Your Pelvic Floor Might Be Overworking — Here's How to Train It Anyway

There's a certain kind of pelvic floor advice that gets handed out like a parking ticket: do your kegels, do them daily, squeeze harder. It's well-meant, it's everywhere, and for some people with endometriosis it's exactly backwards. If your pelvic floor has spent years bracing against pain, it isn't lazy. It's tired, tight and guarding — and asking it to clench more is a bit like telling someone with a clenched jaw to chew with more enthusiasm.

So let's untangle what's actually going on down there, why breath and load often matter more than squeezing, and how to build strength without gritting through pain.

Why "Just Do Your Kegels" Isn't the Whole Story

Kegels are designed for a specific job: strengthening a pelvic floor that's underworking, usually after pregnancy or surgery. They're a useful tool. But they assume the muscles can relax fully between contractions, and that's the bit that gets skipped in the standard leaflet.

With endometriosis, the pelvic floor is often living in a state of low-level emergency. Pain, inflammation, and the anticipation of pain can all make the muscles hold themselves tight — sometimes for years. That's not weakness. It's protection. And a muscle that never gets to switch off doesn't get stronger from more squeezing. It gets shorter, angrier and more painful.

This is why some people find kegels make things worse: more pain with sex, more tailbone ache, more of that heavy, dragging feeling by the end of the day. If that's you, you're not doing it wrong. You may simply be doing the wrong exercise.

Weak vs Guarded: Two Very Different Problems

It helps to separate two patterns that get muddled together.

An underworking pelvic floor tends to show up as leaking when you cough, sneeze, run or lift, and a sense of heaviness or bulging. The muscles need to be taught to switch on and take load.

An overworking or guarded pelvic floor tends to show up differently: pain with penetration, a feeling of tightness or gripping, difficulty fully emptying your bladder or bowels, urgency, tailbone or low-back ache, and a sense that you can't "let go" even when you want to. Many people with endo have a mix of both — some muscles underworking, others overworking — which is exactly why a proper assessment beats guesswork.

You don't need to diagnose yourself from a list. You do need to notice which description sounds more like your body, because it changes what you practise.

Breath First, Squeeze Later

If your pelvic floor is guarded, the first skill is learning to let it downshift — and breath is the lever.

Try this: lie on your back with your knees bent, one hand on your lower ribs and one on your belly. Breathe in through your nose for about four seconds, letting the ribs widen out to the sides and the belly soften. Breathe out slowly for six. On the out-breath, notice the pelvic floor gently dropping and releasing — not pushing down hard, just letting go.

That's it. Two or three minutes, most days. It sounds almost too simple to matter, but rib movement and pelvic floor movement are mechanically linked: when the diaphragm descends on the in-breath, the pelvic floor should lengthen. Restoring that rhythm gives a tight pelvic floor permission to stop bracing.

Once you can find that softening, a contraction becomes far more useful. A good pelvic floor squeeze feels like a gentle lift, not a grip of death — and it should be followed by a full, unhurried release. The release is the training. If you can't let go, stop squeezing.

Load Is a Pelvic Floor Exercise Too

The pelvic floor is part of your deep core team, and like any muscle it responds to load — but the load has to be tolerable. Walking, carrying shopping, standing up from a chair, climbing stairs: all of these ask your pelvic floor to work in coordination with your breath and your hips.

For an overactive pelvic floor, that coordination often looks like learning to exhale on effort rather than hold your breath and brace. Try a slow sit-to-stand: feet hip-width, breathe in to prepare, breathe out as you stand, and let the pelvic floor lift gently with the exhale rather than clench. Ten reps, once or twice a day, is plenty to start.

For an underworking pelvic floor, gradual strength work — heavier carries, controlled squats, a proper progressive plan — is where the real gains come from, ideally with guidance. Either way, if a movement makes you hold your breath, clench your jaw and brace hard, it's currently above your pay grade. Scale it down.

A Gentle Session You Can Try This Week

• Two minutes of 360 breathing, lying down, ribs wide on the in-breath, pelvic floor softening on the out-breath.
• Supported squat hold, hands on a doorframe or kitchen counter, breathing slowly for 20–30 seconds. Let the pelvic floor release at the bottom rather than grip.
• Slow sit-to-stands, exhaling as you rise, five to ten reps.
• Legs-up-the-wall for a couple of minutes afterwards, to let the whole system settle.

Stop if anything sharpens, burns or feels like the start of a flare. Discomfort during a movement isn't a badge of honour — it's information.

When to Ask About an NHS Pelvic Health Physio

If you have pain with sex or tampon use, leaking, a feeling of heaviness, difficulty emptying your bladder or bowels, or pain that persists after you've stopped moving, ask about a referral to a pelvic health physiotherapist. In many areas of the UK you can self-refer through your local NHS trust; in others, a conversation with your GP is the route in. It's worth saying plainly: "I have endometriosis and I'd like a pelvic health physio assessment." You're allowed to ask for that by name.

A good physio will assess rather than assume — checking whether your pelvic floor is underworking, overworking or both, and giving you a plan that fits your body rather than a generic sheet. Waiting lists vary, so ask what you can safely do in the meantime.

The Takeaway

Strength isn't always about squeezing harder. For a lot of people with endo, it starts with letting go: breathing well, moving with your exhale, and loading your body at a pace it can tolerate. Unclench first. The strength follows more easily than you'd think.

This is general information, not medical advice. If you're unsure whether an exercise is right for you, speak to your GP, your endometriosis specialist or a pelvic health physiotherapist.