How to Tell if Pelvic Floor is Tight or Weak?

Authored by Bodyful Physical Therapy and Wellness

How to Self-Assess Your Pelvic Floor: Tight or Weak?

Are you newly postpartum and wanting to do a gentle self-assessment of your pelvic floor?

Are you dealing with pelvic pain or pelvic floor dysfunction and wondering whether your pelvic floor is tight or weak?

This outline is for you.

Pelvic floor tension, pelvic muscle tightness, and weakness often coexist. This guide is meant to help you build awareness—not replace care from a pelvic floor physical therapist.

Step One: Ask Yourself These 3 Questions

Before doing any physical assessment, ask yourself:

• 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 answered yes to any of these, it is likely that your pelvic floor may be over-recruited or tense.

Tight pelvic floor muscles can:

• Make penetration painful

• Interfere with urine flow

• Make bowel movements more difficult

Because pelvic floor muscles influence bowel, bladder, and sexual health, changes in function can provide helpful information about pelvic floor tension or dysfunction.

What About Weakness?

Pelvic floor weakness more commonly shows up as:

• Urinary or fecal incontinence

• Heaviness or pressure in the pelvis

• Tailbone or sit bone pain at the tendons

However, an important concept to understand is this:

Tight muscles are weak muscles.

Most people with pelvic floor dysfunction experience both tightness and weakness, which is why a one-size-fits-all approach does not work. Individualized assessment—whether in person or through virtual pelvic floor therapy—is key.

Step Two: Assess the Somatic Feeling of Your Pelvic Floor

Sit in a chair with your sitz bones firmly connected to the surface beneath you. Take a few slow breaths. Close your eyes if that feels comfortable.

Ask yourself:

• Does my pelvic floor feel like it is lifting away from the chair?

• What images come to mind when I think about my pelvic floor?

• Do I feel discomfort at the base of my pelvis as I sit?

If your pelvic floor feels like it is lifting or gripping, this may indicate pelvic floor tension. This is often paired with gripping your abdominals or breath-holding.

How you visualize a body part can influence how that tissue is held. Your body may also provide imagery.

If you feel discomfort or pain, this can also point toward tight pelvic floor muscles. Tight muscles reduce blood flow—and nerves rely on blood flow to feel safe and regulated.

If you feel bulging or descent, this may suggest prolapse.

Important Safety Note

If you feel complete numbness, inability to feel pressure, loss of bladder/bowel urges and associated full urinary and fecal incontinence, contact your MD immediately. This is different from decreased awareness and requires medical evaluation.

Step Three: Visual & External Pelvic Floor Assessment

If comfortable, remove pants and underwear and sit in a supported low squat. Use a hand mirror to visually inspect the vulvar tissue.

Notice:

• Redness or irritation

• Tearing, scar tissue, or bleeding

• Any visible bulging of bladder, uterus, or rectum

If you observe any of these, notify your MD. Pelvic floor physical therapy may still be indicated after non-musculoskeletal causes are ruled out.

Assess Coordination

Using the mirror, attempt to:

• Lift the pelvic floor

• Relax the pelvic floor

• Bear down gently

You should see three distinct movements. If movement is limited, this suggests coordination challenges—very common postpartum and very treatable through pelvic PT.

Step Four: Internal Pelvic Floor Assessment (Optional)

Only proceed if you:

• Feel emotionally safe

• Have been cleared by your MD for penetration

• Are not in a high-risk pregnancy

Using a clean finger, tampon, or dilator with lubricant, gently insert into the vagina in a comfortable position.

Using the “clock” image (avoiding 12 o’clock at your urethra), apply gentle pressure to the vaginal walls.

If you feel:

• Tenderness

• Tight bands

• Discomfort above 4/10

…this may indicate high-tone pelvic floor muscles.

Assess Coordination Again

• Lift: You should feel a squeeze and lift

• Relax: You should feel space around your finger

• Bear down: You may feel yourself push your finger out

Difficulty relaxing or lifting may reflect tight or weak pelvic floor muscles—often both.

If penetration is not possible, know that this is common. Diagnoses like vaginismus and vulvodynia are treatable with quality pelvic floor physical therapy, including virtual pelvic floor therapy.

Step Five: Pause & Breathe

After the assessment:

• Notice your body’s response

• Notice emotions or judgments

• Take five slow diaphragmatic breaths

It is normal to feel uncertainty around a part of the body that is rarely discussed. This guide is meant to support curiosity—not pressure.

This information does not replace an in-person medical or pelvic PT assessment.

There Is Hope for Pelvic Floor Dysfunction

Whether your pelvic floor is tight, weak, or both, symptoms can change.

With an individualized plan—either in person or through virtual pelvic floor therapy—your pelvic muscle tension can decrease, coordination can improve, and your relationship with your body can shift.

If you are in Oakland, CA, you can work with Bodyful Physical Therapy through an in-person assessment by booking a discovery call here.

If you are not in the Bay Area, Bodyful also offers virtual pelvic floor therapy. Education, embodiment, and nervous-system-informed care can go a long way.

Reach out to see if our approach is the right fit for you.