Obesity levels have risen over 20% in men and over 25% in women during the past 40 years. It is no secret that carrying excess body weight is detrimental to your health. But did you know the impact it has on your pelvic floor? Studies show the likelihood of developing urinary incontinence increases by 7-12% for each 1kg/m2 unit increase in BMI.

"The skeleton is perfectly designed to cope with a healthy weight. But if you're excessively heavy or obese, hips, knees and ankles may all suffer. Excess weight can be particularly damaging to your pelvic floor, which supports all of your crucial internal organs." Tam Fry, chairman of the National Obesity Forum.

Tam Fry, head spokesperson for the National Obesity Forum

Weight Gain During Menopause

Its extremely common to gain weight during your midlife. Nearly three-quarters of women aged 60 and over are overweight. For many women, this is caused, or enhanced, by the menopause. The average age for the menopause to begin is 51, however, 6% of women experience the menopause much earlier as a result of medical conditions and pelvic surgeries (such as hysterectomy's).

Hormone Replacement Therapy (HRT)

Oestrogen receptors play a major role in the regulation and distribution of body fat. As a result, menopausal women who undergo hormone replacement therapy (HRT) tend to have less fat tissue, especially in the stomach area, compared to other postmenopausal women.

When the usage of HRT is stopped, women quickly begin to gain stomach fat. During this process, women store majority of their weight gain as visceral adipose tissue (abdominal fat). This is not the type of fat that you are able to pinch under your skin; instead, this fat is behind the abdominal wall and around some of the vital organs.

The Relationship Between Oestrogen Levels and Visceral Adipose Tissue (Abdominal Fat)

During the menopause, visceral fat mass increases by an average of 44%. A complete loss of the oestrogen hormone can cause visceral fat to increase by 10% in just 5 months. Without the presence of oestrogen, your resting metabolic rate decreases by around 50 calories per day, causing a huge disruption in energy balance.

Over the course of 3 months, this metabolic decrease could add up to a pound of weight gained. Within a year you could have put on almost half a stone! Without reducing your calorie intake or increasing your physical activity, postmenopausal women can naturally gain dozens of pounds over the years through a lowered metabolic rate alone.

Can I Reduce My Risk or Reverse the Damage to My Pelvic Floor?

There is conclusive evidence linking obesity and urinary incontinence. For a lasting improvement in the health of your pelvic floor, you need to maintain a healthy BMI of under 30.

To reverse any damage that you have already experienced, you need to pay close attention to your pelvic floor as you lose weight. For a quick improvement in the condition of your pelvic floor, use an electronic pelvic toner.

  • Exercise your pelvic floor daily - Do your Kegels! Like any muscle, you need to exercise your pelvic floor regularly to keep it strong.
  • Maintain a healthy weight - The National Institute for Heath and Care Excellence (NICE) recommend keeping your BMI under 30 to avoid putting excess weight on your pelvic floor. Studies show that women that lose 10% of their body weight can reduce their leakage by 50%.
  • Avoid high impact exercise - To lose weight you may begin running or join an exercise class. However, these high impact exercises are incredibly damaging to your pelvic floor. When you land heavily on your feet, pressure shoots up your legs to your pelvis. Swap out running for swimming and cross fit for yoga. Yoga and pilates are very good at helping you break a sweat whilst reducing the pressure on your pelvic floor. They can also be modified to balance your weight more evenly.
  • Avoid carrying large weights - Any weight impacts your pelvic floor; regardless of whether it is body weight or cardboard boxes. When you cannot avoid carrying large weights, learn how to lift safely through the National Health Service (NHS). Hold the load close to your waist and avoid bending your back.
  • Avoid constipation and straining - Eat a high fibre diet and improve your toilet posture for easy bowel movements. The best position to go to the toilet is to have your knees high. You can use a toilet stool to get this position just right.


Burgio, K. L. Goode, P. S. Markland, A. D. Redden, D. T. Richter, H. E. Vaughan, C. P. Wu, J. M. (2014). Obstetrics & Gynecology. Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women. [online] 123(1), p 141-148. [viewed 03/04/2018]. Available from: https://insights.ovid.com/pubmed?pmid=24463674

Giarenis, I. Robinson, D. (2014). F1000 Prime Reports. Prevention and management of pelvic organ prolapse. [online] 6(1) p 77. [viewed 03/04/2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4166938/

NHS. (2016) Safe lifting tips [online] National Health Service, 2016 [viewed 20/03/2018]. Available from: https://www.nhs.uk/livewell/workplacehealth/pages/safe-lifting-tips.aspxNHS. (2018) Pelvic organ prolapse [online] National Health Service, 2018 [viewed 14/03/2018]. Available from: https://www.nhs.uk/conditions/pelvic-organ-prolapse/

NICE. (2015). Urinary incontinence in women: management, 1 Recommendations [online] National Institute for Health and Care Excellence, 2015 [viewed 14/03/2018]. Available from: https://www.nice.org.uk/guidance/cg171/chapter/1-Recommendations#physical-therapies

Cooper, J., et al. (2015) Prevalence of genital prolapse symptoms in primary care: a cross-sectional survey. International Urogynecology Journal. 26(4), pp. 505-510.

National Association For Continence (2018) Diet and Exercise for Good Bladder Health [online]. NAFC [accessed 22/08/2018]. Available from https://www.nafc.org/diet-and-exercise/

NHS (2016) Overview Obesity [online]. National Health Service [viewed 20/09/2018]. Available from https://www.nhs.uk/conditions/obesity/

Office for National Statistics (2017) Overview of the UK Population March 2017 [online]. ONS

Penine Acute Hospitals NHS Trust (2015) Obesity and its Effects on the Pelvic Floor [online]. PAT NHS

Parmet, S. (2016) Why is Visceral Fat Worse Than Subcutaneous Fat? [online]. Science Daily [viewed 22/10/2018]. Available from https://www.sciencedaily.com/releases/2016/04/160425161349.htm

Babaei, P., Dastras, A., Tehrani, B.S., Roudbaneh, S.P. (2017) The Effect of Estrogen Replacement Therapy on Visceral Fat, Serum Glucose, Lipid Profiles and Apelin Level in Ovariectomized Rats. Journal of Menopausal Medicine. 23(3), pp. 182-189. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770528/

Kapoor, S. (2016) Manage Menopause Weight Gain [online]. Practo [viewed 22/10/2018]. Available from https://www.practo.com/healthfeed/manage-menopause-weight-gain-5936/post

Franklin, N.C. (2013) What It Means to Have an Apple-Shaped Body [online]. Dr. Nina [viewed 22/10/2018]. Available from http://ninacheriefranklin.com/get-fit/means-apple-shaped-body/

Kozakowski, J., Gietka-Czernel, M., Leszczynska, D., Majos, A. (2017) Obesity in Menopause- Our Negligence or an Unfortunate Inevitability. Menopause Review. 16(2), pp. 61-65. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5509974/

Public Health England. (2016). Health risks of adult obesity. [viewed 22/10/2018]. Available from: http://webarchive.nationalarchives.gov.uk/20170110171059/https://www.noo.org.uk/NOO_about_obesity/obesity_and_health/health_risk_adult

Townsend, M. K. Danforth, K. N. Rosner, B. et al. (20017). Body mass index, weight gain, and incident urinary incontinence in middle-aged women. Obstetrics & Gynecology. 1110, p 346-353.

Waetjen, L. E. Liao, S. Johnson, W. O. et al. (2007) Factors associated with prevalent and incident urinary incontinence in a cohort of midlife women: a longitudinal analysis of data; study of women's health across the nation. American Journal of Epidemiology. 165(3), p 309-318.