A hypertonic pelvic floor occurs when the muscles in this area become too tense. Symptoms can include pain, difficulty urinating or passing bowel movements, and sexual difficulties. Currently, there is no cure, but doctors can help people to manage their symptoms.

Hypertonic pelvic floor symptoms can greatly impact on a person’s quality of life. Hypertonic pelvic floor is a type of pelvic floor dysfunction (PFD). These conditions are more common in females than males.

A person with pelvic floor hypertonicity (PFH) cannot relax their pelvic floor muscles. The pelvic floor supports the organs in a person’s pelvis. These organs include a person’s bladder, rectum, and uterus or prostate.

A person controls their bowel movements and urination by contracting and relaxing their pelvic floor muscles. In females, these muscles also play an important part during sex.

With PFH, the pelvic muscles stay contracted, or continuously contract. This can cause a person to experience several symptoms, including persistent or chronic pain. Other hypertonic pelvic floor symptoms include trouble urinating, bowel movement problems, and sexual issues. Other names for PFH include pelvic floor spasm, nonrelaxing pelvic floor, and pelvic overactivity.

In this article, we will discuss the symptoms, causes, and treatment options for PFH.

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People with PFH may experience symptoms that can make it hard for doctors to make a diagnosis. These symptoms usually develop slowly, sometimes beginning in a person’s adolescence. Symptoms of PFH may also overlap with symptoms of other pelvic floor disorders.

One major symptom of PFH is pain. People with PFH pain often describe it as:

  • a pressure pain
  • over a wide area, or difficult to say exactly where the pain is
  • worse with more physical activity

People with PFH may experience pain in their:

  • pelvic area
  • lower back
  • hips
  • coccyx
  • trigger points

Trigger points are knots in a person’s pelvic floor muscles that develop due to stress, strain, or muscle clenching. People’s trigger points can be very sensitive and painful.

PFH bladder symptoms can include a person having:

  • pain in their urethra, or painful urination
  • a constant need to urinate
  • a need to urinate often
  • paruresis, or an inability to urinate when a person perceives judgment from others around
  • incontinence
  • slow urine flow
  • incomplete emptying of their bladder
  • hesitancy or delayed starts to urinate

A person’s PFH bowel symptoms may include:

  • painful or obstructed bowel movements
  • constipation
  • not being able to empty their bowels completely
  • straining to empty their bowels

Females with PFH may have vaginal symptoms, including:

  • pain during and after sexual intercourse
  • vulvodynia, or chronic pain around person’s vulva
  • vaginismus, or an involuntary tensing of muscles around a person’s vagina

Doctors do not yet fully understand the way people develop pelvic floor dysfunctions. Several different events, traumas, or injuries can lead to a person developing PFH, such as:

  • traumatic injuries to a person’s back or pelvis
  • sexual or physical abuse
  • chronic stress
  • anxiety
  • some pelvic and abdominal health conditions
  • pelvic surgery
  • pelvic pain
  • vaginal birth trauma
  • vaginal childbirth

Some factors can put stress on a person’s pelvic floor, making them more likely to develop PFH. These include:

  • heavy lifting
  • chronic coughing from smoking
  • chronic straining to have a bowel movement
  • overworking their core during exercise
  • holding their bladder to avoid urination
  • holding their bowels to avoid bowel movements
  • having obesity

People at higher risk of developing PFH include:

  • older people
  • people going through menopause
  • pregnant people

Primary care physicians or gynecologists normally diagnose a person’s PFD with a physical examination. During the examination, physicians will:

  • observe a person’s pelvic muscles during contraction and relaxation
  • use lubricated cotton swabs to test for vulvodynia
  • use lubricated cotton swabs to find out where a person’s pelvic pain is
  • assess a person’s muscle tenderness and tone, or how well a muscle resists pressure
  • use digital palpation to check a person’s pelvic muscle function

This examination allows the physician to determine if a person’s pelvic floor disorder is hypertonic.

There is no universal cure for PFH symptoms. However, doctors can prescribe treatments that improve a person’s symptoms, such as:

  • pelvic floor physical therapy (PFPT)
  • lifestyle changes
  • analgesic medication for chronic pain
  • surgical interventions
  • education about pelvic anatomy and function
  • Botox injections
  • electro galvanic stimulation (EGS), also called electrotherapy treatment

However, a person may require a combination of treatment options for relief. For example, some researchers note that botox injections can reduce PFH pain in 50% of patients.

Doctors consider PFPT to be an important treatment for PFH. PFPT includes strategies such as:

  • education about a person’s pelvic floor and related symptoms
  • relaxation exercises
  • core strengthening exercises
  • myofascial release, a form of muscle massaging
  • soft-tissue manipulation
  • behavioral modification exercises

These strategies may help to improve a person’s:

  • pelvic floor muscle function
  • spinal muscle function
  • sexual function
  • urinary and bowel function
  • muscle relaxation
  • pelvic pain
  • trigger points, by relaxing a person’s pelvic muscles

Physical therapy can improve PFH symptoms in females by up to 80%.

Doctors may also prescribe EGS for a person with PFH. Doctors use EGS to apply a safe low-voltage current to a person using skin electrodes. This may:

  • provide pain relief
  • relax the pelvic floor muscles
  • improves a person’s muscle proprioception, or the ability to sense where their muscle is

In a 2017 study, researchers studied a vaginal EGS program. The researchers reported a high rate of success in improving people’s PFD symptoms. However, they also acknowledged that the study results only investigated short-term improvements. The long-term benefits of EGS may need further investigation.

Hypertonic pelvic floor refers to the inability to relax the muscles of the pelvic floor. This can result in a variety of symptoms, including pain, difficulty using the bathroom, and sexual problems. While there is currently no cure for PFH, there are many treatment options that can partially or nearly eliminate PFH symptoms.