Tonic or hypertonic perineum? What differences?

A toned perineum is a healthy perineum that allows you to perform all of your bodily functions, including keeping organs in their place, urinary and fecal continence and sexual pleasure . If a weakened perineum is a known condition – particularly after pregnancy, postpartum, or during menopause, hypertonicity of the perineum is less known. However, this condition can have repercussions on your health and quality of life . What is hypertonic perineum? What are the consequences and what are the treatments? We talk about it in today's article.

What is the perineum?

The perineum is a collection of muscles, ligaments and fascia. Equipped with several important roles for our good health, it is essential.

Where is he?

The perineum is a sort of hammock made up of different muscles and ligaments that extends from the pubis to the coccyx. It particularly surrounds the urethra, anus, vagina and prostate. Both men and women have a perineum, however it is especially known among women because the life stages of pregnancy, childbirth and menopause abuse it a little.

Its main functions in the body

The perineum has three main functions: a role in supporting our organs, a role in urinary and fecal continence and a role in sexual pleasure.

Its supporting role in the body

The primary role of the perineum is to support our genitals, our rectum, our bladder and our viscera. A distended perineum can thus be the cause of a descent of organs (the latter no longer hold in place and sag) or even of a protrusion of organs (the organs come out through the orifices of the human body). Two conditions that can be serious and dangerous.

Its role in urinary and fecal continence

The second role of the perineum is continence. The perineum includes the muscles that allow you to hold back and feel and block the flow of urine and feces. This is why an unhealthy perineum will be linked to urinary and fecal leakage and to problems in the analysis of needs.

Its importance in sexual function

The third and final role of the perineum is sexual pleasure . The latter is linked, in part, in men and women, to the contraction of the muscles located around the genitals. Contraction of the perineal muscles thus helps to intensify sexual pleasure.

What is a healthy perineum?

A healthy perineum is a toned and muscular perineum. 💪

Signs that your perineum is healthy include:

• You feel good in your body: if your perineum is distended, you may feel different from usual, you may have pain in your stomach or lower abdomen;
• You feel when you want to urinate or defecate and are able to hold back a little;
• You are able to contract the muscles of your perineum: if you can feel and contract the muscles of this part of your body, there is a good chance that it is healthy and toned;
• You do not suffer from urinary leakage: if you sneeze or cough, you do not have urinary leakage. This is often a sign of good pelvic floor health.

So, what do we call a toned perineum?

A toned perineum is a perineum that fulfills its various functions – maintaining the organs of the lower abdomen, urinary and fecal continence and sexual pleasure.

It can be distinguished from the weakened perineum (we also speak of “distended”, “loose” perineum) and the hypertonic perineum . If the first is not muscular enough to fulfill its different roles, the second is too muscular and this significant contraction can prove problematic.

And what is a hypertonic perineum?

Perineal hyperactivity , also called pelvic floor muscle hypertonia or hypertonic perineum , occurs when the pelvic floor muscles are constantly in a state of contraction and do not relax. In the absence of relaxation, the muscles continually create muscle spasms and tension.

What are the causes of hypertonic perineum?

The causes and risk factors for hypertonic perineum are:

• Stress: Some people tend to involuntarily contract their pelvic floor muscles in response to stress, anxiety, or other emotions. This excessive muscle tension can contribute to a hypertonic perineum.
• Physical trauma: Physical trauma such as difficult births, episiotomies, pelvic surgeries, or traumatic injuries can lead to increased tension in the pelvic floor muscles.
• Menopause and hormonal imbalances: Hormonal fluctuations, such as those associated with menopause, can affect the pelvic floor muscles and contribute to a hypertonic perineum.
• Inappropriate exercise practices: During perineal rehabilitation, particularly prescribed after childbirth, the use of inappropriate exercises can lead to hypertonicity of the perineal muscles.
• Bad posture habits: Poor posture can put excess pressure on the pelvic floor muscles, contributing to their tightness.

What are the symptoms of hypertonic perineum?

Symptoms associated with hypertonic perineum condition:

• Pelvic pain: Regular or chronic contraction of the pelvic floor muscles can lead to lower abdominal pain, similar to that experienced during painful periods.
• Difficulty urinating: The lack of relaxation of the muscles of the perineum can make urination difficult and disturb the feeling of wanting to go to the toilet.
• Constipation: The lack of relaxation of the perineal muscles around the sphincter can also cause difficulty in having a bowel movement and thus cause constipation.
• Pain during sexual intercourse: The significant contraction of the muscles of the perineum can cause pain during sexual intercourse , particularly during penetration. Indeed, it is generally the relaxation of these muscles which facilitates penetration while the contraction of the muscles then increases sexual pleasure.

What impact on health?

Due to these different symptoms, hypertonic perineum can have different impacts on your health and your quality of life.

• Urinary and fecal problems: Difficulty urinating and having a bowel movement can be disabling and generate, in addition to the hypertonic perineum, other problems that can be fun (hemorrhoids, cystitis, etc.);
• Chronic pain: Pain, in the lower abdomen or during intercourse, can become chronic and bother you on a daily basis.
• Impact on quality of life and mental health: Even more, these issues can have a real negative impact on your quality of life and your mental health. On the one hand, because problems related to this part of the body can be taboo. On the other hand, because it can hinder your sexuality. Finally, because chronic pain can be burdensome and disabling.

What are the treatments ?

The treatment of hyperactivity of the perineum involves exclusively physiotherapy and more specifically by professionals and centers specializing in perineology. They are involved in the rehabilitation of the perineum (when it is weakened) but also, therefore, when it is too contracted.

The methods used vary between:

• Muscle relaxation: Managing to relax your muscles is essential in this pathology. The physiotherapist can perform massages and practices with this objective.
• Manual therapy: This method involves the practitioner using their fingers to help you better understand the muscles in your perineum that you contract or not.
• Biofeedback: Biofeedback is a method which consists of monitoring, in real time, the contractions taking place in your perineum. A probe to be inserted into the vagina or anus is used to allow you to monitor your contractions.

I want this probe >

Alongside these methods, you can consider treatments against stress, to better relax and unwind.

🌈 You can also adopt massages, especially using perineal massage oil . Recommended for application before childbirth or in case of too toned perineum, it helps relax your perineum and soften it. Do not hesitate to talk to your physiotherapist before applying it and performing massages.

I want this oil >

Also read: Comparison of the best devices to strengthen the perineum

How to get diagnosed and treated?

Do you think you have a hypertonic perineum that is causing you pain and various health problems? Consulting a doctor is a first step. To go further, know that there are also gynecologists and physiotherapists specializing in perineology.

See a doctor

The first thing to do if you think you have hyperactivity of the perineum is to consult your doctor. He will interview you, question your symptoms and may carry out an examination to study your case. If the diagnosis is confirmed, he will be able to refer you to a professional specializing in perineology.

Specialized professionals

The perineum being located between several organs of the body, it has the particularity of being mentioned in different health disciplines:

• Physical Therapists: Pelvic-perineal physical therapy is a specialization of physical therapy that focuses specifically on the assessment and treatment of pelvic floor disorders, including those related to the perineum. Physical therapists specializing in this area are trained to treat conditions such as urinary and fecal incontinence, pelvic pain, sexual dysfunction, constipation, genital prolapse, and other health problems related to the pelvic region.
• Midwives/Gynecologists: Midwives and gynecologists are specialists in women's reproductive systems. They play an essential role in women's pelvic health, particularly due to the demand on this organ during pregnancy, childbirth and menopause. Some professionals specialize in perineology.
• Urologists: A urologist is a physician who specializes in the diagnosis and treatment of disorders related to the urinary system, including the kidneys, urinary tract, bladder, urethra, and male genitals. Although their area of ​​specialization does not focus specifically on the perineum, urologists can play a role in the evaluation and management of health problems that may affect this region of the body.
• Gastroenterology: Gastroenterology is a medical specialty focused on the diagnosis and treatment of disorders of the digestive system, including the stomach, intestines, liver, gallbladder and pancreas. Like urology, gastroenterology is not directly related to the perineum, yet certain gastrointestinal issues can have implications for this region of the body.
• Colo-proctology: Colo-proctology is a medical specialty that focuses on the diagnosis and treatment of colorectal and proctological disorders, that is, conditions affecting the colon, rectum and anus. Since the perineum encompasses the region between the anus and the external genitalia, there is some intersection between colo-proctology and perineal health.

The multiplicity of professionals involved in the care of the perineum has led to the creation of health centers specializing in perineology. This allows for faster and more transversal support.

• Perineum center in Neuilly-sur-Seine
• Perineum and Continence Center , at Angers University Hospital

A toned pelvic floor is a healthy pelvic floor that allows this set of muscles to fulfill their essential roles for the human body. However, too much tone (hypertonicity) of the perineum can be annoying , leading to chronic pain, complicated sexual intercourse or even urinary and fecal leakage. Consulting your doctor will allow you to properly manage this medical condition.