Hypertonic (High Tone) Pelvic Floor Muscle Dysfunction

hypertonic-pelvic-floor-musclesHypertonic Pelvic Floor Dysfunction occurs when the pelvic floor muscles are overly tense, inflexible, or in spasm. The muscles do not move or stretch with daily activities. It causes uneven stress on the bones where they are attached and uncomfortable stretching of the muscles themselves. The term “high tone or hypertonic” refers to the presence of high tension in the muscles. This can occur with either strong or weak pelvic floor muscles, and can cause a wide range of problems.

Pelvic floor hypertonicity may be the primary cause of pelvic pain in some patients; in others it may simply be a response to the underlying pelvic disorder. Several mechanisms of injury may lead to spasm of the pelvic floor. It could be the result of  malalignment of the pelvis, especially in the sacroiliac joint, due to trauma, poor posture, pelvic floor deconditioning, muscular asymmetry, or excessive athletics. (See article)

Lisan Jutras in her article, How pelvic physio strives to take the pain out of sex writes about Dr. Caroline Pukall, a clinical psychologist with a focus on human sexuality at Queen’s University. Dr. Pukall recommends pelvic physiotherapists to many of her patients who endure painful sex. She states, “while ob-gyns “are masters of their universe in terms of checking for infections, palpating the uterus, and running tests and talking about sexual health,” she says, “they are not generally very well trained in anything more than a cursory check for tension in the vaginal area.”

Marcy Dayan of the Dayan Physiotherapy and Pelvic Floor Clinic in Vancouver states, “What has been found through both clinical findings and research is that hypertonic – i.e., tight – pelvic-floor muscles can be responsible for various pain complaints in women,” Laura Disenhaus, PT, DOMP in Toronto says. “The only way to effectively stretch and release those muscles is to touch them directly.” (This is why I think trigger point therapy is a must for those suffering with tight pelvic floor muscles)

Dayan also uses bio-feedback, which measures the muscle tension of the pelvic floor and displays a graph to help people understand when and if they are clenching or relaxing. “I teach the person different skills with how to be present in their body,” she says.

This blog post from Jessica Reale, DPT really captures what tight pelvic floor muscles are like.

According to an article written by Andrew T. Goldstein, MD, Hypertonic pelvic floor muscle dysfunction shows itself with – Pain upon penetration, soreness, “pressure in the vagina,” pain upon sitting, tightness, throbbing, aching, stabbing, “spasm, ” urinary frequency, hesitancy, incomplete emptying, constipation, rectal fissures, generalized vulvar burning. 

Other symptoms may include, pain as sexual arousal builds or with vaginal penetration and/or orgasm.  Inability to tolerate wearing tampons or getting a pelvic exam. Constipation and/or pain with bowel movements. Painful urination and/or increased frequency of urination. Ache in the pelvis from constant muscle stress on the lower spine and tail bone.

Who is at risk of developing Hypertonic Pelvic Floor Dysfunction?

  • Women transitioning through menopause. 
  • Women who experience infrequent vaginal penetration. Relaxing to allow penetration helps keep the pelvic floor muscles flexible.
  • Individuals having difficulty coping with stress – this increases the likelihood of carrying tension in the pelvic floor muscles and the abdominals.
  • Individuals who’ve had some sort of trauma to their pelvic floor 
  • Individuals who do Kegels without adequate relaxation both during and in between exercises.
  • Athletes, gymnasts, and Pilates enthusiasts who work out with a focus on core strength without adequate focus on core flexibility and relaxation.

Should you do Kegels?

According to many physiotherapists including those at Pelvic Health Solutions, and Pelvic Floor Exercise , Kegels are NOT always indicated for pelvic floor problems.  Sometimes they do more harm than good, and often they are NOT performed correctly. 

Your pelvic floor muscles are the only group of muscles in the body that never get to rest! Which is a good thing because if they were completely relaxed you would be incontinent. Your pelvic floor muscles do not just rest and relax, so in fact they are working all the time to do the following things.  1) maintain continence 2) support pelvic organs 3) assist with posture and stability. So it would seem that many people probably are dealing with tight un-relaxed muscles versus relaxed and loose muscles.

Liz Rummer, MSPT wrote about this very thing on her blog post, “Why Kegels are Bad for your Tight Pelvic Floor.” She quotes Biomechanics expert Katy Bowman saying, that at the heart of the problem with doing Kegels to strengthen the pelvic floor is a theory in biomechanics called: “Overgeneralized Theory of Strength.” When you do a Kegel, she explains, you are doing a muscular contraction, and if you already have a tight pelvic floor, contracting these muscles will only make it tighter, making your pelvic floor problems worse.”

The muscles are actually weak because they are tight. More “strength” or tension-increasing exercises are going to make things worse, not better. Muscle lengthening exercises, including stretching the calves, hamstrings, groin (adductors)–are the best prescription. Also, you need to learn how to hold your pelvis correctly to optimize strength! According to Ms. Bowman, Athletes tend to be super-tight through the quads and psoas, which also keeps the pelvis tucked under. Wearing high heels requires women to reposition their joints to deal with the torque at the ankle, and many women will post-tilt the pelvis there as well. So another no-no of someone struggling with PFD. She suggests that for optimal pelvic health, one needs to make sure the posterior muscles (glutes, hams, and calves) aren’t pulling the pelvis under and keep the psoas and groin loose as well.

Getting back to the kegel issue, Rummer agrees with Ms. Bowman statement…” If you have a tight pelvic floor, or even a pelvic floor with active trigger points, you should not do kegels. Doing kegels under these circumstances will compound your pelvic floor problems.”

This is a great interview on the Mama Sweat blog that Katy Bowman did. I would highly recommend reading it, and also checking out Katy Bowman’s website for more great information on pelvic floor awareness.

Amy Stein does a great job in describing a hypertonic pelvic floor in this interview that discusses pelvic pain and too tight pelvic floor muscles. 

Kim Vopni, affectionally called the Fitness Doula has done a great interview with Red Tent Sisters that really captures what I believe about the pelvic floor and kegels.

Exercises That Help Relax Pelvic Floor Muscles

I am a big fan of Michelle Kenway, PT –  here are 3 exercises to help relax your pelvic floor.

Treatment

According to this article by Dr. Patrice M. Weiss, the treatment of symptomatic pelvic floor hypertonus begins with rehabilitation of the neuromuscular unit or neuromuscular reeducation using biofeedback, muscle relaxation techniques, and soft-tissue manipulation. During the therapist’s manipulation of the affected pelvic floor musculature, the patient is asked to contract and relax. Verbal and tactile cues are used to help the patient recognize when she has appropriately controlled the pelvic floor. External or intravaginal electrodes may be used to monitor the electrical activity of the pelvis and provide visual or auditory biofeedback as the patient attempts to contract or relax. A key objective of neuromuscular reeducation is to improve the patient’s proprioceptive awareness of the pelvic floor. Once a woman is able to recognize contracted versus relaxed pelvic musculature, she is better able to control the pelvic floor.

Dr. Weiss goes on to state… Although most treatment options can be applied to almost any patient, our experience suggests that generalized hypertonus usually responds best to generalized therapy (such as strengthening, stretching, biofeedback, ultrasound), whereas trigger points and other focal anomalies more often require manual therapy (such as myofascial release, crystal wand manipulation, trigger point injection). I agree with this wholeheartedly and have had such great success with trigger point therapy.

Other treatment options include: pelvic floor physical therapy by womens’ health physical therapists (www.womenhealthapta.org) muscle relaxants such as diazepam, warm baths with epsom salt and tea tree oil, hypnosis, meditation, Open Focus meditation, Yoga, REstorative Exercise, biofeedback, and injections of Botox.

**If you are a sufferer, you may want to check out this very information article on the hypertonic pelvic floor from fellow sufferer and blogger Caits Day.

Articles and Research on Pelvic Floor Treatments

Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness. A significantly higher proportion of women with interstitial cystitis/painful bladder syndrome responded to treatment with myofascial physical therapy than to global therapeutic massage. Myofascial physical therapy may be a beneficial therapy in women with this syndrome.

Rehabilitation of the short pelvic floor.  This review describes the clinical syndromes associated with shortened PFM, and the rehabilitation techniques we have found to be the most useful.

Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor

Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction – Mayo Clinic

Common myths about your pelvic floor – www.pelvicfloorexercise.com.au

LET WHO PUT WHAT WHERE? FINDING A CURE FOR PELVIC PAIN – great article on one women’s journey to finding an answer to her pelvic floor pain

Exercises for Short /Tight Pelvic Floor Muscles – great blog post on safe exercises for those with a tight pelvic floor by Britt Van Hees, DPT.  Britt states: Although these exercises are primarily directed towards those with tight or hypertonic pelvic floor musculature they can provide awareness training for any pelvic floor, big or small, tight or loose, weak or strong.

 Twitter:@MyPelvicHealth

 

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