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How Does Smoking Affect My Pelvic Floor?

Hi friends! Today is The Great American Smokeout. This is a day aimed at helping thousands of people across the United States take steps towards living a smoke-free life to improve health and decrease the risk of cancer.

But why do we care about smoking? Smoking has impacts on our overall health, but it can impact the pelvic floor directly. Both current and ex-smokers, especially women, have a higher risk of urinary urgency (overactive bladder) and urge urinary incontinence compared with non-smokers (Kawahara, 2020). Urinary urgency is a strong, sudden urge to go to the bathroom. Urge urinary incontinence is when this urge turns into leaking urine, whether it be a small drop or two or emptying of the bladder. Researchers think that bladder problems from smoking are a result of poor circulation (atherosclerosis) to the bladder and lower urinary tract—smoking is one of the major risk factors for poor circulation (Kawahara, 2020).

Urinary frequency can be very disruptive to your lifestyle and rarely improves on its own. You should be able to choose when and where you want to use the bathroom. The fear of having an accident causes those suffering from overactive bladder disorder to schedule their lives around bathroom access and limits their activities or travel.

How do we treat overactive bladder and urge urinary incontinence? The American Urological Association recommends behavior therapies as the first line treatment. This can include:

  • Bladder training

  • Bladder control strategies like urge suppression techniques and timed voiding

  • Pelvic floor muscle training

  • Fluid management

  • Avoiding bladder irritants

These are all interventions that can be implemented by a pelvic floor physical therapist. To learn more about OAB and treatment options, read our full blog here.

In addition to increasing the risk for overactive bladder and urge urinary incontinence, smoking is the number one risk factor for bladder cancer (Antoni, 2017). Treatments for bladder cancer, like radiation therapy, can impact the pelvic floor and cause tissue fibrosis (tightness). When the tissues are affected, they don’t work as effectively and can cause pelvic floor dysfunction.

Other treatment options may include having the bladder surgically removed and neobladder reconstruction. A neobladder is a procedure where the surgeon creates a new bladder using part of your intestine (Mayo Clinic, 2020). Individuals who have their bladder removed and a neobladder substitution are at risk for developing pelvic floor disorders like urinary incontinence and prolapse (Littlejohn, 2017).

A pelvic floor physical therapist can help improve symptoms from conditions like incontinence, pelvic pain, and prolapse that result from smoking or bladder cancer treatments. Ask your healthcare provider for a referral to a pelvic therapist, or find a pelvic therapist on your own at We have links to 4 free searchable databases under Find a PT.

If your access to a pelvic floor is limited due to issues like location or money, watch the video below with Jeanice to learn how to train your pelvic floor muscles to pee when and where you choose.

Here are some other great resources to help you stop smoking and manage pelvic floor symptoms:

For providers, check our online courses to help your clients with pelvic floor dysfunction. Consider joining our Ambassador Program and most of our courses are included with your membership!

Written by Emily Reul, PT, DPT


1. Kawahara T, Ito H, Yao M, Uemura H. Impact of smoking habit on overactive bladder symptoms and incontinence in women. Int J Urol. 2020;27(12):1078-1086.

2. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol. 2017;71(1):96-108.

3. Littlejohn N, Cohn JA, Kowalik CG, Kaufman MR, Dmochowksi RR, Reynolds WS. Treatment of pelvic floor disorders following neobladder. Curr Urol Rep. 2017;18(1):5

4. Neobladder reconstruction. Mayo Clinic website. March 3, 2020. Accessed November 17, 2021.


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