How to Tell if the Pelvic Floor is Tight or Weak

by Hannah McDuffie, PT, PRPC, OMT

The pelvic floor is getting a lot of attention right now online, which is great! It’s super important to take care of your pelvic health, no matter your age or gender. However, it’s helpful to understand a little bit more about your own pelvic floor before following exercise recommendations online. Continue reading to learn more about how to tell if your pelvic floor is tight or weak, which will help guide you in managing your pelvic health. 

1. Pelvic Floor Anatomy

2. How to Tell if the Pelvic Floor is Tight or Weak

3. Pelvic Floor Therapy

4. What to Do for a Tight Pelvic Floor

Pelvic Floor Anatomy

Let’s first review the pelvic floor anatomy . The pelvic floor is a group of muscles at the base of your pelvis. If you imagine your pelvis as a bowl, the pelvic floor muscles make up the bottom of the bowl. These muscles help to stabilize the pelvis and support the pelvic organs. The pelvic floor also plays an important role in bladder, bowel, and sexual functions. The pelvic floor muscles do not work in isolation, but rather as a unit alongside abdominal muscles, hip muscles, and the diaphragm to control posture and manage intra-abdominal pressure. 

How to Tell if the Pelvic Floor is Tight or Weak

I wish the answer to this question was more black and white, but the truth is there is a lot of gray area when it comes to pelvic floor function. The pelvic floor isn’t always one or the other, sometimes it is both tight and weak. There are some patterns that we often see in pelvic floor therapy that can help understand which is more likely based on your current symptoms. 

These symptoms are more often associated with a tight pelvic floor:

• Pain in the pelvis, genitals, lower back, or hips

• Bladder urgency (always feeling the need to pee)

• Leaking urine with an urge to pee (also known as urge incontinence)

• Excessive straining to poop

• Pain with arousal and/or penetration

• Pain during or after activities 

While these symptoms are more often associated with a weak pelvic floor, but can also be driven by tension:

• Leakage of urine with cough, sneeze, or exercise (stress incontinence)

• Fecal incontinence 

• Pelvic floor heaviness, feeling of something ‘falling down’ 

• Less sensation than usual during sex 

Now, sometimes individuals may have symptoms from both of these lists, enter the gray area. The pelvic floor can be both tight and weak. Or, the weakness of the pelvic floor could be driven by tension. In those cases, the tension needs to be treated first. This is why just doing kegels is often not the answer to your pelvic floor prayers. Kegels will make symptoms that are driven by tension worse. 

Pelvic Floor Therapy

The most sure way to learn whether your pelvic floor is tight or weak is to see a pelvic floor physical or occupational therapist. At your first appointment, your therapist will ask you questions to better understand your symptom presentation. From there, they will perform an in depth physical assessment evaluating your posture, movement quality, mobility, and flexibility. A pelvic floor internal assessment is an option as well, but not mandatory. The internal assessment gives your pelvic floor therapist the ability to assess whether your pelvic floor is tight, weak, or both. 

What to Do for a Tight Pelvic Floor 

If you’re still not sure whether your pelvic floor is tight or weak, you can incorporate some movements into your routine that address pelvic floor tension first. If your symptoms get better, then it’s likely that tension was driving your symptoms! Try the following exercises to help relax your pelvic floor:

• Diaphragmatic breathing

• Butterfly stretch

• Happy baby

• Childs pose 

• Deep squat against the wall 

Pelvic floor function is not as straightforward as it may seem. This is why individualized pelvic floor therapy is so important, so you can assure you are addressing your pelvic health appropriately. At Wellest, we specialize in assessment and treatment of the pelvic floor. 

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