Part of Pelvic floor weakness
What causes weak pelvic floor muscles, in women and men
Warning signs, and when to get help
What makes the pelvic floor weak?
Pressure, damage, nerves and time. Almost every cause on the list belongs to one of those four, and seeing which one you are dealing with is more useful than the list itself.
Pressure is the biggest group. Anything that repeatedly pushes down on the pelvic floor loads it: pregnancy, months of straining on the toilet, a cough that will not clear, extra body weight, and heavy or high-impact training done in a way the floor cannot match. The NHS names pregnancy and being overweight as raising the pressure on your tummy, and lists long-term constipation and straining and a persistent cough among the causes of pelvic organ prolapse.
Damage is the second group, and it is more specific. The NHS names damage during childbirth, more likely after a vaginal birth than a cesarean, and surgery in the area, including a hysterectomy and removal of the prostate gland.
Nerves are the third, and they are easy to miss because the muscle itself may be intact. The NHS lists neurological conditions such as Parkinson's disease and multiple sclerosis among the causes of leaking, and these need their own assessment rather than a home program. Time is the fourth: the NHS says incontinence becomes more common in middle age and is very common over 80, and that a possible genetic link means a family history may raise your risk.
All four of those are adult causes. A child or a teenager with daytime wetting or leaks has a different list and different checks, and that belongs with their own doctor or a children's continence service.
Pregnancy and birth
The most common cause, and the most commonly treated as inevitable.
The two parts work differently. Pregnancy loads the floor by raising pressure from above for months, which the NHS describes directly, and that part happens whichever way the baby is born. Birth adds the possibility of direct damage, and the NHS says that damage is more likely after a vaginal birth than after a cesarean. It is worth separating them, because women who had a cesarean are often told their pelvic floor should be fine, and the pregnancy half of the load was the same.
What the trials show is that the timing of the training matters more than most advice admits. In the Cochrane review by Woodley and colleagues, women who were still dry and began a structured program in early pregnancy were 62 percent less likely to be leaking in late pregnancy, from 6 trials of 624 women, rated moderate quality, and 29 percent less likely at 3 to 6 months after birth, from 5 trials of 673 women, rated high quality. For women who were already leaking, the same review found the evidence for training as a treatment uncertain, which is a statement about the size and number of the trials rather than a verdict on the exercises.
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 sets out the months after birth, and diastasis recti covers the tummy gap that often sits alongside it.
What causes weak pelvic floor muscles in men?
Nearly the same list, which surprises most men who ask.
Continence Health Australia's page for men names prostate surgery, constipation or straining on the toilet, long-term coughing such as from asthma or smoking, heavy lifting or high-impact exercise, and ageing. The NHS adds removal of the prostate gland to its own list of things that can damage the area and cause leaking under pressure, and names nerve conditions and certain medicines separately.
Prostate surgery is named and left there, because recovery after it runs to its own surgical plan and its own timings, and those come from the team that operated. One step comes before any of that. 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. In the weeks after the operation a new symptom belongs with that team rather than with this page: 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.
What the rest of the list tells a man is that his pelvic floor is weakened by the same four mechanisms as anyone else's, and the modifiable ones are modifiable for him too.
Straining, constipation and a long-term cough
The causes most likely to be still happening while you read about the others.
Straining to empty your bowel pushes down on the pelvic floor every time, and if that is a daily event it is daily load. The NHS lists long-term constipation and straining among the causes of pelvic organ prolapse, and Continence Health Australia names constipation or straining on the toilet as one of the things that weaken the pelvic floor in men. A cough that lasts months does the same thing in sharper bursts. The NHS names persistent coughing on its prolapse list, and the Australian page specifies the usual sources, asthma and smoking.
The reason they matter more than their place on a list suggests is simple. They are ongoing. You cannot undo a birth from four years ago. You can change what happens on the toilet tomorrow morning, and a cough that has gone on for weeks is a reason to see a doctor in its own right.
Lifting, load and high-impact exercise
Real, and overstated in both directions.
Continence Health Australia lists heavy lifting and high-impact exercise among the things that weaken the pelvic floor. The clearest numbers come from sport. Dominguez-Antuna and colleagues pooled 13 studies covering 4,823 women aged 18 to 71, 91 percent of them CrossFit practitioners and the rest comparison groups, and found 1,637 with urinary incontinence, a prevalence of 44.5 percent, with the stress type accounting for 81.2 percent and jump-based movements commonly linked to the leaking. Rates were higher than in the comparison groups, and age, body mass index and number of births were each associated with a higher chance of it.
Two qualifications belong with those figures. Every study in that review was cross-sectional, so it can show that leaking and heavy training go together, not that the training caused the weakness. And the authors rated 10 of the 13 studies as poor quality. The practical reading is not to stop lifting. It is that a floor that leaks under a barbell or a box jump is telling you the load has outrun it today, and the answer is usually a change in load, breathing and progression rather than giving up the gym.
Age, menopause and after pelvic surgery
Three causes that arrive together and get blamed on each other.
Age first. The NHS says leaking becomes more common in middle age and is very common over 80, and that prolapse is more likely with age, particularly after the menopause. The menopause adds something different in kind: Sarmento and colleagues describe genitourinary syndrome of menopause as the signs and symptoms caused by reduced estrogen stimulation of the vulvovaginal and lower urinary tract, reported in 27 to 84 percent of postmenopausal women in their review, with urgency, pain on passing urine and repeated urine infections among the symptoms. That spread is wide enough to tell you this is common and nothing more exact than that, and the review does not say which studies the two ends of it came from.
That distinction decides what training can reach. Pelvic floor muscle work changes the muscle. It does not reverse a tissue change, so dryness, burning and recurrent infections belong in a separate conversation with your doctor or menopause clinic. The pelvic floor in menopause covers that split in more detail, and because the same years bring bone loss, osteoporosis is the page for the other half of midlife strength work.
Surgery is the third, and two different operations get called pelvic surgery in the same breath. One is done for something else, and the effect on the pelvic floor is a side effect rather than the point: the NHS names removal of the womb (hysterectomy) and removal of the prostate gland among the operations that can damage the bladder or the area around it and leave leaking under pressure. The other is done to treat prolapse or leaking, where the pelvic floor is the thing being operated on. A causes page that runs those together leaves a woman weighing up an operation with the impression that surgery can only make her floor weaker, and neither source says that.
Hysterectomy is where the uncertainty shows. The NHS lists it both as a cause of prolapse and as an operation that can damage the area and cause leaking, which is what we report above. The research is not all one way.
In Forner and colleagues' survey of 3,934 women, symptoms of prolapse were not associated with hysterectomy, cesarean section, forceps delivery, body mass index or menopausal status, while age, vaginal parity, a history of constipation or hemorrhoids, and family history all were. One survey taken at a single point in time does not overturn a national page, and the reason for putting them side by side is that no list can tell you what your own operation did. Your surgeon and the record of that operation can.
Either way the timings are not ours to give. When to start, what to lift and what counts as normal healing come from the surgical team. Several of the warning lines below are written for a reader who has been operated on, 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 afterwards goes to that team the same day, whether the operation was done for prolapse or leaking or was done in your pelvis for some other reason. Severe or sudden pelvic pain, a wound that opens up and bleeding that suddenly gets much heavier have their own line, because those need emergency services or an emergency department rather than a phone call. A newly swollen, warm or tender calf or thigh has a line too, because surgery in the pelvis raises the risk of a blood clot. And the day the bulge, the heaviness or the leaking the operation was for comes back is the surgical team again rather than a reason to squeeze harder.
What causes a weak pelvic floor in young women with no children?
A fair question, asked often, and the answer does not depend on having given birth.
Sport and load are the best documented route. Almousa and Bandin Van Loon reviewed 23 studies in nulliparous sportswomen, meaning women who had never given birth, and found leaking during sport reported by between 5.7 and 80 percent of them, with the highest figures in trampolinists. That range is wide because the studies measured different sports in different ways, and the point stands: this happens in young women with no pregnancy history, often enough to have its own body of research.
Then the same pressure causes as everyone else. Long-term constipation and straining. A cough that has run for months. Carrying extra weight. And the make of the tissue itself, since the NHS names joint hypermobility syndrome, Marfan syndrome and the Ehlers-Danlos syndromes among the things that raise the risk of prolapse, and notes a possible genetic link in incontinence.
One more cause belongs here, and it is the one nobody thinks of: the muscle may never have been trained, or may have been trained wrongly. That is not weakness caused by anything that happened to you, and it is the version that responds fastest.
Which of these can you still change?
This is the split that changes what you do on Monday morning.
Still open to you now: how you empty your bowel, and whether constipation and straining are being treated rather than tolerated; a cough that has gone on for weeks, which is a doctor's appointment rather than a pelvic floor problem; smoking, which the Australian page names as one source of that cough; your weight, which the NHS links to pressure on the tummy; how you breathe, brace and progress load in the gym; and whether the muscle is actually being trained. That last one is not a minor item. In the Cochrane review by Dumoulin and colleagues, 56 percent of women with stress leaking who trained reported cure at the end of treatment against 6 percent of those who did not, from 4 trials of 165 women, and the evidence was rated high quality.
Already behind you: a pregnancy, a birth, an operation, your age and your genes. Those set where you start from. They do not set where you finish, and the trial evidence above was collected in women who had all of those histories.
One group waits before any of that. If you have had an operation for prolapse or for leaking, or prostate or other urological surgery, your surgical team sets the start date and the dose, and Continence Health Australia's instruction to men is to wait until your surgeon has checked your healing before starting pelvic floor muscle exercises.
For everyone else, the staged version of the work is on the pelvic floor weakness program, and the first exercise most people need is the pelvic floor exercise lying down. POGP's target is 10 long squeezes held for up to 10 seconds and 10 short, quick ones, at least 3 times a day, and if you can only hold for a second or two, or manage a few before the muscle tires, it says to start little and often instead of pushing for the full hold. Expect months rather than weeks before you judge it, and your physio will adjust the dose, the positions and the progression to what your muscles can do now.
When weakness is not the problem
The word in the question can send people the wrong way for years.
Faubion and colleagues, writing about women, describe a pelvic floor that does not relax as presenting with a wide, nonspecific range of symptoms across pain, bowel movements, passing urine and sexual function, which is most of the list that brings people to a page about weakness. Aw and colleagues found overactive pelvic floor muscles in 85 of 201 patients whose lower urinary tract symptoms had not improved with conservative treatment, and what identified them was tenderness on examination. Continence Health Australia says the same thing in one line for men: tight or overactive muscles cause pain, constipation and urinary symptoms, they are less common than weakness, and they need a different approach.
So if you have pain anywhere in the pelvis, pain with sex, trouble emptying, or a history of squeezing more and more while things got worse, the cause you are looking for may not be weakness at all. Get assessed before you add more squeezes. Red flags in physiotherapy explains why the warning list below is read as its own set of questions rather than as general caution.
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.
- 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 can cause weak pelvic floor muscles in men?
Continence Health Australia names prostate surgery, constipation or straining on the toilet, long-term coughing such as from asthma or smoking, heavy lifting or high-impact exercise, and ageing. The NHS adds that removal of the prostate gland can damage the area and cause leaking under pressure, and names nerve conditions, some connective tissue conditions and certain medicines among the general causes. Most of that list is the same list women get, which is the honest headline: the pelvic floor is weakened by pressure, surgery, nerves and time, not by being male or female.
What does it mean when your pelvic floor is weak?
It means the muscles under your bladder and bowel are not doing one of their two jobs well enough. The NHS describes the mechanism for leaking: when the pelvic floor or the sphincter around the urethra is weak or damaged, the tube carrying pee out of the bladder may not stay closed when pressure inside your tummy suddenly rises. The same muscles hold the bladder, bowel and, in women, the uterus up from below, which is why heaviness and a bulge sensation belong to the same problem. What it does not mean is permanent. Training the muscle is the first treatment for leaking under pressure, and in the Cochrane review by Dumoulin and colleagues 56 percent of women who trained reported cure against 6 percent who did not.
What causes weak pelvic floor muscles in young women?
Three groups of causes reach a woman who has never been pregnant. Load, where sport is the clearest example: Almousa and Bandin Van Loon reviewed 23 studies in nulliparous sportswomen and found leaking during sport reported by between 5.7 and 80 percent of them, highest in trampolinists. Pressure from elsewhere, meaning long-term constipation and straining or a cough that has gone on for months, both of which the NHS lists among the causes of prolapse. And the make of the tissue itself, since the NHS names joint hypermobility syndrome, Marfan syndrome and the Ehlers-Danlos syndromes as raising the risk, and notes a possible genetic link in incontinence generally. A young woman with these symptoms has not done anything wrong, and she does not have to wait for a pregnancy to get it looked at.
How do you tell if your pelvic floor muscles are weak?
Not from the cause, and not reliably from the symptoms either. Leaking, urgency, heaviness and poor bowel control all turn up in a pelvic floor that is too weak and in one held too tight, and Faubion and colleagues describe that second group as presenting with a broad, nonspecific mix of bladder, bowel and sexual symptoms. At home you can tell whether you can produce a squeeze and feel it let go, and whether it survives standing up. Strength, resting tone and tenderness are found by examination, which is why a pelvic health physio settles the question and a symptom list does not.
References
- NHS. Urinary incontinence: causes. Page last reviewed 15 June 2023. https://www.nhs.uk/conditions/urinary-incontinence/causes/
- NHS. Urinary incontinence. Page last reviewed 15 June 2023. https://www.nhs.uk/conditions/urinary-incontinence/
- 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/
- Continence Health Australia. Pelvic floor exercises for men. https://www.continence.org.au/living-with-incontinence/pelvic-floor-exercises/pelvic-floor-exercises-for-men/
- Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Pelvic floor muscles. https://thepogp.co.uk/patients/pelvic_health_advice/pelvic_floor_muscles.aspx
- Almousa S, Bandin Van Loon A. The prevalence of urinary incontinence in nulliparous female sportswomen: a systematic review. Journal of Sports Sciences. 2019;37(14):1663-1672. https://doi.org/10.1080/02640414.2019.1585312
- Dominguez-Antuna E, Diz JC, Suarez-Iglesias D, Ayan C. Prevalence of urinary incontinence in female CrossFit athletes: a systematic review with meta-analysis. International Urogynecology Journal. 2023;34(3):621-634. https://doi.org/10.1007/s00192-022-05244-z
- 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
- Sarmento ACA, Costa APF, Vieira-Baptista P, Giraldo PC, Eleuterio J, Goncalves AK. Genitourinary syndrome of menopause: epidemiology, physiopathology, clinical manifestation and diagnostic. Frontiers in Reproductive Health. 2021;3:779398. https://doi.org/10.3389/frph.2021.779398
- 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
- 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
- Forner LB, Beckman EM, Smith MD. Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. International Urogynecology Journal. 2020;31(8):1551-1558. https://doi.org/10.1007/s00192-019-04163-w
- NICE. 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. Hysterectomy: recovery. Page last reviewed 11 October 2022. https://www.nhs.uk/tests-and-treatments/hysterectomy/recovery/
- 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.