Are you a nocturnal urinator?

What do your pre-bed/sleep habits have to do with the pelvic floor?  As a pelvic floor pilates teacher, I teach that it is not a healthy sign if you have to get up to pee in the middle of the night. When a client reports that they do get up once, twice, three times per night to go pee I will discuss things like bladder irritants, hydration intake before bed and teach habits to “retrain” the bladder. These things are all very important to continue working on but there’s another aspect to why we shouldn’t be getting up in the middle of the night to pee; it’s a sign that we are not reaching the very important REM (rapid eye movement) cycle! 

A lot of great things happen in our body during REM. It is a very important stage of sleep that influences learning, memory and mood. It is also one of the times when antidiuretic hormone (ADH) is released. ADH’s most important role is to conserve the fluid volume of your body by reducing the amount of water that is passed out through the urine. When fluid needs to be conserved and not expelled, ADH secretion increases and we urinate less. When we are properly hydrated, ADH secretion decreases and we urinate at the normal amount (every 2-3 hours and the flow should be strong for 8-12 seconds).

ADH plays an important role in hydration but it also plays a huge role in our ability to sleep through the night! A well-hydrated adult should need to urinate every 2-3 hours. So, how are we supposed to be able to sleep 8+ hours straight without urinating? ADH! When we fall into REM sleep, ADH release is increased which decreases the amount of urine that is produced, we do not have to pee as much and, voila! We are able to sleep without peeing!


During and after menopause, the ADH, which is a hormone is also affected, so we do tend to see ladies going for a wee more often at night.

Healthy Sleep Habit suggestions:

  1. Set a consistent sleep schedule – go to bed at roughly the same time each night.

  2. Have regular bedtime rituals – take a bath, listen to music, meditate. These should be relaxing activities and so that you cue your body that it is time to go to sleep.

  3. Get regular exercise but make sure it is at least 2 hours before bedtime.

  4. Limit caffeine and avoid nicotine – these are stimulants and will interfere with your sleep. Try to stop caffeine intake after 12. Withdrawal from nicotine will initially interfere with sleep. However, once you are past the withdrawal phase, you should be able to sleep better (studies show).

  5. Don’t eat a meal right before bed. Try to eat dinner at least 2 hours before bedtime. A light snack before bed has been shown to promote sleep however.

  6. Avoid alcohol – although alcohol is a sedative and initially promotes sleep, it will interfere with the quality of sleep; you will wake more often and might have increased nightmares.

  7. Keep naps short to increase your “sleep debt” during the day to help you fall asleep easier.

  8. Use your bedroom for sleep only! Try not to eat, watch TV or use other electronics in bed. You want to associate your bedroom with sleep and not other things that might trigger stress.

  9. Stop screen time 2 hours before bed – using screens (TV, cell phones, tablets, laptops) can damage our biological clock. The light emitted “confuses” our brain and makes us think its daytime.

  10. Make sure your bedroom is cool, quiet and comfortable!

What happens to our vaginas as we hit menopause?

Most women are unprepared for changes in their vagina as they go through their perimenopause + menopause years, which are essentially the 40s and 50s. I know I was!

A healthy vagina has a pH of 3.6-4.5. This is an acidic environment where oestrogen creates glycogen and glycogen allows the predominance of lacotbacilli species to dominate.

This diverse gut microbiome is good in your tummy. But a diverse vaginal microbiome is not. A healthy vagina has LOW microbial diversity.

A healthy vagina also has a thick epithelium which provides protection from irritation, and chafing, whether that be from tight clothes or intercourse.

The menopausal vagina is very, very different than the pre menopausal vagina. Oestrogen drives the changes in the menopausal vagina.

When there is low/no oestrogen (as in menopause) + when there is waning oestrogen (as in perimenopause), vaginal health suffers.

I’m talking about this today because it needs to be brought out of the closet. Women suffer a lot from this and it is widely under reported due to embarrassment or thinking that it’s just ‘normal vaginal atrophy’.

Unlike hot flushes, which may settle with time, vaginal problems almost never do.

What can you do?

Smoking is an independent risk factor for contracting BV (bacterial vaginosis, common in menopause)—so if you smoke, stop!

Using certain probiotics vaginally can help. Interestingly, oral probiotics, while helpful, may not have a huge impact on the vaginal microbiome. The 2 systems are not as connected as you might think. Herbal support, teas, modifying sex positions, MLT laser, maintain healthy body weight….all of these things can help.

Using topical Oestrogen lowers pH, increases lactobacilli + more. This is the most successful method of helping, or almost finding some calm in that area.

If you can’t/don’t want to use oestrogen, using a water based lube is helpful.

A healthy vagina=a happier woman=a happier midlife experience!

There are more blogs on this site regarding your pelvic region, and I regularly run 4 week courses for Pilates for Pelvic Floor.

What are the first signs of having a Pelvic Floor problem?

Now I am bang smack into my menopausal years, the words ‘Pelvic Floor’ have been reintroduced to my vocabulary. Over 20 years ago I gave birth to two lovely human beings, and at the post natal check ups, the GP mumbled something about Pelvic Floor exercises and was I doing them. I said yes, but really I didn’t know if I was or not? Nobody had shown me, nobody had explained how. I was busy with my little ones, I vaguely remember someone mentioning a lift or something!

Fast forward 20 years to the present day…

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