Symptoms of a Hypertonic Pelvic Floor Follow Up Q&A

In Female Pelvic Pain, Male Pelvic Pain, Pelvic Health, Pelvic Pain by Stephanie PrendergastLeave a Comment

By Stephanie Prendergast, MPT, Cofounder, PHRC West Los Angeles

A while back we asked you for your questions about having a hypertonic pelvic floor. This week we answer all your questions and then some!


Q- Hi! I have really tight pelvic floor muscles and pain during sex and I was wondering if you might be able to suggest any pelvic relaxation exercises please? Thank you!!


A- Please check out our Pelvic Floor Relaxation Exercises on YouTube.


Q-I have a hypertonic pelvic floor & saw someone comment “the hip pain” on your post. Mine is terrible! Could you share the resource you were referring to with me please?


A- Hip pain is common in people with pelvic floor disorders for several reasons. Here are a few: the obturator internus muscle is an external rotator of the hip and can be a source of hip pain. A separate reason, but one that can coexist with OI dysfunction, is that the pelvic floor muscles are part of our core. If they are tight they may not be supporting us as they should and injuries in the neighboring joint can result. Many studies are now linking the pelvic floor to low back and pelvic girdle pain, including this wonderful study.


Q-Hi, just seen your post about endometriosis. Out of interest can endometriosis symptoms get better over time with no treatment? I had terrible period pains, all in the lower back as a teenager but in my 20’s particularly after starting the contraceptive pill the pains decreased in severity. I was told as a teenager that it might be endo, never got a proper diagnosis though.


A- Generally dysmenorrhea (painful periods) can be a symptom of endometriosis. Typically the disease does not improve without treatment. It is important to note that oral contraceptives do not TREAT endometriosis but may reduce the symptom of dysmenorrhea while you are taking them. Currently the only way to diagnose endometriosis is through a biopsy during surgery. However, people often start other treatments for overlapping symptoms while they are trying to decide if surgery is a choice for them. In addition to endometriosis excision specialists we suggest working with a pelvic floor physical therapist, a GI doctor and integrative health providers if SIBO and/or H.Pylori are present, a psychologist as the symptoms of endometriosis can take a toll on our mental health, and a pain management physician also can offer help with the symptoms. 


Q-I’m surprised anal pain isn’t mentioned. Is it related to hypertonic pelvic floor? Or not…? 


A-  Anal pain can be a symptom of pelvic floor dysfunction. Anal pain can also come from hemorrhoids or fissures, which can also be associated with pelvic floor dysfunction. Anal pain can also be a sign of pudendal neuralgia.


Q-Does Botox procedures hinder chances of getting pregnant?


A-  To my knowledge there are no studies suggesting botox hinders chances of getting pregnant.


Q-I am curious to learn more about hip pain. I have a hip that gives me more trouble than the other and also a feeling of a really tight nerve on the inside of that leg, in the hip/groin as well.


A- If you have not yet seen a pelvic floor PT this may be a good place to start! Pelvic floor PTs use soft tissue techniques, internally and externally, that may not be used by orthopedic PTs. The soft tissue structures (pelvic floor and girdle muscles, tissues, and nerves) can cause as much trouble as the joint itself. 


symptoms of a hypertonic pelvic floor part 2


Q- Does that include piriformis, obturator internus, SI Joint pain?


A-The piriformis and OI muscles are part of the pelvic floor and are usually painful if the Levator Ani muscles are painful too. These muscles are also commonly associated with SI joint pain. The good news is pelvic floor physical therapy can help with all of it!


Q-After an internal work at a pfpt session my lower back and my tailbone start killing me. My pt hasn’t really acknowledged it. What can I do? She said today when starting the internal exam that it wasn’t super tight. I’m worse at night. But even if I’m not super tight I’m still in pain.


A- Unfortunately flares can happen, and when they do they should not last more than a few days. We have a blog that discusses what to do when in a flare. Remember to listen to your body as you work through it, as not everyone responds the same way when handling a flare. It may also be helpful to get a second opinion with a different pelvic floor PT.


Q- Can this lead to vaginismus? Or is this the cause of vaginismus?


A- Pelvic floor hypertonus is a common impairment in women with vaginismus, which basically just means ‘pelvic floor tightness’. We have a handful of blogs about vaginismus if you would like to read more.



Didn’t see your question answered? Have follow up questions to this blog? Drop them in the comments and we would be happy to answer them!


Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

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