Why Your Pelvic Floor Changes in Your 40s (Even Without Pregnancy)

Your pelvic floor muscles are a net-like group of muscles at the base of your pelvis which support your bladder, bowel, and uterus. The pelvic floor muscles contract and relax to allow for these vital functions, and like the rest of our bodies, change with age. 

Even if you’ve never been pregnant, perimenopause pelvic floor changes can impact pelvic floor strength and function as you go through your 40s. Understanding these changes can help you be proactive about your pelvic health and reduce the likelihood of developing problems later on. 

How Estrogen Affects Muscle Collagen

Perimenopause is a transitional stage before menopause that typically starts in a woman’s late 30s to early 40s, when estrogen production gradually declines. Since estrogen is a key hormone supporting muscle tone and repair, as estrogen goes down, all the muscles in the body weaken and lose elasticity, including your pelvic floor muscles.

Some symptoms of lower estrogen during perimenopause include:

• Pelvic organ prolapse
• Urinary incontinence
• Vaginal dryness or discomfort
• Heavier or irregular periods
• Disrupted sleep or fatigue

Common Pelvic Health Issues After 40

In your 40s, a range of pelvic health issues become more common due to weakened pelvic floor muscles and a range of lifestyle factors.

While pelvic health problems are more common in women who have experienced pregnancy and childbirth, it is not the only contributing factor. Weight gain, for example, can put additional stress on your pelvic floor muscles – and as our metabolisms slow with age, it can be difficult to keep the weight off. 

Fortunately, modern medical intervention can reduce or resolve many severe pelvic floor problems. If any of the health issues described below are causing you distress, or interfere with your daily activities, you should consult with your gynecologist about medical or potentially surgical intervention. 

Pelvic Floor Dysfunction

Pelvic floor dysfunction refers to weak, tight, or uncoordinated pelvic muscles. Common symptoms of pelvic floor dysfunction include:

• Pelvic pressure, or a feeling of heaviness in pelvic area
• Occasional urinary leakage or difficulty regulating urination
• Difficulty with bowel or bladder functions
• Pain during intercourse

Pelvic Organ Prolapse

Since the pelvic floor functions as a net separating your lower organs from the vaginal canal, if your pelvic floor muscles weaken enough, the pelvic organs may bulge through. Pelvic organ prolapse is more common in those who have given birth or consistently push on their pelvic floor due to chronic constipation.

Symptoms of pelvic organ prolapse include:

• Lower back pain
• Vaginal bulging or pressure
• Difficulty with urination or bowel movements

Urinary Incontinence after 40: Why “Sneez-leeing” Happens

After a certain age, jokes about peeing when you sneeze are traded among us women like baseball cards. Bladder control issues are one of the biggest issues for women after 40, with the most common being stress incontinence, which is when sudden pressure (such as sneezing) involuntarily forces urine out.

Studies show that 30–50% of women over 40 have experienced some form of stress incontinence from activity like exercising, coughing, or laughing. 

Even though “sneez-leeing” sounds cute, having to worry about peeing when you sneeze or laugh too hard is not. Stress incontinence doesn’t have to be an inevitability and can be addressed through lifestyle, physiotherapeutical, or medical approaches. Some ways to mitigate or reduce mild stress incontinence as you age include:

• Mindful movement that strengthens your core muscles and improves overall muscle tone such as pilates or yoga
• Eating enough fiber to reduce constipation, as constant straining can weaken your pelvic floor
• Staying hydrated and peeing regularly to avoid excess strain 

Hormone replacement therapy (HRT) to stabilize estrogen levels is also an option for women going through perimenopause and menopause. Discussing HRT with your gynecologist will help you weigh the pros and cons, and whether or not it is the right option for you.

Advanced Kegel Routines For Women Over 40

It’s not all bad news for your pelvic floor after 40. The pelvic floor is a muscle, and like all muscles, it can be strengthened through consistent exercise.

Kegel exercises, which involve the intentional rhythmic tightening and relaxing of pelvic floor muscles, have been consistently shown in studies to be highly effective at strengthening the pelvic floor and reducing or preventing pelvic floor problems. In one 2014 study, between 27% to 75% of women who practiced regular kegel exercises reported a reduction in SUI. 

Supervised training is the most effective, which is why success rates span such a wide range. 20-50% of women are unable to properly perform the technique, reducing its effectiveness. If you struggle with Kegels, you should consult your gynecologist, who can offer guidance or recommend a training program using biofeedback technology to ensure appropriate technique.

You can also work with a pelvic health physical therapist towards specific goals. Studies show that most women should notice the effectiveness of regular kegels after eight weeks. 

Kegels To Reduce Reactive Leaks

To get rid of pesky “sneez-leeing,” the goal is to control how your pelvic contractions react to sudden pressure. Since you’re aiming to stop leaks, practice in a standing position, as this is when most leaks occur. Perform the following once daily:

1. Contract your pelvic floor muscles for 1 second, and release. 
2. Repeat 10 times, working up to 30 quick contractions in a row.

Kegels To Improve Endurance

Holding the pelvic floor muscle contraction for a longer amount of time will improve the endurance of your pelvic floor for better bladder support. Try the following three times a week to build endurance:

1. Contract your pelvic floor and hold for 3 to 5 seconds, working up to a 10-second hold.
2. Perform 7-10 reps at first, eventually working up to 15-20 reps without pausing.

Advanced Exercises 

For Kegel yogis among us who have achieved “long hold” endurance, you can move onto a more advanced form, preferably with the assistance of a physical therapist who can help you maximize your kegels.

Using biofeedback tools such as electronic kegel kits provides data on the exact amount of pressure you are exerting to optimize your training. It’s like a high-tech gym for your nether regions! 

The “Descending Elevators” is performed lying on your back in a relaxed position:

1. Perform a pelvic muscle contraction at 100% effort (the amount of pressure shown on the screen when contracting as hard as you can), then hold a contraction at 50% effort for 3 seconds. Rest for a few minutes, then repeat 5 times. Once you can do this every day for 2-4 weeks, it’s time for stage 2.
2. Contract at 100% and hold for three seconds, then hold contractions in descending pressure: 75%, 50%, and 25%. Rest for a few minutes, and repeat 5 times. Repeat this exercise three times a week to maintain muscle tone.
3. To progress the exercise, you can go from ascending to descending. Start at 25%, work your way up to 100%, and go back down, holding for 2-3 seconds at each level.

Conclusion

Along with the rest of our muscles, the muscles in our pelvic floor also lose tone and elasticity as estrogen declines in our forties. Fortunately, regular kegels and lifestyle changes can often help strengthen your perimenopause pelvic floor muscles and mitigate dysfunction. “Sneez-leeing” is common, but it’s not an inevitability.

If you’re dealing with pelvic floor dysfunction or other perimenopausal symptoms, consult with your doctor.