How to treat Overactive Pelvic Floor muscles

Imagine if you clenched your hand or jaw muscles for a long period of time…how would that feel to you?


Overactive (otherwise known as hypertonic) pelvic floor muscles occur when the pelvic floor muscles are constantly working (contracted) and they do not relax. When the pelvic floor muscles fail to relax, they can create muscle spasms and tension and they can become painful just like any other muscle in our body.

Muscles (all muscles) are designed to contract and relax. When a muscle is constantly contracted or holds tension, this reduces blood flow to the muscles and causes ischemia. There is a build up of metabolites and these set off the chemical sensors in your muscles that send signals to your brain to draw your attention to do something about it.

If a woman experiences painful pelvic floor muscles, sexual pain or pelvic pain, then this can
create further muscle spasm in the pelvic floor and lead to further tension and spasm in the pelvic floor muscles. It’s a self-perpetuating cycle.

Also to note: overactive muscles tend to be weak muscles as they are unable to work through range. Think about a bicep curl starting with your arm straight vs. starting at 90degree bent.


Overactive pelvic floor muscles can be caused by a number of reasons and some of these may include:

  • Pain e.g. period pain, bladder pain syndromes, cysts on ovaries, injury to pelvis
  • Hypermobile joints
  • Chronic low back or pelvic pain.
  • Dancers or gymnasts that are constantly required to maintain ‘good posture’.
  • Women who complete too many pelvic floor exercises without focusing on the ‘letting go’.
  • Post-gynaecological surgery or women with pelvic floor dysfunction.
  • Anxiety or stress
  • Sexual assault or abuse

Ultimately, as humans we are hardwired to protect. If we suffer from pain/discomfort or there is a threat of injury, our muscles will protect us. But happens if the the reason to protect is no longer there, but our body still thinks it needs to be protected?


Some of the common symptoms of overactive pelvic floor muscles include:

  • Painful intercourse
  • Pain with inserting or removing a tampon
  • Pain with a vaginal examination or Pap smear
  • Incomplete bladder or bowel emptying
  • Pelvic Pain
  • Difficulty feeling the relaxation or letting go of the pelvic floor muscles


Overactive pelvic floor muscles can cause a range of pelvic floor problem. Some of the more common pelvic floor problems caused by overactive and spasmed muscles include:

Bladder changes:

  • Slow flow
  • Difficulty initiating the flow
  • Incomplete bladder emptying
  • Recurrent Urinary Tract Infections
  • Urinary incontinence
  • Urgency

Bowel changes:

  • Constipation
  • Difficulty evacuating the bowels
  • Difficulty initiating bowel movement
  • Straining to empty bowels. This can cause pain and can result in spasm of the pelvic floor muscles and increased tension.

Sexual changes:

  • Pain on deep penetration
  • Pain at the vaginal entrance
  • Inability to achieve penetration
  • Inability to have an orgasm
  • Abdominal and pelvic pain
  • Vaginal aching


If you have overactive pelvic floor muscles, you need to focus on the release and let go of your pelvic floor muscles. It’s a top down approach…It’s about understanding what the body is protecting you from or understanding unhelpful habits and working from there. As a Women’s Health Physiotherapist I commonly use the following strategies with my patients:

  • Belly breathing and relaxation techniques
  • Education and biofeedback (eg. real-time ultrasound)
  • Manual therapy techniques including external and internal (ie. vaginal and/or rectal) myo-fascial techniques
  • Work on calming the sympathetic nervous system, e.g. mindfulness or yoga
  • Stretches (I like Childs pose and Happy Baby)
  • Sometimes strengthening gluteal muscles is indicated to offload the pelvic floor muscles.

Some visualisations I use in the clinic to help patients connect with their muscles to let go include:

  • Flower blossoming
  • Chocolate or butter melting


If you suffer from any of the symptoms or consequences outlined above, book an appointment with your Women’s Health Physio for a pelvic floor exam. Working with your Physiotherapist, we will identify the most optimal strategy to help you down-train your pelvic floor muscles.

It’s good to know when things are common vs normal. It’s good to know that you don’t have to live with it. Your Women’s Health Physiotherapist is well placed to help assess and educate you on what’s common, normal and what your options are for management.

If you feel like you could benefit from specialised guidance and treatment for your overactive pelvic floor symptoms, reach out by calling/whatsapp 9780 7274 or email help@embracephysio.sg.

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I had a great experience at Embrace physiotherapy with Dr Preet. I started my journey the last trimester of my pregnancy to assess my pelvic floor strength and relaxation level. Dr Preet helped me go through until the end of my pregnancy with exercise plan for the pelvic floor, my hips and quads. My delivery went very smoothly and I am lucky to not have tear or abs separation. I went back after delivery to strengthen back my pelvic floor and got discharge with the chance to fully get back to my usual sport practice. Dr Preet has been wonderful. She listens to your needs carefully and take the time to evaluate your body range of movement. It was also nice to feel understood and share experience as a new mother.

Meggie CL Avatar Meggie CL
April 29, 2022

Preet and her team have been helping me to improve my core strength since the birth of my second child last year. I cannot recommend them more highly for the professional and warm service provided. Preet is highly knowledgeable and competent in post-partum recovery.

Stephanie Krebs Avatar Stephanie Krebs
June 7, 2023

Highly recommend Embrace for women's PT. I saw Preet after the birth of my son and she took very good care of me, helping me to build my strength back. All the staff are lovely, I had a great experience.

Katherine Lobo Avatar Katherine Lobo
July 13, 2022

Embrace life. Embrace Physiotherapy.

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