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Managing the menopause - Pelvic Floor Dysfunction

Our last blog post highlighted exercise and lifestyle tips to help navigate a happy and healthy menopause. This post was written along side Tina Mason, Emily's colleague at Women's Health Brighton where you can book to see Emily or Tina for Women's Health consultations.

The Pelvic Floor & Vaginal Changes of the menopause

The pelvic floor muscles are multi functional:

  • They form the support structure within the pelvis, working with the core abdominal muscles to maintain stability for the spine

  • They are the main support for the pelvic organs consisting of the rectum, bladder and uterus (in women)

  • They aid the sphincters of the urethra and anus, stopping urine or faecal leakages and maintain the size of the vaginal hiatus (opening)

If you have been pregnant and / or have had a vaginal delivery, these muscles can become weak and stretched. They can also become weaker during peri-menopause and menopause due to age and hormone related decrease in muscle mass.

Common symptoms of a weakened pelvic floor are:

  • Urinary incontinence (leaking during activity, coughing, sneezing, laughing etc)

  • Increased frequency or urgency to go to the toilet

  • Loss of control of flatulence and sometimes faecal leakage

  • Pelvic organ prolapse - symptoms often include a feeling of heaviness or dragging within the vagina caused by a decrease in support of the pelvic organs, allowing them to push into the vaginal walls

The Pelvic floor are muscles just like any other in your body and in some people they may be weak and in others they may become overactive and tight. High anxiety or stress, trauma or excessive exercise can lead to high tone in these muscles, meaning that they are unable to relax and contract as they should. When the pelvic floor is always switched on or in spasm, it is unable to function correctly. This can lead to pelvic pains such as vaginismus and dyspareunia (painful sex) as well as incontinence (leaking of urine, faeces or wind).

Test your Pelvic Floor

To test pelvic floor activity, take a gentle breath in and as you breathe out, squeeze around your anal sphincter and up to your urethral sphincter, as if trying to stop passing wind to stopping yourself passing urine. You should feel a lift inside without activity from your legs or gluteal (bottom) muscles. Hold this contraction for a few seconds and then let go. You should feel a drop as the muscles relax. If you struggle to feel the lift or engagement of the muscles, or are unable to feel the muscles drop and relax, it is likely that there is a dysfunction of your pelvic floor muscles.

If you are not sure or would like further guidance, book a consultation via Women's Health Brighton where you will receive comprehensive assessment and expert, individualised help.

NICE guidelines state that to improve urinary incontinence a pelvic floor rehab programme lasting a minimum of 12 weeks should help with symptoms and for pelvic organ prolapse a minimum of 16 weeks, depending on the level of the prolapse.

A daily pelvic floor rehab programme should consist of 3 sets a day of 10x 10 second holds, 10 x short strong on & off contractions and 1x 20 sec hold of a 50% contraction. A really good tool is the NHS Squeezy App which can be downloaded to your phone or tablet.

As well as changes to the pelvic floor muscles, the decrease in oestrogen can cause the vaginal tissues to become thinned, less elastic and dry. This is called vaginal atrophy. This in turn can cause pain, burning and trauma to these tissues. Alongside changes in libido, sexual intercourse can become excruciatingly painful and therefore avoided, which alongside mood changes can lead to relationship pressures.

Having sex can actually improve the changes to these tissues by stimulating your natural lubrication plus arousal and orgasm help to stimulate the production of hormones in the area.

Doing pelvic floor exercises can mimic some of the arousal of orgasm during sex and encourages blood flow to the area which can help with the healing and plumpness of the vaginal and vulval tissues.

When having sex, consider using lubricants such as YES WB, Sylk or Replens. These are water based and non hormonal, be careful of many over the counter lubricants that contain parabens as these can affect the delicate pH balance inside the vagina.

Vaginal moisturiser pessaries and non-hormonal moisturisers can also be used to help increase the moisture balance within the vaginal walls.

If these products do not make a difference, it is worth speaking to your GP to be prescribed a topical oestrogen cream as this will directly help to plump up the vaginal tissues and decrease dryness. Lubricants and vaginal moisturisers can be all prescribed by your GP.

Maintaining a Healthy Gut

Constipation is a common problem in peri-menopause and menopause because of the imbalance of both oestrogen and progesterone slowing the motility of the gut causing bowel movements to become sluggish.

Without as much oestrogen, cortisol levels can increase which can also lead to symptoms such as indigestion, acid reflux, trapped wind, flatulence and nausea.

Having fibre in your diet is essential to maintaining a healthy gut, along with drinking lots of water. Avoiding foods high in sugar, refined carbohydrates, hydrogenated fats and alcohol can also help as these all lead to spikes in cortisol levels in the body. Refer back to Henrietta Norton's guest post 'Eat to Beat the Menopause' for more in depth information.

Using a fold up step or “stool stool” such a Squatty Potty to put your feet on when opening your bowels allows for an easier passage, less straining if constipated and a healthy bowel movement.

In Summary

With all of the changes affecting the most private areas of our bodies as well as the hormonal impact on mood and sleep, women can find themselves in a viscous cycle of pain, anxiety and low self esteem... but we can help to change this by talking!

Having open conversations with a health professional, your family, friends and colleagues will help to increase awareness, help you realise that other people may also be suffering and they may be able to offer tips and advice on what helped them.

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