PELVIC FLOOR HEALTH AFTER 50: BUILDING CONFIDENCE, ONE STEP AT A TIME
A walk with friends. A good laugh around the table. A weekend away without planning every stop around a bathroom.
These everyday pleasures can feel more complicated when you are worried about bladder leakage. If that sounds familiar, you deserve a conversation about it—and support that takes your concerns seriously.
In his recorded message to the Thrivve community, Dr Bruce Crawford introduces PfilAtes™, his movement-based approach to pelvic-floor training. His message opens an important conversation for life after 50: how can we look after the muscles involved in bladder control while staying active and enjoying our lives?
There is reason for hope. There is also value in understanding what exercise can help with, what the evidence supports, and when personalised care matters.
WHY PELVIC FLOOR HEALTH MATTERS AFTER 50
The pelvic floor is a group of muscles at the base of the pelvis. These muscles help support pelvic organs and contribute to bladder and bowel control. Ageing, pregnancy and childbirth, and surgery can affect their function. Pelvic-floor muscle training can help both women and men, although it is not suitable for every situation. NIDDK: Kegel exercises
For women, menopause can also contribute to bladder symptoms. But leakage has several possible causes, and getting older does not mean you should dismiss a new symptom or assume nothing can be done. A healthcare professional can help identify the cause and discuss appropriate options. NIDDK: bladder control problems
The starting point is curiosity about what your body needs, rather than embarrassment about what it is doing.
WHAT IS PfilAtes™? DR CRAWFORD’S APPROACH
In the video, Dr Crawford describes himself as a urogynecologist and reconstructive pelvic surgeon whose experience treating women in Niger changed his thinking. He recalls patients who continued to experience leakage despite successful repair of an obstetric fistula, an injury involving an opening between the bladder and vagina.
That experience, he explains, led him to pay greater attention to the nerves and muscles involved in continence, alongside anatomy.
He describes developing PfilAtes™ by studying pelvic-floor activity during movement, then selecting ten movements from a total of 120 movements studied for a training programme. His approach combines movement with deliberate pelvic-floor contractions, and he proposes a brief morning and evening routine.
These are the programme creator’s account of its development and his recommendations. They are useful context for understanding PfilAtes™, but they are not an independent assessment of how well it treats each pelvic-floor condition.
WHAT DOES THE EVIDENCE SAY ABOUT PELVIC FLOOR EXERCISES?
Pelvic-floor muscle training has an established place in care for urinary incontinence. For women with stress incontinence—leakage with activities such as coughing or exercise—or mixed incontinence, which also includes urgency-related leakage, NICE recommends supervised training for at least three months as a first treatment. For urgency or mixed incontinence, bladder training is also recommended. NICE: urinary incontinence recommendations
This is more than being told to squeeze occasionally and hope for the best. Supervision helps establish whether you are contracting the right muscles and following a programme suited to your needs. Training also involves releasing and relaxing the muscles. NIDDK: learning pelvic-floor exercises
Evidence supporting pelvic-floor muscle training generally should not be treated as proof that every branded programme works equally well—or better.
WHAT DO WE KNOW SPECIFICALLY ABOUT PfilAtes™?
Mushtaq and Ahmed’s small 2019 randomised trial in Isra Medical Journal compared PfilAtes™ with conventional pelvic-floor muscle training over six weeks: 54 women were randomised and 47 completed it. Both groups improved. Quality-of-life scores improved more with PfilAtes™ (about 35% versus 18%), but symptom and muscle-strength results did not consistently favour it. The authors concluded that neither approach was statistically superior overall, although their table reported a significant quality-of-life difference. Mushtaq & Ahmed (2019), Isra Medical Journal, 11(4 Part B), 281–285
With only 47 completers, the trial had limited statistical power and may have been underpowered to detect clinically meaningful differences. A non-significant result does not establish that there is no difference or that the approaches are equivalent; nor can low power establish an unproven benefit. The findings support further research, rather than a claim of overall superiority, and do not show how well benefits last in adults over 50.
Au and colleagues’ feasibility randomised controlled trial, published in PM&R in 2020, enrolled 50 men undergoing radical prostatectomy; 37 completed the trial. It compared conventional pelvic-floor exercises with a programme adding both PfilAtes™ and hypopressives. At 26 weeks, the combined programme showed lower self-reported leakage frequency over 24 hours and during waking hours. Adherence exceeded 70%, with no reported adverse events. These preliminary findings suggest potential benefit, but the small feasibility trial does not isolate the effect of PfilAtes™ or establish a definitive treatment advantage; larger studies with longer follow-up are needed. Au D, Matthew AG, Alibhai SMH, et al. (2020). PfilAtes™ and Hypopressives for the Treatment of Urinary Incontinence After Radical Prostatectomy: Results of a Feasibility Randomized Controlled Trial. PM&R, 12(1), 55–63. doi:10.1002/pmrj.12157
In the Thrivve recording, Dr Crawford describes substantially stronger contractions during certain movements and suggests his programme can help people avoid surgery. Those are his claims. A larger muscle-activity measurement during an exercise does not, by itself, establish better long-term bladder control, a cure, or a particular likelihood of avoiding an operation.
MENOPAUSE, SYMPTOMS AND THE RIGHT KIND OF SUPPORT
Pelvic-floor symptoms do not all have the same cause or need the same treatment. If you have pelvic pain or difficulty passing urine, seek an assessment before starting a strengthening routine. For people with bladder pain syndrome, for example, NIDDK advises avoiding pelvic-floor strengthening unless working with a physical therapist. NIDDK: bladder pain syndrome treatment
Menopause-related symptoms may also need care beyond exercise. NICE recommends vaginal oestrogen for women who have overactive-bladder symptoms together with genitourinary symptoms and signs associated with menopause. Whether that is appropriate for you is a discussion to have with your clinician. NICE: managing urinary incontinence
Needing additional treatment is not a failure. The aim is to find care that fits your symptoms, health and preferences.
A PRACTICAL FIRST STEP TOWARDS BLADDER CONFIDENCE
You do not need to solve everything at once. Start with one manageable step:
– Describe what happens. Does leakage happen when you cough or move, after a sudden urge, or in another situation?
– Ask for an assessment. A GP or pelvic-health physiotherapist can help you understand the problem and discuss suitable treatment.
– Make a realistic plan. If training is appropriate, ask for guidance on technique, progression and when to review your symptoms.
– Look for changes that matter to you. Fewer leaks, greater comfort or more confidence leaving home can be meaningful goals. Results vary, and progress may take time.
Seek prompt medical care for blood in your urine or painful urination. If you cannot pass urine, seek urgent care rather than trying to exercise through it. NIDDK: symptoms that need assessment
YOUR NEXT CHAPTER CAN INCLUDE SUPPORT
At Thrivve, we believe conversations about living well after 50 should include the things people sometimes find difficult to discuss. Bladder confidence belongs in that conversation.
Watch Dr Crawford’s message as an introduction to his approach, then consider one gentle next step: ask a qualified healthcare professional what would suit you. If you would like to share a question or suggest a topic for a future Thrivve conversation, get in touch with the Thrivve team. To learn more about the programme, visit PfilAtes™.
You deserve support, practical choices and the chance to keep doing the things you enjoy. Your dignity is never dependent on perfect bladder control.
This article provides general information and does not replace individual medical advice.
YouTube link: https://youtu.be/PiJJmynh6EA
Spotify link: https://open.spotify.com/episode/4l7xHd6rFnAp0Tt7NWzSDi?si=JOOETZogTae4bUEHnkxefg