You may not think about your pelvic floor very much, but it’s an important area — and one that has more impact on your health than you might realize. If you’re experiencing pain during sex, incontinence, or even back pain, you could be having pelvic floor issues without even realizing it. Specifically, your pelvic floor could be weak, overly tight, or, potentially, both at the same time. (Lucky you!)
As a refresher, your pelvic floor is a set of muscles and tissues that support your pelvis and all the organs in it, like your bladder, bowel, and internal reproductive organs, per the Cleveland Clinic. Being able to squeeze and relax these muscles helps you move waste from your body, and if your pelvic floor is healthy, you’ll be able to do this automatically or deliberately (think: holding in your pee or poop until you can get to the bathroom). Pelvic floor muscles also play a role in sex, including contracting vaginal muscles during orgasms and causing an erection and ejaculation.
But just like other muscles in your body, your pelvic floor can become weak or super-tight and sore. Things like pregnancy, childbirth, chronic constipation, trauma, or injury can stop your pelvic floor muscles from working as they should, which can lead to a number of unpleasant symptoms. You’ve probably heard about pelvic floor weakness and Kegels, a popular set of exercises to strengthen those muscles, but we’re here to tell you that weakness isn’t always the culprit when it comes to pelvic floor issues. Your problem might actually be tightness, and if that’s the case, blindly doing Kegels every day might not be the answer. But how can you tell the difference between pelvic floor weakness and tightness, and most importantly, what should you do if you’re experiencing one or the other? We spoke to an expert to get the answers.
Tight pelvic floor vs. weak pelvic floor: what’s the difference?
According to Dr. Rachel Gelman, pelvic floor physical therapist and owner of Pelvic Wellness and Physical Therapy, it’s not always easy to tell the difference between pelvic floor weakness and tightness.
If your pelvic floor muscles are “in a guarded, tense, or spasmotic state,” Gelman explains, you have a hypertonic, or tight, pelvic floor. On the other end of the spectrum, if you’re unable to contract your pelvic floor muscles or lack strength in that area, your pelvic floor might be considered weak.
Seems straightforward, but there’s one important caveat. Sometimes, pelvic floor muscles can be so tight that they cause weakness, Gelman says. “If these muscles are stuck at their end point, there is no room for further movement, which can make someone think they have weak muscles when in fact that have such a tense muscle that it is unable to fully activate,” she explains.
How to tell if your pelvic floor is tight or weak: signs and symptoms
While the symptoms vary slightly between pelvic floor weakness and tightness, it’s still not always possible to tell which one you’re experiencing. If you’re having pelvic floor issues in general, Gelman recommends seeing a pelvic floor specialist to determine the cause.
That said, there are a few differentiating symptoms. Typically, if you have a tense or tight pelvic floor, you might experience symptoms like:
- Pain in the vulva, vagina, penis, clitoris, perineum, rectum, or “any area between the ribcage and the knees,” Gelman says
- Urinary urgency, hesitancy, frequency, dysuria (painful or difficult urination), or urinary incontinence (inability to control urination)
- Pain with sex
- Inability to have penetrative sex
- Inability to insert a tampon or have a pap exam
- Pain with erection or ejaculation
- Pain with bowel movements or constipation
Someone with a weak pelvic floor might experience the same symptoms, Gelman noted. If the weakness isn’t caused by extreme tightness, though, you might notice symptoms like:
- Vaginal heaviness
- Urinary or fecal incontinence
- Difficulty holding back gas
- Back pain
What to do if your pelvic floor is tight or weak
Whether you’re experiencing pelvic floor weakness or tightness, Gelman highly recommends seeing a pelvic floor specialist, either in-person or virtually. Your treatment will vary, but it’s worth noting that the majority of Gelman’s patients, she says, “have tense or guarded pelvic floor muscles with little range of motion, and treatment involves teaching people to relax their pelvic floor.” Once they’re able to relax those muscles, she says, “we discover they have adequate strength.”
As more general pelvic floor advice, Gelman adds, “the best thing someone can do is start pooping better.” She recommends getting a toilet stool, like the Squatty Potty, which puts you “in the optimal position to defecate” — something that’s important for pelvic floor health. Do your best to stay hydrated too, “which helps with overall wellness and bowel and bladder function.”
Before you go, read up on the yoga poses you don’t want to do on your period:
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