Hypotonic Vs. Hypertonic Pelvic Floor: Why kegels are not always the answer to a better pelvic floor


You've probably been told at some point in your life that you should do kegels to improve your pelvic floor. And while kegels are a great exercise, they might not be the best for everyone. This is particularly true during pregnancy and after giving birth when many women are concerned about issues like bladder control, weight loss, and abdominal separation.

Today, we're going to talk about the difference between a hypotonic and hypertonic pelvic floor, and why you might want to try different exercises depending on which one you have. So keep reading!

Make sure to grab my free resource, 6 exercises every mom should do postpartum- even if you hate exercising! 

What is the difference between a hypotonic and hypertonic pelvic floor?

The pelvic floor is a group of muscles, ligaments, and connective tissue that support the bladder, uterus, and rectum. These muscles stretch like a hammock from the pubic bone to the tailbone.

A hypotonic pelvic floor is a term used to describe a weak or overly relaxed pelvic floor. In contrast, a hypertonic pelvic floor is tight or overly contracted (and often weak as well, but for different reasons as we'll discuss below).

So, what's the difference between the two? And why does it matter?

Simply put, a hypotonic pelvic floor can lead to bladder and bowel leakage (incontinence), prolapse of the uterus or rectum, SI joint or hip pain and sexual dysfunction. This is because the muscles aren't able to provide support and function efficiently.   After a vaginal delivery, the pelvic floor muscles are often turned off and may lead to a hypotonic pelvic floor. 

Whereas, a hypertonic pelvic floor can cause pain during sex, constipation, leakage (incontinence) and other general pain in the pelvis due to overactivity.

As you should now be starting to see, these two disorders of the pelvic floor have different underlying issues that are causing dysfunction. Ultimately, they will need to be addressed with different treatments for effective recovery. 

How do I know if I have a hypertonic pelvic floor?

If you notice any of the following symptoms, it's time to talk to your doctor or physical therapist about the possibility of tight pelvic floor muscles.

  • Painful intercourse
  • Constipation and straining
  • Pain in the low back or pelvis, including in the hip, abdomen, vagina, and rectum
  • A constant feeling of urgency with urination
  • Leaking with sneezing, coughing, jumping and heavy lifting
  • Holding a kegel will often make things worse
  • Difficulty emptying the bladder or an inability to completely empty (potentially leading to urinary tract infections)
  • Difficult to get a deep breath in

What causes hypertonic pelvic floor?

There are many potential causes of hypertonicity (increased tension) in the pelvic floor, these include:

  • A lower-body injury (i.e. the hips, knees, or ankles) or hypermobility, triggering a compensatory tightening of the pelvic floor for stabilization
  • Trauma to the pelvic floor, such as a fall, childbirth, or sexual abuse
  • High levels of anxiety or stress
  • Chronic inflammation due to issues like an underlying infection, endometriosis, or polycystic ovarian syndrome (PCOS)
  • Scar tissue from pelvic surgery or trauma, such as a hysterectomy
  • Chronic holding of urine or stool due to urinary inconteninence, poor control of a bowel movement, weakness, or habit

Is a tight pelvic floor the same as a strong pelvic floor?

The short answer is no. A strong pelvic floor is necessary for a healthy and functioning pelvis, but a tight pelvic floor can actually be a sign of dysfunction.

A strong pelvic floor appropriately promotes healthy urination, defecation, and sexual habits, a tight pelvic floor does not.

Often, muscles become tight in one area of our body to compensate for another area. This leads to over-worked, tired muscles that can't function in balance as they should. This is no different for the pelvic floor. Weak hip and abdominal muscles often contribute to imbalanced and weak, yet ironically tight, pelvic floor muscles.

Why kegels are not always the answer

Kegels are great for strengthening the pelvic floor, but as we've discussed, a tight pelvic floor is not always indicative of a strong one. In fact, kegels can actually make a hypertonic pelvic floor worse when the focus is on "tightening" these muscle groups. Rather, the focus should be on learning to relax these muscles (when appropriate) and use them with intention as they regain normal tension and strength.

What are some exercises I can do at home to relax a tight pelvic floor or strengthen a weak pelvic floor?

Here are a few basic pelvic floor exercises to get you started with reducing tension on your own right now:

  • Stress management. If you are suffering from a lot of anxiety, it's important to add relaxing self-care to your daily routine. This will look different for everyone, ranging from yoga and meditation to an extra hour of sleep or time spent chatting with a good friend (or all of the above!).
  • Deep breathing. Proper breathing is huge for promoting muscular balance between the diaphragm, abs, and pelvic floor. It's easiest to start lying down, focus on keeping your entire body relaxed while breathing through your belly. Try your best to keep tension out of your neck and pelvis. Then, you can try the same breathing in other positions such as sitting or standing.
  • Lower body stretching. If you notice tension and pain in adjacent areas of your body, a good stretching session can help promote overall relaxation. Easy ones to try first include child's pose and happy baby stretch. Both of these stretches will help relax the pelvic floor muscles and low back. 

The following techniques are very effective but may require guidance if you are new to them. Get in touch with a physical therapist that specializes in women's health for the most in-depth education and treatment plan that will get you the results you want.

  • Muscle release. Internal massage (vaginal or rectal) or external release of affected muscles with techniques like myofascial release or trigger point release. This can be done with special tools on your own or with the guidance of a licensed medical provider.
  • Muscle re-education. If your pelvic floor is picking up the slack for other weak or injured muscles, it's time to train those muscles to do their job again. This might include targeting the lower abdominals and hip rotators. Examples include pelvic tilts, bridges, and deadbugs.

What if these exercises aren't enough?

Many women suffer in silence from issues related to the pelvic floor. It is an issue that still feels taboo to many women despite the growing infrastructure for providing them the care they need. Pelvic floor specialists are working to promote awareness and help women know that there's a better way- because it isn't normal to have chronic pelvic pain, painful sex, constipation, and beyond.

Pelvic floor physical therapy can truly do wonders for women’s health. A physical therapist can complete an in-depth exam to determine the exact cause of your overactive pelvic floor and get you on track with a treatment plan that works.

Do you think you might be suffering from chronic pelvic floor dysfunction? Have any questions? Don't hesitate to contact me!

If you would like more support on your postpartum health journey, please join my free private FB group, Healthy Mama Huddle for recipes, workouts and postpartum tips and education!