How Do I Know If I Have A Weak Pelvic Floor?

In this article we’ll discuss how to assess if you may have a weak pelvic floor, what symptoms are and basic orientation to the pelvic floor.

What is the pelvic floor? 

The pelvic floor is a very important group of muscles that live in the bottom of the pelvis. Both men and women have a pelvic floor. These muscles sit in the bottom of the pelvic floor like a hammock, and can move up and down like a trampoline to support your internal organs inside your body. They also help to control the openings and closures in the bottom of the pelvis, which is why they are so essential to urinary, bowel and sexual function. Just like any muscle, when they are weak, they can start to cause issues with any of these functions. Common signs of a weak pelvic floor include urinary incontinence, fecal (or bowel) incontinence, feeling of pelvic heaviness or pelvic organ prolapse, as well as low back or hip pain.

What is urinary incontinence? 

Urinary incontinence is the involuntary leakage of urine. It most commonly occurs when the pressure in the abdomen is increased, typically with a cough, sneeze, laugh or exercise, and the pressure exceeds your body’s ability to support it. When the strength of your pelvic floor is not able to match the force that is generated from these actions, urinary leakage can occur. Incontinence is related to a decrease in self-reported quality of life. Studies have shown that quality of life decreases as severity of incontinence increases and that a higher incidence of UI is associated with lessened cognition, increased malnutrition, and a decrease in mobility.1

Is urinary incontinence a normal part of aging?

Although bladder leaks become increasingly more common as one ages, it is not a normal or acceptable part of aging and symptoms can often improve with the proper treatment. 

What is fecal (bowel) incontinence?

Fecal incontinence is the involuntary loss of stool and is another very common symptom of pelvic floor weakness. Symptoms of fecal incontinence vary, and those who experience this may have an intense urge to have a bowel movement and not control it, or they may have fecal smearing, or staining of fecal matter in their underwear. 

What is pelvic organ prolapse? 

Pelvic organ prolapse is when there is laxity in the supporting tissues of one or more pelvic organs, which can cause the feeling of heaviness or bulging at the vaginal entrance or perineum. It is estimated that up to 50% of women will experience symptoms of pelvic organ prolapse in their life.2 This is a common finding in postpartum women, as well as becomes increasingly more common as women age due to decreased muscle use and hormonal changes. Genitourinary Syndrome of Menopause includes onset of symptoms in the pelvic area. Feeling heaviness during exercise or upright activity can also be a sign of pelvic floor dysfunction. 

How can low back or hip pain be a sign of pelvic floor weakness?

Your pelvic floor works in synergy with your abdominal muscles, as well as your spinal muscles and diaphragm to create the canister of support that we call our “core”. When the pelvic floor is not functioning well in this system, it can often lead to our lumbar and pelvic support system being compromised, leading to pain and dysfunction. 

What can I do to strengthen my weak pelvic floor?

It is important to take care of your pelvic floor and keep it strong and healthy to prevent these issues, and pelvic floor physical therapy is the gold standard to do so.3 Our skilled pelvic floor physical therapists will be able to provide a thorough assessment and create a customized treatment plan to help you achieve your goals. If you are indicated for pelvic floor strengthening, then going back to the basics may be a helpful first step. Pelvic floor contractions, more commonly referred to as Kegels, can be a good way to learn how to connect to your pelvic floor and start to strengthen the muscles there. Start by taking deep breaths into the belly. On your exhale, think about contracting the muscles around the anus or vagina, or the feeling of stopping urine or holding in gas.

It’s important to note that muscle weakness does not always mean you need to start with strengthening. Sometimes muscles are tight, which is another presentation for pelvic floor muscle weakness (and muscle weakness in general). If you’d like to learn more about that process, read our other articles on this topic.

Not sure where you fit? You’re not alone. Schedule with one of our physical therapists for an assessment and treatment plan. We hope to see you soon!

References:

1. Kwon BE, Kim GY, Son YJ, Roh YS, You MA. Quality of Life of Women with Urinary Incontinence: A Systematic Literature Review. Int Neurourol J. 2010;14(3):133. doi:https://doi.org/10.5213/ inj.2010.14.3.133
2. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J. 2013 Nov;24(11):1783-90. doi: 10.1007/s00192-013-2169-9. PMID: 24142054.
3. Romeikienė KE, Bartkevičienė D. Pelvic-Floor Dysfunction Prevention in Prepartum and Postpartum Periods. Medicina (Kaunas). 2021 Apr 16;57(4):387. doi: 10.3390/medicina57040387. PMID: 33923810; PMCID: PMC8073097.