Pelvic floor muscle overactivity refers to pelvic floor muscles which are unable to relax fully when required to do so, and may hold a certain degree of tension, or high tone, much of the time. This can occur in both men and women.
To function optimally, all muscles need to be able to contract appropriately when required (with good timing, strength and co-ordination) and also relax fully when required. In the case of the pelvic floor muscles, relaxation is required to allow complete emptying of the bladder and bowel, and comfortable intercourse.
If there is tension in the pelvic floor muscles much of the time, like other muscles, they can become sensitive and tender to touch. This can mean normal activities such as emptying the bladder and bowels, having intercourse, riding a bike or even wearing tight jeans, may become painful for many with pelvic floor muscle overactivity. Some also develop other symptoms, including urinary urgency and frequency, or a feeling of pressure in the pelvis. It is not uncommon for many with pelvic floor overactivity to have some urinary incontinence as well, as even though the muscles are tight, they may still lack the strength, co-ordination and endurance needed for optimal support.
It is sometimes difficult to determine the cause of pelvic floor muscle overactivity. Some have experienced trauma to the region – such as a difficult vaginal delivery, an injury to their coccyx, or a repeated thrush infection – which may have caused the pelvic floor muscles to go into protective spasm. Others are unable to pinpoint a causative factor, and just seem to carry their tension in the pelvic floor muscles, just as others carry their tension in the neck or shoulders. It is a myth that all those with pelvic floor muscle overactivity or pelvic pain have a history of sexual abuse.
There is commonly an association between pelvic floor muscle overactivity and other pelvic pain disorders, including endometriosis, irritable bowel syndrome and fibromyalgia. Many with these other disorders will develop pelvic floor muscle overactivity as a secondary protective response to the organ pain in the same region. However, pelvic floor muscle overactivity is also believed to contribute to other types of pelvic pain, such as vulval pain and bladder pain syndrome – sometimes it can be hard to work out which has come first.
Just like any other type of chronic pain disorder, those with chronic pelvic floor muscle overactivity and chronic pelvic pain typically find other factors also influence their pain. There are known to be changes in the body’s neurological and immune response with any type of chronic pain, making our system more sensitive and reactive than usual. Our thoughts and beliefs about pain, our emotional state and other stressors in our lives then seem to have more effect on the body’s pain response. It is very common to find those with chronic symptoms also have anxiety or depression – although it can be difficult to tell whether this is a cause or a result of the chronic pain.
An important treatment for pelvic floor muscle overactivity is pelvic floor muscle down-training. This is essentially the opposite of doing pelvic floor muscle exercises, where the focus is on learning to relax the pelvic floor muscles appropriately, rather than hold them tensely most of the time. Feedback from a Women’s Health Physiotherapist with palpation and verbal cues, and guided practise sessions will often help this process.
Desensitisation of tender and sensitive areas around the outside and inside of the genital region is another form of treatment. Areas which are very sensitive to any touch or pressure will benefit from graded reintroduction of normal touch and pressure stimuli. This is usually done in conjunction with pelvic floor muscle down-training, and other tools, such as vaginal trainers may also be useful.
As pelvic floor muscle overactivity and pelvic pain are often chronic, effective treatment should also include education on chronic pain and techniques aimed at down-regulating, or calming, the over-sensitive neurological and immune systems. Common strategies include general relaxation, mindfulness techniques, and yoga. Regular, graded cardiovascular exercise for 30 minutes on most days is also beneficial in managing chronic pain and improving overall mood.
Those who have significant chronic pain may need to speak with their GP regarding medication management, as regular pain relief is generally ineffective. Other medical specialists may also need to be involved in management, depending on the other associated symptoms – including gynaecologists, psychologists and sexual health therapists.
The Pelvic Pain website has a lot of really useful information regarding all sorts of pelvic pain. The free e-book on this site is a great starting point.
You can also find out more about the role a Women’s Health Physiotherapist plays in the treatment of Endometriosis here, and how Move for Better Health™ uses Mindfulness Meditation within treatment of Chronic Pain.
If you’d like to see our Women’s Health Physiotherapist about this issue, you can: