From childbirth to menopause: How your pelvic floor changes and what you can do about it

Learn about changes that can happen to the pelvic floor from childbirth, through to menopause.

How does the pelvic floor change over time?

The pelvic floor muscles play a crucial role in supporting the organs in the pelvis, including the bladder, uterus and bowel. These muscles are under constant strain throughout a woman's life, especially during significant life stages such as childbirth and menopause.

• Childbirth: During pregnancy, the weight of the growing baby places extra pressure on the pelvic floor. Vaginal delivery can also stretch and weaken these muscles, particularly if there are complications like a large baby or an extended labour. This can result in pelvic floor dysfunction, leading to issues such as urinary incontinence or prolapse.
• Menopause: As women age and oestrogen levels decrease during menopause, the pelvic floor muscles may become weaker due to the loss of muscle tone. Oestrogen is essential in maintaining tissue elasticity and strength, so its decline can contribute to urinary incontinence, vaginal dryness, and pelvic organ prolapse.

What are the common symptoms of pelvic floor dysfunction?

Changes in the pelvic floor can lead to various symptoms, including:

• Urinary incontinence: Leaking urine when coughing, sneezing, laughing, or exercising is a common sign of a weakened pelvic floor.
• Pelvic organ prolapse: This occurs when the pelvic organs drop from their normal position and bulge into the vagina, causing discomfort or pressure.
• Faecal incontinence: Difficulty controlling bowel movements can also be linked to a weakened pelvic floor.
• Pain during intercourse: A weakened or tense pelvic floor may lead to discomfort or pain during sexual activity.

How can you strengthen your pelvic floor?

There are several ways to strengthen and maintain pelvic floor muscles to prevent or manage dysfunction:

• Pelvic floor exercises (Kegels): Regularly contracting and relaxing the pelvic floor muscles can help improve muscle strength and control. It’s essential to do these exercises correctly and consistently for the best results.
• Weight management: Maintaining a healthy weight can reduce unnecessary pressure on the pelvic floor, particularly after childbirth or during menopause.
• Physical therapy: A specialised physiotherapist can guide you through targeted exercises and techniques to strengthen the pelvic floor, especially if you’re experiencing symptoms like incontinence or prolapse.
• Avoid heavy lifting: Repeatedly lifting heavy objects can strain the pelvic floor, so it’s important to be cautious and use proper lifting techniques.

What are the treatment options for pelvic floor dysfunction?

If exercises and lifestyle changes are not enough to manage pelvic floor dysfunction, several treatment options are available:

• Pessaries: These are devices inserted into the vagina to provide support for pelvic organ prolapse.
• Medications: Hormonal treatments like oestrogen cream may be prescribed during menopause to help strengthen the pelvic tissues.
• Surgery: In severe cases of prolapse or incontinence, surgery may be recommended to repair and strengthen the pelvic floor muscles.

Maintaining a strong pelvic floor throughout life is key to preventing the discomfort and complications that can arise from pelvic floor dysfunction. With early intervention and proper care, many of these issues can be managed effectively, allowing women to lead a more comfortable life from childbirth to menopause and beyond.