12 not so obvious signs you have pelvic floor tension
A few weeks ago I was doing yoga with some friends and one of them started talking about her tailbone pain. She’d had it for a while but a recent flight made it angrier than usual and the pain wasn’t calming down as quickly as it usually did. Because I have no boundaries, I started asking her more probing questions.
I asked her about her pooping habits. She said she’s always struggled with constipation but lately it’s felt a little worse. Maybe it was because she had been worse about hydrating.
I asked her about her peeing habits. She said she feels like she has a small bladder but it’s always been that way. She usually needs a bathroom break during car rides from Austin to Dallas.
I asked her if she has jaw pain. She said she started wearing a night guard a year ago because she was waking up with massive headaches.
And lastly I asked her about sex (like I said no boundaries). She said that weirdly it’s been more uncomfortable lately, like things are too tight.
Fortunately this was a virtual yoga session so I didn’t break my treatment table out right there and then but ya’ll, I’d be wiling to bet my favorite cat that she has pelvic floor tension. When your quadriceps are tight, you might have knee pain. When your pelvic floor is tight, stuff can go haywire all throughout your pelvis.
To learn more about pelvic floor anatomy, read here. To learn how to manage pelvic floor tension, read here. To learn 12 not so obvious signs your pelvic floor is tight, read on.
I’m going to talk you through 12 signs and symptoms that may signal pelvic floor tension and how pelvic floor tension contributes to each of the common symptoms below. But remember, just because pelvic floor tension may be contributing to these symptoms, that doesn't mean there aren’t other factors involved. If you’re struggling with any of these symptoms, schedule an in-person or virtual visit with us or contact your local pelvic floor physical therapist to get evaluated.
Now let’s dive in. Here are 12 not so obvious signs your pelvic floor is tight:
Stiff hips:
This is for all my tight hip people. If sitting cross legged is uncomfortable for you, if you feel like your hips are really stiff on one side or both, you may want to get your pelvic floor checked out. Your pelvic floor muscles contribute to hip rotation, and all hip rotators have an intimate connection with the pelvic floor. I had a patient recently who could not internally rotate her hips.. At all. I’m talking 0 degrees of movement. Then we worked on her pelvic floor tension and she had in-session improvement by 10 degrees. I’m telling you, this connection is BIG. P.S. This is also why it’s so important for pelvic floor physical therapists to look outside of the pelvis! *insert the leg bone’s connected to the hip bone jingle*
Back pain:
This is particularly common in new parents but can be true for anyone regardless of age or pregnancy status. Believe it or not, your pelvic floor is part of your core. Your pelvic floor muscles contribute to stability of the spine. If you have weakness in your abdominal or back muscles, your pelvic floor often picks up the slack. If you’re struggling with nagging back pain and you’ve struggled to find effective treatment, consider looking at your pelvis.
Jaw clenching:
This may sound familiar to my postpartum people because during labor you’re often cued to relax your jaw as you push. This is because of the jaw - pelvic floor connection! Because of embryological connections resulting in fascial connections, when we clench one, we often clench the other. That’s why there is a high correlation between people with TMJ and pelvic pain. Again, pelvic floor PTs NEED to be looking outside the pelvis, and sometimes WAY outside the pelvis.
Constipation:
Your pelvic floor muscles wrap around your rectum! If these muscles are tight or spasmed around your rectum, it can take a lot more force to get stool to come out, leading it to sit in the rectum longer. The longer stool sits in the rectum, the drier it gets and the harder it is to empty. It’s a vicious cycle, often started by pelvic floor tension.
Pain with penetrative sex (vaginal or anal):
Just like your rectum, your pelvic floor muscles wrap around the vaginal canal. When these muscles are tight, they effectively reduce the space available for penetration. This can cause people to feel like the opening is too small, like they’re too tight, like they’re tearing at the opening of the vagina or anus, or even a deep, achy pain. This pain can occur with either initial or deeper penetration. Learn more about managing pain with sex here.
Tailbone pain:
One thing to know about the tailbone is that tailbones can move. Another thing to know is that pelvic floor muscles attach to the tailbone. If your pelvic floor muscles on one of the tailbone are tight, they can pull it over to the side - ouch. If the muscles on both sides of the tailbone are tight, they can tug it forward - also ouch. If you struggle with tailbone pain, this is the first place I would look.
Urinary urgency:
Urinary urgency is defined as a sudden, strong urge to urinate that can be difficult (or impossible) to control. But you know what contributes to urinary urgency? You guessed it! Pelvic floor muscle tension. When the muscles surrounding the bladder and urethra are tight, shortened or sensitive, they can act up as your bladder starts to fill. This acting up can contribute to bladder irritation, leading to urinary urgency.
Urinary frequency:
This piggybacks a bit off of urinary urgency. When the muscles surrounding the bladder are restricting your bladder’s ability to fill, you get signals that you have to pee more frequently than if this filling is unrestricted. To learn more about why this happens and what you can do about it, read this.
Pain with gynecological exams:
Listen. Most people don’t love gyno appointments. While I love my gyno, I still hate seeing her. As someone with a history of pelvic floor tension, I hate seeing her a little extra. While gynecological exams are not particularly comfortable, they’re not supposed to be painful. And while the technique of the provider performing the exam makes a big difference, reducing pelvic floor muscle tone can, as well.
Pain with tampon insertion:
This is no different than penetrative sex or gynecological exams, except with tampons there is typically even less luberication.
Urge incontinence:
Most people assume that all incontinence is a result of pelvic floor muscle weakness but tension is just as likely to contribute to leakage. Stress incontinence (leaking with sneezing or jumping) is more often weakness driven. Urge incontinence (leaking when you get that sudden urge to pee) is more often pelvic floor tension. And the reality is that most people have something called mixed incontinence, which is a combination of both.
Vaginal or rectal pain:
This one may be a little less surprising, but one big indicator that someone has pelvic floor tension is having vaginal or rectal pain, assuming medical causes have been ruled out. Just like anywhere else in the body, tight muscles can hurt. They hurt because they’re constantly clenching and clenching is tiring and irritating. But in the case of the pelvic floor, we often don’t have the awareness that we’re clenching because we don’t think about our pelvic floor until something has gone wrong
And there you have it, the 12 not so obvious signs your pelvic floor is tight. If these symptoms sound familiar to you, come see us! Schedule an in-person or virtual visit by sending us a message here or calling us at 512-766-2649.
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This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.