Why are my pelvic floor muscles so tight?
It can be hard to pinpoint an exact answer at times, but the main causes of muscle tension are trauma, over activity, or a next door neighbor issue. Trauma encompasses many things like surgery, rape, a difficult delivery, sports accident, etc. Over working of these muscles is a large concern. They are your stabilizers of the spine and hips, so if they are overworking because your abdomen, back and butt muscles are not activating properly, then your pelvic floor has to work even harder to make up the difference and will ultimately result in pelvic floor issues. The final next door neighbor issues also encompasses many possibilities. If things next to the pelvic floor muscles get irritated the muscles will tighten in response. Things like skin issues which affect the vulva (lichen sclerosus, vaginal atrophy, vulvodynia, etc), conditions which affect nearby organs (endometriosis, diverticulitis, hemorrhoids, polycystic ovarian syndrome, etc). There are many conditions and experiences, or combinations thereof even which can drive tension in this area.
What are the symptoms of pelvic floor dysfunction?
Any one of, or a combination of several of the following: urinary incontinence, urinary retention, constipation, fecal incontinence, pain with penetration, pain inserting or removing tampon, speculum, fingers, vibrators, penis, dildo, etc, difficulty achieving or pain with orgasm, lower back, hip, tailbone, or abdominal pain, and maybe the most obvious but still often under-recognized pain with vaginal/vulvar, or testicular/penile pain.
How do you test for pelvic floor dysfunction?
Unfortunately there is no direct test for pelvic floor dysfunction, like a blood test. Typically, it takes a good provider to notice you are reporting the above symptoms, and for them to then observe your pelvic floor for proper range of motion. Palpating them to test for proper bulk, or pain, shortness, or tightness. Putting together patient reporting, combined with what the provider is seeing and feeling, is how you identify pelvic floor dysfunction. Sometimes patients research pelvic floor dysfunction and advocate to be seen themselves after realizing their pattern of symptoms. Many states are direct access, so you might not even need a doctor’s order to get the care you need.
Can pelvic floor dysfunction go away on its own?
Yes and No. If you have been experiencing symptoms for greater than 3 months, the chances of it going away on its own are pretty slim. If you are experiencing these symptoms, don’t wait to get it checked out. I see people so often who tell me “I’ve always had painful pap smears, they just told me that was normal” or “My incontinence started after I had my first child, and now I just had my 4th and I am having to wear depends”. Come in right away so you can minimize or resolve your symptoms as soon as possible. Advocate for yourself and get in to see a PT, please!
How do you fix pelvic floor dysfunction?
I try to avoid the term “fix”, because the bottom line is you are not damaged goods! You simply need some guidance to get yourself back to health. The first thing you need to do is come to a physical therapy evaluation. Evaluations go through your history, focusing on bowel, bladder, sexual, low back and hip function, prolapse concerns, etc and will review your surgical history. Complete with a general movement screening, and if it is deemed appropriate and you consent, an external and internal pelvic floor muscle assessment as well. This will help the therapist deliver a full plan and path to healthy pelvic bliss!
CONDITIONS SOME ARE FACING
The first, and most common, condition that usually comes to people’s minds is urinary incontinence. There are two main types of incontinence. The first occurs if you cough, sneeze, laugh, or lift something heavy though. It can occur in other instances outside of these examples of course. The second type of incontinence that can occur is urinary urge or urge incontinence. This type of incontinence is very sudden. For example, let’s say you are in the back corner of Target, and suddenly, *BAM!* you need to go NOW. I. Have. Been. There. I straight up left my entire cart and headed straight to the restroom in the front of the store, doing the penguin waddle the entire way to keep from leaking everywhere. Many people think these things are normal signs of again and they chalk them up to that, or having kids, or maybe you have always had these issues, even as a kid. These things are definitely common, but that does not mean that this is a normal pelvic floor. These are forms of dysfunction.
The second issue is…drumroll please…POOPING! This is another issue that I encounter frequently on both sides of the spectrum. Either you are having a bowel movement once a week, which my dears, is chronic constipation! Or, you are going constantly and your stool is very loose. Still yet, another common concern for many people is expelling gas when you don’t want to. Friends, if you have to take a bunch of medications to either start or stop your number two, if you are only having a bowel movement every fourth day, or ten times a day, this qualifies as dysfunction.
This third issue is another broad umbrella, covering many different types of prolapse. If you have to physically push something back into your body after being on your feet all day, or in order to complete or have a bowel movement, that is a prolapse. You may actually be able to feel something exiting or protruding from one of your holes, or it may just be a dull, heavy ache that doesn’t seem to go away. If you are struggling with any of these sensations, it may be pelvic dysfunction.
The final dysfunction concern is definitely the one to perk up most people’s ears. It’s time to talk about sexy time! This area of concern is SO INCREDIBLY UNDERREPORTED! And do you know why? You bet I’ll tell you!! Because providers don’t ask, and patients don’t tell. Usually if a patient does say something, it typically isn’t listened to. It’s that simple, and how ridiculous is that?! I’m begging you, if something has changed with your between the sheets time whether solo or partnered, please seek a healthcare provider who will hear your concerns. Really hear them. This issue covers many different types of concerns. It could be that your orgasm just isn’t as strong or as satisfying as it once was, or maybe you have never been able to experience one, or one day it just…vanished. You could be experiencing pain during intercourse, or struggle to get wet. Whatever it is, speak up, tell a provider, and let’s get healing!