27 Feb 2023

How to strengthen your pelvic floor during the menopause

*Disclosure: Some of the links in this post are affiliate links (marked with an *). This means that, at zero cost to you, we will earn an affiliate commission if you click through the link and finalise a purchase.

Ageing and fluctuating hormones during menopause can have a significant impact on our pelvic health. Katie speaks to continence nurse specialist and author Jane Simpson about the common problems we might experience with our pelvic floors, including weak bladders, that feeling of always needing to go to the loo as well as tightness and tension in our pelvis.

Here, Jane shares a whole host of tips and guidance on how you can ease your symptoms.

Listen to the full conversation in The Latte Lounge podcast episode above.

For those who don't know, what is a pelvic floor, and what purpose does it serve in the human body?

Without your pelvic floor, your innards would literally drop out.

If you think of your body as a skeleton and you look through the middle of your pelvis, it's where a baby is born through.

And that area at the bottom is your pelvic floor.

And it's also keeping our insides in and enabling us to walk properly as well as helping us to pee. 

If you think about your pelvic floor muscles, they're attached from the front, that hard bone you can feel behind your pubic hair, to your tailbone.

So like a hammock of muscle, from the front to the back.

And then also from side to side. So if you think of the bones that we sit on, your muscles are like a little hammock going forward and backwards and side to side, and a part of our core. 

They help with forward motion; they help if you want to cough and contract to stop leaking.

They're very important muscles and are much neglected as they're sort of hidden away in our underwear, and we don't think about them until they give us trouble.

Is it an inevitable part of ageing?

Not really. But if you look at the statistics, at least 50% will experience it.

Whether it's constipation, prolapse or stress incontinence, the two biggest causes are childbirth and menopause.

And, as all women have at least one of those happen to them, or both, then it's inevitable that we start to have some problems, whether it be postnatally or as we hit perimenopause. 

Another cause can be constipation.

And we know that 50% of women with pelvic floor dysfunction have constipation, so it's a vicious circle.

The more you strain on the loo, the more your pelvic floor is compromised. 

There can also be a hereditary element.

If your mother had a prolapse or weak pelvic floor, then you might have one too.

RELATED: Is it too late to fix your pelvic floor?

In terms of the menopause, do our hormones have a part to play in that?

They certainly do. I think we have to accept that it's part of the ageing process.

50 is not old, it's midlife, and we're going to live a lot longer. Or let's hope so.

But hormones definitely have a part to play, and there's a significant amount of oestrogen in our urethra.

So if you suddenly start to get symptoms like running to the loo, when you see your front door and feeling that you’re never going to make it in time, that feeling of urgency, that's because of a depletion of oestrogen around the urethra and in the vagina added to the fact that your pelvic floor muscles are possibly weak from childbirth.

As a result, you're not able to squeeze and contract to help yourself get to the loo.

I'm a huge fan of vaginal oestrogen, and I think hardly any women are using it.

It's a really, really important tool, particularly with pelvic floor health.

I've examined so many 1000s and 1000s of women over my career who have no oestrogen in their vaginas, and they have no idea.

They just know that they've come to see me because they can't get to the loo in time, but they had no idea that that was why.

Vaginal oestrogen is very important, so that's a conversation to have with your doctor, but systemic HRT and vaginal oestrogen are both very helpful for pelvic floor dysfunction.

pelvic floor examination

What are the risks of not looking after our pelvic floor health?

One, particularly, is starting to get chronic UTIs and possibly having a bit of vaginal prolapse.

If you continue not to care for your pelvic floor, it could become a significant prolapse, which then means you are in the realm of surgical procedures and things like that.

Whereas if you'd looked after your pelvic floor earlier when the prolapse was tiny, it could have been stopped in its tracks. 

Suddenly getting lots of urinary tract infections can actually physically affect your kidneys over time so it affects our general well-being. If you are having that urgency to the loo and you start changing your lifestyle to avoid being in social situations here, this may be an issue then you may become more isolated as a result of that. 

These sorts of things are a very good reason to start caring for your pelvic floor. I've seen loads of women over the years who've said that they can't believe that they can now go to the theatre and don't mind where their seat is anymore because they were so terrified of not getting to the interval and wetting themselves that they didn't enjoy the play because they spent the whole time worrying about the loo. 

RELATED: What is a prolapse and what can I do to help my symptoms?

Are there exercises we can all do easily to strengthen the pelvic floor and how do we know if we're doing them properly? 

That's the 55,000 million dollar question, are you doing it properly?

There's no point spending years doing these exercises if you’re not actually using your pelvic floor at all.

So it's very important that we actually isolate and locate the pelvic floor, and if you absolutely can't find it, then you need to go and seek help. 

There are various ways of making sure you're using the correct muscles. If you're still having the odd period and have a tampon in your vagina, doing a tug of war, pulling on the string and trying to squeeze it to stop it coming out, is a good way.

Another is occasionally trying to stop peeing mid-flow but we don't recommend you do that regularly as it can cause a bladder not to empty well, and then you end up with cystitis or a urine infection, but that actual physical act of trying to stop midstream is your pelvic floor contracting. 

A simple way of doing the exercises is just sitting on the arm of your sofa and then contracting the anus and vaginal muscles at the same time in a kind of ‘squeeze, lift and hold’.

Count to five, and gently let go. If you just do that five times. 

Try to remember to do this when you clean your teeth because none of us are ever leaving the house without doing that.

Choose any time that suits you and helps you remember, when you eat your toast, on the school run with the children or grandchildren, just find two minutes twice a day.

It takes so little time, and it really really works. 

You’ll soon notice a difference when you sneeze, cough and laugh and also in that sort of heaviness in the vagina, which a lot of us can suddenly start having over the age of 50. 

Want some extra help?

We recommend these pelvic floor trainers to help you strengthen your pelvic floor muscles.

(*Disclosure: These links are affiliate links. This means that, at zero cost to you, we will earn an affiliate commission if you click through the link and finalise a purchase.)

Elvie - App Controlled Women's Pelvic Floor Trainer

Elvie - App Controlled Women's Pelvic Floor Trainer

  • Connect the Perifit probe to the app by Bluetooth, and watch your pelvic floor contractions in real time. Bid goodbye boring and complicated exercises, and get quick results thanks to the app's fun exercises.
  • Perifit's 5D analysis diagram (strenght, endurance, contraction quality, relaxation, agility) allows you to focus on your own areas to improve. The app proposed 6 training programs to address your very own issues and symptoms.
  • Designed in partnership with physiotherapists and pelvic floor specialists. Now, many health professionals worldwide recommend Perifit to their patients for pelvic reinforcement.
  • As a multi-award-winning Kegel trainer, Elvie Trainer is recommended by hundreds of healthcare professionals, from physiotherapists and gynecologists to personal trainers. We’re also proud to work in partnership with the NHS.
  • Perifit - Pelvic Floor Exerciser with App

    Perifit - Pelvic Floor Exerciser with App

  • Connect the Perifit probe to the app by Bluetooth, and watch your pelvic floor contractions in real time. Bid goodbye boring and complicated exercises, and get quick results thanks to the app's fun exercises.
  • Perifit's 5D analysis diagram (strenght, endurance, contraction quality, relaxation, agility) allows you to focus on your own areas to improve. The app proposed 6 training programs to address your very own issues and symptoms.
  • Designed in partnership with physiotherapists and pelvic floor specialists. Now, many health professionals worldwide recommend Perifit to their patients for pelvic reinforcement.
  • Bodyotics Deluxe Kegel Weighted Exercise Trainers – Set of 6 for Beginners to Advanced with E-Book

    Bodyotics Deluxe Kegel Weighted Exercise Trainers – Set of 6 for Beginners to Advanced with E-Book

  • Connect the Perifit probe to the app by Bluetooth, and watch your pelvic floor contractions in real time. Bid goodbye boring and complicated exercises, and get quick results thanks to the app's fun exercises.
  • Perifit's 5D analysis diagram (strenght, endurance, contraction quality, relaxation, agility) allows you to focus on your own areas to improve. The app proposed 6 training programs to address your very own issues and symptoms.
  • A pelvic floor trainer

    Do pelvic floor trainers and biofeedback devices work?

    They do work. The Elvie trainer*, which is probably the most expensive of the devices, is a little egg inserted into your vagina.

    You use your smartphone, it takes five minutes, and you get graphs, and it's very easy to follow it. It also ensures that you’re using the right muscles. 

    If the muscles are too weak, you'd be squeezing away, and absolutely nothing is appearing on the graph.

    Then you need electrical stimulation devices, and there are loads available, you can go on Amazon and buy one.

    If you're at that level, though, you want to go and have yourself assessed because there are contraindications to using some of these bits of kit, particularly the electrical stimulation ones.

    So it's useful to just go and have an assessment if you can.

    A great little thing which is very cheap is called a pelvic floor educator.

    Again, it's a little plastic thing; it's sort of egg-shaped and sits in the vagina with a little stick attached to it.

    Imagine you're lying there on your back, you've got your knees bent, and this little stick is sticking out.

    And as you squeeze the little stick moves, so you can actually see a stick moving and being able to see that you’ve got the right muscles and are doing the right thing is very helpful. 

    I'm a fan of gadgets, but you have to be sure you've got the right one.

    And if you're not sure, then do go and see a Women's Health physio or a continence nurse specialist because you might only need to go once just to be sure you're on the right track. 

    RELATED: 10 nutrition tips for a happy and healthy pelvic floor

    How else can we improve our pelvic health?

    The biggest thing to do with pelvic floor and lifestyle is constipation.

    So many women have constipation, and it can become worse at the time of the perimenopause and menopause when you maybe never had it before.

    If you've got a mild prolapse and you're pushing and straining, sometimes the weakness in the back wall of the vagina means that your poo gets almost stuck there.

    And I see lots of women who tell me they have to put their fingers in their vagina to just push the poo back and actually go. 

    I'm a great fan of the raised footstool because if you just raise your feet sort of seven to nine inches on something like a child set that you have for the grandchildren, it puts you in a slightly squatting position.

    And that really helps as it relaxes a muscle around the back of the rectum called the pubic talus muscle and lets you poo better. 

    So constipation is huge, and we don't actually associate that with that pelvic floor health.

    So look at your diet and try and stop straining on the loo. 

    Sometimes it is difficult to avoid certain things like heavy lifting, but being too overweight, without doubt, puts a great strain on the pelvic floor.

    If you carry extra weight, it’s like carrying a pregnancy.

    It's a downward force on these tiny little muscles which are trying to hold everything up. So just be mindful of your weight. 

    For people who have a chronic cough, maybe this is your moment to quit smoking.

    Obviously, if you're an asthmatic, then there's nothing much we can do about it, but if you try to brace and contract the pelvic floor at that moment of coughing or lifting something heavy, it actually protects the pelvic floor.

    The Americans did some research on this; they called it the neck, which is a wonderful American name.

    And it just means that you get this knack of every time you sneeze or cough, you brace the pelvic floor, and it doesn't just stop you from leaking; it actually protects the muscles. 

    Nothing will help you as much as doing your pelvic floor rehabilitation.

    If you have a small prolapse, wearing a vaginal pessary is a good idea.

    If you were going for a run, you wouldn't go without your sports bra on, or your boobs would juggle about and be jolly painful.

    So why don't we give our vagina the same support?

    There are loads of pessaries out there, ones you can buy over the counter or on Amazon are made of a foam rubber, you’re really better to have one fitted if possible because then you can just wash it and reuse it, whereas the foam ones you have to rebuy. 

    Some women use the moon cup and things like that or a large tampon just to support the bladder neck.

    And that helps sometimes when you're running and things like that.

    I'm never going to stop women from running because I think if that is really what's giving you a release and helping you feel better, then I'm sure that you can work it out with your pelvis.

    Obviously, if somebody has a severe prolapse, then it’s probably best to give up running for a little bit.

    But look at your lifestyle, look at what you're doing that's causing this problem and see how you can change that.

    RELATED: Pelvic Health - it's no laughing matter (or is it?)

    pelvic floor exercises

    Why might we get a tight pelvic floor, and what issues would that create? 

    People with tightness in the pelvic floor are less likely to seek help.

    Sometimes it manifests itself in our sex life.

    We find that sexual intercourse is painful and uncomfortable or even impossible. 

    This can sometimes be more common after caesarean sections, where nothing has been stretched. 

    Often in this situation, when your partner comes towards you to have intercourse, you recoil because it is going to be painful, and then you're almost clenching and tightening the pelvic floor rather than trying to relax it. 

    As it’s a subject that has sexual connotations, women are struggling more to go and seek help.

    I also think people find it harder to diagnose it.

    So you go to the doctor and are told just to light a candle and relax, but in actual fact, it's a medical phenomenon. 

    This can cause a lot of trouble in relationships; it can also cause you to have that urgency to the loo if you're tensing your muscles all the time. 

    Sometimes it is helpful to do what we would call a reverse key goal or a reverse pelvic floor exercise. we're constantly told to pull in and pull up, and actually if you try to do the opposite of that, which is to just let go of the pelvic floor and try to relax it. 

    I sometimes use vaginal dilators. They are a wonderful tool, and they come in various sizes.

    So you would start with a very, very small one, which gets you used to something there.

    And also then, it could give you the confidence to just try to relax your muscles. 

    Seek help rather than worrying about your next smear test because women who fear to go and have a smear and keep putting it off are at an increased risk of cervical cancer.

    So it's quite important that we do deal with it and that you see someone and be properly assessed.

    RELATED: Struggling to get your menopause symptoms taken seriously?

    How would you know when your pelvic floor issues can be treated safely at home and when you should seek medical help?

    If we lived in an ideal utopia, everybody should have a pelvic floor assessment every so many years.

    I would love it if every time we went for a smear test, this was incorporated into it because that's the ideal time to do it. 

    And I do say to patients, when you go through your routine smear test or your gynaecological review, or whatever it happens to be, ask whoever is doing it if your pelvic floor looks alright.

    Ask if it's contracting and relaxing and whether you have some prolapse. Because it's difficult to examine yourself.

    You could have a look with a mirror, but you can't necessarily see very much unless you've got a prolapse protruding out. Clearly, we can't see what's going on inside.

    We can feel inside with a finger and just see if we can squeeze our pelvic floor or if we can relax certain things like that, but you need some proper medical advice.

    You can and should look down there.

    We look at the rest of our bodies in minutiae all the time, but our nether regions are tucked away in our knickers, keeping quiet unless they start to cause an issue.

    I really wish there was a regular Well Woman checkup which included conversations like ‘Do you know what perimenopause is?’

    There are lots of postnatal clinics popping up - Mummy MOTs - but sadly, most of them are private.

    At least now GPs are having to see new mothers, too, because the postnatal check was once only for the baby.

    So we are getting there slowly, but on a serious note, pelvic health is such an important subject that is always at the bottom of the heap. It’s not life-threatening, so it's not a priority, but it's very life-changing.

    Is it ever too late to try and repair or strengthen the pelvic floor?

    Never, never too late.

    I've looked after some wonderful old ladies. And I mean women in their early 90s.

    One intrepid lady was determined to continue collecting for the lifeboat every year and just couldn't do it anymore because she just couldn't get the loo in time.

    And with some vaginal oestrogen at 85 and some pelvic floor exercise, she collected for the lifeboat, and that's one of my favourite stories.

    She couldn't believe it. She didn't think we could do anything about it.

    But you can; it’s never too late.

    If you have mums who are perhaps in their 80s and 90s, please talk openly about things like vaginal dryness.

    Because we hear from women whose mums have been in care homes and are suffering in silence because they're just so embarrassed, and they would never dream of telling, you know, their carer what was going on. 

    Why did you write The Pelvic Floor Bible?

    Having spent all these years looking after women, I realised that it was the tip of the iceberg.

    There was no way that I could get my story out to everybody, just the patients that I treated on a daily basis.

    And I realised that the problem was huge. 

    I really wrote about all the things that happen to us, which the stress incontinence, the leaking when you sneeze, the overactive bladder, that key in the door and the desperation for a pee.

    It's about prolapse, your sex, IBS, and all those things that no one wants to talk about. 

    I wrote a chapter on the menopause and about having a baby.

    Although our podcast will be listened to by mostly women, a lot of us have men in our lives, and it feels more taboo for them to talk about it than it is to us, even because we've had periods and things and we are a little more open about these subjects.

    I just felt that I needed to try to spread the word more globally, and it's been a wonderful journey getting to know so many different people.

    I was very proud that it was the number one best seller in its little group on New Year's Eve, which made me very joyful.

    It's three years old now. So it's a subject that's never going away.

    And in a way, it's almost getting more talked about as the years go by because we are getting more open, and our children and our grandchildren will be so much more aware of their bodies than we ever were. 

    RELATED: The Pelvic Floor Bible

    Read Jane's book: The Pelvic Floor Bible: Everything You Need to Know to Prevent and Cure Problems at Every Stage in Your Life*

    (*Disclosure: This link is an affiliate link (marked with an *). This means that, at zero cost to you, we will earn an affiliate commission if you click through the link and finalise a purchase.)

    What's your parting piece of advice?

    You must love your pelvic floor more, please.

    Love your pelvic floor, and it will love you back so much.

    You don't have to do much every day to really make a difference to your quality of life, and I think the quality of life for us all, having had two years of COVID and all of the rest of it, is really important. 

    You could not leave when you sneeze just by doing a few pelvic floor exercises every day, and it works.

    I think that to love your pelvic floor is my parting shot. 

    Love your pelvic floor with Continence Nurse Specialist, Jane Simpson

    In this episode, I'm talking to continence nurse specialist and author Jane Simpson, about the impact that ageing and fluctuating hormones during menopause have on our pelvic health. We'll cover the common problems we might experience with our pelvic floors, including weak bladders, that feeling of always needing to go to the loo, as well as tightness and tension in our pelvis.

    Watch the video version of the podcast

    Discover more: Listen to more of The Latte Lounge podcast episodes - and don't forget to subscribe / follow to be notified of future episodes!

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