How To Tell if Your Pelvic Floor Is Tight or Weak—and Why Kegels Aren’t Always the Answer
Experts say symptoms like bladder leaks and frequent urination can overlap
If you find yourself needing to pee more often than usual or are experiencing occasional bladder leaks, they could be signs of a weak pelvic floor. But here’s the catch—they can also be symptoms of a tight pelvic floor, which has to be treated in a different way to ease symptoms. So we asked experts how to tell if your pelvic floor is tight or weak, and what steps you can take to improve your pelvic floor function. Here’s what you need to know.
What is the pelvic floor?
The pelvic floor is a group of muscles that stretch from the pubic bone to the tailbone. These muscles support your pelvic organs, including the bladder, urethra, rectum, uterus and vagina.
In a healthy pelvic floor, the muscles are able to contract to hold in urine, gas or a bowel movement or to have an orgasm. They can also relax to help you effectively empty your bladder or bowels.
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But when the pelvic floor muscles become too weak (hypotonic) or too tight (hypertonic), it can lead to pelvic pain and problems with urinating, bowel movements or sex.
While these symptoms may be awkward to talk about, rest assured you’re not alone. According to a study published in Obstetrics and Gynecology Clinics of North America, nearly one in four women experience pelvic floor muscle dysfunction at some point in their lives. And the risk of one of the most common symptoms increases with age—a University of Michigan poll found that half of women over 50 experience urinary incontinence.
What causes a weak or tight pelvic floor?
“Weakness can occur when the pelvic floor muscles have been injured or stretched during childbirth,” says Sarah Hwang, MD, a physiatrist and director of women’s health rehabilitation at Shirley Ryan Ability Lab. And it’s normal for the pelvic floor to weaken with age, too. According to a study in the International Journal of Environmental Research and Public Health, muscle loss during menopause may affect pelvic floor muscles.
Perhaps surprisingly, tight pelvic floor muscles are also common after childbirth, Dr. Hwang says. They can also be caused by stress, back problems, hip problems or pain-causing conditions like endometriosis.
And while it may seem like a contradiction, tight pelvic floor muscles can actually contribute to a weak pelvic floor. “When the pelvic floor muscles are short and tight, they are physiologically weak,” says Heather Jeffcoat, DPT, a pelvic floor physical therapist and owner of Femina Physical Therapy in Los Angeles, CA.
Think of doing leg curls, she offers as an analogy. It can be challenging to pull your heels all the way to your glutes, because that’s the point in the exercise where your hamstring muscles are in their shortest and tightest range and they can’t contract as strongly.
How to tell if your pelvic floor is tight or weak
If you’re concerned about your pelvic health, there are a few symptoms that can help you tell if your pelvic floor muscles are tight or weak. Here’s what to watch out for:
Symptoms of weak pelvic floor muscles
- Urinary incontinence (especially when you cough, laugh, sneeze or jump)
- Frequent urination
- Fecal incontinence
- Pain during sex
- Pelvic pain
- Difficulty emptying your bladder or bowels
- Pelvic organ prolapse, a condition in which the pelvic organs “drop” from their normal position, which can cause pelvic pain or pressure
Symptoms of tight pelvic floor muscles
- Urinary incontinence
- Frequent urination
- Pain while urinating
- Pain during sex
- Bladder pain
- Difficulty peeing or having a bowel movement
- Incomplete urination
- Constipation
Of course, some of those symptoms overlap. So how can you tell if you’re dealing with a tight or weak pelvic floor? “The best way to determine if your pelvic floor is tight or weak is to see a professional who can perform an exam,” Dr. Hwang says.
That said, there are a few other differences that can help to clue you in. “In general, we tend to see more tightness in patients that have pelvic pain, pain with sexual activity and frequent urination,” Dr. Hwang adds. “We tend to see weakness in people who have leakage when they cough, laugh or sneeze or have pelvic organ prolapse.”
How to relax a tight pelvic floor
If your doctor has determined that you have a tight pelvic floor, learning how to relax those overly-contracted muscles can provide relief. “The safest way for everyone to feel more connected to their pelvic floor is to start with slow, deep breathwork,” Jeffcoat says.
She recommends this simple breathing exercise:
- Get in a comfortable position and take a long, slow breath that fills your lungs. Think about expanding your rib cage in 3D, meaning the front, sides and back.
- As you do this, visualize your pelvic floor muscles lengthening and relaxing into a stretch.
- As you exhale, feel them gently rise back to their start position.
- Repeat for two to three minutes, once or twice per day.
How to strengthen a weak pelvic floor
For those of us who have a weak pelvic floor rather than one that’s too tight, the right kind of exercise can help. “The pelvic floor muscles are…muscles,” Jeffcoat says. “If you don’t make a conscious effort to strengthen them, your muscles will gradually get weaker over time.”
However, it’s important to talk to a doctor or physical therapist before you start. If your pelvic floor is tight, strengthening exercises could exacerbate the issue. “Like any muscle in your body, there must be a balance between strengthening a muscle and lengthening a muscle,” Jeffcoat adds.
If you’re dealing with a weak pelvic floor, Jeffcoat recommends kegel exercises:
- Lie on your back with comfortable support.
- Inhale deeply, then exhale as you gently tighten the muscles in your vagina, urethra and anus—as if you’re picking up a ripe blueberry. “Don’t squeeze too hard, as you may start to involve other muscle groups that will interfere with the isolated pelvic floor muscle contraction,” Jeffcoat says.
- Inhale and release the muscles.
- Repeat this cycle, holding each contraction for three to five seconds and doing 10 repetitions.
- Aim to do this three times a day, for a total of 30 kegels per day.
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