How to Tell if the Pelvic Floor is Too Tight or Weak

Are you leaking urine—and not just when you cough or sneeze? Or maybe you have trouble starting your stream when you urinate? 

Do you feel like you can’t relax your pelvic floor? Or maybe, inversely, you have a hard time performing a Kegel (contracting your pelvic muscles)?

These issues could stem from your pelvic floor being too tight or too weak. 

Treatments are different depending on what is going on down there. Kegels alone may not solve issues of pelvic floor weakness, and if the pelvic floor is too tight, they may make it worse. That’s why it’s important to know your own pelvic floor.

But how can you tell if you’re too tight or too weak? Common symptoms can give you some clues, but the best way to know for sure is to consult with a pelvic floor therapist. 

Read on to discover how to tell if the pelvic floor is either too tight or too weak, how it got that way, and how to find relief.

How to tell if the pelvic floor is too tight or weak

Pelvic floor issues are more common than you think. One in three women experience a pelvic floor disorder in their lifetime. These issues can arise from childbirth, surgery, heavy lifting, or even prolonged sitting.

Figuring out if your pelvic floor muscles are tight versus weak is essential to receiving proper treatment in order to return to your daily activities, symptom-free.

1) Check if you have any common symptoms of a tight pelvic floor

The main symptoms of a tight pelvic floor (for both men and women) include:

• Urinary symptoms. Bladder pain, pain while urinating, frequent urination, urinary leakage, or difficulty starting or maintaining a urinary stream.
• Bowel symptoms. Difficulty starting a bowel movement, feeling like you’re unable to empty your bowels completely, pain with pooping, pain with passing gas, or constipation.
• Sexual symptoms. Pain with sex, inability to achieve an orgasm, erectile dysfunction, or pain with erection/ejaculation.
• Difficulty controlling pelvic floor musculature. Specifically with relaxing.
• Pelvic pain. In the urethra, vagina, penis/testicles, rectum, tailbone, low back, and lower abdomen.

2) Check if you have any common symptoms of a weak pelvic floor

The main symptoms of a weak pelvic floor (for both men and women) include:

• Urinary symptoms. Inability to control the bladder (incontinence), increased urinary urgency, and urinary leakage.
• Bowel symptoms. Fecal incontinence, anal prolapse, difficulty holding back gas.
• Sexual symptoms. Reduced sensation during sexual intercourse.
• Pelvic organ prolapse. Pelvic muscles are no longer strong enough to support the pelvic organs. Organs can sag and drop toward the vaginal opening.
• Pelvic pain.

3) Test your ability to perform Kegel exercises

1. Sit up tall in a chair with your feet flat on the floor. Be aware of your pelvic floor pressing gently into the chair. 
2. Contract your pelvic floor muscles (like you’re stopping a flow of urine). You should feel them lifting away from the chair. Be aware of how this feels.
3. Hold for three seconds, then relax. Be aware of how this feels.
4. Ask yourself a few questions.
   1. Was it difficult to contract?
   2. Was I able to contract, but then it was difficult to hold?
   3. Was it difficult to relax?
5. Reflect
   1. If you answered yes to A and/or B, you may have weak pelvic floor muscles.
   2. If you answered yes to A and/or C, you may have tight pelvic floor muscles.

4) Self-assess your pelvic floor

If you’d like to learn more about your own pelvic floor and you’re up for it, you can try a self-guided internal pelvic floor assessment. 

This is safe and easy for anyone to perform. However, check with your doctor first if you’re pregnant, you have a vaginal infection, you’re less than six weeks postpartum, you have recently had pelvic surgery, or you have any unexplained bleeding. 

Here are the steps to take to self-assess your pelvic floor:

1. Before you begin, empty your bladder and wash your hands.
2. Relax comfortably on a bed.
3. Use a mirror to first observe and remind yourself of your anatomy.
4. Examine your vulva. Use your fingers to open the outer labia to get a better view.
5. Examine your perineal body. This is the tissue between your vaginal and anal openings.
6. Try performing a Kegel. If you see your clitoris nodding downward, your anal sphincter drawing inward, and your perineal body moving inward, your muscles are contracting properly. When you relax, everything should return to where it started.
7. Next, try to open up your pelvic floor by bearing down like with a bowel movement. You should see the perineal body move toward the mirror. You may see tissue bulging out toward the opening of the vagina. 
8. Take this opportunity to cough while observing your perineal body. You should see it lift (contract). This shows that your pelvic organs are well supported.
9. Now it’s time to look at the vulva and pelvic floor muscles. Use a Q-tip to gently touch the tissues around the vaginal opening. Make note of any tender areas.
10. Use a clean, lubricated finger to fully insert into your vaginal opening. This should be pain-free (stop if it’s not). Contract your pelvic floor muscles. Your finger should be “pulled in” further by this contraction. Then, relax your muscles.
11. With your finger still in your vagina, bear down like you’re having a bowel movement. You should feel your muscles pressing your finger outward.
12. Finally, with your finger, press on the muscles inside your vagina. They should feel soft and pain-free. Make note of any knots or tension you feel.

5) Consult a pelvic floor therapist

A self-assessment can give you a wealth of knowledge about what’s going on in your pelvic floor. However, a pelvic floor therapist can discern even more and can explain how it affects you and what to do about it.

After a pelvic floor therapist thoroughly assesses your pelvic floor, they will guide you through a personalized treatment plan to help you return to your regular activities, symptom-free.

Understanding how the pelvic floor becomes too tight or weak

The pelvic floor is the musculature that supports your pelvic organs. These important organs include the bladder, urethra, rectum, anus, bowel, uterus, and vagina (female), and prostate (male).

Two main muscle components intertwine to form your pelvic floor. These are the levator ani and the coccygeus.

These muscles act as a hammock, connecting to your pelvic bones (pubic bone, tailbone, and sit bones) to create a strong foundation. There are many nerves throughout your pelvic floor, which work with the muscles to help control urination, bowel movements, and sexual function.

The pelvic floor muscles can become tight or weak, which can cause difficulty coordinating bodily functions and pain.

What causes a tight pelvic floor?

A person can develop a tight pelvic floor for various reasons, including:

• Injury to the pelvic floor. Tailbone injury, sexual abuse, hip injury, trauma in surgery or childbirth, traumatic accident.
• Habitually holding in urine or stool. Some start this habit as a child and practice it into adulthood, whereas others do this out of necessity because of a lifestyle or job.
• Infection or inflammation. Urinary tract infection, thrush.
• Stress, depression, or anxiety.
• Bladder or bowel dysfunction. Irritable bowel syndrome, endometriosis, vulvodynia, anal fissures, painful bladder syndrome. 
• Muscular dysfunction. Caused by prolonged sitting, abnormal posture, irregular gait when walking, and uneven pelvic bones.
• Pelvic surgery complications.
• Hypermobility of the pelvis or hips.

What causes a weak pelvic floor?

The causes of a weak pelvic floor can vary, but include:

• Damage during childbirth. Stretching or tearing of muscles.
• Complications from pelvic or abdominal surgery.
• Aging. Hormone changes during menopause.
• Obesity.
• Neurological conditions. MS, Parkinson’s, stroke, brain injury, spinal cord issues, diabetes.

Finding relief from pelvic floor issues

Understanding whether your pelvic floor is tight or weak is crucial to your health and quality of life. If you are struggling with any of the above symptoms, it is important to seek help. 

Below are some treatment options to keep in mind that can help you get back to living your fullest life. 

• Physical therapy. Seeking care from a pelvic floor therapist is ideal. Your therapist will do an external and internal (with consent) exam. They will ask questions about your lifestyle and daily routine. Once they determine if your pelvic floor is tight or weak, a treatment program will be prescribed accordingly. Strategies may include:
  • Biofeedback. This will help you learn how to contract and relax your muscles correctly.
  • Relaxation techniques. This will help musculature throughout your pelvic floor and abdominal wall.
  • Manual therapy. Massage, muscle stretching, and joint movement.
  • Exercise. Exercises such as Kegels to engage and build strength in the pelvic floor (if weak), or exercises such as breathwork to get the body to release tension (if tight).
• Managing constipation and incontinence. Many treatments (such as diet, exercise, and medications) can help reduce stress on the pelvic floor muscles. 
• Vaginal weights/Kegel balls. For weak pelvic floor. These are specially designed balls that are inserted into the vagina. You hold them in place throughout your day. This can help strengthen the musculature. 
• Self-massage. For tight pelvic floor. A similar process to self-assessment explained above.
• Medical devices. A removable device called a pessary can be placed inside the vagina to help support the pelvic organs.
• Surgery. Pelvic organ prolapse may require reconstructive surgery to secure pelvic organs in place.

Identifying if your pelvic floor is too tight or weak is key to improving your pelvic health and quality of life. By recognizing your symptoms and taking steps to assess the root cause of your issues, you can work toward relief. 

Consult with a pelvic floor therapist for personalized guidance and treatment, and you’ll be on your way to a healthy pelvic floor and a happier day-to-day life.

Learn more about pelvic floor therapy

Here are some of our other popular pelvic floor therapy articles that may help you:

• Pelvic Floor Therapy: What It Is & How It Works
• Benefits of Pelvic Floor Therapy
• Pelvic Floor Therapy During Pregnancy
• When to Start Pelvic Floor Therapy During Pregnancy
• Painful Postpartum Gas: Causes & Relief
• Postpartum Pelvic Floor Pain
• Is Pelvic Floor Therapy Covered by Insurance?
• How Much Does Pelvic Floor Therapy Cost?