Your pelvic floor supports you in more ways than you might realize. A group of muscles and tissues, the pelvic floor provides a shelf for the pelvic organs like the bladder, uterus, and lower bowels to rest on. It plays a critical role in urinary, bowel, and sexual function, and is also important for core stability. Together with the abdominal and back muscles, the pelvic floor stabilizes the pelvis and spine.
Things like pregnancy and childbirth, along with aging and menopause, can weaken the pelvic floor muscles. This can cause conditions such as urinary or fecal (bowel) incontinence, pelvic organ prolapse, and dyspareunia (pain during or after intercourse). Read on to learn more about how your pelvic health changes across your lifespan.
Adolescence (Ages 13-18)
In adolescence, hormonal changes during puberty help contribute to pelvic development. Bones inside the pelvis become larger and wider, which results in a wider birth canal to accommodate childbirth during reproductive age. It’s common to assume that pelvic floor muscles are likely to be strong and healthy during the adolescent years. However, weak muscles or muscles that are too tight can be a problem in this age group. Teen athletes, teens with obesity, or teens who have been pregnant may be particularly at risk. Symptoms like pelvic pain or urinary incontinence (leaking) can be common, but treatment is possible, so it’s important for teen girls to talk to their healthcare providers about any symptoms they might be having.
Education about the menstrual cycle, what’s normal and what’s not, and hygiene (like using tampons, pads, or a menstrual cup for the first time) is important for adolescents. Some teens may notice pelvic pain as puberty progresses. ACOG (American College of Obstetricians and Gynecologists) recommends the first gynecologic visit between the ages of 13 and 15, during which concerns about pain, irregular cycles, and other symptoms can be addressed.
Early education can help teens protect themselves from STIs and more serious, symptomatic diseases by understanding safe sex practices like using condoms and getting tested regularly. Preventive care like routine HPV vaccinations are also recommended around this time.
Reproductive Years (Ages 19-45)
In pregnancy and childbirth, the pelvic floor muscles, which support the pelvic organs like the uterus, bladder, and rectum, can weaken. Vaginal delivery is one of the biggest risk factors for pelvic floor disorders, as the pelvic floor muscles can be stretched, strained, or stressed during active pushing. This can result in pelvic floor conditions like urinary incontinence (leaking urine), chronic pelvic pain, or pelvic organ prolapse (pelvic organs bulging or dropping). Doing pelvic floor exercises during pregnancy and after giving birth, like Kegels, can help to maintain the strength of pelvic muscles.
Pelvic floor physical therapy is also an effective, non-invasive treatment that can also function as preventive care during pregnancy. It has been shown to reduce symptoms and improve quality of life by strengthening and relaxing the pelvic floor muscles. Pelvic floor physical therapy may include internal and external examinations, stretches, and exercises like Kegels. This treatment is beneficial regardless of what stage of life you’re in, so if you’re experiencing symptoms, talk to your healthcare provider about your options.
Though pregnancy and birth can be risk factors, those who have never been pregnant can also experience pelvic floor dysfunction for a variety of reasons. Obesity, smoking, long-term muscle straining from constipation or heavy lifting, and pelvic surgeries or injuries can all be risk factors.
Screening for pelvic floor disorders can facilitate early intervention and treatment, which is why annual well-woman visits are so important. Your regular well visit should include recommended screenings, physical examinations, and preventive care. Your healthcare provider should consider your medical and family history and symptoms as well to make shared decisions about your care. You can also discuss reproductive life planning, including trying to get pregnant, birth spacing, and contraception.
Perimenopause and Menopause (Ages 45-60)
Between the ages of 45 and 60, most women go through perimenopause and menopause. In this stage of life, menstruation stops due to natural aging and a woman can no longer become pregnant. Hormonal shifts, like drops in estrogen, can lead to muscle weakness in the pelvic floor, and can also cause the vaginal and pelvic tissues to become thin and fragile. Low estrogen may cause other symptoms like hot flashes, hair loss, and emotional changes (mood swings, depression, irritability).
Genitourinary Syndrome of Menopause (GSM) can often appear in menopausal women, caused by low estrogen levels. It is a chronic and progressive condition that affects the vagina, vulva, and urinary tract. GSM can greatly impact a person’s quality of life by causing vaginal dryness, urinary incontinence, and painful intercourse. First-line treatments include moisturizers and lubricants, as well as hormonal treatment (local low-dose estrogen). However, hormone therapy may not be recommended if you have a history of breast cancer, as it can cause recurrence.
These changes during perimenopause and menopause increase a person’s risk of pelvic floor disorders like stress urinary incontinence (leaking urine during physical activities) and dyspareunia (pain during or after intercourse). Menopause-specific education and personalized treatment is important for women seeking care during this stage of life. Early intervention and preventive care measures can help combat symptoms and reduce your risk of other health conditions caused by low estrogen, such as osteoporosis, heart disease, and neurological diseases like dementia.
Postmenopause (Ages 60+)
After age 60, a person is generally postmenopausal. During postmenopause, long-term pelvic health maintenance is important to help prevent and manage chronic pelvic pain and dysfunction. At this stage in life, people may be navigating fecal or urinary incontinence, pelvic organ prolapse, or painful sex as a result of decreased estrogen and weakening of the pelvic floor muscles. Along with aging and menopause, other factors like smoking, chronic constipation, and genetic or family history can increase risk.
A pelvic floor physical therapist can work with your primary healthcare provider to create a comprehensive care plan for your needs. Evidence-based interventions such as physical therapy, behavioral therapy (such as cognitive behavioral therapy, known as CBT), and hormonal therapy (like topical estrogen) can provide relief from symptoms and support your pelvic health. Regular exercise and eating healthy can also support your pelvic and overall health. No matter what age you are, moving your body is always beneficial.
Preventive care and lifestyle recommendations
You can nurture your pelvic floor health through daily lifestyle choices in addition to routine well-woman visits. Staying active moves your muscles and keeps them engaged. Core exercises can be helpful because the pelvic floor works in conjunction with the abdomen, back, and hips — it’s part of your core. It can help to use proper body mechanics when weightlifting or lifting heavy objects, as heavy lifting can cause you to bear down on the pelvic floor muscles and may ultimately strain rather than strengthen the muscles. Balanced nutrition, including plenty of protein, can also help support pelvic muscle health. Fiber and fluids and can help prevent constipation, which can strain pelvic floor muscles.
Many women living with pelvic floor disorders are also suffering from mood changes like depression and anxiety. Fearing or worrying about leakage or pain can add to feelings of isolation and shame, and some people may start to avoid public places and traveling. Pelvic floor disorders may start to get in the way of daily activities and the things you used to enjoy, which can feel like a hit to your independence. If you’re struggling, know that you aren’t alone, and you don’t have to live in discomfort.
ACOG and other scientific communities emphasize the importance of shared decision-making between patient and provider, which means you should have a say in what happens as part of your healthcare. This is especially true for sensitive procedures like pelvic or breast examinations. Sometimes, an examination isn’t necessary, but may be helpful depending on your health history and symptoms. Talk to your healthcare provider about your options, and don’t be afraid to speak up or ask questions.
Reviewed by the Ovia Health Clinical Team
Sources
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