How to strengthen your pelvic floor to stop menopause incontinence!


Many of us will have experienced that unexpected failing of our pelvic floor as we cough, sneeze, laugh, run for the bus or trip over the dog. As oestrogen levels deplete, incontinence and prolapse become more prevalent in menopause (see our separate blog ‘Menopause prolapse - the lowdown').

Women’s Health Physiotherapists Christien Bird and Sophie Vohralik work with women at different stages in their lives, treating pelvic floor problems including pain, dysfunction, incontinence and sexual impairment. We met with them to listen to their pearls of wisdom on how and why, we need to work on our pelvic floors before, during and after menopause. It was fascinating and enlightening to find out just how much we can all do to improve our pelvic floor strength and the massive benefits to be had.

Many of us think these leaks are standard for women either as a consequence of childbirth or ageing. However, Christien said leaking is ‘too common but never normal’. Read on for her advice.


What is the pelvic floor?

It's a two-layered floor made up of connective tissue and muscle that sits v-shaped around the vagina, bladder and rectum, maintaining continence.


What causes the pelvic floor to weaken?

The main risks include:

  • Pregnancy and childbirth (not just vaginal delivery)
  • Constipation (a menopause side-effect)
  • Perimenopause
  • Menopause

Why does menopause affect the pelvic floor?

The vagina and vulva are ‘well-oestrogenised’ before perimenopause. Think moist, pink & thick. When oestrogen ‘retires’, it can leave a ‘poorly-oestrogenised’ vagina, red, dry, sore and with thinner tissue. So, what can you do about it? Lots, according to Christien.

What can you do to help improve pelvic floor strength?

Christien recommends:

  • Do your pelvic floor exercises. If exercises are done correctly and regularly pelvic floors can be built up and strengthened, stopping leaks. See our vlog, Hot Flush talking pelvic floors, incontinence, prolapse and prevention for simple, expert advice as Christien talks us through how to exercise correctly.
  • Download the NHS Squeezy App, (£2.99), designed by chartered pelvic health physiotherapists working in the NHS. A non-negotiable for Christien, this app prompts you to do your exercises as well as coaching women through the techniques.
  • Leakage needs following up. Consult your GP for a referral to the appropriate department, including access to NHS Women’s Health Physiotherapists, who can assess your situation and recommend a treatment plan.
  • Ask to see a GP you’ll be comfortable with to get a relevant referral (Research shows women can take 10 years or longer before asking for help with incontinence).
  • Use topical oestrogen to support pelvic floor muscle function and pelvic health. It plumps up vaginal tissue, helps with lubrication and muscle function. Containing a very small dose of oestrogen, it's available on prescription from your GP.

And finally

It’s never too late to start looking after your pelvic floor! Please don’t suffer in silence. Do your exercises, talk to your GP and take heart that this is one menopausal symptom that you can manage effectively. Do take a look at our post on Prolapse, a condition affecting up to 50 per cent of women in menopause - Who knew?

Don't forget to watch our vlog with Christien explaining how to exercise your pelvic floors to prevent incontinence (At around 9 minutes 50 seconds, she shows step by step guidance, it's worth checking out!)