Common Causes of Pelvic Floor Overactivity and Pelvic Pain

May 18, 2021

Most people hear the words pelvic floor, and automatically think of kegels (or pelvic floor contractions). The pelvic floor has gotten a rap for needing to be strong like the Hulk and the stronger it is, the less problems you will have. Leaking: great do kegels all day long. Prolapse: squeeze, squeeze, squeeze and don’t let go. Visiting the restroom over and over again: tighten up and hold that pelvic floor!

Now imagine this: you squeeze your bicep so that your elbow bends and your hand is practically touching your shoulder, then hold that all day long. Does that sound like a great idea? In this scenario, the pelvic floor stands in for the bicep. Add in having pelvic pain, painful sex, constipation, urinary urgency, incontinence and now all that holding really doesn’t sound like a routine you would want to stick with. In fact, it probably sounds amazing to let your bicep go (aka pelvic floor) and find ways to relax.

What would lead someone to having an over-contracted (also described as tight, overactive, hypertonic) pelvic floor in the first place? Let’s dive into that. Please note there is a lot of complexity that can go into this, but we are going to keep it simple here.

  • Musculoskeletal injuries or other biomechanical factors
    • Ankle sprains, knee injuries, overuse injuries, postural habits, walking patterns, etc all have a connection to the pelvis. Our body works in one unit, one impact on the body will always affect another part.
  • Chronic constipation
    • Too much pressure is put on the pelvic floor when we are backed up, pushing, and holding our breath. The pelvic floor often fights back against that.
  • Pain
    • Pelvic pain, hip pain, back pain, knee pain, neck pain all have associations with the pelvic floor. In our body, pain = protection which leads to tightening of muscles.
  • Compression
    • Prolonged sitting at a desk, in the care, or on a bike puts a lot of pressure on the pelvic floor and decreases blood flow.
  • Physical or emotional trauma
    • Similar to pain, our body senses trauma as danger and wants to protect around that. Since the pelvic floor has functions so critical to survival and reproduction, it is the first to react and tighten.
  • Chronic infection (UTIs, etc)
    • Infection = danger and leads to tightening. Are we sensing a theme?
  • Childbirth
    • To keep it simple, the pelvic floor is involved in A LOT of ways during pregnancy, childbirth, and postpartum. A number of things can result from that.
  • Pelvic Organ Prolapse
    • If you get the sense of your organs falling out of your vagina, your pelvic floor is probably going to clench away to keep them from doing so.
  • Stress or Urge urinary incontinence
    • No one wants to have an accident, so the pelvic floor squeezes til the cows come home, but that usually exacerbates the problem. Or someone has recommended kegels and it may not be appropriate for you.
  • Painful periods
    • You guessed it, pain = threat which leads to more tightening. Painful periods do not have to be normal either, and can be addressed in a variety of ways.
  • Reproductive or Gastrointestinal conditions
    • Endometriosis, fibroids, chronic prostatitis, Crohn’s disease all put a lot of stress onto the pelvic floor. And the pelvic floor usually fights back.
  • Vaginismus
    • The pelvic floor muscles can be so contracted that penetration of any kind is either impossible and/or excruciatingly painful. This creates a cycle of further pelvic floor tightness.
  • Anxiety/stress
    • The pelvic floor has a direct connection with our autonomic nervous system, so those of us that are in chronic “fight or flight” likely have tight pelvic floors that respond to all that danger.
  • Bathroom Habits
    • Straining, hovering, “power peeing,” avoiding public restrooms, delaying urges all teach the pelvic floor bad habits and get things all out of whack until our body is taught new habits.
  • Social Stigmas
    • Body image, public shaming around periods/sex/etc, “it’s normal to xyz…” can all lead to holding it (and your pelvic floor) in. Meaning clenching the butt, pelvic floor, abs, etc.

If there is one thing you takeaway here, it is that many variables (and combinations of them) can involve the pelvic floor and make it susceptible to overactivity. And a lot of it happens unconsciously. Until you notice symptoms like pain, urinary urgency, constipation, leaking, etc, the pelvic floor does not become the first thing on our minds. (And hopefully this blog doesn’t make the pelvic floor the ONLY thing on your mind!) The pelvic floor is meant to operate on its own so you can walk, run, workout, have sex, and go to the bathroom all without thinking about it. We wouldn’t have any brain power left if we had to consciously control it all the time.

If you are struggling with confusing symptoms and resonate with any of the above variables, take a break from kegels and do not hesitate to consult with a pelvic floor physical therapist who is an expert in finding the “why” to your pelvic troubles and providing you with a treatment plan. They can even help get you to the right team of medical providers if that is appropriate for you. At Regenerative Edge Physical Therapy & Wellness, we have pelvic health specialists who can work with you one-on-one in-person or virtually. Contact us today or book a discovery call to find a solution to your pelvic troubles!


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