Overactive Pelvic Floor
Therese Stegley • May 28, 2025
The pelvic floor muscles play a crucial role in supporting your bladder, bowel, and reproductive organs. While much attention is given to strengthening these muscles, it’s just as important to understand when they are
overactive—meaning they have difficulty relaxing or letting go. Overactivity in the pelvic floor can contribute to a wide range of symptoms, often overlooked or misdiagnosed.
What Are Overactive Pelvic Floor Muscles?
Overactive pelvic floor muscles are muscles that remain tense or tight when they should be able to relax. This tension may be constant or triggered by certain activities, positions, or stressors.
Some common causes include:
- Ongoing pelvic, hip, or lower back pain
- Chronic conditions like endometriosis, adenomyosis, or bladder/urethral pain
- Recurrent vaginal infections (e.g., thrush or UTIs) or vulval skin disorders
- Holding stress or anxiety in the abdomen or pelvis
- High-intensity or repetitive exercise
- Past trauma, including childbirth or emotional/sexual experiences
Even athletes or those who do frequent pelvic floor exercises may develop tightness—sometimes without realizing it.
Signs and Symptoms of Overactivity
Symptoms can vary, but people with overactive pelvic floor muscles often report:
Bladder symptoms:
- Difficulty starting urination
- Slow or interrupted urine stream
- A feeling of incomplete emptying
Bowel symptoms:
- Thin or pellet-like stools
- Incomplete evacuation
- Difficulty releasing wind
Intimacy-related symptoms:
- Pain with penetration or deep intercourse
- Discomfort or pain during tampon use or pap smears
- Vaginal burning, aching, spasms, or tenderness
- Difficulty achieving orgasm
These symptoms are not “just in your head”—they are often signs that your pelvic floor may be holding more tension than it should.
Treatment Options
If you suspect your pelvic floor muscles may be overactive, a pelvic health physiotherapist can help. At Pelvic Health Melbourne, our team is trained to assess your pelvic floor function and tailor a treatment plan specific to your needs.
Treatment may include:
- Manual therapy to release tight pelvic floor muscles
- Pelvic floor downtraining and stretches to improve relaxation
- Relaxation techniques like deep breathing, mindfulness, gentle movement, or listening to calming music
- Use of heat packs to reduce muscle tension and pain
We’ll also help you explore lifestyle changes and emotional support to address any underlying contributors to pelvic tension.
You Don’t Have to Live With Discomfort.
If you’re experiencing any of these symptoms, don’t hesitate to seek support. Many people live with pelvic floor dysfunction for years without realising the cause of their discomfort. Early assessment and treatment can make a significant difference.
Book an appointment with our team at Pelvic Health Melbourne and take the first step toward feeling better in your body.
More from the blog
Still leaking when you sneeze, run, jump or laugh years after having children? You might have been told it's "just part of having kids." It may be common, but that doesn't mean you have to live with it. Why does leaking happen after childbirth? Pregnancy and childbirth place significant demands on your pelvic floor. Changes can affect the muscles, connective tissues and the way your pelvic floor works with your breathing and abdominal muscles. You may notice leaking when you: Cough or sneeze Run or jump Exercise Lift something heavy Laugh Suddenly need to empty your bladder But leaking doesn't automatically mean your pelvic floor is simply "weak." Sometimes the issue is strength. Other times it's coordination, timing, muscle tension, bladder habits or how your body manages pressure. "But my kids are years old..." It's never too late to address pelvic floor symptoms. You may have adapted by wearing pads, avoiding running or jumping, crossing your legs when you sneeze, or always finding a toilet before leaving the house. These things can become so normal that you forget they're symptoms. You shouldn't have to organise your life around your bladder. What can help? A pelvic health physiotherapist can assess what's contributing to your leakage and develop a treatment plan based on your symptoms and goals. This may include pelvic floor muscle training, breathing and pressure management, bladder strategies, strengthening and movement retraining. And no — it's not always as simple as "just do more Kegels." The bottom line Having children can explain why your symptoms started. It doesn't mean you have to accept them forever. Whether your youngest is six months old or 16 years old, pelvic floor symptoms are worth assessing. If you're leaking after having children, talk to a pelvic health physiotherapist. You don't have to put up with it.
Finding skid marks in your child's underwear can be frustrating. But before assuming they're being lazy or not wiping properly, there's something important to know: Repeated poo stains can be a sign of constipation. And your child may not be doing it on purpose. How can constipation cause skid marks? When children hold their poo, stool can build up in the rectum. Over time, the rectum can become stretched and less sensitive to the feeling of needing to poo. Softer stool can then leak around the harder stool and into their underwear. This can look like: Brown marks or smears Small amounts of poo in their underwear Strong-smelling underwear Regular accidents despite being toilet trained Your child may genuinely not feel it happening. Why do kids hold their poo? Often, it starts with a painful bowel movement. A child may then become afraid of pooing and start holding it in. You might notice them: Crossing their legs Squeezing their bottom Standing on their tiptoes Hiding when they need to poo Avoiding the toilet Unfortunately, holding on can make the stool harder and larger, creating a cycle of pain → withholding → constipation → leakage. Could the pelvic floor be involved? Yes. To poo comfortably, the pelvic floor needs to relax and coordinate with the bowel and abdominal muscles. Some children have difficulty relaxing these muscles when trying to poo. This can make emptying harder and contribute to constipation and soiling. What can parents and carers do? If your child regularly has skid marks, look for other signs of constipation: Large or hard poos Straining Pain when pooing Tummy aches or bloating Hiding to poo Toilet avoidance Frequent underwear accidents Rather than blaming or shaming your child, speak with your GP or a healthcare professional experienced in children's bowel health. A paediatric pelvic health physiotherapist can assess toileting habits, positioning, pelvic floor coordination and relaxation, and help your child develop more comfortable bowel habits. The Bottom Line Skid marks aren't always a hygiene problem. If they're happening regularly, they may be your child's body's way of telling you they're constipated or struggling to empty their bowel properly. Your child isn't necessarily being lazy—and shame won't fix the problem. If your child is regularly soiling their underwear or struggling with constipation, a paediatric pelvic health physiotherapist can help you work out why and what to do next.
Ever finish urinating and immediately feel like there's still some left? Maybe you find yourself sitting on the toilet for longer, going back for a second wee, or returning to the bathroom shortly after. That feeling of incomplete bladder emptying is common, but it's not something you should automatically ignore. Why might this happen? There are several reasons you might feel like you haven't completely emptied your bladder. Your pelvic floor may not be relaxing properly Your pelvic floor muscles need to relax to allow urine to flow freely. If they're tense or you're unconsciously holding them while trying to wee, the bladder outlet may not open as effectively. This can make it feel like you need to push, wait or try again. You're rushing or hovering Your bladder generally works best when you can sit comfortably, relax and give yourself time to empty. Hovering over the toilet, rushing, or constantly tightening your abdominal or pelvic muscles can make it harder to fully relax. And straining or pushing your urine out isn't usually the answer. Constipation can play a role Your bowel and bladder sit very close together. A full or constipated bowel can put pressure on the bladder and may affect bladder sensation and emptying. You don't necessarily need to be severely constipated for this to have an impact. If you're also experiencing bloating, infrequent bowel movements, hard stools or difficulty fully emptying your bowels, it's worth considering the bowel–bladder connection. Your bladder may be sending confusing signals Sometimes the sensation of incomplete emptying doesn't necessarily mean your bladder is actually full. Bladder irritation, urgency, infection and changes in pelvic floor sensitivity can all affect the way you perceive bladder filling and emptying. This is why the sensation you experience doesn't always tell us exactly what's happening. Should you keep trying to "get the last bit out"? You might find yourself doing a second wee immediately after the first, just to make sure you've completely emptied. Occasionally this is harmless, but repeatedly going back and trying to squeeze out more urine can reinforce the habit of checking your bladder. Instead, try sitting comfortably, relaxing your belly and pelvic floor, and allowing your bladder time to empty without pushing. If you consistently feel unable to empty, however, it's worth getting assessed rather than simply trying harder. When should you get checked? Speak with your GP or pelvic health physiotherapist if you regularly experience: A persistent feeling of incomplete emptying Difficulty starting your urine stream A weak or interrupted stream Needing to strain to urinate Needing to urinate again immediately after finishing Frequent or urgent urination Recurrent urinary tract infections Pain or burning when urinating Difficulty emptying your bladder If you suddenly cannot urinate at all despite having a strong urge, seek urgent medical attention. What can a pelvic health physiotherapist do? Your physiotherapist can look at your bladder habits, bowel function, pelvic floor muscle coordination and how you're actually using your muscles when you urinate. Sometimes the answer isn't to strengthen the pelvic floor — it may be learning how to relax it properly. Treatment may include bladder strategies, pelvic floor relaxation, breathing techniques, bowel management and changes to toileting habits. The Bottom Line Feeling like you haven't fully emptied your bladder doesn't always mean your bladder is the problem. Your pelvic floor, bowel, toileting habits and bladder sensitivity can all play a role. If you're regularly finishing a wee and thinking, "I still need to go," don't just keep pushing or making endless trips back to the toilet. Understanding why you're getting that sensation is the first step towards finding a solution.
Prostate surgery can affect the muscles, nerves and structures that help control your bladder. Urinary leakage is very common in the early weeks and months after surgery, and some men also experience urgency, changes in bladder sensation or sexual difficulties. The good news is that bladder control usually improves significantly with time and the right rehabilitation. Pelvic floor physiotherapy can play an important role in recovery. Why does prostate surgery affect bladder control? The impact depends on the type of surgery and which structures are affected or preserved. Radical prostatectomy During a radical prostatectomy, the prostate is removed. This can affect: · The bladder neck: This normally contributes to urinary control. In some surgeries, it can be preserved. · The external urethral sphincter: After prostate removal, this becomes particularly important for keeping urine in. · The pelvic floor muscles: These muscles support the urethra and help with bladder control. They can become weak, poorly coordinated or, in some cases, overly tight. · Nerves: Nerves involved in bladder and sexual function can be affected during surgery and may take months or longer to recover. · Urethral support: Removing the prostate changes the anatomy and the way the bladder and urethra work together. Surgery for an enlarged prostate (BPH) Procedures such as TURP and TUIP affect the prostate and bladder neck in different ways. The amount of tissue removed and whether the bladder neck is preserved depends on the procedure used. What can you expect after surgery? The first few months Urinary leakage is very common after prostate surgery, particularly after the catheter is removed. Leakage is often worse with coughing, sneezing, lifting, walking or exercise. You may also notice: · Difficulty activating your pelvic floor muscles · Reduced awareness of bladder fullness · Urgency or increased frequency · Pelvic floor tightness or muscle guarding · Changes in sexual function Recovery over time Recovery is different for everyone, but bladder control generally improves significantly during the first 3–6 months. Some men continue to notice improvements beyond 12 months as the pelvic floor muscles and nerves recover and coordination improves. Factors such as age, pre-existing bladder symptoms, prostate size and muscle strength can influence recovery. You may need pads for a while, but needing a pad in the early stages doesn't mean you'll always need one. How can a pelvic health physiotherapist help? A pelvic health physiotherapist can assess how your pelvic floor is working and develop a rehabilitation program specific to you. This may include: · Checking pelvic floor strength, endurance and coordination · Teaching you how to correctly contract and relax your pelvic floor · Bladder training and strategies for urgency · Improving your breathing and muscle coordination during movement · Addressing pelvic floor tightness or pain · Helping you return to exercise and everyday activities · Working alongside your urologist or medical team if further treatment is needed When should you seek help? Consider seeing a pelvic health physiotherapist if you: · Have urinary leakage after your catheter is removed · Are using pads regularly · Have urgency or frequent urination · Have difficulty emptying your bladder · Experience pelvic pain or tension · Are concerned about sexual function · Feel you're not making progress with your exercises Frequently Asked Questions How soon can I start pelvic floor exercises? Pelvic floor exercises can generally begin after your catheter has been removed, once your surgical team says it is appropriate. Don't perform pelvic floor exercises while your catheter is in place. Will I need pads after prostate surgery? Many men use pads during the first few weeks or months. Leakage usually reduces as the pelvic floor and bladder control mechanisms recover. What if my leakage doesn't improve? If leakage continues despite consistent pelvic floor exercises and bladder training, speak with your urologist. Further treatment options may be available, including surgical options for persistent incontinence. Can pelvic floor physiotherapy help with erectile dysfunction? Pelvic floor rehabilitation may support sexual function after prostate surgery, although erectile difficulties can also be related to nerves and blood flow. Your physiotherapist can work alongside your medical team as part of your recovery. The Bottom Line Prostate surgery can temporarily disrupt the muscles and structures responsible for bladder control, but leakage is not something you simply have to put up with. Recovery takes time, and everyone's journey is different. The right pelvic floor exercises, bladder strategies and individualised rehabilitation can help you regain bladder control and confidence after prostate surgery. You don't have to manage it alone. Our pelvic health physiotherapists can assess what's happening, make sure you're doing the right exercises for your body and help you work towards getting back to the things you enjoy.
