Menopause and Pelvic Health Physiotherapy

Menopause marks a major transition in a woman’s life—one that can bring both physical and emotional changes. Many women experience pelvic health symptoms during this time that can greatly affect their quality of life. In fact, vulvovaginal symptoms are reported by over half of postmenopausal women, and can influence comfort, intimacy, and daily wellbeing.

The good news? There’s a lot that can be done to help. Research clearly supports targeting the pelvic floor as part of effective menopause care. Evidence shows that pelvic floor muscle training can enhance blood flow to vulvovaginal tissues, improve muscle relaxation, and increase tissue elasticity in women with genitourinary syndrome of menopause or urinary incontinence. It can also improve muscle strength, reduce mild pelvic organ prolapse, and decrease urinary symptoms.

Let’s take a closer look at what the pelvic floor is and how menopause can affect it.

The Pelvic Floor

The pelvic floor is a group of muscles that stretch like a hammock across the base of the pelvis, attaching to the pubic bone, tailbone, and sitting bones. These muscles support the bladder, uterus, and bowels, while also playing key roles in bladder and bowel control, sexual health, circulation, and core strength.

Common Pelvic Health Symptoms in Menopause

• Urinary incontinence, urgency, or frequency

• Fecal incontinence or bowel urgency

• Pelvic pressure or heaviness

• Diastasis recti abdominis (abdominal separation)

• Pelvic organ prolapse

• Vaginismus (involuntary tightening)

• Sexual pain or dysfunction

• Post-hysterectomy or post-surgical changes

• Vulvodynia and vestibulodynia

• Persistent genital arousal disorder

• Interstitial cystitis/bladder pain syndrome

• Lichen sclerosus

• Genitourinary syndrome of menopause (GSM)

The Link: How Menopause Affects the Pelvic Floor

The vagina, pelvic floor muscles, and urinary tract (including the urethra) all contain estrogen receptors, making them sensitive to the drop in estrogen that occurs during menopause. As estrogen levels decline, these tissues can become thinner and less elastic, and blood flow to the area can decrease. This may contribute to muscle weakness, altered tissue health, and symptoms such as dryness, discomfort, or loss of support.

How Pelvic Health Physiotherapy Can Help

A Pelvic Health Physiotherapist is trained to assess, manage, and treat pelvic health symptoms related to menopause.

Your first visit will begin with a detailed health history to understand your symptoms and goals. The physical assessment may include evaluating the muscles, ligaments, joints, and connective tissues of the pelvis, hips, low back, and abdomen. With your consent, an internal examination may be recommended to assess pelvic floor strength, tone, coordination, and areas of discomfort. If you prefer, external assessment techniques can be used instead.

What Treatment May Include

Each treatment plan is personalized to meet your specific needs and goals. Options may include:

• Education about your condition, symptoms, and treatment options

• Breathing coordination and training

• Bladder and bowel retraining strategies

• Constipation management

• Manual therapy for muscles and fascia

• Visceral mobilization

• Pelvic floor relaxation and downtraining techniques

• Pelvic floor and core strengthening

• Motor control training for the abdominal wall, hips, and thorax

• Postural retraining

• Diastasis recti abdominis rehabilitation

• Functional re‑education to improve movement and activity

• Neuromuscular stimulation of the pelvic floor

• Collaboration with other healthcare professionals for comprehensive care

If you’re experiencing pelvic health changes related to menopause, Ottawa Pelvic Health is here to help. Book a complimentary 15‑minute phone consultation with one of our specialized Pelvic Health Physiotherapists to discuss your symptoms and determine the right next steps for you.

References

1. Erekson EA, Li FY, Martin DK, Fried TR. Vulvovaginal symptoms prevalence in postmenopausal women and relationship to other menopausal symptoms and pelvic floor disorders. Menopause. 2016 Apr;23(4):368-75. doi: 10.1097/GME.0000000000000549. PMID: 26645820; PMCID: PMC4814326.

2. Mercier J, Morin M, Tang A, Reichetzer B, Lemieux MC, Samir K, Zaki D, Gougeon F, Dumoulin C. Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause. Climacteric. 2020 Oct;23(5):468-473. doi: 10.1080/13697137.2020.1724942. Epub 2020 Feb 27. PMID: 32105155.

3. Alves FK, Riccetto C, Adami DB, Marques J, Pereira LC, Palma P, Botelho S. A pelvic floor muscle training program in postmenopausal women: A randomized controlled trial. Maturitas. 2015 Jun;81(2):300-5. doi: 10.1016/j.maturitas.2015.03.006. Epub 2015 Mar 14. PMID: 25862491.

4. JOGC September 2014. Chapter 5 - Managing Menopause. Urogenital Health. S35-41. http://dx.doi.org/10.1016/S1701-2163(15)30461-8 (accessed November 1, 2021)

5. Ahinoam L. Postpartum Dyspareunia Resulting From Vaginal Atrophy. ClinicalTrials.gov Identifier: NCT01319968. Last updated April 7, 2015. https://clinicaltrials.gov/ct2/show/NCT01319968 (accessed November 1, 2021)

6. Navarro Brazález B, Torres Lacomba M, de la Villa P, Sanchez Sanchez B, Prieto Gómez V, Asúnsolo del Barco Á, McLean L. The evaluation of pelvic floor muscle strength in women with pelvic floor dysfunction: A reliability and correlation study. Neurourology and urodynamics. 2018 Jan;37(1):269-77. available from : https://www.ncbi.nlm.nih.gov/pubmed/28455942

7. Sherburn M, Murphy CA, Carroll S, Allen TJ, Galea MP. Investigation of transabdominal real-time ultrasound to visualise the muscles of the pelvic floor. Australian Journal of Physiotherapy. 2005 Jan 1;51(3):167-70.