We want to optimise pelvic floor function. So, we’re looking at improving that relaxation in the pelvic floor muscles and that flexibility of the pelvic floor muscles, so there should be some movement in the pelvic floor muscles. There should- there should be some lift when you’re doing a pelvic floor squeeze. There should be a relax and let go and like we said the muscles should tolerate some degree of stretch. So, we want that movement and flexibility through the pelvic floor. So, how do we sort of work on that? So, we work on that with breath work. So, there’s a really important connection between the diaphragm and breathing and the pelvic floor. So, we might just start with looking at how someone’s breathing and particularly with a type of breathing called diaphragmatic breathing. So that would be one thing we would start with often quite early. We might look at some pelvic floor exercises, but not at a squeezing, holding, look at strengthening that squeeze, but really optimising how the let go is. So, looking at a gentle squeeze perhaps, but then a really good sort of let go. So, we might look at some pelvic floor exercises but there’s going to be a different focus to if we were doing strength work with someone.

So that’s what we might be looking at from an exercise point of view, as well as sometime other general stretches that we might look at. We might look at progressing to something, some work with vaginal dilators, potentially. So, a vaginal dilator is a small device, something similar to, looks like, so there’s different sizes and we might be starting with something that just is literally the size of a finger. It could be a kind of soft, flexible silicone or a harder, rigid plastic. And we might start doing some work with the vaginal dilators to look at using them to help some gentle stretch to vaginal tissues and to the pelvic floor muscles. So, it might be something that is inserted into the vagina to gently stretch. And that might gradually progress in terms of the size of the dilator, and that’s something that we might use to really work towards being able to manage penetration for example. So that’s another option and I think the main thing is that you’re always looking at a really individualised program.

But there are other things that might form a part of a program for managing over-active and hypertonic pelvic floor. There might be sort of talking therapy that’s involved, so you might see someone else to sort of look at exploring other reasons why that you might have these symptoms. Sometimes it might be to do also with the condition of the vaginal tissues, so for example in someone post-menopause, they can have slightly thinner, dryer vaginal tissues and they might look at using some vaginal oestrogen. So, there’s definitely other aspects as well. But from an exercise science point of view, we would certainly you know start with looking at breath work and that pelvic floor relaxation and that pelvic floor flexibility.

The main thing to remember with the idea of hypertonic or over-active pelvic floor is that your pelvic floor muscles, like any other muscles in your body, so like your biceps or triceps or hamstrings, should be able to sort of squeeze and pull up, hold, and relax and let go, and also tolerate some degree of sort of gentle stress. And that should all be sort of comfortable. So, with hypertonic or over-active pelvic floor it tends to be that the muscles are held in more of a tense position and we’re not getting that relax and let go. That might be that you’re tending just to hold tension in the pelvic floor almost all of the time. Or it might be that your pelvic floor muscles sort of involuntarily tense or contract in response to some sort of- so for example in to penetration sort of with the vagina so that could be with intercourse, it could be with trying to insert a tampon, it might be with a smear test. So, you’re not sort of in control of that, your pelvic floor muscles are just tensing with that sort of penetration. But like I said it could be just that you’re holding these muscles in some sort of tension almost all of the time. And again, that’s not something that you’re necessarily in control of or aware of.

So, muscles that are tensing all the time can become painful. the way that might sort of manifest when it comes to sort of the pelvic floor muscles is that things like intercourse might become painful, you might struggle to insert a tampon or that might be painful. Like we said things like smear tests could be painful. But also, things like emptying your bowels. So, to be able to effectively empty your bowels, your pelvic floor muscles need to relax, and we want that sort of gentle degree of stretch in the pelvic floor muscles. So, you might struggle to empty your bowels, you might feel that you need to really push or strain to empty your bowels, you might feel that you can’t completely empty your bowels. So, all of those are potential signs that can be associated with that hypertonic or over-active pelvic floor.

We would always offer someone an examination of the pelvic floor, which is that vaginal examination that we sort of previously discussed. So, if someone sort of consented to that examination I might be able to get that information, so particularly by the sort of palpation, so inserting a finger into the vagina if it’s comfortable, if they can tolerate that, might give me an idea of whether there is that tension and-, tension in the pelvic floor, and if that palpation of the pelvic floor muscles is painful or uncomfortable.