Kegel exercises — they’re a polarising topic. Half of us might be thinking confidently, “I’ve been doing them for years”, while the others may well wonder what on earth they are. In short, Kegels are exercises you can do to help strengthen your pelvic floor muscles, which support the uterus, bladder, small intestine and rectum. As your body transitions from the perimenopause to the menopause, these small but powerful movements could be more beneficial to your body than ever before.

Many women going through the menopause find that they develop pelvic related problems (from incontinence to difficulty having sex) during this time of their life — which can take a toll on self-confidence. But there’s nothing embarrassing about this topic, and in fact, the more you understand about pelvic floor weakness, the easier it’ll become to manage. Here, we’ll explain all about the effects of the menopause on your pelvic health, and how Kegel exercises can help to tackle them.

What is a woman's pelvic floor?

Pelvic floor muscles are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. The urine tube (front passage), the vagina and the anus all pass through the pelvic floor muscles. As such, a woman’s pelvic floor muscles help her to control your bladder and bowel, as well as supporting her sexual function.

How does the menopause impact your pelvic health? 

In medical terms, the menopause is diagnosed when a woman’s menstrual cycle has ceased for 12 consecutive months as a result of the ovaries stopping production of the hormones oestrogen and progesterone.1 Since oestrogen is a vital hormone for pelvic health, many women going through the menopause find that they develop pelvic related problems during this time of their life.2

Imagine your pelvic floor like a hammock that helps you control the flow of urine and faeces while also keeping vital organs like your bladder, uterus, and bowels in place.3 During the menopause however, these muscles naturally weaken. This is because oestrogen is essential for the ligaments of your pelvic floor. As your body gradually stops producing oestrogen, the ligaments that hold your bowel, bladder, and womb begin to get thinner, weaker, and less resilient. This thinning of the muscles is also known as vaginal atrophy.

What’s the impact of pelvic floor weakness during the menopause?

Urinary incontinence (UI)

Though it can sometimes feel like we soldier on alone, the World Health Organisation has classified UI amongst the 10 major health issues currently faced by women.4 Urinary incontinence (UI) is also known as “loss of bladder control” or “involuntary urinary leakage”. You can experience UI throughout your life, but UI is particularly common during the menopause when the pelvic floor muscles become weakened as a result of estrogen loss.

There are 3 main types of urinary incontinence associated with the menopause — stress, urge and mixed. Stress UI can occur during physical exercise such as jumping or lifting or even when laughing or sneezing, while Urge UI occurs when your bladder muscles squeeze incorrectly or lose the ability to relax — making you feel like you need to constantly urinate. Mixed UI simply refers to a combination of the two.5

Urinary Tract Infections (UTIs)

The drop in estrogen levels associated with the menopause can also lead to an increase in UTIs. Just like the vaginal wall, the urethra (the tube that drains the bladder and is used for urination) undergoes changes as estrogen levels drop. These changes in the urethra may lead to different kinds of urinary symptoms, including an increased susceptibility to urinary tract infections.

Vaginal Prolapse

Vaginal prolapse (also known as pelvic organ prolapse) is a common condition where the bladder, uterus and or bowel protrudes or bulge into the vagina. During the menopause, this typically occurs due to weak or damaged pelvic floor muscles that cannot support the pelvic organs.6

Some common symptoms can include, dragging or heaviness in the pelvic area, a bulge in the front or back wall of the vagina, incontinence, and lack of sensation during sex. While prolapse is not considered a life-threatening condition, and some can experience prolapse without any symptoms at all, it may cause a great deal of discomfort and distress. Fortunately, this condition is not life threatening, but it’s still important to speak to your doctor to discuss treatment options.

Pain during intercourse

According to the North American Menopause Society, UTIs and vaginal atrophy can result in pain during sex, due to vaginal tightness and dryness, which can take a toll on your libido.9 Using lubrication during intercourse, being open and honest with your partner as well as speaking to a doctor about possible treatment options is the best course of action.  

Pelvic floor and Kegel exercises for the menopause

Now, we know that keeping a strong pelvic floor might not always get the attention it deserves, and it might even get lost in the array of menopausal literature. But, building and maintaining strong pelvic floor muscles can help to keep your pelvic organs in their natural position, prevent incontinence, improve the blood flow to your pelvic region, and reduce discomfort during sex better.3

Kegels are simple contraction exercises for a woman’s pelvic region that can prevent and cure stress incontinence and support the uterus, bladder, urethra, bowel, and vagina. Even if you are not currently experiencing any of these symptoms, doing Kegel exercises now can prevent incontinence later in life.7 

The best part about Kegel exercises is that they can be done absolutely anywhere, and since they require no specialised equipment, there should be no reason these exercises can’t be a part of your daily routine! If you practice Kegel exercises consistently, you should begin to see and experience the benefits in 1 to 3 months. However, if you are experiencing pain during sex, or during medical pelvic exams, you should consult your doctor before adding Kegels to your daily routine. 

Steps to follow for each Kegel Session: 

• Have an empty bladder 
• Relax and focus on muscle control 
• Sit comfortably with your feet on the floor or lie down with your knees bent (feet on the ground) 
• Stomach, leg and buttocks muscles must be relaxed
• Squeeze and tighten the muscles around your anus and vagina
• It should feel like the muscle is being pulled upwards and inward — as if you are trying to stop your flow of urine mid-stream or trying to tighten your vagina around an imaginary tampon
• Tighten your pelvic floor muscles for ten seconds 
• Relax for 3-5 seconds 
• Do this exercise ten times and repeat daily. 

There are more advanced forms of Kegel exercises, as well as equipment such as weights, cones and medical devices that can help ensure women do Kegel exercise correctly. You should speak to your GP about what options are right for you and your lifestyle. 

Yoga and the menopause

Yoga is highly recommended for relief with menopausal symptoms such as hot flushes and hormonal shifts.8 Exercises such as the bridge pose, dolphin pose, downward-facing dog, and hero pose can strengthen core muscles and aid relaxation. Group yoga classes or professional YouTube videos can be sought out for this purpose.  

For even more advice symptoms, explore our Menopause Guide and discover the support you need to tackle all the ups and downs of the menopause.

References

1. Dr Gail A Greendale, Nancy P Lee, Edga R Arriola, The Menopause (1999). Available at: https://www.sciencedirect.com/science/article/pii/S0140673698053525 [accessed 27 Feb 2020]
2. Neen Pelvic Health, The effects of the menopause on your pelvic health (no date). Available at: http://www.neenpelvichealth.com/help-and-advice/news/the-effects-of-the-menopause-on-your-pelvic-health/ [accessed 27 Feb 2020]
3. Lianne McCabe, Kelli Young and Dr. Sarah Ferguson, Pelvic Floor “Kegel” Exercises (2017). Available at: https://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Pelvic_Floor_Kegel_Exercises_for_women.pdf [accessed 27 Feb 2020]
4. Habib, M, Sohail, I & Khan, MA 2018, Are Home Based Pelvic Floor Muscle Exercises (PFMES) Effective in Prevention of Stress Urinary Incontinence During Pregnancy? A Randomized Controlled Trial (2018). Available at: https://njhsciences.com/wp-content/uploads/2018/04/Article-No-5.pdf [accessed 27 Feb 2020]
5. Australasian Menopause Society, Stress and Urge Urinary Incontinence in Women (2013). Available at: https://www.menopause.org.au/hp/information-sheets/749-stress-and-urge-urinary-incontinence-in-women [accessed 27 Feb 2020]
6. Ellis J & Hargreaves E, Exercise and Advice for Vaginal Prolapse: Patient Information Leaflet, The Newcastle Upon Tyne Hospitals NHS, NHS Foundation Trust (2016). Available at: http://www.newcastle-hospitals.org.uk/downloads/Therapy%20Services/Physio_Vaginal_prolapse2.pdf [accessed 27 Feb 2020] 
7. University of Colorado, How and why to do kegels (no date). Available at: https://urogyn.coloradowomenshealth.com/patients/library/teach-me-how-to-kegel [accessed 27 Feb 2020]
8. Tolu Oyelowo, Climacterium, in Clinical Gynecologic Oncology (Seventh Edition: 2007). Available at:https://www.sciencedirect.com/topics/medicine-and-dentistry/climacterium [accessed 27 Feb 2020]
9. The North American Menopause Society, Vaginal Discomfort (2020). Available at: https://www.menopause.org/for-women/sexual-health-menopause-online/causes-of-sexual-problems/vaginal-discomfort [accessed 27 Feb 2020]