8 Signs of a Weak Pelvic Floor

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Most of us have heard of our “pelvic floor,” but we might not be sure exactly what it is, and what changes this area of the body may go through as we journey through pregnancy and childbirth. Simply put, the pelvic floor involves the muscles and connective tissue, or ligaments, that support the pelvic organs including the vagina, uterus, bladder, and rectum.

Pregnancy and childbirth can have strong impacts on your pelvic floor, says Helai Hesham, MD, assistant professor of obstetrics and gynecology at Columbia University Irving Medical Center.

“After delivery, most women have a weakened pelvic floor due to the tension and stretch the muscles undergo, damage from vaginal lacerations, and a lowered estrogen state,” Dr. Hesham says.

Pelvic Floor Health

Although many people do not consider the impact of a weakened pelvic floor or just assume it is part of giving birth, pelvic floor health is something everyone should take seriously. Having a healthy pelvic floor is important for urinary, bowel, and sexual health, says Dr. Hesham.

Fortunately, in the weeks and months after giving birth, the body does a lot of healing, and most people will regain some or most of their pelvic floor strength. But others will have more lasting problems with their pelvic floors.

The good news is that there are ways to strengthen and heal pelvic floor issues you may experience after pregnancy and childbirth. But first, you need to be able to recognize what the signs are of a weak pelvic floor. Here is what you need to know.

Symptoms of a Weak Pelvic Floor

You might be familiar with some of the signs of a weak pelvic floor, and others might take you by surprise. Take a closer look at the signs of a weak pelvic floor are, and what you might feel or experience if you have these symptoms. 

Leaking Pee

Leaking pee is one of the more widely known symptoms of a weak pelvic floor. Incontinence, or loss of bladder control, is due to a lack of pelvic support for the urethra, explains Karyn Eilber, MD, pelvic medicine and reconstructive surgeon at Cedars-Sinai and co-founder of Glissant.

Leaking pee can happen when you cough, sneeze, or exercise, she says. Laughing may even cause people to leak. Some people think that leaking pee after you have kids is normal, and just something you need to live with. But it’s a sign of a weak pelvic floor, and treatment can help eliminate this issue.

Fecal Incontinence

When the muscles of your pelvic floor become weak, you also may experience fecal incontinence, says Gina Cunningham, Physical Therapist (DPT), and Director of Axia Women’s Health Pelvic Health Physical Therapy Program.

Fecal incontinence refers to when stool leaves the body involuntarily. Although less common than urinary incontinence, it’s an embarrassing problem many new parents deal with. You may be more likely to experience fecal incontinence if you experience a fourth-degree tear during childbirth.

Pelvic Organ Prolapse

A weakened pelvic floor can cause one or more of your organs to prolapse. Women can experience prolapse of the uterus, bladder, and rectum. Symptoms range from mild to severe.

“[Prolapse] is when one or more of the pelvic organs ‘falls’ into the vagina causing a woman to notice a bulge in her vagina,” explains Dr. Eilber.

Sometimes the vaginal pressure or bulge can feel worse with lifting and heavy activity. In fact, many women report that the pressure in their vagina from a prolapse feels a lot like sitting on a golf ball, adds Cunningham.

Painful Sex

Pain during sex is one of the lesser-known symptoms of a weak pelvic floor. Pain may be mild or severe and may reduce your ability to enjoy or even participate in sex.

Sometimes people who experience pain during sex attribute it to something else, like a sexually transmitted disease (STD), says Cunningham. But painful sex is often related to changes in your pelvic musculature, including tense, tight pelvic floor muscles.

Vaginal Flatulence (Queefing)

Flatulence or a farting sound coming out of your vagina, otherwise known as “queefing,” is another lesser-known symptom that can be attributed to a weak pelvic floor. Some people are surprised by this experience the first time it happens.

“If you experience vaginal flatulence during yoga or stretching, it could be a sign that your muscles are weaker, allowing more air to get trapped inside your vagina,” Cunningham explains.

A Frequent Urge To Pee

Besides urinary incontinence, you also may feel like you constantly have to pee when your pelvic floor is weakened, says Cunningham. You can have this symptom even without leaking pee.

In fact, she adds, some people think they have a urinary tract infection (UTI). But when a urinalysis shows no sign of infection, you could be experiencing symptoms of a weak pelvic floor instead.

Vaginal Dryness

Vaginal dryness is often a sign of a weak pelvic floor, Dr.  Hesham explains. Weak pelvic floor muscles, combined with a “hypoestrogenic state," or decreased levels of estrogen, can cause dryness he says. In addition to being uncomfortable, vaginal dryness can lead to painful or less pleasurable sexual intercourse.

More Frequent Urinary Tract Infections (UTIs)

A weak pelvic floor can be mistaken for a UTI, but sometimes a weak pelvic floor can also increase the likelihood that you will experience UTIs, says Dr. Hesham. Signs that you may have a UTI include feeling an urge to pee, experiencing a burning sensation when you pee, and finding blood in your urine.

Treatment for Weak Pelvic Floor

Thankfully, if you have signs of a weak pelvic floor, there are treatment options available to you. Most experts recommend that you seek pelvic floor therapy from a pelvic floor physical therapist. Your physical therapist will do exercises with you to help strengthen your pelvic floor and the muscles surrounding it.

Exercises may include breathing work, abdominal strengthening, work on posture, and using equipment like kettlebells, weights, or Bosu balls, says Cunningham. Your pelvic floor therapist will also give you exercises you can complete at home.

When to See a Doctor

While experiencing signs of a weak pelvic floor after childbirth is common, it’s not something you should just “put up with” or learn to live with. Many people will see their symptoms improve within the first few weeks after giving birth, as their body heals and their muscles naturally strengthen, but some may need treatment.

Cunningham advises that if you are still experiencing symptoms like leaking pee or pain with intercourse 12 weeks after birth, you should contact a healthcare provider. They will help you determine if pelvic floor therapy is right for you, or if other medical interventions are necessary.

“Too often, women are cleared after their 6-week postpartum checkup, but their bodies are still healing and recovering from childbirth,” she says.

Medical interventions for weak pelvic floors may include devices used to control prolapse and incontinence issues or pessaries, which are prosthetic devices inserted into the vagina to support the pelvic organs, says Dr. Hesham. Vaginal estrogen also might be recommended to enhance vaginal or urethral health and, at times, surgery might even be recommended.

A Word from Verywell

Dealing with a weak pelvic floor and all its uncomfortable and sometimes embarrassing symptoms can be challenging. It also can be difficult to reach out for help because many of the symptoms you are dealing with can be hard to discuss with others.

If you are experiencing a symptom of a weak pelvic floor, you should know that you are not alone. Many parents experience this after pregnancy and childbirth. Healthcare providers who work with postpartum parents are very familiar with pelvic floor issues, so nothing you share will surprise them. Be sure to talk to someone about your symptoms. You deserve to feel strong and well.

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