The Pelvic Floor: It’s Not Just About Kegels

Topic: Anatomy

We are told that a “strong” pelvic floor is a “tight” one. We are told to do Kegels at red lights.

But for many women, the problem isn’t weakness; it’s tension. Think of your pelvic floor like your neck muscles.

• Weak: It flops. (Incontinence).
• Tight: It is stuck in a spasm. (Pain).

Hypertonic Pelvic Floor (Too Tight)

If you carry stress in your pelvis (butt clenching), your muscles shorten.

• Symptoms: Painful tampon insertion, painful sex, urgency (feeling like you have to pee right now even if bladder is empty), constipation.
• The Mistake: Doing Kegels here makes it worse. It is like doing bicep curls on a cramped arm.
• The Fix: “Reverse Kegels.” Learning to relax and lengthen the muscle (like dropping a bowel movement) on the inhale.

Hypotonic Pelvic Floor (Too Weak)

This is common after childbirth or menopause.

• Symptoms: SUI (Stress Urinary Incontinence) - leaking when you cough/laugh/jump. Prolapse (feeling a bulge).
• The Fix: Strengthening (Kegels/Pilates) in coordination with the breath.

See a Physio

You cannot see these muscles. It is hard to know if you are clenching or lifting. A Pelvic Floor Physical Therapist can internal assess and tell you if you need to Strengthen or Lengthen.

Your pelvis is the hammock that holds your organs. Treat it well.