Pelvic Harmony: Treating Overactive Pelvic Floor Muscles

Let’s do a little experiment. Clench your jaw or fist for a few seconds.

How did that feel? Tense? Tight? When prolonged, that’s bound to hurt!

Well, guess what– it’s similar to what your pelvic floor would feel like when overactive.


Overactive or increased tone pelvic floor muscles occur when these muscles are in a constant state of contraction, failing to relax. This continuous contraction can lead to muscle spasms, tension, and pain, similar to any other muscle in the body.

Muscles, including the pelvic floor muscles, are designed to contract and relax. When a muscle remains constantly contracted or tense, it reduces blood flow or ischemia. The build-up of metabolites triggers chemical sensors in the muscles, sending signals to the brain, and prompting attention and action. This persistent tension can result in discomfort and may contribute to issues like pelvic pain or sexual pain.

If a woman experiences myalgia (painful pelvic floor muscles), sexual pain, or pelvic pain, it can perpetuate further muscle spasms in the pelvic floor, leading to increased tension and spasms in these muscles. This creates a self-perpetuating cycle of discomfort and dysfunction.

Remember that overactive muscles tend to be weak muscles because they struggle to work through their full range of motion. To illustrate, consider a bicep curl: starting with the arm straight versus starting at a 90-degree bend. The inability to work through a full range contributes to weakness in the muscles.


  • Pain: period pain, endometriosis, adenomyosis, bladder pain syndromes, cysts on ovaries, injury to pelvis
  • Hypermobile joints
  • Chronic low back or pelvic pain
  • Jobs requiring constant maintenance of ‘good posture,’ such as dancers or gymnasts
  • Excessive pelvic floor exercises without focusing on relaxation
  • Post-gynecological surgery or pelvic floor dysfunction
  • Anxiety or stress
  • History of sexual assault or abuse

The human body is wired to protect itself. When faced with pain or the threat of injury, muscles tighten to provide protection. However, in some cases, the body may continue to maintain this protective response even when the threat is no longer present.


  • Painful intercourse or difficulty with penile penetration
  • Pain with inserting or removing a tampon
  • Pain with a vaginal examination or Pap smear
  • Incomplete bladder or bowel emptying
  • Straining to pee or poo
  • 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 problems. Some of the more common pelvic floor problems 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 spasms 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, it’s important to focus on releasing and letting go. As women’s health physiotherapists, we use the following strategies with my patients:

  • Belly breathing and relaxation techniques
  • Education and biofeedback (real-time ultrasound)
  • Manual therapy techniques, including external and internal myofascial techniques (vaginal and/or rectal)
  • Work on calming the sympathetic nervous system through mindfulness or yoga
  • Stretches (Child’s pose and Happy Baby)
  • Strengthening gluteal muscles as it may offload the pelvic floor muscles

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

  • Flower blossoming
  • Chocolate or butter melting


This is best to discuss with your women’s health physiotherapist to 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 and even better to know that there is hope. Your women’s health physiotherapist is here for you to assess your situation and provide education on what is common, what is normal, and most importantly, the options available to you. 

If you feel like you could benefit from specialised guidance and treatment for your overactive pelvic floor symptoms, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg.

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://www.embracephysio.sg/what-is-a-pelvic-floor-exam/
  2. https://www.embracephysio.sg/could-i-be-suffering-from-overactive-pelvic-floor-muscles/
  3. https://medlineplus.gov/ency/article/003975.htm
  4. https://soptri.com/chronic-pelvic-pain-and-myofscial-release-therapy/
  5. https://www.sydneypelvicclinic.com.au/the-impact-of-overactive-pelvic-floor-muscle-how-to-relax-pelvic-floor-muscle/
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