Q&A Pelvic Floor Weakness Causes

In Pelvic Floor Physical Therapy by Stephanie Prendergast4 Comments

By Stephanie Prendergast, MPT, Cofounder, PHRC Los Angeles and Admin

In case you missed our latest Q&A about Pelvic Floor Pain/Tightness Causes, you can read it here. If your pelvic floor muscles are weak, your pelvic organs will not have the full support they need! But what is the cause of weakness? Back in October we presented you with numerous causes for a weak pelvic floor. We heard your questions and now we’ve answered them.


Q: I have pelvic floor dysfunction and have been getting the Botox procedures but I recently lost 50lbs. I want to lose more to help this go away…. am I thinking right?


A:  If I am understanding your questions correctly it sounds like you are asking that if you lose weight your pelvic symptoms may improve. In general, higher Body Mass Indexes are associated with more strain on the pelvic floor. Maintaining a healthy BMI of 18.5 – 24.8 can help keep excessive strain from affecting your progress with recovery, however, losing weight alone will likely not ‘resolve’ the problem. 


Q: I have an eating disorder and I can’t intentionally lose weight. What are simple things that strengthen but don’t over tighten and cause spasm? (PF weakness)


A: Breathing! Inhalation results in pelvic floor lengthening and exhalation results in pelvic floor contraction. 


Q: Why do weak pelvic muscles cause problems emptying? Always thought it was over active.


A: This answer is kind of complicated. Most people do not realize the act of urinating at least 18 spinal reflexes and is a coordinated effort of the central and peripheral nervous systems, the bladder and the pelvic floor muscles. Overactive pelvic floor muscles can lead to incomplete emptying and high post-void residuals. People with weak muscles may also have trouble emptying, the cause is not necessarily that the muscles are weak but rather there may be an issue with the bladder itself, or the nervous systems, and this person may ALSO happen to have pelvic floor weakness, versus the weakness being the cause itself. This is possible as people get older, starting as early at the late 30’s. This is also common in people with pelvic organ prolapse which can be associated with pelvic floor tightness or weakness. 


Q: What is considered excessive weight lifting? I thought weight lifting and exercise was supposed to help?


A: It is when you are lifting more than you are prepared for or can handle. Exercise can help, but with improper form, it can cause issues.


Q: Can this affect both men and women?


A: Yes! Both men and women have a pelvic floor


Q: Interested in effects of pelvic floor on orgasm- makes sense, but not a lot of literature out there.


A:  You’re right, there is definitely not a lot of literature out about it. We have a blog on the topic of orgasms in relation to the pelvic floor; however we would like to link you directly to some articles that touch up on this topic.


The article, Pelvic floor muscle strength of women consulting at the gynecology outpatient clinics and its correlation with sexual dysfunction: A cross-sectional study,  found that “subjects with decreased pelvic floor muscle strength value had higher frequency of sexual dysfunction.” Additionally, Ozdemir et. al (2017), found that being overweight and an age of 40+ was directly correlated with sexual dysfunction.


Crane, A. K., Geller, E. J., Bane, H., Ju, R., Myers, E., & Matthews, C. A. (2013). Evaluation of pelvic floor symptoms and sexual function in primiparous women who underwent operative vaginal delivery versus cesarean delivery for second-stage arrest. Female pelvic medicine & reconstructive surgery, 19(1), 13–16. https://doi.org/10.1097/SPV.0b013e31827bfd7b


Golmakani, N., Zare, Z., Khadem, N., Shareh, H., & Shakeri, M. T. (2015). The effect of pelvic floor muscle exercises program on sexual self-efficacy in primiparous women after delivery. Iranian journal of nursing and midwifery research, 20(3), 347–353.


Q: How does excessive weight lifting cause pelvic weakness? Doesn’t it get hypertonic or overactive?


A: For many women high intensity lifting can lead to stress incontinence, particularly if proper training is lacking. We will send you a DM to the blog post


Q: What’s excessive when it comes to weight lifting? To answer my own question, I’d say lifting beyond the current capacity that the pelvic floor can match. I’ll just keep having my own convo… Then I ask: isn’t lifting beyond capacity the exact way we strengthen?


A: We would define excessive the same way you did there. Lifting beyond capacity is definitely the way we strengthen, however in this case, excessive would also mean lifting more than normal and in ways that could damage or harm the body. Additionally, this also fluctuates per person per body, as limits are different for everyone. It is important to keep in mind your own pelvic health and where your pelvic floor is at (weak vs tight), when performing heavy lifting exercises.


Q: I have had the symptoms of hypertonic pf for three months but felt mild prolapse symptoms now for three weeks, how can I strengthen the hypertonic pf muscles?


A: We recommend seeing a PFPT that can help address the hypertonic PF muscles first. You don’t necessarily want to strengthen hypertonic PFMs because if your muscles are already in a shortened or tensed state, doing kegels can contribute to hypertension. Ideally you would like to lengthen the pelvic floors so they are no longer in a hypertonic state first to be able to have proper force production from the PFMs. A PFPT would be able to help get your pelvic floor muscles to a decreased hypertonic state which then would be a better length for them to be strengthened in. In the meantime they can also help you with techniques to help manage prolapse symptoms. Also, they can help you with coordination and if you are contracting the pelvic floor correctly.


Q:  How can you tell (at home) whether you need to tighten or relax your pelvic floor to strengthen it correctly?


A: If you have a tight pelvic floor, you will want to relax it, and if you have a weak pelvic floor, you will want to do exercises to strengthen it. If you are experiencing any of the following, you might have a tight pelvic floor: constipation, painful sex, urgency and pelvic pain. However, we always recommend you seeing a pelvic floor physical therapist to be evaluated properly.


Did you not see your question answered above? Drop your questions below in the comments  to get them answered and potentially featured on a future blog (anonymously).




Ozdemir, F. C., Pehlivan, E., & Melekoglu, R. (2017). Pelvic floor muscle strength of women consulting at the gynecology outpatient clinics and its correlation with sexual dysfunction: A cross-sectional study. Pakistan journal of medical sciences, 33(4), 854–859. https://doi.org/10.12669/pjms.334.12250


Are you unable to come see us in person? We offer virtual physical therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

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  1. i strongly suspect i have prolapse, but i would appreciate knowing specific information on how to know for suee

  2. Your causes of pelvic floor weakness did not include ‘sports hernia’.

    1. Hi Susan,
      The feature image on this post is just a handful of many potential causes of pelvic floor weakness. Thank you for adding to the list!

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