Have You Heard of High Tone Pelvic Floor Dysfunction?
If you have been told that you have high tone pelvic floor dysfunction, read on for an explanation of what this is. The pelvic floor muscles are sometimes called the “pelvic diaphragm”. A “floor” might imply that the muscles are flat, whereas a diaphragm implies that the muscles are more of a sling, which better describes their shape. The pelvic floor muscles are postural muscles and respond to every breath you take and movement you make, to keep you from wetting or soiling. When a person has high tone pelvic floor dysfunction we find stiffness in these muscles and inability to respond effectively to movements, breathing and daily activities. Symptoms of high tone pelvic floor dysfuncition show up as pelvic pain, urinary frequency and urgency, urinary incontinence, fecal incontinece and pelvic organ prolapse.
The Pelvic Floor Muscles lie inside the ring of the bones and attach to the bones.
The pelvic floor muscles are a series of muscles that line the inside of the bones of your pelvis. If you put your hands on your glutes, you are touching muscles that are on the outside of the bones of your pelvis. Meanwhile, the pelvic floor muscles are located inside the ring of bones that make up your pelvis.
These pelvic floor muscles attach to the bones of the pelvis, sort of like a hammock. The pelvic floor also includes fascia, blood vessels and nerves. If the muscles become unhappy, stiff or tense, a person might experience pain in any of the joints, bladder or bowel symptoms, intimacy pain and nerve pain, as well. Each time you move your body, you are generating forces through your pelvic floor muscles and these muscles should have no difficulty receiving these forces and responding appropriately.
Because the pelvic floor muscles attach to the Bones of the Pelvis, if you have high tone pelvic floor dysfunction you may have tailbone pain, SI joint pain, hip pain, lower back pain or pubic pain.
There are multiple pelvic bones that come together to form the ring of your pelvis. At the front of the pelvis you have the pubic bones, forming a joint. There’s one pubic bone on the right side and another one on the left side and they come together to make a joint. Women who experience pubic pain often experience clicking in that joint because the two bones are moving around in a non-optimal manner. With pubic pain, pelvic floor dysfunction is also occurring because the pelvic floor muscles attach to the pubic bones.
At the back of your pelvis you have the sacrum, a triangular shaped bone. The sacrum actually has several joints:
- Lumbosacral joint (the low back joins with the sacrum)
- Sacrococcygeal joint (the sacrum joins with the tailbone)
- Sacroiliac joints (SI joint)
Within the pelvis you also have your hip joints. The pelvic region is so important because it joins the legs to the trunk, allowing us to move.
High Tone Pelvic Floor Dysfunction Involves Stiffness
- The pelvic floor muscles should be able to easily contract and relax.
- With high tone pelvic floor dysfunction the muscles lose the capacity to freely contract and relax.
- The muscles become stiff.
- There is tension in the muscles and we can often palpate trigger points.
- When our patients have high tone pelvic floor dysfunction, the muscles are weak, because they are stiff and tense.
- If we add a bunch of kegels onto a stiff and tense situation, you can worsen your problem.
- This is why many pelvic health physical therapists work, instead, on helping you lengthen and let go of your pelvic floor.
Dropping my pelvic floor? What does that mean?
Your pelvic floor muscles, when working well, will lift and squeeze and lower and relax.
People who have high tone pelvic floor are unable to lower and relax their muscles completely. Often we teach our patients how to “drop” their pelvic floor. By this, we mean, we are asking you to lengthen the muscles so that they descend and relax. This will not come easily to you, if you have pelvic floor dysfunction.
We find that our manual therapy methods, directed to your abdomen, hips, inner thighs and lower back, can help alleviate some of the tension in your pelvic floor muscles.
We can also work, very gently, on the pelvic floor muscles themselves, to provide you trigger point release, fascial mobilization and feedback regarding whether your muscles are dropping or not.
Poses and Exercises you can try to relieve your high tone pelvic floor
Sometimes we use positions that can facilitate your pelvic floor to drop. These might include something like Happy Baby Pose or Child’s Pose or Double Knee to Chest or Deep Squat. When you attempt anything like these poses, you want to quiet your mind and breathing and be conscientious to soften and let go of your pelvic floor.
Things to Avoid if you have High Tone Pelvic Floor Dysfunction:
- Pushing your pee: Urinating should be a relaxed activity. Pushing your pee out is a sign that your have high tone pelvic floor dysfunction. Work to relax and breathe as you urinate.
- Straining with bowel movements: Do your absolutel best to facilitate a daily, formed and soft stool. When defecating, work on relaxing and letting go. Sit with your knees higher than your hips to help the posture and anorectal angle optimize for ease of defecation.
- Forcing sex: If sex is too painful, do not grit your teeth and just get through it. Your pain is causing your pelvic floor to tense up and worsening your problems.
- Peeing more than every 2 hours: Normal urinary frequency is every 2 to 4 hours. Some people who have high tone pelvic floor dysfunction find themselves peeing every 30-90 minutes. If this is you, seek the help of a qualified pelvic health physical therapist who can help you to quiet your bladder and recover your bladder’s capacity to fill and hold urine quietly.
- Sitting for prolonged periods, if it hurts you: If it hurts to sit, then don’t just power through sitting. We work with people all the time whose job requires prolonged sitting and worsens their pain. For example, if we are working with an accountant during tax season and this person has worse pain when sitting, we counsel them to get a standing desk and/or take regular breaks from sitting.
- Ignoring your lower back pain: Low back pain is known to occur with pelvic floor dysfunction. So many of our patients come to us for their pelvic problem and have a comment of “I’ve always had low back pain, but I’m not coming to you for that problem.” Our response is that we must get your lower back pain improved to be able to fully resolve your high tone pelvic floor.
What can you do to prevent pelvic floor dysfunction?
- Postpartum pelvic health physical therapy is the standard of care that will optimize your pelvic floor, abdomen, hips and low back. After vaginal labor and delivery, it is common that a woman might develop high tone pelvic floor.
- Heal your body between pregnancies: avoid getting pregnant back-to-back and/or getting pregnant without first healing your abdominal wall and pelvic floor
- Ask your young daughter if she has any stress incontinence with sports! Research shows that upto 80% of young girls (average age 16 1/2) have stress incontinence in sports that involve running and jumping (think basketball, volleyball, gymnastics, cheerleading, dance)
- Get your young daughter treatment for stress incontinence.
- Teach young people & adults about the pelvic floor so we all understand the signs and symptoms associated with pelvic floor dysfunction
- If you have chronic lower back pain, research shows that you very likely also have pelvic floor dysfunction. We suggest anyone who has chronic lower back pain get treatment to their pelvic floor. This has been shown to help resolve your back pain.
- Keep your hips and core strong, flexible and healthy.
- Meet the exercise guidelines so that you are moving regularly.
- Stretch and keep your legs, hips and back with optimal flexibility.
- Work to have optimal posture. We know that if you have a flat back, then the angle of your boney pelvis is not optimal and this places extra strain on your pelvic floor because the muscles have to work extra to hold up the organs.
Purple Mountain Physical Therapy is a specialty pelvic health clinic located in Grand Rapids, Michigan. We treat many people who have high tone pelvic floor dysfunction, chronic low back pain, chronic pelvic pain, overactive bladder or other pelvic problems. We provide treatment in person at our clinic, in private one-on-one appointments with a doctor of physical therapy. We also offer telehealth visits. Each appointment is upto 55 minutes long and is holistic, meaning we treat the whole body. This is because with conditions such as high tone pelvic floor, we cannot get your pelvic floor back to normal if we do not also address and treat fascia tension, strength, breathing mechanics, scar tissue, boney misalignment and weakness. For high tone pelvic floor, much of our 55 minutes will be spent with manual therapy techniques to reduce trigger points, pelvic floor stiffness, fascial restrictions, nerves that are impaired and muscle guarding. If you are interested in learning more about our treatment for high tone pelvic floor dysfunction, you can reach us here by calling 616.516.4334 or submit this online inquiry and we will be in touch. If you are reading this and would like to find a provider closer to your home, we suggest this directory.
