How does menopause affect your pelvic floor muscles?

Today's topic

Today on A.Vogel Talks Menopause, I answer the question "How does menopause affect your pelvic floor muscles?"

Like many areas of our health, the pelvic floor muscles can be affected during menopause. And it's very often due to low oestrogen affecting muscle strength. So, as well as you losing muscle strength from your legs or your arms, it can also affect some of the internal muscles too.

So, let's take a look at why this can happen, the symptoms associated with pelvic floor muscle dysfunction, and some of the things that you can do to help yourself.

Menopause and your pelvic floor muscles

So, in really simple terms, falling oestrogen can affect our muscle strength, so muscles just get that bit weaker.

The problem with the pelvic floor muscles, they're like a sling. So, they're connected to both sides of your hip and they help to support your uterus/womb, your bladder, and your bowel. So, everything is held up by this muscular sling and the weakening of these muscles can result in a loss of structural support to these organs. This can then cause these organs to shift, which can result in several symptoms and problems.

Symptoms and problems caused by weakened pelvic muscles

When pelvic muscles weaken, it can worsen or cause other vaginal and urinary menopause symptoms such as:

Urinary incontinence: If there's a slight shift in where these organs are sitting, this can affect bladder function. It can squash the bladder a bit, which means that you can't hold as much urine, so you end up running to the toilet a lot more.

It may affect the valve on the bladder. So, if your bladder valve gets weaker, you might find if you laugh, or if you run, or do exercises that you basically leak a little bit of urine.

It can also cause urinary urgency. So that means you could be going about your daily business quite happily and then just suddenly, you get this immense urge to go to the toilet and you might not be able to hold everything in so you can end up, again, getting a urine leakage.

Vaginal dryness and irritation: Again, the slight change in muscle position can affect the vagina. It can make the walls weaker and that can then cause dryness and irritation.

It could be frequent urinary or vaginal infections, such as cystitis. You might find that you're getting cystitis again, and again, and again. And you take antibiotics, and it clears up for a little while and then it comes back again.

You may find that you're getting thrush regularly and again, you're taking antibiotics. Everything clears up for a little bit and then everything starts again.

The problem here is that the vagina and the bladder are closely interlinked as far as bacterial infections go. So, if you get something like vaginal thrush, you get antibiotics that kill off the friendly bacteria in the vagina, but these friendly bacteria in the vagina are needed to help to protect against bladder infections as well. A lot of women find that this just becomes a real vicious cycle between one and the other.

Pelvic pain and discomfort during intercourse: If there's dryness, then obviously, penetration may be really uncomfortable. But it can also be quite a deep internal pain. And some women find that they may actually bleed after intercourse as well. And again, that can be due to the fact that everything has shifted. So, if the vagina is not sitting correctly, if it's slightly to one side or tilted backwards or forward, that's obviously going to cause a lot of discomfort. So just be aware of the connections with these ones.

Pelvic floor or pelvic organ prolapse: So here, either the bladder, the uterus, or the bowel can completely change position. Very often, this will put a lot of pressure on the vagina. It could even basically squash the vagina.

What can happen, again, if there's a bladder shift, you can experience all that balllder discomfort I mention above such as incontinence.

If it's a bowel shift, you may then find that you can't empty your bowel when you go to the toilet. You may get diarrhoea or constipation. So, the whole regular bowel habits can change completely.

And for some women too, there might be slight bleeding when you empty the bowel, and that's something that obviously needs medical attention.

What can you do to help support your pelvic health during and after menopause?

The problem with pelvic floor weakness is that the risks tend to increase with age. So, the older you get, the weaker these muscles become, and the more prone you may be to any of these particular symptoms. However, there are several things you can do to help improve your pelvic health and also to treat some of these urinary and vaginal symptoms. Here are a few things I recommend:

Pelvic floor exercises: A lot of women in some countries are given exercises to do after childbirth because the pelvic floor can weaken after having children, unfortunately. So, if you learn and implement these exercises early enough, then that can have a huge positive impact on pelvic health.

For this, I would suggest Pilates. Go and see a practitioner. I went to a really interesting lecture by a very, well-qualified Pilates instructor who was focusing on women's health and pelvic health. She explained that many women learn how to do Kegel exercises via videos or blogs, but if they do it wrong, it can make everything worse. So, this is one instance, if you're having issues here, I would recommend going to see a Pilates instructor and you may only need a few lessons.

You could even maybe get together with your other menopausal friends and have a few sessions so that you know what you're doing is the correct way to do it. This can sometimes make a real difference because the only other option is an operation.

So, even if you're in your early 40s and you're reading this, be prepared now. Get this sorted now and it will save you so many tears in the future if you can strengthen your pelvic floor muscles.

There are also certain yoga exercises that you can do regularly that can be very, very helpful. But again, I would go to classes for this, just to make sure that you're doing them right for the best results.

Avoid high-impact exercises: If you're jogging, then the whole pelvic area is going to be moving up and down and that can really aggravate the situation. So, you would be looking at maybe more gentle exercises like swimming, walking, and yoga.

Ease constipation: Make sure you're drinking plenty of water and also, you're eating plenty of fibre-rich foods to avoid constipation if your bowel is being affected in this situation.

Helpful supplements and herbs: There are several which can help ease some of the urinary and vaginal symptoms which can occur. So, if it's vaginal dryness and irritation, you could try a Sea Buckthorn Oil supplement. I also recommend a good vaginal probiotic.

If it's more to do with cystitis or UTIs, you could look at the herb Uva Ursi, which is known to be very helpful for balder infections such as cystitis.

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• Adult women over the age of 18 years to take 15 drops in a little water 2-5 times per day. Make sure you drink plenty of fluids while taking this product.

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Avoid irritants: So many women are washing these delicate areas with highly chemical soaps, shower gels, and body washes. So, make sure that you're using natural ingredients in this area and that can certainly help with irritation and any kind of inflammation.

When to consult your doctor?

If you are experiencing any pain during or after intercourse, or any bleeding after intercourse then it's very important to consult your doctor.

If you're getting very deep pelvic pain, if you feel that there's a lot of pressure especially when you sit down, if you get a dragging feeling, if you actually feel that your whole vulvar area is changing and maybe expanding, that can indicate that the organs above are starting to press down and put pressure on the vagina, so it's really important to get all these ones checked out.

If you're getting a lot of deep pain, if you're also getting very low back pain, that can be a sign that the pelvic area is being affected so it's really important to get this one checked out. Your doctor may offer local oestrogen cream or oestrogen pessaries. For some women, this is maybe the only option because of their discomfort.

I've had so many women contact me, some of them in tears because there has been so much discomfort. It's a horrible one but if you can get in with those pelvic floor exercises as young as possible, especially if you've had children, then it can prevent a lot of these symptoms from occurring as you get older.

I hope you found this one helpful and interesting. If any of you have had any of these conditions, did you find something that really helped you? If so, please share them because we would really love to help anybody who's in this particular situation.

Until next week, take care.