The experience of pain while performing Kegel exercises, which are voluntary contractions of the pelvic floor muscles, can be confusing and alarming. These exercises are widely promoted for strengthening the muscles that support the bladder, uterus, and bowels, yet for many people, the effort results in discomfort. This pain signals that the underlying mechanics of the pelvic floor may be dysfunctional, or that the technique being used is incorrect. Understanding the source of the pain is the first step toward correcting the issue and achieving optimal pelvic health.
Errors in Technique and Overexertion
Pain during Kegels is often rooted in improper technique or overworking the muscles. A correct Kegel involves a sensation of lifting and squeezing the muscles that wrap around the urethra, vagina, and rectum, followed by a complete release. If the contraction feels like a bearing-down or pushing movement, this indicates increased intra-abdominal pressure, which can strain pelvic floor tissues and lead to pain.
Many people unintentionally tense surrounding muscle groups, such as the glutes, inner thighs, or abdominal muscles, during the exercise. This added tension prevents the target muscles from isolating and relaxing properly, resulting in muscle fatigue and subsequent soreness. Holding the breath while contracting is another common error that increases pressure in the abdomen and can cause discomfort.
Like any other muscle group, the pelvic floor can be overtrained, leading to fatigue, soreness, and constant tension. Doing too many repetitions or sessions without adequate rest can cause the muscles to become tight and painful. If you experience muscle ache or soreness after a Kegel session, it signals that the muscles were overworked and require rest.
Pelvic Floor Hypertonicity and Tightness
One frequent underlying cause of pain during a Kegel is pelvic floor hypertonicity, an overly tight and non-relaxing muscle state. In this condition, the pelvic floor muscles are already shortened and constantly in a state of increased tone, even at rest. Attempting to contract a muscle that is already tight can trigger a cramp-like pain or activate painful knots within the muscle tissue, known as trigger points.
For a hypertonic pelvic floor, strengthening exercises like Kegels are counterproductive because they increase existing tightness, often worsening the pain. This heightened tension can manifest in symptoms such as pain during sexual intercourse or tampon insertion, difficulty fully emptying the bladder, or chronic constipation. The muscles are unable to fully relax and lengthen, which is necessary for normal function, including controlling the flow of urine and bowel movements.
If hypertonicity is the issue, the therapeutic focus must shift from strengthening to relaxation and lengthening exercises. Techniques such as diaphragmatic breathing, which allows the pelvic floor to descend and relax, and gentle stretching are necessary to restore normal muscle length and flexibility. Only once the muscles can fully relax is it appropriate to consider a strengthening program.
Pain Related to Non-Muscular Conditions
Pain during pelvic floor contraction may indicate an underlying medical condition not directly related to muscle tone or technique. Urinary Tract Infections (UTIs) or generalized bladder inflammation, such as interstitial cystitis, can cause pain aggravated by the pressure changes and muscle tension of a Kegel. The inflammation makes the surrounding muscles more guarded and sensitive to contraction.
In some cases, the pain may be related to the nervous system, such as with pudendal neuralgia, where the pudendal nerve becomes irritated or compressed. Since the pelvic floor muscles are in close proximity to this nerve, contracting them can further irritate it, leading to sharp, shooting, or burning pain. Endometriosis or ovarian cysts can also cause general pelvic pain that is intensified by muscle contractions.
Pelvic organ prolapse, where an organ like the bladder or uterus descends into the vaginal canal, can also cause discomfort during Kegels. An incorrect contraction that pushes down instead of lifts up can pull on supportive ligaments and tissues, exacerbating the sensation of heaviness or causing localized pain. These non-muscular issues require a medical diagnosis to identify and treat the primary source of the pain.
When and Who to Consult for Pain
If you experience pain, discomfort, or worsening symptoms while performing Kegels, stop the exercises and seek professional guidance. Sharp, sudden pain, or pain accompanied by red flag symptoms like fever, blood in the urine, or unexplained weight loss, warrants immediate consultation with a general practitioner or gynecologist.
For pain related to muscle function, a Physical Therapist specializing in Pelvic Health is the recommended specialist. These therapists are trained to perform a comprehensive assessment, including an internal and external evaluation of the pelvic floor’s strength, coordination, and ability to relax. They can accurately determine whether the issue is weakness, hypertonicity, or poor technique.
A typical consultation involves identifying the root cause of the pain and creating a personalized treatment plan. This plan may include biofeedback, manual therapy to release tight muscles, and specific exercises tailored to individual needs. This specialized approach moves beyond general advice to address the actual underlying dysfunction.