We don’t usually talk about peeing, pooping, farting, or sex at the dinner table… While they may earn an uncomfortable grimace, they can have an incredible impact on happiness, mobility, and your ability to remain independent as you age.
It starts with the pelvic floor. This small, often overlooked group of muscles influences the bladder, of course, but it also influences sexual pleasure, self-esteem, balance, and even fall risk.
What happens to the pelvic floor when we get older, and what can we do to help it age with us?
How comfortable are you talking about pelvic symptoms (peeing, BMs, sex, etc...)?
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Meet your pelvic floor
The pelvic floor is a hammock-shaped group of muscles, ligaments, and fascia that help support the pelvic organs. It’s a ‘jack of all trades’ muscle group, says Jamie Lief, OTD, OTR/L, PCES, a pelvic health occupational therapist and the Clinical Coordinator of Pelvic Health at SPEAR.
Its well-being is tied to just about everything we take for granted… regular bowel movements, erections, orgasms, and coughing or laughing without leaking.
Studies also show that it can affect chronic disease risk. The pelvic floor supports cardiovascular health by pumping blood to the heart, and it works with the diaphragm and ab muscles for posture, balance, and mobility.
Why did the floor drop from beneath you?
Most people connect pelvic floor dysfunction to post-childbirth. However, symptoms of dysfunction, which include prolapse, pain, incontinence, and bowel symptoms, can occur at any age and in any sex.
Among aging adults, pelvic floor dysfunction is an ‘invisible illness,’ Lief says.
Some of the most common contributors are:
Muscle loss: Strength and muscle mass naturally decline with age, starting around age 30. Even if you’re an active adult, it’s difficult to maintain pelvic floor function and strength without specific interventions.
Muscle tightness: Most of us are chronically stressed, which makes us subconsciously tense our pelvic floor. Over time, this can cause urgency and bladder leaks, and it might affect GI function and motility. "Nine times out of ten, if someone's telling me they have this stressful job, I'm assuming I'm going to find tension in their pelvic floor," says Lief.
Hormonal changes: Estrogen is like ‘water’ to our pelvic floor, says Lief. During menopause, the sudden drop in estrogen may contribute to pelvic pain, vaginal dryness, and sexual discomfort. Pain with sex during the post-menopause years is Lief’s #1 most common complaint.
We often don’t realize that this can create symptoms that not only affect quality of life, but can also become a lifespan issue if never addressed.
Beyond bladder leaks
The integrity of the pelvic floor matters for staying independent, functional, and thriving as we age, but why is that? Lief breaks down two of the biggest reasons.
Falls and loss of mobility
An underappreciated risk factor, falls are one of the leading causes of disability in older adults.
"A huge reason that older adults have fewer social outings, move into assisted living care, or reduce their physical activity is directly related to pelvic health,” Lief explains.
She lays out a familiar scenario. It’s the middle of the night, and you feel the urgency. You get up and rush to the bathroom, but you can't see where you're moving… You can see where the story is headed.
Urgency does not guarantee a fall, but it can increase fall risk in older adults, whose chances of ending up with hip fracture, disability, or mortality are greater.
Even if your only symptom was urgency, a pelvic floor therapist might address how you move. They can help you practice strengthening, balance, mobility, and stability exercises that support staying physically fit with age, Lief says.
Sexual health, confidence, and esteem
A healthy pelvic floor also invites pleasure, connection, intimacy, and higher self-esteem, which makes it an important conversation for maintaining sexual health, emotional well-being, and high quality of life as we get older.
“Sexual health is a lifespan issue,” Lief says. Yet most aging men and women don’t openly share with a doctor about painful sex or erectile difficulties. These symptoms can create shame and low self-esteem. They can strain relationships and stop us from participating in pleasurable experiences.
A significant proportion (75%) of men report erectile dysfunction
More than 65% of women over 40 report at least one symptom of sexual dysfunction.
Tending to the pelvic floor might help regain health and reclaim confidence, excitement, and quality of life. After all, no one should stop having sex if they don't want to, Lief says.
Support a pelvic floor that ages with you
Why would we not train our pelvic floor to age with us? Lief asks. If pelvic symptoms are affecting your movement, confidence, or quality of life, these are reasonable next steps:
Talk to your doctor about the taboo. Leakage, urgency, constipation, recurrent urinary tract infection, pelvic pain, prolapse symptoms, and painful sex are medical concerns.
Consider a pelvic-floor specialist. A specialist can help identify the root cause and offer exercises, relaxation work, manual therapy, or biofeedback to support healthier muscles.
Keep moving. Strength, mobility, balance, and regular activity support independence. Here are five exercises that can strengthen the pelvic floor.
Make nighttime bathroom trips safer. Clear the path, add night lights, and permit yourself to move slowly.
Manage stress: Stress is linked to tightness and tension in the pelvic floor, which can affect urgency. Evidence-based approaches like cognitive behavioral therapy, meditation, mindfulness, and gentle movement may help.
To optimize health span, Lief encourages people to see a pelvic floor therapist as early as their 30s, before any problems have started. Whether you’re 34 or 84, your pelvic floor deserves attention. Simple things can help improve it.
The floor is now yours.
More from Livelong
Become a member of the Livelong Women’s Inner Circle™ for recordings and slide decks from the Livelong Women’s Health Summit. Join our virtual event, Bone Loss Is Not Inevitable, on Monday, Oct 5, 10:00 AM PDT/1:00 PM EDT. Details and RSVP.
What we’re reading next:
The bathroom clue that could save your heart.
The back pain plan. How to deal and how to thrive again.
Poll response
This week's answer comes from last week’s article, Disagree without disconnecting. We asked:
What’s your conflict subtype?
Livelong is for the lovers. Nearly two-thirds of voters said I’ll hear you out.
“Differences in all ways make our lives rich,” wrote one reader. Another wrote that respectful disagreement allows them to understand others and how they think. It’s “not a chance to prove them wrong or make them feel bad.”
I really appreciated these thoughtful responses this week. I couldn’t agree more.
Until next time!
Erin
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The information provided about wellness and health is for general informational and educational purposes only. We are not licensed medical professionals, and the content here should not be considered medical advice. Talk to a doctor before trying any of these suggestions.
