Hypertonic Pelvic Floor Dysfunction

Pelvic Floor Dysfunction is due to hypertonic musculature (or tight muscles) of the pelvic floor. The floor or bottom of the pelvic area is a bowl-shaped web of striated muscle, connective tissue, ligaments, and bone through which nerves and veins pass to the hips and lower extremities. Normally, the pelvic floor needs to relax to allow for proper urination, defecation, and sexual arousal and orgasm, while at the same time it contracts to support the internal organs. This complex, opposing function can create a myriad of symptoms if it does not function properly.

When the muscles of the pelvic floor are hypertonic, or too tight, a range of acute or chronic symptoms can occur. Pelvic floor dysfunction only involves the posterior (or lower half) pelvic floor muscles. Some of those symptoms include pressure or heaviness in the pelvic area, difficulty with urinating or evacuating stool, constipation, sexual pain, lower back pain, tailbone pain, or achy, radiating thigh pain. The early onset of symptoms is slow and subtle, gradually increasing over time as the tension increases in the pelvic floor, reaching a point where quality of life is impacted.

The pelvic floor’s muscular tension can increase after childbirth and menopause, due to physical stressors or hormonal changes; it can also increase due to conditions such as vulvodynia, endometriosis, IBS, interstitial cystitis, or painful bladder syndrome; or, it can result from physical conditions such as poor posture, prolonged sitting, uneven hips, misaligned pelvis, or other skeletal asymmetries. There is also a relationship between emotional, physical, or sexual abuse and chronic pelvic pain. The direct cause is usually not known.

Most gynecological exams miss the correct diagnosis because the traditional exam does not check the tone of the pelvic floor muscles. Symptoms of pelvic pain are a common complaint with many possible causes, which can frequently lead to surgical intervention such as hysterectomies and laparoscopies. Unfortunately, some patients’ pain persists after the surgery because of the misdiagnosis.

One patient explains, “I lived with painful sex for years. My legs and my back often hurt and I couldn’t do the things I used to enjoy. I assumed that I was just out of shape and that this was normal for women over 40. When Dr. Williams explained to me that it was hypertonic pelvic floor dysfunction, I was relieved and excited to know that I could get my life back. ”

Treatment for Pelvic Floor Dysfunction might include physical therapy, pharmaceuticals, or psychotherapy if there is a history of emotional or physical abuse. Physical therapy can involve trigger point massage, soft-tissue manipulation, manual stretching, core strengthening, and skeletal realignment, while pharmaceuticals might include muscle relaxers. Treatments are highly successful, with most women getting back to a pain-free, high quality of life.

Dr. Katherine Williams specializes in diagnosing and treating complex pelvic and vulvar disorders, including Pelvic Floor Dysfunction. She founded the Southern Institute for Women’s Sexual Health (SIWSH) with locations in New Orleans and Covington, LA to specifically help women with pelvic pain that was not being properly diagnosed. She earned her fellowship from the International Society for the Study of Women’s Sexual Health, making her uniquely qualified to diagnose and treat these patients. SIWSH is the only clinic specializing in women’s sexual health in the southern region of the United States with patients coming to her from across the country for treatment. 

Hypertonic pelvic floor is a stressful condition that can affect women in all stages of life. It can profoundly affect normal body function and quality of life. With the proper treatment, successful remediation of symptoms is highly likely. Women need to be educated on how to relax hypertonic muscles so that they can begin to relax the muscles and prevent further dysfunction. If you think you might be suffering from Pelvic Floor Dysfunction, please contact SIWHS at (985) 871-0707 or info@siwsh.com.



1. Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am. 2009;36(3):707-722 

2. Prather H, Spitznagle TM, Dugan SA. Recognizing and treating pelvic pain and pelvic floor dysfunction. Phys Med Rehabil Clin N Am. 2007;18(3):477-496, ix.

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