Ashley Rawlins, PT, DPT
Kathleen Jordan, MD
Some of the most common symptoms of menopause—painful sex, vaginal dryness, and urinary incontinence, to name a few—involve the pelvic floor. It’s an area of the body that often gets ignored until something goes wrong. And even then, many women tend to push the symptoms aside or consider them a normal—albeit annoying—part of aging.
But Ashley Rawlins, PT, DPT, a doctor of physical therapy, pelvic health physical therapist, and clinical specialist at Origin, wants women to know that there’s a solution. She sat down with Midi’s Dr. Kathleen Jordan to explain why pelvic floor health matters during menopause and how physical therapy (both in-person and virtual) can play an important role in your menopause treatment plan.
What is the pelvic floor?
The pelvic floor is a group of muscles, ligaments, tissues, and nerves at the bottom of our pelvis. Everybody has a pelvic floor, no matter their sex or gender. It’s foundational in helping support pelvic functions, which include our bowel, bladder, and sexual functions. The pelvic floor is also important for balance and stability, movement, breathing—really everything.
What is pelvic floor therapy?
Pelvic physical therapy specializes in treating conditions and anything else that could affect the pelvic floor. As a pelvic floor physical therapist, I provide whole body care with a special focus on pelvic health. For those born with vaginal anatomy, that often focuses on sexual function, bladder function and bowel function at any stage of life.
What are Kegels—and how do they play a role in pelvic floor therapy?
A Kegel is an exercise that involves contracting and then relaxing the pelvic floor muscles. It's basically like a bicep curl for the pelvic floor muscles. To perform a Kegel contraction, imagine that you’re sitting on the toilet and need to stop your urinary flow—those are the muscles that you want to engage in the pelvic floor.
So why do we do Kegels? Pelvic floor dysfunction can occur when your muscles aren’t working the way they’re supposed to, and sometimes that’s because they’re weak or underused. When you do resistance training of these muscles with Kegels, you can strengthen them.
However, sometimes pelvic dysfunction is caused by overly tight, or tender and painful muscles, which Kegels aren’t always effective for. Instead, it is often better to focus on restoring muscle flexibility and function and doing exercises that help rewire the connection between the brain and pelvic floor when pain is present. So while Kegels can be wonderful, they're just one tool in the pelvic health toolbox.
Who would benefit from pelvic floor therapy?
We see patients across the board. There are risk factors in pregnancy and with childbirth that increase the chances of developing pelvic floor muscle dysfunction, but anybody can have it. For example, we see athletes like runners and weightlifters who have leakage or feel like they can’t make it to the bathroom. We also see people who are experiencing painful sex or vaginismus.
Pelvic floor therapy can also help women in menopause with genitourinary symptoms, like vaginal dryness and irritation, painful sex, and decreased libido. The most common changes that I see at this stage of life are progressions or sudden new symptoms of bladder and sexual health. Most often it looks like an increasing or worsening of bladder leakage. Maybe you’re having more frequent leakage during laugh attacks or you need to use the bathroom at every other rest stop on a road trip. You’re really being controlled by your bladder more than you used to.
How does pelvic floor therapy help with menopause symptoms?
There are so many changes in genital health during the menopause transition and the decrease in estrogen levels can impact the pelvic floor in many ways. Additionally, existing pelvic floor issues may worsen during menopause.
For example, lower estrogen levels during menopause can affect the health of the collagen in the pelvic floor. This reduces the thickness and flexibility of the tissues in the vagina and vulva, leaving the tissues brittle and dry. Low estrogen can also impact the support of the urethra, compromise bladder muscle function, and reduce blood flow to all tissues in the urogenital system. In this way, the changes of menopause can impact sexual, bladder, and bowel function.
With pelvic floor therapy, we can help you strengthen your body to regain support, including in your pelvic floor, hips, and abdominals, which can all be affected by menopause. We can also improve the flexibility of tissues that are brittle and dry to enhance sexual function. We work with you to optimize all aspects of sexual health and wellness.
That said, women should know that properly treating your symptoms in menopause is a team sport — in other words, a multidisciplinary approach is required to treat these symptoms. As pelvic floor therapists, we may solve one aspect of what’s contributing, but it takes a village to get better, which could include your gynecologist and other menopause specialists.
What can someone expect during a pelvic floor therapy session?
If your therapy is in-person, you and your therapist may determine that an intravaginal assessment would be best to understand the full picture of your pelvic floor muscle health. Through either the vaginal or rectal walls, we're able to assess the pelvic floor muscles, which primarily sit deeper inside the pelvis. This exam can give us a really good sense of what is going on with the pelvic floor, and how it might be contributing to your symptoms. And we get to visually see how the stages of menopause have changed the vulva or vaginal tissues, the glands around the vaginal opening, the positioning of the pelvic organs, and the muscles.
At Origin, we also provide virtual pelvic floor therapy, which really increases access to treatment. When the therapy is done in a virtual setting, we teach patients how to get an idea of what's going on with their pelvic floor and provide feedback to the therapist.
Patients can combine these two forms of therapy. For example, you could have your initial pelvic floor assessment in person, and then you could continue your treatment virtually if that’s more convenient. Whatever it looks like for you, our goal is to make pelvic physical therapy accessible and convenient so that you can be successful in your rehabilitation journey.
How long is the treatment period for pelvic floor therapy?
It depends on the complexity of what's going on. In general for things like bladder leaks, we might see someone for three to six months, which could include 12 to 16 visits. That’s because it takes time for your body and muscles to change. But if you’ve been experiencing something like chronic pain, you may need therapy for a longer period of time.
But what I want people to know is that relief is possible and you don’t need to put up with these symptoms, whether leakage, painful sex, or something else. You’re not alone, and we’re here to support you.
If you’re in perimenopause or menopause and want guidance from clinicians who specialize in women’s midlife health, book a virtual visit with Midi today.
Hormonal change is at the root of dozens of symptoms women experience in the years before and after their period stops.
Our trained menopause specialists can help you connect the dots to guide you towards safe, effective solutions.
Whether you need personalized guidance or a prescription routine to tackle symptoms—including brain fog, hot flashes, sleep trouble, mood swings, and weight gain—we’ve got you covered. Learn more here.
