Hypo versus Hypertonic Pelvic Floor

PELVIC FLOOR DYSFUNCTION:

Most pelvic floor conditions are either because the pelvic floor muscles are too weak (hypotonicity) or too tight (hypertonicity).

Hypotonic Pelvic Floor:

• When the pelvic floor muscles are too weak, it can cause urinary incontinence and pelvic organ prolapse.
• Many women have a weak pelvic floor after childbirth. Common signs of a weak pelvic floor are urinary incontinence when coughing or exercising and decreased sensation during sex. These symptoms can be quickly reversed with pelvic floor and TVA strengthening exercises.
• Doing tons of ab crunches won't fix the core weakness... in fact, it will make the incontinence worse. That's why the TVA training is crucial. A whole body approach must be followed to fixing imbalances! You can't just go to town on pelvic floor strengthening: this will cause more harm than good.

Hypertonic Pelvic Floor:

Some women have an overactive pelvic floor. This happens when your pelvic floor muscles become too tense (constantly contracted) and are unable to relax. This can cause spasm, tightness, tension and pain. This does NOT mean your pelvic floor muscles are strong. They are WEAK and they are unable to work through range.

Clarification: "hypertonic" doesn't mean the pelvic floor is excessively strong; instead, it implies muscle weakness due to over-tightening.

Overly tight muscles impede proper contraction and relaxation. This hypertonicity contributes to incomplete bladder emptying and subsequent leakage upon standing. When a muscle is constantly contracted, it reduces blood flow to the muscles. This is what makes the vagina dry and numb.

Symptoms can include

• Urinary urgency
• pee leaks
• frequent urination (more than 10 times a day)
• pain with sex
• inability to have an orgasm
• pain during vaginal examinations
• Can’t insert tampons
• incomplete emptying of bladder and/or bowels,
• tight/tense hip muscles (piriformis, psoas, hamstrings)
• Tension and pain in the low back
• tailbone pain
• Pelvic pain and tension
• Recurrent UTIs
• Constipation
• Kegels make your symptoms worse
• Overactive pelvic floor muscles could be due to:
• chronic low back pain
• excessive exercising (this is very stressful on the body)
• exercising incorrectly (bracing through your upper 6 pack abs)
• doing excessive kegels
• sexual trauma
• pelvic surgery
• infection
• anxiety or stress

The obvious solution: take some time to rest, stretch, breathe, and heal. Breathing and pelvic floor stretching exercises are a perfect thing to work on to assist with healing an overactive pelvic floor. So if you have an overactive pelvic floor, first learn how to relax your pelvic floor muscles before you embark on the pelvic floor strengthening exercises... otherwise you'll make things tighter. As always, consult with your urogynecologist or pelvic floor physiotherapist.

Solutions:

1. Gentle stretching exercises and breath work to release hypertonic muscles.
2. You can hum in a lower tone when you exhale: it helps cue the pelvic floor to settle, relax and lengthen
3. Addressing habits that may exacerbate hypertonicity such as tucking your tailbone or holding tension in the pelvic area, excessive Kegels.
4. After working on 1, then you can graduate to rebuilding strength in the pelvic floor and TVA.
5. If necessary, a physical therapist specializing in pelvic health can perform internal manual techniques to release tension in the pelvic floor muscles and they can show you how to use a pelvic wand to self-release pelvic tension.

How does a hypertonic pelvic floor contribute to Recurrent UTIs?

This is due to incomplete bladder emptying. It’s the residual urine in the bladder causes recurrent UTIs. Retained urine in the bladder can lead to infections.

• Stop pushing pee out, relax the muscles for complete bladder emptying. Take an extra 10 seconds to let pee come out naturally without force.
• It’s not normal to pee over 10 times a day. If you are, it’s because you’re probably pushing out your pee, which contribute to incomplete bladder emptying.
• Make a pee diary so you can see how many times a day you pee. Most of us are unaware of our pee habits.
• If you stop pushing out your pee, this will address the issue of waking up multiple times during the night to pee. Rather, relax and fully empty your bladder.