Know the Surprising Signs of a Weak Pelvic Floor

If you’ve ever leaked when you laughed (even if it was only the tiniest dribble), you may have wondered if your pelvic floor is weak. While pelvic floor weakness certainly can lead to bladder leaks, it can also cause plenty of other, less obvious symptoms.

Pelvic floor weakness is a state in which the pelvic floor muscles lose strength, or their ability to effectively generate force. Like any muscle in the body, the pelvic floor muscles can lose the capacity to contract and hold that contraction against outside forces.

Your pelvic floor muscles play a crucial role in supporting your pelvic organs and controlling bladder, bowel, and sexual function. To do their job, these muscles must have adequate strength, endurance, and coordination. 

When they lack one or more of these qualities, you may start to have symptoms. These can include any of the following:

• Decreased sensation during sex
• Feeling like something is falling out of your vagina
• Low back pain, hip pain, and/or pelvic pain
• Bladder leaks
• Difficulty controlling gas or bowel movements
  
  

Read on to learn the symptoms of weak pelvic floor muscles, how to tell if your pelvic floor is weak, and how to fix weak pelvic floor muscles. (Hint: pelvic floor physical therapy is a huge help!)

What are the signs of weak pelvic floor muscles?

A weak pelvic floor can cause symptoms that go beyond bladder leaks. Here are five common signs of a weak pelvic floor:

You feel less of the good kind of intensity during sex

If your pelvic floor muscles are weak or underactive, sex may lose some of its wow factor. Weak pelvic floor muscles provide less resistance during penetrative sex, so you’re getting less of that feel-good friction. 

Weak pelvic floor muscles struggle to perform the rhythmic contraction-relaxation patterns that lead to orgasms, so your Os might feel weaker or harder to reach. A weak pelvic floor can’t deliver as much blood flow to your clitoris, either, so arousal may feel less intense. 

It feels like something is falling out of your vagina

These symptoms can range from a sensation of mild vaginal pressure or heaviness to seeing tissue bulge out of the vagina. This is particularly common if your muscles or ligaments were injured during vaginal childbirth.

Weak pelvic floor muscles are less able to support the pelvic organs (the bladder, bowels, and uterus). This allows one or more organs to descend lower in the pelvis, leading to pelvic organ prolapse. 

In addition to lacking strength, weak pelvic floor muscles usually lack endurance, too: they can’t support your organs against gravity for long periods. This can lead to worsening symptoms at the end of the day or after periods of prolonged standing. 

You have low back, hip, or pelvic pain

The joints of your hips, low back, and pelvis rely on your pelvic floor muscles for support. 

Underactive, weak pelvic floor muscles don’t provide enough support, which can lead to joint instability and discomfort in your lower back, hips, or pelvis. 

Some people with weak pelvic floor symptoms also experience myofascial pelvic pain. This is a condition in which the muscles and fascia (connective tissue) of the pelvic floor generate pain, often because they are quite tense. As counterintuitive as it may seem, muscles that are overly tight and tense can also be weak!

People with myofascial pelvic pain often report feeling pain in their hips and/or bladder region. In these situations, the pelvic floor muscles are contributing to pain in other body parts.

Your bladder leaks a little (or a lot)

Bladder leaks are a form of urinary incontinence. This is the symptom most people tend to correlate with a weak pelvic floor. 

Important note: pelvic floor muscle weakness isn’t the only cause of incontinence, but it is a common one. Often, bladder leaks occur because the pelvic floor muscles aren’t strong enough to resist external pressures such as sneezing, laughing, running, or lifting heavy items. 

Whatever it looks like, bladder leakage is never normal, and it’s not something you have to “just put up with”. Treatment for weak pelvic floor muscles, under the guidance of a skilled pelvic floor physical therapist, can help.

You can't hold back gas (or poop)

Your pelvic floor muscles help your anal sphincter stay closed so you don’t pass gas or stool at inconvenient times. If you have a weak pelvic floor, though, the muscles can’t do this job effectively. You might find yourself unable to control the release of gas or even liquid or solid stool. 

Nerve injury to the anal sphincter is common during vaginal delivery. This injury prevents the pelvic floor muscles from communicating properly with your brain and vice versa. Over time, fewer nerve signals to the area can lead to pelvic floor muscle weakness.

What causes a weak pelvic floor?

Weakness in the pelvic floor muscles can occur for several reasons, including but not limited to:

• Pregnancy and childbirth: The weight of pregnancy and the process of vaginal delivery can stretch and weaken pelvic floor muscles. Even if you had a C-section, your pelvic floor muscles worked hard to support you during pregnancy, so they can become overstretched and weakened, too.  
• Aging: As we get older, pelvic floor muscles naturally lose some of their strength and tone. However, this does not mean you have to live with weak pelvic floor symptoms as you age: you just might need more help to address them!
• Chronic straining: Repeated straining during bowel movements or persistent coughing can gradually weaken the pelvic floor.
• Hormonal changes: Any hormonal change that decreases your estrogen levels can affect the integrity of the pelvic floor. Life events such as nursing and the menopause transition lead to lower estrogen levels.
• Lack of exercise: Like any muscle group, the pelvic floor can become weak from lack of activity: if you don’t use it, you lose it!
• Larger body size: Much like the additional weight of pregnancy, excess body weight puts additional strain on the pelvic floor muscles. This chronic strain can lead to weakness over time.
• Trauma: Trauma manifests differently in every body. Sometimes, trauma can cause our muscles to “turn off”: think of this as the “flight” portion of the fight-flight-or-freeze response. Some trauma survivors dissociate from their pelvic floor; this is a common coping mechanism, but it can lead to underactivity and weakness.

If some of these causes sound familiar, or if you notice any of the signs we’ve just covered, you may be living with pelvic floor weakness… but don’t despair! You have options for pelvic floor muscle weakness treatment.

Pelvic floor physical therapy is a first-line approach to weak pelvic floor treatment. At Origin, our clinicians specialize in assessing and treating these exact problems to help you regain strength, improve pelvic floor function, and feel good in your body again. Schedule your first visit today!

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Sources

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Li, Qiao, et al. "Risk Factors and Severity Indicators of Female Pelvic Organ Prolapse: Insights from a Comprehensive Retrospective Study with a Large Sample Size." Clinical and Experimental Obstetrics & Gynecology, vol. 51, no. 12, 24 Dec. 2024, p. 280, doi: 10.31083/j.ceog5112280.

Meister, Melanie R et al. “Pelvic floor myofascial pain severity and pelvic floor disorder symptom bother: is there a correlation?.” American journal of obstetrics and gynecology vol. 221,3 (2019): 235.e1-235.e15. doi:10.1016/j.ajog.2019.07.020

Sartori, Dulcegleika Vilas Boas et al. “Pelvic floor muscle strength is correlated with sexual function.” Investigative and clinical urology vol. 62,1 (2021): 79-84. doi:10.4111/icu.20190248

Wang, Kaiyong et al. “Factors, mechanisms and improvement methods of muscle strength loss.” Frontiers in cell and developmental biology vol. 12 1509519. 4 Dec. 2024, doi:10.3389/fcell.2024.1509519