top of page
  • Writer's pictureHeather Rader


Sitting pain, sphincter troubles, and sexual dysfunction are typical of an Overactive Pelvic Floor


Recently, I had the honor to speak at TEDxLSSC about the common symptoms of overactive pelvic floor muscles, or what I call a Pelvic Floor Muscle Attack.  Click here to view the talk. 

If someone has pain or difficulty with sitting, having sex, and/or using the toilet to urinate or have a bowel movement,  especially in combination, they likely have overactive pelvic floor muscles and should be evaluated by a pelvic physical therapist to determine if their pelvic floor muscles are tight or in a spasm.   

Or, to put it another way, if you have trouble in the bathroom, bedroom, and every room you sit in, then your problem might be overactive pelvic floor muscles, and your solution might be to see a pelvic physical therapist.

Where Answers Why

Why these seemingly unrelated symptoms cluster together is because of where the pelvic floor muscles are located in your body.

The inner surface of the pelvic floor muscles cradle and support your pelvic organs – the bladder, bowels, and reproductive organs.  My favorite analogy is the pelvic floor muscles are like  water under a boat (1), creating a muscular “buoyancy” underneath the pelvic organs, preventing pelvic organ prolapse.

Just as spinal muscles work with the ligaments in your back to help you have good posture,  the pelvic floor muscles work with the pelvic organ ligaments to keep your bladder, rectum and uterus in a good position.  Think of it as your internal posture.

Weak and uncoordinated pelvic floor muscles, also known as having an underactive pelvic floor, are associated with a cystocele (fallen bladder), a rectocele (fallen rectum), or uterine prolapse (fallen womb). Urinary and fecal incontinence are also associated with an underactive pelvic floor.

That is why pelvic physical therapy can help people with pelvic organ prolapse and incontinence by creating customized pelvic floor muscle strengthening, endurance and coordination exercise plans. 

The outer surface of the pelvic floor muscles make contact with the outside world. If you are sitting, you are sitting on them right know!  Imagine a diamond shape, spanning between your sit bones (ischial tuberosities) side to side,  and from the tailbone (coccyx) in the back to the pubic bones in the front.

The 3 Key Symptoms of a Pelvic Floor Muscle Attack

 1. Sitting Pain

That’s why conditions around these bones and joints, like pudendal neuralgia, sciatica, sacroiliac joint dysfunction, coccydynia, symphysis pubis dysfunction often have tight and spasmed pelvic floor muscles, too.  What do all of these different conditions have as a common complaint – sitting pain!

Pelvic floor muscles follow the same rules as any other voluntary, or skeletal, muscles.  They can get weak and sag, or they can get tight and spasm.  Tight and spasmed pelvic floor muscles are also known as having an overactive pelvic floor.  The cause of this condition is often due to another muscle tendency…to tense and guard in response to nearby pain.

The pelvic floor muscles in particular consider themselves to be your very protective “guard dogs”, barking at any nearby pain.   Whether you are having internal pelvic pain related to Interstitial Cystitis/Bladder Pain Syndrome, IBS or constipation, prostatitis, or endometriosis, or external pelvic pain related to sacral, hip, or low back, the pelvic floor muscles can tense and spasm.  The pressure of sitting on them can cause pain, and bark even more.   

2. Sphincter Trouble

And this is where “trouble on the toilet” can be a common complaint with ANY internal or external pelvic pain condition. Your external urinary and anal sphincters are actually pelvic floor muscles. They circularly contract around the urethra and anus to give you bladder and bowel control.

And by the way, I think potty training should be called “pelvic floor training”, because what is being trained is your ability to feel bladder and bowel sensations and respond with well-timed contractions of your pelvic floor muscles. 

Overactive pelvic floor muscles can pinch around the urethra and anus. They often lack the coordination to “get out of the way”, making it a pain to pee or poop.   There is often a sensation of a closed or stuck door “down there.”

Common sphincter spasm symptoms include a weak, slowed, or spraying urine stream, narrow stool formation, the need to strain excessively to start, maintain, or finish urinating or defecating, and feeling of urine or fecal matter left in the bladder or rectum.

3. Sexual Symptoms

And there is one more very important part of your body in this “underwear area”…your genitals!   The penis and scrotum in the male anatomy and the vulva and vagina in the female anatomy are located in the pelvic floor region.  Your pelvic floor muscles surround the vaginal opening and attach onto erectile tissue.  This is why sexual dysfunction and pain in both men and women can be influenced by pelvic floor muscle dysfunction, and be helped with pelvic physical therapy.

In summary…If it’s a pain to sit, have sex, poop, or pee, see a pelvic PT! Rader Pelvic Physical Therapy specialized in the treatment of overactive (and underactive) pelvic floor muscles.  Are sitting pain, sphincter troubles, and sexual symptoms attacking the quality of your life? Click Here to make an appointment today!


1.       Saunders, Kimberly. "Recent advances in understanding pelvic-floor tissue of women with and without pelvic organ prolapse: considerations for physical therapists." Physical therapy 97.4 (2017): 455-463.

bottom of page