The pelvic floor is a group of muscles at the bottom of your core. They are responsible for supporting the bladder and bowel systems and play a vital role in maintaining continence. Commonly, pelvic floor management is focussed on improving strength and coordination in these muscles to address issues of stress and urgency incontinence.
However, the pelvic floor muscles may also present difficulty when they are overactive (or hypertonic). Pelvic floor muscle (PFM) overactivity is a condition where there is increased tension at rest, during voluntary and involuntary contractions, or while trying to relax the PFMs.
Overactivity of PFMs may present as:
- Difficulty with emptying the bowels or frequently passing thin bowel movements
- Difficulty with initiating urination, painful or reduced urine flow & feeling of incomplete emptying of the bladder
- Increased urgency or frequency
- Diminished ability to feel active PFM contractions
- Pain in the area of the pubic bone, penis, testicles, anus or coccyx
- Erectile dysfunction
PFM overactivity may be a result of any of a number of issues:
- Stress: prolonged increased stress levels may lead to tightening of the PFM in response
- Compensatory stiffening following surgery to nearby areas (abdomen, pelvis, hip, knee, ankle), or hypermobility
- Direct trauma to the coccyx (tailbone)
- Chronic inflammation of the prostate, urethra or bowels (urinary tract infections, prostatitis, IBS)
- Learned bracing/postural patterns of the core, buttocks and pelvic floor
- Bladder/ bowel dysfunction: people experiencing increased urgency to urinate or empty their bowels may be overcompensating with increased tension in the PFM to prevent leakage
Management of PFM overactivity is focussed on achieving full relaxation of the PFMs before transitioning to appropriate strengthening to maintain function. Further strengthening initially may only exacerbate symptoms.
A typical session with a Men’s Health Physiotherapist may include:
- Advice and education on bladder and bowel habits
- Pelvic floor relaxation techniques
- Pelvic, core and hip stretches
- Mindfulness and breathing techniques
- Appropriate strengthening exercises of underperforming muscle groups when relaxation has been achieved
If you have been diagnosed with PFM overactivity or feel that the above information resonates with you, being assessed by one of our Men’s health Team is an excellent next step in managing your situation. Our physiotherapists will diligently go through your past history and assess your current PFM function with the assistance of Real-time Ultrasound to determine if you are suffering from PFM overactivity. We can then put together a tailored plan with you to help optimise your pelvic floor health.