Menopause and Pelvic Floor Physical Therapy: Relief for Incontinence, Prolapse, and Pain
Menopause is a major life change that involves a powerful shift in your hormones. For example, according to the landmark SWAN (Study of Women’s Health Across the Nation) study, between 50% and 82% of American women going through menopause experience major symptoms like hot flashes and night sweats. These changes affect your entire body, including your pelvic floor - the group of muscles and tissues that act as a sling supporting your core.
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As hormone levels like estrogen drop, the muscles and tissues that support your bladder, uterus, and bowel can become less strong and less flexible. This is a natural effect of menopause, but it can lead to frustrating and challenging problems like:
Leaking urine when you laugh, sneeze, or exercise
A feeling of pressure or heaviness in your pelvis, like something is falling out
Pain during sex
Ongoing constipation
But you do not have to “just live” with these symptoms. Pelvic floor physical therapy (PT) is a safe, proven, and effective way to deal with these changes (Mercier et al., 2019). It can help you regain your strength, restore your resilience, and help you stay active, confident, and in control throughout this new phase of life. Here’s how…
How Menopause Affects Your Pelvic Floor
When estrogen drops during menopause, it can cause many of the changes you feel in your pelvic floor. Understanding what’s happening is the first step to feeling more in control. Here are four main ways these hormonal shifts can affect your pelvic floor and pelvic organs:
1. Hormonal Changes and Vaginal Tissue Health
When your estrogen (and to a lesser extent, testosterone) levels drop, blood flow to the pelvic region decreases. This can cause tissues like the vaginal wall and urethra to become thinner, drier, and less elastic. These changes (called vaginal atrophy) may lead to discomfort, irritation, or even pain, especially during sex (known as “dyspareunia”).
2. Pelvic Floor Muscles Weaken After Menopause
Estrogen helps maintain muscle tone. When its level declines, your pelvic floor muscles can weaken. This reduced support for your bladder, uterus, and rectum may cause urinary leakage (called “incontinence”), the sensation of bulging or heaviness sometimes associated with pelvic organ prolapse (when an organ shifts down), or the inability to reach orgasm (anorgasmia) and decreased libido.
3. Connective Tissue and Pelvic Organ Prolapse Risk
The ligaments and fascia (connective tissues) that help hold your pelvic organs in place also rely on healthy hormone levels. With the estrogen drop, they are more likely to stretch, which can increase the risk of pelvic organ prolapse.
4. Bladder Leaks and Bowel Changes in Menopause
Menopause often affects the bladder and bowel muscles. This can lead to urinary issues like leaking, urgency, and frequency (Vaughan et al., 2025), or other frustrating symptoms like chronic constipation or accidental bowel leakage (fecal incontinence).
How Pelvic Floor Physical Therapy Helps You Regain Control and Improve Quality of Life During Menopause
Pelvic floor PT isn’t just about symptom management. Instead of masking issues, pelvic floor PT gives you targeted treatment and tools tailored to your body, helping you regain control and strength in your daily life.
1. Strengthen Your Pelvic Floor and Improve Bladder & Bowel Control
Your pelvic floor PT will guide you through targeted exercises to build strength, endurance, and coordination. Stronger muscles give better support to your bladder and bowels, helping reduce leaks, urgency, and straining with bowel movements. For clients suffering from pelvic organ prolapse, we can fit pessaries and teach you pressure management strategies. All of these steps will help you feel more confident going about your day-to-day activities.
2. Improve Pelvic Tissue Health
Gentle hands-on therapy and specific movement training can increase circulation and tissue mobility in the pelvis. This can counteract some of the effects of lower estrogen during menopause and can help ease dryness or irritation.
3. Relieve Pelvic Pain
Pelvic floor therapy can release tight muscles, ease trigger points (especially when combined with dry needling), and improve movement in scar tissue that may cause pain (including painful sex). When appropriate, we may also recommend treatments (such as hyaluronic acid or topical estrogen) and tools (like dilators) to further support your healing.
4. Use a Whole-Body Approach for Lasting Relief
Pelvic floor PT doesn't just focus on the pelvis - it checks your entire body. We work on your posture, your core strength, your hip muscles, and even your breathing patterns. This complete approach is the key to solving issues like incontinence or prolapse from the ground up, giving you support that lasts (not just a temporary fix).
5. Education, Empowerment, and Referrals
Pelvic floor PT goes beyond exercises. You’ll learn how menopause affects your body, how to manage symptoms like incontinence or prolapse, and what long-term treatment options may help. If desired, we can also connect you with other trusted menopause specialists, such as nutritionists, sex therapists, and mental health counselors, so you feel supported and confident in every step of your care.
When to See a Pelvic Floor PT for Menopause Symptoms
You don’t need to wait until your symptoms are severe to benefit from pelvic floor PT. If you’re experiencing any of the following signs of pelvic floor dysfunction, it's time to schedule a pelvic floor PT evaluation:
Any bladder leaks (incontinence) or urinary urgency/frequency
A feeling of pelvic pressure or bulging (that may signal pelvic organ prolapse).
Painful sex (dyspareunia) or persistent pain during internal medical exams.
Vaginal dryness or discomfort (vaginal atrophy) that disrupts your daily life.
Persistent constipation or other uncomfortable bowel changes.
A pelvic floor therapist can assess what is happening, get to the root cause, and create a treatment plan to help you feel better (oftentimes faster than you’d expect)!
Pelvic Floor PT: Your Proactive, Evidence-Based Plan for Menopausal Health
Menopause is a major life transition, but it doesn’t have to mean losing control or quality of life. Even though these hormonal changes can raise the risk of incontinence, prolapse, or pelvic pain, you have options for effective, lasting relief
Pelvic floor PT is an evidence-based, individualized approach that works to strengthen your muscles, improve tissue health, and reduce pain. It gives you the knowledge and tools to manage this transition confidently and maintain an enjoyable, active lifestyle.
Your best strategy is a proactive one. Take the next step to protect your health for the years ahead. If you’re near Melrose, MA, schedule an initial evaluation with us at Boston Pelvic PT at www.bostonpelvicpt.com, call/text (813) 303-0416, or email info@bostonpelvicpt.com. If you’re outside the area, visit www.pelvicrehab.com to find a pelvic floor PT near you. You can also visit The Menopause Society and check out their excellent collection of patient education materials.