Menopause & Beyond: Healthy Aging For Your Pelvic Floor
November 25, 2020
There’s a fun Satchel Paige quote about getting older:
“Age is a case of mind over matter. If you don’t mind, it don’t matter.”
While those are definitely words to live by, it doesn’t hurt to pick up a little knowledge about how your body, and in particular your pelvic floor, evolves as the years go by (after all, gaining wisdom is one of the key privileges of age ;-).
And the pelvic floor in particular is one area of your body that requires some TLC in order to age gracefully. In this article, we’ll touch on how the pelvic floor changes as time passes and share some tips to keep you living your best life, no matter how many trips around the sun you make.
Define “older”: what ages are we talking about?
It’s a common misconception that pelvic floor dysfunction, from urinary incontinence to pelvic organ prolapse to different varieties of sexual dysfunction, is only a problem for older folks. While that is not actually true, and there are certainly other meaningful risk factors that contribute, it is a fact that pelvic floor dysfunction and the associated symptoms do become more common as you get older (and unfortunately pelvic floor dysfunction is disproportionately a women's health issue).
The study linked above looked at over 8,000 women in the United States, aged 20 years and older, and found that the overall prevalence of at least one form of pelvic floor disorder was 25%. Broken down by age:
- 20-29: 6% of women have at least one pelvic floor disorder
- 30-39: 14%
- 40-49: 23%
- 50-59: 32%
- 60-69: 39%
- 70+: unsurprisingly, the numbers continue to increase
Clearly, this is something worth bearing in mind as you get older.
For reference, the average age range where perimenopause, menopause and the transition to postmenopause most commonly occur is approximately 45-55 years old. While menopause does not represent a black and white turning point for the pelvic floor, there are some hormonal considerations related to the process that can affect pelvic floor function -- we’ll dig into this more in just a second!
What happens to your pelvic floor as you age?
To some extent, your pelvic floor is no different from the rest of your body. It is made up of muscles (and some ligaments, connective tissue and other anatomy), and those muscles tend to weaken over time. That goes double if they are not getting much exercise. Over time, life (and gravity) takes its toll all over our bodies.
But there are also some more pelvic-floor-specific issues in play, particularly for women. Research has found (Wente 2018) that there are three types of ways that aging can lead to pelvic floor dysfunction:
- Muscular: this is what we talked about above, and weakened muscles lead to decreased force output and a situation where the pelvic floor muscles struggle to do important jobs like control the flow of urine from your bladder and urethra or hold your core organs in place.
- Hormonal: a drop in estrogen levels can be typical for pre- and postmenopausal women, and the effects of this and other hormonal changes associated with aging exacerbate pelvic tissue changes.
- Neurological: the mechanisms here are less well understood but it is currently thought that gradual deterioration of the nerves in your pelvic floor can lead to weakness and dysfunction. This can be particularly pronounced in women who have had children
When your pelvic floor weakens (whether due to muscular, hormonal, or neurological factors), it struggles to do many of its key jobs, such as preventing leakage from your bladder and urethra, holding your core / abdominal organs in place, or supporting robust and enjoyable sexual health.
But! Don’t lose heart. While it is common for our pelvic floors to start making trouble as we get older if left to their own devices, it is not inevitable. And you shouldn’t see it that way.
How can you keep your pelvic floor healthy as you age?
The short answer is: the same way you keep the rest of your body healthy -- stay active and exercise!
A productive fitness routine for your pelvic floor can include work focused on down training (in other words, making sure you don’t let your pelvic floor muscles get too tense), breathing exercises or other activities, but the most well-known piece of the puzzle, and probably the most powerful tool in the toolbelt, is pelvic floor strengthening (or Kegel exercise). Basically, this entails contracting and releasing your pelvic floor muscles repetitively to strengthen them and help maintain overall pelvic floor elasticity and fitness, and it is particularly suitable if you either have a weak pelvic floor or are trying to stay out in front of the possibility as you age.
One important note, though -- pelvic floor strengthening is a useful tool but not a cure-all. And for some women, such as those who have pelvic pain (perhaps stemming from an overactive or hypertonic pelvic floor), Kegels are not a great idea. The best approach is always to talk with a healthcare provider such as a pelvic floor physical therapist or gynecologist -- they can help you figure out the right overall plan in terms of pelvic floor physical therapy / exercise or other healthcare and wellness steps that can keep your pelvic floor in tip-top shape.
Speaking of “other steps”, here are a few best practice tips (besides exercise) that may be worth keeping in mind and become particularly important as you get older and your body won’t put up with quite as much mistreatment as it used to:
- Keep an eye on your posture. The way you sit, stand and walk can have a surprisingly large impact on your pelvic floor well-being.
- Breathe! Diaphragmatic breathing is great for your pelvic floor but has benefits far beyond as well.
- Watch your diet. Lots of water and making sure you get enough fiber are good first steps to make sure your diet isn’t submarining your pelvic health.