What happens to your pelvic floor after menopause? It’s something many of us don’t think about until we begin experiencing urinary leakage, urgency, discomfort during sex, constipation, pelvic pressure, or other changes that we may mistakenly assume are simply part of getting older.
But understanding your pelvic floor after menopause is incredibly important — and it involves much more than simply doing Kegels.
In a recent episode of Tea with Sophie, I sat down with pelvic-floor expert and yoga teacher Leslie Howard for one of the most illuminating conversations I’ve had about women’s health. Listen to it now.
And one of the most important things I learned was this:
A pelvic floor problem does not necessarily mean you have a weak pelvic floor.
In fact, for some women, the problem may be exactly the opposite.
What Happens to Your Pelvic Floor After Menopause?
Your pelvic floor is a group of muscles and connective tissues that form a supportive base at the bottom of your pelvis. These muscles help support your pelvic organs and contribute to bladder and bowel control, sexual function, stability, and movement.
Like every other muscle in your body, your pelvic-floor muscles need to be able to do more than simply contract.
Pelvic-floor health is also part of the bigger picture of maintaining strength and function as we age. If you’re interested in protecting your strength for the decades ahead, read my guide to strength training for women over 50.
Pelvic floor muscles need to contract, release, lengthen, and coordinate appropriately with your breath and the rest of your body.
Your pelvic floor after menopause can also be affected by hormonal changes. As estrogen levels decline, changes can occur in the tissues of the vulva, vagina, urethra, and bladder. These changes, known collectively as genitourinary syndrome of menopause (GSM), can contribute to vaginal dryness, discomfort, urinary urgency, recurrent urinary symptoms, and changes in sexual function.
Pregnancy and childbirth, constipation and straining, pelvic surgery, aging, physical activity, and other factors can also influence pelvic-floor function.
The important point is that these symptoms may be common, but that doesn’t mean you should simply accept them as an inevitable part of getting older.
Are Kegels Good for Your Pelvic Floor After Menopause?
For years, women have been given one fairly universal piece of advice:
Do your Kegels.
A Kegel is essentially a contraction of the pelvic-floor muscles. And for a woman with an appropriately diagnosed weak or underactive pelvic floor, pelvic-floor muscle training may absolutely be helpful.
But Leslie explained something that I think every woman needs to understand:
Not every dysfunctional pelvic floor needs more tightening.
Some women have pelvic-floor muscles that are already overly tense or have difficulty fully relaxing.
Think about another muscle in your body. If that muscle were chronically tight and uncomfortable, would your first instinct be to repeatedly contract it even harder?
Probably not.
Yet that’s essentially what many of us have been taught to do with the pelvic floor.
So if you’re concerned about your pelvic floor after menopause, simply adding more and more Kegels may not necessarily be the answer.
The first question is: What does your particular pelvic floor actually need?
A Tight Pelvic Floor Can Cause Problems Too
One of my favourite takeaways from my conversation with Leslie was moving away from this very simplistic idea:
Weak = bad. Strong = good.
A healthy pelvic floor needs both strength and the ability to relax.
An overly tight or overactive pelvic floor can be associated with pelvic discomfort, pain during intercourse, difficulty with bowel movements, urinary symptoms, and other pelvic-floor issues.
And this is why I encourage women who are experiencing persistent symptoms to consider seeing a qualified pelvic-floor physical therapist or other appropriately trained healthcare professional.
Rather than guessing whether your pelvic floor needs strengthening, stretching, relaxing, or something else entirely, you can find out what’s actually happening in your body.
Urinary Leakage After Menopause: Stress vs. Urge Incontinence
Urinary leakage is one of the most common reasons women suddenly start thinking about their pelvic floor.
But not all urinary leakage is the same.
Stress urinary incontinence typically means leakage when pressure inside the abdomen increases — perhaps when you cough, sneeze, laugh, run, jump, or exercise.
Urge urinary incontinence involves a sudden and compelling need to urinate that may be difficult to defer and can sometimes result in leakage before you reach the bathroom.
Some women experience a combination of the two.
Understanding the difference matters because different urinary symptoms don’t necessarily have the same underlying contributors or require exactly the same approach.
Again, this is why “just do your Kegels” is far too simplistic.
Breathing and Your Pelvic Floor After Menopause
This was one of the most fascinating parts of my conversation with Leslie.
Your pelvic floor doesn’t operate in isolation.
It works in relationship with your diaphragm, abdominal muscles, and the changing pressure inside your abdomen.
As you breathe, your diaphragm and pelvic floor move in coordination with one another.
This means that breathing is part of the pelvic-floor conversation too.
During our interview, Leslie actually guided me through a breathing practice so I could experience this relationship in my own body. I highly recommend watching this portion of the episode and trying it with us.
It was such a wonderful reminder that caring for your pelvic floor after menopause isn’t necessarily about squeezing harder.
Sometimes we need to become aware of what we’re holding.
Where we’re gripping.
And whether we can actually let go.
Stress, Tension, and Your Pelvic Floor
We often talk about carrying stress in our shoulders, jaw, or neck.
But we can hold muscular tension elsewhere too — including around the pelvis.
If you’re someone who constantly braces your abdomen, clenches your jaw, holds your breath, or generally tightens your body when you’re stressed, it’s worth becoming curious about what your pelvic floor may be doing at the same time.
This is another beautiful example of why I don’t believe we can separate the different systems of the body.
Breath, nervous-system state, movement, muscle function, and pelvic health are interconnected.
And sometimes the answer isn’t to push the body harder.
It’s learning how to listen to it.
Your Pelvic Floor Is About More Than Bladder Control
Pelvic-floor health is so often reduced to one thing: urinary leakage.
But these muscles are involved in so much more.
Your pelvic floor plays a role in:
- Bladder control
- Bowel function
- Sexual function and comfort
- Supporting your pelvic organs
- Movement and stability
- Managing pressure within your abdomen
This is why changes in your pelvic floor after menopause can sometimes show up in ways that you may not immediately associate with the pelvic floor.
Understanding our anatomy is incredibly empowering.
For many of us, nobody ever taught us this information when we were younger.
It’s time we changed that.
Pelvic Floor After Menopause: What About Prolapse?
Pelvic organ prolapse occurs when one or more pelvic organs descend from their normal position, potentially creating pressure or a bulge into the vaginal canal.
Women may notice heaviness, pressure, a dragging sensation, or a feeling of bulging or “falling down.”
If you’re experiencing these symptoms, don’t diagnose yourself and don’t assume that doing hundreds of Kegels will fix the problem.
There are conservative approaches that may help many women, including appropriately prescribed pelvic-floor rehabilitation and lifestyle strategies. Treatment, however, needs to be individualized according to the type and severity of the prolapse and your overall health.
This is an area where getting a professional assessment can be enormously helpful.
Constipation and Your Pelvic Floor
Here’s something else we don’t talk about enough: your bowel habits matter to your pelvic floor.
Having a bowel movement requires coordination.
Your pelvic floor muscles need to relax appropriately to allow stool to pass. Repeated straining also increases pressure on the pelvic structures.
So if you’re thinking about protecting your pelvic floor after menopause, don’t overlook constipation.
Eating adequate fiber, drinking enough fluid, moving your body regularly, and addressing persistent constipation can all form part of supporting pelvic health.
And if you regularly have to strain or have difficulty emptying your bowels, it’s worth discussing this with an appropriately qualified healthcare professional.
Painful Sex After Menopause Isn’t Something to Ignore
Another subject women are often reluctant to talk about is pain or discomfort during sex.
Hormonal changes during and after menopause can affect vaginal and vulval tissues, while pelvic-floor muscle tension may also contribute to discomfort for some women.
But please don’t assume that painful sex is simply the price of getting older.
If you’re experiencing persistent pain, burning, dryness, or discomfort, talk to your healthcare provider. There are multiple potential causes and treatment options, and you deserve to have the problem properly assessed.
How to Protect Your Pelvic Floor After Menopause
So what can you actually do?
The first step is awareness rather than assumption.
Pay attention to what your body is telling you.
Can you feel your pelvic floor?
Can you gently contract it?
More importantly, can you fully release it?
Do you constantly grip or brace your abdomen?
Are you holding your breath when you lift something heavy?
Are you experiencing leakage, urgency, pelvic pressure, constipation, or pain?
And if symptoms persist, consider seeing a qualified pelvic-floor physical therapist or healthcare professional who can assess what’s actually going on.
Because the goal isn’t simply to have the “strongest” pelvic floor possible.
The goal is to have a functional pelvic floor — one that can contract when necessary, relax when necessary, and coordinate appropriately with your breath and the rest of your body.
It Is Never Too Late to Understand Your Body
I wish pelvic-floor health were something women were taught about when we were young rather than something many of us discover only when we develop symptoms.
But it is never too late.
And after 50, when we’re thinking much more intentionally about building strength, maintaining mobility, protecting our bones, and staying active for the decades ahead, I believe understanding your pelvic floor after menopause deserves to be part of that conversation.
My full conversation with Leslie goes much deeper into pelvic-floor anatomy, menopause, urinary leakage, Kegels, breathing, movement, UTIs, constipation, and the relationship we have with this often-overlooked part of our bodies.
Watch or listen to my full Tea with Sophie conversation with Leslie Howard: What Every Woman Needs to Know About Her Pelvic Floor.
Or, if you prefer, WATCH it here.
Your pelvic floor isn’t something to fear, ignore, or simply squeeze.
It’s something to understand.
And the more we understand our bodies, the better equipped we are to care for them for all the years ahead.
This article is for educational purposes only and is not intended to diagnose or treat pelvic-floor, urinary, bowel, or sexual-health conditions. If you are experiencing pain, bleeding, recurrent urinary symptoms, prolapse symptoms, or changes in bladder or bowel function, please speak with an appropriately qualified healthcare professional.