Restore Your Core Understanding Tight Pelvic Floor Symptoms in People with Female Anatomy: A Comprehensive Guide

Understanding Tight Pelvic Floor Symptoms in People with Female Anatomy: A Comprehensive Guide

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Understanding Tight Pelvic Floor Symptoms in People with Female Anatomy: A Comprehensive Guide

By Lauren Ohayon 03/25/2024

4 Min Read

If you have a pelvis, you have a pelvic floor. But if you were born with a uterus, you might have some very specific pelvic floor concerns, including a tight pelvic floor. Tight pelvic floor symptoms look different in people assigned female at birth than in people assigned male at birth, and we’re going to break it down for you: diagnosis, treatment, and management. Your pelvic floor does not need to be a mystery.

Why is a tight pelvic floor a problem?

Your pelvic floor is an essential part of your body. The pelvic floor is a group of muscles, ligaments, and connective tissues located at the bottom of the pelvis. This group of tissues supports the pelvic organs, such as the bladder, uterus, and rectum, and is responsible for facilitating all the functions of those organs. When the pelvic floor is not functional, a number of symptoms can arise, from constipation to an inability to achieve orgasm.

Pelvic floor dysfunction is incredibly common, with up to one in 10 people reporting symptoms of a tight pelvic floor. Because the symptoms of a tight pelvic floor can resemble and influence other conditions, diagnosis can be difficult. But it doesn’t need to be. Knowing your pelvic floor is a powerful tool for getting the help you need.

tight pelvic floor symptoms

Understanding the Pelvic Floor in Females

Language note: We want to be clear that people assigned female at birth are not all women, and do not all identify with the term “female” as a descriptor. Sadly, search engines and academic papers have not quite caught up with our broader cultural understanding of the difference between anatomy and gender, so you may see this term used in this article from time to time. 

When we are talking about tight pelvic floor muscles symptoms for people with female anatomy, what we’re really talking about is a range of concerns that arise from the pelvic floor muscles being under constant tension:

  • Leaking urine, especially under higher load, such as sneezing, jumping, or running (stress incontinence)
  • Urge incontinence–the sudden urge to urinate usually resulting in leakage
  • Painful intercourse, including difficulty with penetration or difficulty with orgasm
  • Constipation and straining to eliminate
  • Low back pain and hip pain.

Tight pelvic floor muscles can also make engaging the rest of the core muscles more difficult, leading to unnecessary strain on other muscles, compensation patterns that cause pain elsewhere in the body, and more. We’ll break all of these down further in a moment, but what’s important to know right now is that you don’t have just to endure these conditions silently. 

If you have or had a uterus, you have probably had at least one experience of someone telling you that your periods can’t be all that painful. If you’ve had the experience of peeing when you sneeze, you’ve probably also had someone tell you, “Oh, that’s normal.” If you find penetrative sex uncomfortable or unpleasant, you may have been advised to “just relax and use more lube” (ok, we have to admit that more lube is never a bad idea!).

But all of these things can also be symptoms of a too-tight pelvic floor. But because the medical concerns of vagina-havers–particularly when it comes to pain–have historically been dismissed and downplayed even by medical professionals, understanding the difference between a common problem and optimal pelvic floor function is important. And understanding what is normal for your body as opposed to anyone else’s body is important, too. 

With me so far? Here’s a quick test you can do to see whether your pelvic floor muscles are too tight. Let’s get to know your pelvic floor.

Understanding Tight Pelvic Floor Muscles

If your symptoms correspond to having a tight pelvic floor, and you want to look at a picture of what’s going on in your pelvic floor, read on.

Anatomy and function of the pelvic floor

Let’s take a moment to look at the structures involved:

pelvic floor

As you can see, the pelvic floor is connected to the rest of the body via the structure of the pelvis and the muscles of the core and legs. It’s not a separate entity. The pelvic floor muscles are a group of muscles arranged in layers that span the bottom of the pelvis. These muscles form a supportive sling-like structure that runs from the pubic bone in the front to the coccyx (tailbone) in the back and laterally to the sit bones (ischial tuberosities). Ligaments help anchor the pelvic organs in their proper positions and maintain pelvic floor integrity. Connective tissues such as fascia and supportive membranes surround and separate the pelvic floor muscles, providing structural support and helping to distribute forces evenly throughout the pelvis. 

A too-tight pelvic floor is just as problematic as any other muscle group in the body would be if it were under excessive tension all the time. Imagine holding one arm in a biceps curl all the time. First, you’d feel strong. Then the arm would start to shake. After that, you would have a hard time relaxing it to straighten your arm. Then you’d struggle to use that arm at all. Your pelvic floor is not a biceps–it’s even more important. It’s the base of your core muscle group. It is strong, yet supple, able to facilitate carrying a fetus and giving birth, or providing intense pleasure, or just steadily helping your body move through life with ease. 

A tight pelvic floor makes all of those things difficult. Tight pelvic floor muscles are constantly under tension, and that constant tension makes them weak. And the solution to tight, weak muscles is a balance of rest, relaxation, and exercise.

What causes tight pelvic floor muscles?

There are several factors that can play a role in developing tight pelvic floor muscles in all bodies: movement habits, trauma, and stress can all be part of the equation.

How you stand and move throughout the day can affect the resting amount of tension in the pelvic floor. For example, if you find yourself sitting on your tailbone instead of your sit bones (ischial tuberosities), you might find that your pelvic floor muscles spend most of their time in a shortened position, which means they’re under a little bit of tension all the time.

Stress and trauma can also play a role in pelvic floor tension: you might notice that you’ve got a bunch of jaw tension, but that tension also travels right down to your pelvic floor. Think about how you feel when you’re angry or nervous: everything tightens up, and your whole body gets tense. When you are able to relax, that tension eases. But if you’re under chronic stress, your body may never fully relax. In that case, addressing the source of stress may be part of your healing process.

Similarly, trauma shows up in your body in many ways, sometimes including a tight pelvic floor. For people with female anatomy in particular, sexual or birth-related trauma can linger in the body as tight pelvic floor muscles. A combination of mental health support and physical therapy is often the best way to resolve tight pelvic floor muscles related to trauma.

Symptoms of a Tight Pelvic Floor in People with Female Anatomy

The symptoms of a tight pelvic floor in people born with uteruses are many, and some may overlap with other conditions such as pelvic organ prolapse.

  • Chronic pelvic pain: persistent pain in the lower abdominal area, lasting for at least six months. This pain may be dull, achy, sharp, or crampy and can vary in intensity. It may be localized to the pelvis or radiate to the lower back, butt, or thighs. Chronic pelvic pain can significantly affect your quality of life–in addition to ongoing discomfort, fatigue, difficulty sleeping, and emotional distress can occur. Tight pelvic floor muscles are not the only cause of pelvic pain–endometriosis and other conditions need to be ruled out as well.
  • Pain during sexual activity (dyspareunia): Pain during intercourse can range from mild to severe and may occur at the vaginal opening, deep within the pelvis, or both. Difficulty achieving orgasm and pain after orgasm are also symptoms. Other factors to rule out are insufficient lubrication, vaginal infections, scar tissue from previous surgeries or trauma, hormonal imbalances, or psychological factors like stress or anxiety.
  • Urinary issues: urinary urgency, frequency, hesitancy, incomplete emptying, or leakage (urinary incontinence). These issues may look like a constant urge to urinate, frequent trips to the bathroom, difficulty starting or stopping urination, or leaking during activities such as coughing, sneezing, or exercising.
  • Bowel dysfunction: Bowel issues stemming from tight pelvic floor muscles may include constipation, straining during bowel movements, incomplete emptying, fecal incontinence, or a feeling of blockage or obstruction in the rectum. 
  • Lower back pain: The pelvic floor muscles are interconnected with the muscles of the lower back and abdomen, and dysfunction in one area can affect the other.
  • Increased muscle tension: This tension can contribute to a cycle of pain and dysfunction, as tense muscles may become more sensitive and prone to further tightening in response to discomfort or stress. 
  • Pelvic organ prolapse: One or more pelvic organs, such as the uterus, bladder, or rectum, descend or bulge into the vaginal space due to weakened or stretched pelvic floor muscles and ligaments. Symptoms of pelvic organ prolapse can vary depending on the type and severity of the prolapse. Still, they may include a feeling of pressure or fullness in the pelvis, a visible or palpable bulge in the vaginal area, discomfort or pain during intercourse, urinary or bowel dysfunction, and lower back pain. The intensity of symptoms may get worse with prolonged sitting, standing, lifting heavy objects, or straining during bowel movements. Tight pelvic floor muscles and pelvic organ prolapse can be distinguished from one another via palpation–an organ out of place will feel out of place during a physical exam.

It is important to note that many of these symptoms may also be indicative of issues that are not strictly pelvic floor muscle issues, such as IBD or fibroids. It’s a good idea to make sure that you’ve ruled out any other possibilities by checking in with your doctor and any other specialists they refer you to.

Diagnosing Tight Pelvic Floor Muscles

Once other possible diagnoses have been eliminated, the next stop is a pelvic health-focused physical therapist or occupational therapist. Pelvic health is not traditionally covered in great detail during a PT degree, so look for practitioners who have specialized in pelvic health as post-graduates. An appointment with a PT or OT will include an assessment of how your body is moving in multiple positions, and may include internal palpation to determine whether there are specific trigger points that are tender, or whether specific muscles seem to be more tight than others. Your practitioner should talk you through every assessment, and you should feel comfortable asking them questions about what they find. 

You’ll get homework related to your specific concerns; doing the homework is crucial to finding relief from your symptoms. Many members of our Restore Your Core® community find using RYC® is a great way to reinforce what they’re doing in physical therapy. Restore Your Core®  is my 12-week program dedicated to core / pelvic floor recovery. Find out more here.

For many people with milder symptoms of tight pelvic floor muscles, consulting with a PT is not always necessary. In that case, you might consider working with a movement teacher who specializes in pelvic floor health or trying an at-home program like Restore Your Core®. The assessment process is usually similar, but movement teachers are going to focus specifically on what’s visible as you’re moving, your movement habits, and helping you learn new patterns.

tight pelvic floor muscles relax

Easy Ways to Begin Relieving the Symptoms of Tight Pelvic Floor Muscles

It’s completely possible to never do anything about your tight pelvic floor muscles. For many people, the consequences are relatively minor–we’ve been trained to tolerate a great deal of discomfort. But it’s not necessary to be uncomfortable. And it’s not necessary to be uncomfortable to want to have a more functional core and pelvic floor. You might just want to have a better sex life! 

Here are five easy ways to start letting your tight pelvic floor muscles relax:

  1. Attend to your mental health. Mental health is an often-overlooked component of physical well-being, but if you are struggling with pelvic floor dysfunction, mental health is an essential part of your healing journey. Yes, this is easier said than done, but if therapy seems to be financially out of reach for you, ask on local groups for low-cost or sliding-scale options. 
  2. Give yourself time to relax. Relaxation looks different for everyone, but in this case, we are specifically referring to time that lowers your overall stress level. So if sitting and meditating stresses you out, don’t look at that as relaxation! Watch a show that’s comforting. Read a cozy, predictable book. Do a puzzle, and get out in nature. Take a nap. Slow down.
  3. Do learn some mindful techniques for connecting with your pelvic floor. You might start with this video, all about how to relax pelvic floor tension. You might also want to jump all the way into a program like Restore Your Core®.
  4. Take a walk. Walking is one of the best exercises you can do for your pelvic floor. Choose a pace that feels easily doable for you–no need to push yourself beyond what feels comfortable. If walking is not accessible for your body, then see whether there’s a pool you can use for water walking or swimming. 
  5. Move in different ways, in general: sit differently. Stand differently. Get up and down differently. This is much harder than it sounds, but our bodies both need variety and love to do what they’re used to doing. 
  6. Look for opportunities to focus on small joys and pleasures during your daily life. No, this isn’t a physical technique. But it is free and available to everyone. Connecting with your body by learning what makes you feel happy (sunshine? A loved one’s smile? The 30th time watching that show you love?)  is good for your mental health, body image, and yes, your pelvic floor. 

Above all, know that tight pelvic floor muscles are quite common, but don’t have to be your normal experience. You can learn to relax your pelvic floor and get back to doing more of the things you love.

FAQ

1. How can I tell if my pelvic floor muscles are too tight?

Signs of tight pelvic floor muscles may include pelvic pain, discomfort or difficulty during intercourse, urinary urgency or frequency, constipation, lower back pain, and increased muscle tension in the pelvic area.

2. What causes tight pelvic floor muscles in females?

Tight pelvic floor muscles in females can be caused by various factors, including stress, anxiety, poor posture, repetitive movements, hormonal changes, childbirth, trauma, surgery, or underlying pelvic floor dysfunction.

3. Are there specific exercises that can help relax tight pelvic floor muscles?

The answer to this question will vary depending on which muscles are involved, but yes! You might want to begin with this series of videos for some explorations of pelvic floor tension.

4. Can a tight pelvic floor affect sexual health and how?

Absolutely! If your pelvic floor is too tight, then you may experience pain or discomfort during intercourse (dyspareunia), decreased arousal or sensation, difficulty achieving orgasm, and overall sexual dissatisfaction.

5. What types of healthcare professionals can diagnose and treat a tight pelvic floor?

Healthcare professionals who can diagnose and treat a tight pelvic floor include pelvic floor physical therapists, gynecologists, urologists, colorectal surgeons, and pelvic pain specialists.

6. Are there any lifestyle changes that can help alleviate symptoms of a tight pelvic floor?

Lifestyle changes that can help alleviate symptoms of a tight pelvic floor include practicing relaxation techniques, learning and practicing good posture, staying hydrated, avoiding constipation, engaging in regular physical activity, and seeking guidance from a pelvic floor physical therapist or other specialist for targeted exercises and stretches.