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We often think of pelvic floor dysfunction as involving a weak, lax muscle, and that the answer will be 'more Kegels'. Women's Health Physiotherapist Taryn Watson explains exactly what an overactive pelvic floor is, and why management of pelvic floor dysfunction should differ if 'overactivity' is found in an assessment.

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    What is an overactive pelvic floor?

    Have you come across this concept of an 'overactive pelvic floor'?

    If you haven't, let me explain. An overactive pelvic floor could also be referred to as a ‘tense pelvic floor’ or a ‘tight pelvic floor’, and doesn't move through its full range of movement.

    You may think that tighter would be better in the case of the muscles of the vagina… but it can definitely become too tight and cause troublesome symptoms.

    Picture the same scenario but with the muscles at the top of your shoulders - it would be like these muscles being 'on' and holding your shoulders up near your ears all day. These tense neck muscles could lead to neck pain, shoulder pain, and/or tension headaches, and if you needed to use these muscles for daily tasks they would inevitably be weak due to tiredness and lack of range of movement.

    In the same way, chronically tense pelvic floor muscles can end up referring pain elsewhere, to areas including the lower tummy, the groin, the lower back, the hips and the tailbone. It can also cause pain in the vagina and vulva - It's not uncommon to experience what's called 'vulvodynia' (a pain in the vulva that is often described as 'burny') when the pelvic floor is chronically tense.

    And because of the nature of where these muscles are, being able to relax them is an important aspect of being able to easily empty your bladder and bowels, use tampons, and have penetrative intercourse. Overactive pelvic floor muscles can sometimes cause pain with sex, or even an inability to have sex at all (this is called 'vaginismus', when the pelvic floor muscles tense up against penetration).

    Is an overactive pelvic floor a strong pelvic floor?

    Overactive muscles are generally not strong. They can become 'weak', but not in the weak, lax way you may think - more so in the exhausted, inflexible kind of way.

    A pelvic floor that is 'on' all day, will not necessarily be able to function well against increased abdominal pressure like coughing or jumping. Stress urinary incontinence sometimes can occur because of an overactive pelvic floor.

    The importance of a pelvic floor assessment before exercise prescription?

    This highlights the importance of undergoing a pelvic floor assessment with a Women’s Health Physiotherapist before you commence any pelvic floor training - ideally with a vaginal examination if you're comfortable with this. Because guess what? A large proportion of women do have a tendency towards overactivity, and if they start doing pelvic floor exercises given to them on a brochure (10 quick contractions, 10 x 10 second contractions, 3 x per day) - well, they are very likely to just get MORE overactive.

    Want to know more?

    Want to know more? 

    Here’s a blog about why someone might end up with an overactive pelvic floor.

    Book an appointment with a Women's Health Physiotherapist at FitRight HQ to find out whether you have an overactive pelvic floor.

    FitRight

    Perth’s Leading Centre for Women’s Health and Exercise

    Physiotherapy, GP services and physio-led exercise classes specifically for women

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