Your pelvic floor is a group of muscles at the bottom of your pelvis that support your organs and control bladder and bowel function. These important muscles can become either too tight or too weak, causing frustrating symptoms like bladder leaks and pain during sex.
Here’s how to tell if your pelvic floor is tight or weak (or a combo of both). Depending on your symptoms, you can figure out your next steps and what to avoid. To heal, you can see a pelvic floor physical therapist or do pelvic floor physical therapy online with Strong Core Mama.
What Is the Pelvic Floor?
Your pelvic floor is a group of muscles that spans the bottom of your pelvis, creating a hammock-like structure that supports your pelvic organs. These muscles attach from your pubic bone at the front to your tailbone at the back, and from side to side across your sit bones.
Your pelvic floor muscles do several important jobs: they help control your bladder and bowel functions, support your spine and posture, and play a role in sexual function.
Healthy pelvic floor muscles should be strong and flexible: they should stay relaxed throughout the day but be able to contract when needed (like during exercise).
Many women only hear about “doing kegels” to strengthen these muscles, but the truth is that sometimes these muscles become too tight rather than too weak. Both weak AND tight pelvic floor muscles can cause uncomfortable symptoms like pain and leaking urine.
What Is Pelvic Floor Dysfunction?
Pelvic floor dysfunction is when your muscles don’t work correctly, which can happen due to them being too weak OR too tight. When your pelvic floor muscles are too tight, they can’t relax properly. When they’re too weak, they can’t provide enough support.
Pelvic floor problems can develop after pregnancy, from repeated straining during bowel movements, improper heavy lifting, hormonal changes, surgery, or even from stress.
Symptoms of Pelvic Floor Muscle Dysfunction
According to UChicago Medicine, 1 in 3 women will experience a pelvic floor disorder in her lifetime, and 1 in 4 women over 20 has pelvic floor symptoms like urine or stool leakage.
Common symptoms of pelvic floor dysfunction include:
- Bladder leaks when you cough, laugh, or exercise
- Frequent urges to pee
- Difficulty emptying your bladder completely
- Chronic pelvic pain
- Constipation or straining during bowel movements
- Pain during sex
- Lower back and tailbone pain
- Pelvic floor tension or pressure
- Hip pain or pain that radiates down your thighs
With some symptoms, like lower back pain and constipation, you may not even think that it’s related to your pelvic floor muscles, but it is.
As a Pelvic Floor PT with a Doctorate in Physical Therapy and 10+ years of experience, I’ve seen women struggle for YEARS with these symptoms until they discovered their pelvic floor was the root cause.
How to Tell If Pelvic Floor Is Tight or Weak
Most of the time, tight pelvic floor muscles and weak pelvic floor muscles cause different symptoms. However, sometimes these symptoms can be similar, or you may have a combo of both strong AND weak pelvic muscles.
In my experience, women hear way more about pelvic floor weakness than about pelvic floor tightness. This is why many women, especially moms, just suffer in silence, thinking that their symptoms are a “normal” part of life or motherhood.
1. Check for Tight Pelvic Floor Symptoms
If your pelvic floor muscles are too tight, you might experience:
- Pain during sex that can feel deep or like a burning sensation
- Difficulty starting your urine stream or fully emptying your bladder
- Chronic constipation or painful bowel movements
- Frequent urges to pee, even when your bladder isn’t full
- Leaking pee when you cough, laugh, sneeze, or exercise (this happens because your muscles can’t relax enough to contract and prevent leaking)
- Urge incontinence (‘key in door’ syndrome)
- Pelvic pain or pressure that might radiate to your lower back or tailbone
- Muscle spasms in your pelvic area
- Pelvic floor muscle tension (discomfort or feeling like you can’t relax your muscles)
Tight pelvic muscles are sometimes called “hypertonic” or “overreactive.”
If you have a hypertonic pelvic floor, you’ll need to do pelvic floor exercises focusing on relaxation rather than strengthening. Doing traditional Kegels when you have tight muscles will make your symptoms worse.
Keep in mind that you might also be carrying tension in other parts of your body, such as your jaw, glutes, and stomach.
2. Check for Weak Pelvic Floor Symptoms
With pelvic floor muscle weakness, you might notice:
- Leaking urine when you cough, laugh, sneeze, or exercise
- Difficulty holding in gas or stool
- A feeling of heaviness or pressure in your vagina
- Feeling like something is bulging or falling out of your vagina (a sign of pelvic organ prolapse)
- Less sensation during sex
- Difficulty achieving an orgasm
Some of these symptoms can develop with a tight pelvic floor as well. For example, if you experience a feeling of heaviness or pressure in your vagina, your pelvic floor muscles might “tighten up,” which will only make the feelings of heaviness worse.
Weak pelvic floor muscles benefit from strengthening exercises, but by that, I DON’T mean just Kegels.
Effective pelvic floor physical therapy includes evidence-based exercises, 360-degree breathing that coordinates with your core muscles, and strengthening of all muscles that attach to your pelvis, such as your glutes, hamstrings, and inner thighs.
3. See a Pelvic Floor Physical Therapist
One of the best ways to determine if your pelvic floor is tight or weak is to see a pelvic floor physical therapist. Your PT can assess your pelvic floor muscle tone, address other factors contributing to your symptoms, and create a personalized treatment plan.
However, many women don’t have access to a pelvic floor PT because of location or financial circumstances. It can also be hard for moms to organize childcare for weekly or bi-weekly appointments. You may also just not feel comfortable doing internal exams.
For more accessible help with pelvic floor issues, you can book a 1:1 virtual session with me or follow my online program, Strong Core Mama.
Treating Pelvic Floor Dysfunction (Tight and Weak)
It breaks my heart that research shows more than 50% of women with urinary incontinence and 70% with accidental bowel leakage never seek treatment.
They often believe that their symptoms are “normal” with age or after childbirth. Some women also feel embarrassed or think that their symptoms aren’t “bad enough” to seek treatment. Busy moms also struggle to find the time to take care of themselves, even with intense pelvic floor pressure or pain.
Pelvic floor issues are treatable with physical therapy, and it doesn’t have to take hours of your time.
Physical therapy typically includes exercises to address overactive or underactive pelvic floor muscles, manual therapy techniques, and education about how your body works.
Pelvic Floor Exercises
The right pelvic floor exercises depend on whether your muscles are tight or weak.
If your pelvic floor is too tight, you’ll need to focus on relaxation exercises first, not strengthening. These exercises help your muscles learn how to release tension and function normally. This then helps your muscles actually BE stronger because when a muscle contracts from a relaxed baseline, it’s going to produce more power.
For a weakened pelvic floor, you’ll need progressive strengthening exercises. Your pelvic floor also doesn’t exist in isolation, so you’ll want to work on strengthening the muscles that attach to it as well, such as your glutes and core (specifically transversus abdominis).
Just like any other muscle group, your pelvic floor needs balance. It should be able to contract AND relax. Many women are surprised to learn that their “weak” symptoms are caused by muscles that are so chronically tight they can’t work properly.
Pelvic Floor After a C-Section
Many moms who deliver via C-section assume they don’t need pelvic floor rehabilitation because they didn’t have a vaginal birth. This is a HUGE misconception, and it leads many women to struggle with pelvic floor overactivity and issues like painful sex and muscle spasms.
Pregnancy itself, not just delivery, puts significant pressure on your pelvic floor muscles. Plus, the trauma of a major abdominal surgery and scar tissue can cause your pelvic floor muscles to tighten as a protective response.
It’s common for your pelvic floor after a C-section to become too tight. Most C-section moms should focus on scar mobilization techniques to prevent adhesions and pelvic floor relaxation exercises to minimize their chances of developing a hypertonic pelvic floor.
Beyond Pelvic Floor Muscles
Your pelvic floor is part of a larger system of muscles that all work together.
When surrounding muscles like your glutes, abdominals, hamstrings, and inner thighs are weak, your pelvic floor has to work harder to support your internal organs. This constant compensation leads to chronic tension and tightness in your pelvic floor.
Improving your posture, breathing patterns, movement habits (especially spinal and rib cage mobility), and strength in your core and hip muscles is incredibly important for pelvic floor health.
Building strength in these supporting muscles allows your pelvic floor to finally relax because it’s no longer being forced to do everyone else’s job!
FAQs
How do I know if I have a tight or loose pelvic floor?
The easiest way to tell is by looking at your symptoms. If you have pain during sex, constipation, difficulty starting urination, or pelvic pain, your pelvic floor is likely too tight. If you leak urine when laughing or coughing, feel heaviness in your pelvis, or have trouble holding in pee or gas, your muscles are probably weak.
Sometimes, you may have conflicting symptoms. In this case, consider booking a virtual 1:1 session with me or seeing a pelvic floor physical therapist in person.
Does queefing mean weak pelvic floor?
No, queefing doesn’t mean you have a weak pelvic floor. Recent research suggests it’s actually the opposite and queefing is more often linked to tight pelvic floor muscles, not weak ones.
Queefing happens when air gets trapped in the vagina during activities like exercise and sex, and then escapes later. Most of the time, it’s normal. However, many women dislike it and don’t want it to continue. You can learn how to coordinate pelvic floor with your core and breath to help reduce or even eliminate queefing.
Can a tight pelvic floor go away on its own?
No. Tight pelvic floor muscles need physical therapy to resolve symptoms. Just like other muscle tension in your body, chronic tightness usually persists or worsens over time without proper treatment. You’ll need to teach your tight muscles how to relax again through specific exercises and techniques. In my practice, I’ve seen women struggle with pelvic floor muscle tightness for years and even decades before starting therapy, and they always say, “I wish I had started this earlier!”.
What not to do with a tight pelvic floor?
Avoid doing Kegel exercises or other strengthening exercises when your pelvic floor is too tight—this will make your symptoms worse. Don’t strain during bowel movements, hold your breath during exercise, sit for long periods without breaks, clench your glutes, or suck your belly in all the time.
How long does it take to heal weak or overactive pelvic floor muscles?
It depends. I’ve seen women notice positive changes within just a week of starting the right physical therapy program! However, it ultimately depends on how long you’ve had symptoms and how consistently you do your exercises. Your stress levels also play a big role. If you have a lot of stress in your life, it might be impacting your pelvic floor and contributing to tightness.
Improve Your Pelvic Floor Health with Strong Core Mama
You do NOT have to accept pelvic floor symptoms as normal. These issues respond to treatment, and you don’t have to live with them.
However, I know that it’s not always easy or accessible to see a pelvic floor PT. That’s why I created Strong Core Mama, an online pelvic floor therapy program with evidence-based exercises and personalized support.
Learn more about Strong Core Mama and join!
