Pelvic Floor & Core

The conversation your body has been waiting for you to have

Q: What's the difference between a pelvic floor physio and a regular physio?

A pelvic floor physiotherapist has completed specialist postgraduate training in the assessment and treatment of pelvic floor dysfunction. Their approach typically includes an internal assessment — which is done respectfully, with your full consent at every stage, and is enormously informative. A regular physiotherapist generally does not have this training. Specifically seek someone with pelvic floor or pelvic health in their title or specialisation.

Q: Can I do pelvic floor exercises if I have a prolapse?

Yes — pelvic floor rehabilitation is often the first-line treatment recommended for prolapse. Strengthening the muscles that support pelvic organs can reduce symptoms significantly, and many women see meaningful improvement without surgery. A pelvic floor physio assessment is particularly important if you have a prolapse, as generic Kegel advice isn't always appropriate.

Q: How does menopause affect bladder control?

The bladder and urethra both contain oestrogen receptors, so falling oestrogen levels during menopause directly affect how they function. This can lead to increased urgency, frequency, and a greater likelihood of leaking. Both pelvic floor physiotherapy and localised vaginal oestrogen are genuinely effective for menopause-related bladder changes — worth asking your GP about specifically.

Leaking, heaviness, pain, disconnection — these aren't things you simply have to live with. They're signals. And you're allowed to take them seriously. Here's everything you actually need to know about your pelvic floor after 40.

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1 in 3

women experience urinary incontinence — and most never seek treatment

50%

of postmenopausal women have some degree of pelvic organ prolapse

Most

cases improve significantly with the right approach — pelvic floor therapy works

The pelvic floor is a group of muscles, ligaments, and connective tissue that sits at the base of your pelvis — supporting your bladder, bowel, and uterus, anchoring your core, and playing a quiet but essential role in how your body functions every single day. For most of our lives, we don't think about it much. Then our 40s arrive.

Pregnancy, childbirth, and the hormonal shifts of perimenopause all affect pelvic floor function — sometimes dramatically. Falling oestrogen levels change the elasticity and strength of pelvic tissue. What worked before may not work the same way now. And yet this is one of the least discussed areas in women's healthcare, because for decades, women have been told “it's just part of getting older, dear.” And most of them believed it.

They're not. Or rather — they're common, but common doesn't mean untreatable. The pelvic floor responds to the right support. And this is where you'll find it — clearly, without shame, and without pretending that “just do your Kegels” is enough.

The bigger picture

The pelvic floor isn't just a bladder problem. It's the base of everything — and everything else is built on it. After 40, it deserves your full attention.

The hormone connection

Why oestrogen changes everything for your pelvic floor

Oestrogen doesn't just regulate your cycle — it plays a direct role in maintaining the elasticity, strength, and blood supply of pelvic floor tissues. When oestrogen begins to decline during perimenopause, those tissues gradually lose their resilience. So symptoms that were manageable in your 30s can feel more pronounced in your 40s, even without changing a single thing about your exercise or diet.

Connective tissue throughout the body — including the ligaments that support the bladder, uterus, and bowel — becomes less supple under lower oestrogen levels. The mucous membranes of the vagina and urethra also thin, which can contribute to both bladder sensitivity and discomfort during sex. This is why the right approach to pelvic floor health in perimenopause looks different from what worked before.

Two women in their 40s in exercise clothing â€” active and well in midlife

Start reading

Guides for every stage of the conversation

Whether you're newly aware of your pelvic floor or already working with a physio, these guides meet you where you are.

Exercises & Movement

Why Kegels Alone Aren't Enough (And What to Do Instead)

The exercise everyone knows — and why doing it wrong, or in isolation, can actually make things worse. Here's a more complete picture.

The Hormone–Bladder Connection: What Your GP Might Not Have Explained

Urgency, frequency, and leaking often have a hormonal root — and once you understand that, you know exactly what to ask for.

Pelvic Organ Prolapse: What It Is, What It Feels Like, and When to Seek Help

A calm, clear guide to one of the most feared but least discussed pelvic floor topics — and why most cases are manageable with the right help.

Diastasis Recti After 40: Can You Still Fix It?

Abdominal separation that was never fully addressed post-pregnancy can affect your core stability decades later. Here's what current evidence says.

Sex After Menopause: Addressing Pelvic Pain and Dryness Together

Two issues that often travel together — and the approaches that genuinely help, from physical therapy to localised oestrogen.

Finding a Pelvic Floor Physio: What to Expect at Your First Appointment

It's more comfortable, more informative, and more empowering than you probably imagine. Here's exactly what happens — and why it's worth it.

Get the free Pelvic Floor Starter Guide

Five things every woman over 40 should know about her pelvic floor — because nobody tells you this stuff, and they should.

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Worth knowing about

When pelvic dryness is part of the picture

For many women, pelvic floor symptoms don't arrive alone. Vaginal dryness, irritation, and discomfort during sex often accompany the bladder and core changes of perimenopause — because they share the same root cause: declining oestrogen affecting local tissue.

This is sometimes called Genitourinary Syndrome of Menopause (GSM), and it's one of the most undertreated conditions in women's health. The good news is that localised vaginal oestrogen — which works directly in the tissue rather than systemically — is safe, effective, and available without the concerns associated with oral HRT.

Interlude is a telehealth service that gets you a vaginal oestrogen prescription from home — assessed by a licensed clinician, with treatment delivered to your door.

Learn about Interlude →

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Common questions

You're probably not the only one asking this

Is leaking normal after having children, or should I see someone?

It's extremely common — but that doesn't mean you have to live with it. Stress incontinence (a little bit of wee when you cough, sneeze, laugh, or exercise) affects around a third of women who have given birth. The good news is that pelvic floor physiotherapy is effective for the vast majority of cases, regardless of how long ago you gave birth. If it's affecting your quality of life in any way, it's absolutely worth a conversation with a pelvic floor specialist. There's no minimum threshold of “bad enough” to seek help.

What's the difference between a pelvic floor physio and a regular physio?

A pelvic floor physiotherapist (also called a women's health physio or pelvic health physio) has completed specialist postgraduate training in the assessment and treatment of pelvic floor dysfunction. Their approach typically includes an internal assessment — which can feel daunting but is done respectfully, with your full consent at every stage, and is enormously informative. A regular physiotherapist generally does not have this training. When looking for support, specifically seek someone with “pelvic floor” or “pelvic health” in their title or specialisation.

Can I do pelvic floor exercises if I have a prolapse?

Yes — and in fact, pelvic floor rehabilitation is often the first-line treatment recommended for prolapse. Strengthening the muscles that support pelvic organs can reduce symptoms significantly, and many women see meaningful improvement without surgery. The key is doing the right exercises for your specific situation — which is why a pelvic floor physio assessment is particularly important if you have a prolapse. Generic Kegel advice isn't always appropriate, and in some cases of hypertonic (overly tight) pelvic floor, additional strengthening can worsen things before improving them.

How does menopause affect bladder control?

The bladder and urethra both contain oestrogen receptors, which means falling oestrogen levels during menopause directly affect how they function. This can lead to increased urgency (a sudden strong need to urinate), frequency, and a greater likelihood of leaking. The lining of the urethra also becomes thinner and less elastic, which affects its ability to seal tightly. This is why incontinence that was well-managed in your 30s can become harder to control in your late 40s and 50s. Both pelvic floor physiotherapy and localised vaginal oestrogen are genuinely effective for menopause-related bladder changes — and worth asking your GP about specifically.

I've never had children. Can I still have pelvic floor problems?

Absolutely. Childbirth is a common cause of pelvic floor dysfunction, but it's far from the only one. Hormonal changes during perimenopause and menopause affect pelvic tissue regardless of whether you have given birth. Other contributing factors include high-impact exercise, chronic straining (e.g. from constipation), certain connective tissue conditions, and simply ageing. Many women who have never been pregnant experience prolapse, incontinence, or pelvic pain — and they are just as entitled to support and treatment as anyone else.

What we want you to leave knowing

Three things worth holding onto, wherever you are in this journey.

Common is not the same as inevitable

These symptoms are widespread — but they respond to treatment. Most women see real improvement with the right support.

It's never too late to start

Whether your symptoms are new or have been quietly present for years, the pelvic floor responds at any age. You are on a path right now — and this is a step you can actually take.

You don't have to navigate this alone

Pelvic floor physiotherapists, informed GPs, and yes, useful information on the internet — the right help exists. You just need to know where to look. And now you do.

Get the free Starter Guide