From Leakage To Painful Sex: Expert Addresses Pelvic Floor Concerns In Midlife

At Fabulous Over Forty Bengaluru, interesting insights were shared about the pelvic floor—an often-ignored muscle group in the human body—and why it is pivotal in shaping daily bodily functions. Dr Anuja Chandrana, a pelvic floor therapist, explained how and why it plays such an important role

The pelvic floor, as Dr Anuja described, is “essentially a bowl of muscles sitting at the bottom of your pelvis,” supporting the bladder, uterus, vaginal canal, and rectum, along with everything above. These muscles help control urination and bowel movement, and also play an important role in sexual health.

Pelvic floor muscles act like gates, relaxing when you need to urinate, pass stool, or engage in sex, and preventing leakage.  With age, childbirth, or menopause, the pelvic floor may weaken, leading to issues such as leakage or discomfort.

Dr. Anuja explained that the pelvic floor is also connected to breathing and functions as part of a larger system that includes the diaphragm and abdominal muscles. Estrogen plays a crucial role by influencing elasticity and lubrication. As estrogen levels decline, it affects not only strength but also coordination.

“It’s often not just a strength issue, it’s a coordination issue,” she noted, highlighting how stress, sleep, and overall nervous system health affect how the pelvic floor functions.

Common Pelvic Floor Issues

Genitourinary Syndrome of Menopause (GSM) is caused by low estrogen levels and affectsat least fifty per cent of women. Its symptoms include vaginal dryness, itching, burning, pain during intercourse and urinary issues like urgency or inconsistency.

Dr Anuja explained that urinary incontinence can occur during intense physical activity like jumping, laughing, coughing and lifting, during which a female may trickle urine.

She shared the example of her 43-year-old client who could not hold her urine and said, “It was raining, and I couldn’t get to my front door in time—I just peed my pants,” revealing how urinary urgency can strike anywhere, often when an individual is unprepared.

Dr Anuja also mentioned that sometimes women feel like their bladder hasn’t completely emptied, which can be a sign of pelvic floor dysfunction. Talking about recurrent urinary tract infections, she explained that even after the infection clears, discomfort may continue because “your nervous system remembers.” 

She also talked honestly about bowel problems like constipation, sudden urgency, the feeling of not fully emptying the stool, and even accidental leakage issues that many women struggle with but feel embarrassed about discussing. 

In simple words, she described pelvic organ prolapse as a loss of support, when the pelvic floor muscles weaken or don’t function properly, organs such as the bladder or uterus can move downward, causing heavy pressure in the vaginal area.

Does Pelvic Floor Affect Sex Life?

Talking about sexual health, Dr Anuja said that when many women start experiencing dryness, redness, and thinning of the vaginal tissues. Some describe it as feeling like “it’s going to tear down there.”

She also pointed out that when sex becomes painful, and you continue to pursue it repeatedly, it can affect libido and arousal. Even if dryness or redness subsides, the pain may persist because, as she explained, “your nervous system remembers.” To address this, pelvic floor physiotherapy is often required.

What Will Help

Dr Anuja emphasised, “Please stop thinking Kegels are the answer to everything.” Many people are still advised to do them, but they are not the solution for every woman. She stressed that Kegels should only be done when recommended by a pelvic floor therapist.

Sometimes the pelvic floor is too tight, poorly coordinated, or not working well with breathing. In such cases, doing more Kegels can actually make the problem worse. That is why she repeatedly highlighted the importance of individual assessment. “Understanding posture, breathing, and daily movement can solve half the issue,” she noted.

She also normalised topics that people often hesitate to discuss openly, such as using vibrators or self-pleasure as tools to reduce pain and increase comfort. She explained that most pelvic floor issues are common, especially after 40, but women do not have to simply live with them. Since this phase accounts for nearly half of a woman’s life, addressing these concerns can make a significant difference.