Part one of a three-part series on GLP-1 medications and your pelvic floor.
If you’re taking Ozempic, Wegovy, Mounjaro, or Zepbound, you’ve probably heard plenty about blood sugar, appetite, and the number on the scale. You probably haven’t heard much about your pelvic floor.
That’s starting to change. This spring, Medscape published a piece encouraging doctors to ask women on GLP-1s about bladder and sexual health, and to consider pelvic floor physical therapy alongside the medication. So here’s what we know, what we don’t know yet, and what I’d keep an eye on.
Your pelvic floor is muscle
The pelvic floor is a group of muscles at the bottom of your pelvis. Think of it like a hammock. It holds up your bladder, uterus, and bowel, and it helps you stay dry when you cough or jump. It also works as a team with your diaphragm and deep abdominal muscles, which I wrote about in my diastasis recti series.
Like any muscle, it responds to strength training, and it responds to what’s happening in the rest of your body.
The good news: weight loss can help with leaking
Extra weight presses down on the pelvic floor all day long. Taking some of that pressure off can make a real difference.
The best evidence comes from a trial called PRIDE, published in the New England Journal of Medicine in 2009. Women who lost about 8% of their body weight through diet and exercise cut their weekly leaking episodes by nearly half. The biggest improvement was in stress incontinence, the kind of leaking that happens with a cough, a sneeze, or a jump.
That study didn’t involve GLP-1 medications. Researchers are now testing whether weight loss on a GLP-1 helps leaking the same way, and for many women it may.
The part to watch: muscle comes off too
When you lose weight, you don’t only lose fat. A 2026 analysis of GLP-1 trials found that lean mass made up about 25% to 39% of the weight people lost, depending on the medication.
Two things to know about that number. First, lean mass isn’t all muscle. It also includes water and other tissue. Second, the share is about the same as what happens with dieting alone. This isn’t something unique to the medication. It’s what happens with any meaningful weight loss.
What we don’t know yet is how much of that loss affects the pelvic floor specifically. A study at Hartford HealthCare is comparing pelvic floor symptoms in women losing weight with GLP-1s versus bariatric surgery, and its authors note that no published research has looked at this directly yet. I’ll update this post when results come out.
Here’s the encouraging part. When people pair weight loss with strength training, the share of lean tissue they lose often drops below 15%. That’s what Part 2 of this series is about.
The other piece: constipation
GLP-1 medications slow down digestion. That’s part of how they help you feel full, and it’s also why constipation is such a common side effect.
Straining on the toilet pushes down on the pelvic floor. Over time, that extra pressure can show up as pelvic heaviness, hemorrhoids, or prolapse symptoms that get worse. Part 3 covers how to protect yourself.
What I’d watch for
If you’re on a GLP-1, pay attention to:
New or worse leaking when you cough, sneeze, run, or lift
A feeling of heaviness or pressure, or like something is falling out
Straining, or going several days without a bowel movement
Changes in comfort during sex
None of these mean you should stop your medication. That’s a conversation for your prescriber. They do mean your pelvic floor may need some support while your body changes.
Where pelvic floor PT fits
I’m not here to talk anyone out of a GLP-1. For a lot of women, these medications are a real help. My job is making sure your strength keeps up with your weight loss, including the muscles you can’t see.
At a first visit, we look at how your pelvic floor and core are working together, talk through your bladder and bowel habits, and build a strength plan that fits where you are right now. You can read more about sessions and pricing.
In Washington, you can see a physical therapist without a referral. If any of the symptoms above sound familiar, reach out or take a look at what I treat.
Next in this series: Part 2, how to keep your muscle while you lose weight on a GLP-1.
Sources
Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481-490.
Lean mass changes with incretin therapy versus lifestyle intervention: a systematic review and meta-analysis of randomised controlled trials. Diabetes Obes Metab. 2026;28(6):4818-4827. doi:10.1111/dom.70666.
Pelvic Floor Disorder Symptoms in Women Seeking Weight Loss Therapy. Hartford HealthCare. ClinicalTrials.gov NCT07175805.
Amandolare S. The Nuanced Sexual and Pelvic Floor Effects of GLP-1s on Women. Medscape. April 7, 2026.