How menstrual cycles influence bladder and pelvic floor symptoms

In this video, Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, the founder of the Fosnight Center for Sexual Health and a medical advisor for Aeroflow Urology, emphasizes the importance of a detailed, cycle-aware approach when evaluating cyclical bladder symptoms in menstruating women.

Fosnight highlights pattern recognition as a cornerstone of diagnosis, encouraging clinicians to closely examine how urinary symptoms fluctuate across the menstrual cycle. Understanding when symptoms flare—particularly in relation to the luteal phase or the onset of bleeding—can provide critical clues. For example, urgency, frequency, or bladder pain that worsens premenstrually and improves after menstruation may point toward interstitial cystitis or bladder pain syndrome.

Fosnight notes that clinicians often overlook the impact of the menstrual cycle on pelvic organs and stresses the need to become more comfortable asking targeted menstrual history questions. She also encourages exploration of symptom clusters, including bowel changes, pain with penetration, or constipation, which may suggest pelvic floor dysfunction. In her view, referral to pelvic floor physical therapy is rarely a misstep. She describes the pelvic floor as “an onion,” where dysfunction may mask or contribute to other underlying issues; addressing it can help reveal the root cause of symptoms even if it was not the original trigger.

Beyond pelvic floor considerations, Fosnight advocates for a holistic assessment. This includes reviewing diet and fluid intake, noting whether patients restrict fluids due to urinary frequency—potentially worsening symptoms through concentrated urine. She also underscores the value of assessing musculoskeletal health, including core strength, hip mobility, posture, occupational demands, and exercise habits.

Finally, Fosnight strongly supports the use of bladder diaries. Although patient-reported histories are valuable, objective tracking helps clarify symptom patterns, reduces exaggeration or recall bias, and actively engages patients in their care. She finds that tangible data increases patient accountability and follow-through, ultimately improving the effectiveness of treatment planning and shared decision-making.