After menopause oestrogen levels fall, and the tissues of the pelvic floor, vagina and urethra depend on it. They become thinner, less elastic and less well supplied with blood - hence a whole set of symptoms that often arrive together: leaking urine on coughing and exertion, urgency, more frequent urinary tract infections, a feeling of heaviness and prolapse, dryness and pain during intercourse.
These symptoms are for a long time treated as the natural price of age, about which nothing can be done. That is not true: pelvic floor muscle training has strong evidence behind it in urinary incontinence in postmenopausal women, and tissue work together with learning to release clearly reduces pain during intercourse.
Physiotherapy does not replace hormonal treatment. Local oestrogen therapy is sometimes what gives the tissue the conditions to improve - that decision belongs to a gynaecologist, and with these symptoms I always suggest that consultation. The best results come from combining the two.
Therapy
- Detailed history and a bladder diary
- Functional examination of the pelvic floor
- Individual pelvic floor training
- Treatment for urgency - the behavioural part
- Work on vestibular tissue and on pain during intercourse
- Learning to protect the pelvic floor when lifting and exercising
- A home programme