Any medical provider of physical therapist that tells you “just do your kegels!” may not be providing the best advice for you. MANY women and men have overactive or tense pelvic floor muscles and kegels/ tightening exercises can make matters worse, especially during pregnancy and postpartum. So how do you know if your pelvic floor is too tight or tense? A personalized PT session is ideal, but there are some signs and symptoms that may indicate your pelvic floor muscles are TOO TIGHT and you need to work on relaxation before strengthening first.
How To Know If Your Pelvic Floor Is Too Tight
Constipation, straining during bowel movements, a sensation of incomplete emptying, pencil thin poops, hard poops that are difficult to empty, hemorrhoids, painful bowel movements and rectal pain could all be symptoms that your pelvic floor is too tight.
Straining or difficulty starting your stream, a splayed or weak stream, burning during urination, sensation of incomplete emptying, having the urge to pee minutes after you just went, and bladder pain or burning may also point to a too tight pelvic floor.
Sexual Health Issues
Pain with intercourse, pain with initial and/or deeper insertion, if sex feels too tight or like you’re tearing, pain or throbbing after intercourse, if it feels like your partner is hitting a wall, if you feel burning or rawness at the opening, or if you have difficulty with orgasms could all point to a potential tight pelvic floor. Painful pelvic examinations or difficulty inserting tampons are also early indicators of pelvic floor muscle tension.
If you have any of the following it could point to a too tense pelvic floor: vaginal pain, tailbone pain, pain with sitting, pain with tampon insertion, painful pelvic exams, vulvar pain or burning, chronic “infections” when tests are negative or antibiotics don’t work, throbbing or heaviness in the pelvis, or deep hip or high hamstring pain that doesn’t resolve with stretching. If your symptoms get worse after kegels or if you can’t relax after a kegel contraction, those are signs that kegels may not be the appropriate exercise. Focus must be on downtraining or relaxing the pelvic floor muscles first.
When To Seek PT
If any of these are you (or a pelvic floor you know) check in with a Pelvic Health PT. Pelvic floor exercises are not one size fits all! If your muscles are tense or tight, the initial focus should be on relaxation and restoring normal length and tone of the muscles before strengthening.
Sara Reardon PT, DPT, WCS is the owner of NOLA Pelvic Health and founder of The Vagina Whisperer, a resource for online pelvic health education and therapy to help women worldwide with pelvic health conditions. She is a board certified women’s health physical therapist with a special interest in treating pelvic pain and pregnancy and postpartum conditions. She is a mom, wife, Saints fan and wanna be yogi.
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