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Physio: Fixing a wee problem - before, during and after menopause

On World Menopause Day, Chartered Physiotherapist Aoife Ni Eochaidh says practice is key to fixing any pelvic issues.

Aoife Ni Eochaidh

Updated Oct 18th 2021, 9:14 AM

WHAT ABOUT YOUR pelvic floor and menopause? What problems can arise that may be HRT can’t resolve?

There are hormonal changes around menopause that affect muscle function. Though HRT will work on those hormonal changes it won’t train the pelvic floor muscles.

Menopause fatigue and sleep disturbance can also affect the pelvic floor muscle function. The bladder and bowel muscles themselves can be affected by hormonal changes too.

Sexual function can be affected as well with hormonal changes. Keeping your pelvic floor muscle function in the normal range is so important before, during and after menopause and it will prevent and treat bladder, bowel, prolapse and sexual problems.

Pelvic floor

The exact location of the pelvic floor muscles in women is often a mystery. To get us thinking and to solve that mystery, let’s imagine that we are sitting on the corner of a rectangular-shaped table, with one of our legs on the short side of the rectangle and the other leg on the long side of the rectangle. The area of our bodies actually in contact with the top of the table, is a group of muscles called the pelvic floor.

The pelvic floor muscles have four main parts to normal function: The first one is muscle bulk, you can think of this too as muscle thickness. Next, the fitness or endurance is another important feature: this is to do with the number of muscle contractions a person can do.

Next of all, we need to mention muscle strength, this is squeeze strength or the power that is generated when the muscle contracts. Lastly, muscle movement is another key important element of function: this means contracting or squeezing as well as relaxing or letting go properly and moving forwards and upwards, in an automatic or reflex way.

The pelvic floor muscles are among some of the most important muscles in the body because they are responsible for the normal filling, storing, and emptying of our bladder and our bowels. They are important too for normal sexual function (to be able to orgasm or climax correctly) and to hold our pelvic organs in place correctly and to guard as pelvic organ prolapse, the organs coming down (the bladder, bowel, and womb in women).

If the pelvic floor muscles are not in the normal range of function, then our bladder and our bowel may not fill, store and emptying urine (our wee) and stool (our poo) correctly. If we are not eliminating our waste material (wee and poo) correctly we can become unwell, with urinary tract infection or obstructed bowel or constipation.

If our bladders and our bowels are not working correctly or if we have a prolapse or sexual dysfunction and our quality of life can be severely affected. We can’t live our lives, go to work travel or exercise without worries about bladder or bowel leaks or we worry if we night need the bathroom urgently to empty our bladder or bowel.

We won’t feel well if we can’t empty our bowels or bladders and we might not sleep well either and our energy levels will be poor, and we will feel anxious.

Tackling pelvic problems

Problems with our pelvic floor muscles can affect women before, during and after menopause but also in pregnancy, the post-natal period, and as we get older.

So much help is available to get the pelvic floor muscles trained though! So, how do we exercise the pelvic floor muscles? Through specific exercises…. by the way, it is not a quick fix. NICE European guidelines tell us it can take three months to fully train the muscles. We can also train our pelvic floor muscles through lifestyle changes, by using electrical stimulation, by using internal pelvic floor weights.

Training the bladder muscle itself and training the bowel and gut reflexes is needed too. The exercises and routines need to be targeted to the different muscle fibers, and you need to progress them and keep doing them for life at a maintenance dose but much more frequently in the beginning.

One great pelvic floor exercise women can do before, during or after menopause, is called the Decrease the Bladder Urge Exercise. To do the exercise, you must be still, don’t try this one on the move, it won’t work. Tighten or squeeze the muscles around the back passage as if you are trying to hold in wind or gas, hold the squeeze for just one second and then let the muscle go straight away, repeat this six or seven times. The key things are that the squeeze is as strong as possible, a 100% effort, do it as fast as possible and short, only hold it for the bare one second!

Do this exercise twice in the day before you empty your bladder, pick the times that you will do it, for example at 4 pm and 6 pm. It will help train the automatic reflex activity that should be happening between your pelvic floor muscles and your bladder muscle.

You can also use this exercise if you are trying to defer going to the bathroom, it will give you extra time to get to the bathroom more comfortably without having to hope for the best and cross your legs!

This is particularly useful if on reaching your front door and for some women with weak pelvic floor muscles, when they put their key in the door, they can get an overwhelming urge to empty their bladders and they can get caught short and unfortunately have a leak. If this exercise, however, doesn’t work at all for you it might be that your muscles as just too weak, you may need electrical stimulation.

Practice is key

It is recommended also that some people will need medication prescribed by their doctor as well as the pelvic floor muscle exercises for three months and then when the muscles are more trained the person can be weaned off the medication under the supervision of their doctor.

Pelvic Floor Muscle Training is for life. It needs to become a lifestyle change. The more you do the easier it becomes because the muscles start to work more automatically and reflexively the way they do when we are younger, before menopause and before they get weak.

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A great study carried out in Stanford by one of my great UK colleagues Professor Ruth Lovegrove Jones found out using Ultrasound imaging that people with incontinence don’t have this automatic action, it’s a kind of key lifting or tethering of the bladder and the bowel to keep us continent. Thankfully we know it can be trained back in action though.

Some people need to be extra vigilant to train their pelvic floor muscles on a daily basis. Women who are approaching, going through or are after menopause need to train their pelvic floor muscle daily.

Women who have had difficult childbirth and delivery, especially ladies who had a long second stage of labour, the pushing part, particularly if it was longer than one-hour, new mums that needed forceps to deliver their baby, or those unfortunately with a thing called a 3rd or fourth-degree tear. It’s never too late to start the training!

Pelvic floor muscle dysfunction can cause problems for women before, during or after the menopause from a sexual function point of view. Women can have pain during sex, and they can have issues with climax and leaks of urine, wind, or stool. Pelvic floor muscle training will help with all of these problems.

If you think you might be affected by menopause related pelvic floor muscle problems please see your GP, who will refer you to a Pelvic or Women’s Health Physiotherapist, or you can also self-refer.

Aoife Ni Eochaidh is a Chartered Physiotherapist, Clinical Specialist in Women’s & Men’s Health & Continence at the Bon Secours Consultant Clinic in Renmore, Galway. Twitter: @PelvicExpert.

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