Whether it’s endless trips to the loo (as if a good night’s sleep wasn’t hard enough), accidental leakages or vaginal dryness, keeping your pelvic floor healthy can help.
By midlife, it’s been working hard for you for a long time, and it’s showing signs of ageing. (We know how it feels.) It may have been weakened by childbirth, high impact sport or constipation and just about held it together until now. With the menopause, a reduction in oestrogen levels starts to make all things pelvic floor much worse. So here’s what you can do about it.
Why are pelvic floor exercises so important?
As we are living longer, having babies later and exercising harder, please don’t neglect your pelvic floor – it needs you. For millennia, pelvic floor exercises have been performed throughout the world to help with spiritual wellbeing, pelvic floor health and sexual energy. They are an absolutely vital part of our physical wellbeing, are incredibly easy to do and can be utterly life changing.
What are the pelvic floor issues during the menopause years?
The most common things experienced are stress incontinence, overactive bladder or urge incontinence, vaginal prolapse, atrophic vaginitis and constipation.
Let’s start with stress incontinence. What exactly is it?
Stress incontinence happens when you cough, laugh or sneeze. Have you stopped doing a sport that you love “just in case”? There is a tendency to accept that a bit of stress incontinence is ‘ok’ or ‘normal’ after having kids or at the menopause. It absolutely is not. Pelvic floor rehabilitation is the answer here.
What about overactive bladder or urge incontinence, can you explain that?
Do you either frequently or constantly need to pass urine, even if you went only half an hour ago? Do you find yourself crossing your legs on the doorstep, frantically searching in the bottom of your bag for the door keys? Do you have a sudden urgent desire to pass urine often completely out of the blue? One minute you are totally fine and the next you are absolutely desperate to pee. This can then turn into urge incontinence.
A combination of bladder training, pelvic floor exercises and maybe the use of vaginal oestrogen can be the answer here.
What about pelvic organ prolapse/vaginal prolapse?
It is thought that about 50% of women over the age of 50 have some degree or symptoms of prolapse. It happens when the muscles and ligaments of your pelvic floor are weakened. It may feel like you are sitting on an egg or a ball, or you may have a heavy uncomfortable feeling in your vagina, as if everything is going to fall out.
Let’s be clear, it is not normal or right to just accept a prolapse as a normal part of ageing. Whether your prolapse is big or small, don’t just ignore it and hope that it goes away. With good pelvic floor rehabilitation and possibly the use of vaginal pessaries, you can manage a prolapse very well.
Do you have a sudden urgent desire to pass urine often completely out of the blue? One minute you are totally fine and the next you are absolutely desperate to pee.
How does the menopausal pelvic floor impact your sex life?
Vaginal dryness or atrophic vaginitis (when the walls of your vagina start to thin and lose elasticity), is hugely underreported. I ask all my patients about it, and I remain shocked and saddened by the amount of women who are having painful and miserable sex, but grin and bear it. Many others have just stopped having sex altogether. Pelvic floor rehabilitation, the use of vaginal oestrogen and possibly vaginal dilators are of huge help here.
What about the bowels?
Your bowels may not be glamorous, but we all need to go. Decreasing hormone levels can lead to a new joy in life – constipation. So keep active, drink enough fluids and eat a healthy diet. Endless straining on the toilet can ultimately lead to a prolapse.
Now we know why we should care about the pelvic floor, how do we go about finding it so that we can exercise it?
Try this: Sit on the arm of a chair, a fitness ball or any hard surface, with your feet flat on the floor. Lean slightly forward, with your vulval area in contact with the hard surface. With your hands on your thighs, try to lift the area around your vagina and anus away from whatever it is you are sitting on.
The most important thing of all is, have you isolated the right muscles? If you really are not sure, please seek help from a continence specialist or a women’s health physiotherapist.
Can you give us some pelvic floor exercises?
Draw up the muscles around your anus and vagina at the same time, then squeeze, lift and hold for the count of five. Then let go gently and count to five again – this is the rest phase of the programme. It is very important not to overtire your muscles, particularly when you are just starting and your muscles are weak.
Repeat the above exercise five times. If you can, do this three times a day. If that’s impossible, do what works for you – something is better than nothing. Over time you can increase your holds up to 10 seconds.
Additionally, once a day, you should do 10 short sharp contractions. These are done in a rhythmic pattern of squeeze let go squeeze let go.
Are there gadgets that can help with pelvic floor rehabilitation?
There are lots of gadgets on the market. If you’ve bought one and it’s helping you, then great. I’m always a fan of any gadget that makes our busy lives easier. If it motivates you, fantastic, because motivation is definitely the key to pelvic floor rehabilitation.I use a variety of gadgets tailored to individual women’s needs, including the Squeezy app, vaginal weights, the Kegel 8 and the Elvie trainer.