Symptoms and Causes of a Weak Pelvic Floor

As our pelvic floor is out of sight, it is difficult to self-diagnose its condition. However being aware of the symptoms that suggest you have a weak pelvic floor can allow you to begin treatment early. Forget your misconceptions; it is not just older women that experience problems associated with a weak pelvic floor. You may be in your teens or early twenties and experience some of the tell tale signs that your pelvic floor has weakened.

The three most common issues that occur as a result of a weak pelvic floor are:

  • Urinary incontinence - Inability to control urine flow.
  • Faecal incontinence - Inability to control bowel movements.
  • Pelvic organ prolapses - The movement of a pelvic organ out of its natural place, it droops (prolapses) into the vagina or rectum and in the latest stages, protrudes entirely out of the vagina or anus.

It is important that you do not delay the treatment of a weak pelvic floor due to embarrassment. Pelvic floor issues affect 25% of women, and leaving a pelvic issue untreated for a long time can cause severe pain and may cause damage that requires surgery.


Symptoms of a Weak Pelvic Floor

Many of the symptoms associated with a weak pelvic floor are the same as that occur with other pelvic issues as they usually go hand in hand:

  • a feeling of pressure inside the vagina, and/or a dragging feeling that something is going to fall out (usually associated with a pelvic organ prolapse)
  • vaginal bleeding, outside of menstruation
  • an excessively widened vagina, so much so that tampons don’t stay in place
  • noticeable tissue protruding from the vagina, that may also be painful and bleed (usually associated with a pelvic organ prolapse)
  • discomfort/pain during sex and/or loss of feeling or tightness when having sex
  • unexplained pelvic or lower back pain
  • pain that reduces when you lay down and increases when you stand for a long time
  • persistent or frequent urinary tract infections (cystitis)
  • urinary stress incontinence – the inability to hold in urine when you cough, sneeze, laugh, exercise or lift heavy objects
  • a frequent need to urinate and/or difficulty passing urine
  • difficulty having a bowel movement – constipation and a feeling of not having fully emptied the bowel

Causes of a Weak Pelvic Floor

Just like any other muscle, if you don't use it, it weakens. Unlike many of the other muscles in the body, the pelvic floor muscles cannot be exercised through traditional exercises. In fact, some high impact exercises such as running, actually damage the pelvic floor. It is important that you become familiar with the common causes of a weak pelvic floor and learn how to reverse the effects:

  • Ageing - Its unavoidable, as you get older all your muscles will begin to weaken.
  • Forgetting to do or incorrectly doing your Kegel / Pelvic Floor Exercises - Kegel exercises are proven to strengthen your pelvic floor, and reverse the weakening that happens due to ageing. Alone, they can often resolve mild and moderate pelvic organ prolapses. However most of us forget to regularly do them and may even be doing them incorrectly.
  • Pregnancy - The hormones which are produced during pregnancy, relax and stretch the pelvic floor, sometimes beyond its rebound level. Along with the weight of the growing baby, the pelvic floor can loosen and allow the prolapse of the pelvic organs downward. This is more likely if you already have a weak pelvic floor before you fall pregnant. Having multiple pregnancies causes more damage.
  • Vaginal childbirth - During vaginal childbirth, the uterus and pelvic floor are really tested. Even in an uncomplicated delivery there will be a degree of damage occurring to the pelvic floor muscles. If you are unfortunate and experience a complicated delivery, especially with the use of forceps, you will likely suffer from prolapses in later life.
  • Menopause - As you reach this stage in life, the balance of your hormones change. The drop in oestrogen leads to a weakened pelvic floor.
  • Sugar and being overweight or obese - It should be no surprise that having an unhealthy diet impacts your pelvic health. Being overweight puts unnecessary pressure on your pelvic floor. The National Institute for Heath and Care Excellence (NICE) recommend keeping your BMI under 30. Even if you keep your BMI under 30, if you intake a lot of sugar you are potentially removing the elasticity out of your muscle fibres and ligaments, leaving your pelvic floor brittle.
  • Smoking and chronic coughing - Persistent coughs, brought on by smoking or lung conditions, cause strain to your pelvic floor muscles and can weaken them over time.
  • High impact exercise - As you take part in high impact exercises such as running and cross fit, your feet land heavily on the ground. This literally shakes your body and the vibrations cause damage to your pelvic floor. To learn about which exercises are suggested for those with a weak pelvic floor, visit the Exercises Which Damage Your Pelvic Floor page.
  • Constipation - If you are frequently constipated and spend a lot of time straining on the toilet, you are putting unnecessary pressure on your pelvic floor.
  • Surgery - Undergoing a pelvic surgery, especially a hysterectomy, is likely to have caused a degree of damage to your pelvic floor. Putting you at an increased risk of developing a pelvic organ prolapse.
  • Heavy lifting - Lifting heavy loads often or incorrectly can put unnecessary strain on your pelvic floor.
  • Genetics - You may have a higher genetic risk of having a weak pelvic floor.
  • Putting off emptying your bladder - It’s not always convenient to go to the toilet when you feel the urge. However, if you hold your wee in until you’re absolutely desperate then you strain your bladder. Not urinating frequently enough leads to an atonic bladder; where the bladder is not strong enough to hold urine in properly. A weak bladder will have a knock-on effect on your pelvic floor muscles.
  • Emptying your bladder when it isn't full - Did your mum make you go to the toilet before you left the house when you were little? For many of us, this habit continues into adulthood. What you are actually doing is training your bladder to only hold a small amount of wee at once. This causes you to feel the urge to go when you don’t actually have a full bladder. This can develop into urge incontinence.
  • Squatting over the toilet - Fears about germs lead some women to hover over the seat while they are peeing to avoid touching it. When you squat, the muscles in your pelvis are all activated and engaged. This includes your pelvic floor muscles, which prevents your bladder and bowels from fully emptying. Squatting to pee can cause a weak pelvic floor in the long term as well as urinary tract infections.
  • Tumors - The extra weight of a tumour in the pelvis can weaken your pelvic floor.

Even though some of the causes of a weak pelvic floor are inevitable; ageing, pregnancy, menopause, it is important that you know when your pelvic floor has begun to weaken and take steps to strengthen it. Do not accept that a weak pelvic floor is a part of getting older. To learn more about Strengthening Your Pelvic Floor Muscles, visit our page.


Sources

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McNeeley, S. G. (2018). Pelvic Floor Disorders (Pelvic Support Disorders; Pelvic Organ Prolapse. [online] MSD Manual, 2018[viewed 03/04/2018]. Available from: https://www.msdmanuals.com/en-gb/home/women-s-health-issues/pelvic-floor-disorders/pelvic-floor-disorders

National Continence Helpline. (2010).06 Pelvic Floor Muscle Training For Women: What Are The Pelvic Floor Muscles? [online] National Continence Helpline, 2010 [viewed 06/04/2018]. Available from: http://www.bladderbowel.gov.au/assets/doc/brochures/06pelvicfloorwomen.html

NICE. (2015). Urinary incontinence in women: management, 1 Recommendations [online] National Institute for Health and Care Excellence, 2015 [viewed 14/03/2018]. Available from: https://www.nice.org.uk/guidance/cg171/chapter/1-Recommendations#physical-therapies

The North American Menopause Society. (2017). Yoga, Kegel Exercises, Pelvic Floor Physical Therapy. [online] The North American Menopause Society, 2017 [viewed 03/04/2018]. Available from: https://www.menopause.org/for-women/sexual-health-menopause-online/effective-treatments-for-sexual-problems/yoga-kegel-exercises-pelvic-floor-physical-therapy

UChicago Medicine. (2018). Frequently Asked Questions About Pelvic Floor Disorders [online] UChicago Medicine, 2018 [viewed 03/04/2018]. Available from: http://www.uchospitals.edu/specialties/pelvic/faq/pelvic-floor-disorders.html