How To Tell If Your Pelvic Floor Is Tight or Weak
The pelvic floor is a group of muscles that supports the bladder, uterus, and rectum while contributing to bladder and bowel control, core stability, and sexual function. This article explains the differences between a tight (hypertonic) and weak (hypotonic) pelvic floor, the symptoms each may cause, and why an accurate diagnosis matters.
Many symptoms, including urinary leakage, pelvic pressure, and pain, can occur with either condition, making self-diagnosis difficult. A pelvic floor physical therapy evaluation can determine the underlying cause and guide the most appropriate treatment.
What Does the Pelvic Floor Do?
The pelvic floor is a group of muscles that support the pelvic organs (bladder, uterus, rectum). We can imagine the pelvic floor as a hammock or trampoline since it needs to respond to constant pressure changes in our body. Pressure changes can include things like sneezing, coughing, straining, pushing, pulling or lifting.
The pelvic floor muscles have five main functions: support, stability, sphincteric, sump pump (lymphatic system) and intimacy. Outside of the support to the organs, the pelvic floor is an important part of our trunk that provides stability to our body. Every time we take a step for example, the pelvic floor and core engages to stabilize the upper half of our body. The pelvic floor also provides sphincteric control with both the urinary and anal sphincters. This prevents us from leaking out pee or poop! Lastly the pelvic floor is an important part of our lymphatic and vascular system and also an important part of intimacy. Pelvic floor muscles can play an important part in pleasure.
What Is a Tight Pelvic Floor?
A tight or hypertonic pelvic floor presents with increased tone, lack of coordination and often pain. The increased tone can cause difficulty contracting and relaxing and for some can be the cause of pelvic pain. Muscle tone exists on a spectrum, so the best way to understand it is to understand the two ends of the spectrum. A severely hypertonic pelvic floor will present as someone who cannot insert a tampon, have an gynecological exam or have penetrative intercourse. An internal assessment of the pelvic floor muscles will often be uncomfortable or painful. On the other hand, an efficient pelvic floor would present as an individual who has no bladder, bowel or intimacy concerns. The exam would largely be comfortable with no areas of pain or discomfort and the individual would be able to contract and relax their pelvic floor well.
Common Symptoms of a Tight Pelvic Floor
· Pain with intimacy
· Increased urinary urgency and frequency
· A feeling of incomplete emptying with peeing
· Burning sensation
· Pelvic pain
· Stress or urge incontinence (Leaking right before making it to the bathroom or leaking with coughing, sneezing, running, jumping or laughing)
· Pain with bowel movements
· Referred pain to the low back or hips
What Is a Weak Pelvic Floor?
A hypotonic pelvic floor is defined as pelvic floor muscles that are weak, low tone and present with poor endurance. Muscle tone is inherently a good thing, as we want our muscles to contract and support us. However, we do not want to have too low muscle tone (hypotonic) or too high muscle tone (hypertonic).
A hypotonic pelvic floor can be caused due to a variety of factors such as:
Chronic straining or constipation
Aging and hormonal changes
Pregnancy, labor and delivery
Connective tissue disorders (such as Ehlers-Danlos Syndrome)
Nerve injury or surgery
Common Symptoms of a Weak Pelvic Floor
· Fecal incontinence or gas leakage
· Urinary incontinence (urge or stress)
· Pelvic organ prolapse symptoms
· Core weakness
· Decreased sexual sensation
· Heaviness or pressure in the pelvis
Can You Have Both a Tight and Weak Pelvic Floor?
Yes it is possible to have both a tight and weak pelvic floor. Generally, what we see in clinical practice is when we first assess we can see if there is tightness or tension in the pelvic floor. Then once we work on improving the tension and increasing the length of the muscle, we can better determine if it is weak or strong. When a muscle in the pelvic floor is tight, it cannot go through its entire range of motion. Therefore, once the muscle can fully contract and lengthen, then we can more accurately assess its strength.
Also, it is important to understand that the pelvic floor is made up of both endurance and faster twitch muscle fibers. The pelvic floor muscles are always on and working to support the pelvic organs and to absorb changes in pressure. They are mostly working sub-maximally. Therefore, functional strengthening of the pelvic floor is very important. While some people may benefit from Kegel training, overall core training is also important.
How Pelvic Floor Therapy Can Identify the Difference
Both a tight or weak pelvic floor can present symptoms such as urinary incontinence, fecal incontinence, pelvic organ prolapse, heaviness and pressure and decreased sexual sensation.
Since both increased tone and reduced tone can cause these symptoms, it is very important to get a correct diagnosis. Pelvic floor therapy is the gold standard for diagnosis whether you have a tight or weak pelvic floor. We can assess this through an internal exam where we can directly touch the muscles and assess the muscle tone. This exam is explained initially using a pelvic model and is only performed with the full and enthusiastic consent of the patient.
When to Seek Professional Evaluation
If you are experiencing any bladder, bowel or intimacy symptoms, you should definitely seek the help of a pelvic floor therapist. It can also be helpful to consult your primary care physician, urologist or gynecologist depending on what is going on in order to first rule out any medical causes to your symptoms.
Where to Find Pelvic Floor Physical Therapy For A Weak or Tight Pelvic Floor In Queens, NYC
If you are experiencing symptoms of a tight or weak pelvic floor, help is available! Pelvic floor physical therapy is the gold standard treatment for this condition. If you are in the Forest Hills, Queens, NYC area and you are looking for help today, reach out to us! Give us a call or fill out our contact form today!
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