How To Tell If Your Pelvic Floor is Tight or Weak: A 5 Step Guide to Self Assessment
Are you newly postpartum and want to do a self assessment of your pelvic floor?
Are you dealing with pelvic pain symptoms/dysfunction and want to know if your pelvic floor is tight or weak?
This outline is for you!
Step One: Ask Yourself These 3 Questions
Before doing any type of physical assessment, ask yourself these three questions:
Do you have pain with intercourse or any type of penetration?
Do you have difficulty starting a stream of urine or feel like you did not fully empty?
Do you have to strain to eliminate bowel movements?
If you answer yes to any of these questions, it is already likely that your pelvic floor may be a bit over-recruited. Tight pelvic floor muscles can cause penetration to be painful, can stop urine from leaving the urethra effectively, and can make it difficult to have bowel movements. Pelvic floor muscles dictate bowel, bladder, and sexual health so you can use data about how your function is to determine if there is any pelvic floor dysfunction.
You may be wondering, but what if I am weak? Generally weakness will show up as urinary or fecal incontinence, or even heaviness in the pelvis with symptoms from something like a prolapse. If you do not have pelvic pain but still have some of these symptoms, it is possible you are dealing with weakness.
However, one concept that is important for you to understand is that tight muscles are weak muscles! Even though it would feel easier to be put into one clear category, the reality is that most people with pelvic floor dysfunction have a mixture of tightness and weakness. This is why it is important to have an individualized assessment in person so that your specific presentation can be addressed with the specificity and nuance you deserve!
Step Two: Assess the Somatic Feeling of Your Pelvic Floor
For this step, sit in a chair where your sitz bones are firmly connected to a surface beneath you. Take a couple deep breaths, close your eyes if you can, and ask yourself:
Does my pelvic floor feel like it is lifting away from the chair and being held?
What images come to mind when I think of my pelvic floor?
Do I feel any discomfort along the base of my pelvis as I sit here?
If you are feeling your pelvic floor is actively lifting away from the chair, you may be holding tension in your pelvic floor. This might also come with a sense of your stomach being sucked or held in.
Images are important to be curious about because what you visualize when you think of a part of your body can inform how that tissue is held.
If you feel discomfort or pain, this can be a clue to tight muscles as well. Tight pelvic floor muscles decrease blood flow to the area and nerves love blood flow. When nerves are not getting their nourishment, they can become sensitized and begin to express pain signals.
If you are feeling a sense of bulging or something descend down as you sit, this could be a potential sign of prolapse.
If you do not feel anything, no information is still helpful information. Lack of sensation* suggests a disconnect of your brain to your pelvic floor and may suggest that there will be potential coordination issues in the beginning. Luckily, this can all be addressed via pelvic PT.
*One important distinction to note is that if you feel absolutely nothing at your pelvic floor, no feelings of pressure or touch, and that area feels completely numb, please contact your doctor immediately. There is a difference between not being able to visualize and connect vs not being able to feel anything at all. This paired with the inability to urinate or defecate, or not feeling the urge to urinate or defecate, is a medical emergency and your MD should be contacted immediately.
Step Three: Assess Your Pelvic Floor Visually and Externally
If you are comfortable, remove pants and underwear and sit in a low squat that is supported, perhaps against a wall so you can relax. Have a hand held mirror underneath you, and see if you can visually inspect the external tissue (vulva).
Is there any abnormal redness at the tissue?
Do you see any signs of tearing, scar tissue, or active bleeding?
Do you visually see anything dropping down (bladder, uterus, rectum)?
If you answer yes to any of these questions, you may want to notify your MD. These can also be signs that pelvic PT will be indicated after non musculoskeletal causes have been ruled out.
You may also be curious to visually inspect your pelvic floor coordination. Still using the mirror, you can try to:
Lift your pelvic floor up and in
Relax your pelvic floor
Bear down or imagine pushing something out
When performing these three motor tasks, you should be able to visually see a difference between all three. If you try one and do not see any movement or change in tissue, this may also suggest coordination deficits that can be addressed through pelvic PT.
Step Four: Assess Your Pelvic Floor Internally
If you are comfortable, you might try assessing your pelvic floor internally. For this, you might use your finger, a tampon, or a dilator to get feedback. Please note that whatever you choose to insert, please make sure it is clean and sterile before inserting. The vagina is sensitive to soaps so please either use a pH matching soap or just hot water to clean to ensure you do not disrupt your vaginal pH and microbiome.
You can choose the position that is most comfortable for you. It may be laying on your side or on your back, as long as you are not straining your abdominal muscles to reach. Use a lubricant of your choice and gently insert one finger into the vagina. Please only do this internal assessment if you have been cleared by your MD for intercourse and/or are not currently experiencing a high risk pregnancy of any kind.
Once the finger is inserted, you may gently press your finger against the sides of the vaginal wall. If the opening of your vagina was a clock where your pubic bone is 12 o’clock and your tailbone is 6 o’clock, you can assess anywhere except 12 and 6 (avoiding the urethral and tailbone). Go slow and with no more than 50% of your strength. If you note any areas that feel tight or tender, you again may be experiencing a high tone pelvic floor. Please do not surpass a 4/10 on the pain scale with this assessment.
If you still feel safe and regulated in your body as you do this assessment, you may also once again assess the three coordination tasks:
Engage and lift pelvic floor against your finger
Relaxation around your finger
Bulging or bearing down (trying to push your finger out)
For the first task, you should be able to feel the sensation in your vagina as well as pressure on your finger. There should be both a squeeze and a lift. If you do not feel a lift, you may be experiencing some weakness.
When relaxing, you should feel a sensation of space around your finger as the pelvic floor expands. If you do not feel this, you may be having trouble coordinating lengthening of your pelvic floor.
When bulging or bearing down, you may want to look visually to see if there is any movement of tissue down and out of the vaginally walls. If there is movement with tissue that seems golf ball shaped, you may be expressing prolapse. This can be more thoroughly assessed by your MD and PT to give you an accurate diagnosis of the type of prolapse, the grade, and the appropriate interventions with expected outcomes.
If you are not able to complete penetration, please know this is a common response. Common does not mean it is normal. However, many people suffer from pelvic floor muscles that become sensitized and do not allow for penetration to occur. Common diagnoses for this include vaginismus and vulvodynia and this can be successfully treated with quality pelvic floor PT.
Step 5: Take a Few Deep Breaths
Notice how your body and mind feel after all of these assessments. Pause and go slow with yourself.
Notice if judgments or anxieties surface.
Take five deep, diaphragmatic breaths and allow your nervous system to settle.
It is normal to feel confused about or even fearful of a part of your body that is not talked about enough in this culture. Please know that this guide is just the first step on a journey to helping you feel safer and more confident in this part of your body.
This guide is not medical advice and does replace an in personal comprehensive assessment by your MD and pelvic PT. It is meant to empower you with education and allow you to begin to explore your pelvic floor with curiosity.
Whether you are tight, weak, or both, there is so much hope for pelvic floor dysfunction. With an individualized treatment plan, your symptoms can change and your relationship to your body can be transformed.
If you are interested in an in person assessment in Oakland, CA you can work with Bodyful Physical Therapy by booking a discovery call here.
If you are not in the Bay Area but are interested in Bodyful’s somatic approach to pelvic physical therapy, you can still work with us via Telehealth and wellness services. Education and embodiment can go a long way! Reach out to see if you are the right fit for our methodology.
