What’s the Difference Between a Hypertonic and Hypotonic Pelvic Floor?

    August 10, 2022

    There are many reasons why you might be experiencing issues with your pelvic floor. You might have symptoms that are mild and annoying, or you might have gotten to the point where your symptoms are interfering with your daily life.

    In this post, we’re going to outline what the pelvic floor is, the differences between a hypertonic and hypotonic pelvic floor, and why it’s important to get appropriate treatment for both conditions.


    Your pelvic floor muscles are a group of muscles that stretch from the tailbone to the pubic bone at the front and between the sitz bones from one side to the other. They act as a hammock, providing support for your pelvic organs.

    One way to feel your pelvic floor is to imagine picking up a cherry with your vagina (if you have one) – you’d be using your pelvic floor muscles to do that!


    A hypertonic pelvic floor occurs when your pelvic muscles are too tight or tense and can’t relax. Hypertonic pelvic floor is also known as pelvic floor tightness or hypertonicity. Signs and symptoms of a hypertonic floor include:

    • urge or overflow urinary incontinence – impacting frequency (having to pee often), urgency (a sudden, strong need to pee), or hesitancy (having trouble starting the stream or keeping it going)
    • painful urination
    • incomplete emptying of the bladder
    • constipation or straining during bowel movements
    • pain during or after bowel movements
    • unexplained pain in your low back, pelvic region, hips, genital area, or rectum
    •  pain during or after sexual intercourse (dyspareunia), sexual stimulation, orgasms, or vaginal penetration
    • uncoordinated muscle contractions causing the pelvic floor muscles to spasm


    There isn’t one single reason or cause for a hypertonic pelvic floor. However, some contributing activities or conditions that have been linked to pelvic floor hypertonicity include:

    • repeatedly holding your urine or feces for long periods
    • tensing the core muscles in workouts
    • sexual trauma
    • high levels of stress or anxiety that might cause you to frequently tense your pelvic floor
    • chronic pain caused by endometriosis or irritable bowel syndrome (IBS) that can cause you to tense your pelvic floor muscles
    • conditions like interstitial cystitis, pudendal neuralgia, or vulvodynia
    • birth trauma, including scarring or one-sided pelvic floor tears
    • cancer treatments, such as internal and external radiation
    • surgeries to the pelvic area

    It’s very important to see a specially trained doctor or pelvic floor therapist if you are experiencing any of these symptoms so that they can identify the root cause of your hypertonic pelvic floor. Once diagnosed, a pelvic floor therapist may offer you:

    • suggestions for pelvic muscle relaxation, including breathing techniques
    • advice on bladder and bowel habits (for example, no straining)
    • pelvic floor and abdominal massage techniques
    • scar tissue massage techniques
    • pelvic and hip stretches

    A hypotonic pelvic floor occurs when your pelvic muscles are too weak to function how they’re supposed to and aren’t able to properly support the pelvic floor organs.

    Hypotonic pelvic floor is also known as pelvic floor weakness or hypotonicity. Signs and symptoms of a hypotonic pelvic floor include:

    • stress urinary or fecal incontinence (leaking of urine or feces)
    • pressure in your pelvic area that can lead to pain
    • pelvic organ prolapse (when one or more organs drop against the vagina)
    • decreased sensation (feeling less) during sexual intercourse

    There isn’t one single reason or cause for a hypotonic pelvic floor. However, some contributing activities or conditions that have been linked to pelvic floor hypotonicity include:

    • trauma to the pelvic floor (such as a car accident)
    • pregnancy and giving birth
    • chronic constipation
    • interstitial cystitis , which can cause pain in the pelvic floor muscles and loss of muscle strength
    • menopause and aging

    Once diagnosed, a pelvic floor therapist may offer you:

    • specialized exercises to help to strengthen the pelvic floor (kegels)
    • use of a biofeedback device

    It’s important to know the difference between hypertonic and hypotonic pelvic floor because they’re both treated very differently.

    Many people think that when they start to experience pelvic pain, urinary incontinence, or leaking that all they need to do is start kegel exercises or buy a kegel trainer to tighten their pelvic floor muscles. However, if you have a hypertonic pelvic floor, these exercises can make the problem worse. Ignoring your symptoms or just waiting to see if they go away can also lead to worsening symptoms.

    When in doubt, remember to put your health and wellness first by seeing a certified health professional who’s trained specifically to diagnose and treat the pelvic floor.

    Hopefully after you read this article you will feel more empowered to understand the difference between the hypertonic and hypotonic pelvic floor and understand why it’s so important for you to know the difference.




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    Here at Hyivy Health, we’re dedicated to helping you down there and everywhere. The purpose of this blog post is to offer resources and education about pelvic health and is not intended to serve as medical advice. The information provided above is not a substitute for the treatment, advice, or opinion of a medical professional. Always consult with a certified health professional before starting any treatments.