You might have pain during or after penetrative sex, or be unable to achieve orgasm. You might have constipation, or pain passing gas. You might notice that you can't feel a pelvic floor contraction or release at all. Symptoms of overactive or hypertonic pelvic floor usually develop slowly and get worse over time.
A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain.
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).
Lie down and insert a finger into your vagina. Try to squeeze around your finger with your vaginal muscles. You should be able to feel the sensation in your vagina, and you may also be able to feel the pressure on your finger. If you can feel this, you are using the right muscles.
Pelvic floor dysfunction is the inability to correctly relax and coordinate your pelvic floor muscles to have a bowel movement. Symptoms include constipation, straining to defecate, having urine or stool leakage, and experiencing a frequent need to pee.
Your pelvic floor is always “on” to some extent, but you should not be actively contracting it at all times. Bulging is what the pelvic floor should be doing ideally to help with emptying during pooping and during vaginal childbirth.
Take a deep breath in to the count of three, and then exhale to the count of four. When you inhale, your pelvic floor relaxes, and as you exhale, your pelvic floor returns to its resting state. Practice this breathing for 5-10 minutes each day.
Suppository medication with a muscle relaxant (valium 5 mg), nonsteroid anti-inflammatory drugs (e.g., baclofen 10 mg), and painkiller (lidocaine 5 mg) HS for 1–2 week is helpful for most patients in initial management. Subsequently, physical therapy carried by a well-trained physical therapist is also critical.
The Link Between Anxiety and Pelvic Pain
One common response to stress is to clench our muscles. And in fact, clenching the pelvic floor muscles specifically is a common reaction to stress.
In some people, constant stress can lead to a condition called Non-relaxing Pelvic Floor Dysfunction (NPFD), which can present as pain, sexual dysfunction and problems with urination and defecation.
Difficulty evacuating stool or straining with bowel movements, a sense of incomplete evacuation, bloating, and constipation are bowel symptoms characteristic of nonrelaxing pelvic floor dysfunction. Urinary symptoms include frequency, hesitancy, urgency, dysuria, bladder pain, and sometimes urge incontinence.
Sit on a padded surface. A hard surface may lead to some extra pressure and discomfort on the bony structures at the base of your pelvis. Sit with your buttocks right at the back of the seat, allowing the back rest to support your spine.
If you are sitting with poor posture or sitting too long, your core and the parts of your body that make up that area, such as the pelvic muscles, can be impacted. This can lead to pelvic floor disorders, pelvic pain, fecal incontinence, and urinary incontinence.
Doing the exercises while you are urinating can weaken your pelvic floor muscles over time or cause damage to bladder and kidneys. In women, doing Kegel exercises incorrectly or with too much force may cause vaginal muscles to tighten too much. This can cause pain during sexual intercourse.
Constantly using your kegel muscles, even to a mild degree, can lead to muscle strain, muscle fatigue, muscle pain, discomfort with exercise, and painful sexual intercourse. It can also contribute to muscle “knots” or trigger points.
Kegel exercises are less helpful for women who have severe urine leakage when they sneeze, cough or laugh. Also, Kegel exercises aren't helpful for women who unexpectedly leak small amounts of urine due to a full bladder (overflow incontinence).
Regular gentle exercise, such as walking can also help to strengthen your pelvic floor muscles.
Factors that put pressure on the pelvic floor.
These factors include overweight or obesity, chronic constipation or chronic straining to have a bowel movement, heavy lifting, and chronic coughing from smoking or health problems.
Magnesium is a mineral with an important role in muscle relaxation throughout the body. Due to its relaxing effect, it may be used to ease pelvic pain caused by tight or taut muscles.
Diazepam (Valium®) is used to treat levator ani syndrome in conjunction with other treatments to help relax the pelvic floor muscle group (levator ani). Diazepam has U.S. Food and Drug Administration (FDA) approval for use as a muscle relaxant.
Pelvic floor physical therapy (PFPT), also referred to as pelvic floor muscle training (PFMT), is a conservative, first-line treatment for many pelvic floor disorders [1&].
Talk to your primary care doctor or gynecologist if you notice changes in bathroom use or start experiencing bothersome symptoms in your pelvis. This is especially important if you're an older woman and more susceptible to these disorders.
In general, treatments for pelvic floor dysfunction include: Muscle relaxers or other prescription medications. Physical therapy to retrain and strengthen the muscles. Behavior changes, like reminding yourself to avoid straining when using the bathroom.