How muscles that have trouble relaxing can affect going to the bathroom, intimacy and everyday comfort.
Society loves to talk about and suggest Kegels as a fix for everything pelvic floor-related. If you’re leaking a bit, do some Kegels. If you have pelvic pain, do some Kegels. If sex is painful, do some Kegels. But the reality is that you can be incredibly diligent about doing the Kegels that everyone is telling you to do, but you may find that your symptoms aren’t changing at all.
With so much advice out there about strengthening your pelvic floor, it’s easy to assume the answer is always to do more. What doesn’t get talked about nearly enough is pelvic floor relaxation.
A strong pelvic floor matters, but so does one that can let go. If your pelvic floor is tight or engaged all the time, it has very little room left to contract further when you actually need it to, like when you sneeze, cough, or jump. Think of it like a fist that’s already clenched: you can’t squeeze much harder. Your pelvic floor muscles need to be able to fully relax so they’re ready to respond when it counts.
If your pelvic floor muscles are struggling to relax, adding more strengthening exercises might not help much. This is also why some people who feel very tight still have difficulty with bladder control. It sounds contradictory at first, but it makes more sense once you understand that these muscles need to both contract and relax to do their job well.
Pelvic floor tightness can happen during pregnancy, after birth and in people who have never been pregnant. Your concerns deserve attention whether or not you’ve given birth. And if an exercise is leaving you more uncomfortable, you don’t need to keep doing it just because someone told you it’s good for your pelvic floor.
How can a pelvic floor be tight and still not work well?
Your pelvic floor is a group of muscles that sits at the base of your pelvis, a bit like a hammock. It helps support your pelvic organs, plays a big role in bladder and bowel control, and is constantly adjusting as you breathe, move and go about your day.
These muscles have more than one job. Holding in urine while you hurry to the bathroom takes something very different from letting it go once you’re sitting on the toilet. And every squeeze needs a release afterwards, so the muscles can rest instead of staying switched on.
That’s why tightness isn’t the same as strength. A pelvic floor that’s always tense may struggle to give a good squeeze when you need one, and may also have trouble relaxing enough when it’s time to empty. So if you’re leaking, that alone doesn’t tell us which exercises will help.
What we really want to know is whether your muscles can squeeze, let go, and work together with the rest of your body. Once we understand that, we can choose a treatment and exercises that fit the problem you’re actually dealing with.
What can pelvic floor tightness feel like?
You may notice discomfort with sex, when inserting a tampon or during an internal exam. Some people feel it as soreness or tightness near the vaginal opening. For others, it’s a deeper ache that lingers afterwards.
Bathroom troubles can be part of the picture too. You might sit down to pee and have to wait for it to start, notice that the stream stops and starts, or get up feeling as though you haven’t quite finished. Bowel movements may take a lot of pushing even when the stool isn’t particularly hard. Aching around the pelvis, tailbone or hips can also be connected.
It’s completely understandable not to naturally link all of that together. A bathroom problem doesn’t necessarily seem related to discomfort during sex, and neither seems like something you’d mention when someone is asking you about your hips. Still, it’s worth bringing them all up, even if you’re not sure whether they’re related. All of those details help us understand the full picture.
Of course, there are other possible causes too, including urinary infections, constipation, changes to the vaginal tissue and conditions such as endometriosis. An assessment helps us understand which pieces fit together and whether you need further medical care. If you notice new burning when you pee, blood in your urine, unusual bleeding, or a sudden change in pain, those require a medical examination.
Why do the muscles start holding tension?
When something hurts, muscles often tighten to protect you. After a difficult birth, surgery, or sex that has been painful more than once, your pelvic floor may start bracing before anything painful has even happened. Straining with constipation can add to this too. Some people spend much of the day holding in their belly and pelvic floor without realizing how rarely those muscles get a chance to let go.
Stress can play a role in that tension. As you no doubt are aware, telling someone whose pelvis hurts to “just relax” doesn’t exactly give them much to work with. If relaxing their pelvic floor muscles were that easy, they probably wouldn’t be looking for help.
Effective treatment focuses on figuring out what keeps triggering the tension and helping your muscles learn a more comfortable way to respond. Often there’s more than one thing going on, and there usually isn’t one “aha” moment that we can point to to tell us when or why your pain started in the first place.
You don’t need to have it all figured out before your visit. Simply telling us what feels hard is a good place to start.
Should I stop doing Kegels?
If Kegels cause pain, leave your pelvic floor feeling tight or tired, or make emptying your bladder or bowel more difficult, it’s definitely worth taking a break from them and getting assessed.
Kegels and pelvic floor strengthening might not be completely off the menu for you, but you might need help with pelvic floor relaxation and muscle coordination first, before you add those Kegels back into the mix.
For an overactive pelvic floor, treatment usually starts with learning to release and move the muscles more easily. Your treatment and plan should be tailored to your specific situation.
What happens at a pelvic floor appointment?
Your first appointment will begin with a conversation. Your physiotherapist will want to know how long you’ve been symptomatic, get some information about your bathroom habits, find out if sex is uncomfortable, and also hear what you’ve already tried in terms of treatment. They will also want to know about your previous pregnancy, birth and surgical history.
The examination may include an assessment of muscle coordination in your abdominal and pelvic muscles, your overall abdominal function, and your physiotherapist will likely also assess your hips and back as well as the pelvic floor. An internal vaginal examination can give more direct information about muscle tension, tenderness, and coordination but it’s always optional and should be explained before you decide whether to proceed. You can say no, ask to begin another way, pause or stop the assessment or treatment at any point.
If you’ve had a pelvic examination before and it was painful, tell your therapist. They will use that information to do their best to make this examination as comfortable as possible for you. If you have ideas about how to make the entire experience more comfortable, share those. Your comfort is extremely important.
What does pelvic floor relaxation actually involve?
Have you ever tried to picture the muscles of the pelvic floor? It’s tricky, even when those muscles are in your own body. It can be incredibly difficult to relax a muscle that you can’t see, or even feel. Working with a pelvic floor physiotherapist can help you isolate those muscles and understand whether you’re doing the right thing with your exercises.
One of the first things that your physio might begin with is learning to coordinate your breathing and pelvic floor muscles. Your diaphragm muscle (a major breathing muscle) and your pelvic floor muscles are connected and should move together. Your pelvic physiotherapist will help you learn to coordinate that movement in a way that works for you, to restore function.
What else might help?
Everyone’s treatment plan is different. Your plan may include muscle coordination exercises, hands-on treatment and you may be asked to make some minor changes to your bathroom habits. The goal of treatment is always to make you feel better. For painful sex, your practitioner will have guidelines and information for you on how to improve your experience. Your pelvic physio should explain how to begin and build up slowly, and it should never involve pushing through pain.
Vaginal dryness and irritation should also be addressed. These can be particularly problematic during perimenopause/menopause but are also incredibly common after giving birth and while breastfeeding. Your pelvic physio will likely have suggestions about preferred lube brands. Pelvic physiotherapy can’t address every source of dryness or irritation, so this is also worth chatting about with your doctor or nurse practitioner. There are medications available to help, but only they will know if they’re the right fit for you. Our guide to discomfort with intimacy after birth explains more about dryness, healing and scar sensitivity.
Persistent pelvic pain can absolutely also affect your overall feelings about sex. Mental health support or sex therapy may be useful alongside physical care when that’s part of your experience.
Why bathroom habits belong in the conversation
It can be surprisingly difficult to relax when you’re rushing, holding your breath and trying to get a bowel movement over with. Supporting your feet while you’re on the toilet with a small footstool to put your body into a more natural squat position can really help. Keeping your abdomen relaxed and avoiding repeated hard pushing can help too. Remember though, if nothing is happening after a few minutes, it’s time to call it and try again later. Persistent pushing can cause not only pelvic floor problems but also lead to hemorrhoids.
Constipation can be a real issue, both during pregnancy and postpartum. Your pelvic physio will have suggestions on how to soften your stool. Our postpartum bowel guide looks at other changes that can make bowel movements more difficult after birth.
One of the more common pieces of advice that you may have heard elsewhere is that you should do your Kegels by practising stopping your urine stream halfway through. This is a fabulous way to train dysfunction into your pelvic floor, but that’s about it, and we don’t recommend that. Peeing should be easy, without needing to strain. Difficulty with getting started, straining to pee or returning to the bathroom because you feel like your bladder isn’t fully empty is worth talking through with your physiotherapist or doctor.
If leaking is the main concern, our guide to postpartum urinary incontinence explains why strength is only one part of bladder control.
When do I need medical care?
Sudden severe pelvic pain, fever, blood in the urine or unusual bleeding should be medically assessed. The complete inability to pee needs urgent care.
New numbness around the pelvic area (commonly called the “saddle area” when we’re referring to pelvic numbness), new leg weakness or a sudden change in bladder or bowel control, particularly with back pain, needs emergency assessment. These can be signs of a nerve problem and shouldn’t be put down to pelvic floor tightness.
A few questions that come up
Can I have tightness and leaking at the same time?
Absolutely. Tension doesn’t mean muscle control; you can be tight but also weak. Understanding your specific muscle coordination patterns will allow your physio to prescribe the right kind of treatment and exercises for you.
Should I be able to feel my pelvic floor relaxing?
Yes, and in the beginning it may feel a little like you’re going to pee. It can be a really subtle movement and you might need a bit of help to learn how to do it properly.
How will I know treatment is helping?
Take a good look at what led you to get treated in the first place. If those things are improving, then your treatment is helping. Your practitioner will regularly review your progress and adjust accordingly.
Doing more Kegels isn’t always helpful
If you’ve been doing those Kegels that everyone has told you about but you’re not getting better, that’s a great time to get a proper pelvic floor assessment. Relaxation, strength and coordination are all incredibly important and your treatment should be specific to you. More Kegels is rarely the answer.
Where to start at Oona
Our pelvic floor physiotherapists in Toronto and Newmarket look at relaxation and coordination as well as strength. You can bring the concerns that seem connected and the ones you’re not sure belong in the same conversation, since part of the appointment is helping you make sense of how they fit together.
You can book pelvic floor physiotherapy without a referral. If you’d prefer to talk through what’s been happening before choosing an appointment, our free Care Navigator call can help you decide where to begin. You don’t need to diagnose your pelvic floor before getting in touch.
