Pelvic Floor Tension vs Pelvic Floor Tightness – What’s the Difference?

Throughout many pelvic floor-focused articles and resources, you may have seen terms like “pelvic floor tension” and “pelvic floor tightness.” These broad terms are often used to describe symptoms associated with pelvic floor dysfunction. 

You may also notice “tension” or “tightness” used when describing other terminologies like pelvic floor overactivity, hypertonic pelvic floor muscles, pelvic floor tension myalgia, and myofascial pelvic pain—which, while having slightly different nuance and usage, still all relate to pelvic floor dysfunction.

Many sources (even my blog) use “tension” and “tightness” interchangeably, and for the most part, that’s totally fine.

However, knowing the slight differences between these two terms can be useful for understanding your unique condition and symptoms, factors that may be causing your symptoms, and how certain strategies or treatments can be beneficial.

So, let’s look at the both the differences and similarities between these two terms below:

About pelvic floor tension:

• Often tied to sympathetic nervous system responses to stress and overexertion.
• Usually caused by pain guarding or stress-related factors.
• May fluctuate quickly.
• Can be present without tissue shortening (which prevents flexibility and mobility).
• Treated with breathwork, downtraining (pelvic floor relaxation and control).

As you can see above, pelvic floor tension is often related to stress, overexertion, and things of that nature. This can be attributed to both physical and mental stress, as the body and mind are both affected by stress. 

Experiencing significant stress, having a dysregulated nervous system, or experiencing chronic pain can all contribute to muscle tension. Chronic conditions or injury are often accompanied by pain guarding, which can significantly contribute to pelvic floor tension.

Pain guarding refers to the body’s natural response to pain. For example, when you experience stomach pain, your natural response is to tighten muscles in that area. With chronic pain, you may be unknowingly tightening your muscles very often, which can build tension in the pelvic floor and other areas of the body.

This is especially common with individuals who have chronic pelvic conditions, such as the following:

• Endometriosis
• Pelvic inflammatory disease
• Irritable bowel syndrome
• Inflammatory bowel disease
• Constipation
• Interstitial cystitis
• Prostatitis
• PMOS (PCOS)
• And more

About pelvic floor tightness:

• Refers to restrictions in the muscles or fascia (connective tissue).
• Tissues are shortened, stiff, or unable to stretch.
• Tightness can be a result of heavy lifting or repeated stress.
• Doesn’t typically fluctuate.
• Improves with mobility training and resistance training that is progressively more challenging.

Pelvic floor tightness refers to muscles or fascia that have become short and immobile. When healthy, these tissues are flexible, mobile, and able to stretch. This allows for regular body movements and function.

But for various reasons, muscles can become tightened and short, making them less mobile and in many cases painful.

This pain can be created by the pulling of other nearby structures or the creation of trigger points, which are aching “knots” or tender spots of muscle tissue.

Tissue tightness can be attributed to many things, such as inactivity, overactivity (extreme workouts), weakness, poor form or posture, or repeated physical stress (such as at work, during sports, or with exercise).

Pelvic floor tension and pelvic floor tightness are very similar, and many people cannot tell the difference between the two. They often occur simultaneously, and can actually be a significant cause of one another. This means that pelvic floor tension can lead to tightness, and vice versa.

As described earlier, pelvic floor tension usually refers to muscles that are in a guarded, clenched, or spasmed state. Pelvic floor tightness refers to muscles or tissues that are shortened, stiff, restricted, or inflexible.

Both of these problems can affect urinary, bowel, or sexual functions, and may cause a wide variety of effects. 

Some symptoms that are caused or worsened by tension or tightness include:

• Pelvic pain or pressure
• Muscle spasms
• Trigger points
• Pain with sex
• Erectile dysfunction
• Frequent or painful urination
• Constipation
• Difficult bowel movements
• Pain in the hips, low back, abdominals, or tailbone
• Low mobility or range of motion
• Muscle weakness
• Fatigue
• Symptoms that worsen with stress
• Pain with sitting
• Pain during exercise
• And more

You may be reading this and wondering, “If pelvic floor tension and pelvic floor tightness have such similar symptoms and are used interchangeably, why does it matter to know the differences?”

For starters, understanding what tension and tightness really mean in regards to the pelvic floor is a great first step towards relieving and preventing your symptoms. 

If you experience any of the symptoms described in the previous section, you may need to address a variety of daily behaviors like poor posture, incorrect form during exercise, harmful bathroom habits, and more.

Or, perhaps you need to integrate more strategies for managing a chronic condition, daily stress levels, or your current muscle balance.

Additionally, as mentioned before, not every provider can identify these issues. The unfortunate reality of healthcare is that you often have to advocate for yourself and “shop around” for care. Say you receive treatment for the symptoms above, but you continue to have pain, even after many sessions.

This could be a sign that the root issue of your pain and symptoms are not being properly addressed. I have unfortunately met many individuals who say they previously “failed” physical therapy, when in reality they were just not getting the comprehensive or specialized care they needed.

Therefore, in the next section, we’ll talk about pelvic floor physical therapy treatment.

Pelvic floor physical therapy is just like regular physical therapy, but it focuses on all things related to the pelvis! This area of care looks to address pelvic floor dysfunction, restore tissue health, and support better urinary, bowel, and sexual function. 

Pelvic floor physical therapy is the best form of treatment for things like pelvic floor tension and pelvic floor tightness—read more about it below!

While this blog looks to differentiate tension and tightness to improve your understanding of the two, it can actually be very hard to know which you are currently dealing with and how to solve it.

Luckily, a pelvic floor physical therapist like myself can evaluate your pelvic floor for characteristics like tightness, shortness, tension, incoordination, and other aspects of pelvic floor dysfunction.

By engaging in a thorough evaluation and possibly an examination, we can identify your pelvic floor’s current condition and the root causes of your symptoms.

With these factors identified, I’ll be able to formulate a comprehensive treatment plan that will relieve your pelvic pain, restore your tissue mobility, and educate you on how to better prevent these problems in the future.

My treatment approach looks at the body as a whole. This is because the pelvic floor is closely connected with many other areas, such as your hips, abdominals, and lower back! By taking a more holistic look at your body’s needs, I can provide a more thorough care plan and ensure long-lasting results.

Discover what your own treatment plan could look like by booking an appointment with me!

So, what can physical therapy treatment look like when it comes to pelvic floor tightness or tension? Each and every patient receives a curated plan based on their needs, but you can expect to engage in any of the following:

Correcting Form

Form while lifting matters, whether it’s just everyday items or actual weights in the gym. Incorrect form can put excess stress and strain on your pelvic floor, so we’ll want to make sure this isn’t a potential cause of your symptoms.

Correcting Posture

Similarly to form, having good overall posture matters, too! You’d be surprised just how much the way you stand or sit can affect your pelvis. I’ll be sure to evaluate your posture and correct any harmful habits. 

Exercise Prescription

Sometimes weak muscles can be a significant cause of tension and tightness. I’ll examine your pelvic floor, hips, lower back, and abdominals to identify any imbalances.

Weak muscles or imbalances can cause significant pelvic strain and can even negatively affect your posture, so I’ll be sure to create a thorough exercise plan to improve on these aspects.

Teach Safe Exercise Strategies

It’s important to have proper warm up routines with your exercise, as well as mobility and stretching strategies, too! I’ll help evaluate these areas of your exercise routines and ensure your body is being properly warmed up and cooled down.

Similarly, for those who engage in weight training, you should know how to progress gradually—taking on too much weight too fast can harm your muscles and inhibit your gains. Rest assured that I can teach you strategies for gradual progression during weight training!

Manual Therapy

Manual therapy is a hands-on treatment that looks to reduce tension, relieve trigger points, increase tissue mobility, encourage blood circulation, and more! It’s an incredibly beneficial treatment; especially for those with significant pelvic floor tension.

At Home Care

Understanding how to relieve stress and tension at home is crucial for supporting long-term health. I’ll teach you strategies for managing pain and stress, such as breathing techniques or preventative techniques for pain guarding. 

You can also try this free guide for managing nervous system regulation!

Neuromuscular Re-Education

Neuromuscular re-education refers to treatment that helps you better understand the movements of your pelvic floor and how to control those movements. This can help you significantly to strengthen your muscles and better understand active relaxation. 

There are many more treatments that could be suitable for pelvic floor tightness or tension—book an appointment today and see what your care plan could include.

For appointment-related questions, try a discovery call!