Pelvic Floor in Your Forties and Beyond

Changes to the pelvic floor throughout a woman’s life

For those who have experienced pregnancy and childbirth, a major strain will have been placed on the pelvic floor muscles, but an increase in body weight can make this even worse.

usually starts in the late forties or early fifties, however in some cases it can happen earlier or later than this. As the body starts to produce less oestrogen, many women find themselves putting on weight much easier than when in their thirties. In fact, fat mass can increase as much as 44% during menopause. When a person has a higher Body Mass Index (BMI) of 26 or above, their pelvic floor has a consistently heavier load to support. Body fat presses down on the bladder and bowel and can result in difficulty controlling the release of urine, faeces or wind.

Skeletal muscle atrophy and associated weakness are inevitable as people age, and the pelvic floor muscles are no exception. Once in their forties, people will lose as much as 5% of their muscle per decade. This decreased strength and muscle mass is related to myriad pelvic floor dysfunctions, including stress UI, pelvic organ prolapse, faecal incontinence and sexual dysfunction.

Common symptoms of a weakened pelvic floor or bladder dysfunction:

• Leakage of urine when coughing, sneezing, bending, laughing or lifting weights which is called stress incontinence.
• It is also common to leak when hurrying to the toilet, hearing running water or even when putting a key in the door when arriving home, this is called urge incontinence.
• Many women experience a dragging or aching sensation around the vagina or anus which can be due to a prolapse of the pelvic organs.
• Problems in controlling wind or bowel contents which often is associated with constipation due to difficulties in emptying your bowels causing a need to strain.
• Painful sex or decreased sensation due to vaginal dryness.

A perhaps less well known issue, although also common, is tightness of the pelvic floor muscles as a result from rarely relaxing them. This can lead to pelvic pain and trigger other symptoms.

The importance of making pelvic floor health a priority

In their twenties and thirties women might not have paid much attention to their pelvic floor and assumed that issues such as leakage and prolapse are symptoms one just has to learn to live with. However, it is very important to understand that as people age, if not looked after, the pelvic floor is likely to become weaker and therefore could exacerbate any issues and hugely affect ones quality of life. The good thing is that, if given the appropriate attention and care, these symptoms are often reversible.

How to protect your pelvic floor

As well as staying generally healthy with consistent exercise, a varied fibrous diet and drinking lots of water, there are other important ways to look after our pelvic floor:

Posture

The posture of the body changes the way the pelvic floor muscles work. If sitting slumped, it’s hard for the muscles to do anything to help. If sitting taller, supporting the head and neck up better, the abdominal muscles can work much more efficiently and the pelvic floor is not as switched off and compromised by the pressure.

When standing, if posture is poor, the pelvic can end up tilting which will also impact how the pelvic floor muscles work. When standing with a better posture, the abdominals, bottom, pelvic floor and leg muscles are allowed to work together in synergy.

Breathing

This is something that comes completely natural to us yet most of us don’t do it the as efficiently as we are meant to. We tend to hold our breath when concentrating doing our pelvic floor exercises as well as not breathing properly down into our tummy and not expanding the breath into the side of our ribs. As your diaphragm (breathing muscle) moves, so should the pelvic floor.

Your pelvic floor is not a rigid structure, meaning it should move up and down in synergy with our breathing. As we breathe in, the pelvic floor moves down. As we relax, it moves back up. It follows the movements of your lungs and diaphragm.

The knack

Get into the habit of tightening your pelvic floor muscles the second before any activity which involves a rise in intra-abdominal pressure – coughing, sneezing, lifting, carrying, bending – even laughing sometimes.

Toileting position

Using a step or stool under your feet while on the toilet helps create a squatting position which will reduce pressure into your rectum when passing a stool. This will reduce pressure on the ligaments and muscles in this area. It is also important to ensure you always sit and relax on the toilet and not get in a habit of hovering as this does not allow your pelvic floor to relax completely while you empty your bladder.Dr Anjana Kulkarni

Recommended pelvic floor exercise routine:

Pelvic floor muscle exercises should include long, held squeezes as well as short, quick squeezes; ensuring that you let the muscle ‘go’ or ‘relax’ after each squeeze. You should work the muscles until they tire and do the exercises regularly to help the muscles become stronger and more effective.

Always remember to breath out as you lift the pelvic floor and breath in as your relax. Also start the lift from the anus, then the vagina and finally a gentle drawing in of the lower part of your tummy to activate your deepest of the abdominal muscles.

The NHS Squeezy app can be very helpful for visualisation and motivation. And, you can do these exercises anywhere without any equipment at all.

Long squeezes

Tighten your pelvic floor muscles, hold them tight, then release and let them fully relax. Repeat the squeeze and hold until the pelvic floor muscles tire. Aim to be able to do 10 long squeezes, holding each squeeze for 10 seconds.

Short squeezes

Quickly tighten your pelvic floor muscles, then immediately let them go again. Always let the muscles fully relax after each squeeze.

You may need to start with ‘little and often’ if you find that you can only hold the squeeze for a short time, or only do a few before the muscles tire. Aim for 10 short squeezes.

It’s great if you manage to do your pelvic floor muscle exercises at least 3 times each day, however this might not always be possible. Little is better than nothing.

You may find it easier to do them when you are sitting or lying down. Build up your exercise routine gradually over the weeks and months. You should notice an improvement in 3 – 5 months and then keep practising your pelvic floor muscle exercises once a day to maintain the improvement.

When to start working on your pelvic floor

If you’re not already, think about prioritising your pelvic floor health now. Pelvic floor health is for life and it’s better to start late than never.

Just like any other muscle group in the body, the pelvic floor muscles can always be improved in strength and in their ability to relax. Your bladder and bowel are adaptable too and respond to various trainings.

Final advice on looking after your pelvic floor

Sadly, too many people suffer from pelvic floor issues unnecessarily, often due to little knowledge that exists or when too embarrassed to seek help. However please be assured that passionate women’s health professionals are here to help and there is no need to suffer in silence, there is nothing your health practitioner hasn’t seen or heard before.

And on a very positive note, with the right support (and a little bit of patience and determination) many pelvic floor issues can be treated and symptoms improved greatly.  On a final note, always take your time to urinate and poo, never strain.

For more information on how to protect your pelvic floor, contact our Pelvic Floor Clinic on 020 3504 8864 or email PelvicFloorTeam@kingedwardvii.co.uk.