If you suspect or have been told that you have an “overactive” pelvic floor, this means that the pelvic floor muscles tend to contract more than is necessary, resulting in excessive pelvic floor muscle tension, similar to ‘tight shoulders’. Causes of an overactive pelvic floor include stress; pelvic trauma, injury, surgery, or infection; untreated bowel or bladder issues; and hypermobility. A few symptoms that could indicate an overactive pelvic floor include painful sex, painful bowel movements, tailbone pain, and leaking.
Exercise can contribute to an overactive pelvic floor, typically in cases of high intensity exercise without sufficient mobility and relaxation to provide balance. This can be especially exacerbating if the person also has a fast paced or stressful lifestyle.
In some cases, refraining from high intensity exercise may be recommended to allow time for the pelvic floor to normalize, using rehab activities guided by a qualified physical therapist. However, many people can continue to exercise as desired if they have awareness of overactivity, and use strategies to balance the impact from their exercise.
Here’s our guide to working out with an overactive pelvic floor.
Use Your Breath.
Breathwork can reduce the nervous system’s stress response and mobilize the pelvic floor.
1. Diaphragmatic breathing can be used in a warm-up before exercise, a cool-down after exercise, during times of stress and anxiety, and as a daily exercise for pelvic floor mobility. To do this: place your hands on the upper belly. Slowly inhale, sending air to your hands. Now slowly exhale – the belly should flatten as the air leaves. Continue this, building up to a 6-second inhale/6-second exhale, making sure you’re getting belly movement as you breathe. Do this for at least 10 breaths.
2. Don’t make breath-holding a habit. In exercise, breath-holding is typically used to increase tension for support during heavy exertion. But this should be used sparingly, and ideally trained first for proper technique. (There’s a difference between proper bracing and improper strain.) Unless this applies to you and you can work with a coach to achieve a proper brace, it is recommended to avoid breath-holding. Instead, continue breathing throughout exercise, exhaling on the hardest part of an exercise. This breath pattern encourages contraction of the pelvic floor when it’s necessary, but not excessively.
Include Mobility Programming.
If your workout of choice is low impact with full body movement (like yoga, tai chi, etc.) then you can probably use your workout to your advantage to address an overactive pelvic floor. But if you like to do burpees, powerlifting, dance, or anything else that includes high impact, high resistance, and/or speed, then a complimentary mobility program is a must. Higher intensity workouts increase muscle demand and elevate cortisol levels (a stress hormone). This is normal, but if you already have an overactive pelvic floor, this can prevent it from improving. Rather than stopping your workouts, first try a mobility program. Plan a cool-down after each workout, and incorporate stretching throughout each day. Here are some examples:
- Thread the Needle
- Cat Cow
- Child’s Pose
- Shin Box
- Figure 4 Stretch (Pigeon Pose)
- Prone Press-up (Cobra or Upward Dog Pose)
- Downward Dog
Strengthen The Booty.
Weak or tight hips have been demonstrated to contribute to dysfunctional pelvic floor muscle activity. It’s worth strengthening the hips to address this factor. If you are a person who sits a lot, is deconditioned, has knee or back pain, or has poor posture, this may be especially valuable for you. Some exercises to strengthen the hips include: clamshells, hip thrusts, bridges, lateral leg raises, squats, lunges, and side planks.
Sometimes it’s the other stuff in life that greatly affects tension in the body. Dealing with sources of stress can help to relieve muscle overactivity. Reduction in pain and improved pelvic floor function (like continence) could be indicators that muscle tension is improving.
Get medical care for pelvic floor issues.
Exercise can help or hinder pelvic floor symptoms. But if the source has never been examined, then it might be the right next step. See a qualified physician or physical therapist to evaluate and treat sources of muscle dysfunction or pain. It may make a great difference in the ability to restart or continue your exercise of choice.
Interested in more tips on how to prevent or overcome Pelvic Floor Problems?
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Melissa Stendahl, PT, DPT is a pelvic health physical therapist with specialty certificates in the areas of prenatal and postpartum physical therapy. She has a unique approach with clients by promoting preventative care, active participation, education and understanding of their diagnosis and treatment plan so they feel empowered in their ability to achieve wellness. Melissa is a lifelong athlete, military veteran, and mom. She is the owner of Stendahl Physical Therapy, PLLC. Follow along on her Instagram.