Tag: pelvic floor

Categories
Menopause & Perimenopause

Why Your Pelvic Floor Feels Different After 40 and How to Strengthen It

A woman performing a weighted step-up exercise to address midlife pelvic floor changes by integrating functional strength training and core engagement.

If you’ve noticed subtle (or not so subtle) midlife pelvic floor changes, you are not imagining it.

Maybe you leak a little when you cough.
Maybe intimacy feels different.
Maybe your core feels weaker even though you’re still working out.

And here’s the part no one talks about enough: Pelvic floor dysfunction is not just a postpartum issue.

Midlife is another major hormonal transition. And just like pregnancy changes tissue, so does perimenopause and menopause. The difference? Fewer women are warned about it.

Let’s break down what’s happening and, more importantly, what you can do about it.

Why We Only Talk About the Pelvic Floor After Baby

A diagram of the pelvic floor, illustrating the importance of pelvic floor strength during pregnancy and postpartum

Culturally, pelvic floor conversations center around childbirth. And yes, pregnancy and delivery do place enormous strain on pelvic tissues. But midlife introduces a different kind of stressor: hormonal change.

If pregnancy is a rapid surge of hormones, perimenopause is a gradual and fluctuating withdrawal. And that shift affects the same tissues.

The truth is, your body is navigating another rebuild phase. And that includes your pelvic floor.

The Role of Estrogen in the Female Body

Estrogen is not just a reproductive hormone. It plays a structural role throughout your body.

Estrogen helps support:

  • Collagen production
  • Connective tissue elasticity
  • Blood flow to pelvic tissues
  • Muscle protein synthesis
  • Nervous system signaling

It is protective. In the pelvis specifically, estrogen supports:

  • Vaginal tissue thickness
  • Urethral support
  • Ligament integrity
  • Muscle tone and coordination

When estrogen levels are stable, tissues tend to be resilient. When they decline, tissues require more intentional loading and support.

(If you want a deeper dive into estrogen’s impact on connective tissue, see Menopause and Joint Pain: The Estrogen Connection for a broader look at how hormones influence structural integrity.)

What Happens to Estrogen in Perimenopause?

Perimenopause can begin in your late 30s or 40s; long before your period officially stops.

A graph illustrating the decline of estrogen levels over time, showing a corresponding decrease in muscle mass and bone density along with increased injury risk and faster bone loss.

It is not a straight decline. It’s a rollercoaster.

Estrogen fluctuates unpredictably before it eventually trends downward. That fluctuation is why symptoms can feel inconsistent:

  • Some months feel normal.
  • Some months feel inflamed, dry, weak, or unstable.

Eventually, estrogen levels settle at a lower baseline after menopause. And that shift directly influences midlife pelvic floor changes.

How Declining Estrogen Affects the Pelvic Floor

Let’s get specific.

Comparison of pelvic floor changes after childbirth and during menopause

Reduced Tissue Elasticity

Lower estrogen reduces collagen production.

That means:

  • Vaginal tissues may thin
  • Connective tissues may feel less elastic
  • Support structures may feel less firm
  • Dryness can increase

This is not “just aging.” It is tissue remodeling in response to hormone shifts.

Decreased Muscle Mass

After 40, women naturally begin to lose muscle mass at a faster rate if they are not strength training. This includes pelvic floor muscle.

When muscle mass decreases:

  • Contraction strength decreases
  • Endurance decreases
  • Reaction time slows
  • Pressure control weakens

This is why learning about core and pelvic floor coordination matters. Your deep core system is designed to function as a team. (For a deeper look at this synergy, revisit The Core & Floor Connection: Why Traditional Abs Are Outdated for Women 30-60.)

Impact on Core Strength and Pressure Management

Your pelvic floor is part of your pressure management system.

It works with:

  • Diaphragm
  • Deep abdominals
  • Glutes
  • Spinal stabilizers

If the pelvic floor weakens or loses elasticity, managing intra-abdominal pressure becomes harder.

That’s when you may notice:

  • Leaking with jumping
  • Leaking with heavy lifts
  • Feeling of heaviness
  • Difficulty “connecting” to your core

This is not a failure. It is a sign your tissues need strategic strength work.

Signs Your Pelvic Floor Needs Support

Midlife pelvic floor changes can show up as:

  • Urinary leakage
  • Pelvic pressure or heaviness
  • Pain with intimacy
  • Constipation
  • Lower back instability
  • Difficulty stopping urine mid-stream
  • A sense that your core feels disconnected

These are not things you have to “just live with.” They are feedback.

How to Train the Pelvic Floor in Midlife

First: Kegels alone are not enough.

Isolated contractions have their place, but the pelvic floor does not function in isolation in real life.

It works during:

  • Squatting
  • Lifting
  • Carrying
  • Walking
  • Breathing
  • Rotating

Strength training provides the mechanical load needed to stimulate tissue adaptation.

If estrogen is declining, your strategy must increase intentional loading.

That means:

  • Coordinated breath
  • Progressive resistance
  • Glute engagement
  • Core integration

If you need additional movement ideas beyond traditional Kegels, revisit 5 Pelvic Floor Exercises That Are Not Kegels for supportive variations.

3 Foundational Moves to Strengthen the Pelvic Floor

These movements teach pressure control while building real strength.

Glute Bridge with Breath Coordination

Why it works:

  • Activates glutes (key pelvic support muscles)
  • Encourages coordinated exhale during effort
  • Reinforces core connection

Coaching cues:

  • Inhale to prepare
  • Exhale as you lift hips
  • Gently engage pelvic floor as if lifting a blueberry with the vaginal muscles
  • Avoid clenching or bearing down

Deadlift Pattern (Dumbbell or Kettlebell)

Why it works:

  • Builds posterior chain strength
  • Teaches pressure management under load
  • Reinforces spinal stability

Coaching cues:

  • Inhale before hinge
  • Exhale during lift phase
  • Maintain rib cage stacked over pelvis
  • Avoid pushing breath downward

This movement trains the pelvic floor to function during real-life lifting.

Step-Up or Split Squat

Why it works:

  • Builds unilateral hip stability
  • Improves pelvic alignment
  • Challenges balance and deep core activation

Coaching cues:

  • Slow, controlled tempo
  • Exhale on effort
  • Maintain tall posture

These movements help rebuild tissue capacity, not just tone.

Red Flags: When to See a Pelvic Floor Therapist

Strength training is powerful. But some symptoms require evaluation.

See a pelvic floor physical therapist if you experience:

  • Persistent or worsening leakage
  • Pelvic heaviness that increases throughout the day
  • Pain during intimacy
  • Pain with exercise
  • Difficulty emptying bladder or bowels
  • Visible or diagnosed prolapse

Stop exercise immediately if you notice:

  • Sharp pelvic pain
  • Sudden increase in heaviness
  • Bulging sensation
  • New or worsening incontinence

There is no shame in needing support. Therapy and strength training often work best together.

The Big Takeaway: Your Pelvic Floor Is Trainable at Any Age

Midlife pelvic floor changes are common. They are physiological. And they are responsive to strength.

This is not about shrinking; this is about rebuilding.

Just like postpartum, midlife is a transition. And transitions require intentional strategy.

When you:

  • Load your muscles
  • Coordinate breath
  • Train your hips
  • Strengthen your core system

You create resilience. Your pelvic floor is not failing you. It is simply asking to be trained differently.

Medical Disclaimer

This article is for educational purposes only and is not medical advice. If you are experiencing pelvic pain, prolapse symptoms, or persistent incontinence, consult a licensed pelvic floor physical therapist or healthcare provider.

join the tfc community!

subscribe to be best friends 🤍

Weekly wellness tips & mom support, straight to your inbox 💌

Categories
Postpartum Strength Prenatal Fitness

5 Pelvic Floor Exercises That Are Not Kegels

5 Pelvic Floor Exercises That Are Not Kegels

If you’ve ever experienced pregnancy or childbirth, you know firsthand the importance of pelvic floor strength, and how difficult it can be when those muscles have been compromised (if you cross your legs when you sneeze, or jumping jacks send you running to the bathroom, you know what I’m talking about!). So why does this happen?

First, let’s talk about what the pelvic floor is and what that really means. The pelvic floor is a group of muscles that are part of our larger core muscle group. We tend to think about our “core” as just our abs, or “6-pack muscles;” but the core is actually made up of our abdominal wall, oblique abdominals, transverse abdominis, erector spinae, supporting and stabilizing muscles of the chest and back, hip flexors, glutes, diaphragm, and, of course, the pelvic floor. The pelvic floor muscles span from one side of the pelvis to the other and act as a “net” to support the pelvic organs, such as the bladder, vagina, anus, and uterus.

In pregnancy, the growing baby and uterus stretch and push the muscles of the abdominal wall and pelvic floor, and the pelvic floor supports the added weight throughout the pregnancy.

Kegels are an exercise that targets the pelvic floor muscles, particularly around the urethra, through contracting, or tightening, the muscles. While performing kegels is undoubtedly an essential part of maintaining the strength of the pelvic floor, if this is all you are doing, you likely do not feel the strength returning to the desired level.

It’s important to diversify your pelvic floor workouts to include the entire muscle group of the pelvic floor muscles, as well as working to integrate and strengthen the surrounding muscles of the hip complex and glutes. Intentionally strengthening the entire “net” of pelvic floor muscles and their surrounding joints and neighboring muscles will provide a stronger foundation and better support your internal pelvic organs.

Disclaimer: Before starting any new exercise routine, it is essential to consult with your healthcare provider or medical care team, particularly if you have any existing health concerns or conditions. This blog post is intended for informational purposes only and is not a substitute for professional medical advice. Always prioritize your health and safety by seeking guidance tailored to your individual needs.

1. Glute Bridge

The glute bridge exercise is performed while lying on your back and by lifting your hips in an upward motion. The glutes, hips, low back, and pelvic floor are all engaged during this movement.

Start by lying on your back with your knees bent and feet planted on the floor. Begin squeezing through the glutes, exhale, and lift the hips off the ground as high into the air as you can, while continuing to contract the glute muscles. Relax the muscles and inhale as you return the hips to the starting position on the floor. You can make this move more challenging by holding for a few seconds at the top, continuing to engage the glute muscles and breathing normally.

The glute bridge strengthens the pelvic floor muscles, along with the glutes, hips, and core; adding to overall stability as well as pelvic floor strengthening.

2. Squats

Squats represent one of 3 lower body functional movements (bending) used throughout our daily activity – such as sitting down and standing back up. They engage the lower body muscles, as well as the core, glutes, hips, and pelvic floor.

Start standing with feet slightly wider than hip-distance. Inhale as you hinge forward at the hips, sending the glutes backwards behind you, and continue motion downward by bending through the knees. When you have lowered as much as you can without pain or losing control of the motion, exhale as you press through both feet firmly and squeeze through the glutes to return to the starting position of standing.

Squats strengthen the muscles that support and hold up the pelvic floor (hamstrings, glutes, and hips), as well as strengthening the pelvic floor muscles through proper engagement of the core.

3. Dead Bug

The dead bug movement engages the core muscles, including the pelvic floor, while working to stabilize the body throughout a coordinated movement.

Start by laying on your back with your arms and legs in the air above you (i.e., looking like a dead bug on its back, hence the name!). Arms should be straight and positioned directly above the shoulders; legs should be bent to a 90 degree angle with the knees positioned directly above the hips and the feet extended outward, away from the body. Inhale and reach the right arm overhead to touch the floor above your head, while extending the left leg straight through the knee to touch your foot to the floor in front of you. Exhale as you return arm and leg to their starting positons over your body, then repeat with the left arm and right leg.

The dead bug exercise strengthens the pelvic floor muscles by engaging the deep core muscles that support the pelvis and spine. This exercise is particularly effective for strengthening the transverse abdominis, which is a key muscle for pelvic stability and pelvic floor support.

4. Bird Dog

The bird dog exercise engages the core muscles, including the pelvic floor, while working to stabilize the body throughout a coordinated movement.

Start in a tabletop position on your hands and knees, with hands positioned directly under the shoulders and knees positioned directly under the hips. Draw the belly button toward the spine to engage the core, then inhale and extend the right arm straight in front of you at shoulder height, while also extending the left leg directly behind you at hip height. Exhale and create a crunching movement through the abdomen, drawing the right elbow toward the left knee, then return to the starting tabletop position.

The bird dog exercise strengthens pelvic floor muscles by engaging the core, including the abdominal muscles and pelvic floor, which are crucial for supporting the spine and maintaining stability. By challenging the core and balance while moving your limbs, the bird dog exercise helps improve core stability and indirectly strengthens the pelvic floor.

5. Clamshells

The clamshell exercise engages the hip complex, the glutes, the stabilizing muscles of the core, and the pelvic floor. This movement is performed lying on your side and targets one side of the body at a time.

Start by lying on your left side with your knees slightly bent and stacked, your feet in line with your spine and stacked. Firmly press your heels together and exhale while lifting the right knee upwards, opening through the hips as wide as you can without pain. Inhale as you relax through the hips and glutes and return to the starting position of knees touching. Repeat on each side.

The clamshell exercise primarily strengthens hip muscles that work in synergy with the pelvic floor. By strengthening these surrounding muscles, the clamshell exercise can contribute to the overall stability and strength of the pelvic floor, which can indirectly benefit pelvic floor health and function.

In a nutshell, taking care of your pelvic floor is super important for a strong core and overall health. Mixing in exercises like glute bridges, squats, dead bugs, and bird dogs can really help strengthen those muscles. If you’re interested in boosting your pelvic floor strength and just feeling better overall, don’t hesitate to reach out! We’d love to chat and see how we can help you on your fitness journey!

Have you tried any of these pelvic floor exercises? Let us know either way in the comments!

Leave a Reply