The pelvic floor is a group of muscles forming a supportive ‘hammock’ across the base of your pelvis. These muscles surround the openings for your urethra, vagina and rectum, supporting critical organs such as your bladder, rectum, and reproductive organs. Strong pelvic floor muscles are vital for bladder and bowel control and maintaining continence.

This article was included in issue 104 (Spring 2025) of The Menopause Exchange newsletter. 

Factors affecting function

Many factors can weaken or impact on how well pelvic floor muscles work, including chronic constipation, smoking, increased weight, childbirth and genetics. As women get older, particularly during the menopause, changes to pelvic floor muscle function become more common. This is partly due to sarcopenia (the natural loss of muscle mass) and is worsened by declining oestrogen levels. Hormonal changes can weaken pelvic floor muscles and loosen the supporting connective tissues. Many women focus on maintaining overall muscle strength during the menopause, and strengthening the pelvic floor is often overlooked.

Pelvic health and the menopause

The menopause can lead to a range of pelvic health conditions that may affect daily life. One in three women who have had children will develop a pelvic organ prolapse, but only 6% report symptoms. One in three women experiences bladder leaks, and one in 10 men and women will experience bowel leaks. It’s also common for women to experience both urinary incontinence and pelvic organ prolapse. Up to 60% of women with prolapse experience urinary leakage, and 40% of women with urinary leakage have some form of prolapse.

Urinary incontinence

Urinary incontinence refers to a weakened ability to control bladder function. The two most common types are urge incontinence and stress incontinence. Urge incontinence is a sudden, intense need to urinate that can lead to leaks. This may also occur alongside bowel incontinence. In stress incontinence, leakage is caused by activities that increase abdominal pressure, such as laughing, coughing or exercising.

Drinks such as caffeine, alcohol and fizzy drinks may worsen urinary incontinence, while dehydration can make urine more concentrated, increasing urgency and leaks. Pelvic floor muscle weakness is a significant risk factor, and strengthening the pelvic floor muscles can significantly improve stress and urge incontinence symptoms.

Pelvic organ prolapse

Pelvic organ prolapse occurs when the vaginal walls or the top of the vagina get lower. Symptoms may include:

• a sensation of heaviness in the vagina
• feeling like something’s stuck (similar to a misplaced tampon)
• a visible or palpable bulge in the vagina
• difficulty emptying the bladder or bowels fully

While prolapse is more common in women who have had children, it can also occur in those who haven’t. The risk of prolapse increases with age, and a family history of prolapse may also increase the risk. Obesity, heavy lifting and chronic constipation can all contribute.

Prolapse management may include:

• pelvic floor exercises to improve support for vaginal and pelvic organs
• lifestyle changes such as weight loss and modified exercise routines
• bowel management to ease constipation
• pessaries to provide internal support

Genitourinary syndrome of the menopause (GSM)

GSM refers to a range of symptoms caused by the menopause. It affects around 50% of women, although only 25% seek help. Common symptoms include:

• vaginal dryness (affecting up to 75% of women), irritation, itching or burning
• vaginal discharge changes
• frequent urinary tract infections (often due to changes in vaginal pH)
• Pain during sex or bleeding afterwards.

Easing GSM symptoms includes removing irritants such as tight clothing, synthetic underwear, wet wipes and harsh soaps, and using non-hormonal treatments such as high-quality vaginal moisturisers. Women should consider topical oestrogen or HRT. Pelvic floor muscle training may also help.
Note: While laser treatments and vaginal rejuvenation procedures are becoming more common, more high-quality research is needed to confirm their safety and efficacy.

Pelvic floor exercises

Pelvic floor exercises or ‘Kegels’ are simple contractions that help to strengthen pelvic muscles, but proper technique is key.

1.  Start by squeezing and lifting your back passage as if trying to stop passing wind.
2.  Continue this lift and squeeze forward into your vagina.
3.  Hold for up to 10 seconds while avoiding breath-holding or tensing your abdominals.

No one should be able to tell you’re doing a pelvic floor exercise if they look at you. If they can, you’re probably trying too hard. Aim for 10 x 10-second holds and 10 quick squeezes daily to improve muscle strength and prevent future dysfunction. You can also include functional pelvic floor exercises such as squats or lunges to challenge these muscles for real-life demands.

When to seek help

Many women believe pelvic health symptoms are a normal part of childbirth or the menopause. Yet these aren’t something you have to live with. If you experience prolapse, incontinence or GSM, seek help from a qualified medical professional. A pelvic health physiotherapist can assess symptoms, provide personalised advice and create an effective treatment plan. New urinary symptoms should be assessed by your GP to rule out an infection.

About the author

Laura Patterson is an MSK and pelvic health specialist physiotherapist of over 20 years and runs her own private practices in Aberdeen, Scotland. She works in collaboration with The Menopause Consortium.

Created Spring 2025
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