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Hypertonic Pelvic Floor: Symptoms, Causes and Treatment

As women's health physiotherapists, we are frequently educating women about pelvic health. Many women suffer from weak pelvic floor muscles and, as a result, experience a wide range of symptoms that indicate urinary or gynaecological problems. Some of these include pain, bladder or bowel issues and even sexual dysfunction. 

For those women, treatment plans will include exercises to strengthen the pelvic muscles to give their internal organs the support they need. 

But did you know that the opposite problem can also cause difficulty with pelvic floor dysfunction?

A hypertonic pelvic floor happens when the pelvic muscles tone is increased. 


 In this article, we'll identify the symptoms of an overactive pelvic floor and discuss causes and treatment.

Find out treatment for hypertonic pelvic floor dysfunction and how it's different from weak pelvic floor muscles.

What is Hypertonic Pelvic Floor Dysfunction?

Simply put, hypertonic means excessive tone. So, hypertonic pelvic floor muscles are overly tense. Like other muscles in the body, they can be in spasm or very tight, in a constant state of contraction. When they are working this way, they can't relax. 

Also known as overactive pelvic floor, this problem is not rare. It's a condition affecting women, men and transgender people alike. Due to differences in anatomy, however, the symptoms may be vastly different from person to person. What's more, the evidence pointing to a diagnosis may not always be clearcut.  

The symptoms are easily mistaken for other conditions, so it's thought that it frequently goes undiagnosed. Pelvic floor dysfunction, in general, is very common, so it's likely that hypertonic muscles in this area are also fairly widespread. 

What Does a Hypertonic Pelvic Floor Feel Like?

Women who are experiencing gynaecological problems due to lax muscles are treated every day by doctors, physical therapists and other healthcare providers. The symptoms are very clear and recognisable, so treatment is quick to be delivered.

Trigger Points

In contrast to weakness, a nonrelaxing pelvic floor can often present with many non-specific symptoms. They can even seem unrelated. 

For example, when the muscles are clenched for an extended period, they can develop knots that are particularly painful. These areas are called trigger points, and they're very sensitive. Pressure on these points can actually refer pain to muscles elsewhere in the body.


It could be difficult to diagnose pelvic floor dysfunction from discomfort that's manifesting somewhere else in the body, seemingly unrelated.


Pain is one of the primary hypertonic pelvic floor symptoms. It most commonly affects the pelvic bones, vagina, bladder and anus. But because of the trigger points, it can be felt anywhere in the pelvis as well as the thighs, groin, lower back, buttocks or abdomen. It can even cause menstrual cramping.

If you're suffering from pelvic pain, it could be a symptom of overactive pelvic floor muscles.

Other problems you might experience if you suffer from overactive muscles are:

  • General pain or pressure
  • Vaginismus
  • Pain when you have bowel movements or urinate
  • Bladder urgency
  • Frequent urination
  • Problems with starting or maintaining a urine stream
  • Constipation
  • A feeling that you haven't completely emptied
  • Urinary incontinence 
  • Painful sex
  • Inability to achieve orgasm (or erectile problems in men)

If you're familiar with some of our other articles, you will know that these problems can be related to many different types of dysfunction, including weak muscles! So, it's easy to see how an overly tight pelvis can easily be misdiagnosed. 

Is Hypertonic Pelvic Floor Curable?

Many people find it uncomfortable to discuss the intimate details of their gynaecological problems, even with healthcare providers or clinic staff. But it's important to seek treatment because the issues caused by this complaint are very unlikely to go away on their own.  


In most cases, overactive pelvic floor muscles can be fixed with the proper treatment. Resolving the muscle problems will, in turn, resolve the symptoms.


How Hypertonic Pelvic Floor is Diagnosed

When you seek help for this condition, you will need to give a full medical history and be prepared to speak openly about your toileting habits, sexual history and details of your symptoms. These details will help your healthcare provider make an accurate diagnosis. 

You will also be given a physical examination that will involve an internal vaginal inspection to determine how your pelvic floor muscles are functioning. You might also have a rectal exam to see how the muscles of your anus are working.

Following the initial investigation, you may be referred for further tests. 

Your doctor or women's physiotherapist will then provide you with a plan to return your pelvic floor to normal tone and eliminate the symptoms. 

The truth about whether overdoing your kegel pelvic floor exercises can cause overactive or hypertonic pelvic floor dysfunction.

Causes of Overactive Pelvic Floor Muscles

Because the muscles affected by this condition are internal, it's likely you've never given them much thought—especially when you're young. Until you start to have issues that affect your day-to-day life, you take it for granted that this part of your body will just continue to operate in a healthy way and that the muscles will go on to support the organs as they should.

So, what makes a pelvic floor hypertonic?

You might think you're doing everything right. For example, you could be doing your pelvic floor exercises regularly. But don't be fooled; kegels might still the cornerstone of good pelvic health, but they won't prevent you from developing excessive tightness in this area. And they certainly won't be a cure for a hypertonicity.


In fact, as the function of pelvic floor exercises is to tighten the muscles, they are probably making your hypertonic pelvic floor worse.


Why Hypertonic Pelvic Floor Occurs

There is no one reason you might develop this condition, but there are several causes that can make these muscles unable to relax appropriately, including: 

  • Excessive exercise (including kegels)
  • Frequently holding the bladder and/or bowel for long periods of time
  • Prolonged fear, stress or anxiety 
  • Abuse or other trauma
  • Birth trauma, with or without scar tissue
  • Other health conditions affecting the pelvis and/or abdomen, including surgery

Can Overdoing Kegels Cause Hypertonic Muscles?

As a matter of fact, yes, you can overdo your pelvic floor exercises. When you're not actively tensing the muscles in other parts of your body, they rest and recuperate. However, the pelvic floor is different. Those muscles are always working to support the internal organs and posture, so when you're not deliberately contracting them, they're still working of their own accord. 

Therefore, if you over-extend the pelvic muscles through too much exercise, they can become over-strengthened and tight. 

If you're not sure whether your pelvic floor exercises are helping you, a consultation with a women's health physiotherapist will be able to put your mind at ease.

Is it Possible to Have Both a Weak and Tight Pelvic Floor?

It might sound like these are contradictory conditions. But it actually is possible to have overly tight pelvic muscles that are also weak through being over-stretched (for example through childbirth or during menopause). So even though you have an overactive pelvic floor, you can still suffer from prolapse or other complications of weakness. 

In these cases, your women's health physiotherapist will treat the tightness and pain from trigger points first before recommending appropriate strengthening therapy. 


For more information about, managing your pelvic floor health, call Magdalena on 07877 017 936 or drop PelviCare an email. Alternatively, you can book an appointment online.

PelviCare Women's Health Physiotherapy is located in Greenwich, London, serving women across South London, East London, Essex, Kent and beyond.  

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