Talking about the pelvic floor can be embarrassing for many women, however, incontinence and sexual dysfunction are very common menopausal issues and it’s important to talk about what causes them and what can be done about it.
The pelvic floor
The pelvic floor muscles are arranged like a hammock in your pelvis and support your bladder, uterus, vagina and rectum. They aren’t fixed like a floor but move up and down in time with your breath.
They should be strong and reactive enough to contract to keep the neck of your bladder closed when you laugh, cough and sneeze and to resist impact forces when you run, dance or jump, and be able to help you ‘hold on’ if there is no toilet available.
As you get older and go through menopause, you might find that your pelvic floor muscles grow weaker and thinner as your estrogen levels start to drop.
A weak pelvic floor leads to leaks (like when you sneeze, at the gym etc). It’s important to strengthen the pelvic floor by doing Kegel (pelvic floor) exercises regularly even if you aren’t experiencing any leaking yet.
Kegel exercises to strengthen your pelvic floor
Kegel exercises can increase the strength of your pelvic muscles, prevent a number of diseases and improve your sex life.
The exercises are easy to perform after finding the right muscles and improving your technique with perseverance and discipline.
They can be done in any position of the body, but in the beginning, it will be easy for you if you lie on the ground with bent legs and relax.
Who should be doing Kegel exercises?
Many factors can weaken your pelvic floor muscles, including menopause, pregnancy, childbirth, surgery, ageing, excessive tension from constipation or chronic cough, and being overweight.
Kegel exercises can help with urinary incontinence and other pelvic floor problems.
You can benefit from Kegel exercises if you’re experiencing any of these:
- Excretion of some urine when sneezing, laughing or coughing (stress incontinence)
- You have a sudden urge to urinate just before you lose a large amount of urine (urinary incontinence)
- Stool leakage (faecal incontinence)
Finding your pelvic floor muscles
The easiest way to locate the right muscles is to observe your muscles while using the bathroom. While you’re urinating, try to stop the flow of urine and pay attention to which muscles you are tightening.
In case you have difficulties and you are not sure whether these are the right muscles, you can try another method. With clean hands, insert a finger into your vagina and tighten it until you feel the muscles around your finger.
What exercises to do
As written in The New Hot book, there are two types of pelvic floor contraction: a long hold and quick flicks. The long hold will help you strengthen your muscles especially for those times when you need to hold on, the second will stop leaking if you laugh or jump. Both of these are great for women in menopause.
Long hold exercises:
- Take a deep breath in, sigh out as you squeeze and lift your bumhole.
- Hold for a count of 10 (keep breathing) and relax. Don’t worry if you can’t hold it for a count of 10, keep practising, and as you get stronger, you’ll be able to hold on for longer.
Quick flicks exercises:
- This time, quickly tense then release the muscles, 10 times.
Try not to hold your breath as you do this. If you are experiencing leakages, do both those exercises three times a day, for three months. Once you are dry do the exercises once a day, every day, for maintenance.
Frequency and effects of exercise
To enjoy the benefit of the Kegel exercises, it’s important to be constant. Exercises are best done 3 times a day – in the morning, at noon, and in the evening.
If you feel pain during or after the exercises, you are probably not tensing the right muscles. If you do the exercises properly, you should not experience any pain or discomfort afterwards.
You can increase the repetitions over time, but the tight contraction and relaxation of the pelvic floor muscles can have the opposite effect (leading to increased muscle fatigue, which may be the reason for the pelvic floor’s poor performance).
As with any physical workout, it takes time to see the results you want. The effects are usually present within four to ten weeks.
- before training, make sure to empty your bladder to avoid pain and discomfort
- make the exercises a routine: include them in your daily activities and do them three times a day
- do not stop the Kegel exercises after achieving the desired effect: if you stop training the old pains and problems will reappear. Alternatives
There are various alternatives to pelvic floor exercises (Kegel exercises), such as:
- electrical stimulation: a method by which electrical stimulation activates desired muscle groups
- Kegel balls: small, spherical balls that are placed in the vagina and the main purpose is to keep them there
- vaginal weights: usually weighing no more than 500 grams, up to 20 centimetres long and up to 3 centimetres wide
Numerous studies support Kegel exercises as the most effective method and therapy of choice in patients with urinary incontinence, as some of the alternative methods (electrical stimulation, use of vaginal weights) are not approved by many countries and their use is not recommended.
What if you don’t see any improvement?
If, after three months of doing exercises, you are still not dry or if you get pain when you do the exercises, are not sure what you are doing, or they just don’t work, then go to see a specialist pelvic health physiotherapist.
They work directly on training the muscles in this area, just like a sports physiotherapist might help strengthen your back or legs after injury. To find one, search online for ‘pelvic health’ or ‘women’s health’ physiotherapy. Some health services have a self-referral system, some need GP referral, and some physios work privately, so ask at the clinic what you need to do to make an appointment.
While you’re working on the exercises, pads are a useful tool to protect from leaks. Although remember that while a pad can help confidence, it won’t fix anything. Do your pelvic floor exercises, don’t put up with leaking.
But don’t be afraid to talk about this with friends who are going through the same! There is nothing to be ashamed of – it’s a very normal part of life and you don’t need to suffer in silence.