Looking after your pelvic health in perimenopause

As you approach menopause, you might be anticipating well-known symptoms like hot flushes or your periods ending. But what about peeing when you sneeze? Discomfort during sex? Or a feeling of pressure in your pelvis? These are often signs of changes to your pelvic floor, which are more common at this time. Here I’ll explain the effect perimenopause can have on your pelvic health, and what you can do to feel more comfortable.

Dr Zoe Williams: When it comes to bladder health one of the most important things for us to talk about is how to train your pelvic floor. I think looking after your pelvic floor is one of the best ways that we can prevent issues like incontinence in the future, but it also forms a really important part of the treatment plan if people are having issues like incontinence. So here are my top tips for looking after your pelvic floor.

Firstly, I think it's important to identify what the pelvic floor is it's a structure that's deep in the pelvis that's made up of muscles and connective tissue. You can kind of think of it as a trampoline that attaches at the front on the pubic bone at the back on the tailbone and either side on the seat bones. You want that trampoline to be firm and strong but have a little bit of give like a good trampoline on top of that trampoline sits your bladder your womb if you're a woman and your bowels.

There are some holes in it and these holes allow you to pee and poo. When you jump up and down for example or cough or sneeze, those muscles give a little bit of tension to maintain control of the bowels and the bladder. So pelvic floor exercises are what are important to keep it healthy and keep it strong. The good news is that you can do these just about anywhere and just about at any time. So they take about two minutes so you could do it whilst you're waiting for the kettle to boil, whilst you're waiting for your toast to pop up, or even whilst you're just running some water to do the washing up. Ideally you should do them three times a day.

So what I'm going to do next is I'm going to describe exactly how to do a pelvic floor exercise. It's a bit complicated so I'm going to do it in a stepwise approach and I'm going to do it with you. So I want you to follow along with what I do.

Okay first of all just go with me on this. Imagine you need to fart but you're in a busy lift and you need to hold on to it. So just imagine that and what I want you to do now is hold on to the fart. So the muscles you're using are part of the pelvic floor relax them. Now what I want you to do is do that again, imagine you're going to fart hold on to it and pull those muscles up inside and hold on to them.

Well done that's the first bit. The next bit is imagine you're having a pee and somebody's walking in the room and you don't want them to know you're there so you need to stop midway through. So imagine you're having a pee, hold on to it, stop it, and relax. We'll do that one again. So imagine you're having a pee, stop it, pull those muscles up inside, squeeze and relax.

The relaxation part is really important as well. Some people have what we call a hypertonic pelvic floor and that's when the trampoline is a bit too taut because they're clinging onto those muscles all day long. What tends to happen in that scenario is that they get tired as the day goes on and people might notice that they have issues with bladder control later in the day for example.

Okay so now you've got all the different components we're going to put it all together to do one exercise.

So first of all imagine you need to fart hold on to it draw it up inside. Imagine you need to pee hold on to it draw it up inside. You should relax your buttocks relax your legs it should be just the muscles inside. Squeeze for as long as you can and then relax.

You'll only be able to hold on to it for one to two seconds at the start, but that will get longer as you progress.

So you just did one exercise well done. You do eight of those three times a day and that is the ideal workout for your pelvic floor. I know it's a lot to remember but there are things out there to help so the squeezy app is amazing. It gives you daily reminders to do your exercises and guides you as to how to do them so that's great for both men and women.

There are also lots of devices out there for women to use that you insert into the vagina. So kegel weights as well as lots of new electronic devices that are coming on the market all the time so do check those out and see what's going to work for you.

Remember you know we all have a pelvic floor we all should be exercising and if you are somebody who's having symptoms such as incontinence then stick with it. It can take a while before these exercises kick in but after a couple of months you should have noticed a benefit.