Menopause brings changes to the lives of many women. The high level of oestrogen receptors in the pelvis means pelvic organs are particularly impacted by the lower levels of oestrogen that occur during menopause. Pelvic Health Physiotherapy can provide relief of these issues.
The genitals and urinary tract have high numbers of oestrogen receptors and are directly impacted by lower levels of oestrogen. This can result in a reduction in the connective tissue and circulation in these areas. This can cause thinning of tissues and increased sensitivity. The vulva may appear pale and dry or shiny. The urethral opening can become red. The low levels of oestrogen can cause symptoms of urethral irritation and a reduced ability to completely close which may contribute to bladder leakage.
Changes in the vaginal biome, lubrication, circulation and sensitivity can occur with the lower levels of oestrogen that occur during menopause. This dryness can cause vaginal discomfort or irritation. This may be particularly uncomfortable during sexual intercourse. A reduced libido along with other menopausal symptoms (fatigue, brain fog, anxiety, hot flushes, headaches) can impact your sexual desire and your body's response during intimacy. This can result in pelvic floor muscle protective tightening with attempted penetration which further increases discomfort with sexual activity.
Increased sensitivity of the bladder and urethra can occur during menopause and can result in an increased urge to empty your bladder. Increased bladder urgency can also result in increased frequency. These issues can be annoying when your bladder urge interrupts your daily activities. Anxiety can develop in association of locating toilets when out. Anxiety is a known trigger to urgency so a cycle of anxiety and bladder urgency can result.
Bladder leakage
It is not uncommon to develop bladder leakage in menopause -this may be with activities like coughing, sneezing or lifting which is known as Stress Urinary Incontinence or leakage with a strong urge to empty the bladder which is known as Urge Urinary Incontinence. This leakage can be due to the changes in the wee pipe (urethra) mentioned in the GUSM section above and/or due to reduced strength and support of your pelvic floor muscles. It is possible to improve the strength, control and co-ordination of your pelvic floor muscles at any stage in life. It is never too late to improve pelvic floor muscle strength and bladder control.
Recurrent Urinary Tract Infections
Due to the changes in the bladder and urethral biome and reduced structural support of the walls of the bladder and urethra with lower levels of oestrogen it means urinary tract infections can occur more frequently. The bladder may be empty less completely which can result in some urine remaining in the bladder which can grow bacteria. Urinary tract infections may also occur more often after sexual activity in menopause.
Pelvic Organ Prolapse
Low oestrogen levels can reduce the support of the connective tissue in the pelvis which can result in vaginal wall laxity and pelvic organ prolapse. Prolapse can be worsened by weak pelvic floor muscles and activities that cause strain on the pelvic floor like coughing and constipation. Long days of standing and lifting can also make prolapse symptoms worse. We can help yu increase the strength and control of the pelvic floor muscles and suggest modifications for any activities you may be doing that may be aggravating your symptoms. We also fit eplvic organ pessaries which can help support your prolapse and reduce symptoms.
Bowel issues
The bowel is also sensitive to oestrogen levels. Low oestrogen during menopause can cause changes in the gut biome, gut motility and sensitivity. This can result in constipation, loose stools, bowel urgency or frequency. These issues, combined with reduced strength and support of the pelvic floor muscles, can contribute to bowel leakage.