When you hear “pelvic floor,” chances are, you think Kegels, or those infamous exercises often described as what you’d need to do to pick up a blueberry with…your vagina. And it’s true: Doing them regularly is proven to strengthen your pelvic floor, or that sling of muscles running from your pubic bone to your tailbone. But for all the hype about toning these up, we rarely hear about the opposite: learning to relax them, which is essential if you have symptoms of a tight pelvic floor.
Like any other muscle, the ones that make up your pelvic floor are just as capable of being too tight as they are weak, Sara Reardon, PT, DPT, WCS, New Orleans–based board-certified pelvic floor physical therapist and founder of online pelvic floor workout platform The Vagina Whisperer, tells SELF. Weakness has just become the diagnosis du jour because the symptoms of it are more common (affecting roughly 24% of women and 16% of men) and often more overt too—like peeing a little when you laugh. But that doesn’t negate the fact that pelvic floor muscles can also tense up and become difficult to relax for an estimated 1 in 10 people.
All that tightness down there can be a sneaky cause of a bunch of problems, given how interconnected those muscles are with your bowels, bladder, and sex organs. What you really want is the Goldilocks of a pelvic floor, Darla Cathcart, PT, DPT, PhD, Arkansas-based pelvic floor physical therapist and president of the Academy of Pelvic Health of the American Physical Therapy Association, tells SELF. “If you cough or sneeze, you need that muscle to be able to contract and prevent leakage,” she says, “but you also need it to be able to [relax and] open up when you pass gas or a bowel movement, or to birth a baby or insert something into the vagina.”
Below, experts break down the key symptoms of a tight (or hypertonic) pelvic floor, and what to do if you think your pelvis is basically stuck in a contraction.
First, let’s talk about what can cause your pelvic floor to tighten up in the first place.
This basket of muscles functions a little differently than, say, your bicep: You have to flex your bicep to move your forearm, but your pelvic floor muscles are always working for you, supporting the organs in your pelvis and stabilizing your core. That means you may inadvertently engage these muscles throughout the day—kinda like how you might clench your jaw when you’re stressed. “[Your pelvic floor] is a load-bearing portion of the body, so it tends to be a place where tension can build up,” Lopa Pandya, MD, MS, FACOG, Illinois-based urogynecologist, reconstructive surgeon, and medical advisor at Aeroflow Urology, tells SELF. Over time, constant contraction can morph into chronic tightness, Dr. Reardon says.
Certain habits can pile onto that tension, too, like forcing pee out (versus just relaxing to let it flow), straining to poop, and regularly doing exercises that firmly engage your core—anything from CrossFit and heavy lifting to Pilates and barre—without counterbalancing by stretching out your pelvic floor, Dr. Reardon says. Not to mention, the one poor habit so many of us are guilty of: sitting all damn day, and often in a slumped posture, which puts pressure on your hip flexors and, yep, your pelvis.
There’s also the possibility that you’re clenching your pelvic floor without realizing it to compensate for weakness or an injury elsewhere in the lower half of your body, Dr. Pandya says, or in response to damage caused by childbirth or the trauma of sexual assault. Relatedly, conditions that affect different parts of the pelvis, like irritable bowel syndrome, interstitial cystitis, endometriosis, and recurrent UTIs could also prompt those nearby muscles to flex, Dr. Reardon says.
Because your pelvic floor isn’t exactly visible, it’s often not easy to identify if it’s tense (much less release the muscles). And it certainly doesn’t help that symptoms of a tight pelvic floor can span different medical specialties—you’d go to one doctor for your bladder, another for your gut, and another for your vagina or penis, “and none of them are necessarily evaluating your muscles,” Dr. Reardon says. But if you know the symptoms of a tight pelvic floor, you can seek out the specialized care of a physical therapist (more on that below). Here’s what to watch out for:
1. If you have a vagina, inserting something is deeply painful.
When the pelvic floor is locked up, it can restrict entry of things that you might need or want to put into your vagina, like a tampon, speculum, finger, penis, or dildo. You might feel resistance, or, if you can get something in there, it really hurts. “Any type of pain with penetration can be a sign that those muscles…can’t relax,” Dr. Reardon says.
On the severe end of the spectrum, that tightness can manifest as involuntary muscle spasms around the vagina with any type of insertion—a condition called vaginismus that makes penetrative sex excruciating. But even in milder cases of pelvic floor tightness, trying to get a penis or dildo into your vagina might feel like trying to shove a square peg into a round hole.
2. You can’t reliably orgasm (or finish at all).
Pain during sex and orgasm don’t exactly go hand-in-hand, so you might’ve seen this one coming. But it isn’t just troubles with penetration that can make it tough to finish; after all, if you have a vagina, you probably know that stimulating your clitoris can also get you there. The thing is, any orgasm is, in part, a series of pelvic-floor contractions, so if those muscles are tightly clenched, they might not be able to experience that movement and satisfying release—hence, anorgasmia.
If you have a penis, you might similarly struggle to finish or experience painful ejaculation with a tight pelvic floor because those balled-up muscles cut off some of the usual blood flow to your nether region and press on the nearby nerves.
3. You have a weak, trickling, or start-and-stop pee stream.
Stress urinary incontinence—characterized by dribbles of pee spurting out during everyday activities—is a common indication of weak pelvic floor muscles. So it only makes sense that the opposite can be true with tight ones: Pee might not come out super easily. “Your urinary sphincter [the muscle that controls your flow] may not relax well,” Dr. Reardon says, “so you could have a hard time starting your urinary stream, or it could be weak, splayed, or stop-and-start.” That same issue could also show up as “having a constant urge to urinate [along with] an inability to do so,” Dr. Pandya says.
You might also struggle with emptying your bladder fully, so you wind up back in the bathroom 5 or 10 minutes after peeing to go again, Dr. Reardon adds.
4. You’re straining to poop or dealing with regular constipation.
The back-side version of the above, struggling to poop can be another key symptom of pelvic floor tightness. Just as your urethral sphincter might not be able to soften up and allow the flow of pee, your anal sphincter (the same kind of muscle, but in your butthole) might similarly not be able to relax, Dr. Reardon says, leaving you really pushing to get poop out. And if your butthole can’t fully open up, you might also notice pencil-thin poops, she adds, almost like you’re squeezing toothpaste through a tube.
In the same realm, you might feel like “you don’t empty completely, and there’s poop left in your rectum afterward,” Dr. Reardon says. Having to push or strain a ton could also lead to hemorrhoids, which are swollen and sometimes painful clusters of veins around your anus.
The less poop you’re successfully getting out, the more likely you are to wind up with constipation too. In folks with IBS-C (a constipation-dominant subtype of irritable bowel syndrome) and a tight pelvic floor, it’s often tough to say which one came first, Dr. Cathcart adds, but it’s likely that each can exacerbate the other, as well.
5. You have very deep pain in your lower back or hips.
A super-tense pelvic floor can create a chain reaction of pain in nearby areas. After all, your muscles are all connected, so when one is out of whack, others can bear the brunt.
There are tons of different things that could trigger hip or back pain, but in the case of something pelvic-floor-related, it’ll typically feel very deep, or like something you can’t readily access or massage away, Dr. Cathcart says. Often, her patients have been to an orthopedist, had an MRI and/or CT scan, and tried physical therapy for their back or hip with no resolution, she says, but “when we do that internal pelvic floor exam, they’ll say, ‘You’re the first person to touch the thing that has been the problem.’”
6. You have a feeling of fullness or heaviness down there.
If you have a vagina, the sensation of a tampon (or anything else) sitting in there even when you don’t have one inserted can also be a sign of a tight pelvic floor, Dr. Reardon says. The same goes for a feeling of heaviness, like something is weighing down your pelvis or butt. Essentially, those muscles being all balled up may just draw your awareness to them and make them feel like they’re taking up more space than usual in your pelvis.
7. You really struggle with doing Kegel exercises.
It might seem counterintuitive, but you’re probably going to have as much trouble actively contracting your pelvic floor if it’s in a constant state of tightness as you do relaxing it. Just think about it: It’s tough to flex an already flexed or tensed-up muscle.
Dr. Reardon says she can often identify someone with pelvic floor tightness because they tell her that they can’t release their pelvic floor to pee or poop, and they also feel like they can’t contract to do a Kegel correctly. When tightness in that region goes unchecked, it often coincides with a general lack of connection to or awareness of those muscles, Dr. Reardon says, whether you’re trying to lengthen or contract them.
What to do if you think you have a tight pelvic floor
First things first: Lay off the Kegels (if you’ve been doing them), Dr. Reardon says. When your pelvis is already clenched, these exercises can actually just trigger further tension.
You can start by discussing your symptoms with a doctor that you already see, like a primary care physician or gynecologist (or a urologist if you already have one); if they suspect or determine that your pelvic floor is to blame, your best plan will ultimately be to see a pelvic floor physical therapist. (You can use this credible PT locator to find one near you.)
The appointment will be something like “a cross between a typical physical therapy visit and a gynecological [or urological] exam,” Dr. Reardon says, meaning it’ll include a chat about symptoms and some muscle assessment—pressing on your abdomen, checking out your posture—as well as an internal exam with a gloved finger in the vaginal or anal canal (in a private space, of course). “We ask you to squeeze your muscles, assess relaxation, and press on the pelvic floor to see if there are any tender points,” she says.
If they pinpoint tightness, follow-up appointments will involve a regimen for releasing those muscles, including stretching, massage, and training techniques like biofeedback. That might sound scary, but it just involves a small tampon-shaped device that a therapist inserts into your vagina (or anus); as you squeeze or release your pelvic floor, sensors on the probe translate that activity onto a computer screen, Dr. Cathcart says. This way, you can visualize what’s going on down there and learn to contract and relax correctly.
The other big part of therapy is learning activities you can do at home to unclench those muscles on a regular basis, Dr. Reardon says. That includes things like diaphragmatic breathing (which naturally requires contraction and relaxation of the pelvic floor); stretches like a deep squat, “happy baby,” and “cat-cow”; and using a vaginal wand for internal massage. A therapist can also teach you how to use silicone tubes called vaginal dilators or, if you’re comfortable with it, your thumb or finger, inserted into your vagina or butt, to gently stretch and massage your pelvic floor from the inside; this trains those muscles not to reflexively tighten with penetration, Dr. Cathcart says.
Over time, the pelvic floor can become more flexible (just as much as it can bulk up)—as with any new exercise program, it can take a couple weeks to a few months to start seeing results, but persistence is key. With concentrated effort, ideally under the guidance of a medical professional, you can stretch those fibers out until you’re pooping, peeing, and having sex with ease.
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