Overactive pelvic floor. Many Australians have never even heard of it but some have it without even knowing, or confuse the symptoms for another condition.
We asked three experts about the signs of overactive pelvic floor and how it's treated.
Plus, why more women may be experiencing it during the COVID-19 pandemic, according to one pelvic floor physiotherapist.
What is an overactive pelvic floor?
Also known as 'tight' or 'hypertonic' pelvic floor, overactive pelvic floor is "a very common problem that people don't talk about", says Dr Chin Yong, a Melbourne-based urogynaecology and pelvic floor reconstruction surgeon.
An overactive pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. This can lead to pelvic pain, as well as other symptoms.
The symptoms can mirror those of weak pelvic floor
Confusingly, the symptoms can overlap with those of weak pelvic floor, says Shan Morrison, a specialist pelvic health physiotherapist and founder of a Melbourne-based physiotherapy practice.
"If they've got incontinence most people think they've got a weak pelvic floor, but that's not always the case."
Both overactive and weak pelvic floor can involve regularly feeling the urgent need to wee, as well as bladder leakage.
But if you also experience pelvic pain - which can include urethral, vaginal, rectal, or lower abdominal pain - or pain during sex or while inserting a tampon, you may be looking at overactive pelvic floor, our experts say.
Other symptoms include problems releasing your bladder or bowels, such as straining during a bowel movement or incomplete emptying of the bladder.
Sound familiar? Think twice before self-diagnosing, and find a professional who can examine you instead: "The only way to tell is by having a proper assessment clinically," says Dr Yong.
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Anyone can experience overactive pelvic floor, but often presents with other issues
Anyone can get overactive pelvic floor at any age but some people can be more prone to it than others, says Angela James, a physiotherapist who specialises in pelvic health and is founder of a Sydney pelvic clinic.
She says these include athletes who tense their core muscles a lot and people who have experienced trauma (including sexual and childbirth trauma).
"And if you've got really strong religious beliefs about, say, sex before marriage ... and you've got really little understanding about sexual anatomy, that can lead to a heightened protective response" causing pain when you have sex, Ms James adds.
Patients don't normally present with overactive pelvic floor on its own, Dr Yong says: "Overactive pelvic floor is a generally by-product of a clinical condition ... such as bladder pain syndrome."
People with endometriosis also commonly experience overactive pelvic floor, adds Ms Morrison.
"It's almost impossible to have something like endo and not have pelvic floor tension ... because you've been in cyclical pain forever," she says.
Similarly, irritable bowel syndrome can result in pelvic floor muscle pain and cramping.
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Stress and anxiety (including COVID-related anxiety) can contribute
People with anxiety can also be prone to overactive pelvic floor, and stress can make the condition worse, our experts say.
"What we know is certainly stress and anxiety, which I've seen a huge increase in my patients since COVID began, has a big impact on conditions in the pelvis," says Ms Morrison.
She says she has "absolutely, without a doubt" seen an increase in patients presenting with symptoms of overactive pelvic floor over the last year or two, since the pandemic began.
"It's about the link between the mind and the body. And I think it manifests when people are stressed and anxious; they often really hold their tension in that area."
The good news: it's treatable
Overactive pelvic floor isn't a problem you just have to live with: It's actually "very treatable", says Ms Morrison.
Treatment by a pelvic floor physio often involves education, which means "helping people understand what their pelvic floor is doing, and how that's leading to their problem" as well as talking about bladder and bowel habits, says Ms Morrison.
"For a lot of people there's a lightbulb moment. Patients say, 'Well, I had no idea I was doing this but now you've explained it to me I totally understand it.'"
Treatment can also involve teaching the patient breathing or relaxation exercises, says Ms James. Sometimes an ultrasound will be used for biofeedback while the physio is teaching you to relax the pelvic floor muscles.
For patients experiencing pain during sex, sometimes dilation therapy will be appropriate: "That is using graded sized dilators to gently stretch out" the muscles in the area, says Ms James.
A doctor may also refer you to other specialists to treat associated problems: For example, Dr Yong often works in tandem with a physiotherapist, as well as a pain clinic.
If a patient's symptoms are bowel-related, Dr Yong will often refer the patient to a colorectal surgeon.
Patients may also need to see a clinical psychologist to manage stress or anxiety exacerbating the issue.
Beware of relying on Kegel exercises
Ms Morrison also sees a lot of patients who have been diligently doing pelvic floor exercises known as Kegels every day for years, and they're stunned to hear that won't prevent or cure their overactive pelvic floor.
"If you were focusing on Kegels and just focusing on trying to tighten and strengthen them, then yes, that would make your problem worse," says Ms Morrison.
If you have an overactive pelvic floor, as part of your treatment your physio may still teach you to do a Kegels-like exercise - but only so you can learn how to relax from that contracted position.
"We will still teach them to activate their pelvic floor. But the focus isn't on doing it really strong and really hard and holding it - the focus is on relaxing the pelvic floor," says Ms Morrison.This article contains general information only. You should consider obtaining independent medical advice in relation to your particular circumstances.
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