Pelvic floor in your 40s and beyond

I have to admit, I have really noticed a change in my pelvic floor and my ability to control my bladder since I hit my 40s. There, I said it. But it’s not a truth most of us would never be bold enough to admit, until someone else did. And although there has been a lot in the news lately about pelvic floor health in the menopause, very little has been said about it in decade before. So what happens to your pelvic floor in your 40s and what we can do to address some of the issues we might face when it comes to pelvic floor health? We get the lowdown here with Karin Goldschmidt, Pelvic Health Senior Physiotherapist at The King Edward VII hospital.

How does your pelvic floor change in your 40s?

Pregnancy and childbirth will have put a major strain on your pelvic floor muscles, but an increase in body weight can make this even worse.

Menopause usually starts when you are in your late forties or early fifties, however in some cases it can happen earlier or later than this.  As the body starts to produce less oestrogen, many women find themselves putting on weight much easier than when in their 30ies. In fact, fat mass can increase as much as 44% during menopause. When a person has a higher Body Mass Index (BMI) of 26 or above, their pelvic floor has a consistently heavier load to support. Body fat presses down on the bladder and bowel and can result in difficulty controlling the release of urine, faeces or wind.

Skeletal muscle atrophy and associated weakness are inevitable as we age, and the pelvic floor muscles are no exception. Once you reach 40, you ‘ll lose as much as 5 percent of your muscle per decade. This decreased strength and muscle mass is related to myriad pelvic floor dysfunctions, including stress UI, pelvic organ prolapse, faecal incontinence and sexual dysfunction.

What changes/symptoms does this mean women in their 40s might experience

Common symptoms of a weakened pelvic floor or bladder dysfunction are:

  • Leakage of urine when coughing, sneezing, bending, laughing or lifting weights which is called stress incontinence.
  • It is also common to leak when hurrying to the toilet, hearing running water or even when putting a key in the door when arriving home, this is called urge incontinence.  
  • Many women experience a dragging or aching sensation around the vagina or anus which can be due to a prolapse of the pelvic organs.
  • Problems in controlling wind or bowel contents which often is associated with constipation due to difficulties in emptying your bowels causing a need to strain.
  • Painful sex or decreased sensation due to vaginal dryness.

A perhaps less well known issue, although also common, is tightness of the pelvic floor muscles as a result from rarely relaxing them. This can lead to pelvic pain and trigger other symptoms.

Why is it important that women in their 40s make pelvic floor health a priority?

In our 20s and 30s women might not have paid too much attention to their Pelvic floor and thinking that issues such as leakage and Prolapse are symptoms one just have to learn to live with. However it is very important to understand that as we age, if not looked after, the Pelvic floor is likely to become weaker and therefore their issues could potentially become worse and hugely affect ones quality of life. The good thing is that, if given the appropriate attention and care,  these symptoms are often reversible.   

How can women in their 40s protect their pelvic floor – and is it all about kegels?

Kegels are very important indeed, as well as staying generally healthy with consistent exercise, a varied fibrous diet and drinking lots of water, there are other important ways to look after our Pelvic floor.


The posture of your body changes the way your pelvic floor muscles work. If you’re sitting slumped, it’s hard for your muscles to do anything to help you. If you sit taller, supporting your head and neck up better, your abdominal muscles can work much more efficiently and your pelvic floor is not as switched off and compromised by the pressure. When standing, if your posture is poor, you can end up tilting your pelvis which will also impact how your pelvic floor muscles work. When standing with a better posture, your abdominals, bottom, pelvic floor and leg muscles are allowed to work together in synergy.


This is something that comes completely natural to us yet most us don’t do it the as efficiently as we are meant to. We tend to hold our breath when concentrating doing our pelvic floor exercises  as well as not breathing properly down into our tummy and not expanding the breath into the side of our ribs. As your diaphragm ( breathing muscle) moves, so should the pelvic floor. Your pelvic floor is not a rigid structure, meaning it should move up and down in synergy with our breathing. As we breathe in, the pelvic floor moves down. As we relax, it moves back up. It follows the movements of your lungs and diaphragm.  

The knack

Get into the habit of tighten your pelvic floor muscles the second before any activity which involves a rise in intra-abdominal pressure – coughing, sneezing, lifting, carrying, bending – even laughing sometimes!

Toileting position

Using a step or stool under your feet while on the toilet helps create a squatting position which will reduce pressure into your rectum when passing a stool. This will reduce pressure on the ligaments and muscles in this area. It is also important to ensure you always sit and relax on the toilet and not get in a habit of hovering as this does not allow your pelvic floor to relax completely while you empty your bladder.

Can you share a recommended pelvic floor exercise routine? And how often should women aim to do this?

I often recommend to download the NHS Squeezy app for help with visualisation and motivation. However you can do this routine anywhere  without any equipment at all.

Pelvic floor muscle exercises  should include long, held squeezes as well as short, quick squeezes; ensuring that you let the muscle ‘go’ or ‘relax’ after each squeeze. You should work the muscles until they tire and do the exercises regularly to help the muscles become stronger and more effective. Always remember to breath out as you lift the pelvic floor and breath in as your relax. Also start the lift from the anus, then the vagina and finally a gentle drawing in of the lower part of your tummy to activate your deepest of the abdominal muscles.  

Long squeezes         

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 tire. How many times can you repeat the squeezes? Aim to be able to do 10 long squeezes, holding each squeeze for 10 seconds.

Short squeezes

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? Always let the muscles fully relax after each squeeze.

You may need to start with ‘little and often’ if you find that you can only hold the squeeze for a short time, or only do a few before the muscles tire. Aim  for 10 short squeezes.

It’s great if you manage to do your pelvic floor muscle exercises at least 3 times each day, however we all lead busy lives and this obviously might not always be possible, however remember than little is better than nothing!

You may find it easier to do them when you are sitting or lying down. Build up your exercise routine gradually over the weeks and months. You should notice an improvement in 3 – 5 months and then keep practising your pelvic floor muscle exercises once a day to maintain the improvement.

Is it ever too late to work on your pelvic floor health?

Absolutely not, better late than never. Your pelvic floor health is for life! Just like any other muscle group in the body, the pelvic floor muscles can always be improved in strength and in their ability to relax. And your bladder and bowel are adaptable too and responds to various trainings.

Any other advice you can share on looking after your pelvic floor in your 40s?

Sadly, too many women suffer from pelvic floor issues unnecessarily, often due to little knowledge that support exists or too embarrassed to seek help. However please be assured that passionate  women’s health professionals are here to help and there is no need to suffer in silence, there is nothing we haven’t seen or heard before! And on a very positive note, with the right support (and a little bit of patience and determination) many pelvic floor issues can be treated and symptoms improved greatly.  On a final note , always take your time to urinate and poo, never strain!

So how is your pelvic floor doing ladies?


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