How to Know If You Have a Tight or Weak Pelvic Floor
Introduction into Tight and Weak Pelvic Floors
If you're reading this, you're probably curious about your pelvic floor or already dealing with symptoms like muscle spasms, bladder leaks, chronic constipation, pain with sex, or having to sprint to the bathroom. Seeing a pelvic floor physical therapist is the best way to figure out what's going on with your pelvic floor and get the treatment you need to resolve symptoms for good. In the meantime, the following self-assessment tools will help you decode your symptoms and learn more about your pelvic floor — including whether your pelvic floor muscles are too tight or too weak.
How Does the Pelvic Floor Become Tight or Weak?
The pelvic floor muscles span the base of your pelvis and help to support and control healthy bowel, bladder, and sexual function. Healthy pelvic floor muscles are simultaneously strong, flexible, and coordinated.
When your pelvic floor muscles are not working the way they should, it's referred to as pelvic floor muscle dysfunction (PFD). PFD can develop for a variety of reasons including:
Muscle imbalances: Your body likes symmetry. When there is an imbalance, let’s say in your hips or pelvis, the pelvic floor muscles might have to take that load leading to dysfunction.
Hormonal Changes: Changes in hormones, particularly estrogen (during pregnancy or menopause, for example), can affect pelvic floor function.
Trauma or Injury: Both psychological and physical trauma or injury can lead to PFD.
Chronic Pressure: Intense pelvic floor pressure, often caused by pregnancy, frequent coughing, heavy lifting, or chronic constipation, can lead to dysfunction.
Types of Pelvic Floor Muscle Dysfunction
There are two primary types of pelvic floor muscle dysfunction:
Overactive Pelvic Floor Muscle Dysfunction
Tight, overactive pelvic floor muscles have poor flexibility, struggle to relax, and are tender to the touch. Because muscle tightness restricts a muscle’s ability to produce force, tight muscles can also be weak and unsupportive.
Under-active Pelvic Floor Muscle Dysfunction
If your pelvic floor muscles are under-active, they're too weak or overly lengthened to function properly.
Symptoms of a Tight Pelvic Floor
If you experience any of the following, you may have tight pelvic floor muscles:
Chronic constipation or having very thin stools
Pain during sex (inner course, outercourse, or orgasm) or difficulty with penetration
Painful urination or urinary urgency and/or frequency
Low back, pelvic, or tailbone pain
Sensation of UTI’s without positive culture
Pelvic or genital pain
Incomplete emptying with urination
Symptoms of a Weak Pelvic Floor
If you experience any of the following, you may have weak or underactive pelvic floor muscles:
Bladder or bowel leakage
Difficulties holding back gas
Pelvic heaviness or prolapse
Low back, pelvic pain, or tailbone pain
Decreased sensation during sex, or delayed or absent orgasms
Sensation of air getting trapped vaginally with exercise
How to Tell if Your Pelvic Floor is Tight or Weak
Here are four ways to figure out what's happening with your pelvic floor.
1. Check for Symptoms of a Tight Pelvic Floor
If you experience any of the symptoms listed above, you may have tight pelvic floor muscles. Chronic constipation, pain during sex, difficulty with urination, and pelvic pain are common indicators of tightness.
2. Check for Symptoms of a Weak Pelvic Floor
If you experience any of the symptoms of a weak pelvic floor, such as bladder or bowel leakage, difficulties holding back gas, pelvic heaviness, or decreased sensation during sex, you may have under-active pelvic floor muscles.
3. Assess your pelvic floor activation and relaxation
Sit on a chair with a firm flat surface. Make sure your feet are flat on the floor, and you are sitting up straight on your sit bones so that you can feel your perineum pressed gently into the chair.
Contract or gently squeeze your pelvic floor muscles to lift your perineum up and away from the chair. This should feel like the movement you make when you are trying to hold back gas or stop the flow of urine. Are you able to do it? How hard is it to do? Did you feel your perineum lift up and away from the chair surface.
Hold the squeeze for a few seconds if you can, and then release your contraction. Pay attention to the way it feels when you release your pelvic floor. Did you feel it relax? Did it relax quickly or take some time? Did it stay contracted and not relax at all?
If it felt difficult or impossible to contract your pelvic floor muscles, or if you could contract but it was too hard to hold and they quickly released, you may have weak pelvic floor muscles.
Alternatively, you may have pelvic floor tightness if you notice that the contraction felt difficult or weak, and/or releasing the contraction was difficult. Tight pelvic floor muscles can be so used to being held tight, that it can be difficult to release after a contraction. Muscles could also be tight if you felt a very small or minimal movement.
4. Try an Internal Self-Assessment
If you're open to explore your pelvic floor more, a self-guided, internal pelvic floor muscle assessment could give you some insight about how your muscles are functioning. This is a more advanced step and should be approached with caution.
For Women: Insert a clean finger into your vagina and feel the muscles contract and relax as you perform a Kegel. Note any areas of tenderness or tightness, as well as your ability to contract and relax the muscles.
For Men: Insert a clean finger into your rectum to assess the pelvic floor muscles. Feel for contractions and relaxations, noting any areas of tightness or difficulty in movement.
Make sure to take notes about what you find so you can discuss them with a pelvic floor physical therapist.
Importance of Seeing a Pelvic Floor Physical Therapist
Pelvic floor dysfunction can significantly impact your quality of life, and self-assessment tools, while helpful, are not a substitute for professional evaluation and treatment. It’s crucial to seek the expertise of a board-certified pelvic floor physical therapist. Here’s why:
Expert Diagnosis: A pelvic floor physical therapist can provide a comprehensive evaluation and accurate diagnosis of your pelvic floor status and condition.
Individualized Treatment: Treatment for pelvic floor muscle dysfunction is not one-size-fits-all and depends on many factors, including the nature of your symptoms and what may be contributing to them. A pelvic floor physical therapist will ask about your daily bathroom habits, stress level, diet, physical activity, medical history, and more to gain a better understanding of any underlying causes.
Targeted Techniques: A trained therapist can guide you through exercises and techniques tailored to your specific needs. They can help identify if the right muscles are activating or working which is crucial for progression toward improving your pelvic floor condition.
Education and Support: Pelvic floor physical therapists provide education on pelvic health, proper techniques for exercises, and lifestyle modifications that can help manage symptoms.
Professional Guidance: They can help you avoid common mistakes and ensure you’re performing exercises correctly, maximizing their effectiveness. They can also help guide you through techniques that can help if your symptoms flare up.
Treatment Options
Once you have been properly diagnosed by a pelvic floor physical therapist, they will develop a personalized treatment plan tailored to your specific needs. Here are some common treatment options:
Pelvic Floor Exercises
This might include exercises known as Kegels or reverse kegels, which are designed to strengthen or relax the pelvic floor muscles. Pelvic floor exercises also include things outside of kegels, such as strengthening your deep core, glute activation training, or mobility exercises for your back or hips. Your therapist will guide you on how to perform these exercises correctly and will create a routine that suits your condition.
Manual Therapy
Manual therapy involves hands-on techniques to release tight muscles and improve mobility. This can be particularly beneficial for those with overactive pelvic floor muscles. This can include internal techniques as well as soft tissue work around the hips, abdomen, or back.
Education and Lifestyle Modifications
Your therapist will provide education on pelvic health, proper body mechanics, and lifestyle changes that can help reduce symptoms. This may include dietary recommendations, stress management techniques, and advice on physical activities.
When to See a Pelvic Floor Physical Therapist
If you suspect you have pelvic floor muscle dysfunction, it's important to see a pelvic floor physical therapist. Here are some signs that you should seek professional help:
Persistent symptoms such as pain, bladder or bowel issues, or sexual dysfunction.
Difficulty performing daily activities due to pelvic discomfort or weakness.
Symptoms that do not improve with self-care measures or exercises.
Conclusion
Remember, a pelvic floor physical therapist is your best resource for diagnosing and treating pelvic floor muscle dysfunction. Whether you have a tight or weak pelvic floor, trained pelvic floor therapists are going to be the best professionals to provide you with how to properly relax or strengthen your muscles versus self directed exercises. Don't hesitate to seek professional help to ensure you get the care you need.
By following these tips and paying attention to your body's signals, you can better understand your pelvic floor health and take proactive steps toward managing any dysfunction. For more information and personalized advice, schedule a consultation with a board-certified pelvic floor physical therapist. They can help you navigate your symptoms and develop a plan to achieve optimal pelvic health.
Written by:
Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health
Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.
