Menopause and the Pelvic Floor

The menopause and perimenopause can bring with it problems associated with pelvic floor dysfunction. The menopausal years can span any time from 45-55 years. The perimenopause can occur for many years before this while women are still having their monthly cycles. Some women who go through an early menopause could  experience symptoms at a much younger age.

What is your pelvic floor?

Your pelvic floor muscles are a broad sling of muscles, like a trampoline, stretching from your pubic bone at the front of your pelvis to your coccyx (tail bone) at the back. They form the floor of your pelvis and are responsible for:

  • Supporting your pelvic organs - your bladder, bowel and womb
  • Controlling your bladder, bowel and sexual functions

Experiencing urinary incontinence (leakage) should not be accepted as normal at any point in a woman’s life. Below are the different types of incontinence.

Stress Incontinence

This is the most common type of incontinence and is when urine leaks during activities such as coughing, sneezing, lifting, and during exercise. It can be caused by weakening of your pelvic floor muscles. When these muscles become weak they may be unable to cope with the rise in abdominal pressure that occurs during activity.  Weakness of these muscles can happen because of childbirth, chronic constipation, persistent coughing and around the menopause.

Urgency and Urge Incontinence

Women who experience these problems may be tempted to empty their bladder at more frequent intervals. However this may make your bladder misbehave. In time your bladder will only hold a small volume of urine, and it has to be emptied often. This is called frequency.

Urgency arises when your bladder needs to be emptied in a great hurry. Sometimes the urge to pass water is so strong that leakage happens before you get to the toilet. This is called urge incontinence. All these problems are related to the size of your bladder, how much it holds, and how it is trained to respond.

During the menopause oestrogen levels become depleted and this can exacerbate bladder symptoms. It is not unusual for women to report vaginal soreness, dryness and a general feeling of discomfort which can be attributed to low levels of oestrogen. This is often termed vaginal atrophy or atrophic vaginitis.


It is not unusual to experience feelings of pressure or a bulge vaginally or rectally during the menopausal or perimenopausal years. This is termed “prolapse”. This can be understandably quite distressing for women. By performing regular pelvic floor exercises, studies have demonstrated significant improvements in symptoms of prolapse. The physiotherapist can reassure whether the exercises are being performed correctly or not.

Physiotherapy for the pelvic floor

All of the above problems can be helped by seeing a pelvic health physiotherapist.

The physiotherapist would start by taking a detailed history of the main complaints and would then fully assess your pelvic floor muscles to test the strength, endurance and timing of your muscles. A programme can then be devised which may include pelvic floor strengthening exercises or indeed may involve relaxation of your muscles. Bladder training may be commenced and the physiotherapist can also offer guidance on any lifestyle changes that could help your symptoms.

Click here to book an appointment with Nicola.

Click here to listen to the podcast: Menopause and the pelvic floor.

Author: Nicola Mulkeen, Pelvic Health Physiotherapist

Last Updated: 18th December 2019

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