Up to 1 in 3 women experience urinary incontinence before, during or after menopause.

Have you ever laughed at a joke, sneezed unexpectedly, or jumped during a workout, and felt that sudden, mortifying leak? Or maybe you’ve started mapping out bathroom locations everywhere you go, just in case. If this sounds familiar, know this: what you’re experiencing has a name, a cause, and, most importantly, effective treatments.

Incontinence and pelvic floor changes are some of the most common, and least openly talked about, symptoms that can happen before, during, and after menopause. A lot of women quietly adapt instead, wearing pads more often, avoiding certain activities, or planning their day around bathroom access because they assume it’s “just part of aging.” While these changes are common, they’re not something women simply have to accept without support or conversation around them.

Pelvic floor dysfunction is common during these times, but it is not something you simply have to live with. With the right approach, most women see significant, sometimes complete, improvement.

What Is the Pelvic Floor?

The pelvic floor is a group of muscles, ligaments, and connective tissues that sit at the base of the pelvis like a supportive sling or hammock. These muscles help support organs like the bladder, uterus, and bowel, while also playing important roles in bladder control, bowel function, posture, and core stability.

These muscles are responsible for:

• Controlling the release of urine and bowel movements
• Supporting your pelvic organs, especially during movement and physical effort
• Playing an important role in sexual sensation and function
• Contributing to core stability and spinal support

Why Perimenopause/Menopause Changes Everything

During perimenopause and menopause, estrogen levels naturally decline, and while estrogen is often thought of mainly as a reproductive hormone, it also helps support the strength, elasticity, and moisture of tissues throughout the pelvic region, including around the bladder and urethra.

As levels decrease, these tissues can become thinner, drier, and less supportive over time, which is part of why bladder and pelvic floor symptoms can become more noticeable during this stage of life.

On top of the hormonal changes happening during these times, muscle mass also naturally declines with age. For many women, the pelvic floor may have already been under strain for years from things like pregnancy, childbirth, heavy lifting, chronic coughing, or past pelvic surgeries. Perimenopause and menopause can sometimes bring those underlying weaknesses or changes more noticeably to the surface.

Did you know?

The pelvic floor muscles work continuously throughout the day, helping support the pelvic organs, manage pressure, and stabilize the core. Like other important postural muscles in the body, they benefit from regular attention and support.

Types of Urinary Incontinence

Not all incontinence happens for the same reason. Understanding which type you’re dealing with can make a big difference when it comes to finding the most appropriate support or treatment approach.

Stress incontinence

This type of leaking happens when physical pressure is placed on the bladder, not emotional stress. It usually occurs when the muscles and tissues supporting the urethra and pelvic floor aren’t able to fully hold back urine during sudden movements or exertion.

Common triggers: Coughing, sneezing, laughing, lifting groceries, jumping, running, or any sudden movement.

The most common type during menopause.

Urge incontinence

This type is often referred to as overactive bladder (OAB). It involves a sudden, strong urge to urinate that can come on very quickly, sometimes making it difficult to reach the bathroom in time.
It’s usually related to involuntary bladder muscle contractions or increased bladder sensitivity, even when the bladder isn’t completely full.

Common triggers: Running water, cold air, touching a door handle, or anxiety

Mixed incontinence

Some women experience a combination of both stress and urge incontinence at the same time. This is known as mixed incontinence and is actually quite common during and after menopause. Because there are multiple factors involved, support and treatment often need to address both the pelvic floor and bladder symptoms together, sometimes through a combination of exercises, lifestyle strategies, bladder training, or professional therapies depending on the situation.

Signs: Leaking with physical activity AND experiencing sudden urgent urges throughout the day or night.

Causes & Risk Factors

Pelvic floor weakness usually doesn’t come from one single cause. For many women, it develops gradually from a combination of factors, some related to hormones and aging, some connected to pregnancy or childbirth, and others influenced by lifestyle, health history, or everyday physical strain over time.

Biological factors

• Declining estrogen during perimenopause and menopause
• Natural muscle loss with age
• Pregnancy and vaginal childbirth (especially with prolonged pushing or large babies)
• Instrumental delivery (forceps or ventouse)
• Genetics and connective tissue type
• Previous pelvic or abdominal surgery
• Hysterectomy

Lifestyle factors

• Excess body weight (increases pressure on the bladder)
• Chronic constipation and straining
• Smoking (causes chronic coughing)
• Regular high-impact exercise without pelvic floor support
• Chronic dehydration (concentrates urine and irritates the bladder)
• Caffeine and alcohol excess

Health conditions

• Back or hip injuries (affect pelvic alignment)
• Neurological conditions (MS, Parkinson’s)
• Type 2 diabetes (can damage bladder nerves)
• Recurrent urinary tract infections
• Pelvic organ prolapse
• Respiratory conditions causing chronic cough

Signs You May Have Pelvic Floor Weakness

Symptoms can range from mildly annoying to genuinely disruptive in day-to-day life. If any of the following sound familiar, it may be a sign that the pelvic floor could benefit from additional support or evaluation:

Leaking urine when coughing, sneezing, or laughing

Leaking during exercise, running, or jumping

Sudden, strong urges to urinate with little warning

Frequent trips to the bathroom (every 1–2 hours or more)

Waking more than once a night to urinate (nocturia)

A feeling of heaviness or pressure in the pelvis

A sensation of something bulging in or near the vagina

Lower back pain without a clear musculoskeletal cause

Pain or discomfort during sex

Difficulty fully emptying the bladder

Leaking when transitioning from sitting to standing

Reduced sensation or pleasure during sex

Important note

A feeling of heaviness, pressure, or bulging in the vaginal area can sometimes be a sign of pelvic organ prolapse, which happens when pelvic organs shift downward due to weakened support structures in the pelvic floor.

It’s more common than many women realize, especially after menopause, pregnancy, or childbirth, and supportive treatments are available. If you notice symptoms like this, it’s important to speak with your doctor or a pelvic floor specialist for proper evaluation.

Treatment Options

The encouraging part is that there are many supportive treatment options available, and a lot of women notice meaningful improvement even with more conservative, non-invasive approaches.

The best approach usually depends on the type of incontinence involved, how severe the symptoms are, overall health factors, and personal comfort and preferences.

Kegel exercises

Kegel exercises, which involve gently contracting and relaxing the pelvic floor muscles, are one of the most commonly recommended first-line approaches for stress incontinence. They may also help support bladder control in some cases of urge incontinence by improving awareness and coordination of the pelvic floor muscles.

The biggest factor is consistency and proper technique, because many people are either doing them incorrectly or using the wrong muscles without realizing it.

How to find your pelvic floor muscles

One way to identify your pelvic floor muscles is to notice which muscles you would use to briefly stop the flow of urine midstream. Another common cue is imagining the gentle internal squeeze you’d use to stop yourself from passing gas. These can be helpful ways to recognize the correct muscles, but it’s important not to regularly stop urine flow as an exercise, since doing that repeatedly may interfere with normal bladder emptying and coordination.

Get into position

When first learning pelvic floor exercises, many people find it easiest to start lying on their back with their knees bent, since it helps reduce pressure on the pelvic floor and makes the muscles easier to feel. Over time, the exercises can also be practiced sitting, standing, or incorporated into daily activities. It’s generally recommended to empty your bladder beforehand so the muscles can relax and contract more comfortably.

Contract the right muscles

Gently contract and lift the pelvic floor muscles, almost like a subtle internal lifting sensation. Try to focus only on the pelvic floor itself while keeping the buttocks, thighs, and abdomen as relaxed as possible. And remember to breathe normally, holding your breath can create extra pressure instead of helping the muscles work properly.

Hold and release

Try holding the contraction for about 5–10 seconds, gradually building up if that feels too difficult at first. Then fully relax the muscles for the same amount of time before repeating. The relaxation phase matters just as much as the contraction. Pelvic floor muscles need to be able to both engage and release properly, since muscles that stay constantly tight can also contribute to discomfort and dysfunction.

Repeat & build frequency

A common starting goal is around 10–15 repetitions per session, done about 3 times throughout the day. Consistency tends to matter more than doing large amounts all at once.

Many women start noticing improvements in bladder control and pelvic floor awareness within several weeks, though the timeline can vary depending on factors like muscle strength, technique, consistency, and the severity of symptoms.

Common mistakes to avoid

Try to breathe normally throughout the exercise and avoid holding your breath, since that can create extra pressure through the abdomen and pelvic floor.

It’s also important not to compensate by tightening the abs, buttocks, or inner thighs too much, because that usually means the pelvic floor muscles aren’t doing the work on their own, and don’t rush the relaxation phase. Fully letting the muscles release is an important part of healthy pelvic floor function.

Like any muscle group, the pelvic floor can also become fatigued or overworked, so more isn’t always better. If you’re unsure whether you’re doing the exercises correctly, a pelvic floor physiotherapist can help assess muscle function and guide proper technique.

Exercises that support the pelvic floor

Kegels are often one part of the picture, but a broader strengthening and movement approach can also help by supporting the muscles that work together with the pelvic floor, including the core, hips, glutes, diaphragm, and lower back.

• Glute bridges
• Pilates (mat-based)
• Squats (bodyweight)
• Dead bugs
• Bird-dog
• Diaphragmatic breathing
• Side-lying clamshells
• Hip flexor stretches
• Core stability work

If symptoms are active or significant, high-impact activities like running, jumping, or certain intense workouts may place extra pressure on the pelvic floor and sometimes worsen leaking or discomfort.
For some women, it can help to temporarily focus on lower-impact movement while rebuilding strength and coordination, then gradually return to higher-impact exercise with guidance from a pelvic floor physiotherapist if needed.

Pelvic Floor Physical Therapy

Pelvic floor physiotherapy is considered one of the most effective first-line treatments for many types of incontinence and pelvic floor dysfunction. It often goes far beyond simply being told to “do Kegels,” because treatment is individualized based on how the muscles are actually functioning.

A pelvic floor physiotherapist can assess things like strength, coordination, tension, breathing patterns, posture, and pressure management, then create a more targeted plan based on a person’s specific symptoms and needs.

To find a pelvic floor PT: Ask your GP or gynecologist for a referral, or look specifically for practitioners who list “pelvic health” or “women’s health physiotherapy” as their specialty.

Lifestyle Changes That Make a Real Difference

• Maintain a healthy weight: Even a modest reduction in BMI can meaningfully reduce pressure on the bladder and pelvic floor
• Stay hydrated with water: It might seem counterintuitive, but staying properly hydrated can actually help support bladder comfort. When urine becomes very concentrated, it can irritate the bladder lining and sometimes worsen urgency or frequency symptoms. A simple general guide is aiming for urine that’s a light or pale yellow colour most of the time.
• Reduce bladder irritants: Caffeine, alcohol, fizzy drinks, artificial sweeteners, spicy foods, and citrus can all irritate the bladder and worsen urge incontinence
• Address constipation: Straining during bowel movements puts chronic pressure on the pelvic floor. Increase fibre, hydrate well, and speak to your doctor if constipation is ongoing
• Quit smoking: Smoking causes chronic coughing, which places repeated strain on pelvic floor muscles. It’s one of the most modifiable risk factors
• Bladder training: For urge incontinence, gradually extending the time between bathroom visits (starting with just a few minutes) can retrain the bladder’s urgency reflex over several weeks

What NOT to Do

Some common habits can quietly make incontinence worse. Here’s what to avoid:

Don’t restrict your fluid intake. Many women drink less water hoping to reduce leaks. This actually concentrates urine, irritating the bladder and worsening urgency, and increases the risk of urinary tract infections.

Don’t accept leaking as a normal part of aging. It’s common, but it’s not inevitable or untreatable. Effective help is available at every stage.

Don’t continue high-impact exercise while actively leaking. Running, jumping, or heavy lifting while the pelvic floor is compromised can worsen weakness. Work with a pelvic floor PT before returning to these activities.

Don’t hold your breath during Kegels or any lifting. Holding your breath, especially during lifting, straining, or exercise, can significantly increase pressure inside the abdomen. That added downward pressure places more load on the pelvic floor, which may worsen symptoms in some people if it happens repeatedly over time.

Don’t squeeze your buttocks, thighs, or abdomen during Kegels. This is the most common mistake and means you’re not actually training the pelvic floor muscles at all.

Don’t ignore worsening symptoms. If leaking is increasing in frequency or severity, you develop pain, or notice blood in your urine, seek medical attention promptly.

Don’t rely on pads alone as a long-term solution. Pads manage the symptom, they don’t address the underlying cause. Use them for comfort and dignity, but also pursue treatment.

When to See a Healthcare Provider

While mild, occasional leaking can often be addressed with self-care, there are certain signs that warrant a prompt medical evaluation. Please see your doctor if:

• You’re leaking daily or multiple times per week
• Incontinence is affecting your work, social life, exercise, or confidence
• You experience pain or burning when urinating
• You notice blood in your urine at any time
• You feel pelvic heaviness, pressure, or a sensation of bulging
• You cannot fully empty your bladder
• You’re experiencing recurrent urinary tract infections
• Symptoms are worsening despite self-care efforts
• Leaking is accompanied by pelvic or lower back pain
• You’ve had a recent pelvic surgery or difficult delivery

Recovery Is Real

With consistent pelvic floor exercises, many women begin noticing improvements within several weeks to a few months, though results can vary depending on the type and severity of symptoms.

When exercises are combined with pelvic floor physiotherapy and a more individualized treatment approach, outcomes are often even stronger. Some women experience major improvement in symptoms, and in certain cases symptoms may resolve completely.

The earlier you begin, the better, but it is never too late. Women in their 60s, 70s, and beyond have made meaningful progress with the right support.

• 70% of women improve significantly with pelvic floor PT
• 6–12weeks to see results with consistent Kegels
• 1 in 3 menopausal women experience this so you’re not alone

Simply Salt & Soul

Pelvic floor weakness and urinary incontinence are extremely common during and after menopause, and they’re also highly supportable. These changes are not something women simply have to silently put up with as they age. They’re connected to real physiological changes involving hormones, muscles, connective tissue, and pelvic support, and many women see meaningful improvement when those areas are properly addressed and supported.

The most important thing you can do is start. Start the Kegels today, even if you’re not sure you’re doing them perfectly, you’ll build awareness. Talk to your doctor or gynecologist at your next appointment. Ask for a referral to a pelvic floor physiotherapist.

This article is intended for informational and educational purposes only and does not constitute medical advice. Individual circumstances vary. Please consult your doctor, gynecologist, or a qualified pelvic floor physiotherapist before beginning any new treatment or exercise program, particularly if you have existing health conditions or your symptoms are severe.