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My PFM are tight, Why Am I Still Leaking?

Hi friends! You may have heard that weak pelvic floor muscles can cause urinary leakage, but did you know that pelvic floor muscles that are too tight can also contribute to incontinence? How can this be? Having tight pelvic floor muscles means they are really strong, right? It's not quite that simple. This week we are going to talk about why tight pelvic floor muscles can still have a hard doing their job well.

A healthy muscle is able to fully contract (at the right time) and then it’s able to fully relax (at the right time). An overactive 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.

Have you ever heard of Kegels? They are an exercise that can be done for the pelvic floor. 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 overactive 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.

Your therapist may use many different techniques in addition to exercises. They may use hands-on techniques to help improve tissue flexibility and range of motion. To help with pain they might use modalities like heat, ice, and electrical stimulation. They may also give you at home treatments to do including the use of vaginal dilators or a pelvic wand.

Tight pelvic floor muscles often happen because of weakness in another area of the body. A pelvic floor therapist should do a thorough assessment and help to develop an program based on your individualized needs. Pelvic floor therapy often incorporates breathing exercises, hip and core stretching and strengthening exercises, coordination training, and so much more!

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

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.

Remember that there is hope! You don’t have to live with constant pelvic pain and urinary incontinence.

To learn more about your pelvic floor muscles, check out these great resources:

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!

Written by Emily Reul, PT, DPT

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