Are You Straining to Pee? It May Be Your Pelvic Floor Muscles Not Relaxing
If you have to push, bear down, or strain to urinate, it’s often a sign that your pelvic floor muscles aren’t relaxing the way they should. This issue affects both men and women, but it can show up differently depending on anatomy, posture, and daily habits—especially how much time you spend sitting.
How Urination Is Supposed to Work
Urination depends on coordination, not effort.
The bladder contracts while the pelvic floor muscles and urethral sphincters relax and lengthen. When the pelvic floor stays tense, urine flow becomes restricted, leading to straining, hesitation, or incomplete emptying.
Differences Between Men and Women
Although the underlying problem—pelvic floor muscles not relaxing—is similar, how it presents can differ.
In men:
The urethra is longer and passes through the prostate, so resistance is naturally higher.
Pelvic floor tension often causes hesitancy, weak stream, start-stop flow, or the need to push at the end.
Symptoms are frequently mistaken for prostate issues, even when imaging and labs are normal.
Sitting posture and hip tension play a significant role due to longer periods of sitting at work or while driving.
In women:
The urethra is shorter, so symptoms may show up more as urgency, difficulty initiating the stream, or feeling unable to fully empty.
Pelvic floor tightness may be related to childbirth, pelvic pain, or chronic holding patterns.
Straining may be less obvious, but incomplete emptying and urinary discomfort are common.
In both men and women, pelvic floor overactivity can exist even without pain or obvious pelvic symptoms.
How Sitting Contributes to Straining
Sitting is one of the most overlooked contributors to urinary difficulty.
When you sit for long periods:
The pelvic floor stays in a shortened, compressed position
Hip flexors tighten, altering pelvic alignment
The diaphragm’s ability to move freely is reduced
Nervous system tone shifts toward tension rather than relaxation
Over time, this makes it harder for the pelvic floor to fully let go when it’s time to pee.
Slouched sitting or posterior pelvic tilt increases pressure through the perineum and pelvic floor, especially in men. This can directly interfere with urinary flow and emptying.
Bathroom Posture Matters Too
How you sit on the toilet also matters.
Sitting with feet flat and leaning slightly forward promotes pelvic floor relaxation
Elevating the feet on a small stool can reduce the need to strain
Holding your breath or bearing down increases pelvic floor tension
Urination should feel passive, not forced.
Why Kegels Are Often the Wrong Solution
Straining to pee usually means the pelvic floor is already doing too much.
Adding strengthening exercises without addressing relaxation can:
Increase muscle tone
Worsen urinary hesitancy
Increase pelvic or genital discomfort
Make emptying more difficult
Learning how to relax and coordinate the pelvic floor comes first.
What Actually Helps
Pelvic floor physical therapy focuses on:
Releasing overactive pelvic floor muscles
Improving coordination and timing
Addressing sitting posture and daily positions
Restoring diaphragmatic breathing
Reducing nervous system tension
This approach is different from general core or strengthening programs.
When to Get Help
If you regularly strain to pee, feel incompletely emptied, or have urinary symptoms despite normal medical tests, pelvic floor dysfunction may be the missing link.
The Bottom Line
Straining to pee is often not a bladder or prostate problem—it’s a pelvic floor coordination issue.
Understanding the differences between men and women and addressing how much (and how) you sit can make a meaningful difference in restoring normal urinary flow. Looking to optimize your well being with pelvic floor physical therapy? Reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at receptionmadison@pelvichealthnj.com.