At a certain point in your life – as you prepare for having a baby, for example – a doctor or midwife may start asking about your pelvic floor. The emphasis is usually on getting it stronger and tighter, but can you go too far?

To get the answer, we went to Dr Rachel Hines, a GP who specialises in women’s health and all things gynae.

First up, what is the pelvic floor?

“The pelvic floor is the muscles and ligaments that hold all the organs in the pelvis up, between the pubic bone in the front and the coccyx at the back. So, it's like a sling that goes from front to back,” says Dr Hines.

“Essentially, it helps to support the bladder, bowel and uterus,” she says, adding that it provides strength in this area. “There isn’t much awareness of it, I don’t think,” she continues. “Really we should be doing pelvic floor exercises from your twenties, because then it helps give really good support for future.”

How can I strengthen my pelvic floor?

For those that haven't heard of strengthening your pelvic floor, it involves clenching and unclenching the muscles you use to go for a pee. These exercises are known as kegels. There's even an app called Squeezy that the NHS recommends if you ever need to tighten up. But there’s always a flipside, which is why we’re asking if it can ever go too far the other way.

Can my pelvic floor muscles ever be too tight?

“The most common symptom is finding it too painful or uncomfortable to have sex. Or things like finding speculums (when you have your smear tests) or putting tampons in to be painful. It depends, but that's certainly something that we see,” says Dr Hines

When your pelvic floor muscles are too tight, it’s known as a hypertonic or overactive pelvic floor.¹ Just like other muscles in your body, when they work too hard for too long, they can cause discomfort.

“You can also have a rare condition called vaginismus² which is when the muscles in the vagina contract involuntarily, rather than your pelvic floor muscles” says Dr Hines. “You can't really control it, and so it can be really difficult for things like putting a tampon in or having sex.”

What can cause an overactive pelvic floor?

Imagine clenching your jaw or squeezing your hand into a fist for a long time and think how sore your muscles would be.

There might not be an immediate explanation for why your pelvic floor is experiencing tension, but here are a few common causes to speak to your healthcare professional about.

Causes of an overactive pelvic floor can include:

childbirth³
anxiety and stress³
doing kegal exercises too frequently or intensely⁴
intense abdominal core exercises⁵
recurrent UTIs or thrush³
pelvic surgery³
a wider condition such as endometriosis³
inflammation or trauma to the pelvic floor³

How would I know if my pelvic floor is too tight?

Confusingly, symptoms of an overactive pelvic floor are often similar to a weak pelvic floor, such as incontinence (not being able to hold your pee in). This is why it’s good to chat to your GP about any pelvic health concerns you have, and they might point you in the direction of a gynaecologist or pelvic physiotherapist.

“There are some amazing women's health physiotherapists out there,” shares Dr Hines.

“They can assess you and see whether it feels too tight. Some women do have really strong pelvic floors too though – so they can see what exercises are best recommended to be able to help them. They've got lots of different therapies that they can do as well, to help when you’re feeling very tight and uncomfortable.”

Symptoms of an overactive or too tight pelvic floor include:

pelvic pain or spasms
feeling like you need a wee
bladder leaks
constipation
painful sex or sexual function, such as orgasms
pain when you do pelvic floor strengthening exercises

How can someone ‘loosen’ their pelvic floor if it’s too tight?

An overactive pelvic floor can happen when the muscles have tightened and not fully relaxed. This means the muscles don’t relax when they're supposed to, such as when going to the loo.

If diagnosed with this, you should practice relaxing the muscles as opposed to the typical ‘squeeze and lift’ when doing kegal exercises. Pelvic floor down-training is the opposite of the usual pelvic floor exercises and involves relaxation techniques and breathing exercises.⁶

Here are some examples of down-training exercises to help an overactive pelvic floor, which your physiotherapist may guide you through...

belly breathing is the practice of taking deep breaths in and out of your stomach while lying relaxed on your back. It can help with relaxation of your diaphragm, causing the pelvic floor muscles to move down
pelvic stretches such as lying on your back while slowly moving your knee to your chest and holding for 30 seconds are designed to lightly stretch and relax your pelvic muscles
yoga positions like the relaxed frog and happy baby
mindfulness practice like mediation apps or breathwork

The final say

While we may hear about loose pelvic floors more than tight ones, it’s definitely ‘a thing’ – and one you can get help with by talking to your GP.

Remember, the symptoms may not be totally different from those of a weak pelvic floor, so it’s always worth getting properly diagnosed before you do too many exercises one way or the other.

“Once you’ve had children, people are often like, ‘Oh, I can't go on the trampoline… or I can't do this… or I can't do stuff for my kids…’” says Dr Hines. “Everyone normalises it. But it isn’t actually normal. So if you’re experiencing things like leaks, don’t be embarrassed to get it checked out!”

Looking to learn more about women’s health? Check out the best and worst foods to balance your hormones or from periods to restless legs: can magnesium help with women’s health issues?

Sources

Faubion SS, Shuster LT, Bharucha AE. Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction. Mayo Clinic Proceedings [Internet]. 2012 Feb;87(2):187–93. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498251/pdf/main.pdf
NHS Choices. Vaginismus [Internet]. NHS. 2019. Available from: https://www.nhs.uk/conditions/Vaginismus/
Overactive Pelvic Floor Muscles V1.1 Overactive Pelvic Floor Muscles Information for patients [Internet]. [cited 2024 Aug 27]. Available from: https://services.nhslothian.scot/urologyphysiotherapy/wp-content/uploads/sites/6/2021/09/OveractivePFMuscles.pdf
Overcoming Overactivity: Could I Have Overactive Pelvic Floor Muscles? | Embrace Physiotherapy [Internet]. Embrace Physiotherapy. 2021 [cited 2024 Aug 27]. Available from: https://www.embracephysio.sg/overcoming-overactivity-could-i-have-overactive-pelvic-floor-muscles/
Pelvic Floor Muscle Overactivity [Internet]. Available from: https://www.stgeorges.nhs.uk/wp-content/uploads/2022/08/PHY_PFR.pdf
Pelvic health physiotherapy - Overactive Pelvic Floor Information for patients, families and carers [Internet]. [cited 2024 Aug 27]. Available from: https://www.imperial.nhs.uk/-/media/website/patient-information-leaflets/physiotherapy/overactive-pelvic-floor.pdf

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