Is my pelvic floor weak or tight?
How can you tell?
Life is all about balance, and that includes your pelvic floor. Pelvic floor dysfunction (PFD) typically arises from a muscle imbalance - whether they are too shortened and overactive, or too lengthened and underactive. So, that means your pelvic floor can be tight, weak, or a combination of both. Regardless of the scenario, PFD leads to symptoms that often interfere with our day-to-day life. The lists of symptoms below can help you identify which type aligns with your pelvic floor. When you find the right match, a pelvic floor therapist can help you take that next step to get you back on track.
Signs of an tight pelvic floor:
Urine leakage
Urgency, always feeling you have to run to the bathroom
Hesitation on the toilet, difficulty starting or stopping urine flow
Painful urination
Doing the “power pee” push
Urine stream is weak or sprayed out
Dribbing after you pee, like you have to go again right away
Repeated or chronic history of urinary tract infections (UTI)
Chronic abdominal clenching
& Pain…
Where? Vagina, tailbone, pelvis, hips, low back, groin, buttocks, inner thighs
When? In sitting, with exercise, while performing kegels, while going #1 or #2, insertion or penetration (i.e. tampons, during a pelvic exam, during intercourse)
In this case, kegels are not your answer. These muscles are having a hard time relaxing, often are tender to touch and typically lack flexibility. This can seem like a catch 22 because the muscle restrictions and limited movement from a tight pelvic floor can actually cause muscle weakness at the same time. Other factors that can directly contribute to a tense pelvic floor can be more psychological, including stress and anxiety. The bigger the stressors, the worse your symptoms can feel. Focusing on stretching, mobility and relaxation of your pelvic floor muscles will lead you in the right direction.
Signs of a weak pelvic floor:
Leakage when laughing, coughing, sneezing, or with exercise (even just a little)
Not reaching the toilet in time
Feeling the need to pee constantly
Feeling a bulge, downward pressure, or as if something is slipping down from the vagina
Decreased sensation in the vaginal area, at rest or during sex
Reduced or inability to orgasm
Difficulty feeling your pelvic floor activate
Chronic clenching of the buttocks, inner thigh, or abdomen when trying to contract your pelvic floor
Tampon feels like it’s slipping down
Difficulty controlling gas
You have to use some sort of protection (i.e. pads, liners, tampons)
Stool smearing or leakage (even just a little)
Underactive pelvic floor muscles are the classic case for pelvic floor weakness. These muscles are typically non-supportive and weak, which is more susceptible to leakage of urine, gas, stool and is a risk factor for developing pelvic organ prolapse. Many may have tried kegels in the past, but without proper instruction from a trained professional, it is difficult to distinguish whether this technique was done correctly. Other factors that can contribute to pelvic floor weakness include hormone changes (i.e. pregnancy, menopause), chronic high pressure on your pelvic floor (i.e. constipation, respiratory issues), and your overall fluid intake. In this case, focusing on strengthening and coordination with breathing are key factors to success.
So, what are your pelvic floor symptoms telling you? Get started with a full evaluation from a pelvic floor therapist who can best understand your symptoms and steer you in the right direction.