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A weakened pelvic floor: Why does it happen?

A weakened pelvic floor: Why does it happen?


The pelvic floor is a layered sheet of muscles that stretch like a hammock from your pubic bone at the front of your pelvis to your tailbone at the back.

Why pelvic floor muscles weaken

Reasons why the pelvic floor may become weak can be:

  • Pregnancy. The pregnancy hormone progesterone relaxes and weakens the pelvic floor to increase its suppleness for birth. However, this also means that having a caesarean does not prevent pelvic floor weakness.
  • Childbirth. If you experience a vaginal birth, the muscle will be stretched to enable you to give birth, but will inevitably be weakened.
  • Menopause. The hormonal changes influence the strength of your pelvic floor.
  • Persistent heavy lifting. This puts pressure on your internal organs and therefore your pelvic floor.
  • Continual straining to empty your bowels, possibly due to constipation.
  • Continual coughing either because of a medical condition or smoking. This puts a strain on your pelvic floor every time you cough.
  • Being overweight, meaning the pelvic floor has more to support.
  • Being generally unfit. Having yet another muscle in need of exercise!

A weakness in the pelvic floor muscle can result in:

  • Stress incontinence - when you have a leakage of urine if you cough, laugh or sneeze.
  • Urge incontinence, or a feeling of urgency or 'accidents' before you get to the toilet.
  • Overflow incontinence - when you involuntarily lose urine because your bladder is overfull. This can sometimes happen during labour or after the birth.
  • Frequency - a feeling of needing to pass urine more often both night and day.
  • Bowel Dysfunction - being unable to hold your faeces (being incontinent) or being unable to empty your bowel efficiently, causing constipation.
  • Prolapse of the internal organs - when the weakened pelvic floor and vaginal walls are unable to support the internal organs. The woman usually experiences heaviness or a dragging sensation. The uterus can prolapse or move down the vagina, sometimes to the point that the cervix can protrude out of the vagina. This is called a uterine prolapse. If the bladder is unsupported by the vaginal wall (internally), it is called a cystocoele. If the bowel is unsupported, it is called a rectocele. If the uterus, cervix and small bowel are all involved it is called an enterocoele. At times surgery may be required to treat these conditions.
  • Sexual dysfunction. For women with a weakened pelvic floor they can have a lessened sexual sensation with penetration, and sometimes pain and discomfort if the internal organs are not adequately supported. Some women find if their pelvic floor is very weakened they are unable to retain a tampon when menstruating.

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