There’s a long-standing myth that heavy lifting is bad for a woman’s pelvic floor, that it weakens the muscles, causes incontinence, or even leads to pelvic organ prolapse. Because of this, many women—particularly those new to strength training—are hesitant to lift heavy weights, and some even avoid strength training altogether. The concern makes sense on the surface. When you think about the intra-abdominal pressure created during a heavy squat or deadlift, it’s easy to assume that the pelvic floor might struggle to handle the load. But what if that’s not actually the case?
A recent study on strength-trained women found that heavy lifting doesn’t weaken the pelvic floor at all—in fact, it appears to be well tolerated, even at intensities of 75–85% of a person’s one-rep max. This challenges the idea that lifting is inherently risky for pelvic health and instead suggests that, like any other muscle, the pelvic floor can adapt and strengthen when trained appropriately.
But pelvic floor health is about more than just whether lifting is safe. A separate study on physiotherapists working with pelvic floor muscle training (PFMT) found that empowerment, education, and personalisation play a huge role in helping women engage with pelvic health training successfully. This means that, as fitness professionals, it’s not just about giving clients exercises—it’s about making sure they understand why those exercises matter and how they can incorporate them into their broader training.
And then there’s the question of prevention. The third study we’re pulling from—a pilot trial on midwife-led pelvic floor training—suggests that when women receive proper education and consistent encouragement during pregnancy, they are more likely to engage with pelvic floor exercises and less likely to experience postpartum urinary incontinence. This raises an important point: it’s not just about what happens in the gym. Long-term pelvic floor health starts much earlier, and strength training might actually be part of the solution rather than the problem.
So, if lifting heavy isn’t inherently dangerous for the pelvic floor, what do trainers need to know? And how can we ensure women feel confident in their ability to train safely, without fear or misinformation holding them back?
Myth #1: Heavy Lifting Causes Pelvic Organ Prolapse
One of the most common fears among women who lift is that the increased intra-abdominal pressure will push pelvic organs downward, leading to prolapse. But the study on strength-trained women found no evidence that lifting at high intensities had any immediate negative effect on pelvic floor strength, endurance, or resting pressure.
In reality, prolapse is more multifactorial than people think. It can be influenced by genetics, pregnancy, hormonal changes, chronic coughing, constipation, and high-impact sports—but strength training alone doesn’t seem to be a major cause. The issue isn’t necessarily the act of lifting itself, but how a person manages pressure within their body. If the pelvic floor is trained to handle loads properly—just like any other muscle—then it can actually become more resilient, not weaker.
As trainers, this means focusing on breathing and bracing strategies rather than avoiding lifting altogether. Teaching clients to exhale on exertion rather than holding their breath (Valsalva manoeuvre) can help regulate intra-abdominal pressure, reducing unnecessary strain on the pelvic floor.
Myth #2: Heavy Lifting Causes Urinary Incontinence
Stress urinary incontinence (SUI)—leakage during exertion—is a real issue for many female athletes, but it’s most commonly reported in high-impact sports like gymnastics, running, and CrossFit rather than in weightlifting. The study on heavy lifting and pelvic floor response showed no significant increase in urinary leakage after lifting, suggesting that strength training alone is not a direct cause of incontinence.
However, if a client does experience leakage while lifting, it’s a sign that something needs adjusting, not that they should stop lifting entirely. This is where lessons from the PFMT empowerment study come in. Physiotherapists working with pelvic floor clients found that education and reassurance are key. Many women assume leakage means their pelvic floor is weak, when in reality, it might be a coordination issue rather than a strength issue. Sometimes, the pelvic floor is actually overactive, gripping too tightly and failing to relax when it should.
Trainers can help by modifying intensity, adjusting breathing mechanics, and incorporating pelvic floor relaxation exercises. If symptoms persist, referring a client to a pelvic health physiotherapist is a great step. The key is to work with the body, not against it, and to remove the fear around strength training.
Myth #3: Kegels Are the Only Solution for a Strong Pelvic Floor
Many women have been told that if they want to keep their pelvic floor strong, they should do Kegels regularly. While Kegels have their place, they aren’t a one-size-fits-all solution. In fact, the midwife-led PFME study found that education and consistency matter just as much as the exercises themselves. Many women don’t stick with PFMT because they don’t fully understand its benefits or aren’t given clear guidance on how to integrate it into their daily lives.
The pelvic floor doesn’t function in isolation. It works as part of the core system, along with the diaphragm, deep abdominals, and glutes. Exercises like squats, deadlifts, and lunges naturally engage the pelvic floor as part of a whole-body movement pattern. Instead of prescribing Kegels alone, we should focus on full-body movements that integrate pelvic floor activation in a functional way.
For women who experience pelvic floor dysfunction, strength training should be approached with progression and awareness, rather than avoidance. Starting with bodyweight movements, mastering breath control, and gradually adding load is a practical and effective way to train safely.
How to Build Confidence Around Pelvic Floor Training
One of the biggest takeaways from the PFMT empowerment study was that confidence and trust play a major role in successful training. Many women feel hesitant about discussing pelvic floor concerns, and they may have been given conflicting advice from different sources.
As trainers, our job isn’t just to give exercises—it’s to create an environment where clients feel heard and supported. This means:
- Having open, judgment-free conversations about pelvic health. If a client is worried about lifting, help them separate fact from fear by explaining what the research actually says.
- Providing practical, progressive solutions rather than black-and-white rules. Instead of saying, “Don’t lift heavy,” help them build a plan that respects their concerns while keeping them strong.
- Collaborating with other professionals. If a client has persistent pelvic floor symptoms, don’t hesitate to recommend a pelvic health physio. The more we work together, the better outcomes our clients will have.
Strength Training as a Tool for Long-Term Pelvic Health
The idea that women should avoid heavy lifting due to pelvic floor concerns is outdated and not backed by science. In fact, strength training, when done properly, can be one of the best things for pelvic health. By moving past fear-based narratives, educating clients, and using research-backed approaches, we can help more women train with confidence, without unnecessary restrictions.
Women deserve to feel strong in their bodies, and lifting heavy isn’t the enemy, it’s an opportunity for resilience, confidence, and long-term health. The fitness industry has come a long way, but old myths about women and strength training still linger. Now that you know the truth, it’s time to pass it on. The next time a client says she’s afraid of lifting because of her pelvic floor, don’t let misinformation hold her back. Show her the science. Teach her how to breathe and brace. Help her gain confidence under the bar. Because strength isn’t just about muscles, it’s about breaking barriers. So let’s start lifting.
References
- Skaug, K. L., Engh, M. E., & Bø, K. (2024). Acute Effect of Heavy Weightlifting on the Pelvic Floor Muscles in Strength-Trained Women: An Experimental Crossover Study. Medicine & Science in Sports & Exercise, 56(1), 37-43. Click here to review the full research article.
- Giardulli, B., Bertoni, G., Coppola, I., Buccarella, O., Testa, M., & Battista, S. (2025). Pelvic Floor Muscle Training Strategies to Empower Patients: A Critical Incident Qualitative Study. European Journal of Physiotherapy. Click here to review the full research article.
- MacArthur, C., Bick, D., Salmon, V., Jones, E., Hay-Smith, J., Bishop, J., Gkini, E., Hemming, K., Webb, S., Pearson, M., Coleman, T., Terry, R., Edwards, E., Frawley, H., Oborn, E., & Dean, S. (2025). Antenatal Pelvic Floor Muscle Exercise Intervention Led by Midwives in England to Reduce Postnatal Urinary Incontinence: APPEAL Feasibility and Pilot Randomised Controlled Cluster Trial. BMJ Open, 15, e091248.Click here to review the full research article.
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