Pelvic floor weakness is extremely common among postpartum women.
It’s a primary cause of incontinence (the common postpartum issue of leaking pee). Jumping on the trampoline, sneezing, or even laughing with a weak pelvic floor can cause urine to leak.
Most women with a weak pelvic floor assume their muscles aren’t working hard enough. That the muscles are UNDERACTIVE.
But this isn’t always the case. WEAKNESS DOES NOT ALWAYS MEAN UNDERACTIVE MUSCLES!
Many women with a weak pelvic floor actually have OVERACTIVE pelvic floor muscles. Muscles that are working harder than they need to.
Both over and underactive muscles can cause weakness in the pelvic floor.
In this post, I’ll share some ways to know whether your pelvic floor muscles are over or under active and how to correct your specific issue.
But before I do, let me state explicitly:
KEGELS ARE NOT NECESSARILY THE SOLUTION!
When dealing with weak pelvic floor muscles and/or incontinence the most common advice is… do some Kegels!
Kegels are the popular pelvic floor exercise where you engage your pelvic floor muscles.
While Kegels can help women with underactive muscles, Kegels can make overactive muscles worse!
So let’s dive a little deeper and uncover the root cause of your pelvic floor weakness.
The Difference Between An Over Active and an Under Active Pelvic Floor
What happens in an underactive pelvic floor?
Underactive pelvic floor muscles are weak in the same way a muscle that never gets exercised is weak. If you never strengthen your bicep, it will be weak. If I then place a 10 pound weight in your bent arm, your arm will fall to your side.
Your muscle doesn’t have the strength to hold that weight.
The same thing can happen with your pelvic floor.
If your pelvic floor muscles are underactive, they have trouble contracting fully and/or holding a contraction.
So when you put a large amount of pressure on underactive pelvic floor muscles (as you do when you sneeze), the muscles can’t effectively hold the contraction.
The result: you likely end up pee-ing yourself!
What happens in an overactive pelvic floor?
Overactive pelvic floor muscles are weak because they are trying to contract all the time.
Imagine your bicep again. If I ask you to squeeze your bicep for the entire day, that muscle is going to get TIRED because it is working so hard.
If I then place a 10-pound weight in your arm, the arm will, again, drop to your side. In this case, it will happen because the muscle is worn out from the work it has been doing. It doesn’t have enough strength left to handle any more load. It is weak from overactivity.
This is similar to what happens in an overactive pelvic floor.
Overactive pelvic floor muscles are weak because they are constantly contracting.
So, when you put a large amount of pressure on underactive pelvic floor muscles (like in a sneeze), the muscles aren’t able to contract anymore because they are already contracted (and a bit worn out).
The end result…you pee yourself!
Do You Have An Underactive or Overactive Pelvic Floor?
How do you know what is happening in your pelvic floor?
It’s always helpful to see a physiotherapist who specializes in pelvic floors. They will be able to assess you internally and tell you exactly what is happening in your muscles.
However, that isn’t always accessible or possible. Luckily, there are some other ways you can get a sense of what is happening in your muscles.
Signs of an underactive pelvic floor
If you have an underactive pelvic floor it may feel hard to hold the engagement when you kegel.
You likely feel the muscles engage but then feel them quiver, shake, and begin releasing after a few seconds. You may not be able to hold the Kegel for more than a few seconds before you feel the muscles release.
You may also feel like tampons don’t stay in as well as they once did. Or you may feel that you have less sensation during sexual intercourse.
Also, the muscles often reflect the personality of a person. So, if you are more of a relaxed, Type B, person in general, it’s possible your pelvic floor muscles tend to be more underactive.
Sound like you? You’ll want to check out this post on how to strengthen an underactive pelvic floor.
Signs of an overactive pelvic floor
If your pelvic floor is overactive, you might feel that nothing (or very little) happens when you try to Kegel. When you try to engage your pelvic floor, you don’t feel much change. This happens because your pelvic floor is already contracted and can’t contract further!
You may also experience pain during intercourse or find it difficult to insert tampons.
You may find it difficult to take deep, full breaths. This happens because your breathing muscles and core/pelvic floor muscles are intricately connected. Tightness in your pelvic floor can prevent the diaphragm from dropping down, which makes your breaths more shallow.
You may find that after you pee, you feel you haven’t emptied your bladder completely and you have to pee again.
Also, odds are you tend to be more of a Type A personality that tends to hold tension in her body, in general.
If this sounds like you, you’ll want to check out our post about how to relax an overactive pelvic floor.
**If you aren’t quite sure which one sounds like you, that is normal! Not every pelvic floor falls neatly into one of these two categories.
Some women have areas of underactivity and areas of overactivity. And some women have scar tissue that prevents proper muscle firing.
My Pelvic Floor Pick-Me-Up Program walks you through a full self-assessment of your pelvic floor and can help you determine exactly what is happening in your body.
How to Properly Strengthen Your Pelvic Floor
Underactive Pelvic Floor
If you have an underactive pelvic floor, you want to get your muscles back in the game.
Practicing Kegels, and other core strengthening exercises can be very helpful for you.
This post gives three of my favorite ways to strengthen an underactive pelvic floor.
Overactive Pelvic Floor
If you have weakness caused by an overactive pelvic floor, your priority is to first get your pelvic muscles to relax.
The best way to do this is by focusing on (1) deep breathing that reaches all the way to your pelvic floor and, (2) stretching and muscular release that helps the muscles relax.
For more tips on releasing an overactive pelvic floor check out our post here.
And if you are interested in addressing your pelvic floor issues, once and for all, you might be interested in my Pelvic Floor Pick-Me-Up Program.
This mini-program helps you assess your pelvic floor and guides you through the appropriate exercises to strengthen your pelvic floor. It is appropriate for both over active AND under active pelvic floors!
Click below to learn more.