Your Pelvic Floor Doesn't Need More Kegels

Your Pelvic Floor Doesn't Need More Kegels

If you feel like — or have been told — you have a weak pelvic floor, you're not alone. The go-to exercise across the board tends to be the same: more Kegels (aka pelvic floor contractions).

But here's what doesn't get talked about enough: a tight pelvic floor is often a weak pelvic floor. If a muscle can't lengthen, it can't produce a good contraction.

The Real Problem: Tightness

There are different types of pelvic floor issues — weakness, tightness, pain, leaking, prolapse. The tricky part is that these often overlap, yet the treatment approaches are different. Even today, Kegels are usually the first thing prescribed.

That approach doesn't work for everyone or every issue. If you've tried Kegels and they made things worse, or you did them faithfully and nothing changed, that's a sign something else is going on.

Why would contracting a muscle that's already tight help? It's like holding your shoulders up to your ears all day and then doing shoulder shrugs to fix it. That obviously doesn't make sense — and pelvic floor issues are no different.

Signs You Might Have a Tight Pelvic Floor:

• Bladder urgency, incontinence, or difficulty voiding

• Constipation or straining

• Discomfort or pain with intimacy

• Pain around your tailbone or deep in your hips

• Tightness on one side causing SI joint or deep hip pain

• Prolapse symptoms — surprisingly, muscle tightness can contribute to these too

It's Often Not the Pelvic Floor's Fault

Weak hips, limited diaphragm expansion, glute clenching, collapsed arches, poor posture, tight hip flexors, an unstable trunk — all of these can force the pelvic floor to work overtime. When the surrounding muscles aren't doing their job, the pelvic floor compensates and becomes overworked. That's where a lot of tightness originates.

Proper assessment and treatment have to involve the whole picture: addressing weak hips, improving diaphragm function, correcting posture, and strengthening the core (not just the abs). Once the surrounding muscles are working better, the pelvic floor doesn't have to work so hard — and it can finally relax and lengthen when it needs to.

What a Real Assessment Looks Like

A thorough physical therapy assessment evaluates the pelvic floor's ability to contract, relax, and lengthen — not just squeeze. It also includes posture, breathing, overall strength and coordination, and movement patterns, so we can identify the root cause and understand your symptoms in full context.

For someone with tightness, treatment focuses on coordination and relaxation first. Manual therapy, myofascial release, and specific exercises help reduce tension, while relaxation techniques and breath work become central. From there we address the postural and movement patterns feeding the problem — the trunk, the diaphragm, and everything that contributes to pelvic stability.

As tension decreases and pain improves, progressive strengthening and coordination work get added in. It takes some time and consistent effort, but your symptoms truly can improve.

The Missing Piece

If you've been doing everything right and still aren't seeing results, the missing piece might be simpler than you think. Sometimes the pelvic floor needs permission to relax before it can truly strengthen.

If standard approaches haven't worked, it's worth coming in for a thorough evaluation. At Alex PT, our pelvic health specialist, Leah, can identify what's contributing to your symptoms and build an individualized plan for your situation.

In most cases you don't need a referral to start — Minnesota allows direct access to physical therapy, so you can typically book an evaluation without seeing a physician first.  

Ready to stop planning your day around your pelvic floor?

Whether your goal is jumping on the trampoline with your kids, getting through a workout without crossing your legs, walking the lake trail without hunting for the next bathroom, or simply sitting through a long car ride comfortably — we'd love to help. If you're in Alexandria or anywhere in the Douglas County lakes area, come see us.

Alex PT

591 Northside Dr. NE, Suite 200

Alexandria, MN 56308

Voted "Best of the Best" in Alexandria — and Stella and Margot approve this message.