Pelvic Floor Dysfunction in Perimenopause: Symptoms, Causes and How to Strengthen Your Muscles

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Your Health Magazine Contributor

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Pelvic Floor Dysfunction in Perimenopause: Symptoms, Causes and How to Strengthen Your Muscles

Stress urinary incontinence, the involuntary leaking of urine when you cough, sneeze, laugh, jog or exercise, is one of the most common health complaints among women in their 40s and 50s. It is also one of the least discussed.

Leaks of this kind usually point to a problem with the pelvic floor: the network of muscles, ligaments and connective tissue at the base of the pelvis that supports the bladder, uterus and bowel. When these structures become weak, fatigued or poorly coordinated, they can no longer hold firm against sudden pressure.

How common is it?

Very. According to the Mayo Clinic, nearly one in three women experience some form of pelvic health dysfunction, and urinary incontinence affects 50% of adult women. Prevalence rises with age, with up to 75% of women over 65 reporting urine leakage, the Mayo Clinic states.

Despite this, only 25% to 61% of women who experience weekly incontinence episodes raise the issue with their health care teams, and many assume it is simply a normal part of aging.

“I often hear that a weakening pelvic floor is just something to accept as part of getting older,” says Dr. Charity Khoo, a UK-based gynecologist and obstetrician. “My patients will say, ‘I don’t really have a problem, just the usual leaks’ or ‘it’s because I’ve had kids – there’s nothing that can be done.’

“But a lot can be done and it starts with simple exercises that you can do at home,” she says. “With any exercise though, they only work if you do them correctly and keep doing them.”

Symptoms of pelvic floor dysfunction

“Symptoms often creep in slowly and many women suffer with them for years before seeing a doctor or getting help,” says Dr. Khoo, who recommends Kegel exercises from a woman’s 20s onwards as a preventive measure.

Symptoms may include:

• Stress incontinence: leaking urine when coughing, sneezing or exercising
• Urgency: a frequent, urgent need to urinate
• Sexual changes: reduced sexual satisfaction
• Possible prolapse: pelvic pain or discomfort, a dragging sensation or pressure in the lower abdomen or vagina, or a bulge in the vagina

When to see your doctor

Dr. Khoo recommends a pelvic floor assessment before starting any exercise regimen. “They can check that you’re finding the right muscles, squeezing effectively and relaxing fully, and then tailor an exercise plan for you,” she says.

What causes pelvic floor weakness?

Pelvic floor problems usually develop from several overlapping factors, which often converge in midlife.

“Pregnancy and childbirth put considerable strain on the pelvic floor,” explains Dr. Khoo. “Meanwhile, aging naturally affects muscle strength and tissue quality; hormonal shifts, particularly falling estrogen, changes the health and elasticity of pelvic tissues; and collagen loss means the connective tissue is less supportive than it once was.”

In summary: “Several things add up over time – and they tend to peak around perimenopause.”

Getting the technique right

Correct technique is essential. According to Columbia University’s Department of Surgery, 50% of people perform pelvic floor exercises incorrectly after learning them from a pamphlet alone.

“Common mistakes include using the buttocks, thighs or belly, instead of the pelvic floor; breath-holding, bearing down or focusing only on the squeeze and forgetting the relaxation,” Dr. Khoo says.

“Relaxation is also just as important as the squeeze, as a muscle that can only tighten and can’t fully let go, isn’t working properly. For women who have an overly tight pelvic floor, squeezing can make symptoms worse.”

Two evidence-based ways to train

1. Unassisted exercises. Dr. Khoo advises eight to 12 contractions, three times a day. This program was found by British and Brazilian researchers to be an effective unsupervised starting point for women. Performing a quick contraction just before a sneeze or other bladder stress can also help.

2. Biofeedback training devices. Feedback devices can help some users identify whether they are contracting and relaxing the pelvic floor muscles as intended. One example is the Smile Makers Pelvic Partner, which uses haptic feedback in response to muscle contractions. Device-guided exercises should be used according to the manufacturer’s instructions and, when symptoms are persistent or unclear, alongside guidance from an appropriate healthcare professional.

“These devices give you feedback so you can be sure not only that your squeeze is right, but that your muscles are relaxing properly afterward,” says Dr. Khoo. “That feedback can be motivating too, because you can see and feel progress rather than just guessing.”

Making it a long-term habit

Building exercises into daily routines, such as while making coffee, after parking the car or while checking social media, improves consistency. Tracking apps can also support adherence.

“Think of it as a habit, not a short course – it should be as routine as brushing your teeth and treated as just as important,” Dr. Khoo says.

“People often go wrong as once symptoms start to improve, the exercises get forgotten. Or, if results aren’t quick, people give up. But like any muscle, the pelvic floor needs ongoing work to stay strong.”