Belly Balancing Journal

Pelvic Health · Treatment

Overactive pelvic floor?

Name: Overactive pelvic floor? Why more Kegels make it worse
Creator: @dr.hailey_tonguetotoes
Keywords: pelvic health, pelvic floor, overactive pelvic floor, hip flexors, release-restore-rebuild

Why more Kegels make it worse

Here’s a scenario every pelvic provider knows. A client reports weakness, leaking, or heaviness. The instinct — hers, and often ours, is more strength. More Kegels. More aggressive activation. And for a subset of clients, that advice quietly makes everything worse.

The reason is simple once you see it: not every struggling pelvic floor is a weak one. Many are overactive already tight, already gripping, already stressed. Stretch or strengthen a muscle that’s stuck in tension and you send the nervous system the same message it’s already stuck on: keep holding.

The question that changes the plan

Before you prescribe a single exercise, ask: is this area overactive, underactive, or both? It sounds obvious, but it’s the step most treatment skips. An overactive pelvic floor can absolutely feel weak — a muscle held in constant tension has no range left to generate force. So the client is, in a real sense, overactive and weak at the same time. Treat only the weakness and you feed the tension.

She doesn't need a stronger pelvic floor. She needs a pelvic floor that can let go and then work.

It usually starts at the hips

Overactivity rarely lives in isolation. In pregnancy especially, tight hip flexors pull the pelvis into an anterior tilt, and that tilt puts the pelvic floor on constant stretch-and-grip. Chase the pelvic floor alone and you’ll keep losing, because the posture driving it never changed. Assess the hip flexors, the pelvis, and the floor as one connected chain.

Release, restore, rebuild — in that order

The sequence matters more than any single technique. Release the overactive, restricted tissue first, soft tissue work externally, and internally if you’re trained and in scope. Restore mobility and down-regulation with breathing: inhale to soften and lengthen, exhale to gently engage. Only then do you rebuild, light, coordinated strength and glute activation to rebalance the hips. Reverse that order and you’re building strength on top of restriction, which is exactly how these cases get “stuck.”

Get the sequence right and something clicks: the client who felt weak for months finally has a floor that can both relax and respond. That’s not a stronger muscle. That’s a balanced system.