Pelvic Floor Physical Therapy for Pelvic Pain

How can you tell if your pelvic floor muscles may be tight? Not uncommonly women share with me that they think they may have a tight pelvic floor. They may have an understood history of tension, and been medically diagnosed with a "Hypertonic Pelvic Floor", or simply done some research that led them towards the terminology.

There are 3 layers of muscle that make up the pelvic floor, the 1st and 2nd layer are superficial and the 3rd layer is the deepest. All 3 layers include approximately 17 different muscles and collectively provide deep core stability, organ support, sphincteric control, lymphatic drainage, and sexual function. Like any other muscle in our body that can feel painful, stiff or tense (hypertonic), the muscles in the pelvic floor can too! However, when the pelvic floor muscles are hypertonic you can start to notice symptoms such as; pain or inability with anything being inserted, difficulty with emptying processes such as having a bowel movement, bladder urgency/frequency, leaking, and even heaviness.

Pelvic pain specifically can be a common complaint when the pelvic floor muscles are hypertonic. There can many different reasons why the pelvic floor muscles become tensed such as; musculoskeletal compensation for inefficiency at neighboring muscles ( think trunk and hips), birth injury, hormonal drivers, inflammatory conditions of the gut, physical and or emotional traumas, and more. When the pelvic floor muscles are too tight, one of the first steps in pelvic floor PT is to build awareness in order to help your body's ability to relax and lengthen these muscles. (Easier said than done!) Strategies to help build awareness typically include breathing techniques with and without positional strategies ( i.e. sidelying may be easier than lying on your back for some), manual therapy supportive of helping relax overactive muscles, muscle reeducation ( retraining patterns that are not serving you well), improving mobility deficits, and of course strengthening muscles that have been identified as inefficient and or weak.

How long you spend in PT varies patient to patient, however keep in mind that the longer your symptoms have been around the longer you can anticipate rehabilitation to take. Consistency matters with PT as well as with your focus on small daily habits, or movement snacks, that support calming the nervous system as well as provide mental and physical reassurances ultimately supportive of your larger goals!