The pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone within the pelvis, and support the bowel and bladder along with the uterus and vagina (in females).
Muscular bands (sphincters) encircle the urethra, vagina and anus as they pass through the pelvic floor. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.
If the muscles are weakened, the internal organs are no longer fully supported and you may not be able to control your urine, faeces or wind.
Common causes of a weakened pelvic floor include pregnancy, childbirth, prostate cancer treatment in males, obesity and the associated straining of chronic constipation.
Pelvic floor exercises are designed to improve muscle tone and prevent the need for corrective surgery.
Symptoms of a weak pelvic floor
The symptoms of a weakened pelvic floor include:
- leaking small amounts of urine when coughing, sneezing, laughing or running
- failing to reach the toilet in time
- uncontrollably breaking wind from either the anus or vagina when bending over or lifting
- reduced sensation in the vagina
- tampons that dislodge or fall out
- a distinct bulge at the vaginal opening
- a sensation of heaviness in the vagina.
Causes of a weak pelvic floor
The pelvic floor can be weakened in many ways, such as by:
- supporting the weight of the uterus during pregnancy
- vaginal childbirth, which may overstretch the muscles
- the pressure of obesity
- chronic constipation and associated straining to pass motions
- constant coughing
- some forms of surgery that require cutting the muscles (including prostate cancer treatment in males)
- lower levels of oestrogen after menopause.
Complications of a weakened pelvic floor
Loss of bladder control is a common symptom of a weakened pelvic floor. Some people experience bowel incontinence, which means they can’t always control the passage of wind or faeces.
Weak pelvic floor muscles can also cause sexual difficulties such as reduced vaginal sensation. In severe cases, the internal organs supported by the pelvic floor, including the bladder and uterus, can slide down into the vagina. This is called a prolapse. A distinct bulge in the vagina and deep, persistent vaginal aching are common symptoms.
Familiarising yourself with the pelvic floor
Pelvic floor exercises are designed to strengthen the muscles. Each sphincter (vaginal, urethral, anal) should be exercised, so you need to familiarise yourself with these muscles in order to contract them at will. If the pelvic floor is especially weak, it may be difficult to detect any muscular contractions at first.
Suggestions on identifying your sphincters include:
- vaginal – insert one or two fingers into your vagina and try to squeeze them
- urethral – imagine you are passing urine and try stopping the flow in midstream (do not do this while urinating)
- anal – pretend you are trying to stop yourself from breaking wind and squeeze tightly.
Pelvic floor exercises
You can perform pelvic floor exercises lying down, sitting or standing. Ideally, aim for five or six sessions every day while you are learning the exercises. After you have a good understanding of how to do the exercises, three sessions each day is enough.
Before you start, direct your attention to your pelvic floor muscles. Try to relax your abdominal muscles. Don’t bear down or hold your breath. Gradually squeeze all three sphincters and increase the tension until you have contracted the muscles as hard as you can. Release gently and slowly. Then perform the exercises, which include:
- Squeeze slowly and hold as strongly as you can for 5 to 10 seconds while breathing normally. Release slowly. Repeat up to 10 times. Relax for 5 to 10 seconds between each one.
- Perform quick, short, strong squeezes. Repeat 10 times.
- Remember to squeeze the muscles whenever you clear your throat or cough.
It is important to perform these exercises correctly. You can consult with your doctor, physiotherapist or continence advisor to ensure proper performance. It may take weeks or months before you notice a substantial improvement. In severe cases, pelvic floor exercises aren’t enough to solve the problem and further medical treatment may be needed. Be guided by your healthcare professional.
Reducing symptoms of pelvic floor weakness
You can further improve the strength of your pelvic floor and reduce symptoms of pelvic floor weakness in many ways, including:
- lose excess body fat
- prevent constipation by including more fruit, vegetables, fibre and water in your daily diet
- seek medical attention for a chronic cough.
Where to get help
This page has been produced in consultation with and approved by:
Australian Physiotherapy Association
Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your doctor or other registered health professional. Content has been prepared for Victorian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.