Hi friends! The pelvic floor muscles are all the rage on social media nowadays. While we are happy and grateful that it is becoming less taboo to talk about our problems and more people are getting access to help, the amount of information on the internet can be overwhelming! Should I do kegels or should I avoid them? Should I strengthen my pelvic floor muscles or stretch them? Is my pelvic floor overactive or underactive?
Let’s first start with what are the pelvic floor muscles. People of all genders and all ages have layers of muscle that support their pelvic organs called pelvic floor muscles. They start in the front at the pubic bone and stretch to the tail bone in the back, functioning like an internal hammock at the base of the pelvis.
In females, the pelvic floor muscles wrap around the vaginal canal, the anus, and the urethra (the canal leading from the bladder). While in males, the pelvic floor muscles wrap around the urethra and the anus.
The pelvic floor muscles help to control what goes out and what comes in. If your pelvic floor muscles lack strength, flexibility, or coordination, many problems can occur with each of these canals.
While in diagnosis and treatment it is very complex, a simplified comparison of high and low tone pelvic floor muscles is: pelvic floor muscles with high tone are too tight and are difficult to lengthen and relax, while pelvic floor muscles with low tone are very weak and stretched.
What are the common symptoms of high tone pelvic floor muscles?
Pelvic pain
Hip pain
Pain with intercourse
Urinary leakage
Constipation and straining to poop
Straining to pee
What are the common symptoms of low tone pelvic floor muscles?
Urinary leakage
Incontinence of gas or stool
Decreased sensation with intercourse/difficulty maintaining an erection
Vaginal bulging
Kegels are often recommended to help with common pelvic floor problems like urinary leakage. If we practice Kegel exercises when our pelvic floor is tight and the muscle does not know how to relax, we will likely make symptoms worse. This is why some individuals with leakage might think that “Kegels don’t work.”
With that said, treating high tone pelvic floor muscles and strengthening weak muscles involves much more than just the pelvic floor itself! If you are experiencing pelvic pain or pelvic floor muscle tightness, a pelvic therapist is a great resource. They can not only help you to address your symptoms but also figure out why your pelvic floor muscles are tight in the first place.
Tight pelvic floor muscles aren’t able to work the way they should. Imagine grasping your hand into a tight fist and holding it—it would be hard to use your hand the way it was designed to work!
A healthy muscle is able to fully contract (at the right time) and then it’s able to fully relax (at the right time). A high tone pelvic floor muscle is stuck halfway in between the two—it is not relaxing well but it is also not contracting well. It is often painful, stiff, and tight but it’s not contracting well to do the job that it needs to do and therefore causes urinary leakage.
Even if the pelvic floor muscles have low tone, Kegels are often done improperly. The good news, a pelvic floor therapist can help you learn to properly train these muscles! Pelvic floor muscle training taught by a pelvic floor physical therapist has shown significant improvement within 3 months, (Davila, 2011), and is more effective than training at home alone (Felicissimo 2010, Ferreira 2010, Hung 2010). A dedicated and expert pelvic floor physical therapist can develop and coordinate a treatment plan especially for you. They can also help you to address any other underlying back, abdominal, and hip issues that may be contributing to pelvic floor symptoms. Did you know hip weakness is closely related to urinary incontinence (Foster, 2021)?
If you go to a pelvic therapist and they only give you Kegels to do, we highly suggest seeking out a different therapist. You can search four free databases for pelvic floor therapists near you at www.mypfm.com/find-a-pt.
There may be several factors that limit your ability to see a therapist, including time, money, or even the availability of a therapist near you. If this is the case, the Women’s DIY Pelvic Pain Relief Program can be a good alternative.
Regardless of the state of your pelvic floor, there is help for any symptoms you may be having!
To learn more about your pelvic floor muscles, check out these great resources:
Watch our YouTube playlist on Pelvic Pain and Your Pelvic Floor
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
Learn more about your pelvic floor on our Instagram
Visit our Amazon store for our favorite pelvic health products
Sign up for our email newsletter
For providers, check out our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!
What Do We Really Know About PFM Tone? with Beth Shelly, PT, DPT, WCS, BCB-PMD
Does the Inability to Relax Pelvic Floor Muscles Cause Pelvic Pain? With Dr. Susie Gronski DPT, Sexuality Counselor, and Educator Certified Pelvic Rehabilitation Practioner
New Structure for PFM Assessment Using ICS Terminology with Beth Shelly, PT, DPT, WCS, BCB-PMD
Understanding and Treating Pelvic Pain with Dr. Lauren Trosch, PT, DPT, OCS
Pelvic Pain Strategies to Empower Patients at Home with Dr. Amanda Olson, PT, DPT, PRPC
The Hip and Urinary Incontinence: A look beyond the pelvic floor at what keeps us dry with Lauren Trosch, PT, DPT, OCS
Written by Emily Reul, PT, DPT
References
Davila G. W. (2011). Nonsurgical outpatient therapies for the management of female stress urinary incontinence: long-term effectiveness and durability. Adv Urol. 2011: 176498. doi:10.1155/2011/176498 Felicissimo MF, Carneiro MM, Saleme CS, Pinto RZ, da Fonseca AM, da Silva-Filho AL. Intensive supervised versus unsupervised pelvic floor muscle training for the treatment of stress urinary incontinence: a randomized comparative trial. Int Urogynecol J. 2010;21 (7):835-840.
Ferreira M, Santos PC. Impact of exercise programs in women's quality of life with stress urinary incontinence. Rev Port Saude Publica. 2012;3(1):3-10.
Foster SN et al. Hip and pelvic floor muscle strength in women with and without urgency and frequency—predominant lower urinary tract symptoms. J Womens Health Phys Therap.2021;45(3):126-134.
Hung HC, Hsiao SM, Chih SY, Lin HH, Tsauo JY. An alternative intervention for urinary incontinence: retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Man Ther. 2010: 15(3):273-279.
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