High-Tone Pelvic Floor Dysfunction: Symptoms, Causes & Relief Tips

What Is High-Tone Pelvic Floor Dysfunction?

When muscles become excessively tense, they are called ‘high-tone’. Tone refers to the level of tension a muscle has at rest. This becomes a pattern of dysfunction or imbalance when tension is chronic, excessive, and the muscles are unable to release it. They can be experienced or described as ‘stuck’ in a contracted state, ‘held’ or ‘clenched’. This excess tension, if left untreated, can affect surrounding tissues and become a source of pain and discomfort. 

What Causes a Chronically Tense Pelvic Floor?

1. Weakness & Imbalance in Surrounding Muscles

So, how does musculature like the pelvic floor become excessively tense, potentially leading to high-tone pelvic floor dysfunction? Excessive, chronic tension can be caused by weakness in surrounding tissues, potential posture or alignment issues, lifestyle choices, nervous system dysregulation from chronic stress or pain and overall overuse of the muscles beyond their capacity to handle what you task them with. 

As stated earlier, the pelvic floor isn’t isolated. It is connected by bones, ligaments and fascia to surrounding muscles and even parts of the body you may think are totally unrelated, like the feet or jaw! If there is weakness or excess tension in surrounding areas, the pelvic floor often responds by gripping to make up for other muscles’ inability to share in the work. This is especially true if the core, glutes and hip flexors are overly tense and /or weak. The pelvic floor can end up bearing the brunt, leading to strain, clenching and high-tone pelvic floor dysfunction.

2. Posture & Alignment Issues

This imbalance of strength and functioning in the pelvic floor and surrounding tissues tends to go hand in hand with posture or alignment issues and lifestyle choices. Your body is incredible in its ability to adapt. It follows your lead and will adjust itself to meet the demands you ask of it most often. A largely sedentary lifestyle, for instance, leads to a weak core, glutes and hip flexors because those muscles aren’t being tasked adequately. The act of constant sitting can also cause the tailbone to become excessively tucked under, effectively shortening the length of the pelvic floor, contributing to contracted musculature. Therefore, exercises that help to strengthen and lengthen these areas can go a long way towards helping the pelvic floor re-pattern itself out of dysfunction. We will get into some examples of these exercises for high-tone pelvic floor dysfunction later on in this article.

3. Overuse & Guarding Patterns

A pattern of holding in urination or bowel movements, or tensing the pelvic floor to try and mitigate the feeling of tissue ‘falling down’ that can come with pelvic organ prolapse, are other ways the pelvic floor can become excessively tense. This is an example of overuse of the muscles beyond their capacity to handle load. 

4. Nervous-System Dysregulation & Stress Response

Perhaps one of the biggest contributing factors to dysfunction from hyper-tonic pelvic floor is chronic stress, chronic pain, trauma and injury. Chronic stress and pain are largely driven by the state of your nervous system. If you are hypervigilant to potential external dangers or are chronically stressed and in fight, flight or freeze, your soft tissues, especially the pelvic floor, tighten to brace against the perceived stressor or to be able to react or flee at a moment’s notice. This is a basic survival instinct. This ‘bracing’ and tightening is also often a response to chronic pain and discomfort associated with other conditions, such as endometriosis or PMDD (Premenstrual Dysphoric Disorder). Scar tissue from tearing during birth or abdominal surgery, such as a C-section, can also affect the pelvic floor, creating tension and even tightening as a protective response. (2)

Symptoms of Pelvic Floor Dysfunction

Now, let’s get into what you may experience as high-tone pelvic floor dysfunction symptoms and what to watch for:

• Chronic pelvic pain or sense of fullness
• Pins and needles or loss of sensation in the groin / penis / vulva
• Painful intercourse or pain after orgasm
• Lower back, hip and lower abdominal discomfort or tension
• Constipation
• Incomplete emptying of the bladder/bowels
• Delayed or slow urine stream
• Painful (burning) urination
• Vaginismus
• Urinary urgency / frequency
• Tailbone pain
• Urinary stress incontinence (when jumping, sneezing, etc)
• Pain while sitting or standing for extended periods of time (2)

Say you experience one or more of these symptoms, now what? Luckily, there are many tools you can use – both at home and with a professional – to help you find relief. 

High-Tone Pelvic Floor Dysfunction Treatments: Finding Relief

Before getting into what you can do to help mitigate discomfort, let’s first talk about one of the most widely prescribed pelvic floor exercises: Kegels. 

Kegels are an exercise intended to strengthen the pelvic floor by contracting the muscles of the vaginal canal or perineal area. When it comes to high-tone pelvic floor dysfunction, however, Kegels can often make symptoms worse. This is because, with a hypertonic pelvic floor, the muscles are already in a contracted state. Instead of adding excess tone through contractions, we need to focus on exercises and treatments that allow the pelvic floor to lengthen and release while we work to strengthen surrounding muscles and prioritize proper pelvic alignment. 

Professional Interventions:

It can be really helpful to begin treatment with a professional who can get you started in the right direction. Some examples of professional interventions include a pelvic floor physical therapist, a massage or myofascial release practitioner, a licensed acupuncturist, biofeedback therapy, the RYC® Program, or working with a certified RYC® Teacher.

A pelvic floor physical therapist can help diagnose high-tone pelvic floor dysfunction so you can be sure that is what you are dealing with regarding your symptoms. They are trained to use internal and external methods to do so. They can then offer you specific exercises based on their findings. 

A massage or myofascial release practitioner can use manual manipulation of the soft tissue of your abdomen, hips, glutes, pubic area, thighs and hip flexors to help release excess tension and give your nervous system a chance to unwind from chronic pain or stress. Massage and myofascial release also promote circulation and hydration of the soft tissue, which can go a long way towards healing. Acupuncture works similarly to enhance circulation and provide nervous system relief. 

Biofeedback therapy is a modality that can help you consciously control and influence involuntary bodily responses, which can be super helpful if your pelvic floor feels unable to release. Biofeedback can help regulate your stress response and alleviate pain. During a biofeedback session, sensors are attached to your body to detect changes which you can then learn to self-regulate with the help of a trained professional. (4)

The  RYC® 12-Week Program is another excellent resource. Developed by a movement and somatic professional with decades of experience in treating core and pelvic floor dysfunction. It is a rehab program and combines whole body mobility and strength-building exercises that help you to build greater awareness of your pelvic floor–all while nourishing your nervous system.

At Home Strategies For Relief:

Aside from and in conjunction with professional treatments and interventions, the best way to manage and find relief from symptoms is to practice regularly at home. Again, your body adapts to the demands you task it with most often. The more you practice with tools, techniques and exercises at home that help you release tension, manage stress and prioritize strength and alignment without overtaxing the pelvic floor, the more you can find lasting relief and alleviate symptoms. Creating a daily pelvic floor wellness routine for yourself can be a great way to begin to create a lifestyle that prioritizes your nervous system, mental and pelvic health. 

In this section, we will outline some exercises and techniques that can help you with high-tone pelvic floor dysfunction.

Let’s Start With Your Breath

The depth and quality of your breath impact your heart rate and state of your nervous system. This is why using your breath to release tension and manage stress is an excellent place to start. 

Exercise:

• Lie on your back, legs on the floor with the bottoms of your feet touching, legs in butterfly pose. Support your legs with blocks or pillows under your knees as needed to make this exercise restorative. 
• Take a few deep belly breaths while you bring your attention to your pelvic floor. 
• As you inhale, see if you can feel your pelvic floor lengthen, extending away from your pubic bone. 
• As you exhale, see if you can feel your pelvic floor retract slightly, lifting back up into your pelvic bowl. 
• This movement of your pelvic floor will most likely feel subtle and is not meant to be consciously engaged through actively bearing down or contracting the muscles.

In addition to the above exercise: now, after you have focused on just breathing deeply and slowly and feeling into your pelvic floor, slowly and gently close your knees together and open them, bringing them back down to the blocks/pillows that were supporting them. Move very slowly while breathing deeply. This move can help release the inner thigh muscles and their attachments to your pelvic floor, thus promoting tension relief.

The slower you move and breathe, the more your nervous system is given a chance to wind down, which ultimately helps your muscles release in tandem.

Release and relaxation take practice. Just as it most likely took a long time for your pelvic floor to become so tense that it presents patterns of dysfunction, it can take time to repattern and release.

Postural and Alignment Considerations

Your overall alignment and posture are important aspects to consider when treating high-tone pelvic floor dysfunction. As stated earlier, as an example, a sedentary lifestyle can cause the tailbone to become chronically tucked under, shortening the pelvic floor muscles, which can exacerbate excess tension. Even when standing or doing other activities, the tailbone can stay in this tucked under position, leading to postural imbalances up the chain of your spine.

Tips for sitting: When sitting, try to maintain the natural curve of your lumbar spine and sit more on your sit bones (the bones directly beneath your bum). This allows the tailbone to keep from being excessively tucked under by maintaining a neutral position of the pelvis. 

Tips for standing: When standing, try not to lock your knees – this can create a forward thrust of your pelvis, which doesn’t allow for full engagement of stabilizing muscles like the glutes and core. Keep a slight bend in your knees and bring your awareness to your tailbone. Imagine a string dangling from your tailbone, and move your pelvis forward and backward until it feels as if the string is dangling in a straight line down towards the floor. This can help you ‘recalibrate’ your pelvis to a neutral position. 

When the pelvis is in a ‘neutral’ position – i.e the tailbone isn’t overly tucked or untucked – your muscles, including your pelvic floor, are able to be at the ready and engage reflexively as needed, which equates to those muscles being neither overtaxed and tense nor overly slack.