Before going any further, let's break down what it means to use terms like "too loose" and "too tight" when describing these muscles. "In the case of the pelvic floor, if your muscles lack flexibility, we may also refer to these muscles as overactive or nonrelaxing," says Dr. Jeffcoat. In other words: We may experience "nonrelaxing" pelvic floor muscles as tense or tight, but that doesn't necessarily mean they're strong. In fact, Dr. Jeffcoat says that tight pelvic floor muscles can contribute to weakness overall. The complicated nature of this muscle group is why it's so important to talk to a doctor about your symptoms.
The exact reasons for pelvic floor tightness aren't very well understood. Some causes of pelvic floor tightness include psychological factors like stress, holding your pee when you have to go, or co-occurring conditions like vaginismus, according to the Cleveland Clinic. A few tell-tale signs include constipation, straining when you poop, painful penetrative sex, difficulty reaching orgasm, strong urges to pee, increased urinary frequency, urinary incontinence, painful tampon insertion, painful orgasm, and vulvar pain, Dr. Jeffcoat explains. However, sometimes, people who have a tight pelvic floor don't experience any symptoms.
On the other hand, loose or lengthened pelvic floor muscles have different symptoms and causes. Traumas to the region, like pregnancy and childbirth, are common culprits. "During delivery, there may be tearing of pelvic floor muscles and fascial structures that can lead to laxity (looseness)," Dr. Jeffcoat says. Some symptoms of a loose pelvic floor include urinary incontinence, bowel incontinence, and pelvic organ prolapse. Additionally, tightness and looseness can co-occur in the pelvic floor (so, as we mentioned, it's essential to talk with your provider about these symptoms).
Many people with pelvic floor dysfunction might assume the solution is more Kegels after a cursory search online, but these muscles ultimately need more individualized care. Dr. Jeffcoat shares that treatment for your pelvic floor can include a mix of manual therapy like massage and bodywork outside or inside the affected areas like the vagina or rectum. It might also include joint mobility, general muscle strength, and pelvic floor stretches, she says. The nature of treatment requires trust in your provider, which is why she stresses the importance of finding a licensed and attentive provider.
The pelvic floor is a part of so many bodily functions. It's so important to feel like you have agency over areas of your life, like going to the bathroom and sexual health. Additionally, these areas can be hard to talk about with loved ones or doctors because of the intimacy involved. Just remember that there's nothing wrong with advocating for yourself and getting help to address symptoms that concern you. If you're experiencing pelvic floor tightness or dysfunction, you are not alone. Learning more about what is going on in your body is an important part of figuring out your next steps.
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