Almost every piece of popular advice about the pelvic floor directs people to strengthen it. Do your Kegels. Contract, hold, release. This is appropriate advice for some conditions and some people. For a significant proportion of those experiencing pelvic pain, sexual difficulty, or urinary symptoms, it is the exact wrong approach.
When the pelvic floor is hypertonic, meaning it is in a state of chronic, low-grade contraction, adding more contraction exercises tightens an already tight system. The analogy is instructive: you would not treat a severe muscle cramp by asking the cramping muscle to contract more forcefully. You would stretch it and allow it to lengthen.
What hypertonicity means
A hypertonic pelvic floor is one in which the resting muscle tone is chronically elevated. The muscles are not fully relaxing between uses. This persistent low-level contraction restricts blood flow, causes lactic acid accumulation, and creates nerve irritation throughout the pelvis.
This matters because a muscle that cannot fully relax also cannot fully contract. Range of motion requires the capacity to move in both directions. A chronically shortened muscle has lost a significant portion of its functional range.
A pelvic floor that cannot relax is a weak pelvic floor, regardless of how many Kegel contractions it can perform. Strength requires full range of motion.
How common is it?
Estimates from pelvic floor physiotherapy clinics suggest that between 30 and 40 percent of patients presenting with pelvic floor dysfunction have hypertonicity as the primary or contributing problem, rather than weakness. This proportion is higher among those presenting with pelvic pain and painful intercourse.
Common symptoms of a hypertonic pelvic floor
The presentation varies but typically includes one or more of the following: pain during or after intercourse, difficulty with penetration, urinary urgency or incomplete bladder emptying, chronic aching in the perineum, tailbone, or lower abdomen, painful ejaculation in men, and constipation or pain during bowel movements. Many people experience several of these simultaneously without recognising a common cause.
Why tension accumulates
The pelvic floor has a particular affinity for emotional and physiological stress. Just as chronic stress causes some people to clench their jaw or raise their shoulders, it causes others to unconsciously hold tension in the pelvic floor. Because the muscles are internal and largely outside awareness, this tension can persist for years without being noticed.
Anticipatory anxiety about pain, such as that experienced in vaginismus, also maintains hypertonicity. The brain pre-activates the protective contraction before any threat has actually arrived.
The treatment approach
The primary intervention for a hypertonic pelvic floor is learning to consciously release tension rather than contract it. This is called a pelvic floor drop or reverse Kegel. The sensation is one of opening and lengthening rather than squeezing.
The easiest way to access this sensation initially is to notice what happens in the moment before you begin to urinate. There is a distinct release and downward movement. That is the pelvic floor dropping from its resting tone to full relaxation. The goal of treatment is to develop conscious, voluntary access to that state.
Diaphragmatic breathing supports this work profoundly. Each full inhalation physically requires the pelvic floor to yield and expand. Consistent diaphragmatic breathing practice is both a diagnostic tool and a treatment intervention for hypertonicity. Both our Vaginismus Programme and our Premature Ejaculation Programme include structured pelvic floor release work from the first week of training.
