Hypertonic Pelvic Floor
I Peed my Pants!
There was a period of time last year when I was going through a particularly rough patch. Anxiety was high, and all of the regular holding spots in my body were feeling tight.
My entire pelvic girdle and the surrounding areas were all bound up. My low back hurt, my second-best hip (my right hip) flared up in the way it does sometimes, and my digestion was out of whack.
I was walking to the bathroom when I sneezed. And I peed a little.
WTF?!
I’m a healthy, fit, pelvic floor specialist, who has not had any babies, and I just leaked.
That was a wake-up call for me. My nervous system was clearly overwhelmed, as were my poor, contracted pelvic floor muscles. Because I was in a period of elevated sympathetic arousal (super stressed out), my pelvic floor muscles were in a chronically contracted, shortened state. Which means that they were working overtime.
When my body experienced a high-pressure situation, a sneeze, my overworked and exhausted, already shortened pelvic floor muscles weren’t able to contract/shorten more than they already were. The continence function of my pelvic floor muscles wasn’t available, because of their “hypertonic” tissue state. And at the root of all of this, was anxiety.
Moving forward I will use the term “high tone” in lieu of “hypertonic”. “High tone” is the current terminology used by pelvic health professionals to describe pelvic muscles in a shortened/contracted state.
In that moment of Stress Incontinence, were my pelvic floor muscles “weak”?
Yes.
Does that mean I started doing a bunch of Kegels or Pelvic Floor Contractions?
No!
Kegels would have made my experience of incontinence worse.
I’ve seen this countless times in my practice, in folks of all ages, fitness levels, and sexes…. High tone pelvic floor muscles, resulting in incontinence.
It may be surprising to learn just how many different kinds of people experience urinary incontinence:
some begin experiencing incontinence in their childhood or teens for various reasons
others are involved in athletics, dance or rigorous exercise, and incontinence occurs as an adult
sometimes incontinence develops during pregnancy or postpartum
reproductive hormone, tissue + organ changes can increase the likelihood of incontinence
Often the only recommendation given by medical practitioners or coaches when there’s leaking is to do Kegels/pelvic floor contractions. Almost 100% of the time the individual is never taught to do a proper pelvic floor contraction. At best they are told to “stop the flow of urine” to find their pelvic floor muscles, and then to squeeze those same muscles all day long.
Ugh… don’t get me started on this Kegel instruction! It’s inaccurate, inadequate, and negligent.
The Pelvic Floor + Breathing
Our pelvic floor muscles are supposed to move with every breath we take. The pelvic diaphragm, the inner-most layer of the pelvic floor, moves in tandem with the respiratory diaphragm. As we breathe, there’s no need to put forth any intentional effort in the muscles of the pelvic floor. There’s no pressing or bearing down with the inhalation, nor any squeezing with the exhalation.
As we inhale, the respiratory diaphragm widens and descends, and the muscles of the pelvic diaphragm lengthen and descend.
As we exhale, the pelvic floor muscles shorten and lift upwards, as the respiratory diaphragm also hugs inward and ascends upward.
Check in with your Pelvic Floor right now
Welcome a deep breath and notice:
As you inhale do you feel any sensations of your pelvic bowl deepening or your pelvic muscles softening, and lengthening?
Maybe there’s a feeling of your pelvic girdle expanding, or your sit bones widening as you breathe in?
As you exhale do you feel sensations of your pelvic bowl becoming shallower?
Or your pelvic floor muscles shortening, hugging inward and upward as you breathe out?
Maybe there’s a feeling of your pelvic girdle contracting, or your sit bones, pubic bone and tail bone all drawing inwards?
While our pelvic floor muscles ought to move with every breath we take (in various degrees depending on our body position and movement task), for many folks, this movement isn’t happening.
How do the muscles of the pelvic floor lose their full range and strength?
Due to patterns of:
Posture
Breathing
Bracing
Compensation patterns (other muscles tight +/or weak)
Anxiety, Anger and Trauma. The muscles of the pelvic floor respond to fear, anger and trauma, often resulting in holding excess tension. Overtime that excess tension can cause limited range of motion and weakness
What to do when there's Stress, Urge, or Mixed Incontinence
While incontinence is still a culturally taboo topic, it is a very common experience. Over 50% of women and 13% of men have experienced urinary incontinence.
Let me be clear, incontinence is common, but it’s not a “normal” tissue state. Incontinence isn’t just something to chalk up to pregnancy or age, it’s an indication that the body needs support.
The health of our pelvic floor muscles informs the health of the rest of the body.
When we have pelvic floor muscles that are in a high tone, shortened/contracted state, we may experience the following symptoms:
Stress, Urge or Mixed Urinary Incontinence
Unexplained constipation
Indigestion, gas and bloating
Hemorrhoids
Painful sex (during or after intercourse, with erections, with climax)
Genital pain: vulvar, vaginal, testicular
Pelvic Pain: Coccyx or Pubic bone pain, SI joint, Hip
Menstrual Pain
Low Back Pain
The following are some Pelvic Health steps to explore:
Be kind and gentle with yourself. You did not screw up or fail. Incontinence is not your fault. We are not taught how to care for, nor prioritize this area of our body. Your nervous system, your needs, and how your body is managing stress, impacts symptoms like incontinence, tightness and pain, and can make them worse.
Stop doing pelvic floor contractions/Kegels, unless you’ve recently been to a Pelvic Health Physical Therapist for an exam, and this is your recommended protocol. If you’ve been doing Kegels for weeks, months or years without symptom improvement or resolution, it’s an experiment worth trying,
Incontinence can be a symptom of pelvic floor muscles with “low tone”. In a “low tone” tissue state, properly executed and tailored pelvic floor contractions may be recommended as a part of a whole-body approach in pressure management, mobility and strength.
Incorporate nervous system down-regulation strategies, as well as resilience strategies in your formal practice, and off-the-mat practice. Nervous system dysregulation, including persistent anxiety and depression, is often a core component of muscular tension imbalance (tight muscles and pain).
Include breathing + postures that lengthen/stretch and mobilize the pelvic floor muscles:
Pelvic Breath - breathe so you can feel the movement of the pelvic floor (w/o intentional effort in your pelvic muscles)
Forward folds like Downward Facing Dog, or Dog with hands on a Wall or on a Table
Knees to abdomen/chest postures like Child’s pose, Happy Baby, Deep Wide-Legged Squat
Legs up Wall or Couch with legs wide
Massage Pelvic Floor with hands, massage ball or foam roller
Email me to schedule a 10-15 minute complimentary phone consultation.
You are not alone
One of the reasons I love specializing in Pelvic Health is that I have the opportunity to help people feel more comfortable with their body and in their body. Have pee, poop, or sex questions? I talk about this stuff all day long - let’s discuss!
I’m on a mission to de-stigmatize pelvic health challenges, and make pelvic health accessible. Everyone has a pelvis - lets learn to love them 💛
In community and connection,
Emily