Part of Pelvic floor weakness
Weak pelvic floor symptoms: the signs in women and men
Warning signs, and when to get help
What are the signs of a weak pelvic floor?
Start with the ones that cost people the most. The order matters more here than the length of the list.
Leaking pee under pressure comes first. The NHS describes it as urine escaping when the bladder is under pressure, and the pressure is physical: a cough, a laugh, a sneeze, lifting a toddler or a kettlebell, the first few strides of a run. Next is the control group of symptoms: a sudden urge that arrives with no warning and is hard to hold, going to the toilet more often than the people around you, and in some cases leaking on the way there.
Then the support symptoms, which people describe instead of naming. Heaviness, dragging, or a sense that something is sitting lower than it used to, often worse by the evening or after a day on your feet. The NHS lists a feeling of heaviness, discomfort or pressure in the lower tummy or vagina among the symptoms of pelvic organ prolapse, along with a bulge or lump, pain or numbness during sex, constipation, and bladder problems such as not emptying fully.
Last, the bowel group, which gets mentioned least and matters as much. The NHS describes bowel incontinence as poo leaking out without being able to stop it, needing to go and not reaching the toilet in time, or streaks and stains in your underwear. Trouble holding wind sits in the same family. None of this is something to live with quietly: the NHS says to see a doctor, because there are treatments that help.
Two things about the list as a whole. Not every symptom has to be there, and most people have two or three of them, not the lot. And a prolapse can be present without any symptoms at all, which the NHS states directly, so the absence of a bulge sensation settles nothing either way.
What are weak pelvic floor symptoms in women?
The list above, weighted differently depending on where you are in life.
In practice, three patterns walk into a clinic. Leaking on effort, with no urge beforehand, which is the stress pattern the pelvic floor weakness program is mainly built for. Urge and frequency, where the problem is the warning time, not the effort. And the support pattern, where leaking is mild or absent and the main complaint is heaviness, a bulge, or discomfort with sex.
Plenty of women have a mix, and the mix is not a sign of anything unusual. What changes the plan is which one dominates, because training the muscle helps the first one most convincingly. In the Cochrane review by Dumoulin and colleagues, 56 percent of women with stress leaking who trained reported being cured by the end of treatment against 6 percent of those who did not, across 4 trials of 165 women, and that evidence was rated high quality. Around the menopause the picture gets another layer, because tissue changes in the bladder outlet produce their own symptoms: see the pelvic floor in menopause for what training does and does not reach there.
What are weak pelvic floor symptoms in men?
Men have the same muscles and the same symptom list, and they are a real share of the people asking this question.
Continence Health Australia lists leaking urine or poo when you cough, sneeze, laugh, lift or exercise, urgency with difficulty controlling either one, and reduced sexual sensation. Its page also notes that tight or overactive pelvic floor muscles can cause pain, constipation and urinary symptoms, that overactivity is less common, and that it needs a different approach.
One pattern needs separating out, because it sends men down the wrong road. A weak or stop-start stream, dribbling after you thought you had finished, or the sense that the bladder never quite empties is a flow problem, not a closure problem. The NHS lists an enlarged prostate, bladder stones and constipation among the causes of a bladder that cannot empty fully. Squeezing harder does not fix a blockage, and that pattern earns a doctor's appointment rather than a home program.
There is an evidence gap to allow for as well. The strongest trials of pelvic floor training were done in women, and there is much less research in men who have not had prostate surgery. That is not a reason for a man to skip the training. It is a reason to get the diagnosis right first.
One group of men has a step to clear before any of this. If you have had prostate or other urological surgery, Continence Health Australia's advice is to wait until your surgeon has checked your healing before starting pelvic floor exercises, and the timings and the program come from the team that operated. That team is also where a new symptom belongs in the first weeks afterwards. A weak or stop-start stream, a bladder that will not empty, blood in your pee or a fever each have post-operative causes that need their own checks, not more squeezing.
On how long it takes, use the figure written for men. POGP's leaflet for men says that if you do the exercises the way it describes you should notice an improvement in 3 to 6 months, and it says plainly that they are not a quick fix. Continence Health Australia's men's page adds that many men see results within weeks, and treats 3 weeks with no sign of improvement, or symptoms getting worse, as a reason to get assessed by a pelvic health physio or a continence nurse specialist rather than a reason to stop. The 3 to 5 months further down this page is POGP's general figure; 3 to 6 months is the one it gives men.
Signs during pregnancy and after birth
This is where most people meet these symptoms for the first time, and where they are most often written off as inevitable.
In pregnancy the usual story is leaking under pressure in the second half, and the NHS explains the mechanism simply: pregnancy raises the pressure on the tummy. After birth, the same leaking plus heaviness, dragging and trouble holding wind are common, and the NHS names damage during childbirth as a cause, more so after a vaginal birth than a cesarean.
The prevention evidence here is better than the treatment evidence. Know that before you judge your own progress. In the Cochrane review by Woodley and colleagues, women who were still dry and started a structured program in early pregnancy were 62 percent less likely to be leaking in late pregnancy, from 6 trials of 624 women, which the review rated moderate quality, and 29 percent less likely at 3 to 6 months after birth, from 5 trials of 673 women, which it rated high quality. Both percentages are the review's own way of putting its risk ratios.
For women who were already leaking, the review found the evidence for training as a treatment uncertain. Read that as a reason to be seen rather than a reason to stop: uncertain in a review means the trials were too few and too small, not that the exercises failed.
If you have recently given birth, including by cesarean section, or you have a gap down the middle of your stomach muscles (diastasis recti), ask your physio, midwife or doctor first. Postnatal core and pelvic floor covers the months after birth, and pregnancy back and pelvic pain covers the pain side of the same period.
One limit on the warning list at the foot of this page, worth knowing if you gave birth recently. It covers pelvic floor symptoms, not the signs that belong to the birth itself, and those are on the postnatal core and pelvic floor list instead.
Two of them should not wait for anything on this page. A cesarean wound, or the stitches from a tear or a cut (episiotomy), that turns red, swollen, hot or more painful, oozes pus or fluid or smells unusual goes to your midwife, maternity unit or GP straight away, the same day. If a cesarean wound opens up, or watery pink or straw colored fluid suddenly leaks or gushes from it, go to an emergency department straight away instead, because the deeper layer that was stitched may have given way. Bleeding that is bright red and flowing constantly and soaking your pad and your clothes, or any bleeding that comes with feeling faint or dizzy or a racing heartbeat, means calling emergency services rather than waiting for a same-day call back, and it can happen at any time up to 12 weeks after the birth.
Can these symptoms mean a tight pelvic floor instead?
Yes, often enough to change what you should do next.
Faubion and colleagues describe a pelvic floor that does not relax as presenting with a broad set of nonspecific symptoms across bowel, bladder and sexual function, and they make the point that the pattern of symptoms identifies it better than any one symptom. In other words, the list you just read does not belong to weakness alone. Aw and colleagues found overactive pelvic floor muscles in 85 of 201 patients whose lower urinary tract symptoms had not responded to conservative care, and the sign that separated them was tenderness found on examination, not anything the patient could report.
What tilts suspicion toward tightness in clinic: pain anywhere in the pelvis, pain with sex, pain or difficulty emptying the bowel, a feeling that you are never finished, and a history of doing more and more squeezing while the symptoms got worse. None of that is a diagnosis, and you cannot sort it out from the outside. It is the reason the standard advice to squeeze harder is wrong for a share of the people who read a symptom list like this one.
How do you know if you have a weak pelvic floor?
You can learn something at home, and you cannot finish the job there. Both halves of that are true and both get overstated.
One reader should not test anything at home yet. If you have had an operation for prolapse or for leaking, or prostate or other urological surgery, your surgical team decides when you squeeze and how much, so wait for them before you try the checks below. Continence Health Australia gives men that instruction in plain words, to wait until your surgeon has checked your healing before starting pelvic floor muscle exercises, and we apply it to anyone whose pelvic floor has been operated on.
What a home check can show you: whether you can feel a squeeze and a lift inside when you try, whether you can feel the muscles drop back and let go afterwards, and whether your buttocks, your inner thighs or your held breath are doing the work instead. Our video for the pelvic floor exercise lying down times the lift and the release with the breath, which is the easiest way to notice a release that never happens.
What a home check cannot show you: how strong the contraction actually is, whether the muscle is resting too tight before you even start, whether the lift is in the right direction, or whether a prolapse sits behind the heaviness. The numbers on this are old and still sobering. Bump and colleagues tested 47 women after brief standardized verbal instruction: 23 produced an ideal effort, 12 used a technique that could promote incontinence, and nothing about age, number of babies, weight or previous surgery predicted who would get it right. Their conclusion was that simple verbal or written instruction is not adequate preparation for starting this kind of program.
One method to leave alone. POGP advises against practicing by stopping your urine flow. Imagining it is a good way to find the muscles; doing it repeatedly on the toilet is not an exercise, and Continence Health Australia allows it only as a one-off check at most, because doing it regularly can disturb the bladder's rhythm. Where the two differ, follow POGP and leave the flow alone. If you cannot tell whether the right muscles are working, that is a question for an examination rather than for the toilet, and it is a particularly bad test for anyone who is already having trouble emptying.
What to do next, and when to see a pelvic health physio or physical therapist
Start with the step people skip for years.
See your doctor about any kind of leaking, which is what the NHS advises, and say the bowel and heaviness symptoms out loud as well, because they are the ones most often left in the room. A doctor can rule out the things on the warning list below, and can refer you to a pelvic health physio, a physical therapist in the USA, or a continence service. In some areas you can refer yourself.
Then start the muscle work while you wait, unless something on the warning list applies to you. Having been operated on is the exception that catches people out. After surgery for prolapse or for leaking, and after prostate or other urological surgery, the program and the timings come from your surgical team rather than from this page.
The warning list at the foot of this page has lines written for that reader, and they are worth reading before you start rather than after. A fever, heavy bleeding, smelly discharge or a wound that is oozing or coming apart in the weeks after an operation goes to your surgical team the same day, whether the operation was done for prolapse or leaking or was done in your pelvis for some other reason. A separate line names the pictures that need emergency services or an emergency department instead of a phone call, among them severe or sudden pelvic pain, a wound that opens up and bleeding that suddenly gets much heavier. A newly swollen, warm or tender calf or thigh has its own line, because surgery in the pelvis raises the risk of a blood clot. And the day the bulge, the heaviness or the leaking you had the operation for comes back is the surgical team again, not a reason to squeeze harder.
For everyone else, the pelvic floor weakness program sets out the staged version, with long holds and quick squeezes, usually several short sessions a day, and your physio will adjust this to what your muscles can do now. If a long hold is only a second or two to begin with, that is where you start: POGP's advice for a muscle that tires quickly is to do the exercises little and often rather than to push for the full hold. Give it months, not weeks: POGP tells people to expect an improvement in 3 to 5 months and then to keep a short daily routine going to hold on to it.
Do not carry on alone. Get assessed sooner if you cannot feel anything happening after a few weeks of trying, if squeezing makes your symptoms worse, if you have pain anywhere in the pelvis or during sex, or if you can feel a bulge. A pelvic health physio checks whether the muscle contracts, whether it relaxes, and how it behaves under load, which is the part no self-check reaches. Red flags in physiotherapy explains why the list below is treated as its own set of questions rather than general caution.
For physiotherapists
This page is written to stop a reader converting a symptom list into a diagnosis. The symptom set in Faubion 2012 for nonrelaxing pelvic floor dysfunction overlaps heavily with the underactive presentation, and Aw 2017 found overactive pelvic floor muscles in 85 of 201 patients with refractory lower urinary tract symptoms, identified on examination through tenderness rather than from the history. Bump 1991 remains the cleanest argument against unsupervised starts: 49 percent ideal performance and 25 percent potentially incontinence-promoting technique after brief verbal instruction. Dumoulin 2018 supplies the high quality cure estimate for stress incontinence in women, 56 percent against 6 percent, and Woodley 2020 separates the antenatal prevention signal from the weaker treatment evidence. The page routes flow symptoms in men to medical assessment rather than to training, and routes pain, failed squeezing and bulge sensation to assessment rather than to progression.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: numbness, tingling or altered feeling around or under your genitals, between your inner thighs, or around your bottom (anus), for example it feels different when you wipe after using the toilet. Call emergency services or go to an emergency department straight away. This can be a sign of pressure on the bundle of nerves at the base of the spine (cauda equina syndrome), which needs emergency treatment.
- Emergency: you suddenly cannot control your bladder or bowels at all. The same applies to new leaking of pee or poo, new trouble starting to pee, not being able to feel yourself peeing, not noticing when you need to poo, a new change in how your genitals feel during sex, or new trouble getting an erection or ejaculating, if it comes with back pain, sciatica, or pain, tingling, numbness or weakness in one or both legs. Call emergency services or go to an emergency department straight away. These can also be signs of cauda equina syndrome.
- Emergency: you cannot pee at all, especially if your lower tummy feels full and painful. Call emergency services or go to an emergency department straight away.
- Emergency: leaking that starts suddenly in an older person who is also newly confused or agitated, very drowsy, or has trouble speaking. Call emergency services or go to an emergency department straight away. This can be a sign of a serious infection or another illness that needs urgent treatment.
- Emergency: since any operation in your pelvis, including an operation for prolapse or for leaking, removal of the womb (hysterectomy) or removal of the prostate gland, you have pain in your tummy or pelvis that is severe or came on suddenly, a wound from the operation that opens up, bleeding that suddenly becomes much heavier or that soaks a pad within an hour, or you feel faint, dizzy or breathless, your heart is pounding, or you feel very unwell. Stop your pelvic floor exercises and call emergency services or go to an emergency department straight away, and do not drive yourself.
Get help today
- Same day: pain or burning when you pee together with a high or very low temperature, feeling hot or cold and shivery, or pain in your back just under the ribs. Get medical advice the same day, as this can be a kidney infection. If you also become confused, very drowsy or have trouble speaking, call emergency services or go to an emergency department straight away.
- Same day: leaking that starts suddenly or gets much worse over a few days in an older person, without any of the signs above. Get medical advice the same day, as this can be caused by a urine infection or a medicine.
- Same day: blood in your pee, which may look pink, red or dark brown, even a small amount, even once, and even with no pain. Get medical advice the same day. It needs checking even if it goes away.
- Same day: since an operation for prolapse or for leaking, you have a fever or feel hot, cold or shivery, heavy bleeding from your vagina or blood clots, discharge that smells, a wound from the operation that is oozing or whose edges are coming apart, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding from the repair. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
- Same day: since an operation in your pelvis for any other reason, for example removal of the womb (hysterectomy) or removal of the prostate gland, you have a fever or feel hot, cold or shivery, heavy bleeding, discharge that smells, a wound from the operation that is oozing or whose edges are coming apart, or pain in your pelvis that is new or getting worse quickly. Stop your pelvic floor exercises and contact your surgical team, or the ward you went home from, the same day, and if you cannot reach them get medical help the same day anyway, for example at urgent care or an emergency department. These can be signs of an infection or of bleeding. If the pain becomes severe or comes on suddenly, a wound from the operation opens up, the bleeding suddenly becomes much heavier, or you feel faint, dizzy, breathless or very unwell, call emergency services or go to an emergency department straight away rather than waiting for a call back, and do not drive yourself.
- Same day: since any operation in your pelvis, a calf or thigh that is newly swollen, warm, tender, red or darker than usual, has swollen veins that are sore to touch, or has a throbbing or cramping pain that feels different from normal muscle soreness. Stop your pelvic floor exercises and get medical advice the same day, because surgery in the pelvis raises the risk of a blood clot (deep vein thrombosis). If you are also short of breath or have chest pain, call emergency services.
Book an appointment
- Within a few days: any bleeding from your vagina after your menopause, including spotting or pink or brown discharge, even if it is only a small amount, only happened once, or came on during or after sex. Book an appointment with your doctor within a few days. Bleeding after the menopause is usually not serious, but it has to be checked, because it can be a sign of cancer, and cancer found early is easier to treat.
- Routine: a bulge or lump you can feel or see inside or coming out of your vagina, or a feeling of heaviness or pressure in your lower tummy or vagina. Book an appointment with your doctor. This can be a sign of pelvic organ prolapse, and pelvic floor exercises are often part of the treatment once it has been checked.
- Routine: since an operation for prolapse or for leaking, the bulge, the heaviness or the leaking you had it done for has come back or is getting worse, or you have new pain, new bleeding or discharge from your vagina, or new trouble peeing or pooing. Stop your pelvic floor exercises and book an appointment with your surgical team rather than waiting for your next routine review. A repair can give way, and after mesh surgery these are also the symptoms a specialist checks the mesh for. Which of those it is takes an examination, and it is not something this page or a physiotherapist can tell you.
- Routine: new trouble emptying your bladder or your bowels, a weak or stop-start stream, dribbling after you think you have finished, or a feeling that you have not emptied. Book an appointment with your doctor rather than doing more pelvic floor squeezes, because a flow or emptying problem has its own causes. If you are passing only small amounts and your lower tummy feels full or swollen, or you are leaking all the time without feeling the need to go, get medical advice the same day.
- Blood in your poo, bleeding from your bottom, or a change in your poo or how often you need to go that is not normal for you. See your doctor within a few days. If your poo is black or dark red, or you have bloody diarrhea, get medical advice the same day. If you are bleeding non-stop from your bottom, or there is a lot of blood or you see large clots, call emergency services.
- Routine: poo or wind leaking out when you cannot stop it, not reaching the toilet in time, not being able to get fully clean after going to the toilet, streaks or stains of poo in your underwear, or finding that you no longer notice when you need to go, without any of the signs above. Book an appointment with your doctor, as there are treatments that help, and ask about a pelvic health physio or a continence service.
Common questions
What are signs of a weak pelvic floor in men?
The same control symptoms women get, with one addition. Continence Health Australia lists leaking urine or poo when you cough, sneeze, laugh, lift or exercise, urgency with difficulty controlling either one, and reduced sexual sensation. One symptom men often blame on the pelvic floor usually is not: a weak or stop-start stream, or a feeling that the bladder has not emptied, is a flow problem, and the NHS names an enlarged prostate, bladder stones and constipation as causes of a bladder that cannot empty fully. That pattern needs a doctor rather than more squeezing. One timing point as well: if you have had prostate or other urological surgery, Continence Health Australia's advice is to wait until your surgeon has checked your healing before you start pelvic floor muscle exercises.
How do you know if you have weak pelvic floor?
Not from symptoms alone, and not reliably from a home test either. What you can tell at home is whether you can feel a squeeze and a lift inside, whether you can feel it let go again, and whether your buttocks, thighs or breath take over. What you cannot tell is how strong the contraction is, whether the muscle is resting too tight, or whether there is a prolapse behind the heaviness. Bump and colleagues measured what brief verbal instruction achieves: of 47 women taught this way, 23 produced an ideal effort and 12 used a technique that could make leaking worse, and the authors concluded that simple verbal or written instruction is not adequate preparation for starting an exercise program.
What are weak pelvic floor symptoms in pregnancy?
Mostly leaking under pressure, and it usually starts in the second half. The NHS explains that pregnancy itself raises the pressure inside the tummy, so a cough, a sneeze, a laugh or standing up from the sofa can be enough. Leaking in pregnancy is common and it is still worth raising with your midwife or doctor rather than waiting it out. Training has prevention value here: in the Cochrane review by Woodley and colleagues, women who were dry and began a structured program in early pregnancy were less likely to be leaking in late pregnancy, with a risk 62 percent lower across 6 trials of 624 women, rated moderate quality.
What are the signs of a weak pelvic floor after birth?
Leaking with coughs, sneezes and lifting the baby or the stroller, urgency, trouble holding wind, and heaviness or dragging low down, especially by the end of the day. The NHS names damage during childbirth as a cause of leaking under pressure, and says it is more likely after a vaginal birth than a cesarean. Heaviness that gets worse as the day goes on deserves naming at your postnatal check, or at an appointment of its own if that check is still weeks away, because a prolapse is checked by looking rather than guessed at. If you have recently given birth, including by cesarean section, or you have a gap down the middle of your stomach muscles (diastasis recti), ask your physio, midwife or doctor first.
References
- NHS. Urinary incontinence. Page last reviewed 15 June 2023. https://www.nhs.uk/conditions/urinary-incontinence/
- NHS. Urinary incontinence: causes. Page last reviewed 15 June 2023. https://www.nhs.uk/conditions/urinary-incontinence/causes/
- NHS. Pelvic organ prolapse. Page last reviewed 3 July 2025. https://www.nhs.uk/conditions/pelvic-organ-prolapse/
- NHS. Bowel incontinence. Page last reviewed 15 August 2024. https://www.nhs.uk/conditions/bowel-incontinence/
- NHS. Bleeding from the bottom (rectal bleeding). Page last reviewed 12 April 2023. https://www.nhs.uk/symptoms/bleeding-from-the-bottom-rectal-bleeding/
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pelvic floor muscles. https://thepogp.co.uk/patients/pelvic_health_advice/pelvic_floor_muscles.aspx
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pelvic floor muscle exercises (for men). 2021. https://thepogp.co.uk/Resources/122/pelvic_floor_muscle_exercises_for_men/
- Continence Health Australia. Pelvic floor exercises for men. https://www.continence.org.au/living-with-incontinence/pelvic-floor-exercises/pelvic-floor-exercises-for-men/
- Bump RC, Hurt WG, Fantl JA, Wyman JF. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. American Journal of Obstetrics and Gynecology. 1991;165(2):322-327. https://doi.org/10.1016/0002-9378(91)90085-6
- Faubion SS, Shuster LT, Bharucha AE. Recognition and management of nonrelaxing pelvic floor dysfunction. Mayo Clinic Proceedings. 2012;87(2):187-193. https://doi.org/10.1016/j.mayocp.2011.09.004
- Aw HC, Ranasinghe W, Tan PHM, O'Connell HE. Overactive pelvic floor muscles (OPFM): improving diagnostic accuracy with clinical examination and functional studies. Translational Andrology and Urology. 2017;6(Suppl 2):S64-S67. https://doi.org/10.21037/tau.2017.05.41
- Woodley SJ, Lawrenson P, Boyle R, Cody JD, Morkved S, Kernohan A, Hay-Smith EJC. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. 2020;5:CD007471. https://doi.org/10.1002/14651858.CD007471.pub4
- Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018;(10):CD005654. https://doi.org/10.1002/14651858.CD005654.pub4
- NHS. Hysterectomy: recovery. Page last reviewed 11 October 2022. https://www.nhs.uk/tests-and-treatments/hysterectomy/recovery/
- National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management (NICE guideline NG123). Published 2 April 2019, last updated 24 June 2019. https://www.nice.org.uk/guidance/ng123
- NHS. Postmenopausal bleeding. Page last reviewed 24 September 2026. https://www.nhs.uk/conditions/post-menopausal-bleeding/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-22.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.