Overactive Pelvic Floor: Why Relaxation Can Be Just as Important as Strengthening

When most people think about pelvic floor problems, they think about muscles that are too weak. But in some cases, the issue is the opposite: the pelvic floor is too tight. This is known as high-tone or overactive pelvic floor dysfunction, and it can be just as problematic as weakness. Sangeeta Sharda is personalised to guide, support and empower you.

What is High-Tone or Overactive Pelvic Floor Dysfunction?

The pelvic floor is a group of muscles that support the bladder, bowel, and reproductive organs. These muscles are designed to contract and relax in a balanced manner. In high-tone dysfunction, the muscles stay tense or “switched on,” making it difficult for them to relax when needed.

Common Symptoms of an Overactive Pelvic Floor

 Women with high-tone pelvic floors may experience:

•  Pain during or after sex (dyspareunia)

• Pain or burning feeling localized at the vaginal opening when attempting to touch or apply pressure (vestibulodynia)

• Vaginal tightness and frequent spasming of pelvic floor muscles interfering with penetration (sometimes called vaginismus)

• Difficulty starting or completing bladder emptying

• Constipation or straining with bowel movements

• Pelvic pain, hip, or low back discomfort

• Urinary urgency, frequency, or retention

Research shows that high-tone pelvic floor dysfunction is often linked to sexual dysfunction, painful bladder syndrome (interstitial cystitis), endometriosis, and chronic pelvic pain conditions (Mosca et al., 2022).

Why does it happen?

Causes may include:

• Childbirth or pelvic surger

• Trauma or injury to pelvic muscles or nerves

• Habitual clenching (holding urine for hours or bracing)

• Stress, anxiety, or past trauma that results in muscles staying on “high alert”

• Pelvic pain conditions like endometriosis, IBS, painful bladder syndrome, persistent pelvic pain, vaginismus or vestibulodynia

How can physiotherapy help?

At Praxis Rehab Physiotherapy in Belair , we focus on teaching the muscles not just how to contract, but also how to release and let go. Treatment may include:

• Relaxation techniques and breath work

• Gentle internal muscle release and massage

• Stretching and posture work

• Biofeedback to retrain muscle activity

• Education and self-management strategies

• Support for intimacy and sexual comfort

In some cases, other treatments such as medications (muscle relaxants, analgesics before intercourse, antispasmodics), trigger point or botulinum toxin injections, or multidisciplinary care may be recommended if symptoms persist.

 If you’ve been told to “just do Kegels” but your symptoms don’t improve or get worse, you may be dealing with a high tone or overactive pelvic floor. Not every pelvic floor needs strengthening; some need help learning to relax!

 At Praxis Rehab Physiotherapy in Belair, our women’s health physiotherapist, Sangeeta Sharda, is here to help you find relief from pelvic pain, bladder and bowel difficulties, and sexual discomfort caused by high-tone pelvic floor dysfunction.

Book an appointment today and take the first step towards recovery.

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Reference: 

Mosca L, Riemma G, Braga A, Frigerio M, Ruffolo AF, Dominoni M, Munno GM, Uccella S, Serati M, Raffone A, et al. Female Sexual Dysfunctions and Urogynecological Complaints: A Narrative Review. Medicina. 2022; 58(8):981. https://doi.org/10.3390/medicina58080981