Does menopause mean it’s too late to fix your pelvic floor health? No! While pelvic floor dysfunction can be more common around the time of menopause, Kim Vopni, author of Your Pelvic Floor, explains how you can still strengthen your pelvic floor and relieve some of your symptoms.
What is the pelvic floor?
The pelvic floor isn’t just one muscle but a hammock of muscles spanning your pelvis, from the tailbone to the pubic bone from front to back, and side to side at the sit bones. The pelvic floor is the foundation of your “core”: supporting our internal organs, holding our sexual energies and providing stability for our body in movement and rest.
Watch and learn more: Kim Vopni joined The Latte Lounge to explain all about the pelvic floor and why it’s not too late to fix your pelvic floor:
Why is the pelvic floor important?
When working as it should, we rarely have to think about the pelvic floor at all. But when things go wrong, we realise it plays a central role in so many aspects of our lives.
The pelvic floor provides structural support for our pelvis and back, keeps us continent and is vital in our sexual pleasure. Not only that, it provides a sense of emotional balance: when it’s not working properly, this has a huge impact on our sense of self-efficacy, and can cause embarrassment and shame.
What are the symptoms of pelvic floor dysfunction?
One of the most common symptoms of pelvic floor issues is incontinence: leaking wee when you laugh, cough, sneeze, when you run or jump.
Society has normalised female incontinence, we laugh it off and are told to stick on a pad. Leaking urine may be common but it is not normal, and it can be treated.
Other signs of a pelvic floor that needs attention are pelvic or lower back pain, painful sex, constipation or wind.
Feelings of heaviness in the vagina (or like something is “stuck” in there) is one of the symptoms of pelvic organ prolapse: when the bladder, uterus and/or bowel have shifted out of their optimal position and begin to descend into the vagina.
Any and all of these symptoms are worthy of investigation, and are treatable with pelvic health physiotherapy. Women on average wait 7 years before visiting a pelvic health specialist. Don’t delay if you’re worried. If it doesn’t feel “normal”, chances are it isn’t.
Why does the pelvic floor weaken and what causes this?
There is a common misconception that weakness means laxity, but an overactive, tight pelvic floor is just as problematic for body balance.
There are many factors that may cause pelvic floor issues in a lifetime. Women tend to meet pelvic floor issues at key stages in life such as pregnancy and motherhood: when there are hormonal changes, the challenges of growing a baby and physical injury to the pelvic floor through childbirth. Then again in the perimenopausal / menopausal stage of life, hormonal fluctuation becomes a factor.
Weight lifting, high impact exercise and also prolonged sitting (the HiIT and SIT effect) can contribute to weakness in the pelvic floor over time.
In truth it may be a gradual build up of the various pieces of our unique physical puzzles over time, such as our habitual posture, or weight fluctuation, rather than one single “event”.
What impact does menopause have on the pelvic floor? Is it too late to fix things?
When oestrogen declines this can have a negative effect on pelvic floor resilience; which is also why pelvic floor dysfunction symptoms can increase just before your period if you are still menstruating.
Pelvic organ prolapse and incontinence issues are more common around menopause – but ladies, it’s not something we should put up with! Pelvic floor exercise is proven to have positive effects on symptoms pf pelvic floor dysfunction, whatever age you are – it is never too late.
How do you do pelvic floor exercises (“Kegels”) correctly?
To find your pelvic floor muscles, firstly – relax. Sit up tall. Find your ‘sit’ bones, the bony part of your bottom, and make sure you’re sitting upright on them. Then imagine your ribcage is balanced directly above your pelvis.
Take a deep, slow breath in and allow your tummy to soften. As you breathe out, imagine lifting your back passage as if you’re trying to stop breaking wind. Travel that engagement forward and up, lifting into the vagina. Avoid tensing anything else: it’s an internal lift. Relax your thighs, buttocks, shoulders, eyebrows!
Breathe out, and fully let that engagement relax. The relax part is every bit as important as the squeeze. Repeat this 10 times, trying to maintain that hold for up to 10 seconds each time. Then, practise with 10 short pulses, lift, let go, lift, let go, lift, let go.
Good visual cues are: “imagine picking up a blueberry with your vagina and anus”, “imagine sipping a milkshake through a straw with your vagina”, “imagine your pelvic floor like a jellyfish that softly opens on the inhale and draws in and up on the exhale”.
Find an image that helps you find the rhythm of “contract, lift and release”. You can use your own fingers to check your engagement: placing your (clean!) fingers into your vagina, squeeze: if you’re finding a good level of squeeze it should feel like a baby sucking. Nothing is the perfect replacement for a pelvic health physio assessment, but you can buy pelvic tech such as the Elvie, which demonstrates whether you’re engaging correctly/fully enough.
Are there other ways to strengthen the pelvic floor?
Ideally pelvic floor exercise should be incorporated into your everyday movement, rather than being something “else to do”. For example, you can tag a pelvic floor lift into any activity which requires exerting effort, such as picking up your baby or lifting heavy weights: coordinate the lift with breathing out and a pelvic floor engagement.
It’s useful to practise pelvic floor exercises when seated or lying down, but once you have the knack, combine it into your movements like bridges, squats and lunges. This ensures the pelvic floor is trained to respond dynamically to your natural movement.
There are exercise methods which particularly target pelvic floor connection to movement and breath, such as Pilates and the Hypopressive, or “low pressure fitness” Method. This technique involves a series of poses that are considered to be low pressure, meaning they don’t place additional stress on the pelvic floor.
How long does it take to strengthen pelvic floor muscles?
Our bodies respond well to committed practice. The gold standard to heal issues such as incontinence is: 10 long holds, 10 short squeezes, 3 times a day. Remember to always relax the muscles in between contractions. Practising your pelvic floors isn’t a quick fix but an ongoing commitment – you wouldn’t just brush your teeth once and consider your teeth clean forever, you brush every day all your life: it’s the same principle with our pelvic floor health.
About the author: Kim Vopni is a restorative Exercise Specialist, a certified Personal Trainer, Pre/Post Natal fitness consultant, fitness for fertility specialist and hypopressive method trainer. She believes passionately in pelvic floor health and spreading the awareness that incontinence and bladder issues are NOT just part of being a woman.
Kim is also the author of Your Pelvic Floor – a practical guide to solving your most intimate problems which is out on 9 March 2021.
Follow Kim on Instagram and Twitter @VaginaCoach or read more on her Vagina Coach website
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