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Common problems with pelvic floor muscles

The pelvic floor muscles can sometimes become too loose and weak.  This is a common problem for women because of pregnancy and childbirth. However, they can be successfully strengthened with pelvic floor muscle training. For men, common causes of weak pelvic floor muscles include surgery for prostate cancer, bladder or bowel problems, constipation, heavy lifting and more.

For some people the muscles can become too tight. This is a less common but very distressing problem, especially  for women. The causes are often complex and professional help is required to resolve the problem.

In almost all cases it is possible to gain control over the pelvic floor muscles and to train them to do their job well.

What can make these muscles too loose?

Pregnancy and childbirth in women
Evidence suggests that problems can start during pregnancy, not just after birth. Women who have had multiple births, instrumental births (with forceps or ventouse), severe perineal tearing or large babies (birth weight over 4kg) are at greater risk of pelvic floor muscle damage.

Straining on the toilet
Chronic or repeated straining on the toilet (associated with constipation) can lead to pelvic floor weakness and/or prolapse of the organs into the vagina (for women) or the anus (the rectal lining protrudes from the anus). It is important to address the cause of constipation and learn good toilet habits.

Chronic coughing
An ongoing cough for any reason (for example, asthma, bronchitis or a smoker's cough) increases the risk of urinary incontinence and prolapse.  

Heavy lifting
Heavy lifting can create pressure on the pelvic floor and ultimately lead to prolapse. Men and women in certain professions such as nursing or courier services are at particular risk. People performing heavy weight training at a gym can also be at risk of straining the pelvic floor. 

High impact exercise
Participating in high impact sports such as basketball, netball or running can mean an increased risk of leaking urine, especially for women. This applies to elite athletes as well. For more information about pelvic floor safe exercise visit the Pelvic Floor First website.

Pelvic floor muscles tend to get weaker with increasing age. Pelvic floor muscle exercises can help strengthen them at any age.

Being overweight increases the risk of leaking urine and may place greater strain on the pelvic floor.

What can make these muscles too tight?

This is a complex issue. Sometimes pelvic floor muscles can fail to relax properly, which causes the bladder and bowel not to empty properly. Sometimes pelvic floor muscles can be very tight in women so that intercourse is difficult or impossible. Pain is often the culprit causing the pelvic floor muscles to tighten up protectively. Because the pelvic floor is hidden from view, the problem can often go undiagnosed for a long time. However, seeking help from a pelvic floor physiotherapist can effectively treat it.