Weak Vs. Tight Pelvic Floor - What’s The Difference?
Most people assume (understandably) that leaking, pelvic pain or prolapse = weakness.
In reality, I find that ~70% of women in general and ~80% of women who’ve had a hysterectomy or myomectomy actually have tightness. Now, tightness CAN cause weakness, but the solutions to weak + tight or weak + flaccid are quite different.
So why does surgery cause tightness? Surgery is trauma + stress.
Think about what your shoulders/neck do during a stressful work day. They tighten up.
What happens when you’ve been in chronic pelvic pain and had years (or decades) of period problems? Now you have the trauma of surgery on top of that…
Things tighten up!
Your body has literally been traumatized.
(In some cases, ligaments are also resuspended during a hysterectomy, in particular, which tightens things further. This is NOT a bad thing, but it does benefit from rehabilitation + kegels aren’t the first line of treatment for this.)
Anyway, doesn’t society say that being "tight" down there is a good thing?
This is a misogynistic myth.
I like to use the analogy of your bicep. If your elbow was always bent, would you expect your bicep to be strong? Would you expect it to feel good?
Nope.
Our muscles function best when they can fully expand AND fully contract. A tight pelvic floor = a pelvic floor that is chronically contracted. Because it’s never moving through a full range of motion, this can lead to weakness over time, BUT the first priority of treatment is relaxation.
This is one of the things I see go wrong most often after a hysterectomy. Kegels are prescribed too soon, too much, and without anything to help relaxation.
Here are some signs of a tight pelvic floor:
Tailbone pain
Urinary urgency
Sexual pain, especially with deep penetration
Trouble emptying the bladder
Getting up from urination & having to go again right away
Urine leaking
Trouble taking a deep breath
Feeling like your abs or glutes are always clenched
Sensations like a UTI, but cultures are negative
Fecal smearing (you have to wipe constantly)
Needing to squeeze your whole body really hard to achieve orgasm
Here are some signs of a weak pelvic floor:
Urine leaking
Decreased sensation during sex
Inability to orgasm
You feel like your butt is getting flatter and flatter
Trouble feeling your glutes during exercise
... see how much longer the "tight" list is? It’s just so much more common, really!
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