How A Pelvic Floor That’s Too Tight Can Cause Incontinence

When most of us think of pelvic floor problems we think about weakened muscles, but too tight muscles can also be a problem – and you don’t have to have had a baby to be at risk of them.

I’ve been writing about health for donkey’s years, so it’s rare for me to discover something I haven’t heard of, especially regarding a problem like stress incontinence that’s so common. However recently my mind was blown when a women’s health physiotherapist mentioned that actually, stress incontinence can be caused by a pelvic floor that’s too tight – not just one that’s too weak.

Officially called a hypertonic pelvic floor, in the problem the muscles that normally contract and relax to control the flow of urine don’t work properly.

With a tight pelvic floor the muscles are constantly contracted, this means when they need to tighten quickly to stop the flow of urine when you laugh, sneeze or pick something up they can’t respond effectively and you leak,’ says women’s health physiotherapist Samantha Cattach from Body and Birth Physiotherapy.

Even experts don’t know exactly how many women with stress incontinence it affects, but Cattach says it’s a large number of those she sees. ‘And I’m also seeing it in younger women like those in their twenties who haven’t had children yet.’

The reason for this is that while a weakened pelvic floor tends to be caused by damage to the muscle during childbirth or weakening that happens as part of ageing, a tight pelvic floor can be caused by having kids, but also by muscle tension caused by chronic stress, by over-enthusiastic kegels or by inactivity. ‘We don’t put our body in positions like a low squat that stretch the pelvic floor much anymore which causes it to tighten,’ says Cattach.

One problem with a hypertonic pelvic floor is that it’s not that obvious that you’ve got one. As such, many women keep doing tightening and toning exercises which not only don’t make any difference to their symptoms, they actually compound things. ‘There are some very subtle differences in symptoms though,’ says Cattach.

‘A tight pelvic floor often causes pelvic pain as well as leaking urine. Some women can also actually feel that they can tighten their internal muscles okay but don’t feel them relax afterwards.’ The only way to get an accurate diagnosis of the problem therefore is an assessment by a qualified women’s health physiotherapist who can test exactly how the muscles respond. The good news is, if the problem is found, stretching and releasing the muscles can help counteract it.