Did you know that your pelvic floor muscles can be overactive? This occurs when your pelvic floor muscles have higher tone and activity than what we’d consider normal and in these cases, Kegels are the very last thing you should be doing.
And while there is no denying that it’s a great thing that women are becoming more informed about their bodies and how important the pelvic floor is, for some women, weakness isn’t the problem. And when we’re all being bombarded with the message to do our pelvic floor exercises every single day, we’re not necessarily being told about symptoms other than weakness and leaking. And so any problem down there at all, we think can be fixed by squeezing and lifting every day.
And this could be doing more harm than good.
HERE'S WHAT WE COVER:
What is an overactive pelvic floor?
Commons signs and symptoms
What to expect when working with a women’s health physiotherapist
Pelvic floor relaxation exercises
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Hello, and welcome to episode 16 of The Mana Women’s Wellness Podcast. I’m your host, Rachel and today I’m talking about a topic that has popped up quite a few times in my DMs now, women who’ve been told they have an overactive pelvic floor and wanting to know more about what they can do to fix their symptoms.
And if you want to know a little more about your pelvic floor, then go back and have a listen to episode 3 – 5 things every woman needs to know about her pelvic floor. In that episode we cover the basics of what the pelvic floor is and why it’s so damn important.
or you want to know what questions to ask yourself to see if you have any symptoms that might need addressing, you can grab my free pelvic floor quiz. It’ll take a couple of minutes, just some yes and no questions to help you decide if your pelvic floor needs a little extra love.
And if you’re ready to dive deep into all things pelvic floor, you can sign up for my free pelvic floor bootcamp, you’ll get access to three days of video training and exercises to help you to manage your pelvic floor symptoms.
You can grab both of these freebies at www.manawomenswellness.com/freebies or head to today’s shownotes and I’ll include all the links there as well. And that’s over at www.manawomenswellness.com/post/overactive
And while there is no denying that it’s a great thing that women are becoming more informed about their bodies and how important the pelvic floor is, for some women, weakness isn’t the problem. And when we’re all being bombarded with the message to do our pelvic floor exercises, do our kegels every single day, we’re not necessarily being told about symptoms other than weakness and leaking. And so any problem down there at all, we think can be fixed by squeezing and lifting every day.
And so, let me begin today by saying that if you’re experiencing leaking or weakness or dragging or heaviness, then yes, you probably need to do pelvic floor exercises to strengthen your muscles and improve your symptoms. But kegels aren’t the be all and end all, there are situations where these strengthening exercises can do more harm than good. And that’s why it’s so so important to be assessed by a qualified women’s health physio. You need to have your pelvic floor checked. And if you start doing kegels and your symptoms get worse, stop. Self-diagnosis here can make your symptoms worse.
Now, an overactive pelvic floor, a hypertonic pelvic floor, a high tone pelvic floor refers to muscles that have a higher than normal tone at rest and have diffiuclty relaxing. Just as your neck or shoulder muscles might become tight, your pelvic floor muscles can too. But I don’t like to use the word tight when it comes to this area of the body because I think these days having a tight vagina is seen as a positive thing – and it isn’t, so we’ll called it overactive instead. This condition can kind of be considered the opposite of a weak pelvic floor. It’s not that the pelvic floor muscles are too strong, it’s that they have difficulty relaxing and they’re switched on more than we’d like.
Some common signs of an overactive pelvic floor include:
Pelvic muscle pain
Constipation, a feeling of Incomplete emptying or really straining to empty your bowels. Because muscles need to relax for your bowels to open.
Pain in your pelvis, lower back, tail bone or in your hips. Hip and pelvic muscles that surround the tight pelvic floor muscles, will also likely become tight. You may not necessarily feel tightness and pain in your pelvic floor, but actually deep in the hip, groin or in your bottom muscles.
Pain during sex, pain with inserting tampons or menstrual cups – remember, pain is never normal and something you need to put up with.
Vaginismus (spasm or involuntary tightening of muscles around the vagina)
Urinary incontinence, and this is the symptom that confuses women because they think their muscles are weak and need strengthening with exercises.
Incomplete emptying of the bladder, feeling like you need to go to the toilet even though you’ve just been.
Slow flow of urine, or delayed start of your urine stream
Urinary urgency – suddenly needing to go
Urinary frequency – going all of the time
What Causes an Overactive Pelvic Floor?
While there is no single definitive cause of an overactive pelvic floor, there are factors that are thought to contribute to tightening of the pelvic floor muscles.
Someone who exercises frequently and does a lot of core work may develop pelvic floor tension because these muscles always being switched on.
People that hold on to their bladder or bowel despite signs to go, for example not wanting to use public toilets, you can develop tension due to frequent tightening to prevent accidents.
When we are stressed, anxious or afraid our muscles contract instinctively, all over our body. Continuous stress at high levels can cause shortening and tension of the pelvic floor muscles.
Trauma and scar tissue, like a perineal tear during childbirth and getting stitches, can cause tightening of the pelvic floor muscles as a protective response, especially while the area is still healing.
Pelvic health conditions like endometriosis, where a woman experiences chronic pain and inflammation in the area, that initial pain response can lead to tension and pain in the pelvic floor muscles over time.
Abdominal pain and cramping, like Irritable Bowel Syndrome, can also contribute, so can pelvic nerve dysfunction like in interstitial cystitis, pudendal neuralgia and vulvodynia.
So often, any other painful or inflammatory conditions affecting the area can lead to that tightening and protective response, just like how our back muscles get tight and spasm when we hurt our backs.
How Do We Treat an Overactive Pelvic Floor?
When people experience pelvic floor dysfunction, their first thought is to do pelvic floor strengthening exercises. However, further activity and contraction of these already tight muscles can worsen your symptoms when your muscles are overactive. This is why it is so important to seek treatment from a qualified women’s health physiotherapist to check what type of dysfunction you are experiencing and to manage your symptoms before they progress.
When working with a physio, here are some of the things you might be doing:
Pelvic floor muscle relaxation techniques – and I’ll go through one of these in a minute.
Breathing techniques, again it’s all about relaxing and easing muscle tension
Lots of education about bladder and bowel habits – so, some of the symptoms I talked about were related to difficulties emptying the bladder or bowel. And that’s because the openings to the bladder and bowel – the urethra and the anus – the opening is a sphincter. And we need this sphincter to relax to open to allow them to empty. The job of the pelvic floor is to squeeze these openings closed to stop leaking, and an overactive pelvic floor is doing the job a little too well and can’t relax when we need it to.
Pelvic floor and abdominal massage, or scar tissue massage if you’ve had a perineal tear or stitches. This helps to relax the muscles and break up any scar tissue that might have formed and be contributing to this tightness.
You’ll be taught hip and pelvic muscle stretches too because as I said, these muscles are likely also tight. So again, back to my back pain example, if we hurt out lower back and those lower back muscles become tight and painful and go into spasm, the surrounding muscles in our hips or even up in our neck and shoulders will likely also become tight and go into spasm as that protective response.
And finally, you may use vaginal dilators which are inserted into vagina to stretch the pelvic floor muscles. Now this is used especially if you’re experiencing pain during sex or if you can’t use tampons due to pain. Now you can imagine that if you struggle to insert a tampon due to pain and tight muscles, a penis is going to hurt a whole lot more. And this has a huge impact on your relationships and really takes a lot of communication and understanding and support from your partner too. So dilators come in different sizes and it’s all about gradually stretching the pelvic floor muscles and building up your tolerance so that you can enjoy pain-free sex that’s actually pleasurable with your partner.
Now I’m not going to pretend to be an expert in this area at all. Chronic pain, complex pain, is a still a very new area in physiotherapy and in healthcare really. And the way we treat chronic pain is very different to the way we would treat an acute injury, like a twisted ankle. Chronic pain changes the way we see our bodies, it changes our thinking patterns.
And when it’s affecting the most intimate part of your body, it’s not obvious from the outside and it’s something that really affects a person’s life, their comfort wearing underwear, their relationships, their ability to have sex – it’s a hugely sensitive subject. And the mental toll that this would have on woman who struggles with it and her partner too, is huge.
And so I guess here, if you’re noticing small symptoms, subtle symptoms, if you’ve recently had a baby and you’ve had a perineal tear and stitches – go and see a women’s health physio. In Australia, you don’t need a referral, you just need to book an appointment. Get this stuff sorted early to avoid your symptoms getting worse.
Pelvic Floor Muscle Relaxation Exercise
Ok, so now I want to take you through a quick pelvic floor relaxation exercise. This is something everyone can try and it’s even just something you can add to your daily routine, if you have a meditation practice, chuck it in at the start or the end.
So I want you to find a place to relax, free from noise and distractions.
Lie down in a comfortable position with your knees bent up and feet flat on the floor.
Close your eyes and slowly breathe in through your nose for around 3 seconds. Allow the air to flow down in to your belly, causing your belly to rise. Place your hands on your belly to feel this movement. This may be difficult to coordinate at first, your belly may not be used to stretching and rising with your breath.
Now that you’ve got your breathing pattern under control, add in your pelvic floor contraction.
Breathe in, then on your next breath out, lift and squeeze your pelvic floor.
But instead of focusing on contraction, I want you to focus on the relaxation because that’s where these muscles have trouble.
Imagine your pelvic floor is an elevator, squeeze and lift going up 123, Then relax your pelvic floor slowly and imagine the elevator going back down 3, 2, 1 levels.
Allow your pelvic floor to completely relax and imagine the doors of the elevator opening again.
Continue with this exercise for 1-2 minutes, coordinating your pelvic floor contraction with your breath out and the relaxation with your breath in.
Practice this exercise at least once a day.
Ok, we are going to wrap it up for today. I hope I shed some light and some new knowledge on an area that really isn’t addressed a lot. And while it’s great that women are learning more about their pelvic floor and starting to incorporate strengthening exercises into their daily routine, it’s just as important to take note of the signs that maybe your pelvic floor doesn’t need any more strengthening, that it really needs some help to relax instead. And I hope if you’ve related to any of the symptoms I’ve talked about in this episode, that maybe you’re feeling a little more inspired to get some help, to see physio to get assessed and work with them for an individualised treatment plan.
If you learnt something new or found value in today’s episode, or if you’ve got a question, I’d love to hear from you! Send me a DM on Instagram and ask away, or let me know what you want me to talk about. As always, this podcast is created with you in mind and so I want to talk about the things that are most important to you!
Don’t forget you can download the freebies I talked about in this episode – your pelvic floor quiz or you can join the 3 day pelvic floor bootcamp at www.manawomenswellness.com/freebies or head to today’s shownotes and I’ll include all the links there as well. And that’s over at www.manawomenswellness.com/post/overactive
I will see you in next week’s episode, where I am so so excited to have another guest joining me and I am getting schooled next week because we’re talking about something I know very little about and I am so excited to learn about this topic. I promise you won’t want to miss that one!
Ok, bye for now and don’t forget that knowledge is power!
When you truly understand your body, you are empowered to make informed decisions and take control of your health!
Until next time.