Knowledge Centre

A life story of the pelvic floor

By Dr. Praveen G Pai · 19 October 2026

Three generations of women sitting together, one holding a baby

As a gerontologist, I spend my days with the end of the story. The women I see at 70 with leaking, urgency or a dragging feeling “down there” didn’t arrive there suddenly. Their pelvic floor has a history, and much of it was written decades earlier: in a labour room, in the weeks after a baby, in the years when periods stopped.

So this article goes backwards in time and then forwards again. It is a life story of a set of muscles most women are never taught about, told stage by stage, with what helps at each one.

First, what is the pelvic floor?

It’s a hammock of muscles and connective tissue slung across the base of the pelvis. It holds up the bladder, the womb and the bowel, helps keep urine and stool in until you choose to let them out, and plays a part in sexual function. Like any muscle, it can be strong or weak, coordinated or confused. And like any muscle, it can be trained.

Pregnancy

The weight of a growing baby and the hormones that soften tissues put the pelvic floor under steady strain. Leaking during pregnancy is common.

What helps: pelvic floor muscle training during pregnancy. Cochrane reviews of the trials suggest that women without incontinence who train their pelvic floor during pregnancy are less likely to have urinary incontinence in late pregnancy and in the months after birth. Ask your obstetrician or midwife to check you’re doing the exercise correctly. Many women aren’t.

Birth and the first six weeks

A vaginal birth, especially a long one, a large baby or an assisted delivery, stretches and sometimes injures the pelvic floor muscles and nerves. Some leakage in the first weeks is very common.

In many Indian homes this is also the period of prasava raksha, the traditional postnatal care that many Kerala families still follow, with rest, special foods and massage. Much of it is wise. The rest it prescribes gives tissues time to heal.

What helps: gentle pelvic floor contractions can usually begin within days of birth. Avoid heavy lifting for a few weeks. Treat constipation, because straining on a healing pelvic floor is harmful. And if you had a significant tear, ask about follow-up.

The first year

This is the stage I wish I could reach more women in. The baby is the focus, rest is over, and the household is back. So is the lifting: the water pot, the gas cylinder, the toddler on the hip. Leaking that hasn’t settled by three months is often quietly accepted as “what happens after children”.

What helps: it needn’t be accepted. Supervised pelvic floor muscle training, ideally with a women’s health physiotherapist for at least three months, is the recommended first treatment for stress incontinence, and it works well. The earlier it starts, the less ground there is to recover.

Perimenopause and menopause

As oestrogen falls, the tissues of the vagina, urethra and bladder base become thinner and less elastic. Many women notice new urgency, more frequent urination, recurrent urinary infections, dryness or discomfort. Doctors call this cluster the genitourinary syndrome of menopause. Weakness that was hidden for years may now show itself.

What helps: keep up or restart pelvic floor training. Ask your doctor about local (vaginal) oestrogen, which can help with urgency, dryness and recurrent infections, and which is different from systemic hormone therapy. Keep a healthy weight, because each extra kilo is more load on the hammock.

Later life

Here we meet the accumulation: weaker muscles, a less elastic bladder, perhaps a prolapse (the feeling of a bulge or of something coming down), and often other conditions such as diabetes, a cough, reduced mobility or the medicines that come with them. Getting to the toilet in time becomes as much about legs, eyesight and lighting as about the bladder.

What helps: pelvic floor training still works at this age. Women in their seventies and eighties improve with it. Add bladder training (gradually lengthening the time between visits), good fluid habits, regular bowels, a clear path to the toilet at night and a review of medicines. Pessaries and surgery are options for prolapse, and a gynaecologist or urogynaecologist can discuss them.

The thread through all of it

If you read only one line of this piece, let it be this: the pelvic floor is a muscle, and muscles respond to training at every age.

The other thread is silence. At every stage I’ve described, women tell me they didn’t mention their symptoms because they were embarrassed, or assumed it was normal, or thought nothing could be done. A daughter who learns about her pelvic floor after childbirth may spare herself decades of the problems her mother lived with. That’s prevention in the truest public health sense: not a test or a pill, just knowledge passed on in time.