A Pelvic Floor PT’s Guide to Overactive Pelvic Floor Muscles

Where do you carry your stress? Most people would say in their neck, shoulders, and chest. But did you know that you can carry stress in your pelvic floor muscles (PFM) as well?

Carrying stress in your pelvic floor is one of the leading causes of overactive pelvic floor muscles, a condition that occurs when your muscles do not relax or contract when full relaxation is necessary. Other causes of an overactive pelvic floor, include worrying about urine/fecal leakage (incontinence), trying to stay “tight,” scarring, fear of prolapse, abuse and trauma - to name a few. Holding tension in your pelvic floor fatigues the muscles and makes them tight and weak, leading to a host of pelvic floor dysfunctions that can interfere with daily life. 

If you suspect you have overactive pelvic floor muscles, follow this guide to identify the symptoms, familiarize yourself with the source, and learn practices that will help you loosen and relax your pelvic floor muscles. 

Symptoms of overactive pelvic floor muscles:

  • Limited prolonged posture (sitting or standing)
  • Difficulty sleeping
  • Difficulty voiding (pain, hesitation, frequency)
  • Difficulty defecating (pain, constipation)
  • Pain with intercourse, pelvic exams or tampon use
  • Irritation when wearing tight clothing or jeans

Before introducing exercises or practices into your routine to treat your overactive pelvic floor muscles, you must first, familiarize yourself with your PFM. 

How to find your pelvic floor muscles:

Lying on your back, take some deep breaths. Now, take your thoughts to your pelvic floor muscles. The PFM have surface and deep layers. The surface muscles surround the bladder, front and back openings. The deep muscles support the bladder, rectum and front canal. To release your PFM, take an expansive breath and allow your muscles to drop toward your feet, imagine widening your sitting bones, a circle enlarging or moving your tailbone away from the pubic bone. If you are having trouble finding your muscles lying down, sitting on the toilet is a natural time to let your muscles release. The feedback from the toilet seat is helpful. If you’re still unsure about this releasing thing, don’t fret! Contract/squeeze your muscles and focus on the release/relaxation following to be more aware of the differences.

Overactive Pelvic Floor Muscles: Symptoms and Treatment. Every Mother.
Photo c/o OpenStax

Tips to relax and loosen your overactive pelvic floor muscles:

Sleep Hygiene for Overactive Pelvic Floor Muscles:

Healthy sleep assists in healing the body, managing pain, and hormone regulation. Here are some ways to improve sleep quality:

  • Do not eat or drink within 2 hours of bed.
  • Do not smoke, have caffeine, or alcohol within 6 hours of bedtime.
  • Limit computer, video games, TV, and phone use right before bed - blue light has been found to suppress the production of melatonin which interferes with sleep.
  • Keep sleep and wake times as consistent as possible.
  • Keep your bedroom dark, cool and quiet.
  •  Use audio experiences to help you sleep such as sounds, music, and stories – Matthew McConaughey can read to you at night, it’s wonderful!
  • Use your bedroom for sleep and sex only.

Aromatherapy for Overactive Pelvic Floor Muscles:

As you already know, sleep boosts your wellbeing and reduces stress. Aromatherapy oils like Lavender, Roman chamomile, and Bergamot have been shown to improve sleep and further reduce stress, making them a great addition to any sleep and PFM relaxation regimen. To use, try massaging them into your neck and shoulders, adding them to a bath, or using a diffuser. 

Guided Imagery for Overactive Pelvic Floor Muscles:

Guided imagery is a stress management technique that uses storytelling or descriptions to replace negative images and thoughts with positive images and thoughts. For example, replacing painful intercourse with pain-free intercourse. It’s a simple practice that can be used anywhere (from home to the office) that effectively reduces stress in the body. To learn more about guided imagery for relaxation check out this article

Deep Abdominal Breathing for Overactive Pelvic Floor Muscles:

Deep abdominal breathing also known as diaphragmatic breathing reduces muscle tension, relaxes the body, and calms the mind. It is a highly efficient practice to relax your pelvic floor muscles. 

Here is a simple breathing technique:

  1.  Lie on your back with a pillow under your knees or sit straight in a comfortable position with arms and legs uncrossed and supported.
  2. Breathe through your nose comfortably into your abdomen (the area between your chest and your hips). You may place your palms over your belly button to feel it rise and fall with each breath. Pause briefly before you exhale through your mouth.
  3.  Repeat this cycle for 5 minutes and then build to 15 minutes.
  4. You should notice your breathing gradually slowing, your body relaxing, and your mind calming as you practice this breathing technique.
  5. If you feel your chest rise and fall you may be doing shallow chest breathing. Chest breathing is associated with tension.

Progressive Relaxation for Overactive Pelvic Floor Muscles:

Progressive relaxation is a muscle relaxing technique that focuses on contracting and relaxing muscle groups with the goal of controlling stress and anxiety while reducing bodily tension. It is a great practice that can be combined with guided imagery and breathing.

Here is a simple guide:

  1.  Lie on your back with a pillow under your knees or sit straight in a comfortable position with arms and legs uncrossed and supported.
  2. Focus your attention on different parts of your body.
  3. Go through the sequence below three times:
  • Tense and release: tense that body part, hold it for a few moments, then relax
  •  Lightly tense and release: tense that body part with just enough tension to notice, then relax
  • Release only: just pay attention to each muscle group and decide to relax it

    Sequence:

  • Right arm and hand - clench the fist and tighten the muscles in the arm; then the left arm and hand
  • Right leg - tense the leg, lifting the knee slightly; then the left leg
  • Stomach and chest
  • Back muscles- pull the shoulders back slightly
  •  Neck and throat- push the head back slightly into the pillow/surface
  • Face- scrunch up the muscles in your face

Autogenic Retraining for Overactive Pelvic Floor Muscles:

Autogenic retraining is a technique that focuses on physical sensations such as breathing and the heartbeat. It is a form of self-hypnosis that trains the body to respond to commands, giving you control over anxiety and stress. To learn more about autogenic retraining check out this article.  

Stretching for Overactive Pelvic Floor Muscles:

Stretching is a very therapeutic and effective way to relax and release overactive pelvic floor muscles; happy baby pose, child’s pose, hip flexor release, and piriformis stretches are a great place to start. For further guidance connect with a pelvic floor physical therapist.

 Images courtesy of Jordan Mrosewske, featuring Abby Inman, PT, DPT.

Stress Walk for Overactive Pelvic Floor Muscles:

Exercise is proven to boost both physical and mental fitness. The endorphins released in as little as 30 min of aerobic exercise is shown to decrease tension, improve mood, sleep, and more, making it an excellent method to relax overactive pelvic floor muscles. It's as easy as putting on your favorite tunes and rocking out around the block or on the treadmill. 

When it comes to overactive pelvic floor muscles, sometimes the simple awareness of the muscles being tight can help to relax and release the tension. If that proves ineffective, it’s time to introduce practices that help train your brain to manage stress better and carry it differently throughout your body. Stress is hard to avoid, but do your best, check-in with your body daily, and when things feel stressful, be like Taylor Swift and “Shake it Off”!

If you are still experiencing voiding problems (leakage, frequency, urgency), obstructed or painful defecation, pain with intercourse and/or chronic pain, the problem may not be isolated to just your pelvic floor muscles, but the lower abdomen, perineum, anus, tailbone or low back. In this case, please consult your healthcare provider- OB, midwife, and ask for a referral to a pelvic physical therapist.


Overactive Pelvic Floor Muscles: Symptoms and Treatment. Every Mother. Jordan Mrosewske, PT, DPT,

Jordan Mrosewske, PT, DPT, is a pelvic physical therapist at Advocate Aurora Health (AAH), in Milwaukee, WI. She is passionate about empowering and educating her patients to be in control of their well-being; physically, emotionally, mentally and/or spiritually. She is also part of the Pregnancy committee within AAH and specialized in Pelvic Health for the Tgncnb Community. 

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