When it comes to pelvic health, we’ve all heard the advice: do your kegels. Squeeze, lift, repeat… daily.

But what if I told you that for some women, this advice could actually be making their symptoms worse?

If you’re dealing with discomfort, pain, or even leaking – and kegels haven’t helped – it’s time to talk about a condition that’s finally getting the attention it deserves: the overactive pelvic floor.

In this post, I’ll unpack what it really means to have an overactive pelvic floor, how to recognise the symptoms, and why working with a women’s health physiotherapist is a must (not a maybe).

What Is an Overactive Pelvic Floor?

An overactive pelvic floor – also called a hypertonic pelvic floor – means the muscles in that area are too tight or switched on more than they should be. Just like tension in your neck or shoulders, your pelvic floor muscles can become tight and resistant to relaxation.

This isn’t the same as having a strong pelvic floor. Overactivity is about difficulty letting go, not extra strength.

And while “tight” might sound like a good thing in the context of our pelvic floor, it’s actually not. Tight muscles can be painful, dysfunctional, and disruptive to your everyday life, including sex, digestion, urination, and overall comfort.

Signs and Symptoms of an Overactive Pelvic Floor

You don’t need to experience all of these symptoms to have pelvic floor dysfunction. But if you relate to a few, it’s worth speaking to a women’s health physiotherapist.

Common signs include:

• Pain in the pelvis, lower back, tailbone or hips
• Constipation or incomplete bowel emptying
• Pain during sex, tampon insertion or internal pelvic exams
• Vaginismus (involuntary muscle tightening around the vagina)
• Urinary symptoms like:
  • Leaking
  • Incomplete emptying
  • Slow or hesitant urine flow
  • Urgency or frequency
  • Painful urination

Many women with these symptoms assume their pelvic floor must be weak, so they start doing more kegels, which can actually make the problem worse.

What Causes an Overactive Pelvic Floor?

This condition doesn’t have a single cause, but several contributing factors can increase tension in the pelvic floor muscles.

These include:

• Frequent core or high-intensity exercise that keeps pelvic muscles switched on
• Regularly holding in urine or bowel movements (e.g. avoiding public toilets)
• Chronic stress or anxiety, which activates a whole-body tension response
• Scarring from childbirth, especially with stitches or perineal tears
• Painful conditions like endometriosis, IBS or pudendal neuralgia
• Sexual pain or trauma, where the body instinctively tries to protect itself

Just like your back muscles might spasm after an injury, your pelvic floor can tighten in response to trauma or chronic discomfort.

Why Kegels Aren’t Always the Answer

Most women assume that any pelvic issue means their muscles are weak, so they double down on kegels.

But if your pelvic floor is already overactive, adding more contractions can lead to more pain, more urgency, and more dysfunction.

This is why seeing a women’s health physiotherapist is key. They can assess whether your muscles need strengthening or relaxation, and guide you through the right kind of recovery plan.

How Is an Overactive Pelvic Floor Treated?

Treatment is all about relaxation – not squeezing. Your physio might include some or all of the following in your care plan:

• Pelvic floor relaxation techniques (like the one below)
• Breathing exercises that coordinate with muscle release
• Bladder and bowel education to help retrain your body’s habits
• Pelvic and abdominal massage, including scar tissue release
• Hip and pelvic muscle stretches to reduce surrounding tension
• Use of vaginal dilators, especially if you experience pain during sex or tampon use

Chronic pelvic pain can impact everything from your relationship to your self-confidence. Getting support early can make a huge difference, both physically and emotionally.

Pelvic Floor Relaxation Exercise You Can Try Today

This simple practice can help you connect with your pelvic floor, and learn to let go rather than hold tension.

1. Find a quiet space to lie down, with your knees bent and feet flat on the floor.
2. Place your hands on your belly and breathe in through your nose for 3 seconds. Let your belly rise as you inhale.
3. As you breathe out, gently lift and squeeze your pelvic floor – imagine an elevator going up.
4. Then relax. Let the elevator descend slowly – 3, 2, 1 – and the doors open again.
5. Repeat for 1–2 minutes, focusing on the relaxation phase more than the contraction.

Try practising this daily, especially if you’re working on cycle charting or trying to conceive naturally – your pelvic floor health is a crucial part of the puzzle.

The Bottom Line

The message that “every woman should do kegels” misses the mark for so many. Pelvic floor dysfunction isn’t always about weakness, and in some cases, squeezing more only fuels the problem.

If anything in this post resonates, or if you’ve had a baby recently and are unsure what’s going on down there – don’t wait. Book in with a women’s health physio and get assessed properly. You don’t need a referral in Australia.

You deserve to feel confident, pain-free, and supported – whether you’re aiming to conceive naturally, optimise your natural fertility, or simply reconnect with your body after birth.

As a fertility and preconception coach, I can’t emphasise enough how important pelvic health is when it comes to tracking your cycle and preparing for pregnancy. And understanding your pelvic floor is a powerful step toward that.