When it comes to tight pelvic floor muscles, the most commonly asked questions are:
- What are the symptoms of tight pelvic floor muscles?
- Are tight pelvic floor muscles painful?
- What causes tight pelvic floor muscles to begin with?
- Can tight pelvic floor muscles cause constipation?
- Are tight pelvic floor muscles and lower back pain related?
- Can tight pelvic floor muscles cause bladder pain?
- Are tight pelvic floor muscles treatable?
- And finally, what to do if pelvic floor muscles are tight?
In order to answer the important questions, we need to understand some basic foundational facts. The pelvic floor is the floor to your pelvis and without a stable pelvis, the floor becomes unstable. Instability does not always lead to weakness but can especially when combined with overly tight muscles to compensate for the instability which btw leads to weakness in itself. Let me explain: If a muscle is overused, it gets tired and when it is underused, it gets weak for not being conditioned. The end result is weakness even though there is an overactivity going on.
Where is the Pelvic Floor?
Your pelvis looks like a table shaped like a bowl with your legs being the legs of the table. The bowl is also attached to the spine so the stability of the spine and the legs directly influences how level the bowl is. There are muscles that line the inside of the bowl and of course, there are muscles that connect the bowl to the legs and to the spine as well as attach different parts of this bowl to each other.
What we tend to forget is that in order to address the issues related to the pelvic floor, we 
cannot just look at the floor by itself; this is one of the biggest mistakes we make when it comes to the treatment of pelvic floor dysfunction which is treating the floor when the ‘housing’ is unstable only leading to a temporary fix of the problem.
Sometimes the legs are shaky so the way the brain manages this condition is by tightening the attachments of the legs to the bowl which means the inner thigh and the muscles directly related to the center of the ‘bowl’ (pelvis) get overactive and tight.
We do not need to have an internal examination of the pelvis to see what is going on. In my practice, for instance, by watching the way you walk and perform certain movements I ask my patients to do, I can clearly see the malfunction.
What Are the Symptoms of a Tight Pelvic Floor?
While some of the symptoms of having a tight pelvic floor are shared by other conditions, it is important to note that a clinical assessment of the pelvic floor includes understanding the related signs and symptoms as well as examination of the individual. So do not look at this list and say just because you are constipated, for instance, you have a tight pelvic floor though chronic constipation can lead to pelvic floor dysfunction which is not always due to tight pelvic floor muscles!!! With that addendum, let’s look at the list:
- Constipation
- Feeling of not emptying the bowels despite defecation
- Straining when emptying the bowels
- Pelvic Pain
- Low Back Pain
- Hip Pain
- Tailbone Pain
- Painful Sex
- Urinary Incontinence (coming in different forms so check my blogs for the list of blogs related to Urinary Incontinence)
- Slow flow of urine
- Painful Urination
- Poor posture which is presented in many different ways
What Causes a Tight Pelvic Floor and Is It Painful?
A tight pelvic floor can be painful depending on the location of the tightness and the compensation of the whole body in response to the tightness. You do need to understand that the tightness is a response to the lack of stability and an attempt to stabilize a structure or structures that are not moving properly as a result of an injury, lifestyle, or limitations that exist. My blog on why pelvic floor dysfunction exists explores the subject in more detail.
Can Tight Pelvic Floor Muscles Cause Constipation?
Yes, BUT not every constipation is caused by tight pelvic floor dysfunction. This question is so prevalent that I wrote a whole blog on pelvic floor dysfunction and constipation that you should take a look at. I also did a video on my youtube channel for you to watch.
Tight Pelvic Floor and Bladder
Imagine the bowl I referred to earlier is full of fruit; what happens if the same amount of fruit is put in this ‘flexible bowl’ that now for whatever reason is tighter? Is it fair to say that all of your internal organs, regardless of their location need to have room to move and not be compressed? Your natural state of posture is balanced and leveled so a shifted forward pelvis for instance puts more pressure, more load, and more compression on the bladder which is in the first row of organs that reside in the pelvis. Tight pelvic floor muscles can cause pain in urination, incontinence-related issues, and malfunctioning of the bladder itself.
Can Tight Pelvic Floor Muscles Cause Lower Back Pain?
Having a tight pelvic floor plays a direct role in the quality of the pelvis and its attachments. In the picture below, you will clearly see the connection of the pelvis to the lower back and how instability, tightness, and weakness of the pelvic floor play a role in the functionality of the lower back and what it does.
Lower back and pelvis
It is the dysfunction created as a result of imbalanced pelvic floor muscles that leads to the function and usability of the lower back and its performance during the activities of daily living. In fact, through postural neurology and functional movement components of my treatment for pelvic floor dysfunction, this very important correlation is addressed and how the effectiveness of the treatment prolongs.
How to a Treat Tight Pelvic Floor?
Treatment of a tight pelvic floor starts by first assessing the extent of its impact on posture and movement. This is attained through a comprehensive examination involving postural neurology, functional movement, and postural assessment. Internal manual examination of the pelvis may or may not be necessary and in most cases, it is NOT the first line of work that needs to be done. We first need to stabilize the house, before assessing the floor.
When it comes to a tight pelvic floor, I work on the external components of this tightness first. That means the:
- Adductors
- External obturator muscles
- Poses
- Iliacus
- Gluteal muscles
- And piriformis muscles
The work includes and is not limited to functional rehab modalities such as Active Release Technique, manual therapy technique, and manipulation of the pelvis itself.
Assessment of the breathing technique comes before applying any functional and developmental exercises in the form of DNS.
Now that the foundation to building the pelvis is in effect, we can go internally to work on some of the internal manual work that may be needed. The use of dilators and devices to help expand the actual soft tissue vaginally may be helpful but not necessary in all cases.
If you suspect to have tight pelvic floor muscles and dysfunction and have received treatment that did not work fully or long enough, contact my office.
Dr. Shakib
