTI. You need to be able to relax to eliminate urine and this is also why tight muscles can cause issues with starting a stream of urine or feeling like you have fully emptied your bladder.

Tight pelvic floor muscles can also contribute to symptoms like constipation or rectal pain when having a bowel movement. Your pelvic floor muscles need to relax in order for the anus to open and eliminate stool. If you have tightness and/or lack of coordination in relaxing your pelvic floor muscles, this can create difficulty with bowel movements and even rectal pain. 

You can also have pelvic pain from tight pelvic floor muscles. Pelvic pain can show up as pain provoked or unprovoked anywhere from below the belly button all the way to the inner thighs. Some forms of low back pain can actually be classified as pelvic pain as joints such as the sacroiliac joint are technically part of the pelvic girdle. It is important to consider the pelvic floor with back pain as these muscles are a part of the core which can help support the spine and decrease pain and dysfunction. Tailbone pain can also be a result of tight pelvic floor muscles as they attach onto the tailbone and can pull it or sensitize it if the muscles are nonrelaxing. Hip pain can also relate to pelvic muscles because there are a few hip rotators that are also the back wall of the pelvic floor. Addressing tight and uncoordinated pelvic floor muscles can make a difference in seemingly orthopedic cases such as hip and back pain. 

Tight Pelvic Floor & The Nervous System

Having a tight pelvic floor can come from a combination of factors. As pelvic floor physical therapists, we specialize in assessing your biomechanics to see what could be contributing to this dysfunction. Some areas we will consider include your posture, breathing patterns, core coordination strategies, hip mechanics, and even how you bear weight in your feet.

These are all important aspects that can and should be addressed. However, an important factor of why you develop holding patterns in muscles and fascia, and why you experience pain, is due to how the nervous system perceives safety in the body. This is why we practice a somatic approach at Bodyful in addition to indepth biomechanical assessments when working with our clients.

The pelvic floor supports some very vital organs that our body needs to protect for survival. The brain and nervous system are wired to more vigilantly track these areas in our body. In fact, this has been studied and when people are exposed to stressful or scary stimuli, the pelvic floor muscles tend to be the muscles that engage first and to the highest extent, even before the upper trapezius muscles or other muscles you might associate with stress.

It would not be advantageous to urinate or defecate when running from a lion. Your nervous system cannot always differentiate a scary email from your boss and a real life lion. Whether we are conscious of it or not, this reaction can be part of our fight or flight response. Even more difficult is when we are not consciously aware of this pattern, and why would you be? We live in a culture that rarely talks about the pelvic floor and even if we do it is always in the context of tightening and strengthening, not relaxing and releasing. Even harder when you do not know what these muscles look like or feel like. A big part of pelvic floor therapy is essentially “putting brain cells” in your pelvic floor, or rather helping your brain develop a clearer map of this area so it can help to coordinate and regulate it. Pelvic floor therapy is not a passive modality. We are actively working with your nervous system to help you create more sustainable patterns and ways of being with your pelvic floor and body so you can decrease pain and dysfunction. 

If you are someone who identifies as having trauma, sexual or not, this can also be a meaningful part of your body’s story and why you may have developed the holding patterns you have. Your body is not wrong or bad, it is doing its best to protect you. This is why approaching the body’s patterns with safety, curiosity, and empathy is important in pelvic floor therapy and treatment. This type of container is how real and sustainable change can occur. 

How to Recognize if You Have a Tight Pelvic Floor

One simple way you can check for tightness at your pelvic floor is to see if you have a hard time relaxing your pelvic floor. If you try to do a “kegel” or pelvic floor contraction (imagine trying to stop a stream of urine), first notice if you even feel your pelvic floor lift? If you do not feel it, it is possible that the tightness is preventing your pelvic floor from contracting more. It is also possible that there is enough tightness which decreases blood flow, and nerves love blood flow. When you have a lack of blood flow, you can also have a lack of sensation. So not being able to feel your pelvic floor lift is a first sign of potential tightness.

If you can feel your pelvic floor lift, notice if you can also feel it actively relax. If you are unable to feel this clear difference, it is possible your pelvic floor is tight. Whether you are relaxing and cannot feel it or do not have the coordination to relax, both are cases where pelvic floor therapy could be helpful to address this potential tightness and imbalance in your pelvic floor muscles. 

If you have any of the symptoms mentioned earlier including urinary urgency, frequency, incontinence, urethral burning, constipation, rectal pain, tailbone pain, pain with sex or pain with penetration, or even back pain, it is advised you see a pelvic floor physical therapist. Even small symptoms are a sign that something is imbalanced and getting ahead of it early can save you time, money, and emotional energy as you work to prevent pelvic floor dysfunction down the road. You deserve to feel strong, healthy, and connected in your core and your pelvic floor- even if you do not have symptoms! 

Treatment Options & How a Somatic Pelvic Floor Physical Therapist Can Help

At Bodyful, we highly value a somatic approach to how we provide care and treatment. Imagine instead of being given a generic exercise sheet, you are asked to explore how certain exercises and movements feel in your body. Imagine going at a slower pace so that curiosity can be present in determining what exercises and movement explorations feel best for your individual experience. Imagine specific cueing, imagery, detailed and embodied anatomy, and attunement to your nervous system. This is just a sample of what you can expect when working somatically at Bodyful for your pelvic care.

At Bodyful, we have studied and practiced for countless hours extensive and detailed manual therapy techniques. We can perform trigger point therapy and cupping when indicated, as well as working with myofascial release techniques and visceral fascial mobilization techniques. Working with the fascia has proven to be incredibly effective as it works synergistically with the nervous system. At Bodyful, we do not claim to “fix”, “manipulate”, or “adjust” any structures in your body. All of our manual therapy works under the philosophy that your nervous system is collaborating with us to help co-create the change. This provides a deeper sense of agency and sustainability as we do not operate under a model in which you need to be dependent on us. Everything we do from a hands-on perspective we can teach you a variation that you can continue at home. 

Manual therapy is effective, but alone it is not enough. Combined with individualized and targeted exercise is where the real magic happens. At Bodyful, we pride ourselves on being up to date with the most evidenced based and effective exercises. We are currently studying under the model of Dynamic Neuromuscular Stability (DNS) which is an evidenced based way of working more thoroughly with the core and pressure management. We have seen this approach make real and clear differences with our clients when certain generic exercises plateaued. 

At Bodyful, we also focus deeply on optimal breathing techniques. Diaphragmatic breathing is essential to good pelvic health and is often performed incorrectly or non-optimally when taught in class settings by folks who are not clinicians. An individualized assessment can make a big difference in how you organize your core, regulate your nervous system, and regulate your pelvic floor muscles. 

Pelvic floor exercises are also a focus as pelvic health specialists. However, contrary to popular belief, a typical kegel is not often what we teach. As you may now understand from reading this blog, tight muscles are not strong muscles. Most connotations with kegel exercises are to constantly lift, tighten, and engage, with not enough focus on relaxation and down training. At Bodyful, we will focus on the full range of motion of your pelvic floor muscles, ensuring that they are elastic, supple, coordinated and therefore strong. 

Lastly, at Bodyful we have a strong emphasis on posture and alignment. Daily habits of how you sit, stand, and sleep are arguably more important (or at least just as important) than the exercises you do a few times a day. If you exercise for 30 minutes but then sit at a desk with non optimal posture for 8 hours, the posture will dictate your symptoms more than the exercises alone will. 

The Importance of Self-Care & Prevention

One of the most important things you can do daily to begin self-care and prevention is just to notice. If you do not bring conscious awareness to a part of your body, it is hard to regulate it. Notice if you can even begin to be aware of your pelvis as a whole. If it is hard to connect here, try looking at pictures and seeing what comes up for you. It is important to go slow and stay curious, especially if there are stories of charge or trauma in this part of the body.

Another act of prevention is stress management. In our current country and culture, this may seem like an impossible task. However, reclaiming your agency through small yet powerful acts of radical resilience, such as pausing to notice the tree outside your window and breathing three times can significantly improve your nervous system state. We are not seeking perfection here, but more so adaptability and fluidity. That is the sign of a healthy nervous system. 

In the long term, having a healthy pelvic floor means having a healthy core. Having a healthy core means less back pain, hip pain, or pelvic pain. It can also mean being less at risk for other issues such as incontinence, constipation, and even pelvic organ prolapse. 

It can also mean having a less painful and perhaps even more pleasurable experience with sex. The pelvic floor muscles dictate so much about your experience with penetration, arousal, and orgasm. Healthy pelvic floor muscles can mean a healthier and more joyful sex life. 

Conclusion

It is important to consider your pelvic health, especially if you have any of these symptoms of a tight pelvic floor. 

If you have concerns or curiosities- reach out! We would be more than happy to work with you.

If you are in the state of California,book a discovery call to learn more about tight pelvic floor symptoms. We offer Telehealth and in person visits. Our office is located in Oakland, CA. Somatic wellness is available to anyone in or outside of CA.