What are your pelvic floor muscles?

Your pelvic floor muscles are a group of muscles that form a bowel- or hammock-like structure at the base of your pelvis. They support your bladder, bowels and internal reproductive organs, helping to keep everything in place.

They also play an important role in everyday bodily functions, including:

• Controlling when you go to the toilet and pass wind.
• Preventing leaks when you cough, sneeze or exercise.
• Supporting vaginal contractions during sex and orgasm.
• Supporting vaginal delivery during childbirth.

When you squeeze your pelvic floor muscles, they contract and narrow the openings of your urethra and anus, helping you control when waste is released. When you relax them, the muscles widen, allowing you to pee and poo.

Your pelvic floor is made up of 14 muscles that intertwine and layer together to form a sheet of muscle.

How does menopause affect your pelvic floor?

One of the biggest changes during menopause is the shift in hormone levels, particularly oestrogen.

Your pelvic floor muscles have oestrogen receptors, meaning they respond to changes in oestrogen levels. As oestrogen declines, the tissues in your body also change as you age.

The muscles and fascia can become more fibrotic, meaning they become tighter, much like scar tissue. This can make the muscles weaker and less agile.

This degenerative process can affect the pelvic floor muscles more than other muscle groups, helping to explain why pelvic floor problems become increasingly common as we age.

Signs of a weak pelvic floor

When your pelvic floor muscles become weak, you may notice changes in how well they support your pelvic organs and control bodily functions.

Common signs include:

• Stress incontinence: Leaking urine when you cough, sneeze, laugh, jump, lift or exercise.
• Urinary urgency: Sudden, strong urges to pee that can be difficult to control, sometimes resulting in leakage before reaching the toilet.
• Heaviness or dragging: A feeling of pressure or heaviness in the vagina, particularly towards the end of the day or after exercise. This can sometimes be an early sign of prolapse.
• Reduced sensation during sex: Changes in your ability to grip or release your pelvic floor muscles intentionally.
• Vaginal flatulence (queefing): This is when air enters and leaves the vagina. It can sometimes be associated with reduced pelvic floor muscle tone, but can also happen when a tight pelvic floor traps air before releasing it.

Queefing on its own isn’t necessarily a sign of weakness, but it can be worth investigating alongside other symptoms.

Can your pelvic floor muscles be too tight?

Yes! Pelvic floor problems aren’t always caused by weak muscles. In fact, excessive tightness can also cause problems.

When pelvic floor muscles are too tight or struggle to relax, this is known as a hypertonic pelvic floor.

Although this has been less widely studied than pelvic floor weakness, it can cause a number of symptoms, including:

• Back, hip or leg pain.
• Constipation or difficulty pooing.
• Difficulty peeing.
• Painful sex.
• Pelvic pain.

Many women going through menopause assume their pelvic floor symptoms are caused by weakness, but excessive tightness can also be responsible.

Changes in connective tissue after menopause, including a reduction in collagen, can also make these tissues less elastic.

It’s important to remember that your pelvic floor needs to be able to both contract and relax.

How can you tell if your pelvic floor is weak or tight?

A simple way to start understanding your pelvic floor is to see whether you can both contract and release the muscles.

Try this gentle self-check:

1. Sit upright on a firm chair with your feet flat on the floor.
2. Take three slow breaths, allowing your lower tummy to soften as you breathe in.
3. As you slowly breathe out, gently draw your pelvic floor upwards and forwards, as though trying to stop yourself from passing wind.
4. Hold for two seconds.
5. Now let go and allow the muscles to relax.

Notice whether you can feel the muscles lift and, importantly, whether you can feel them release.

If you struggle to feel a contraction, your awareness or strength may need some work. If you can contract but struggle to release, this could be a sign of tightness.

If the movement causes pain, stop. This is only a simple screening exercise, not a diagnosis. A hands-on assessment with a specialist pelvic health physiotherapist is the only reliable way to understand what is happening in your pelvic floor.

How can you relax tight pelvic floor muscles?

If your pelvic floor muscles are too tight, the aim is to help them relax and regain their full range of movement.

This is sometimes called down-training, which involves teaching muscles that are holding tension to release.

Some approaches include:

• Diaphragmatic breathing: Slow, deep breathing in supported positions can help encourage the pelvic floor to lengthen as you breathe in.
• Supported positions: Child’s pose, lying on your side with a pillow or lying on your back with your knees bent can help you relax.
• Reverse Kegels: Gentle exercises that focus on dropping and relaxing the pelvic floor rather than squeezing.
• Manual release work: A pelvic health physiotherapist can use hands-on techniques to address areas of tightness, trigger points or scar tissue.
• Nervous system regulation: Stress and holding your breath can contribute to pelvic floor tension, so breathing exercises and relaxation techniques can also be helpful.

The goal isn’t to make your pelvic floor muscles weak or floppy, but to help them regain their ability to both contract and fully relax.

What is Genitourinary Syndrome of Menopause (GSM)?

Genitourinary Syndrome of Menopause (GSM) is a collection of symptoms affecting the genital and urinary systems.

It is one of the common dysfunctions associated with changes in the pelvic floor during menopause.

Symptoms can include:

• Recurrent urinary tract infections (UTIs).
• Urinary pain.
• Urinary incontinence.
• Urinary urgency.
• Vaginal dryness.
• Painful intercourse.

Research published in the journal Climacteric reported that up to 50% of postmenopausal people experience GSM.

GSM is treatable with topical low-dose vaginal oestrogen cream, which is described in your research as a safe treatment option, including for patients with a history of breast cancer and blood clots.

What can you do to look after your pelvic floor?

Understanding your pelvic floor is the first step towards looking after it.

Some things you can do include:

• Become more aware of your pelvic floor muscles and how they contract and relax.
• Find out whether your muscles need strengthening or relaxation.
• Explore appropriate pelvic floor exercises.
• Consider using the NHS Squeezy app for guidance with pelvic floor exercises.
• Speak to a pelvic health physiotherapist if you are experiencing symptoms or are unsure where to start.

Remember, pelvic floor health isn’t just about having strong muscles. It’s about being able to contract, relax and coordinate them properly.

Sources:

Cleveland Clinic. “Pelvic Floor Muscles: Anatomy, Function & Conditions.” Cleveland Clinic, 13 Apr. 2022, my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles. Accessed 13 Nov. 2026.

“Home Page.” Squeezy, squeezyapp.com/. Accessed 13 Nov. 2026.

NHS INFORM. “Pelvic Floor Muscles.” NHS Inform, 2023, www.nhsinform.scot/healthy-living/womens-health/middle-years-around-25-to-50-years/pelvic-health/pelvic-floor-muscles/. Accessed 13 Nov. 2026.

“Pelvic Floor Tight or Weak? How to Tell | PhysioReform.” PhysioReform, 5 June 2026, www.physioreform.co.uk/pelvic-floor-tight-or-weak/. Accessed 13 Nov. 2026.

UPMC Magee-Womens Center for Bladder and Pelvic Health. “How Does Menopause Affect the Pelvic Floor?” UPMC HealthBeat, 30 Oct. 2024, www.upmc.com/healthbeat/womens-health/menopause-and-pelvic-floor. Accessed 13 Nov. 2026.