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menopause and pelvic health

What are the Links Between Menopause and Pelvic Health?

Menopause is a period of life transition for many of us. Today we will review what menopause is and how symptoms can negatively affect pelvic health, including bowel, bladder and sexual function.

What Happens During Menopause?

Menopause is an important life transition for those with female anatomy, marking the end of the regular menstrual cycle and the transition to life beyond the reproductive period.

Babies born with female anatomy have a set number of eggs which are stored in their ovaries. The ovaries make the hormones estrogen and progesterone, which control monthly periods and ovulation. Menopause happens when ovaries no longer regularly release an egg every month and menstruation stops.

The age menopause starts can vary, but usually it is after the age of 40. Some people can go through menopause early, usually after a hysterectomy, damage to the ovaries, and sometimes from chemotherapy.

=Menopause Symptoms Can Affect Quality of Life

More than 80% of those with menopause report physical and psychological changes the period before, during and after the last menstrual cycle.

In Minkin et al.’s 2015 study of over 8,200 people going through menopausal found that up to 77% of respondents experienced changes in their genitals (vulva, vagina, pelvic floor) that affected their lifestyle, emotional well-being, and sexual function.

Common Menopause symptoms that affect the genitals:

Other common symptoms that affect quality of life:

  • Hot flashes
  • Night sweats
  • Disrupted sleep
  • Weight gain
  • Mood Swings
  • Joint pain
  • Headaches

Layered on top of the changes that happen with menopause are other underlying issues that existed before the onset of menopause like pelvic floor dysfunction, orthopedic dysfunction, vulvodynia, pelvic organ prolapse, urinary incontinence, and bowel issues including chronic constipation and IBS. An existing pelvic floor issue with some menopause sprinkled on top can contribute to aggravated symptoms and reduced quality of life.

Common Menopausal Pelvic Health Issues and How Pelvic Floor Therapy can Help

Urinary Incontinence

Losing urine when with coughing, sneezing, and laughing is known as stress urinary incontinence. It is common to hear stories about this, as well as “overactive bladders” and “nervous bladders” which lose urine on the way to the bathroom and with strong urge.

Between 12.8 to 46% of women deal with urinary incontinence during their lifetime, with an increase during and after menopause. This is due to: a reduction of elasticity in the genital tissues, thinning in the tissues lining the urethra (the tube that empties urine from the bladder, and reduced muscular strength in the pelvic floor, the group of muscles that supports your pelvis and keeps your “holes” closed.

How Pelvic Floor Therapy Can Help: Pelvic floor therapy can help you train your pelvic floor muscles, increasing the strength of the muscles. A pelvic floor therapist can will also correct muscle incoordination that can lead to leakage.

Bowel Issues

The research is inconclusive as to whether or not menopause directly causes or worsens constipation, diarrhea, and Irritable Bowl Syndrome (IBS). However it is clear that stress tension, and anxiety all affect bowel health and regularity.

How Pelvic Floor Therapy Can Help: A pelvic health therapist can help you with neuromuscular re-education, biofeedback, and self care techniques such as abdominal massage that can regulate the GI system and promote regularity.

Pelvic Pain and Painful Sex

According to Minkin et al. 77% of women with menopause report vaginal dryness, and about 40% report pain with sexual intercourse and touch to the genitals.

When sex is painful, this can trigger anxiety about sex. This anxiety then triggers a new cycle of sexual problems: muscle guarding, decreased lubrication, and pelvic floor tension.

How Pelvic Floor Therapy Can Help: A pelvic floor therapist can help break the muscle tension cycle with manual therapy and teaching you self-treatment to maintain gains at home. By releasing pelvic floor tension, you free pelvic floor muscles, allowing for pain free sex. Pelvic floor therapists can also screen for musculoskeletal dysfunction in the spine, hips and pelvis; educate about sexual ergonomics and help you find positions that reduce pain during intercourse. Pelvic floor therapists can also provide you with self care programs which can reduce dryness and irritation in the tissues of the vulva, labia, and vaginal canal.

Give the therapists at Femina Physical Therapy a call today!

Resources

Callan, N. G. L., Mitchell, E. S., Heitkemper, M. M., & Woods, N. F. (2018). Constipation and diarrhea during the menopause transition and early postmenopause. Menopause, 25(6), 615–624. doi:10.1097/gme.0000000000001057

Castellani, D., Saldutto, P., Galica, V., Pace, G., Biferi, D., Paradiso Galatioto, G., & Vicentini, C. (2015). Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence. Urologia Internationalis, 95(4), 417–421. doi:10.1159/000381989

Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009;9(4):186-97

Minkin, M. J., Reiter, S., & Maamari, R. (2015). Prevalence of postmenopausal symptoms in North America and Europe. Menopause, 22(11), 1231–1238. doi:10.1097/gme.0000000000000464

Mehta, R. S., & Staller, K. (2018). Menopausal transition and bowel disturbances. Menopause, 25(6), 589–590. doi:10.1097/gme.0000000000001110

**This information is for educational purposes only and is not intended to replace the advice of your doctor.

What Our Patients Have to Say

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Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

Testimonial by Ann V.

I wish i could give this place 10 stars!! 
I have been suffering from vaginismus for 5 years and never found the cure to it. I had seen an ob/gyn and he diagnosed me with vaginismus and told me i needed a surgery to cure my condition, which i refused to do. He also referred me to a PT that he works with, i had given them multiple calls and they never responded back to me, so i started searching yelp for another PT. I am SO HAPPY I found Heather's office! I was working with Laureen, and with her guidance and techniques i was able to be cured from vaginismus in only 2 1/2 short months!!! I couldn't believe how quickly their program worked for me! I am forever grateful and thankful from Heather, and Laureen! They are the absolute best at what they do!

Read more: Testimonial by Ann V.

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

Read more: Testimonial by Jamie M.

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