Menopause brings about a lot of changes to a women’s body both emotional and physically and it can be a challenging time of change in a women’s life. It is a natural occurrence that ends the fertility phase with the most obvious sign being the end of menstruation. Menopause usually occurs between the ages of 45 and 55 and can vary significantly from one woman to the next. The pelvic floor undergoes many different changes which can impact women during this time period immensely. Let’s dive in
So, what is the pelvic floor? The pelvic floor is a sling of muscles, ligaments and connective tissues that support the bladder, bowel, and uterus. Some of the many changes that occur to the pelvic floor during menopause include prolapse, incontinence, overactive bladders, vaginal dryness, and sexual dysfunction.
During menopause, there is a huge hormonal shift that occurs in the woman’s body. There is a decrease in the hormone estrogen which is the hormone that causes the most symptoms. Estrogen’s role is to contribute to the elasticity of the tissues, strength of the pelvic floor, lubrication of the vaginal tissues and support the walls of the bladder. As we see this hormone decrease in our body’s during menopause the following usually occurs which impacts pelvic health. The following is commonly experienced:
- Muscle weakening – the dropping estrogen levels affect the elasticity and strength of the pelvic floor muscles which are responsible for supporting the bladder, rectum, and uterus. When these muscles atrophy and become weak you can see increased incidences of prolapse and incontinence
- Vaginal dryness – as mentioned estrogen assists with lubrication and therefore a decline in estrogen leads to increased vaginal dryness. This can lead to discomfort during intercourse
- Bladder and bowel function – with atrophied muscles there can be displacement of the bladder and bowels in a downward fashion, this can cause more pressure on these organs and symptoms of overactive bladders, urinary incontinence, and bowel incontinence.
- Increased risk of pelvic organ prolapse – with the atrophied pelvic floor muscles, there is more likelihood of prolapse occurring, which is a descent of the pelvic organs, which can be visualized and protruded from the vagina. Symptoms include a feeling of a bulge, pelvic pressure, and urinary symptoms as described above
Common Pelvic Health Issues During Menopause
As estrogen levels decrease, many women begin to experience pelvic health issues. While some of these conditions are more common as women age, the hormonal changes associated with menopause can exacerbate these problems. Below are some of the most common pelvic health concerns that women may face during this time:
1. Urinary Incontinence
Urinary incontinence is one of the most prevalent pelvic health issues during menopause. It can manifest as stress incontinence which is leakage during coughing, sneezing, laughing, or exercising; urge incontinence which is a sudden intense urge to urinate; and mixed incontinence which is both stress and urge together.
Weakened pelvic floor muscles and changes to the urethra and bladder during menopause contribute to these issues. Additionally, reduced estrogen levels can affect the bladder’s ability to store urine, leading to frequent urination or nighttime bathroom visits.
2. Pelvic Organ Prolapse (POP)
Pelvic organ prolapse occurs when the pelvic floor muscles weaken to the point that the organs they support, such as the bladder, uterus, or rectum, descend into the vaginal canal. Symptoms of POP include:
- A feeling of heaviness or fullness in the pelvic area.
- A visible bulge or lump in the vaginal area.
- Difficulty urinating or having bowel movements.
- Pain during intercourse.
POP is more common in women who have had multiple pregnancies, those who are overweight, or those who have experienced a traumatic vaginal delivery. Estrogen loss during menopause can worsen POP by further weakening the pelvic floor muscles and connective tissue.
3. Vaginal Dryness and Painful Intercourse
Vaginal dryness is a very common symptom of menopause. As estrogen levels decline, the vaginal tissues become thinner, drier, and less elastic, making sexual intercourse uncomfortable or even painful. Vaginal dryness can also lead to irritation, itching, and an increased risk of urinary tract infections (UTIs).
4. Sexual Dysfunction
In addition to vaginal dryness, menopause can lead to other sexual health issues such as reduced libido with dropping estrogen levels; painful sex due to thinning tissues and less lubrication, and difficulty achieving orgasm due to changes in blood flow
5. Pelvic Pain and Discomfort
Some women experience chronic pelvic pain during menopause. This can result from a combination of factors, including changes to the pelvic floor muscles, vaginal atrophy, or even conditions like interstitial cystitis (a chronic bladder condition)
Managing Pelvic Health During Menopause
While many of the pelvic health changes associated with menopause are a natural part of aging, there are several steps women can take to manage and alleviate these symptoms. It is an important time to seek out pelvic physiotherapy that can assist you during this transitional time. Pelvic floor strengthening is at the forefront of the training to help combat the atrophying and weakening muscles due to reduced estrogen; pelvic floor physiotherapists can recommend vaginal moisturizers and lubricants; introduction of a healthy diet and weekly exercise program can not only benefit your pelvic floor but also contribute to improved bone mass. Treatment with a doctor or healthcare provider can also be beneficial if hormone replacement therapy is indicated.
Menopause is a challenging time in a women’s life, however with the support of various healthcare providers including pelvic floor physiotherapists the transition period with challenging symptoms can be eased. We have two physiotherapists on our team ready to help!
Importance of Pelvic Floor Postpartum
The excitement pregnancy and childbirth brings is a remarkable journey to experience. There are so many positive and beautiful moments, however with that comes the not-so-beautiful and the challenging aspects of the journey, both physically and emotionally.
The pelvic floor is a group of muscles, ligaments and connective tissues that create a sling at the base of the trunk that supports the bladder, rectum, and uterus. These muscles play a crucial role during pregnancy to allow for childbirth, however there can be damage and dysfunction that develops after birth and that is why it is crucial to have your pelvic floor assessed.
What Happens to the Pelvic Floor During Pregnancy and Childbirth?
During pregnancy, the pelvic floor muscles are subjected to increased pressure from the growing uterus, which can lead to stretching and weakening. This is why c-section moms can also experience issues to their pelvic floor postpartum!
That said, the most significant impact on the pelvic floor comes during labor and delivery. The process of vaginal birth involves the pelvic floor muscles being stretched to their limits in order to accommodate the baby’s passage through the birth canal. The pelvic floor and perineum need to stretch during crowning which can cause weakening, tears can occur during delivery, and there can be nerve damage and reduced sensation afterwards. Even if you do not experience birth trauma or tears, there is still stretching and accommodating that occurs during childbirth that will be different post-partum than it was before pregnancy. There is a role for rehabilitation in this context too.