What are the causes and symptoms of weak pelvic floor muscles and what can I do about them?

If you’ve started to suffer from stress urinary incontinence or noticed a lack of sensation during sex, you could have a weak pelvic floor.

The pelvic floor muscles are a group of muscles that extend from your tailbone to your pubic bone and support your pelvic organs.

Below, we look into the causes and symptoms of pelvic floor weakness and what you can do to help tighten these muscles:

• Common causes of weak pelvic floor muscles
• Common symptoms of weak pelvic floor muscles
• What can I do if I have weak pelvic floor muscles?
• Frequently asked questions on weak pelvic floor muscles

Common causes of weak pelvic floor muscles

Pelvic floor muscles can weaken for several reasons, including pregnancy and constipation. The good news is that regularly exercising these muscles can help relieve many symptoms, no matter what’s caused your pelvic floor to become weak in the first place.

Below, we take a closer look at the most common causes of weakened pelvic floor muscles.

Pregnancy and childbirth

Pregnancy and childbirth can affect the pelvic floor in three ways:

1. The weight of the baby putting pressure on the pelvic floor
2. The increase in hormones such as oestrogen and relaxin¹ that loosen ligaments to help the body prepare for labour
3. The pelvic floor being overstretched or torn during childbirth²

It’s a common misconception that only vaginal births can cause issues with the pelvic floor muscles. Studies have shown that even if you have a caesarean birth, you can still experience the problems that a weakened pelvic floor can cause (such as stress urinary incontinence³), although you’re likely to be at lower risk than if you’d had a vaginal birth⁴.

This means that whether you have a vaginal birth or a caesarean, it’s important to do regular pelvic floor muscle exercises, such as Kegel exercises, to keep your muscles healthy and to help prevent issues such as stress urinary incontinence.

As well as doing regular pelvic floor exercises, simply having a good posture can help relieve some of the pressure on the pelvic floor during and after pregnancy⁵.

You can find out more about Kegel exercises and other ways to strengthen your pelvic floor with our guide Vaginal exercises—what they are, how to do them and their benefits.

Constipation

Long-term constipation can weaken the pelvic floor muscles. In some cases, constipation is one of several symptoms associated with pelvic floor dysfunction, a condition that stops the pelvic floor muscles tightening and relaxing to allow a bowel movement.

A weakened pelvic floor can lead to problems such as faecal incontinence (also known as bowel leakage) and can affect both men and women. Physical therapy involving pelvic floor exercises led by a physiotherapist can help improve symptoms of pelvic floor dysfunction and constipation⁶.

Heavy lifting

Regularly lifting heavy weights (at the gym, for example) can put extra pressure on the pelvic floor muscles, causing them to overstretch and weaken.

Obesity

Being overweight can put more pressure on the pelvic area and put strain on the pelvic floor muscles.

Poor posture

If you already have a weak pelvic floor, a poor posture could make other symptoms such as stress urinary incontinence worse. Maintaining a good posture means you aren’t putting the pelvic floor muscles under adverse pressure by sitting in a slouched position⁷.

Common symptoms of weak pelvic floor muscles

Painful sexual intercourse

If the pelvic floor doesn’t relax enough during sex, it can make sex painful⁸. However, although a weakened pelvic floor muscle can cause pain during sex, painful sex is usually a result of overly tight or tense pelvic floor muscles, rather than weakness.

Unfortunately, if you’ve experienced painful sex before, your pelvic floor muscle may tighten before or during intercourse in anticipation that it might hurt again. This is known as vaginismus⁹.

Lack of sensation during sexual intercourse

Pelvic floor disorders, such as weakened muscle, can lessen sensation during intercourse. One study found that “pelvic floor symptoms are significantly associated with reduced sexual arousal, infrequent orgasm, and dyspareunia”¹⁰. Dyspareunia refers to painful sexual intercourse.

Pelvic organ prolapse

A pelvic organ prolapse is when one or more of the pelvic organs (uterus, bowel or bladder) drops from its normal position in the pelvis and protrudes into the vagina. It can create a feeling of heaviness in the pelvis¹¹.

If you have mild pelvic organ prolapse, doing regular pelvic floor exercises can:

• help relieve symptoms
• strengthen the muscle and prevent the prolapse from getting worse

Performing regular pelvic floor muscle exercises can also help stop pelvic organ prolapse happening in the first place. You can find out more about how to do pelvic floor exercises with our guide Vaginal exercises—what they are, how to do them and their benefits.

Stress urinary incontinence

The main symptom of stress urinary incontinence (SUI) is urine leaking when there is pressure on your bladder, such as when you laugh or during exercise. SUI can be a debilitating problem, with one report stating that “women with urinary incontinence have a significantly poorer quality of life than their counterparts”¹². 

Many sufferers also experience urge incontinence at the same time—the main symptom of which is a sudden urge to pass urine¹³.

Having a strong pelvic floor is one of the best ways to avoid SUI, and strengthening the muscle can help improve existing symptoms. Studies have found that two-thirds of women with urinary incontinence saw an improvement or cure after pelvic floor training, compared to women who had no treatment¹⁴.

Some women may also experience faecal incontinence (lack of bowel control) and excessive wind if they have a weak pelvic floor.

Overactive bladder

A weak pelvic floor can contribute to symptoms of an overactive bladder—where you experience an urgent need to urinate without warning. If your pelvic floor muscles are weak, you may be more likely to leak urine when your bladder contracts¹⁵.

What can you do about it?

If you have any of the above symptoms, the first thing you should do is speak to your GP. They will be able to diagnose the condition and offer you advice and treatment.

There are many non-surgical options for treating a weak pelvic floor, including the following:

• Pelvic floor exercises

Simple Kegel exercises can help tighten and tone the pelvic floor muscles. You can find out how to do these with our pelvic floor exercise guide.

• Pelvic floor exercises with a device

Special devices such as Kegel balls can help strengthen the pelvic floor muscles. Find out more about Kegel balls, vaginal cones and vaginal tightening apps here.

• Physiotherapy

Gemma Marshall, physiotherapist and founder at Knots ‘n’ Niggles, a sports massage and physiotherapy clinic, says:

“For anyone with poor pelvic core control, I would normally recommend early stage Pilates exercises to start implementing control of the pelvic core with movement. Also, devices such as the ‘Elvie’ (a pelvic floor exercise device) are great tools to use on a daily basis to retrain the muscle.

“If you’re really struggling, get help from a women’s health physiotherapist. They can assess you appropriately and provide a specific programme tailored for you.”

• Emsella Chair

The Emsella Chair uses electromagnetic energy to cause deep pelvic floor muscle stimulation without getting undressed! 

• Laser vaginal tightening

Although this treatment doesn’t strengthen the pelvic floor, it can help to relieve symptoms associated with a weak pelvic floor, such as stress urinary incontinence. You can find out more about what vaginal laser tightening is and the benefits of the treatment here.

Read our guide to vaginal tightening exercises to find out more about how to do pelvic floor exercises, their benefits and the potential side effects.

Frequently asked questions on causes and symptoms of a weak pelvic floor

Can stress cause a weak pelvic floor?

Stress can make pelvic pain worse as it can cause pelvic floor muscles to actively contract. If these contractions happen frequently, this could lead to the pelvic floor muscles becoming tighter or weaker¹⁶.

Is squatting bad for my pelvic floor muscles?

No, squatting can help improve symptoms of a weak pelvic floor by strengthening core muscles.

Can coughing weaken the pelvic floor muscles?

Coughing is unlikely to weaken your pelvic floor muscles. However, if you have a weak pelvic floor, you may notice that you leak urine when you cough.

Can a weak pelvic floor cause back pain?

Yes, studies have shown that a weak pelvic floor can lead to trunk instability (being unable to control the core muscles), which can result in lower back pain¹⁷.

Can a weak pelvic floor cause frequent urination?

Yes, a weak pelvic floor can contribute to symptoms of an overactive bladder¹⁸. One of the main symptoms of an overactive bladder is a strong, frequent need to urinate urgently¹⁹.

What next?

You can find more general information about vaginal tightening in our guide Vaginal tightening: what are the options and does it work? If you want to find out more about how exercises can help strengthen the pelvic floor muscles then read our guide Vaginal exercises—what they are, how to do them and their benefits.

We have a section of our Advice Centre dedicated to laser vaginal tightening—you can find out more about Femilift vaginal tightening laser treatment here.

Sources

1. https://www.hormone.org/your-health-and-hormones/glands-and-hormones-a-to-z/hormones/relaxin
2. https://www.independent.co.uk/life-style/health-and-families/pelvic-floor-training-in-pregnancy-could-help-prevent-the-need-for-barbaric-vaginal-mesh-surgery-a7701886.html
3. https://www.ncbi.nlm.nih.gov/pubmed/30561480
4. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2000.tb11669.x
5. https://pelvicpainrehab.com/female-pelvic-pain/4569/posture-and-the-pelvis-part-one/
6. https://www.bladderandbowel.org/help-information/resources/pelvic-floor-exercises/
7. https://www.health.harvard.edu/staying-healthy/3-surprising-risks-of-poor-posture
8. https://www.pelvicpain.org.au/painful-sex-women/
9. https://www.nhs.uk/conditions/vaginismus/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746737/
11. https://www.nhs.uk/conditions/pelvic-organ-prolapse/
12. https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1576/toag.13.3.143.27665
13. https://www.nhs.uk/conditions/urinary-incontinence/symptoms/
14. https://discover.dc.nihr.ac.uk/content/signal-000702/pelvic-floor-muscle-training-can-improve-urinary-incontinence
15. https://www.physio-pedia.com/Impact_of_stress_and_cortisol_levels_on_pelvic_pain_and_pelvic_stress_reflex_response
16. https://www.physio-pedia.com/Low_Back_Pain_and_Pelvic_Floor_Disorders
17. http://www.choosingwisely.org/patient-resources/overactive-bladder-and-pelvic-organ-prolapse/