Why Pelvic Health Becomes More Important in Midlife and How to Improve It
- Jun 27, 2024
- 4 min read
Miyara Women | Jun 27, 2024 | Updated: Jul 26, 2025
Have you ever been told — "Leaking urine while sneezing, laughing or jumping is common among aging women and is not a big deal"?
Yes, it is common.
Population studies across numerous countries report urinary incontinence prevalence anywhere between 5% and 70%. Several recent Indian studies have reported 25–45% prevalence of bladder issues — and a 2024 AIIMS Rishikesh study published in Cureus found pelvic floor disorder prevalence as high as 56.7% among women in Uttarakhand, with 89.6% experiencing symptoms across all three compartments (urinary, uterovaginal, and colorectal). The same study flagged the condition as significantly underreported in India.
Higher-prevalence disorders in the same category include:
Pain/irritation while peeing or increased urgency to pass urine
Vaginal pain during or after sexual intercourse
Pain in the lower back
Fecal incontinence (involuntary leakage of stool)
Have you been able to talk about these openly among your peers? If yes, consider yourself lucky. Women often suffer in silence and feel helpless, given the stigma and stereotyping.
But is brushing aside the annoying symptoms the only option? A big no.
Read on to understand the common underlying issue that leads to these experiences, especially in the post-partum and (peri)menopausal periods.
The magnificent muscular cradle
Your major internal organs — the urinary bladder, uterus, and rectum — are housed by a group of muscles lining the hip/pelvic girdle, called the pelvic floor.
While the pelvic organs are held in position by tough ligaments connecting to the abdominal muscles in the front and back, the pelvic floor muscles support them from below. These muscles run from the pubic bone in the front to the tip of your backbone and extend on the sides like a hammock. They contract to close the excretory passages and expand as these canals open. Think of the ligaments as ropes and the pelvic floor as a weight-bearing cushion that prevents those ropes from stretching too much.
How to identify the pelvic floor muscles?
Relax the muscles of your stomach, thighs, and buttocks.
Squeeze the muscles around your urethra, vagina, and anus as if trying to hold urine or stools — pull them up together inside the pelvis.
Loosen them and repeat to feel the contracting muscles.
Why is pelvic floor health important, especially in perimenopause?
Among all body systems affected by fluctuating estrogen during the menopausal transition, the urogenital system and the pelvic floor are the most sensitive. This is because of the dense concentration of estrogen receptors in the bladder, urethral and vaginal tissues, and pelvic floor itself — making these tissues directly estrogen-dependent.
Optimal estrogen levels are crucial for maintaining a regular menstrual cycle, pubic hair growth, breast development, and proper vaginal moisturisation. As estrogen declines, the pelvic floor muscles — like all other muscles — can weaken, lose mass and strength, and become flaccid. This is referred to as pelvic muscle dysfunction (PMD).
A weakened pelvic floor can give way instead of holding the pelvic organs in place under load or impact, leading to a range of symptoms — from urinary and bowel dysfunction to vaginal and sexual issues. If left uncared for, the condition can progress to pelvic organ prolapse (organ displacement). Beyond the physical discomfort, these issues are significant sources of low self-esteem, often causing women to avoid socialising for fear of embarrassment. With proper nutrition and targeted physical activity, however, PMD can be both prevented and mitigated.
How can you work on your pelvic floor health?
A 2024 meta-analysis in the European Journal of Obstetrics and Gynecology found a 92% chance of significant improvement in urinary incontinence symptoms for postmenopausal women who received pelvic floor muscle training (PFMT), compared to controls. A 2025 systematic review in PMC — covering 205 studies published between 1997 and 2024 — found that 14 out of 15 trials showed improvement in pelvic floor muscle function. PFMT with or without hormonal therapy, and certain breathing techniques, can improve genitourinary symptoms and sexual function, and thereby quality of life in both peri- and post-menopausal women.
In your routine yearly gynaecological exam, ask your doctor to assess your pelvic floor health and discuss any symptoms. Depending on their recommendation, a physiotherapist specialising in pelvic floor health can provide targeted guidance. With the right tools, such issues can be delayed, minimised, and even partially reversed.
It is never too late.
Interested in improving your pelvic health? Click the flyer below to join our pelvic power program!
Tips for a Happy Pelvis
Kegels — Pelvic floor exercises strengthen the muscles supporting the bladder, uterus, and bowel. Regular practice makes a measurable difference.
Hydration — Adequate water intake is key to good pelvic health and urinary function.
Bowel health — Healthy bowel movements and pelvic health are directly connected. Straining during constipation puts repeated pressure on the pelvic floor.
Posture — Good posture supports your pelvic floor. Prolonged slouching adds unnecessary load to these muscles.
Pelvic support devices — Tools and devices are available to support pelvic floor recovery alongside exercise.
Stress management — Chronic stress tightens muscles throughout the body, including the pelvic floor. Actively managing stress supports pelvic well-being.
Written by: Dr. Ayshwarya Ravichandran PhD | Expert contributor: Viviane Hoeger, Pelvic Floor Specialist, Switzerland
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