Check it out: This is the little-known portion of the Goldilocks story where Goldilocks and the Three Bears learn about kegels pelvic health!
Most women I work with assume that they should constantly be strengthening their pelvic floor by kegeling all. the. time. In fact, like any muscle in your body, you don’t want your pelvic floor to be crazy strong and tight with no ability to relax and release. (Picture meatheads at the gym who can’t get their arms to rest by their sides because they’re so tight.)
Just like you want your elbow and arm to be able to fully bend and fully extend, you want your pelvic floor to be able to fully release and fully engage. Often, performing a kegel is a really good way to gauge if you have a well-balanced pelvic floor. Can you feel your pelvic floor rise all the way up and release all the way back down? If not, look for other indications of an issue:
Signs Your Pelvic Floor Is Too Tight
- Do you feel like you can’t lift or engage your pelvic floor AT ALL? Counterintuitively, that actually might mean that it’s already completely engaged and lifted all the time. If you don’t feel like you can use your pelvic floor muscles at all, I would look for other signs of an overly tight — or, “hypertonic” — pelvic floor.
- Do you have discomfort during intercourse or when anything is inserted into the vagina?
- Do you have pain elsewhere in the pelvis, like deep in the outer hip (piriformis) or around your sit bones? Sometimes these areas become inflamed when the pelvic floor is too tight.
- Do you leak urine when you have to “hold it” while getting to a bathroom?
- Have you had trauma to the pelvic floor, such as significant tearing, instrumental delivery, episiotomy, or other injury? Even a C-section, which obviously seems to have nothing to do with the pelvic floor, can contribute to hypertonicity.
While none of these symptoms can single-handedly diagnose you with a hypertonic pelvic floor, they might be a good sign you should get some professional support from a pelvic floor PT, or reach out to me and I can let you know where to go from here.
Signs Your Pelvic Floor Is Too Loose
- Do you feel like you can kinda engage your pelvic floor, but if you had to release it gradually it would just completely give up the ghost all at once? Do you have a sense that the muscles of the pelvic floor are fatigued or tired if you try to do more than a few or more controlled/slow kegels?
- Do you have little sensation or pleasure from sex?
- If you insert a finger or object into the vagina, does it physically seem “loose”?
- Have you been diagnosed with pelvic organ prolapse, or do you have a feeling of “heaviness” in the vagina?
- Do you leak urine when running, jumping, laughing, or sneezing?
- Have you had a vaginal birth? (Truly, this does NOT mean that you have a loose pelvic floor. It is one of many things that can contribute, but it is far from a clear sign that the pelvic floor is loose.)
With the exception of organ prolapse, many of the issues listed above are not considered “medical” concerns, and can safely be addressed with at-home exercises like kegels. However, if your intuition tells you something more is going on or your symptoms get worse, you should always see a doctor.
Weak vs. Loose
Let me first say I hate the word loose when referring to the pelvic floor. I think it brings to mind all kinds of icky, misogynistic, stereotypical cultural ideas. But I use it here because most of you will know what I’m talking about when I say “loose.” If you prefer, feel free to choose a word like “lax” or “lengthened” or “open” instead.
Note: Loose, which we often use in reference to female pelvic floor tissue, seems to have a negative connotation. On the other hand, “open” or “flexible,” which we might say in reference to some super-bendy yogi’s hamstrings, seems to have a positive connotation. I would argue that to veer too far away from the middle of the spectrum is unhealthy for any muscle tissue. I don’t think it’s good for your hamstrings, just like I don’t think it’s good for your vaginal walls.
All of that to say, I want to clarify here that loose and weak are not synonymous. Even a very tight pelvic floor can be weak. Weak and strong refer to a muscle’s ability to exert force. A shortened or tight muscle may be just as incapable as exerting force as a long or loose muscle. Being tight does not mean your pelvic floor is strong. Neither tight nor loose are healthy or desirable.
So, What Can You Do About It?
Head here for exercises for a tight pelvic floor. And check back soon for exercises for a loose pelvic floor.