Bladder Leaks Can Be Caused By Over-Tight Pelvic Floor Muscles… And Kegels May Make Things Worse!

Bladder Leaks Can Be Caused By Over-Tight Pelvic Floor Muscles… And Kegels May Make Things Worse!

January 21, 2021

Say What?!  Women in our society are constantly hearing the phrase “do your Kegels” once they have had babies or reach a certain age.  We have likely heard a doctor or a family member say this.  But we are NOT used to hearing people talk about making sure our pelvic floor muscles are not too tense.  

However, these issues could be the actual cause of bladder leakage from stress like coughing or sneezing.

A muscle that is stuck in a short/tight position (imagine an elbow tuck in the bent position), won’t be able to do its job as designed.  Although this may sound counterintuitive, it is a VERY COMMON issue seen by pelvic physical therapists who are trained in identifying the real cause of issues like bladder leakage and pelvic pain.

Patients very often initially tell us that they know their pelvic floor muscles are weak and they need help with strengthening them.  They have already been doing many Kegels without improvements and are looking for answers and help.

However, many of our patients have pelvic floor and core muscles that are stuck in a state of elevated tension.  Relaxing these muscles is all but impossible for them.  More Kegels would only worsen their issues.


There are often clues that a pelvic physical therapist will look for: 

  • A history of pelvic pain or discomfort with intimacy or gynecologist exam

  • Chronic constipation or difficulty emptying our bladder

  • Being an athlete such as a runner, dancer, or gymnast

  • Issues with a lot of tension in the leg muscles

  • Being challenged with taking deep belly breaths

When I learn of these things, I may begin to suspect that my patient needs more help than just some strength exercises.

This is where a head to toe assessment is required to determine what imbalances are occurring.  This will also ideally include a pelvic floor muscle assessment.  Only then, can we confirm that this is actually the issue.


1.   First, this is NOT the time for pelvic floor strengthening.  Kegels may be a part of the solution, but not until these muscles are able to fully relax as well as contract.  Think of being able to fully straighten the elbow before it’s appropriate to start doing bicep curls.

2.   We start with relaxed belly breathing.  Learning to connect the entire core and pelvic floor muscle team with breath will be essential to being able to learn to release pelvic floor tension.

3.   Identify tense muscles in the abdominals and upper legs that all attach to the pelvis.  Tension in these muscles can often add to the tension of the pelvic floor.

4.   Work with a pelvic physical therapist to learn how to be able to coordinate the pelvic floor muscles to be able to contract, relax, and bulge slightly.

5.   Once the above issues are improved upon, true pelvic floor weakness may be the remaining issue which can now be worked on without making things worse.  Know that ideally, pelvic floor muscles are not usually the only muscles that are weak.  A strength program should eventually look more like a full body strength program… because our body is very much connected.

So if you think you have plateaued with the typical pelvic floor strength program, symptoms have become worse after trying to strengthen, or have a combination of pelvic tension and bladder leakage, this could be YOU.

You can download the bladder health guide as well as the pelvic tension stretches guide and then contact us for a virtual or in office consult.  Let’s get things truly figured out for you so we can make this bladder leaking thing be a thing of the past!

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