A Hyperactive Pelvic Floor

“Something about my pelvic floor feels weird but the gynecologist says that everything looks good”

Some women experience that something feels unusual or wrong in the genital area, but when they visit the gynecologist they get a pat on the shoulder and the answer that everything looks great. If you have experienced this you might have a hyperactive pelvic floor.

If the reality doesn’t add up…

…you won’t be reassured. Instead you’ll most likely feel anxious and feel like the gynecologist missed something. The anxiety and stress unfortunately obviates the problem and your pelvic floor muscles get even more tense.

What is the function of the pelvic floor?

The primary function of the pelvic floor is to lift the organs in the pelvis and abdomen, close to the urethra and rectum, and to hold or relax when it comes to regulating urinary and intestinal emptying. These muscles are normally voluntarily controlled, as are the skeletal muscles (as opposed to eg. the muscles of the intestines that cannot be controlled through the will).


For some women, hyperactivity is caused by an unconscious activation. In these cases the pelvic floor muscles often don’t relax completely either when resting. A common reason for this problem is stress or pain. Many of us experience the same thing in our neck muscles. When we get stressed we tend to tense certain muscles.

Another reason might be a protective mechanism against something we unconsciously want to close out, or hold.

What is happening?

When the pelvic floor muscles become overly activated, the normal conscious willpower to coordinate these muscles is disturbed and it gets hard to relax and activate the muscles. A hyperactive pelvic floor may cause pain and discomfort but not in all cases. This means that it’s a chance that you are not aware that you have a hyperactive pelvic floor. However, you may have vague secondary problems like fatigue and discomfort in the genital area. 

In some cases women think they have a prolapse, even though most gynecologists have said that’s not the case. The feeling of a heavy weight and aching sensation in the genital area may instead be the pain of fatigue that occurs in muscles that are never allowed to rest.

How does it feel?

Hyperactivity in the pelvic floor can cause difficulties to urinate or poop. It may also cause decreased sexual desire/ability and pain. This condition often develops over a long period of time and may be triggered by some sort of pelvic pain (sexual abuse, birth damage or gynecological surgery). Women with a hyperactive pelvic floor tend to exhibit a cluster of similar symptoms: frequent urinary incontinence, chronic constipation, pain when having sex, chronic pelvic pain and lower back pain. Unfortunately, it’s far too rare that women with long-term lower back and pelvic pain are offered examination of the pelvic floor.


  • Discomforts, aches or pain
  • An extreme tightness. If the vagina could talk she would say “Nothing will ever enter here again”
  • A feeling of that something’s wrong, even though the gynecologist notes that everything looks good

Sometimes the hyperactivity causes pain in other areas,, see picture:

Hyperactive pelvic floor

What causes a hyperactive pelvic floor?

  • Surgery or trauma
  • A long lasting pain from e.g. bowel trouble, endometriosis or urinary bladder problems.
  • Pain from the lower back, pelvis or hips
  • Stress or anxiety
  • Sexual abuse 
  • Hyperactive pelvic floor muscles may also be a primary cause 
  • Prolonged sitting can sometimes aggravate the symptoms

Sometimes the pain comes from healing

A trauma or a surgery may cause pain that’s characterized by an inflammatory and immunological response. This response is part of the body’s healing process and may lead to a muscle reaction in the surrounding tissue. In some cases the muscle reaction itself causes further inflammation and hypersensitivity in the nerves around the area.

How do I know if I suffer from a hyperactive pelvic floor

  • An examination of the pelvic floor in terms of soreness, activation, muscle strength and ability to relax will be able to answer if you have a hyperactive pelvic floor.
  • It may be of value to examine the lumbar spine, pelvis and hip area too, to rule out that the pain is related to other problems.

How to treat it

It is important that you educate yourself about the anatomy of the pelvic floor and the processes that may contribute to hyperactivity. Learn how to stretch and relax the pelvic floor muscles and make sure to book an examination of the lumbar spine, pelvis and hip area to rule out that the pain is associated with other problems.

The treatment often consists of relaxation exercises, soft tissue treatment (stretch and trigger treatment). Cognitive therapy methods may also be needed to learn to manage and accept the sensory input the brain receives, without interpreting it as pain. If you have received sensory input from the abdomen for several months, or maybe years, it may require a lot of “reprogramming” to learn to not interpret these signals as pain. 

Postpartum activewear

It’s beneficial to wear the right clothes when exercising, especially if you are breastfeeding and need to be available for your baby. We recommend these postpartum activewear (click the link).

Emelie Hollsten
Author: Emelie Hollsten

Hej! Jag är mamma och utbildad föräldrahandledare och skriver artiklar om föräldraskap & personlig utveckling. Här hjälps vi åt att bli både tryggare och starkare. Varm kram!

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Emelie Hollstenhttps://restlessmama.com
Hej! Jag är mamma och utbildad föräldrahandledare och skriver artiklar om föräldraskap & personlig utveckling. Här hjälps vi åt att bli både tryggare och starkare. Varm kram!

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