GLP‑1 Medications and Pelvic Floor Health: What the Research Really Says

stephanytritt
Feb 13
4 min read

Updated: Feb 17

How do GLP 1 Medications like Ozempic and Wegovy affect the Pelvic Floor?

With more people using GLP-1 medications like Ozempic and Wegovy, you might question if it affects the pelvic floor muscles, especially if you’ve been working on managing symptoms. Some popular articles discuss the possibility of these medications weakening the pelvic floor muscles. We know that being overweight is a risk factor for pelvic floor dysfunction due to the strain placed on these muscles. So what are we to do if we need help losing weight but also want to protect our pelvic floor muscles? The answer is nuanced, and as always an individual choice. Read on for information to help you work with your health care practitioner to make the right choice for you.

Obesity and the rise of GLP 1 medications

Obesity rates have nearly tripled since 1975 according to the World Health Organization. We know it can impact the cardiovascular, endocrine and musculoskeletal systems, which includes the pelvic floor. Weight management medications like GLP 1 drugs were originally used to help manage Type 2 Diabetes. GLP 1 is a naturally occurring hormone that helps secrete insulin (which helps manage blood glucose levels), lower appetite, and slow stomach emptying. The ability of GLP 1 medications to lower the appetite and promote weight loss is what has gained popularity with those who are not diabetic but are looking to lose weight for health or cosmetic reasons. Common side effects are nausea, vomiting, diarrhea and because of the slowing of food through the digestive tract, constipation. Straining due to constipation can place an increased load on the pelvic floor muscles. On the other hand, if someone has a weak pelvic floor and now suffers from diarrhea, they may develop concerns about fecal incontinence.

Metabolic Effects of GLP 1 meds

Studies have noted positive cardiovascular effects in people taking GLP 1 medications and they have also been shown to have some positive metabolic effects when microdosed. There is growing evidence that GLP 1 medications can help with chronic inflammatory conditions such as MCAS (mast cell activation syndrome) which suggests they may be beneficial in treating other overlapping conditions like:

Ehlers-Danlos Syndrome
POTS (Postural Orthostatic Tachycardia Syndrome)
Autoimmune disorders
Inflammatory Bowel Disease
Fibromyalgia.

Physical therapists commonly treat people with these conditions to assist in managing pain, pacing activity and exercise levels, protecting joints, and improving daily functions. Therefore, your physical therapist will take into account what medications you're taking as side effects may uncover pelvic floor dysfunction.

Do GLP 1 medications weaken your pelvic floor muscles?

More research is needed when addressing the question of muscle weakening with GLP 1 medications. People with Type 2 Diabetes have an insulin resistance which prevents proper glucose management. There is research that increasingly shows a decrease in the force of muscle contraction of the pelvic floor muscles in those with insulin resistance. This study used blood testing to confirm that higher insulin levels, indicative of greater insulin resistance, had a higher negative effect on pelvic floor muscles. What you might extrapolate from this information is the potential source of weakness is the insulin resistance, so if you manage your metabolic state and insulin control with GLP 1 medications, you may have a positive effect on muscle strength.

Effects of GLP 1 meds and Erectile Dysfunction (ED)

Men who were being treated for type 2 diabetes and also reported (ED) reported improvement in erectile function after 12 months of GLP 1 meds combined with Metformin compared to Metformin alone. They also showed more weight loss, waist circumference reduction, improvement in HbA1-C levels, improvement in fasting plasma glucose and increase in testosterone levels. This study was retrospective in nature so a cause - effect can not be confirmed. The researchers suggest that the ED may have improved due to improved glucose control, weight loss, and increases in blood flow and smooth muscle changes in the penis.

Let’s summarize the effects on the pelvic floor muscles

✨️We see conditions treatable with GLP 1 meds negatively affect the pelvic floor muscles.

At the same time,

✨️GLP 1 medications have side effects that may uncover underlying pelvic floor dysfunction.

GLP 1 medications may be a part of the solution for some, and the source of new symptoms for others. Combining GLP 1 medications with healthy lifestyle choices like exercise and diet have been shown to have improved effects compared to medication alone. Physical therapists will work holistically with you, knowing that pelvic floor dysfunction can originate from a variety of factors. Schedule an appointment if you're ready to make a change for a healthier lifestyle and healthier pelvic floor. 🍃