I see a lot of women with muscle tightness in their pelvic floor- in the levator and obturator muscles (although many other muscles can be involved).  And while these women may be aware of a change in their muscle tension, usually they are experiencing bothersome symptoms. The pelvic floor muscles have an intimate relationship with the bladder, vagina and rectum and this create a host of symptoms besides pain.  There can be many different ways that pelvic floor muscle tightness declares itself, but this is what I most commonly see (and remember that you can get more than one type of symptom):

Pelvic Floor Muscles Symptoms

• Feeling UTI symptoms but bladder cultures are negative. Tight pelvic floor muscles can make you feel like you have to pee all of the time.  You may need to rush to the bathroom, have bladder leakage, pain when you empty, or pain after you empty.  Most women (smartly) associate these symptoms with a bladder infection.  But if your urine culture is negative, bacteria are not to blame (there are a few exceptions here but generally this is true).  This means your symptoms are being caused by something other than a bacterial infection.  And pelvic floor muscle tightness is a common cause.
• Pain with sex,  There is a lot of pressure on the pelvic floor muscles during sex.  If the muscles are tight before sex, they may become painful during and after.  This pain can even last for a day or two until the muscles relax a little more.  Having this intense pain that can last for a day or two can be really frightening for women.
• Pain before pooping. Pelvic floor muscle tightness can cause pain when the rectum is full.  Having a bowel movement usually results in relief.
• Bladder leakage.  When the pelvic floor muscles are tight, they don’t work normally.  This can result in bladder leakage.  This type of leakage may feel very random and like there is no pattern to it.
• Trouble emptying the bladder.  When the pelvic floor muscles are tight, they relax poorly.  And this may make it hard to empty.  Your urine stream may take a while to start.  It may stop and start rather than just emptying.
• Prolapse symptoms.  Women with prolapse (a vaginal hernia) always have more symptoms and bother when their pelvic floor muscles are tight.  The degree of prolapse doesn’t change, it just all feels a lot worse.

What to do

If you are having any of these symptoms, you should see a health care practioner.  It is completely reasonable to start with your primary care or gynecologist.  And while you may not want to talk about these symptoms, we talk about them all the time.  It shouldn’t feel gross or embarrassing.  They are just a sign that your body isn’t functioning quite right.  Your pelvic floor muscles are always working to support your organs and keep you clean and dry.  Once they are flared and painful, it can take some work to get them to relax.  The most common treatment is physical therapy.

When I evaluate someone with pelvic floor muscle pain, I perform a vaginal exam.  I ask you to squeeze your pelvic muscles (a kegel) and then I lightly press on the muscle.  If it hurts, they’re tight.  I can usually feel the extra tension in the muscle.  You can assess this yourself by putting your thumb in the vagina (pad of the finger pointing towards your butt).  Touch the muscles there (if you think of the opening of the vagina like the face of a clock, you would push at 5 and 7 o’clock).  You can also try hip relaxing stretch (try happy baby or child’s pose) to see if the stretch hurts through the pelvis.  These poses stretch the pelvic floor muscles and can also work to calm them down.  If you are having pelvic floor muscle tightness, you should stop doing all pelvic floor strengthening.  It will only make things worse.

A few more thoughts

Different women hold their stress in different places.  Many of us hold it in the pelvic floor.  Seeing a physical therapist will give you more insight into your body and where you have excess muscle tension.  And it will give you the tools to handle your symptoms.  If your pelvic floor muscles start to flare again, you will know what to do.  And when to make a follow-up visit with yout PT.  All of these syndromes have always been around, they are just much more common in our current environment!