The missing links in pelvic floor dysfunction…..

Written By Whitney Ellsworth

"Prolapse isn’t always about weakness.
Sometimes your pelvic floor is working too hard.
You can’t strengthen what’s already tight — and Kegels on tense muscles can make symptoms worse.
Release first. Then strengthen.
This simple shift can reduce prolapse severity and bring real relief.
Read the full blog to learn why."

Pelvic Organ Prolapse: Why Strength Isn’t Always the Answer

When most people hear “pelvic organ prolapse,” they immediately think of weakness in the pelvic floor. The common advice that follows? “Just do Kegels.”

While pelvic floor weakness can be a factor, it’s far from the whole story. In fact, one of the most overlooked — and important — aspects of prolapse is pelvic floor muscle tension.

The Hidden Tension Problem

Your pelvic floor muscles are meant to be dynamic — able to contract, relax, and lengthen when needed. But for many people with prolapse, these muscles are actually too tight in certain areas.

Tightness might sound like a good thing, but in muscle physiology, a tight muscle is often a weak muscle. Imagine trying to strengthen a bicep that’s already stuck in a half-bent position — you can’t effectively work it through its full range of motion. The same goes for your pelvic floor.

Why Kegels Aren’t Always the Solution

Kegels are designed to strengthen by contracting the pelvic floor. But if your muscles are already tense, layering more tension on top can actually make symptoms worse. That’s why some people diligently do Kegels yet see no improvement — or even feel more heaviness or discomfort.

Release First, Then Strengthen

Before strengthening, it’s crucial to address muscle tension. This process is often called down-training or release work. It can include:

  • Gentle breathing exercises to relax the pelvic floor

  • Stretching and hip mobility work

  • Manual release (by a pelvic floor physical therapist)

  • Mind-body techniques to reduce guarding or holding patterns

When tightness eases, the pelvic floor can move through its full range, circulation improves, and coordination between muscles and connective tissue gets better. In many of my clients, simply reducing pelvic floor tension leads to noticeably less prolapse severity and fewer symptoms — even before we begin traditional strengthening.

The Big Takeaway

Pelvic organ prolapse isn’t always about weakness. Sometimes, it’s about muscles that are working too hard for too long. By releasing what’s tight first, you give your pelvic floor the chance to work as it was designed — strong, supple, and responsive.

If you’re struggling with prolapse, it’s worth getting assessed by a pelvic floor physical therapist who can determine whether tension is playing a role in your symptoms. Your best results will come from an approach that restores balance, not just strength.

Whitney Ellsworth