Menopause musings - How's your pelvic floor doing?

The pelvic floor in perimenopause seems to take a bit of a holiday (regardless of whether you have had kids or not). That was a surprise!

Just before we go any further, the pelvic floor is a group of muscles that effectively hold your insides, inside. And control the evacuation of bladder or bowel. Think of it as a sling under your internal organs which has parts of it that can relax to allow you to pee or poop or indeed have a baby!

OK so hands up who actually takes time out to do pelvic floor exercises/kegels? Nope, nor me. If you are a new Mum, especially, do you have time to stop and do them with a brand new baby, lack of sleep etc? You will be doing well to shower daily….. Then later as the kids grow, so does the ‘to do list’ so yet again you put yourself at the bottom of the list. And pelvic floor contractions at the bottom of that list!

Even if you haven’t had kids, you still need to work that muscle. We talk about training now for our Old Lady Body but we also need to be training now for our perimenopause/menopause body. Yes, yet another symptom of the menopause is reduced pelvic floor strength or control.

Now. Ignore those silly adverts, don’t just settle for “letting it all go“. There IS something you can do. Also, a weak pelvic floor that leaks could lead to a prolapse. (Where a part of the bladder, uterus or bowel drops through the sling of the pelvic floor). You don’t want that. You definitely don’t want that.

The image below shows how the pelvic floor and diaphragm are connected. When you breathe out your diaphragm lifts, and this pulls up on the pelvic floor as well. So if you breathe out as you stand up from a chair, you are pulling the pelvic floor up. This then helps to protect it from being pushed down with the pressure in your abdomen as your core muscles contract. How many times a day do you stand up from a chair? If you get into the habit of breathing out every time you stand, you will go a long way to protect from leaks and prolapse.

Once you get into that habit, add in a pelvic floor contraction at the same time as standing and breathing out.

What is a pelvic floor contraction?

Imagine trying to pull the front of your pelvic bone towards the tail bone. This is the contraction you are looking for. REMEMBER YOU ARE BREATHING OUT! Some people find themselves breathing in to do this, make sure you are breathing out. If you are breathing in you will be pushing the pelvic floor down and so fighting against yourself.

DONT try to stop peeing while on the loo. I’m sure we have all been told this in the past. But it sends the wrong signals to the pelvic floor and bladder muscles. They need to work opposite each other so when your bladder contracts to expel the pee, your pelvic floor should relax. And vice versa i.e. the pelvic floor is contracted and the bladder is relaxed so you DONT expel pee.

This is from Burrell Education and my Pelvic Floor and Core Foundations training.

As you breath out, your diaphragm rises. This is connected via the abdominal wall to the pelvic floor. Thereby lifting the pelvic floor.

Exercise and your pelvic floor

OK so now you have got the hang of breathing out as you stand and contracting your pelvic floor at the same time. Lets add this to exercise.

When you exercise you are often applying pressure to your abdomen. Think standing up from a squat, pushing up from a press up, pulling down on a bar or holding a plank. So to protect your pelvic floor make sure you are breathing out at these points. Obviously just keep breathing during a plank, nice and steady, in and out. Don’t hold your breath as that can push down on your pelvic floor, weakening it.

Start NOW using your breath to protect your pelvic floor during exercise. Breathe out when there is the most pressure in your abdomen. Normally in the ‘effort’ part of an exercise. Pushing against gravity or moving weights or stretching a band. You can even improve it if you add in a pelvic floor contraction at the same time as the breath and the exercise. Side lunges are particularly good for this due to the inside leg muscles also connecting to the pelvic floor.

When to see a specialist

You may need to see a women’s health physio if you already have a prolapse or suspected prolapse. Also if there is any pain during sex. You can find one locally and some NHS trusts have them available now. They will be able to examine you and give you more specific advice.

Something else to be aware of is that if you are constipated, get this sorted ASAP. Constipation can often lead to a weak pelvic floor so lots of water, fibre and movement.