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How Pilates Helps Peri- and Post-Menopausal Women Take Control of their Pelvic Floor

This set of muscles is present in all of us, male or female, but are so often ignored, unless we experience problems or we are giving birth!

Sitting where they do, they are often associated with shame, a lot of misinformation, and often embarrassment.

But let’s break that taboo and investigate why women really should not be accepting pelvic floor problems as a part of childbirth or menopause.

Take control of your pelvic floor!

So what exactly are the pelvic floor muscles and why should we exercise them like the more obvious muscles of our body?

Our pelvic floor muscle lies across the base of the pelvis to keep the organs that sit within the pelvis - the bladder, the bowel and in females, the uterus, in the correct position.

A well functioning pelvic floor muscle will ensure that you don’t leak urine when you move, including if you choose to bounce on the trampoline! It will lessen your chances of a pelvic organ prolapse (more information on this to follow) and will also improve your sex life! Strong pelvic floor muscles can mean increased sensitivity during sex and stronger orgasms.

This all sounds great, but how do you know how to find your pelvic floor?

Perhaps start sitting down and imagine that you are absolutely NOT allowed to pass wind or have a wee at the same time! Can you draw the pelvic floor muscles up from the back passage towards your bladder? Perhaps you can feel a lifting sensation, perhaps some tightening as the muscles contract. Can you breathe normally? Just try not to hold your breath.

If this feels terribly difficult, do not fret. Just as you would train your biceps, you can train your pelvic floor, and over time you will notice a difference. If you are worried, do contact your GP or a woman’s health physiotherapist who will help you. Read on to get some tips and tricks on how to exercise your pelvic floor.

Before I took a real interest in menopause, I had always assumed, wrongly, that the biggest reason for pelvic floor problems was childbirth. However, I was wrong.

Pelvic floor muscle problems come about when they are weak, overstretched, slow to work, too tight or injured. So whilst childbirth and pregnancy could lead to one or more of these issues, there are more reasons to consider, such as being overweight, high impact training, and the menopause.

Why is the menopause a risk factor for our pelvic floor?

Pelvic floor dysfunction often occurs after childbirth and during the perimenopause and menopause, as the hormone estrogen drops significantly at these times. Estrogen plays an important role in our urinary and reproductive systems. The vagina, vulva, and urinary tract are lined with estrogen ­receptor cells. When estrogen is no longer in plentiful supply in the body, these areas can really suffer. As a result, the lining of your bladder and urethra (the tube which carries urine out of the body) thins and your pelvic floor muscle gets weaker.

What Could a Problem Look Like?

Below are some of the more common issues that women suffer from. Please don’t panic if it sounds like you are experiencing any of the symptoms. There is help out there so contact your GP or women’s health physio.

Stress Incontinence

This is when there is a leak of urine as a result of coughing, laughing, sneezing or running. There are two types; the overactive bladder and urge incontinence. Overactive bladder refers to a frequent or constant need to pass urine, whilst urge incontinence means you experience a desperate feeling of needing to go to the toilet without much warning – when you simply can’t hold on and you leak.

Pelvic Organ Prolapse

It is thought that 50% of women over 50 years have some degree, or symptoms of, prolapse. A prolapse happens when the muscles and ligaments in the pelvic floor are weakened. It can feel like something is falling out of your vagina, a heavy feeling, or like sitting on an egg or a ball.

Urine Infections

Urinary Tract Infections (UTIs) happen when harmful bacteria spreads to the area and overwhelm the natural defences of more helpful bacteria. Lower estrogen levels reduces the amount of good bacteria present, lessening the body’s ability to fight off the infection. It can be common to experience symptoms of a UTI even if you have no actual infection, due to the lack of estrogen in your bladder and surrounding tissues.


Preventing constipation by drinking plenty of water and having a fibre rich diet to keep stools regular and soft, as well as not straining too hard when on the toilet will help. Constipation can put pressure on the back wall of your vagina, causing the wall to bulge into your vagina, possibly causing a prolapse.

Vaginal Dryness

As the walls of the vagina start to thin and lose some of their elasticity and natural lubrication, this can lead to dryness leading to pain during sex, increased urinary infections and other urinary symptoms, as well as itching and soreness of the vulva. It can be incredibly painful too.

How Pilates helps

No muscle in our body works alone. The human body operates in complex movement patterns, mostly on auto-pilot. Pilates encourages the coordinated use of our centre; our breath, abdominals and pelvic floor muscles. This coordinated movement is the way the pelvic floor muscles should work in everyday life.

During a Pilates class, you are using your centre appropriately to take you through a variety of movements, many of which are highly functional. In Raise Pilates’ online and group classes that I run in Kingston, we often focus on exercises to support this function

Prof Fionnuala McAuliffe of the Royal College of Physicians of Ireland says, “Pilates addressing pelvic floor exercises are as successful as pelvic floor exercises alone”. There does not seem to be current evidence suggesting that Pilates are better than doing pelvic floor exercises however. Professionals suggest that more research needs to be done to address this.

And whilst exercising the pelvic floor muscle on

its own is important, we should take an holistic view.

You can improve the health of your pelvic floor by looking at your feet, your shoulders, your glutes… in fact your posture is so important.

Having poor posture, from slumped shoulders to tilted pelvis, can have a negative effect on the health of your pelvic floor. How we sit, stand and go about our daily routines can affect pelvic floor strength and necessary flexibility.

When we sit in a slumped posture, our pelvic floor muscles aren’t getting the workout they get when we sit up straight. Your pelvic floor gets lazy from just sitting there doing nothing. That’s because slouching in a chair decreases the activity of your transverse abdominal muscles, which work with the pelvic floor muscles.

If we find ourselves ‘sucking in’ our stomachs, it causes us to take more shallow breaths, constricting the diaphragm’s full range of motion. The diaphragm and pelvic floor work together so when the diaphragm isn’t moving, the pelvic floor is also slacking and getting no exercise, stretching or tone.

BUT, don’t think that clenching your glutes while standing for long periods of time will help - in fact it can make them weaker. This, in turn, makes it harder for your pelvic floor contract. Clenching your glutes will often make you clench your pelvic floor as well, which makes it ineffective.

Extending, stretching and contracting all have to happen for the pelvic floor to stay in shape and do its job: All of which we practice during a Pilates class.

Pelvic Floor Exercises To Try

There are some excellent ways to start training your pelvic floor muscles today. Just don’t do these exercises as you take a wee - I remember being told that this was a great way, but it is no longer deemed a good idea - just imagine it!

These exercises should include long, held squeezes as well as short, quick squeezes. Do ensure that you let the muscle ‘go’ or ‘relax’ after each squeeze.

The long squeeze

  • Tighten your pelvic floor muscles, hold them tight, then release and let them fully relax.

  • How long can you hold the squeeze?

  • Repeat the squeeze and hold until the pelvic floor muscles tires. Work up to increase the number you can do

The short squeeze

  • Quickly tighten your pelvic floor muscles, then immediately let them go again.

  • How many times can you do this quick squeeze before the muscles get tired?

You should exercise regularly to help the muscles become stronger and more effective, as you would any other muscle in your body.

These exercises can be done in a variety of starting positions and getting 3 sets of 10 of each in a day is a great starting point.

Try to integrate doing these exercises with things that you do daily, such as waiting at the school gates, sitting at the edge of your bed before you get up, lying in bed as you put your night cream on, brushing your teeth, boiling the kettle for your morning cuppa.

Warning! Standing up is the hardest way to work the muscles to begin with so give yourself a chance and start doing them lying down or seated!

Pilates for your future self

With Pilates being such a wonderful tool for improving our alignment, our body awareness and our centring, there is no reason not to use it as a first class tool for improving our pelvic floor health.

Of course, Pilates won’t just help your pelvic floor! There are a huge range of benefits for women in peri and post menopause who regularly practice Pilates, improving flexibility, strength and confidence.

Come and experience a class, either online or face to face, in a group or one to one. Pop me a message and I would love to guide you!

Here are some additional resources for you should you wish to delve a little deeper into this subject.


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