We say pelvic health, you think Kegels. It’s like one of those stadium chants: Pelvic health? Kegels! Pelvic health? Kegels! And if you have weak pelvic floor muscles, this strengthening exercise is usually recommended. Kegel exercises work to make those muscles stronger, which can help improve things like bladder and bowel control and even your sexual response. But. Pelvic floor muscles don’t always need strengthening. In fact, some pelvic problems (like pelvic pain, trouble emptying your bladder, and urinary urgency and frequency) may be due to pelvic floor muscles that are hypertonic, or too tight. In those cases, you might need exercises that do the opposite of Kegels — relax (not tighten) your pelvic floor muscles. Read on to learn about your pelvic floor, the benefits of pelvic floor physical therapy for too-tense muscles, and the best exercises to relax pelvic floor muscles. 

What Is Your Pelvic Floor?

Not familiar with your pelvic floor? This group of muscles and tissues is shaped like a bowl at the bottom of your torso. Your pelvic floor stretches from your pubic bone in front to your tailbone in the back. Like the foundation of a house, the pelvic floor supports everything above it. It helps hold pelvic organs in place and plays a role in bladder and bowel control and sexual response.

Just like other muscles in your body, your pelvic floor muscles can get too tight. They may stay contracted, spasm, or have difficulty relaxing. An overly tight pelvic floor can lead to pain, bowel and urinary symptoms, and sexual problems. For example, pelvic floor muscles need to relax to allow urine to flow out of the bladder. If the muscles are too tense, it can be hard to start a stream of urine. You may feel like you can’t empty your bladder completely or have another urge to go right after you finish urinating.

Pelvic floor tightness may be due to many different factors. Some common reasons include: holding stress and tension in your pelvic floor muscles, frequently delaying urination or bowel movements, injury to your pelvic floor from surgery or trauma, health conditions like irritable bowel or painful bladder syndrome, and more.

Signs Your Pelvic Floor Needs Relaxation Exercises

One common symptom is pain. You may feel pain in your pelvic area, lower back, or hips. It may also occur in a specific spot, such as your tailbone or bladder. You may also feel pain with urination, during bowel movements, or during sex. Other signs of a tight pelvic floor include: 

• Difficulty starting a bowel movement

• Feeling like you’re straining when pooping, or are unable to empty completely

• Constipation

• Difficulty starting a stream of urine

• Slow urine stream

• Urinary urgency and frequency (feeling like you need to pee right after you go)

• Urge incontinence (having a sudden urge to urinate, followed by leaking pee)

Symptoms of a tight pelvic floor tend to develop slowly and get worse over time. 

How Physical Therapy Helps Relax Pelvic Floor Muscles

Muscles are designed to contract and relax. For a healthy pelvic floor, you need to be able to tighten (contract) the muscles and fully release (relax) them so they function properly. When pelvic floor muscles are constantly contracted, it can cause pain and other symptoms. Pelvic floor physical therapists (PTs) can provide relaxation exercises to help stretch and relax tense muscles to relieve symptoms.

If your pelvic floor muscles are both tight and weak — which is common — PTs will address the tightness first. Trying to strengthen overly tight muscles could make symptoms worse. Imagine you spent all day flexing your bicep. After a while, it would ache and not work as well. You would need to relax and stretch, or lengthen, the bicep before doing anything else. The same is true with your pelvic floor muscles. PTs will help you lengthen these muscles before you strengthen them. Pelvic floor physical therapy is a comprehensive treatment that may include education, behavioral and lifestyle strategies, movement and exercise, and manual therapy. You can see a physical therapist in person or use a program like Hinge Health to access a PT who specializes in pelvic health via telehealth video visit.

Depending on your symptoms, a pelvic floor physical therapist may also recommend lifestyle strategies for overall well-being, such as: 

• Stress management techniques, like mindfulness meditation or talk therapy 

• Nutritional changes, such as adding more fiber to your diet to improve your bowel health 

• Sleep strategies, like adjusting your sleep schedule or avoiding electronic devices before bedtime 

Benefits of Pelvic Floor Relaxation Exercises

Pelvic floor relaxation exercises can help address many different pelvic symptoms. They can help you:

• Reduce pain in your pelvic area, lower back, hips, or bladder 

• Reduce pain while urinating or during bowel movements

• Enjoy more comfortable sex

• Improve bladder control and reduce urgency and frequency 

• Improve bowel control and reduce constipation

There are many exercises to help stretch and relax pelvic floor muscles. These relaxation exercises are most effective when you coordinate them with your breathing. Think of your diaphragm (the muscle that sits on top of your rib cage) and your pelvic floor (at the bottom of your core) as dance partners. They move together. When you inhale, your diaphragm moves down. At the same time, your pelvic floor drops and lengthens. (When you exhale, your diaphragm and pelvic floor rise back to a neutral position.) Focus on breathing down into the pelvic floor when you inhale. Try to feel (or even just picture) your pelvic floor descend to help enhance the stretch. 

The above exercises recommended by Hinge Health pelvic floor physical therapists are a great way to help relax and stretch your pelvic floor muscles.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Remember, Kegels Are Not for Everyone

“Kegel exercises have a lot of benefits and can be an important way to improve your pelvic health," says Sarah Fogle, PT, DPT and Hinge Health pelvic floor physical therapist. “But there is a time and place for them in your program. When your pelvic floor muscles are too tight, Kegels can make your symptoms worse. You may need to focus on relaxing those muscles first,” she says.

“I have people avoid Kegels until I know they can relax or drop their pelvic floor,” says Dr. Fogle. “Once they can do that, then we can start Kegels and strengthening exercises. Think of your body like a three-legged stool: it needs a balance of strength, mobility, and flexibility."

Learn More About Hinge Health for Pelvic Symptom Relief

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here. 

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Faubion, S. S., Shuster, L. T., & Bharucha, A. E. (2012). Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction. Mayo Clinic Proceedings, 87(2), 187–193. doi:10.1016/j.mayocp.2011.09.004

2. Grimes, W. R., & Stratton, M. (2021). Pelvic Floor Dysfunction. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559246/

3. Huang, Y. C., & Chang, K. V. (2022). Kegel Exercises. In StatPearls. StatPearls Publishing. 

4. Shaheed, H. (2019, June 13). The hypertonic pelvic floor. Continence Foundation of Australia. Retrieved August 17, 2023, from https://www.continence.org.au/news/hypertonic-pelvic-floor

5. van Reijn-Baggen, D. A., Han-Geurts, I. J. M., Voorham-van der Zalm, P. J., Pelger, R. C. M., Hagenaars-van Miert, C. H. A. C., & Laan, E. T. M. (2021). Pelvic Floor Physical Therapy for Pelvic Floor Hypertonicity: A Systematic Review of Treatment Efficacy. Sexual Medicine Reviews, 10(2). doi:10.1016/j.sxmr.2021.03.002