During menopause, the body undergoes significant hormonal changes, including a decrease in estrogen levels. This reduction in estrogen can have an impact on the pelvic floor muscles and the bladder and for this reason menopause is often a time when we see an increase in pelvic floor dysfunction including stress urinary incontinence (SUI), bladder urgency and painful intercourse. The effects of decreased oestrogen may impact the pelvic floor and surrounding structures in the following ways:
- Pelvic floor muscle tone: Estrogen plays a role in maintaining the strength and elasticity of the pelvic floor muscles. When estrogen levels decline, the muscles may become weaker and less able to provide adequate support to the bladder and urethra. This can lead to urinary leakage during activities that put pressure on the pelvic floor, such as coughing.
- Tissue integrity: Estrogen helps maintain the health and integrity of the tissues in the urinary tract, including the lining of the urethra and the supportive tissues around the bladder and urethra. Reduced estrogen levels can result in thinning and weakening of these tissues, making them more susceptible to stress-induced leakage.
- Urethral changes: Estrogen helps maintain the tone and thickness of the urethral lining, which is important for maintaining continence. With lower estrogen levels, the urethra may become more lax and less able to maintain closure during activities that increase intra-abdominal pressure, leading to urinary leakage.
- Increased urinary frequency: Some women may experience an increase in urinary frequency during menopause. This means needing to urinate more frequently than before, both during the day and at night. Estrogen helps maintain the elasticity and strength of the tissues in the urinary tract. As estrogen levels decrease, the bladder and urethra may become more sensitive, leading to a heightened sensation of needing to urinate.
- Urinary urgency: Menopause can also be accompanied by urinary urgency, which is a sudden and strong urge to urinate that is difficult to postpone. Estrogen plays a role in maintaining the coordination between the bladder muscles and the urethral sphincter, which helps regulate the timing and control of urination. The decline in estrogen can disrupt this coordination, leading to increased bladder contractions and a sense of urgency.
- Urinary tract infections (UTIs): Estrogen helps maintain the health and integrity of the tissues in the urinary tract, including the urethra and bladder lining. When estrogen levels decrease, these tissues may become thinner and more vulnerable to infections. As a result, postmenopausal women may be at an increased risk of developing urinary tract infections.
- Vaginal atrophy: Vaginal atrophy, a condition characterized by the thinning, drying, and inflammation of vaginal tissues, is commonly associated with menopause and reduced estrogen levels. The bladder lies in close proximity to the vaginal walls, and the thinning of vaginal tissues can affect the support and function of the bladder. This can contribute to symptoms such as increased urinary frequency and urgency, painful intercourse and vaginal dryness.
- Painful intercourse: Vaginal dryness, thinning of the vaginal tissues (vaginal atrophy), and reduced genital sensitivity can contribute to pain or discomfort during sexual intercourse. This condition is known as dyspareunia. The discomfort may range from mild to severe and can impact sexual satisfaction and intimacy.
It's worth noting that while menopause and reduced estrogen levels can contribute to SUI and other pelvic floor dysfunction, they are not the sole causes. Other factors such as muscle strength, previous pregnancies, and lifestyle factors also play a role.
What are the treatment options for pelvic floor dysfunction related to menopause?
If your symptoms arose during menopause, then there is likely a strong correlation between oestrogen and your symptoms. Therefore, it is likely that your health care provider may recommended topical Vaginal Oestrogen, which can assist in increasing local oestrogen actions. Hormonal Replacement Therapy (HRT) is also another option which acts systematically on the body. A discussion with your GP or Gynaecologist about what is best for you is always a good place to start.
In absence of increasing the oestrogen supply, seeing a pelvic floor physio may be recommended to achieve and address the following things:
- Vaginal Dryness: using vaginal lubricant and/or a vaginal moisturiser to keep the tissue soft and reduce friction during intercourse
- Vaginal narrowing: if vaginal narrowing is occurring, which may be impacting your bladder, bowel, or sexual function your physio may recommended dilator therapy to assist in keeping the vaginal canal more open and flexible.
- Bladder Urgency/Frequency: Bladder retraining is a common technique used by pelvic floor physios that can involve increasing the time between trips to the bathroom using a voiding schedule, using urge deferral techniques, and working with the neural supply to the bladder through specific exercises or pelvic floor down training.
- Pelvic Floor Muscle Training: If you are experiencing SUI, leaking at the end of the day or vaginal heaviness, then you may be recommended to begin pelvic floor muscle training. This may involve the use of vaginal weights, body weight exercises or static “Kegels” to strengthen the pelvic floor and better support your bladder and bowel.
- Prolapse and vaginal heaviness: if you are experiencing a vaginal bulge, heaviness or dragging sensation then you have a vaginal prolapse. This can be treated with pelvic floor physio a lot of the time, using devices called support pessaries, amongst other things.
To find a Pelvic Floor Physio near you, you can use our online Clinician Locator