Today marks day five and the final day of the 2019 Women’s Health Week! We hope you’ve learnt something new about your body and have gained some useful tips over the past week. Today our musculoskeletal and Women’s Health Physiotherapist, Dr. Lauren Earles, is talking about overactive (tight) pelvic floor muscles and how this can be managed with Physio.
When we talk about Pelvic Floor muscle dysfunction, most people think of leakage (incontinence) when you cough, sneeze or lift anything due to weakness of the muscles. Did you know the Pelvic Floor muscles can also be overactive (hypertonic)? They can!
The pelvic floor is a complex web of muscle, fascia and fibrous tissue that helps support the pelvic organs. There are 3 layers of pelvic floor muscles and their collective role is to provide support to our pelvic organs (bladder, bowel and uterus in females) so as prolapse does not occur, provide bladder and bowel continence (and allow us to go to the toilet when they relax), as well as provide pleasure during sexual intercourse.
The three layers of the pelvic floor muscles are as follows:
✖️First Layer – Superficial layer consisting of the urogenital triangle and external anal sphincter.
✖️Second Layer – Deep perineal pouch consisting of the deep transverse perineii, external urethral sphincter and perineal membrane.
✖️Third layer- Pelvic Diaphragm consisting of the levator ani and coccygeus.
Weakness or tearing of any of these muscles may cause urinary, faecal or flatal incontinence. Refer to our blog earlier in the week here to learn more about incontinence. A pelvic organ prolapse (where one of the pelvic organs descends) may be related to weak pelvic floor muscles, as well as damage to the pelvic fascia.
Overactive or hypertonic pelvic floor muscles can also occur. This is when the pelvic floor muscles are unable to ‘relax’ and stay in a contracted position. Pelvic floor muscles do need to contract (eg. to keep us continent) but they also need to have the ability to relax. Like any muscle group, the pelvic floor muscles should not be ‘on’ all the time. Overactive pelvic floor muscles can lead to and be associated with pelvic pain, dyspareunia (painful sexual intercourse) and constipation. There are many different causes for overactivity of the pelvic floor and it can be common in people with these conditions:
1️⃣ Pelvic pain (eg. Endometriosis, PCOS, bladder pain syndrome)
2️⃣ Dyspareunia (painful intercourse)
3️⃣ Anxiety and panic disorder
4️⃣ Previous trauma (psychological, physical and sexual abuse)
5️⃣ Chronic constipation
Overactive (hypertonic) Pelvic Floor muscles require specialised assessment and treatment from a Pelvic Health or Women’s Health Physiotherapist. Those not trained adequately in this area may prescribe Pelvic Floor muscle retraining/strengthening exercises, however this will further tighten the already hypertonic muscles and potentially cause more issues such as pain.
Physiotherapy for hypertonic Pelvic Floor muscles can involve the following:
1️⃣ Myofascial release (a massage technique) of the internal and external pelvic floor, hip and leg muscles
2️⃣ Relaxation techniques (eg. Deep breathing, visualisation, mindfulness and meditation)
3️⃣ Stretching (eg. ‘Child’s pose’ and ‘happy baby pose’ in yoga)
4️⃣ Myofascial release with a Pelvic Wand (click here to learn more)
5️⃣ Vaginal dilators
Please note that a thorough and specialised Women’s Health Physiotherapy assessment needs to be performed first before any treatment is prescribed. Internal examination and internal treatment will only be performed if the patient consents and is comfortable to do so. The use of pelvic wands and vaginal dilators must also be prescribed and monitored by a qualified Women’s Health Physiotherapist. The good news is that Physiotherapy for pelvic pain and overactive pelvic floor muscles is very effective and can greatly reduce your symptoms.