Overcoming Overactivity: Could I Have Overactive Pelvic Floor Muscles?

Overactive pelvic floor muscles are muscles that struggle to relax or release tension. These muscles maintain a level of tension considered above normal, categorised as either neurogenic or non-neurogenic in origin. Diagnosing overactive pelvic floor muscles can be challenging, given the limited awareness of their role in symptoms, especially when there are changes in bladder or bowel function.


Overactive pelvic floor muscles, also known as increased tone pelvic floor muscles, are characterised by muscles that struggle to relax or release tension or display an increase in resting tone. The term ‘increased tone’ is in line with the updated pelvic floor dysfunction terminology (Frawley et al. 2021).


Patients will often describe difficulty in feeling the contraction and/or relaxation of pelvic floor muscles.

Symptoms of this can be challenging to differentiate from those of weak pelvic floor muscles. A pelvic floor examination is a must and is performed to determine whether increased tone pelvic floor muscles contribute to your symptoms, which may include:

  • Urinary incontinence
  • Urinary urgency
  • Frequent urination
  • Incomplete emptying of the bladder
  • Slow flow of urine
  • Hesitancy or delayed start of the urine stream
  • Painful urination
  • Constipation
  • Incomplete emptying of the bowels
  • Straining when emptying the bowels
  • Pelvic pain
  • Low back pain
  • Hip pain
  • Coccyx pain
  • Dyspareunia or painful sex
  • Vaginismus
  • Pain with tampons or Pap smears


Tight pelvic floor muscles, also increased tone pelvic floor muscles, can result from various factors. While there isn’t one single cause, it is often observed in people who:


  • Hold their tummy in throughout the day. This is something I commonly observe in postpartum mummies or persons with pain as a protection mechanism.
  • Ignore the urge to urinate and defecate constantly or feel uncomfortable using public toilets, leading to prolonged periods of holding it in.
  • Have high levels of stress or fear, as tension can manifest in the pelvic floor muscles just like headaches, neck, or jaw pain when stressed.
  • Have inflammation or infections, such as a urinary tract infection.
  • Endure birth trauma, such as a levator ani injury, perineal tears, or episiotomy.
  • Undergo abdominal or pelvic surgery such as a hysterectomy, causing scar tissue formation.
  • Suffer from conditions like irritable bowel syndrome, endometriosis, adenomyosis, or interstitial cystitis, creating a cycle of pain and tension.
  • Have hypermobility in the hips, resulting in pelvic floor compensation.
  • Experience pelvic trauma, such as a fall onto the buttocks, or a history of sexual abuse.


If you suspect you have overactive pelvic floor muscles, it’s advisable to schedule an appointment with a women’s health physiotherapist. A detailed history will be essential to identify contributing factors to your symptoms. The gold standard for assessment is a pelvic or rectal exam, although there are instances where it may not be appropriate. Click here to learn more about our techniques.


Symptom resolution potential exists, but it’s best determined on a case-by-case basis, considering your personal experience. To achieve treatment and outcomes that matter to you, a comprehensive discussion is necessary, delving into factors within and beyond the pelvis. Stretching muscles may not be effective if the underlying issue stems from day-to-day movement patterns causing tightness.

If you would like to know whether overactive pelvic floor muscles are contributing to your symptoms, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg and let’s talk about how we can help you.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as individual medical advice.


  1. https://pubmed.ncbi.nlm.nih.gov/27037746/
  2. https://www.embracephysio.sg/what-is-a-pelvic-floor-exam
  3. https://www.embracephysio.sg/recurrent-urinary-tract-infection-ruti-how-womens-health-physio-can-help/
  4. https://www.embracephysio.sg/what-is-a-perineal-tear-and-episiotomy/
  5. https://www.embracephysio.sg/what-is-a-hysterectomy/
  6. https://www.embracephysio.sg/what-is-interstitial-cystitis-or-bladder-pain-syndrome/
  7. https://www.embracephysio.sg/what-is-a-pelvic-floor-exam/
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Years ago, I approached doctors and gynaecologists to find out why penetration was so difficult for me and how to resolve it, but they couldn't understand that it was a problem, possibly because I was young, not married and without children. I later heard about vaginismus, but didn't know what to do about it since I had already approached doctors. In late 2022 I found out from Embrace's social media page that women's health physiotherapy existed, and made an appointment. I worked with Brenda, then Preet. They were able to identify the different muscle groups in my pelvic area, and tell me what exercises I can use to release the tension. I was able to progress from an initial zero-tolerance to touch at the entrance, to the ability to self-insert a 3cm width dilator without issues. My body awareness has increased a lot, and a large mental block about sex and post-pregnancy recovery has cleared. I strongly encourage women facing similar issues to find out if women's health physiotherapy can help you too.

Fresna Lin Avatar Fresna Lin
February 11, 2024

Preet is amazing! Took a thorough history, and helped me so much. She is calming, reassuring and I loved the holistic approach she took 🙂

Natasha Cullen Avatar Natasha Cullen
November 23, 2023

I saw Preet throughout my pregnancy and postnatal period. She is the BEST. She saved my body and provides free emotional support whole she's at it. Preet obviously knows what she's doing and could identify the root source of the pain and assigned exercises to address it. She also doesn't make you feel bad if you fail to do them. I highly, highly recommend Embrace.

Jana Shih Avatar Jana Shih
December 15, 2023

Embrace life. Embrace Physiotherapy.

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