Factors that Can Influence Pelvic Floor Functioning

Have you been struggling with leaking, vaginal heaviness, or pelvic pain? Or have you just recently heard of the pelvic floor and are researching to find out the best ways to keep yours functioning optimally (read our last blog post!)? There may be some lifestyle or behavioral changes that could help but it is also important to recognize the role of who we are genetically that may be contributing. Rather than a single factor, it is more probable that combinations of anatomical, physiological, genetic, lifestyle and reproductive factors interact throughout a woman’s lifespan to contribute to pelvic floor function and dysfunction 1 . Below is a list of several modifiable (things that YOU can change) and non-modifiable(things that you cannot change) factors that may influence the functioning of your pelvic floor.

Lung disorders and smoking

  • Smoking is a modifiable factor
  • Chronic lung conditions are non-modifiable however appropriate management is modifiable
  • Coughing, especially chronic coughing, increases intra-abdominal pressure which in turn increases forces down onto the pelvic floor which over time can lead to leaking/incontinence
  • Dietary Influence
  • Diet is a modifiable factor
  • Caffeine and carbonated drinks have an association with stress urinary incontinence as well as overactive bladder symptoms
  • Chocolate, spicy and acidic food have also been reported to have an influence on triggers for leaking as they can be a bladder irritant.

Lower back and hip mobility

  • Flexibility and mobility of our spine and hips are most often modifiable factors
  • Our pelvic floor has a close relationship between our lower back and our hips (this is where these muscles attach to) and both need to have good mobility ensure a good length-tension relationship of these muscles. A good length-tension relationship would mean that they have enough movement to allow a full range of motion, but enough stiffness that they are able to produce force to contract


  • Changes to our body during pregnancy is a non-modifiable factor, however, we can learn to accommodate for some of these changes
  • During pregnancy our abdominal muscles and pelvic floor muscles stretch to accommodate for the growing fetus which changes their length-tension relationship to be less optimal for force production/ contraction. Additionally, hormonal changes and the increased weight of the baby pushing down on the bladder may lead to incontinence


  • The method we deliver our baby is most often not a modifiable factor
  • With a vaginal delivery, we may have some tearing of the muscles or need them cut (episiotomy) to get the baby out. Instrument assisted delivery, such as when forceps are used, may also cause increased damage to the pelvic floor muscles, supporting tissues or nerves in the area.


  • Age is a non-modifiable factor
  • Connective tissue changes, such as decreased collagen and increased stiffness, may lead to decreases in strength of the pelvic floor muscles. The capacity, or how much urine the bladder can hold, over time may be reduced as well.
  • Additionally, decreased estrogen during menopause (and while breastfeeding) may lead to decreased integrity of the bladder and urethra


  • Addressing constipation is a modifiable factor
  • Constant straining to pass a bowel movement can lead to increased strain on the pelvic floor muscles which may cause them to become weaker over time. Additionally. compacted stool may increase pressure on the bladder and increase how often you feel you need to urinate


  • Weight is most often a modifiable factor
  • Being overweight can add extra pressure to the bladder and pelvic floor musculature which over time may weaken them which could lead to incontinence, particularly stress incontinence (such as when laughing, coughing, sneezing, jumping)


  • Lifestyle and habits are mostly modifiable
  • Toileting position, just in case peeing, power peeing, standing while peeing and peeing in the shower can influence our pelvic floor functioning over time with these repetitive behaviors
    See our last blog post on how to begin to change these modifiable factors!

If you would like a more personalized approach to changing your modifiable factors and working around non-modifiable factors, that are applicable to your individualized person, visit us in FortCollins, CO for a 1:1 session with a pelvic health physical therapist.

Delancey, J et al, 2008. Graphic Integration of Causal Factors of Pelvic Floor Disorders: An Integrated Lifespan Model


This blog was written by our very own Pelvic/Women’s Specialist, Dr. Sam Greig.

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