Exercising your pelvic floor should be as important a part of your daily routine as brushing your teeth. Read more
Retrain your bladder to develop good habits by practising the Bladder Drill. Read more
The menopause is when your body’s ovaries stop producing the hormones oestrogen and progesterone and your periods stop. Oestrogen is an important hormone for pelvic health and this is why many women find that they develop problems at this time of their life.
Oestrogen is important for keeping the ligaments of your pelvic floor (Pelvic Floor article) strong and elastic. When the levels of this hormone drop, the ligaments that hold your bowel, bladder and womb in place become thinner, weaker and less resilient. The result is a greater chance that you will develop a prolapse or begin leaking from your bladder or bowel. Oestrogen also has a direct effect on your urethra (the tube that carries urine from your bladder to the outside world) and when levels drop, it becomes harder for a close, tight seal to be formed at the opening to your bladder.
Around 50% of all menopausal women suffer from either a prolapse or some form of leakage, or often both.
A prolapse simply means that one of the three organs in your pelvis has moved down into the vagina. A cystocele is where the bladder has prolapsed down and is pressing on the front wall of your vagina. A rectocele is where the bowel has prolapsed down and is pressing on the back wall of your vagina. A uterine prolapse is where the womb has moved down into the vagina. It is possible to have more than one prolapse at the same time. These prolapses can be mild (in which case you may not even be aware they are there) or more advanced when you may see a ball shape at the entrance to, or just outside your vagina. These organs can’t drop out altogether but they can be very uncomfortable if they are protruding a long way past your vagina.
If you have a prolapse then you may feel a dragging sensation or even have low back pain. Even if you have had a hysterectomy (removal of your womb), you can still develop a prolapse of your bladder or bowel, particularly if you have not strengthened your pelvic floor muscles before or after your operation.
There are two types of bladder leakage that can happen after the menopause. The first is known as Stress Urinary Incontinence and happens when the ligaments and muscles of your pelvic floor become stretched. When you cough, sneeze or laugh, pressure is applied to your bladder. If the ligaments and muscles supporting it are weak, then urine escapes.
Over-Active Bladder. This type of leakage happens when you are desperate to go to the loo and can’t hold on. Our article on ‘When your bladder rules you’ tells you more about this problem and what you can do to help it. Changes in the sensitivity of the bladder lining due to lower levels of oestrogen are thought to cause menopausal Over-Active Bladder.
Much of the damage to the ligaments, muscles and tissues of the pelvic floor is actually caused by being pregnant and giving birth. Other risk factors include having a long history of constipation (link to Constipation article), being over-weight or doing lots of heavy lifting. Before the menopause, the ligaments and muscles are often able to cope with some level of weakness but after oestrogen levels plummet, the weakness can suddenly become much worse. This is when you need your pelvic floor muscles to begin to compensate if you are to avoid symptoms. As we get older, our muscles naturally lose mass. This means that we have to actively work these muscles in order to keep them strong and active. Without this, it is inevitable that they will weaken after the menopause.
Our article on ‘Pelvic Floor Exercises’ tells you how you can begin to strengthen these muscles. If you struggle to feel your pelvic floor muscles, or do not seem to be making any improvement, then Neen products are designed to help you increase the power of your pelvic floor muscles so that they can over-come the effects of these stretched ligaments. The peritone, aquaflex and educator will all help you to become more aware of, and strengthen, your pelvic floor muscles (insert links).
Other pelvic health problems caused by the menopause
Lower levels of oestrogen also have an effect on the skin of your vagina and vulva. This means that skin conditions that cause redness, itching or irritation are more common after the menopause. It is also common to feel dryer and to need some form of lubrication during sexual intercourse. You may also notice changes to your vaginal discharge. Before the menopause, the skin in the pelvic area is quite acidic but it becomes less acidic after oestrogen levels drop. This makes it easier for bacteria to grow so you may find that you begin to get bladder or vaginal infections. If your skin does become sore or itchy, it is important to discuss this with your GP so that it can be treated. Sometimes a referral to a Dermatologist who specialises in vulval skin conditions may be necessary.