How to Tell if Pelvic Floor is Tight or Weak?

Many believe if they are experiencing pelvic floor symptoms it must be a weak pelvic floor causing the issue- this is not the case! In this blog you will learn how to tell if your pelvic floor is tight or weak. 

There are actually many reasons why a person may be experiencing pelvic floor symptoms- weakness is just one. Pelvic floor tension, or a tight pelvic floor is often not the assumption- although we will argue is a bit more common than weakness alone.

Many aspects contribute to pelvic floor dysfunction symptoms including poor coordination, pressure management, mobility of tissues, scar tissue, stress, posture, exercise (or lack of), or orthopedic dysfunctions. 

Many people have both a tight and weak or uncoordinated pelvic floor- understanding the difference between tight and weak will get you on the right track.

Understanding Pelvic Floor Function

The pelvic floor is a group of muscles, supportive structures, nerves, vessels within the bony pelvis that support the pelvic( bladder, rectum, uterus, prostate) and abdominal organs. The pelvic floor works with the diaphragm, abdominal muscles, and hips. 

Throughout the day the pelvic floor functions in different capacities to enable all of the functions with different demands of tasks.  A well functioning pelvic floor must be able to contract and be able to relax and lengthen- all at the the right time, with the right series of events. 

What does the pelvic floor do?

• Contracts to maintain continence throughout the day

• Contributes to stability of the trunk and lower extremities

• Relax and length to urinate or have a bowel movement. 

• Contracts to counteract pressure down on the pelvic floor

• Contributes to comfortable sexual function

The pelvic floor is far more complex than just a tight or weak pelvic floor- if you have tried the exercises for pelvic floor strength, or stretches to help decrease pain for pelvic floor tension and it’s not working it’s likely there are other factors at play that a pelvic floor therapist can help you correct. 

The Difference Between Tight and Weak

The assumption is often I am experiencing symptoms I must need more strength- this is often not the case!

A weak pelvic floor does not have the strength and endurance to meet the need of the task performed. The muscles are often trying and coming part way to the demand but not hitting the threshold for success. Think of a really flexible trampoline, you jump on it and it has so much give without the power to withstand your bounce so much that you fear you will touch the ground with each landing.

A tight pelvic floor is often stiff and lacking movement, therefore can not generate enough movement or power to meet the demands. A tight pelvic floor can have tender trigger points, contributing to pain with vaginal insertion (tampons, penetration, OBGYN exam).  

What Does a Tight Pelvic Floor Mean?

Tight pelvic floor muscles are stiff and lacking the ability to move well. Just like any other muscle in our body when the muscle is holding tension all day it can become painful. 

Picture your shoulders, if you are hiking them up by your ears all day they tend to get sore, maybe get some tender spots, and may feel very fatigued by the end of the day- the same goes for the pelvic floor. 

Tight pelvic floor muscles are not necessarily strong. Tight pelvic floor muscles often have difficulty relaxing and lengthening. These tight muscles often lack power due to the small range of motion they can move. 

Think about a brand new trampoline that has really tight springs- it's often hard to get a good bounce because there is so much tension, limiting the ability for the fabric and springs to give back, contributing to that larger bounce. The same concept applies to the pelvic floor, tight muscles are often too rigid to perform the way they are supposed to.

A tight pelvic floor can be caused by:

• Stress

• Habits of postures, sitting positions, movements 

• Experiencing physical pain

• High intensity exercise without mobility

• GI difficulties

• Poor breathing
  

What Does a Weak Pelvic Floor Mean?

Weak pelvic floor muscles often do not have the coordination, power, or endurance to meet the demands of the task- therefore contributing to pelvic floor dysfunction. The pelvic floor muscles are always active and must have enough endurance to hold an appropriate tension through a series of sneezes,  the jumping jacks, or even something as long as a run. 

The pelvic floor muscle must have enough strength to meet the demands of the task. Strength, although it can in some cases be built through Kegel exercises there are better ways that will translate to your real life tasks. Pelvic floor strength is best built through whole body movements, such as a squat or many of the exercises you are already doing. 

In addition to strength the muscles need to be active for long enough for you to get through the task at hand successfully. Take a couple of sneezes for example, the pelvic floor not only needs strength but it also needs endurance to last through the last sneeze.If you find you start out strong, and sneeze 1-2 goes well, but  by the time sneeze 3 rolls around you are starting to leak, lose gas, or feel pressure- endurance may be contributing.

A weak pelvic floor is not broken, and weakness does not mean the pelvic floor is permanently damaged.

A weak pelvic floor can be caused by:

• Pelvic floor muscle injuries

• Habits of postures, sitting positions, movements 

• Inactivity

• Difficulty coordinating or turning on the right muscles for the task

• Breath holding

• Difficulty coordinating pelvic floor with breath

Can Your Pelvic Floor Be Both Tight AND Weak?

Yes, and it’s incredibly common! Muscles that are always tight are often fatigued. When muscles are fatigued they often have difficulty generating enough strength to meet the demand. Similar to a long flight of stairs- you have a good flow going initially, but by those last couple steps your movements are slower, less powerful, and less coordinated. 

A tight but weak pelvic floor is often seen in patients experiencing chronic pelvic pain, people with constipation, people working out and experiencing leaking with exercises, and often postpartum no matter if it was a vaginal or C-section birth. 

Pelvic floor muscles need to have:

• Good range of motion and be able to move from contraction to relaxation

• Good coordination with the diaphragm and the core

• Enough endurance to get through the tasks at hand

Your pelvic floor can be both tight and weak- the lack of movement of a tight pelvic floor can limit the power of the muscle creating symptoms of both tight and weak at the same time.

One can not make an assumption that because my symptoms are “X” I must have a tight (or weak) pelvic floor.

Signs of a Tight Pelvic Floor

When the pelvic floor can not move normally, many systems begin to be affected including the bladder, bowels, sexual, reproductive and musculoskeletal function.

A Tight Pelvic Floor Often Experiences:

• Pain

  • Pelvic Pain

  • Hip Pain

  • Tailbone Pain

  • Pain in low back

  • Pain with exercise

• Urinary

  • Difficulty initiating urine stream

  • Needing to pee urgently

  • Using the bathroom more often than every 2-4 hours

  • Feeling like you are never fully emptying your bladder

• Bowel

  • Difficulty having full, comfortable bowel movements

  • Constipation or straining to have a bowel movement

• Sexual

  • Pain with intercourse, tampons, pelvic exams

  • Erectile dysfunction

  • Pain after orgasm

• Muscle fatigue or pelvic heaviness

• Poor coordination

• Feeling unable to let go and stiff 

Signs of a Weak Pelvic Floor

• Urinary

  • Leaking with:

    • Coughing

    • Sneezing

    • Yelling

    • Singing

    • Exercise

  • Difficulty holding urine until you get to the bathroom

• Bowel

  • Difficulty controlling gas

  • Difficulty holding back a bowel movement

• Sexual

  • Decreased sensation

  • Decreased ability to achieve orgasm

• Pelvic heaviness or pressure

• Sensation of bulging in vagina

• Feeling unstable during movements or exercise

Many of the symptoms above overlap and could be caused by a tight or weak pelvic floor. Symptoms alone can not determine if a pelvic floor is tight or weak. That’s why two people with the same exact symptoms need 2 completely different plans. A pelvic floor PT or OT can help identify your specific factors. 

Common Misconceptions About Pelvic Floor Health

Myth: Everyone needs Kegels at stoplights.

Truth: Kegels are not appropriate for all, especially for those that have difficulty relaxing the pelvic floor. If someone with pelvic floor tension does Kegels they will often make the symptoms worse.

Myth: Leaking means weakness.

Truth: Tight immobile muscles can also leak. The muscles need enough strength at the right place, with the right coordination.

Myth: I've had babies, this is my new stage of life.

Truth: This is not true! There are so many changes in your posture, hormones, muscles, stress, sleep, nutrition in this transition that it's never one thing. Some people carry more tension after pregnancy and delivery. Scar tissue either perineal or C-section often needs attention to return to its normal movement as well. 

Myth: Pain means my muscles are too strong.

Truth: A tight painful pelvic floor is not strength, this is tension. Pelvic pain has several causes, seldom- if ever, associated with muscles being “to strong” 

Why Self-Diagnosis Can Be Tricky

Many symptoms are caused by similar presentations. A tight pelvic floor can have very similar symptoms as a weak pelvic floor. Symptoms alone do not indicate muscle function and strength.  

One must figure out if the muscles can contract well, are strong enough, but then can lengthen and relax once done contracting.  An internal muscle assessment when appropriate and with informed consent,  is the gold standard for understanding the current status of your pelvic floor muscles for effective treatment. 

A complete diagnosis requires a look at breath, posture, movement patterns, medical history, stress and lifestyle. 

How Pelvic Floor Physical Therapy Can Help

Pelvic floor therapy can begin to help manage symptoms within the first few visits. During the evaluation we discuss what’s working, what’s not, any relevant history (medical tests, injuries, life events, etc), posture & movement patterns, muscle function, breathing and coordination. The therapist considers all details to develop a treatment plan to address your concerns and correct the root cause.

Pelvic floor therapy treatments include coordination training specific to problematic movements, hands-on manual therapy to decrease pain and tension, strengthening through whole body movements, addressing the nervous system (stress, fears, tension holding patterns), and education on modifications to support the pelvic floor. Each visit our clients leave with actionable items to do at home between visits.  At Bloom Pelvic Therapy our clients start feeling a noticeable difference within the first couple of visits.

Pelvic therapy is way more than Kegels. It is our goal as pelvic floor therapists to give you the tools to succeed.  

The pelvic floor is far more complex than just a tight or weak pelvic floor- if you have tried the exercises for pelvic floor strength, or stretches to help decrease pain for pelvic floor tension and it’s not working it’s likely there are other factors at play that a pelvic floor therapist can help you correct. If you are local to Tampa, St. Petersburg, or Lutz in Tampa Bay, FL Bloom Pelvic Therapy can help! 

When to Seek Professional Help

Although the internet is full of information and can be a great place to start learning- if you feel you have tried a couple suggestions without result, feel like you are reading and reading and nothing is resonating 100%, your symptoms are getting worse, or your symptoms tend to go away for a period of time but then always come back- it’s time to get to a pelvic therapist! 

You should seek pelvic floor therapy if you are experiencing:

• Pelvic pain with insertion

• Pelvic, hip, low back pain

• Urinary leakage

• Constipation

• Urinary or bowel urgency 

• Pelvic heaviness or pressure

• Difficulty with exercise because of leaking, pain, or pressure.

• Discomfort in pregnancy

• Difficulty returning to movement comfortably

• Pain with urination or bowel movements

The pelvic floor is not resigned to just being weak or just tight- it's often both and there is a ton of overlap between symptoms.  

A healthy pelvic floor needs to be strong, mobile, responsive, and have the ability to reach full contraction or full relaxation. Pelvic floor therapy is often indicated since there is so much overlap it's difficult to pinpoint exactly how to help based on symptoms alone. A visit with a pelvic floor therapist, and if you are local to Tampa, FL- a visit with Bloom Pelvic Therapy can help identify the root cause and develop a plan specific to the cause and your goals to get you back to doing the things you love without a thought of your pelvic floor. 

There is help, there is a world where your pelvic floor is not a thought every day or holding you back from doing the things you love. 

Pelvic floor dysfunction is common, but it is not something you need to live with.