Hypotonic Pelvic Floor: Symptoms, Causes, and Treatment Options
A hypotonic pelvic floor presents as weak, low tone and with poor muscular endurance. A hypotonic pelvic floor is the opposite of a hypertonic pelvic floor; however both muscular conditions can share similar symptoms. Both a hypotonic and hypertonic pelvic floor can present symptoms such as urinary incontinence, fecal incontinence, pelvic organ prolapse, heaviness and pressure and decreased sexual sensation. It is important to consult with a pelvic floor physical therapist to learn about what is causing symptoms. Treatment involves a tailored pelvic floor physical therapy program.
Introduction
The pelvic floor is a group of muscles that support the organs of the bladder, uterus and rectum. It is an important part of our trunk and core that provides support and stability.
A hypotonic pelvic floor refers to pelvic floor muscles that are weak and present with low tone and poor endurance. It can be difficult to know if you are experiencing symptoms because your pelvic floor is hypotonic or hypertonic. Both conditions can present similar symptoms.
This article will cover how to get a proper diagnosis for this condition and how treatment guided by a pelvic floor therapist can lead to symptom management and resolution.
What Is a Hypotonic Pelvic Floor?
A hypotonic pelvic floor is defined as pelvic floor muscles that are weak, low tone and present with poor endurance. This can lead to symptoms such as urinary or fecal incontinence, pelvic organ prolapse, heaviness and decreased sexual sensation. 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).
Hypotonic vs. Hypertonic Pelvic Floor: What’s the Difference?
A 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. A hypotonic pelvic floor is the opposite. It presents as low tone and decreased strength and is usually not painful.
Both a hypotonic and hypertonic 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 hypotonic or hypertonic pelvic floor.
It’s also important to point out that the advice of just doing Kegels for any pelvic floor issue is not standard of care. Kegels can actually cause a worsening of symptoms if there is hypertonicity or increased tension in the pelvic floor.
Common Symptoms of a Hypotonic 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
What Causes a Hypotonic Pelvic Floor?
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
How Is a Hypotonic Pelvic Floor Diagnosed?
A hypotonic pelvic floor is diagnosed by a pelvic floor physical therapy evaluation. This usually involves an internal and external assessment of the pelvic floor muscles. You will be asked to squeeze the muscles and to relax. The therapist will assess the strength and endurance of the muscles.
Treatment Options for a Hypotonic Pelvic Floor
Pelvic floor physical therapy is the gold standard treatment for a hypotonic pelvic floor. Core and hip strengthening is especially important as this can help strengthen the entire trunk including the pelvic floor. Kegels may be prescribed but will likely only be a small part of the program. Pelvic floor physical therapy will also recommend looking at postural, bowel habits, bladder symptoms, sleep and stress.
If a hyptonic pelvic floor is leading to feelings of heaviness and pressure that is not improving with physical therapy, it is recommended to seek a referral to a urogynecologist. A urogynecologist may suggest a pessary. A pessary is a removal device that helps support the pelvic organs.
Conclusion
If you are experiencing symptoms of a hypotonic 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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Bladder Prolapse During Pregnancy: Causes, Symptoms, And How To Manage It Safely
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