Hypertonic pelvic floor (HPF) is commonly associated with urologic, gynecologic, gastrointestinal, and sexual problems, as well as chronic pelvic pain. The incidence ranges from 50% to 90% and has an impact on quality of life. Various terms are used in the literature for HPF, such as pelvic floor spasm, non-relaxing pelvic floor, and pelvic floor hyperactivity. IUGA and ICS define the term “non-neurogenic hypertonicity” as an increase in muscle tone associated with contractile or viscoelastic components that may be accompanied by increased contractile activity and/or passive muscle stiffness. In addition, hypertonic muscle tissue may contain myofascial trigger points. PFH may be a primary problem or a secondary adaptation to acute or chronic damage to one or more musculoskeletal components of the pelvic floor and surrounding structures. Pelvic surgery, complicated natural childbirth, spinal or pelvic trauma, gait abnormalities, pelvic pain, experienced risk, and (chronic) stress are associated with PFH. A history of physical or sexual abuse is also common in women with PFH. According to some authors, PFH may be a symptom of chronic activation of the stress defense system (the autonomic system) and should therefore be treated as a physical manifestation of emotional dysregulation (1,2). Interestingly, exposure to a stressful event (trauma) in women with a positive screening test for PTSD (post-traumatic stress disorder) is associated with an overly tense pelvic floor, possibly as part of the defense mechanism associated with that trauma. The more severe the PTSD, the more pelvic floor tone (3). It is important to understand two facts about the pelvic floor: 1) the pelvic floor plays a role in processing emotions and 2) the tone or tension of all muscles, including the pelvic floor, increases during stress and anxiety-provoking experiences. Thus, when a person feels threatened, he or she responds by tensing the muscles, especially the pelvic floor muscles.
High PFM activity can lead to chronic pelvic pain, which in turn can cause central sensitization and the onset of comorbid psychiatric disorders. Importantly, it can also disrupt the hypothalamic-pituitary axis, increase cortisol secretion, and sensitize nociceptive receptors. Therefore, it is important to work physiotherapeutically with the pelvic floor, taking into account other myofascial connections and the autonomic nervous system (4).
Symptoms associated with an overly tense pelvic floor in women include: (5)
- Chronic pelvic pain
- Irritable bowel syndrome
- Constipation
- Urethral syndrome
- Overactive bladder
- Interstitial Cystitis
- Dyspareunia (Painful sexual intercourse)
- Vulvodynia
- Sexual arousal disorder
- Perineal pain
- Hemorrhoids
- Pelvic congestion
- Orgasmic pain
- Coccyx pain (Coccygodynia)
- Lower back pain
- Hyperventilation
Martyna Kasper-Jędrzejewska
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. Sex Med Rev [Internet]. 12 czerwiec 2021 [cytowane 26 czerwiec 2021]; Dostępne na: https://www.sciencedirect.com/science/article/pii/S2050052121000123
- van Reijn-Baggen DA, Elzevier HW, Pelger RCM, Han-Geurts IJM. Pelvic floor physical therapy in the treatment of chronic anal fissure (PAF-study): Study protocol for a randomized controlled trial. Contemp Clin Trials Commun. 16 listopad 2021;24:100874.
- Karsten MDA, Wekker V, Bakker A, Groen H, Olff M, Hoek A, i in. Sexual function and pelvic floor activity in women: the role of traumatic events and PTSD symptoms. Eur J Psychotraumatology. 11(1):1764246.
- Tim S, Mazur-Bialy AI. The Most Common Functional Disorders and Factors Affecting Female Pelvic Floor. Life Basel Switz. 14 grudzień 2021;11(12):1397.
- Carriere B, Merkel Feldt C, Umphred D. The nervous system and motor learning. W: The Pelvic Floor. 1. wyd. Thieme; 2006. s. 21–33.
