How can pelvic physiotherapy support perimenopause?

Poor pelvic health, such as bladder, bowel and sexual dysfunction, is a leading barrier to continuing exercise and can be detrimental to our mental health.

For much of our lives, oestrogen is our power house - it’s what keeps muscles, tendons and connective tissue stretchy, subtle and strong, our joints healthy and lubricated. It keeps the vaginal and urethral walls moist and elastic, with capacity for distention and constriction. We go through life not fully appreciating the wonderful things oestrogen does for us.

A reduction in oestrogen levels can cause local changes to the vaginal and vulvar tissues and muscles which we call Genitourinary Syndrome of Menopause (GUSM). This describes a collection of symptoms which are all caused by this hormonal shift.

Symptoms of GUSM include:

• Vaginal dryness, burning or sandpaper-like feeling

• Pain with sex and decreased lubrication

• Vaginal and vulvar itching - Changes in odor and discharge

• UTI’s or vaginal infections

• Skin irritation

• Change in orgasm

• Reduced strength or takes longer to achieve

• Smear tests or tampon insertion (if still using) become uncomfortable

• Symptoms of prolapse, such as heaviness or pressure - Increased frequency and urgency to empty bladder

• Leaking urine with exertion or not making it to toilet on time

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Firstly, bringing attention to our vulvar skin care, and use of lubricants, vaginal moisturisers (like YesYesYes) and a prescription for vaginal oestrogen could be instrumental for managing these symptoms. Depending on the person, HRT can also play a role in improving these issues, too.

Pelvic floor Physiotherapy can be a game changer, and is actually a gold standard treatment for managing GUSM symptoms.

So how does physio work?

Leaking urine on coughing, running or jumping (called stress urinary incontinence or SUI) is extremely common. If the pressure in our tummy is less than the pressure created by the muscles surrounding the urethra, then we are protected from leaking. This urethral closure pressure is created in two ways:

1. Like the vaginal walls, the urethral walls fold in on themselves to allow for considerable expansion when emptying the bladder, and creating a leakproof closure pressure when at rest. 2. Abdominal pressure presses down onto the bladder neck, and compresses it - stopping the flow of urine, like stomping on a garden hose.

Any changes to tissue quality, like GUSM, can alter this mechanism, as the plump urethral walls become drier and thinner, and the connective tissue supporting the bladder weakens.

However, learning how to fully contract and relax the pelvic floor muscles has been shown to increase blood flow, tissue elasticity and muscle bulk, improving tissue quality and often improving or resolving SUI.

Pelvic organ prolapse (POP) symptoms may also begin or worsen during perimenopause or post-menopause. This is where there is an excess of downwards movement in the vaginal walls and connective tissue that provide support for your pelvic organs, causing descent to or past the entrance of the vagina. Childbirth, pregnancy, hypermobility and chronic straining are all examples of risk factors for pelvic organ prolapse, and declining oestrogen levels and tissue quality could contribute to an increase in symptoms.

Types of pelvic floor prolapse

Thankfully, we can use pelvic floor muscle training to create a hammock of support from underneath to manage prolapse symptoms.

A pelvic floor physiotherapist will also look at your whole body biomechanics to help you optimise support from below and minimise pressure from above, as well as optimising bowel habits and toileting postures to minimise straining.

Keep exercising!

Pelvic health concerns should never be a barrier to exercise. Exercise and keeping muscles strong is especially crucial during this stage of life, as it also helps body weight, bone density, cardiovascular health, and supports mental well-being by managing anxiety and depression.

Exercise has even been shown to improve vasomotor symptoms like hot flushes!

If you’re experiencing pelvic floor symptoms or want to protect your pelvic floor for the future, reach out to a pelvic floor physiotherapist for support.

Alma Physiotherapy offer a Menopause Pelvic Floor Assessment & Treatment appointment with their specialist physios, and you can get 10% off the first session with code BM10.

Meg is a sports (MSK) and pelvic health physiotherapist based at Alma Physiotherapy, 25 Lower Redland road, Bristol, BS6 6TB. Book via: www.almaphysiotherapy.co.uk/book-online Email her PA Zainab pa@almaphysiotherapy.co.uk or call 07942 494506 for help booking.

References:

Russo et al. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas. 2021 Jan;143:223-230. doi: 10.1016/j.maturitas.2020.09.005. Epub 2020 Sep 30. PMID: 33008675. Mercier et al. 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. Mercier et al. Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: A single-arm feasibility study. Maturitas. 2019 Jul;125:57-62. doi: 10.1016/j.maturitas.2019.03.002. Epub 2019 Mar 29. PMID: 31133219.