Menopause marks a significant transition in a woman’s life, bringing with it a range of physical and hormonal changes. While symptoms such as hot flashes, mood swings, and weight gain are commonly discussed, the impact on pelvic floor health often remains under the radar. The pelvic floor is a group of muscles and connective tissues that support the bladder, uterus, and rectum, and its function plays a crucial role in maintaining urinary, bowel, and sexual health.
As estrogen levels drop during menopause, these muscles may weaken, contributing to pelvic floor dysfunctions like incontinence, pelvic pain, and sexual discomfort. Fortunately, pelvic floor physical therapy (PFPT) can be a transformative solution. Let’s talk about how menopause affects the pelvic floor, the symptoms women may experience, and how pelvic floor physical therapy can offer relief and restore function.
How Menopause Affects the Pelvic Floor
The pelvic floor muscles, like any other muscles in the body, require proper hormone balance to maintain their strength and integrity. Estrogen plays a key role in keeping muscles and connective tissues, including the pelvic floor, pliable and strong. When estrogen levels decline during menopause, these tissues lose some of their flexibility and strength, leading to potential dysfunction.
Here’s a closer look at how menopause can affect the pelvic floor:
• Weakened Pelvic Muscles: With reduced estrogen, pelvic muscles may become weaker and less able to support the organs in the pelvic region. This can lead to issues like prolapse, where organs like the bladder or uterus drop into the vaginal space.
• Thinning of Urogenital Tissues: The tissues of the urethra, vagina, and bladder lining become thinner and less elastic due to decreased collagen production, a result of estrogen decline. This can lead to increased susceptibility to infections, irritation, and discomfort.
• Decreased Circulation and Tissue Health: Blood flow to the pelvic region may decrease, further affecting tissue health and muscle tone. This can lead to decreased sensation, dryness, and even pain during sex.
Common Pelvic Floor Symptoms in Menopause
Because of these hormonal changes, women often experience a variety of pelvic floor-related symptoms during and after menopause. Some of the most common conditions include:
• Urinary Incontinence: One of the most common pelvic floor issues in menopausal women is stress urinary incontinence, which occurs when activities like sneezing, coughing, or exercising lead to urine leakage. The weakening of the pelvic muscles and changes in tissue elasticity make it harder to control the bladder.
• Pelvic Organ Prolapse: Pelvic organ prolapse is when one or more of the pelvic organs (bladder, uterus, or rectum) descends into or through the vaginal canal. This can cause discomfort, pressure, and difficulties with bowel movements or urination.
• Pelvic Pain: Many women in menopause report chronic pelvic or lower back pain. This can be linked to muscle weakness, reduced support to the organs, or scar tissue from childbirth or surgeries. Tightness or hypertonicity in the pelvic floor muscles can also contribute to this pain.
• Sexual Dysfunction: Menopause can also lead to sexual health issues, including vaginal dryness, painful intercourse, and decreased libido. Reduced estrogen levels lead to thinner, less elastic tissues, making sexual activity uncomfortable or even painful.
Recurring Urinary Tract Infections
How Pelvic Floor Physical Therapy Can Help
Pelvic floor physical therapy is an evidence-based, non-invasive approach to assessing and treating the muscles of the pelvic region. A pelvic health physical therapist evaluates the function, strength, and coordination of the pelvic floor muscles, identifying areas of weakness, tightness, or imbalance. PFPT offers personalized treatment plans designed to restore muscle strength, improve function, and alleviate pain.
Here’s how pelvic floor therapy can specifically benefit women in menopause:
1. Strengthening the Pelvic Floor Muscles
Pelvic floor physical therapy helps improve the strength and endurance of these muscles, allowing them to better support the pelvic organs. Therapists use a combination of exercises (similar to Kegels but more targeted) and manual techniques to retrain the muscles, improving bladder control and reducing prolapse symptoms. Specific strengthening exercises for other parts of the body can also reduce pain by addressing muscle imbalances that may contribute to tension or weakness.
2. Restoring Coordination and Relaxation
In addition to strengthening, pelvic floor physical therapy focuses on improving the coordination between the pelvic floor and other core muscles. Many women experience tension or over-activation of the pelvic floor muscles, leading to pain and discomfort. PFPT helps restore the proper function of these muscles by teaching relaxation techniques and breath work, enabling the pelvic floor to contract and relax in harmony with other muscles.
3. Reducing Pelvic Pain
Chronic pelvic pain can stem from muscle tightness, trigger points, or scar tissue in the pelvic region. Pelvic floor therapy uses manual therapy techniques to address these areas of dysfunction, reducing pain and restoring normal muscle function. By targeting the underlying muscular issues, PFPT helps alleviate pain from conditions such as pelvic floor hypertonicity or tension.
The Link Between Pelvic Floor and Core Strength
The pelvic floor doesn’t work in isolation; it’s an integral part of the body’s core system, which also includes the diaphragm, abdominal muscles, and back muscles. Together, these muscles support posture, spinal health, and movement. Weakness or dysfunction in the pelvic floor can lead to compensations in other parts of the body, contributing to issues like lower back pain, hip pain, and poor posture.
Pelvic floor therapy addresses these interconnected areas by focusing not only on the pelvic muscles but also on strengthening and stabilizing the entire core. A strong core can reduce the strain on the pelvic floor and help prevent injury or further dysfunction.
Pelvic Floor Therapy and Sexual Health
One often-overlooked benefit of pelvic floor therapy is its role in enhancing sexual health. As estrogen levels decline during menopause, the tissues of the vagina and pelvic floor become thinner and less elastic, leading to discomfort or pain during intercourse. Pelvic floor physical therapists can guide women through specific exercises and relaxation techniques to improve muscle flexibility, reduce pain, and improve sexual function.
Manual therapy techniques and extra-corporeal shockwave therapy like Softwave can also help break up adhesions or scar tissue that may have formed from previous surgeries or childbirth, further improving sexual health. With regular pelvic floor therapy, many women experience a reduction in pain and discomfort during intercourse, leading to a more satisfying and enjoyable sexual experience.
Preventing and Managing Chronic Pelvic Pain
Pelvic floor dysfunction can be a significant source of chronic pain, not only in the pelvic region but also in surrounding areas like the lower back, hips, and thighs. When the pelvic floor muscles are weak, tight, or uncoordinated, the body compensates by relying on other muscles to provide stability, often leading to pain and discomfort elsewhere.
Pelvic floor physical therapy provides a comprehensive approach to managing and preventing chronic pain by addressing the root cause of dysfunction. Whether through manual therapy, strengthening exercises, or postural retraining, PFPT helps to realign and restore balance to the body’s core systems, leading to long-term relief from pain.
Conclusion: Prioritizing Pelvic Health During Menopause
While menopause brings many changes to a woman’s body, it doesn’t have to mean living with discomfort, pain, or dysfunction. Pelvic floor physical therapy offers a powerful, holistic solution to the musculoskeletal challenges of menopause, addressing everything from incontinence to sexual health. By strengthening and retraining the pelvic floor and core muscles, PFPT can help women regain control, reduce pain, and improve their quality of life during and after menopause.
If you’re experiencing pelvic floor symptoms or chronic pain related to menopause, don’t hesitate to reach out. Our functionally minded approach to pelvic floor physical therapy can help you navigate this stage of life with strength and confidence. Schedule a consultation today to learn more about how we can support your pelvic health.
About the Author
Dr. Koehl is a Doctor of Physical Therapy looking to make a difference in the health and well-being of the people in her community. She loves to educate patients to empower them in taking control of their health and reaching their goals including those with acute and chronic orthopedic conditions, pelvic floor dysfunction, and neurological conditions.