Getting Older Is Not A Reason To Put Up With This
Leaking, prolapse and pain with intercourse get filed under aging and left there. They are common at this stage of life, and common is not the same as something you have to accept.
We cannot change your hormone levels, and we will say so plainly. What happens to the muscles as a result is treatable, and that is the part we work on.
What Actually Changes In Perimenopause And Menopause
Estrogen is everywhere in the body, from the brain to the bones to the pelvic floor itself. As levels start to wax and wane through perimenopause and then settle lower in menopause, the tissue changes with them.
Three things happen in this area specifically. The tissue becomes more frail. The muscle loses some of its plumpness. And blood flow to the region drops.
There is a name for the cluster of symptoms that follows, the genitourinary syndrome of menopause, and it covers the urinary tract and the pelvic floor together. (The same set of changes shows up in breastfeeding mothers, for the same reason, which is why some of this will sound familiar if you had it postpartum.)
What That Feels Like
Not all of these are obviously related to each other, and that is part of why they get missed.
- ✓ Vaginal dryness
- ✓ Tissue that is fragile enough to bleed
- ✓ Urinary urgency, and frequency
- ✓ Feeling like you need to go when there is very little there
- ✓ Symptoms exactly like a urinary tract infection, with a negative culture
- ✓ Pain with intercourse
- ✓ Getting up more than once at night
The negative-culture one is worth naming. People are told repeatedly that there is no infection, which is true and unhelpful, and the reason is the change in the tissue and the support of the urinary tract rather than anything to culture.
What We Can And Cannot Do
We cannot change your estrogen levels. That is not pelvic floor physical therapy and I would not pretend otherwise. What we do instead is connect you with providers who can have the menopause hormone therapy conversation properly, if that is right for you.
What we work on is what has happened as a result. Are the muscles now restricted because things have become painful? Are they short and tight, so that the work is lengthening and relaxation? Or have they simply stopped moving well, because this is an area nobody thinks about until it complains, and you have been relying on underlying tone?
Alongside that there is the practical side, which people are rarely told about: which lubricants and vaginal moisturizers are worth using, and which have ingredients you would rather avoid.
Dr. Amy Pannullo, PT, DPT, PWCS, CLT
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If You Do Not Use It, You Lose It
The pelvic floor is muscle, and it behaves like the rest of your muscle. Pliability and function decline with age if nothing asks anything of them, and the pelvic floor feels that the same way your shoulders do.
Which is the argument for paying attention to it rather than waiting. Awareness first, then training the muscles properly, so that they go on supporting your pelvic organs for the rest of your life.
But the thing worth repeating is the first one. Getting older is not a reason to have leaking, or prolapse, or pain with intercourse. Those are treatable, and being told otherwise is the most common thing we undo.
Worth Asking About
Book a free 15-minute call and we can tell you honestly whether this is ours to help with.
Schedule an AppointmentThese changes rarely arrive one at a time. These often travel with them: Urinary Leakage & Bladder Issues, Pain With Intimacy and Tight Pelvic Floor.