The Menopause

7 signs of a weak pelvic floor you need to know

You might not think it, but a strong pelvic floor can be a superpower, especially as we age and experience menopause. These muscles play a crucial role in supporting the pelvic organs, including the bladder, uterus, and rectum.

A strong pelvic floor is particularly important for women in midlife, as it influences everything from bladder control to sexual relationships – both of which can also be affected by hormonal changes caused by the menopause. Having a weak or dysfunctional pelvic floor can lead to issues such as incontinence, pelvic organ prolapse, sexual dysfunction, and even chronic pelvic pain.

Here, we chat to the experts who explain why understanding this group of muscles can help to safeguard your health for the future.

7 signs you need to work on your pelvic floor

Despite its supporting role, it’s easy to underestimate the significance of pelvic floor health and how it affects other areas of the body.

“The pelvic floor muscles form a hammock-like structure that stretches from the pubic bone at the front of the pelvis to the coccyx at the back,” says Dr Shahzadi Harper, a GP and menopause expert. “These muscles play a crucial role in supporting the bladder, vagina, and rectum as they act as a foundation for the organs of the pelvis. The muscles themselves run from the front of the pelvis to the base of the spine, providing stability and helping to maintain proper bodily function.”

Signs you need to know

Signs of a weak pelvic floor can vary from person to person, but some common indicators to look out for include:

  • Urinary incontinence: this can manifest as unintentional leakage of urine when coughing, sneezing, laughing, or during exercise.
  • Frequent and urgent need to urinate: you may feel the need to urinate more often than usual, even with smaller amounts of urine.
  • Difficulty emptying the bladder: struggling to completely empty the bladder during urination may indicate pelvic floor muscle dysfunction.
  • Bowel incontinence: weak pelvic floor muscles can also lead to difficulties controlling bowel movements, resulting in involuntary leakage or difficulty in controlling gas.
  • Pelvic organ prolapse: a weakened pelvic floor can contribute to pelvic organ prolapse, where the pelvic organs (such as the uterus, bladder, or rectum) descend or bulge into the vaginal canal. Symptoms may include a feeling of pressure or fullness in the pelvic area or a visible bulge.
  • Sexual dysfunction: weakened muscles can impact sexual function, leading to decreased sensation, discomfort during intercourse, or difficulty achieving orgasm.
  • Lower back or pelvic pain: chronic pain in the lower back or pelvic region, including the hips or groin area, can be associated with pelvic floor muscle weakness.

If you experience a few of these symptoms, then it’s worth speaking to your GP.

When the muscles are too tight

It’s also possible to have a pelvic floor that’s too tight, as Clare Bourne, a pelvic health physiotherapist explains.

“Our pelvic floor muscles can increase in tone over time – this refers to the tension in a muscle at rest,” she says. “There are a number of reasons this can increase. It can be related to symptoms such as painful intercourse, being unable or finding it painful to use tampons, pelvic pain, or struggling to open your bowels.

“It is possible to improve these symptoms, through breathwork, and pelvic floor rehabilitation (which doesn’t always include contracting the muscles initially).”

How does the menopause impact your pelvic floor?

“There are a few ways in which the menopause transition, from perimenopause through menopause to post-menopause, can impact the pelvic floor,” says Clare. “Hormonal changes during this time, such as fluctuations and decline in oestrogen are one significant factor. The vulvar and vaginal tissues have lots of oestrogen receptors. As oestrogen levels decline this can lead to the tissues becoming drier, thinner and sore. This can cause urinary frequency and urgency, painful intercourse, recurrent urinary tract infections, urinary incontinence and many more.

“As we age there is also a process called sarcopenia, which is the gradual loss of muscle mass and strength of skeletal muscles.”

Fortunately, there are various strategies available to support and strengthen the pelvic floor during menopause. Targeted exercises are a great place to start.

How to do kegels

“My top tip for women looking to strengthen their pelvic floor is to practice regular exercises known as kegels,” says Shahzadi. Here are some steps to get started:

Find the right muscles

To do kegels, you need to identify the muscles that you use to stop the flow of urine. You can do this by trying to stop the flow of urine mid-stream during a trip to the bathroom.

Practice regularly

Once you’ve identified the right muscles, start practising kegels by squeezing and lifting these muscles as if you’re trying to hold in urine or gas. Hold the contraction for a few seconds, then release and relax the muscles for a few seconds before repeating. Aim to do 10-15 repetitions, three times a day.

Gradually increase intensity

As your muscles get stronger, you can gradually increase the intensity and duration of your kegel exercises. Try holding the contraction for longer periods of time or adding more repetitions.

Be consistent

Consistency is key when it comes to strengthening your pelvic floor muscles. Make kegel exercises a regular part of your daily routine, just like brushing your teeth or taking a shower.

Seek professional help if needed

If you’re having difficulty with kegel exercises or experiencing problems such as incontinence or prolapse, seek advice from a healthcare professionals, such as a pelvic floor physiotherapist, who can provide personalised guidance and treatment.

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