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Writer's pictureLauren Shuster

The Silent Struggle: Uncovering Pelvic Floor Issues in Perimenopausal and Menopausal Women

As women journey through perimenopause and menopause, a range of changes can greatly affect their health. One of these changes is the emergence of pelvic floor issues, which can be a significant and often overlooked challenge. Many women may feel isolated regarding these issues, leading to misperceptions about their normality. Increasing awareness is essential for finding the right treatment options and improving overall well-being.


Pelvic floor issues are often the result of hormonal changes during this transitional period but can also be compounded by years of poor training techniques. This article examines common conditions seen in perimenopausal and menopausal women, investigates their causes, addresses the challenges, and highlights effective solutions.


What is the Pelvic Floor?


The pelvic floor consists of muscles, ligaments, and tissues spanning the bottom of the pelvis, offering support to the bladder, bowel, and uterus. The urethra, vaginal canal and anus pass all pass through the pelvic floor muscles. Therefore, bladder control, bowel movements and sexual function rely strongly on the integrity of this structure.


During perimenopause and menopause, hormonal shifts, especially the decline in estrogen, can weaken these pelvic floor muscles and contribute to incontinence. Research shows that nearly 30-50% of women experience some form of pelvic floor dysfunction at this stage, which may include incontinence, pelvic organ prolapse, and issues related to sexual health.


Common Pelvic Floor Issues


Urinary Incontinence


A prevalent concern during this phase is urinary incontinence, which is characterized by the involuntary leakage of urine. This leakage can happen during sneezing, laughing, or exercising. Stress urinary incontinence is due to weakened pelvic floor muscles that fail to support the bladder adequately.


In addition to stress incontinence, women may also experience urge incontinence. This occurs when hormonal fluctuations weaken bladder control, triggering a sudden urge to urinate. According to a 2015 survey, 40% of women reported episodes of both stress and urge incontinence during menopause.


Pelvic Organ Prolapse


Pelvic organ prolapse is another significant issue for women experiencing menopause. It occurs when weakened pelvic floor muscles allow organs such as the uterus, bladder, or rectum to descend into the vaginal canal. The beginning of prolapse is often missed after women give birth and can take 20 years to worsen. This is why it is so important for new moms to make sure they get a proper assessment of their pelvic floor after giving birth so that any issues can be caught early.


Women with pelvic organ prolapse may report symptoms like a heaviness in the pelvic area, discomfort while emptying the bladder or bowel, or visible bulging tissue. Research indicates that approximately 50% of women who have given birth will experience some degree of prolapse, which can lead to both physical and emotional distress.


Changes in Sexual Function


Hormonal changes can also affect sexual health, leading to issues like vaginal dryness and pain during intercourse. Many women notice a decline in interest in sexual activity as well. A study showed that around 30% of postmenopausal women experience significant sexual dysfunction, impacting their quality of life and relationships.


An effective pelvic floor is essential for a satisfying sex life. When issues arise, women might experience discomfort or reduced satisfaction, creating additional stress in intimate relationships.


Causes of Pelvic Floor Issues


Pelvic floor issues can mainly be traced back to hormonal changes and the natural aging process. Here are the primary contributors:


  • Declining Estrogen Levels: Estrogen has a vital role in keeping pelvic tissues strong and elastic. As estrogen levels drop during menopause, the risk of developing pelvic floor problems increases.


  • Aging: Aging naturally reduces muscle tone, which can worsen pelvic floor dysfunction. Research shows that muscle strength declines by approximately 15% per decade after the age of 30.


  • Childbirth & Genetics: Experiences such as childbirth can extend pelvic floor muscles, making them more vulnerable to later issues like incontinence or prolapse. Genetic factors can also influence muscle strength and predisposition to these problems.


The Challenges Women Face


Despite the prevalence of pelvic floor issues, societal stigma and shame often prevent women from seeking help. Many may feel reluctant to discuss their symptoms, leaving them to suffer in silence.


Furthermore, healthcare providers may not prioritize pelvic floor health during routine visits. This lack of focus can result in women's conditions going unnoticed and untreated. Understanding that these struggles are both common and manageable is essential for women.


Solutions and Management Strategies


Fortunately, various treatment options can help tackle pelvic floor problems experienced by women during perimenopause and menopause:


Pelvic Floor Physical Therapy


Seeking help from a specialized pelvic floor physical therapist can be advantageous. They offer personalized exercises and education tailored to women’s unique conditions. These professionals can guide women in body mechanics and effective muscle-strengthening workouts.


Pelvic Floor Exercises


Most women have heard about Kegel exercises which involve the tightening and releasing of the pelvic floor muscles. Regular practice can strengthen these muscles, leading to better bladder control. While Kegel exercises can be very effective for some women, it is important to first understand the pelvic floor issue before jumping on the Kegel train. Since the pelvic floor is a set of muscles, women can develop imbalances within the pelvic floor muscles and using Kegels may be too generalized an approach. For example, athletic women can have pelvic floor muscles that are too tight and may need to work more on releasing the muscles than strengthening them. This is where it is important to work both with a pelvic floor physio as well as an experienced trainer who can give you exercises specific to your own body.


Breathing Exercises


Correct breathing technique is intricately tied to pelvic floor health. The muscles of the pelvic floor and diaphragm must work together when we inhale and exhale. Ideally when you breathe in, the pelvic floor needs to relax so that the diaphragm can draw downwards to allow for the expansion of the lungs. If the diaphragm can't release downward because the muscles are too tight, a downward pressure on the pelvic floor occurs which can over time lead to damage of the pelvic floor and incontinence. So, by training the deep core muscles with proper breathing techniques, the pelvic floor can become more healthier and more functional.


Hormonal Treatment


For some women, hormone replacement therapy (HRT) may be an option. By restoring estrogen levels, women can alleviate symptoms associated with pelvic floor dysfunction. This treatment should only be initiated after thorough discussions with a healthcare provider about potential risks and benefits.


Lifestyle Modifications


Making healthy lifestyle changes can significantly improve pelvic health. Caffeine can be irritating to the bladder and cause more urgency so reducing your intake can have positive effects. Also, strategies such as maintaining a balanced weight, quitting smoking, and practicing bladder training techniques can lead to enhancement in pelvic floor function.


Open Communication


Promoting open conversations about pelvic health can help diminish the stigma surrounding these problems. Women should feel encouraged to discuss their symptoms openly with healthcare providers, a crucial step toward receiving appropriate treatment.


Final Thoughts


Pelvic floor issues represent a silent struggle for many women navigating the changes of perimenopause and menopause. By increasing awareness and understanding how hormonal shifts impact pelvic health, women can better confront these challenges.


The path to reclaiming pelvic health lies in education, communication, and seeking suitable treatment. It is time to break the silence and empower women to take charge of their pelvic health, enhancing their quality of life and overall well-being.


Recognizing and understanding pelvic floor issues is the first step to effectively addressing them, ensuring women can thrive throughout this transformative life phase.


Looking for private training to improve pelvic floor issues and build core stregnth? Contact me here for more information or to set up a session.



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