Vulvodynia

Hot flushes get all the attention. Mood changes, irregular periods and night sweats are talked about more than ever. But there's one symptom that still catches many women completely off guard: Changes in bladder function. Many women in their 40s and 50s suddenly find themselves planning every outing around the nearest toilet, waking multiple times overnight to wee, or leaking urine when they laugh, cough or exercise. If this sounds familiar, you're not imagining it—and you're certainly not alone. Bladder symptoms are common during perimenopause, but they're often overlooked or dismissed as "just getting older." The good news? They're common, but they're not something you have to put up with. Can perimenopause really affect your bladder? Yes. Perimenopause is the transition leading up to menopause, during which hormone levels—particularly oestrogen—begin to fluctuate. Oestrogen plays an important role in maintaining the health of the bladder, urethra and surrounding tissues. As hormone levels change, some women notice new bladder symptoms, even if they've never had problems before. Common bladder changes during perimenopause Every woman experiences perimenopause differently, but some of the most common bladder symptoms include: You're going to the toilet more often Do you find yourself needing to wee every hour or two? You may also notice you're planning car trips around toilet stops or always checking where the nearest bathroom is. While this can happen for many reasons, hormonal changes during perimenopause can make the bladder feel more sensitive. You suddenly can't "hold on" One minute you're fine. The next minute you're desperately searching for the nearest toilet. This sudden, difficult-to-ignore urge to urinate is known as urgency, and it can become more noticeable during perimenopause. You leak when you cough, laugh or exercise Bladder leakage isn't an inevitable part of ageing. Many women notice stress urinary incontinence during perimenopause, particularly if they've previously been pregnant, had vaginal births, or participate in high-impact exercise. These symptoms are often very treatable. You're waking several times overnight to wee Getting up once occasionally isn't unusual. But if you're waking multiple times every night, it may be affecting your sleep, energy and overall wellbeing. Nocturia (waking overnight to urinate) can have many causes, including bladder changes associated with ageing and hormonal fluctuations. It's worth discussing persistent symptoms with your healthcare provider to identify the underlying cause. Recurrent urinary tract infections (UTIs) Some women notice they begin experiencing UTIs more frequently during perimenopause. Changes in oestrogen levels can affect the tissues around the urinary tract and alter the protective environment of the vagina, increasing susceptibility for some women. If you're experiencing recurrent infections, it's important to seek medical assessment. Is it just a weak pelvic floor? Not necessarily. One of the biggest myths is that every bladder problem means your pelvic floor is weak. In reality, bladder symptoms can result from a combination of factors, including: hormonal changes changes to the bladder lining pelvic floor muscles that are weak pelvic floor muscles that are overactive or don't relax well constipation bladder habits fluid intake certain medications other medical conditions. That's why the same treatment doesn't work for everyone. What can a pelvic floor physiotherapist do? A pelvic floor physiotherapist looks beyond the symptom itself. Your assessment may include: pelvic floor muscle strength muscle relaxation and coordination bladder habits fluid intake bowel function breathing patterns movement and exercise lifestyle factors. Treatment is personalised and may involve: pelvic floor muscle training (when appropriate) bladder retraining urgency management strategies advice on bladder-friendly habits breathing and pressure management education about lifestyle factors that may influence symptoms. If your physiotherapist believes hormonal changes are contributing significantly to your symptoms, they may also recommend discussing treatment options with your GP or menopause specialist. Don't cut back on water A common response to bladder urgency is to drink less. Unfortunately, this can sometimes make things worse. Concentrated urine can irritate the bladder lining, increasing urgency and frequency. Rather than drastically reducing your fluid intake, it's better to identify the underlying cause of your symptoms and develop a management plan that's right for you. Frequently Asked Questions Can perimenopause cause an overactive bladder? Yes. Hormonal changes during perimenopause can contribute to bladder urgency and frequency in some women. However, other conditions can cause similar symptoms, so an assessment is important to identify the underlying cause. Why am I suddenly leaking urine in my 40s? Bladder leakage during your 40s can be influenced by hormonal changes, pregnancy history, pelvic floor function, ageing and lifestyle factors. Many women benefit from assessment and treatment by a pelvic floor physiotherapist. Will bladder problems improve after menopause? Some symptoms improve over time, while others may persist without treatment. The outlook depends on the underlying cause. Early assessment can help identify strategies to improve bladder function and quality of life. The Bottom Line Perimenopause can bring unexpected changes—but constantly thinking about your bladder doesn't have to become your new normal. Whether you're leaking urine, rushing to the toilet, waking overnight or simply feeling that your bladder has "changed," there are effective treatment options available. You don't need to wait until symptoms become severe to seek help. If bladder changes are affecting your confidence, sleep or daily life, our pelvic health physiotherapists can help identify what's contributing to your symptoms and create a personalised treatment plan, so you can get back to living without your bladder calling the shots.

When you hear the words "pelvic floor," what comes to mind? For many people, it's pregnancy, childbirth or women's health. But here's something that surprises many of our male patients: Men have a pelvic floor too. And when these muscles aren't working as they should, they can contribute to a wide range of symptoms that are often overlooked, misdiagnosed or simply accepted as "part of getting older." The good news? Many pelvic floor issues are treatable, and you don't have to live with them. What is the pelvic floor? The pelvic floor is a group of muscles that sits at the base of the pelvis like a supportive hammock. In men, these muscles help: support the bladder and bowel control urination and bowel movements contribute to sexual function provide stability for the pelvis and lower back coordinate with your breathing and core muscles. Like any other muscle group, they can become weak, overactive, poorly coordinated or painful. 1. You're going to the toilet "just in case" Do you find yourself using the toilet before leaving the house, before meetings or whenever you see a bathroom—even when you don't really need to go? While this habit can seem harmless, it may contribute to bladder urgency over time. If you're frequently: rushing to the toilet needing to urinate often waking multiple times overnight struggling to hold on, your pelvic floor and bladder coordination may be worth assessing. 2. You leak urine Bladder leakage isn't just a women's issue. Some men notice leakage: after prostate surgery during exercise when coughing or sneezing after they've finished urinating (post-void dribbling) without warning. Many men are embarrassed to bring this up, but it's a common reason to see a pelvic floor physiotherapist. 3. You have ongoing pelvic pain Pain in the pelvis isn't always coming from the prostate. Persistent pain may be felt in the: perineum (between the scrotum and anus) tailbone lower abdomen groin penis testicles hips. In some men, overactive or sensitive pelvic floor muscles contribute to these symptoms. 4. You struggle to empty your bowels Your pelvic floor muscles need to relax for a bowel motion to pass comfortably. If they don't coordinate well, you may experience: constipation straining incomplete emptying prolonged time on the toilet. Improving pelvic floor coordination can be an important part of managing bowel symptoms. 5. Sitting is uncomfortable Does sitting for long periods increase your discomfort? Persistent aching around the tailbone, deep pelvis or perineum may be related to several different conditions, including pelvic floor dysfunction. A comprehensive assessment can help identify contributing factors. 6. Sex has become painful—or isn't functioning the way it used to The pelvic floor also plays an important role in sexual health. Pelvic floor dysfunction may contribute to: pain during or after ejaculation erectile dysfunction in some cases reduced confidence pelvic muscle tension during intimacy. Because sexual function can be influenced by many factors—including cardiovascular health, hormones, medications and psychological wellbeing—it's important to have a thorough assessment to understand what's contributing to your symptoms. 7. You've had prostate surgery Pelvic floor physiotherapy is commonly recommended before and after prostate surgery. Treatment may help improve: bladder control confidence returning to activity pelvic floor muscle coordination recovery following surgery. If you're preparing for prostate surgery, seeing a pelvic floor physiotherapist beforehand can help you learn the correct exercises and what to expect during recovery. It's not always about weakness One of the biggest misconceptions is that pelvic floor problems are always caused by weak muscles. In reality, some men have pelvic floor muscles that are too tight, don't relax well or aren't coordinating properly. That's why doing pelvic floor exercises you find online isn't always the best approach. A personalised assessment is the safest way to determine what your body actually needs. When should you see a pelvic floor physiotherapist? Consider booking an assessment if you have: bladder leakage urinary urgency or frequency constipation or straining pelvic or tailbone pain pain around the penis, scrotum or perineum pain with ejaculation difficulty returning to exercise after prostate surgery ongoing symptoms that aren't improving. Many men wait months—or even years—before seeking help because they assume these symptoms are normal. They're common, but they aren't something you have to simply live with. Frequently Asked Questions Do men have pelvic floor muscles? Yes. Men have pelvic floor muscles that support the bladder and bowel, assist with continence, contribute to sexual function and work with the core muscles to provide stability. Can a pelvic floor physiotherapist help men? Absolutely. Pelvic floor physiotherapists assess and treat a range of conditions affecting men, including bladder leakage, pelvic pain, constipation, and recovery after prostate surgery. Should men do Kegel exercises? Not always. While pelvic floor strengthening is beneficial for some men, others have muscles that are overactive or poorly coordinated. An assessment helps determine whether strengthening, relaxation or a combination of approaches is most appropriate. The Bottom Line Pelvic floor problems are far more common in men than many people realise. Whether it's bladder leakage, pelvic pain, constipation or changes in sexual function, these symptoms are not something you should ignore or simply put down to ageing. The first step is understanding what's causing your symptoms. From there, a pelvic floor physiotherapist can develop a personalised treatment plan to help you regain confidence, comfort and control. You don't have to put up with pelvic floor symptoms just because you're a man. If something doesn't feel right, book an assessment with one of our pelvic health physiotherapists and take the first step towards getting back to doing the things you enjoy.

If you've ever leaked urine when you coughed, sneezed, or exercised, chances are someone has told you to "just do your Kegels." It's one of the most common pieces of advice given for pelvic floor issues—but it's not always the right advice. In fact, for some people, doing more Kegels can actually make their symptoms worse. The truth is that your pelvic floor isn't just about strength. It's about strength, coordination, flexibility, endurance, and the ability to both contract and relax . Just like any other muscle in your body, your pelvic floor needs balance. What are Kegels? Kegels are exercises that involve consciously contracting and relaxing your pelvic floor muscles. They can be incredibly effective for some people, particularly those with weakness contributing to bladder leakage or reduced pelvic floor support. However, they're not a one-size-fits-all solution. Before starting any pelvic floor exercise program, it's important to know why you're experiencing symptoms in the first place. When should you stop doing Kegels? If you're experiencing any of the following symptoms, it's worth seeing a pelvic floor physiotherapist before continuing with strengthening exercises. 1. You have pelvic pain Pain is not usually a sign that a muscle simply needs to get stronger. Many people with pelvic pain actually have overactive or tight pelvic floor muscles that struggle to relax. Adding repeated contractions may increase muscle tension rather than improve symptoms. 2. Sex is painful Pain during intercourse can have many causes, but an overactive pelvic floor is one possible contributor. If your pelvic floor muscles are already working overtime, strengthening exercises alone are unlikely to address the underlying issue. Treatment often focuses on helping the muscles learn to relax, lengthen and coordinate appropriately. 3. You're constantly rushing to the toilet Urgency doesn't always mean your pelvic floor is weak. Sometimes the muscles surrounding the bladder and urethra remain tense, creating altered bladder signals or poor coordination. A comprehensive assessment can help determine what's driving your symptoms. 4. You struggle to empty your bladder or bowels Your pelvic floor needs to relax to allow urine and stool to pass. If these muscles don't let go properly, you may experience: constipation straining incomplete emptying difficulty starting your urine stream. Doing repeated Kegels without addressing relaxation may not be helpful. 5. You feel tight "down there" Some people describe: a feeling of pressure tightness aching muscle spasms difficulty inserting tampons discomfort during pelvic examinations. These symptoms may suggest your pelvic floor is overactive rather than weak. 6. Your symptoms are getting worse If you've been faithfully doing Kegels for weeks or months but your symptoms haven't improved—or they've become worse—it's time to stop guessing. Pelvic floor dysfunction is complex, and not every problem is solved with strengthening exercises. Isn't a stronger pelvic floor always better? Not necessarily. Imagine someone whose shoulders are permanently shrugged up towards their ears. Would giving them shoulder shrugs all day solve the problem? Probably not. Instead, you'd want to help those muscles relax, move normally and regain healthy function. The pelvic floor works the same way. A muscle that's constantly switched on isn't necessarily a strong muscle—it's often a muscle that's working inefficiently. Healthy pelvic floor muscles need to: contract when needed relax fully respond quickly generate appropriate force coordinate with your breathing and core muscles. So who actually needs Kegels? Kegels may be recommended for people experiencing certain types of: stress urinary incontinence (leaking with coughing, sneezing or exercise) reduced pelvic floor strength after pregnancy some cases of pelvic organ prolapse recovery after certain surgeries. Even then, the exercises should be tailored to your individual needs rather than copied from an app or social media video. How do you know if your pelvic floor is weak or tight? The short answer is—you can't tell based on symptoms alone. Many symptoms overlap. For example, both weak and overactive pelvic floor muscles can contribute to: bladder leakage urinary urgency pelvic discomfort feelings of pelvic heaviness. That's why an assessment with a pelvic floor physiotherapist is so valuable. Rather than guessing, they'll assess how your muscles: contract relax coordinate respond during movement work alongside your breathing and core. From there, they can develop a treatment plan that's specific to your body and your goals. Frequently Asked Questions Can Kegels make pelvic pain worse? Yes. If your pelvic floor muscles are already overactive or unable to relax properly, repeatedly contracting them may increase tension and aggravate symptoms. An assessment can help determine whether strengthening, relaxation, or a combination of both is appropriate. Should I stop doing Kegels if they hurt? Pelvic floor exercises shouldn't be painful. If they cause discomfort or worsen your symptoms, stop the exercises and seek advice from a pelvic floor physiotherapist. Are Kegels bad? Not at all. Kegels are an effective treatment for many people—but only when they're prescribed for the right reason. Like any exercise, they work best when they're matched to the individual rather than applied as a universal solution. The Bottom Line Kegels can be incredibly effective—but they're not the answer to every pelvic floor problem. If you've been doing pelvic floor exercises without improvement, or you're experiencing pelvic pain, painful intercourse, constipation or difficulty emptying your bladder, your muscles may need a different approach. A pelvic floor physiotherapist can assess exactly how your muscles are functioning and develop a treatment plan that's tailored to your needs—not just your symptoms. Don't guess whether you should be doing Kegels. If your symptoms aren't improving, book a pelvic floor assessment and find out what your body really needs.