Pelvic Floor Health
Your pelvic floor is not only affected by child birth. There are also a variety of symptoms that are brought on by changes in hormones. We dive into what can happen, the causes, and what you can do to improve by making simple adjustments to your daily habits.
The role of estrogen and the pelvic floor
Estrogen can affect multiple systems in our body, including our musculoskeletal and cardiovascular system. The bladder, urethra, anus, vulva, vagina and pelvic floor muscles are home to many estrogen receptors and as such are termed ‘estrogen-responsive’. Estrogen subsequently has a significant role in maintaining the thickness of these tissues, providing support and contributing to good blood flow and lubrication.
During peri and post menopause as estrogen levels decline prolonged deprivation of estrogen can impact these tissues and may lead to a variety of pelvic floor related changes and symptoms.
What can happen to the pelvic floor during menopause?
Given the role of estrogen on the muscular function of the pelvic floor and surrounding tissues, during menopause women and menopausal individuals may notice new onset or worsening symptoms of:
Bladder or bowel incontinence (leaking)
Urinary urgency or frequency
Pain with vaginal penetration or other sexual dysfunction
Vaginal dryness
Difficulty initiating the flow of urine or having a bowel movement (constipation)
Pelvic heaviness (Pelvic organ prolapse)
Reduced sexual sensation
Pelvic pain or low back pain
Whilst low estrogen can contribute or cause these symptoms, it’s not always to blame. Previous injuries, pregnancy, birth and other health factors can also impact muscular function and cardiovascular tissue health which may also result in some of these changes.
Bladder and bowel symptoms:
Stress incontinence
Stress incontinence refers to urinary leaking with increased intra-abdominal pressure. This is commonly caused by a cough, sneeze, jump or run. It is fairly common in women with an underlying weakness in the pelvic floor, potentially caused by an obstetric injury during childbirth or chronic history of constipation or coughing.
However, as we know that our pelvic floor muscle strength will weaken during menopause, and the tissue at the urethra and base of the bladder thickness is impacted, peri and post-menopause can also be a contributing factor to stress urinary incontinence or a time when symptoms noticeable worsen.
Urinary Urgency
Urinary urgency may be also described as Overactive bladder and the terms used interchangeably. OAB infact describes urinary frequency and urgency with or without urinary leaking. Triggers for urgency can be activities such as turning on a tap or putting your key in the door and may cause an uncontrollable urge to urinate. During peri and post menopause a combination of increased bladder sensitivity due to low estrogen and weaker pelvic floor muscles can result in worsening of this condition.
Pelvic organ prolapse
Pelvic organ prolapse is when the organs ( bladder, uterus, bowel ) within a woman's pelvis descend from their natural position into the vagina. Common symptoms may include feeling heaviness and/ or a dragging sensation in the pelvic area, difficulties with continence or challenges emptying bladder or bowel and physical budging into the front or back wall of the vagina. Menopause has been associated with the development of pelvic organ prolapse as the declining estrogen levels contribute to pelvic floor muscle weakness as well changes in the connective tissue supporting the pelvic organs from above.
Constipation
Constipation is when you experience less than 3 bowel movements per week, with stools that are hard, dry or difficult to pass. Declining levels of progesterone during peri and post menopause can cause stools to stay in the colon for longer. The longer the stool stays in the colon, the more they tend to dry out, which leads to dry, pebble-like stools that are difficult to pass.
Additionally, as the estrogen levels decline cortisol levels may rise slowing down the digestive system and as such leading to constipation.
Vaginal dryness
Estrogen is a vital hormone that helps maintain the vagina's lubrication, elasticity and thickness. Your body produces less and less estrogen as you step into menopause, which may lead to the thinning, drying and inflammation of vaginal lining, as well as causing the lack of elasticity in the vagina. This is a common presentation but research supports pelvic floor muscle exercise, vaginal lubrication and topical estrogen in improving symptoms.
Urine Infection
Urinary infections commonly increase in incidence in this phase of life. Changes in hormone can alter the bladder and vaginal microbiome as well as changes in tissue thickness and reduced lubrication. Topical estrogen can be helpful in this instance.
Pelvic floor management during the menopause transition and beyond
A combination of treatments can be beneficial for managing pelvic floor conditions in this phase.
Some changes to lifestyle and daily habits include:
Improving bladder and bowel habits
Avoiding the ‘just in case’ wee
Optimal food and fluid intake
Stress management
Optimising bowel opening posture
These are just the beginning. For many these are enough to see great improvements. For others a more tailored and individual approach is needed.
If more a more tailored approach is needed, pelvic floor physiotherapy is recommended. This can help any pelvic floor related conditions and includes a range of treatment options including pelvic floor muscle retraining, advice around lubrication and vulval hygiene, use of dilators, pessary fitting (to support pelvic organ prolapse) as well as advice around devices to improve sexual comfort such as ‘OHNUT’.
Medically, topical estrogen therapies (also known as Hormone Replacement Therapy, or HRT) have also been shown to improve the urinary and vulvo vaginal symptoms of menopause and can be an excellent addition to pelvic floor physiotherapy.