How to Differentiate Exercise for an Underactive vs. Overactive Pelvic Floor

Did you know that pelvic floor muscle dysfunction could be a result of either an underactive pelvic floor, or an overactive pelvic floor?

The treatment for your specific pelvic muscle issue will differ depending on the exact reason behind it. This is why it’s always important to see a pelvic floor physiotherapist first, to ensure you’re approaching treatment the right way.

Take kegel exercises, for example. A kegel exercise is a common therapy for pelvic floor issues and can do wonders to help an underactive pelvic floor. However, if you have overactive muscles, this exercise can actually make things much worse! Instead of helping, it will keep the muscles tense and can make symptoms like bladder leakage get worse.

To help you avoid scenarios like this one, we’re going to walk you through the difference between having an underactive pelvic floor and an overactive pelvic floor. With this knowledge in mind, you can better understand what may be affecting your pelvic floor, and the types of treatments needed for your specific pelvic floor muscle issue.

What Are the Pelvic Floor Muscles?

A person’s pelvic floor muscle(s) refers to the muscles located in the pelvis, between the sacrum and the pubic bone. These muscles work to hold and lift your internal pelvic organs in place, which include the bowel, bladder, and uterus.

What Issues Affect Pelvic Floor Muscles?

As the pelvic floor muscles work to keep a lot of essential internal organs in place, issues that affect this muscle can have a big impact on the body.

The most important bodily function your pelvic floor muscles assist you with is your ability to control the release of faeces, flatulence, and urine. The most common condition a person with a pelvic floor problem will face are issues controlling their urination (urinary leakage), bowel movement, or flatulence processes. Issues with the pelvic floor muscles can also lead to overall pelvic pain and/or genital pain, and even conditions like pelvic organ prolapse.

The exact issues a patient will face will differ depending on their diagnosis, and whether they have a weak pelvic floor or a tight pelvic floor. A lot of this comes down to whether the cause of their issue is an overactive, or underactive pelvic floor.

Overactive Pelvic Floor vs Underactive Pelvic Floor

What exactly are these two pelvic floor muscle issues, how can we differentiate them, and how are they treated?

Overactive Pelvic Floor Muscles

Overactive pelvic floor muscles, also referred to as hypertonic pelvic floor muscles, happen when the pelvic floor muscles are unable to relax. With the muscles constantly working, this leads to chronically tight pelvic floor muscles, which can lead to muscle spasm, muscle tension, and pelvic muscle pain.

If left untreated, an overactive pelvic floor muscle can lead to different issues, including chronic pelvic pain, pain during sex, and struggles with emptying the bladder or bowels.

What are the Symptoms of Overactive Floor Muscles

The main symptoms of this issue, for both men and women, include:

  • Inability to control the pelvic floor muscles
  • Pelvic pain (urethra, vagina, penis/testicles, rectum, lower abdomen)
  • Slow urination/inability to complete urination
  • Pain when emptying the bowels
  • Stress urinary leakage
  • Erectile dysfunction
  • Premature ejaculation
What Causes Overactive Pelvic Floor Muscles?

A number of factors can lead to someone developing overactive pelvic floor muscles. These include:

  • Injury to the muscles or area (ex/ tailbone injury, sexual abuse, hip injury)
  • Infection or inflammation in the pelvic area (ex/ urinary tract infection, thrush)
  • Stress/tension
  • Bladder and/or bowel dysfunction
  • Pelvic surgery complications
  • Hypermobility issues in the hip/pelvis
How Is It Treated?

How do we go about treating this issue? One might assume you need to weaken the muscle, but that’s not actually the case. Pelvic Physio, Rhyannon Spring, explains:

“Overactive pelvic floor muscles might sound strong, but in fact, they are also weak, because they are contracting all the time.”

To address the pelvic floor overactivity issue, a physiotherapist can work with a patient to find ways to get the body to release that tension. In many cases, incorporating breathwork can help to get the muscles to achieve pelvic floor muscle relaxation and go back to a better state.

One way Sydney Pelvic Clinic works to address these issues is with physio-led Pelvic Floor Release workshops. These sessions can be wonderful in helping to reduce pelvic tension, focusing on deep breathing into the belly to help women let go of these tight muscles. Click here to learn more.

Underactive Pelvic Floor Muscles

A person with underactive pelvic floor muscles is a person whose pelvic floor muscles are having issues contracting when patients need it. With an inability to control the pelvic floor muscle, patients will deal with issues such as urinary incontinence, and in the worst case, pelvic organ prolapse.

What are the Symptoms of Underactive Floor Muscles?

As we touched on above, common symptoms of this kind of pelvic floor dysfunction include:

  • Issues with faecal and/or urinary incontinence (inability to control bladder/bowels)
  • Pelvic organ prolapse
  • Anal prolapse
  • Increased urinary urgency
  • Pain in the pelvic region
  • Reduced sensation during sexual intercourse
What Causes Underactive Pelvic Floor Muscles?

The cause behind a person’s underactive pelvic floor muscles can vary, but some causes include:

  • Damage to the pelvic floor during childbirth (stretching/tearing of the pelvic muscles)
  • Complications from pelvic surgery/abdominal surgery
  • Aging
  • Obesity
  • Neurological conditions (MS, Parkinson’s, stroke, brain injury, spinal cord issues, etc.)
How Is It Treated?

To treat this kind of pelvic floor dysfunction, we first start by building strength in the muscle.

“If your pelvic floor muscles are underactive, they have trouble contracting fully and/or holding a contraction.” Explains pelvic physio Rhyannon Spring. “We prescribe exercises to practise contracting and releasing the pelvic floor…”

Exercises that engage and build strength in the pelvic floor are the most common form of treatment. At Sydney Pelvic Clinic, we have treatments like the Emsella Chair that can do wonders to improve weak pelvic floor muscles. Other help includes pelvic floor exercise classes, held at SPC, to improve strength.

Getting Help From Sydney Pelvic Clinic

If you need to address pelvic floor health, look no further than us! With custom treatment plans and classes tailored to improving pelvic health, we have the tools you need to get your pelvic health back on track.

Click here to get a consultation today, and learn more about how we can help you address pelvic floor dysfunction.

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Chronic Pelvic Pain, Female Pelvic Health, Pelvic Health, Pelvic Pain, Pelvic physio, Sexual Dysfunction

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