Your Pelvic Floor Changes During Menopause Too
Menopause is one of those topics that when it comes to the pelvic floor, does not get nearly the amount of attention it should. Truth be told, whenever anyone finds out I’m a pelvic PT, the followup question is, “Oh that’s for pregnant and postpartum moms right?” To which I say, “NOPE.” It’s for anyone with a pelvis, but I digress…let’s dive in on that another time. For now, let’s draw some attention to some women who are just navigating life feeling frustrated and dismissed.
It does not matter if you had kids or not, every woman will go through menopause and may experience a wide range of unpleasant symptoms. This could be leaking when you sneeze, feeling like you have a different relationship with the bathroom than before because you’re going frequently or having urgency, it could be in the bedroom where you’re finding things are dry, itchy, uncomfortable, or downright painful, or it could be pressure or aching in the pelvic floor.
So naturally, you start wondering:
Is this normal during menopause?
Well before you take that somewhere else and get told for the 5th time, “that’s normal and nothing can really be done,” allow me to remind you: yes, these symptoms are incredibly common, no they are not normal, and yes there are things that can be done to help.
What Does Menopause Have to Do With Your Pelvic Floor?
Quite a bit, actually.
As estrogen levels change during the menopause transition, tissues in and around the vagina, vulva, bladder, and urethra can change too. You may hear your medical provider refer to some of these changes as genitourinary syndrome of menopause, or GSM, which is saying hormonal changes can affect your vaginal and urinary tissues. The thing is, estrogen plays a huge role in the health of the pelvic tissues and as estrogen decreases it impacts the tissue and muscles of this region.
Vaginal dryness or irritation, pain or discomfort with sex, increased urinary urgency or frequency, urinary leakage, recurrent urinary tract infections, or changes in sensation are all common signs and symptoms during menopause.
Hormones aren't necessarily the only thing contributing to what you're experiencing, though. Your pelvic floor muscles, breathing, pressure management, hip mobility, strength, previous pregnancies, childbirth, surgeries, exercise habits, constipation, and even how much tension you're carrying can all become part of the picture.
Which is exactly why simply saying, "Well, you're in menopause," isn't particularly helpful.
Wait. Does Menopause Make Your Pelvic Floor Weak?
Sometimes weakness can be part of the problem, but if you’ve been here for a bit, you know what's coming next.
Not every pelvic floor problem is a weak pelvic floor.
We've talked about this before, but it deserves repeating because women are still being told to do kegels for basically everything that happens below the waist…or being told to never kegel a day in their life. Gotta love the internet and our absolutes…
Your pelvic floor needs to be able to contract and relax. It also needs to coordinate with your diaphragm, abdominal muscles, hips, and the rest of your body. If those muscles are overactive or holding too much tension, adding more contractions isn't necessarily going to help. In some cases, it may actually aggravate symptoms. Equally, if these muscles are weakened, avoiding pelvic floor strengthening isn’t going to help either.
We need to figure out what your muscles, joints, ligaments, and nervous system are doing before deciding what they need more of or less of.
Why Am I Suddenly Leaking?
You can have had three kids and never leaked a day in your life, but then somewhere in your 40s or 50s, you sneeze and starting to panic a little.
Urinary leakage can become more noticeable during perimenopause and menopause, but that doesn't mean there’s nothing to be done. As the estrogen drops, the tissue can have decreased strength and support, which means things may shift or the urethral sphincter isn’t as able to stop the flow of urine as it might have with a pre-menopause amount of hormones.
There are also different types of urinary incontinence, and multiple factors can be involved. We may need to look at pelvic floor coordination, strength, breathing, pressure management, bladder habits, mobility, and what you're actually doing when leakage happens, because leaking during a sneeze and suddenly having to sprint to the bathroom aren't necessarily the same problem. They shouldn't automatically get the same treatment either.
"Why Do I Have to Pee All the Time?"
This is another big one.
A lot of women go from not really thinking about their bladder to suddenly knowing the location of every bathroom in Greenville.
Urinary urgency and frequency can occur around menopause, and tissue changes associated with declining estrogen may play a role. But your bladder habits and pelvic floor can also contribute.
Constantly going to the bathroom "just in case," for example, can sometimes train your bladder to expect more frequent trips. The bladder is highly capable of expanding to accommodate urine, but if it never gets that chance, it can get sensitive to that stretch.
Increased pelvic floor tension can also affect urinary symptoms, and things like fluid intake, constipation, certain bladder irritants, and nervous system activity may be worth looking at. If you’ve had a hysterectomy, that can impact things as well. The point is that "I pee all the time" doesn't automatically tell us why. We need more information.
Let's Talk About Painful Sex
Please don't sit there and suffer through this one because you think you're supposed to.
Hormonal changes during menopause can contribute to vaginal dryness and tissue changes that make sexual activity uncomfortable or painful. This is where I especially love a multidisciplinary approach because there are musculoskeletal things that help, but there are also medical interventions that can help as well.
If your body starts anticipating pain, your pelvic floor may tighten or guard. Over time, that can create a lovely little cycle where you expect pain, your muscles tense, penetration hurts, and then your body becomes even more protective the next time. Not exactly the cycle we're looking for. This does not mean you did anything to cause this or that you can just talk yourself out of pain. What it does mean is that we need to introduce neutral experiences to the pelvic floor, desensitize the tissues of the pelvic floor, build your confidence back in this area, ensure the muscles are adequately mobile and strong. Pelvic floor physical therapy can address all of those things as well as pelvic floor muscle tension, difficulty relaxing the pelvic floor, scar tissue, hip and pelvic mobility, breathing and muscle coordination, or pain associated with certain positions or movements.
We also need to improve the overall tissue quality, but this one is going to be more your OBGYN or Urogynecologists’ area as this may involve a topical estrogen cream or other medication that is outside the PT’s scope of practice.
And no, you don't need to be embarrassed to talk to us about sex. There is no such thing as TMI in our line of work.
What About Pelvic Pressure or Heaviness?
The feeling of pressure, heaviness, something falling, or a bulge can be symptoms sometimes associated with pelvic organ prolapse. If that's happening, please don't immediately panic and decide you're never allowed to lift anything heavier than your purse again.
Pelvic organ prolapse can vary considerably in severity and symptoms. Pelvic floor physical therapy may help with muscle function, pressure management, movement strategies, constipation management, and safely returning to exercise. And yes, many women with prolapse can still lift weights and exercise, we may just need to figure out the right approach for you.
So...Do I Need to Stop Lifting Weights?
Probably not. If you've read our other blogs, you already know Fortis is not in the business of telling women their bodies are too fragile to move.
Strength training is incredibly valuable as we age for far more reasons than just our pelvic floors. If you're experiencing leaking, pressure, heaviness, or pelvic discomfort when you're lifting, the first question shouldn't automatically be "what exercise do I need to stop doing?"
A better question might be "why is this happening when I do it?"
Many times this has more to do with how you’re doing something than the specific something itself. Your breathing strategy may need to change, the load may need adjusting temporarily, your pelvic floor may not coordinating well with the rest of your core, you may be gripping without realizing it, or something else entirely may be going on. That’s where an assessment (which is also called an evaluation) gives us the broader picture so we can get to the root of what’s causing your symptoms.
What Does Pelvic Floor Physical Therapy Actually Do During Menopause?
Pelvic floor physical therapy does not treat the hormonal changes of menopause. That's important to know.
There may be times when your gynecologist, primary care provider, or another medical professional needs to be involved, particularly when symptoms may benefit from medical evaluation or treatment. Our job is to look at the musculoskeletal and functional side of what you're experiencing.
At Fortis, that may mean evaluating your pelvic floor strength, tension, and coordination, bladder and bowel habits, breathing and pressure management, hip and core strength, mobility, pain with movement or intimacy, exercise technique, and your ability to do the activities that actually matter to you.
We want to actually understand why the symptom is happening and what your body needs to function better, that way you leave with a plan personalized to you, your goals, and your life.
Please Don't Assume It's "Just Menopause"
Menopause can absolutely change your body, but that doesn't mean every symptom should be dismissed because you're getting older.
If you're noticing you’re now leaking, constantly running to the bathroom, experiencing pelvic pressure, avoiding sex because it hurts, or changing the way you exercise because you're worried about your pelvic floor, it’s time to have an actual conversation. Sometimes hormones are part of the answer, sometimes your pelvic floor is, and sometimes it's both. That's why having the right providers involved matters.
Looking for Pelvic Floor Physical Therapy in Greenville, SC?
If you're going through perimenopause or menopause and something just feels different, you don't have to figure out which random pelvic floor exercise the internet thinks you need this week.
At Fortis Physical Therapy and Pelvic Health, we provide individualized pelvic floor physical therapy in Greenville, South Carolina. We'll look at your symptoms, pelvic floor function, movement, strength, lifestyle, and what you're actually trying to get back to doing. Your pelvic floor should be able to handle your actual life, not just keep you from peeing your pants.
Frequently Asked Questions
Can menopause affect your pelvic floor?
Yes. Hormonal and tissue changes during perimenopause and menopause can affect vaginal, urinary, and sexual health. Pelvic floor muscle function, strength, tension, coordination, previous pregnancies, exercise habits, and other factors may also contribute to symptoms.
Can menopause cause urinary leakage?
Urinary leakage can become more common during and after the menopause transition. However, leakage shouldn't automatically be dismissed as a normal part of aging. A pelvic floor physical therapist can evaluate factors such as muscle function, coordination, breathing, pressure management, and movement.
Why do I have to pee more often during menopause?
Urinary urgency and frequency can occur during menopause. Hormonal and tissue changes may contribute, but bladder habits, pelvic floor tension, fluid intake, constipation, and other factors can also play a role.
Can menopause cause painful sex?
Hormonal changes can contribute to vaginal dryness and tissue changes that make sexual activity uncomfortable or painful. Pelvic floor muscle tension, scar tissue, mobility, and previous pain may also contribute. Depending on the cause, care may involve both a medical provider and pelvic health physical therapist.
Should I do Kegels during menopause?
Not necessarily. Some people benefit from pelvic floor strengthening, while others have muscles that are already overactive or aren't coordinating properly. A pelvic floor assessment can help determine whether strengthening, relaxation, coordination, or another approach makes the most sense.
Can I lift weights if I have pelvic floor symptoms during menopause?
In many cases, yes. Experiencing leaking, pressure, or other pelvic floor symptoms doesn't automatically mean you need to stop strength training. A pelvic health physical therapist can help identify what's contributing to the symptoms and modify your training when appropriate and build you back to being able to confidently participate in the exercise you love.
Where can I find pelvic floor physical therapy in Greenville, SC?
Fortis Physical Therapy & Pelvic Health provides individualized pelvic floor and orthopedic physical therapy in Greenville, South Carolina. Treatment is based on your symptoms, movement, lifestyle, and goals rather than a one-size-fits-all exercise program.
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