What is a Hypertonic Pelvic Floor!? (HPF).

A hypertonic pelvic floor is when your pelvic floor muscles become too tight/tense due to overactivity of the pelvic floor, this means they are contracting too much & too hard and they struggle to relax – causing a whole host of problems that’s often missed or misdiagnosed.

Why have I never heard of this before!?

Hypertonic Pelvic Floor is a topic that’s not widely known about or discussed & the symptoms can be mistaken for lots of other conditions. Awareness is starting to grow but lots more needs to be done to help the condition become widely recognised amongst women & healthcare professionals.

What causes a Hypertonic Pelvic Floor?

There are a number of issues that can cause hypertonic pelvic floor; there is no one definitive cause.  There are however, a few things that can lead to the over activity of the pelvic floor, including:

• Prolonged contraction of the pelvic floor/core when weight training & not giving the muscles time to relax.

• Using Valsalva manoeuvre when lifting weights (forcefully breathing out against closed airways).

• Birth trauma or scar issues; ladies who experience vaginal or perianal tearing can have an increased risk, due to the pain and scaring causing increased tightness through the pelvic floor. One sided vaginal/perineal tears can also cause opposite side hypertonic pelvic floor due to overactivity in the ‘unaffected side’ to make up for the weakened side which had birth trauma.

• Completing too many pelvic floor exercises, and/or with incorrect technique.

• Anyone who holds in their pee or poop, can develop over activity / tension in the pelvic floor. This means the pelvic floor muscles are prolonging their contraction to stop someone opening their bladder or bowls.

• Holding in your stomach day to day instead of relaxing the core, which can also lead to:

• • Paradoxical breathing patterns – breathing using only your upper airways, causing your tummy to suck inwards on inhalation & on exhalation pushing your abdomen outwards.

• Pelvic conditions & abdominal conditions e.g. – endometriosis or irritable bowl syndrome can cause HPF as chronic pain & inflammation in the pelvic region increases the risk with endometriosis, & similarly IBS symptoms of abdominal cramping & pain can also contribute to HPF. Other illness like cystitis & vulvodynia can also cause HPF.

Signs & Symptoms of HPF

• Pelvic floor pain.
• Urinary incontinence.
• Bowl incontinence.
• Struggling to empty bladder or bowel.
• Straining & constipation.
• Struggling to initiate flow of urine, increased frequency of urination, or increased urgency to pee.
• Painful urination.
• Slow flow when peeing.
• Frequent UTIs/cystitis.
• Low back pain.
• Hip pain.
• Vaginismus – sudden tightening of the vagina if you try to put a tampon in for example.
• Painful sex.

What to do if you experience these symptoms or think you may have HPF?

Firstly, if you experience any of the above symptoms you must speak to your GP or health care professional ASAP to rule out anything that requires urgent assessment & treatment.

Once any red flags have been ruled out, the root cause of the problem needs to be investigated by a women’s health physiotherapist. A women’s health physio will be able to provide techniques and advice to help overcome the issue.

If you are experiencing the above symptoms, you must be very careful with your exercise programme & stop any exercises that may be contributing to the issue until you have seen a women’s health physio to assess the condition and advise you on how to continue safely.