Written by the Endometriosis Australia Clinical Advisory Committee
Somewhere in your endo journey you may have been told that your pelvic floor muscles are overactive or even in spasm. The pelvic floor muscles comprise of deep and superficial layers and are an incredible set of muscles. The deep pelvic floor muscles attach from the pubic bone to the tailbone in a sling like shape about 3cm above the level of entrance of your vagina. You also have pelvic wall muscles that sit in front of the bladder and attach outwards onto your hip bones. The superficial layers of the pelvic floor lie closer to the entrance of the bladder, vagina and rectum. When functioning well these muscles generate core strength, support our organs to prevent prolapse, stop bladder and bowel leaks and add to sexual function. Most people understand the consequences of a weak pelvic floor, but it is common with longstanding pelvic pain that these muscles can become overactive, short and tight: instead of a sling shape they can become a tight stiff band that pulls through the pelvis.
How do the muscles get tight with endo?
One of the main symptoms of endometriosis is pain, and when you are in pain its common for your muscles to tighten in response. If your pain is every month with your period (or more than this!) your muscles get very good at clenching and it can get to the point where you don’t even realise you are holding them in a tight position any more. The pelvic floor then loses its ability to contract and relax properly.
In addition the structures in our pelvis are all really close together, and often share the same nerve pathways. This means that if an organ is irritated by endometriosis (e.g. your bladder) it can cause inflammation, hypersensitivity and overactivity in some of the pelvic muscles innervated by the same nerve pathway. This phenomenon is called viscero-somatic convergence. There is suggestion that the reverse can also happen, where irritation of the pelvic muscles can cause further irritation to the organs (called somato-visceral convergence).
Common symptoms of an overactive pelvic floor can include;
- Abdominal pain
- Back pain
- Groin pain
- Constipation, pain emptying your bowels (dyschezia) or incomplete evacuation of your bowels.
- Difficulty using tampons
- Pain during or after intercourse
- Slow flow and/or discomfort with urination
What to do if you suspect you have overactive pelvic floor muscles
Seeing a pelvic floor physiotherapist who specialises in pelvic pain is an excellent first step in managing an overactive pelvic floor. An important part of your treatment will be for you to regain control of your pelvic muscles so they can get back their full range of motion of contract, relax and gentle bulge for bowel emptying. Physiotherapy treatment options for overactive pelvic floor muscles are varied and dependent on your symptoms, but could include a combination of:
- Desensitisation of the nervous system with movement, manual therapy and breathing exercises
- Relaxation and stretching of the pelvic floor muscles
- Using feedback devices to help you relax your pelvic floor (e.g. EMG biofeedback or real time ultrasound)
- Dilator therapy
- Postural adjustments for bladder and bowel emptying.
No treatment is the same as your physio will treat your symptoms and address the underlying changes that have occurred in the pelvis. Your treatment plan will be developed to help you achieve your goals for an active and involved life.
Alexandra Diggles and Ruth Schubert, physiotherapists