Underactive Pelvic Floor: Causes, Symptoms & Treatment

Amanda Olson - DPT
Medically Reviewed By Dr. Amanda Olson, DPT, PRPC


Underactive pelvic floor muscle dysfunction describes a classification of the pelvic floor muscles (PFM) in which the pelvic floor muscles do not voluntarily contract when it is appropriate to do so.

This condition results in symptoms such as urinary incontinence, anal incontinence or pelvic organ prolapse. The muscles may be weak, lack proper tone, have poor endurance, or fail to coordinate in a timely manner.

Causes of Underactive Pelvic Floor Muscles

Underactive pelvic floor muscle dysfunction can have many root causes:

  • Pregnancy and childbirth can cause underactive pelvic floor muscle dysfunction by over stretching or tearing the pelvic floor muscle fibers themselves or compressing or damaging the nerves to the pelvic floor
  • Pelvic or abdominal surgery
  • Illness involving cough, diarrhea, or vomiting
  • Chronic cough
  • Natural aging processes
  • Cancer treatment such as radiation and chemotherapy can cause in impairments to the pelvic floor muscles
  • Smoking
  • Constipation
  • Obesity
  • Some neurologic diagnosis (These include multiple sclerosis, Parkinson’s disease, stroke, traumatic brain injury, spina bifida, and spinal cord injury)

Signs and Symptoms of Underactive Pelvic Floor Muscles Include

Treatment for Underactive Pelvic Floor Muscles

Treatment for underactive pelvic floor muscles includes building proper tone and retraining the pelvic floor muscles to contract and relax under coordinated control. This is commonly done with pelvic physical therapy as a first line treatment.

Pelvic floor physical therapists are specially trained to evaluate and treat pelvic floor and abdominal issues including underactive pelvic floor. Pelvic floor training using muscle tightening exercises, manual therapy, biofeedback, and ultrasound imaging are commonly utilized.

Strengthening exercises referred to as Kegels are commonly utilized to build control, strength, and endurance of the muscles and prevent leakage. Kegels involve the pelvic floor muscles contracting and lifting within the pelvic bowl similarly to how the toy video game claw closes and lifts the toy up from the toy bin.

These Kegel exercises yield the best response when they are learned first in isolation, without the activity of the surrounding larger muscles such as the gluteal or abdominals.

To Perform a Kegel Exercise:

Lay down on your back or sit in a chair. Use the following breathing pattern and cues:

  • Inhale and relax
  • Exhale and contract the pelvic floor muscles as if you were shutting of the flow of urine-hold for 3-5 seconds.
  • Inhale and relax

Repeat this 10 times, 3-5 times per day.

During the Kegel exercise the pelvis should not rock or move, and you should not feel a gripping sensation in your abdominals or gluteal muscles. If the “shutting of the flow of urine” cue is difficult, imagine that you are trying pull a blueberry from the tip of the vaginal opening and into the vagina.

Vaginal Weights to Build Strength, Endurance, and Coordination

Vaginal weights (also referred to as Kegel weights or vaginal balls) are often utilized to build strength, endurance, and coordination of the pelvic floor muscles and to improve overall function. These noninvasive treatments are commonly available and allow for improvement and curing of symptoms and overall wellbeing.

The most beneficial aspect of vaginal weights is that the provide feedback and awareness as to where the pelvic floor muscles are located. This makes it significantly easier to learn to contract the muscles properly. If Kegels are performed improperly by bearing down, the user receives this feedback instantly as the vaginal weight will be pushed out of the body.

To build strength, perform active Kegels with the vaginal weight in the vagina. Contract the muscles pulling the weight further into the vagina and hold for 3-5 seconds. Perform 10 sets. Do this 3-4 times per day.

To build endurance simply place the vaginal weight in and perform light household tasks or chores for 10-15 minutes. Activities may include take a shower, fold the laundry, or do the dishes. The pelvic floor muscles will contract sub-maximally to maintain the weight in the body and the light movement will provide added challenge. These activities will help to build endurance when performed 5-6 times weekly.

If you suspect that you have underactive pelvic floor muscles, be sure to see your physician and request a referral to a pelvic health physical therapist. Some strengthening exercises may be performed independently to reach your goals.

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