Why You Should take Pelvic Muscle Weakness Seriously

Are your pelvic floor muscles doing their job? Unfortunately for many of us women, the answer is likely, “No, not completely.”

Because of our particular female anatomy, these muscles tend to weaken. If you’ve experienced leaking urine, that’s a common symptom. Though there are several causes, the main one is childbirth.

Where are these muscles?

These muscles support the bladder, bowel, uterus, and vagina. They stretch from the tailbone to the pubic bone. This is part of the Pelvic Core Neuromuscular System (PCNS), which includes the respiratory diaphragm at the top, the abdominals in the front, the back and hip muscles in the back, and the pelvic floor muscles at the bottom, explains Tina Christie, physical therapist and Health Program Manager at Athletico Physical Therapy. All of these muscles are interconnected and need to work as an integrated unit, she adds.

“Almost every female I see has some level of PCNS weakness because they are already coming in with a diagnosis of dysfunction (incontinence, low back pain, pelvic pain, and an array of orthopedic injuries),” says Christie. She says pelvic floor dysfunction affects 1 in 3 females.

Indeed, the Center for Pelvic Health at UChicago Medicine cites a study by the National Institutes of Health which found that pelvic floor disorders affect about 10 percent of women ages 20-39, 27 percent of women ages 40-59, 37 percent of women ages 60-79, and nearly half of women age 80 or older.

There are three main types of pelvic floor disorders: Urinary incontinence, fecal incontinence, and pelvic organ prolapse. Eleven percent of American women will have some surgery in their lifetime either for pelvic organ prolapse or urinary incontinence, and one-third of these women will have a reoperation because of recurrence over time, says Dr. Cedric K. Olivera, urogynecologist at NYU Langone Hospital-Brooklyn.


Symptoms vary, but common ones include:

  • Urinary problems – urgency, painful urination, incomplete emptying of bladder
  • Pain or pressure in vagina or rectum
  • Heavy feeling in pelvis or bulge in vagina or rectum
  • Constipation, straining or pain during bowel movements
  • Muscle spasms in pelvis
  • Unexplained pain in the lower back, pelvic region, genital area, or rectum
  • Pain during or after intercourse, orgasm, or sexual stimulation


Having a vaginal delivery increases the risk of developing this condition, says Dr. Olivera. In fact, in the UK and France, pelvic floor strengthening is a normal part of postpartum care, according to Dr. Amy Rosenman, Obstetrics and Gynecology, UCLA and past president of the American Urogynecologic Society.

“Most women who have had a baby have transient weakness that improves over six months; those without vaginal births have much less,” says Dr. Rosenman.

The more a woman has given birth, the more her risk tends to increase. Things associated with labor like operative deliveries with forceps and vacuum devices, episiotomies, or pushing too long to deliver can all result in pelvic muscle weakness.

If you take a look at the potential causes, they all have something in common:

  • They involve weight, stretching, or straining.
  • Obesity
  • Chronic constipation and straining
  • Heavy lifting
  • Pelvic surgery or radiation treatments
  • Coughing
  • High impact lifestyle (paratroopers, heavy weight lifters)

Along with a urinary tract infection, anything that causes damage to the spinal cord like a motor vehicle accident, multiple sclerosis, spinal cord injury, or diabetes can also lead to this condition, says Dr. Olivera. Like the examples above, anything that will increase intra-abdominal pressure can lead to symptoms. “Not all women who do these things will develop these conditions,” says Dr. Olivera, “but we do know these are risk factors.”

In theory, exercise like repetitive heavy squats might put a patient at risk over time, Dr. Olivera says, and the incidence increases with age. All muscle weakness increases with age, but in women, hormonal changes after menopause may also contribute.


After menopause, pelvic muscle weakness won’t get better without some attention, and then not completely, says Dr. Rosenman. The key is to see someone as soon as there are symptoms, because the earlier it’s treated, the better the outcome.

Some therapies that can help are:

  • Pelvic floor exercises or Kegels
  • Medication
  • Botox
  • Posterior tibial nerve therapy
  • Sacral nerve neuromodulation (InterStim)
  • Surgery
  • Biofeedback
  • Physical therapy

Isabel Arlington (real name protected for privacy) has tried many of these treatments. It all started about six years ago at age 65, when she noticed that her bladder felt really low. She was told she needed surgery for a prolapsed bladder but instead went to someone who specializes in pelvic floor issues. She started doing Kegel exercises diligently, but the relief didn’t last.

Some of her symptoms included a heavy feeling in the vagina as well as urgency and frequency of urination. Her UTIs became more frequent. She tried antibiotics and then another drug, which helped the UTIs but not the incontinence. She also couldn’t void completely. This led to her using FormaV for tightening, which has helped, as has using Impressa tampons (which stop bladder leaks) every other day.

“There are options and they work,” says Arlington. “You don’t have to be resigned to pads and feeling like your bladder is falling out!”

Patients should be referred to a subspecialist sooner rather than later, recommends Dr. Olivera. Female pelvic medicine and reconstructive surgery (urogynecologist/urologists) would be the sub-specialists most appropriate for this condition.

Gynecologists and urology specialists in the pelvic floor are known together as FPMRS, or Female Pelvic Medicine and Reconstructive Surgery specialists, which has been a board certified sub specialty since 2013, according to Dr. Rosenman.

The American UroGynecology Society has a website, which can be utilized as a valuable resource for information and finding physicians.

“Women should know that treatments are available and they don’t have to live with or deal with uncomfortable symptoms,” says Dr. Olivera. “The overall goal is to improve a patient’s quality of life.”

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Lisa A. Goldstein

Lisa A. Goldstein

Lisa A. Goldstein is a freelance journalist with a Master’s in Journalism from UC Berkeley. She has two kids, a love of books and sweets, and wishes her metabolism is what it used to be.

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