The pelvic floor consists of muscles, ligaments, fascia, and connective tissue.1 Together, they provide support to pelvic organs, the spine, and are involved in urinary, defecatory, and sexual functioning.1,2
Pelvic floor dysfunctions are common in women. Pelvic floor dysfunctions can be separated into two broad categories: relaxing pelvic floor dysfunction or nonrelaxing/hypertonic pelvic floor dysfunction.3 Relaxing pelvic floor dysfunction is more common, with patients typically presenting with urinary or fecal incontinence, or organ prolapse.2,3 With nonrelaxing pelvic floor dysfunction, symptoms include chronic pelvic pain, low back pain, pain and difficulty with defecation, urination, and sexual function as these functions require relaxation of pelvic floor muscles.2,3 Patients with nonrelaxing pelvic floor dysfunction have increased tension and muscle tone in the pelvic floor muscles, and it may also have myofascial trigger points in the pelvic floor muscles.1
Pelvic floor hypertonicity can be a primary problem or occur secondary to an injury to the pelvic floor or surrounding structures.1 Pelvic surgery, injuries to the back and pelvis, disturbances or asymmetries in gait, stress, and pelvic pain are associated with nonrelaxing pelvic floor dysfunction.1,2 The specific event causing pelvic floor hypertonicity is typically unknown, as a combination of factors may contribute to the problem.
To diagnose pelvic floor hypertonicity, the pelvic floor muscle tone and function of the muscles are assessed.1 There is no standard way to evaluate the pelvic floor. However, an assessment of muscle tone, ability to contract, and ability to relax the pelvic floor muscles is beneficial.2
Pelvic floor physical therapy to treat pelvic floor hypertonicity is led by symptoms and aims to improve the relaxation of the pelvic floor muscles. Interventions include patient education, behavioral changes, and exercises to relax the pelvic floor muscles.1 Manual therapy techniques such as soft tissue massage, myofascial release, and others may also be utilized.1 Additionally, exercises to strengthen the core muscles that stabilize the pelvis are included.2,3 Biofeedback for patients to learn how to contract and relax the pelvic floor muscles correctly is also utilized.2
References:
- van Reijn-Baggen DA, Han-Geurts IJM, Voorham-van der Zalm PJ, Pelger RCM, Hagenaars-van Miert CHAC, Laan ETM. Pelvic floor physical therapy for pelvic floor hypertonicity: A systematic review of treatment efficacy. Sexual Medicine Reviews. 2022;10(2):209-230. doi:10.1016/j.sxmr.2021.03.002
- Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic Proceedings. 2012;87(2):187-193. doi:10.1016/j.mayocp.2011.09.004
- Louis-Charles K, Biggie K, Wolfinbarger A, Wilcox B, Kienstra CM. Pelvic floor dysfunction in the female athlete. Current Sports Medicine Reports. 2019;18(2):49-52. doi:10.1249/jsr.0000000000000563
