Will I ever get on a trampoline again?


Keep reading if you want to know more about pelvic floors, what they do and how they can be impacted by peri-menopause.


WHAT ARE PELVIC FLOORS?

The pelvic floor is a group of muscles that help support the pelvic organs: bladder, uterus (womb) and bowel. The openings from these organs - the urethra from the bladder, the vagina from the uterus and the anus from the bowel - pass through the pelvic floor. A healthy, balanced pelvic floor functions reflexively, in relationship with surrounding musculature, posture and breath, to assist urinary and faecal continence, childbirth, sexual pleasure and to maintain optimal intra-abdominal pressure.


WHAT HAPPENS TO THEM AS OUR HORMONES CHANGE?

As oestrogen levels fluctuate and drop during perimenopause our pelvic floor muscles, organs and supportive structure can become less elastic and ‘juicy’. Weakness can show up in the form of areas of laxity - or tightness - across the various pelvic floor muscles. The uterus can reduce in size during menopause, further compromising pelvic structures. Lubrication to the vagina can change, usually becoming dryer. A reduction in testosterone (connected to our libido and our motivation overall), can impact our sex life.

This can lead to the following issues which asides from being painful and uncomfortable can be embarrassing, distressing and have a huge impact on a woman’s quality of life.


VAGINAL/VULVAL SYMPTOMS:

  • Vaginal atrophy (including dryness/burning/itching/occasionally with excess discharge)

  • Vaginal shortening

  • Pelvic organ prolapse - 1 in 2 of women over 50 experience a change in the position of where the bladder, cervix/uterus, and/or rectum sit in the pelvis. When any of these organs shift out of place, this creates pressure, heaviness, or protrusion into the vaginal wall, or difficulty with urination or having a bowel movement.

BLADDER SYMPTOMS:

  • Urge Incontinence/ Stress Urinary Incontinence (SUI) - 1 in 3 women experience leaking of urine with sneezing, coughing, laughing, exercising, hearing water running, or getting to the toilet. This leaking could be anything from a dribble to full wetting self

  • Recurrent urinary tract/bladder infections

  • Pain with urination (Dysuria)

BOWEL SYMPTOMS:

  • Faecal incontinence: 1 in 5 women over 40 experience loss of stool (from smearing on underwear to full loss) that can happen with a strong urge to go, after a bowel movement, or with activity (walking, changing positions, lifting, etc).

  • Constipation: when bowel movements occur less than every 2 to 3 days and/or you have the feeling of incomplete emptying, the need to strain/push, or stool that is hard, bulky, or pellet like. Constipation often exacerbates the bladder issues listed above due to the pressure it puts through the pelvic system.

SEXUAL SYMPTOMS:

  • Pain or discomfort with sexual intercourse (Dyspareunia): 1 in 5 women experience pain with intercourse and/or sexual activity. Pain can happen because of gripped pelvic floor muscle issues, skin conditions, or vulvar / vaginal tissue dryness, irritation, or sensitivity, and can occur with initial insertion of something into the vagina, deep penetration, or after sexual activity.

  • In addition, pain can occur either with or separately from low libido and difficulty with arousal and desire.

The good news...

In 85% of cases pelvic rebalancing exercises can help and incontinence pads are not inevitable.


Our take away message...

Although this all sounds really grim, and it can be…. the takeaway message is our pelvis is amazing and hugely under-appreciated. Recognise your body’s capacity to heal itself, start normalising the conversation about these issues to reduce the stigma and shame that surrounds it and then learn what you can do and how to find external support, such as specialist yoga or women’s health physiotherapy when you need it.


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