Pelvic Floor Considerations for Women Over 50 Beginning Strength Training

Here at She Healthcare our individual sessions, groups and Strong and Steady classes are the perfect type of strength training catering to females around 50 and beyond.

Strength training is increasingly recognised as one of the most effective forms of exercise for women over 50. Research consistently demonstrates its benefits for maintaining muscle mass, preserving bone density, improving metabolic health, enhancing balance, and supporting long-term functional independence. However, as women begin resistance training, it is important to consider the role of the pelvic floor and how exercise can impact pelvic health.

The pelvic floor is a complex group of muscles, ligaments, and connective tissues that provide support to the bladder, bowel, and pelvic organs. These muscles also contribute to continence, sexual function, core stability, and pressure management within the abdomen.

Following menopause, declining oestrogen levels can affect the strength and elasticity of pelvic tissues. Combined with age-related changes in muscle mass and connective tissue, some women may experience symptoms such as urinary incontinence, pelvic organ prolapse, urgency, or a sensation of pelvic heaviness. While these symptoms are common, they should not be considered a normal or inevitable part of ageing.

Strength training can be highly beneficial for pelvic floor function when introduced appropriately. Resistance exercise promotes overall muscle strength, including the muscles involved in postural support and pressure regulation. However, excessive intra-abdominal pressure generated during heavy lifting, breath-holding (Valsalva manoeuvre), or poorly controlled movement patterns can place additional stress on the pelvic floor.

Women new to strength training should focus on establishing sound movement and breathing strategies before progressing to heavier loads. Exhaling during the exertion phase of an exercise—for example, when rising from a squat, standing from a deadlift, or pushing during a chest press—can help manage pressure and reduce unnecessary strain on the pelvic floor. Attention should also be given to posture, core muscle coordination, and exercise technique. We will consistently educate and guide on these aspects in the Strong and Steady classes.

It is important to monitor for symptoms that may indicate the pelvic floor is struggling to cope with exercise demands. These may include urinary leakage, increased urinary urgency, pelvic pressure, a sensation of vaginal bulging, lower abdominal heaviness, or persistent pelvic discomfort during or after training sessions. The presence of these symptoms does not necessarily mean exercise should be stopped, but it may indicate that modifications, load adjustments, or professional assessment are required.

A gradual and progressive approach to resistance training is particularly important. Beginning with bodyweight exercises or lighter resistance allows the body time to adapt while developing confidence and movement competency. As strength improves, training loads can be increased safely and effectively.

Women experiencing pelvic floor symptoms, or those with a history of pelvic surgery, childbirth-related trauma, or pelvic organ prolapse, may benefit from an assessment with a pelvic health physiotherapist. Individualised guidance can help optimise exercise participation while supporting long-term pelvic health. In our Katoomba clinic we have Sam, our women’s health physio, and in Glenbrook we work closely with Jo, another extremely experienced local women’s health physio - reach out if you would like to make contact with either of them!

Strength training and pelvic floor health are not opposing goals. In fact, when exercise is appropriately prescribed and progressed, women can achieve significant improvements in both physical strength and pelvic floor function. The key is to train with awareness, respect the body's signals, and build strength progressively from a foundation of good movement and pressure management. We will continue to focus on all these things in our individual sessions, groups and the Strong and Steady classes and any treatment you have at the clinic in general.