Pelvic floor and bladder changes during menopause

Understand why pelvic floor and bladder changes happen during menopause, including leakage and prolapse, plus practical support options and next steps.

Almost 4 in 10 women in Australia experience some form of incontinence, according to research commissioned by Continence Health Australia. Despite how common these changes are, many women don't know why they happen or what support is available. Despite how common these changes are, many women don't know why they happen or what support is available.

This guide looks at how perimenopause and menopause can affect the pelvic floor and bladder, including leakage, urgency and pelvic organ prolapse. It covers what's happening in the body, practical steps that may help, and when it's worth speaking with a pelvic health physiotherapist or GP.

Why pelvic floor and bladder changes can happen around menopause

Jean Hailes explains that pelvic floor muscles can stretch and weaken around the time of menopause, and that the bladder itself can become less elastic, both of which can contribute to urinary incontinence. Continence Health Australia adds that lower oestrogen levels can cause vaginal dryness, which is linked to symptoms such as burning when passing urine and needing to go more often, along with an increased risk of urinary tract infection.

Ageing plays a role too, since muscle mass naturally declines over time regardless of hormone status. Other factors can add further pressure on the pelvic floor during this life stage, including pregnancy and childbirth, constipation, being overweight, and persistent coughing.

What is the pelvic floor and why does it matter?

Jean Hailes describes the pelvic floor as muscles and tissue running from the pubic bone at the front of the pelvis to the tailbone at the back and expanding sideways between the sitting bones. These muscles work like a supportive hammock for the bladder, bowel and uterus, and pelvic floor muscles need to relax fully for the bladder to empty properly.

The pelvic floor is also part of the body's core, working alongside the deep abdominal and back muscles to support the spine and manage pressure through the abdomen. Like any other muscle group, it can be strengthened. It can also become too tight or overactive rather than only weak, which matters when it comes to choosing the right kind of support.

Leakage, urgency and bladder changes explained

A normal bladder holds up to around 600 mL of urine, empties four to six times a day and up to once overnight, and gives enough warning to reach a toilet in time, according to Jean Hailes. Urinary incontinence is when this process doesn't work as expected, and it's a common condition that can be treated, managed and often cured.

Stress incontinence and urge incontinence

There are several patterns of incontinence. Stress incontinence is leakage triggered by physical pressure on the bladder, such as coughing, sneezing, laughing or jumping. Urge incontinence involves a strong, sudden need to urinate that can be hard to delay before reaching the toilet. Mixed incontinence is a combination of both, and overflow incontinence happens when the bladder doesn't empty properly and becomes overfull. Around menopause, weaker pelvic floor muscles and a less elastic bladder can make these patterns more noticeable.

What is prolapse and what signs should women know?

Pelvic organ prolapse happens when the tissues and muscles supporting the bladder, bowel or uterus stretch or weaken, allowing one or more of these organs to shift and press into the vagina. Continence Health Australia notes that prolapse is a common experience, and around 1 in 2 women who have had a baby experience some degree of it.

Signs some women notice include a heavy or dragging feeling in the vagina, a sense of something coming down or bulging, discomfort during sex, difficulty fully emptying the bladder or bowel, and lower back pain. Symptoms can feel more noticeable later in the day or after time on your feet and often ease with rest.

Menopause is one of several factors that can contribute to prolapse, alongside long-term coughing, heavy lifting, constipation and straining, and family history. Noticing these changes and speaking with a health professional early can help identify options before symptoms progress further.

Pelvic floor exercises: what they can and cannot do

A Cochrane systematic review found that women with any type of urinary incontinence who did pelvic floor muscle training were around twice as likely to report their symptoms cured or improved compared with women who received no treatment (67% versus 29%). For women with stress incontinence specifically, the effect was larger again, at around six times more likely. The review's authors concluded that pelvic floor muscle training could be included in first line conservative management for women with urinary incontinence, while noting that its long-term effectiveness needs further research.

Pelvic floor exercises may also support recovery after childbirth or pelvic surgery, though they don't reverse prolapse that has already progressed.

How to get started

To find your pelvic floor muscles, try identifying the muscles you would use to stop the flow of urine, without regularly practising the exercise while urinating, then the muscles around the vagina, then the muscles around the anus as if holding in wind, relaxing fully each time. Once you can feel this lift, aim to hold for a few seconds, relax for the same length of time, and build up gradually.

Technique matters more than effort. Incontinence can also happen when pelvic floor muscles are too tight, or overactive, rather than weak. In this case, standard strengthening exercises aren't the right fix and can leave symptoms unchanged or worse. A pelvic health physiotherapist or nurse continence specialist can check your technique and confirm whether strengthening, relaxation, or a combination of both, is right for you.

When to see a pelvic floor physiotherapist

It's worth seeking support if you can't feel your pelvic floor muscles working, you notice a bulge or heaviness in the vagina, you feel pain during or after pelvic floor exercises, or symptoms haven't improved after a few weeks of regular practice. Support is also worth arranging after childbirth, pelvic or gynaecological surgery, or whenever bladder or bowel symptoms are new or getting in the way of daily life.

A GP, pelvic health physiotherapist, urogynaecologist or nurse continence specialist can each play a role, and a referral from your GP is a reasonable place to start if you're unsure. The National Continence Helpline (1800 33 00 66), funded by the Australian Government, offers free, confidential advice from nurse continence specialists and can help you find a pelvic health physiotherapist near you.

Lifestyle habits that may support bladder comfort

Several everyday habits that may help prevent or manage bladder symptoms include:

• Doing regular pelvic floor muscle exercises
• Eating a balanced, fibre rich diet to help avoid constipation and straining
• Moderating things that can irritate the bladder, such as caffeine and alcohol
• Staying physically active and maintaining a healthy weight
• Practising good toilet habits, such as weeing only when you need to rather than "just in case"

Continence Health Australia also recommends strengthening the pelvic floor before menopause where possible, as a way of supporting these muscles through the transition ahead.

How to talk about pelvic floor symptoms with a healthcare professional

Bladder and pelvic floor changes are common, but many women feel embarrassed to raise them, even with a doctor. It's worth remembering that bladder leakage is common, but it isn't something you have to live with, and it can usually be treated, managed or cured.

When you see your GP or a nurse continence specialist, they'll typically ask about how often you go to the toilet, how often and how much you leak, when the leaking happens, whether there's any burning sensation, and how much fluid you drink. Being specific helps (for example, "I leak a small amount when I sneeze" rather than "I have bladder problems"). A bladder diary can make this easier: it's a simple record of your bladder symptoms that you can bring to your appointment.

If you don't feel you've been heard, you're welcome to ask for a referral to a pelvic health physiotherapist or seek a second opinion.

Supporting yourself through the broader menopause transition

Pelvic floor and bladder changes are one part of the menopause transition. Many women are also navigating hot flushes, night sweats, and changes to sleep and mood during this time.

For general perimenopausal wellbeing support, Blackmores Peri & Menopause Balance is formulated with Affron® (a standardised saffron extract), Withania and Trigonella, traditionally used to support the body through hot flushes, night sweats, emotional wellbeing, mood balance and healthy sleep patterns. It isn't formulated to address pelvic floor weakness, bladder leakage or prolapse. For those symptoms, the professional support and pelvic floor training outlined above remain the appropriate starting point. You can find more general guidance in our overview of menopause symptoms and support options.

Key takeaways: support options and when to seek help

• Pelvic floor and bladder changes, including leakage and prolapse, are common around menopause and are linked to weaker pelvic floor muscles, reduced bladder elasticity and declining oestrogen.
• Pelvic floor exercises are a well supported first step for many women, but correct technique matters, and some women need relaxation rather than strengthening.
• Signs of prolapse, such as heaviness, bulging or a dragging feeling, are worth checking with a professional rather than managing alone.
• A GP, pelvic health physiotherapist, nurse continence specialist or urogynaecologist can each help, and the free National Continence Helpline (1800 33 00 66) is a good starting point.
• These changes are common, manageable, and nothing to feel embarrassed about raising with a health professional.

Frequently asked questions

Can menopause cause bladder leakage?

Yes. Around menopause, pelvic floor muscles can weaken, and the bladder can become less elastic, which can lead to leakage, urgency or needing to go more often. These changes are common and can usually be improved with pelvic floor exercises and professional support.

What is pelvic floor weakness?

Pelvic floor weakness happens when the muscles supporting the bladder, bowel and uterus stretch and lose strength, making it harder to control urine, wind or bowel movements. It's often linked to childbirth, ageing and hormonal changes, including menopause.

Can pelvic floor exercises help bladder control?

For many women, yes. Regular, correctly performed pelvic floor exercises are a well supported first step for stress and urge incontinence. A pelvic health physiotherapist can check your technique, since exercises done incorrectly may not help and can occasionally make symptoms worse.

What is prolapse and what are the signs?

Prolapse occurs when pelvic organs, such as the bladder, bowel or uterus, drop and press into the vagina due to weakened supporting tissue. Signs include heaviness, bulging or a dragging feeling in the vagina, and discomfort during sex. It's common and manageable with the right support.

When should women see a pelvic floor physiotherapist?

It's worth seeking support if you notice leaking, heaviness or bulging, if symptoms haven't improved after a few weeks of pelvic floor exercises, or after childbirth or pelvic surgery. A GP can provide a referral, or you can contact the National Continence Helpline on 1800 33 00 66

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Disclaimer: This article provides general information only and is not intended to diagnose, treat, cure, or prevent any disease. The information presented is not a substitute for professional medical advice. If you have concerns about your health, please consult your GP or healthcare provider for a personalised assessment and recommendations. Supplements should not replace a balanced diet.