Is Your Pelvic Floor Tight or Weak?

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 whole variety of reasons including:

• Lack of use — like any other muscle, if you don't exercise your pelvic floor, it will lose strength
• Change in hormones, particularly estrogen (during pregnancy or menopause, for example)
• Trauma or injury (psychological or physical)
• Chronic, intense pelvic floor pressure (this can be caused by pregnancy, frequent coughing, heavy lifting, or chronic constipation)

There are two 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.
• Underactive pelvic floor muscle dysfunction: If your pelvic floor muscles are underactive, they're too weak to function properly.

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, and more to gain a better understanding of any underlying causes.

How to Tell if Your Pelvic Floor is Tight or Weak

Here are 4 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 following, you may have tight pelvic floor muscles:

• Chronic constipation
• Pain during sex (inner course, outercourse, or orgasm)
• Difficulty starting or stopping urine flow
• Painful urination or urinary urgency and/or frequency
• Low back, pelvic, or tailbone pain

2. Check for 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, or tailbone pain
• Decreased sensation during sex, or delayed or absent orgasms

3. Decode your kegel.

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 vulva pressed gently into the chair.

Contract or squeeze your pelvic floor muscles to lift your vulva 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?

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.

4. Give yourself an internal self-assessment.

If you're ready to explore your pelvic floor even more, a self-guided, internal pelvic floor muscle assessment will give you a wealth of information about how your muscles are functioning. Check out this blog for a full explanation of how to do the assessment. Don't forget to take notes about what you find so you can discuss them with a pelvic floor physical therapist.