In part 2 of this video series by Physical Therapist Amanda Olson, we learn how various activities including giving birth can damage or weaken your pelvic floor. Learn more about your anatomy and how kegel exercises and kegel exercise weights might be the answer for your urinary incontinence or fecal incontinence.


I’m Amanda Olson from, and I’m a physical therapist specializing in pelvic floor rehabilitation.

This is part two of a three-part series on the pelvic floor.

In the first video, we covered what the pelvic floor is, including some anatomy and the general structures associated with the pelvic floor.

Today, we’re going to talk about different injuries and activities that can result in pelvic floor weakness and lead to things like incontinence and lower back and hip pain.

So to review, we’re looking at the pelvis here. We’ve got the bony structures in white.

Coming at it from the top view, the organs associated with the pelvic floor are the bladder, the uterus, and the rectum.

And then the pelvic floor itself, which is comprised of the superficial layer, and, again, everything that you see here in red; so the superficial layer, and the deep layer right behind it.

They are joined by a layer of fascia.

So looking at it from the top view, the pelvic floor is in through there.

So the most common injury or activity that can lead to pelvic floor weakness is pregnancy and childbirth.

So when you’re considering that the weight over the top of the pelvic floor increases significantly for nine months during pregnancy, the uterus places a lot of pressure onto that pelvic floor.

The uterus grows up and out through the bowl of the pelvis, and that prolonged carrying time of that increased weight can lead to stretching and weakening of the pelvic floor muscles.

Delivery of a baby, especially if it’s vaginally, can lead to stretching and tearing of the pelvic floor as well.

Even having a C-section can affect the pelvic floor.

It doesn’t matter if it was a planned C-section or the person went into labor and ended up with a C-section later. Having a C-section scar can put pressure on the bladder and the structures lying right over the top of the pelvic floor.

That can lead to stretching and weakening of the pelvic floor muscles as well.

The next thing that can lead to pelvic floor weakness is chronic constipation.

So in the last video, we discussed how the organs sit in the pelvic bowl.

They are very tight neighbors. So they share close quarters, and the only thing separating them is a thin piece of fascia, which is just a thin piece of tissue that covers the organs and protects them.

With chronic constipation, the rectum is full for a prolonged period. And especially with chronic constipation, if it’s happening over years, that pressure of that bowel being full, over time, puts pressure on the pelvic floor.

So the rectum comes down, and the pelvic floor can become weak as a result of that.

So managing your constipation by visiting a physician or seeing a pelvic floor physical therapist is helpful.

And then, following that, strengthen the pelvic floor muscles.

The next thing that we’ve been seeing a lot more in the past few years is pelvic floor weakness and damage related to heavy lifting.

So in females that are lifting heavy things, whether it’s at work or as part of a fitness regimen, if the lifting is happening while they’re holding their breath, that’s pressure on the pelvic floor.

The reason is the thorax, the area between the pelvis and the ribcage, is like a soda can. The soda can has high pressure, and when you pop the top of it, it releases air.

The thorax functions similarly, where the pelvic floor is the bottom and the diaphragm is the top of that soda can.

When we breathe, when we exhale, that releases the pressure in the thorax.

So if you are lifting something heavy and holding your breath, that pressure stays in the thorax and puts all of that force down into the organs and, finally, through the pelvic floor itself.

So there have been some videos of females actually leaking urine during lifting. And that’s not normal. It happens, it’s common. But it’s not normal, and it’s very preventable.

The number one way to do that is to be sure to exhale while lifting anything heavy.

The second is to contract the pelvic floor during that lift, aside from using proper mechanics during the lift itself.

This is especially important for the Olympic lifts, like clinging jerks, deep squats, things like that.

These are muscles, just like everywhere else in the body. So it is possible to tear them. They have tendons. You can rupture those tendons by lifting forcefully, in an improper way.

The nice thing is, just like anywhere else in the body — the rotator cuff or the hamstring — they do mend over time.

But you have to strengthen them properly, and you have to then use them properly afterward, to prevent re-injury.

So strengthening the pelvic floor is a key step in that rehabilitation process.

The last activity that can lead to damage to the pelvic floor is a fall.

This is common in the winter; people slip and fall on ice and come down on their tailbone. Not only does it hurt the tailbone, but it can damage the pelvic floor muscles.

Just reviewing from last time: We talked about the fact that the pelvic floor attaches onto the tailbone and wraps around to the front.

Falls include accidents on a horse, where there’s pressure and force coming into the pubic bone and onto the pelvic floor,  as well as slips and falls on ladders, trampolines, and other things like that.

That blunt trauma can injure the muscles.

Again, the nice thing is that they do mend.

Strengthening of the pelvic floor, first by doing kegels, and then adding resistance with vaginal weights, is a crucial part of that rehabilitation process.

So that was part two of our three-part series.

Be sure to visit, and look forward to the next video to come, where we’re going to talk about what a Kegel is.

This will include how to do it properly and what types of Kegels can be used for different purposes, As well as how vaginal weights can help in that process.

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