602: What you need to know about pelvic floor health | Sara Reardon, PT, DPT
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One in three women will experience sexual pain. And after 65, nearly half would deal with urinary incontinence. Yet pelvic floor health is still one of the most overlooked aspects of women's health care. It

it's time we start paying attention and today's guest is leading the charge. Dr. Sarah Reardon is a doctor of physical therapy and board-certified pelvic floor specialist who's made it her mission to normalize pelvic floor conversations and revolutionize the care we receive at every age and stage. Known to her followers as the vagina whisperer, Sarah has helped thousands of women overcome everything from bladder leaks to painful intercourse, and she's on a mission to change the way we approach everything from birth to menopause and beyond. In

In today's show, we dive deep into pelvic floor health, what it is, why it matters, and how to actually strengthen it and support it. We'll break down the truth about kegels, the surprising ways breathwork and strength training can improve your symptoms, and why your bathroom habits might be working against you. This conversation sheds light to topics that are often overlooked or ignored. Let's dive in.

So what do you think most people are getting wrong about the pelvic floor? I feel like most people aren't even aware that they have one and that there is a group of muscles that are responsible for some really important day-to-day functions like peeing and pooping and sexual health and menstruation and pregnancy and birth.

And so the fact that we don't even know this part of our body exists, which is something I hear from many women almost every day, just really shed some light on how uninformed we are about our bodies and how important it is to be educated about the pelvic floor so that we can not only overcome pelvic health issues, but also prevent them. On that note, how does one assess their pelvic floor health? You know, I think it can be based off of two

two different ways of assessment. I think one is symptoms.

So most often women can experience things like little bladder leaks. It may be something as small as a leak with playing tennis or laughing or coughing, or it can be, you know, full-on incontinence when they are trying to get to the restroom in time or when they hear running water or, you know, they're wearing pads and even diapers later down the line. Other symptoms may be sexual health and pain, so pain with intercourse, anxiety.

a feeling of rawness, dryness, difficulty having orgasms, and then even things like pooping problems, you know, constipation, hemorrhoids, anal fissures, leakage of stool, fecal staining, kind of these really embarrassing symptoms we don't often talk about, but they're actually quite common. And we don't even know where to get help for them. On the flip side, I think to assess the pelvic floor as a muscle group, we have to understand what it does. So

The pelvic floor muscles support your pelvic organs, your uterus, your ovaries, your vagina. I mean, I'm sorry, your uterus, your ovaries, your rectum and your bladder. And they also have sphincters to keep urine and stool in. So if you are urinating and you want to stop your urine stream, that's a pelvic floor contraction. That kind of gives you a sense that you can hold and squeeze urination.

When you're having a bowel movement, that's pelvic floor relaxation. That's allowing you to relax those muscles and control them. So there are some ways you can kind of in your day-to-day routine, like, can I use this muscle? Can I connect with it, contract and relax it? But also look at the symptoms you might be experiencing that you thought were normal for being a woman, and they're actually related to your pelvic floor health.

So is it safe to say, if I think of something we all do daily, it's we go to the bathroom? Right. Many times a day. Yes, many times a day. Is it safe to say that feeling like assessing your control over your ability to wait, for example, to go to the bathroom on your timeline versus I really have no, like, I gotta go. Like, can we start to, as I think about that daily occurrence,

Is that something we can exercise, if you will? So like, would it benefit our pelvic floor health if we have to go and we say, you know what, I'm going to try to delay 10 seconds, 15 seconds, a minute.

And if we can't, that's a problem. Right. It depends. And I think every pelvic floor physical therapist will say that same thing. So the normal range to go pee is every two to four hours during the day and zero to two times at night. So if you are within that range of two to four hours and you have to pee, go ahead and pee. But if you're

Have the urge to pee every 30 minutes? Yes. You will want to delay the urge 10 minutes, 15 minutes to get you closer to that range. And where we see this a lot with women, you know, where dysfunction starts to happen is after pregnancy.

pregnancy and birth. You know, during pregnancy, we have more fluid, we have weaker pelvic floor muscles, we start going to the bathroom more frequently, and that can often persist postpartum. And then we see it in the perimenopausal and menopausal era when you have less estrogen receptors, less pelvic floor tone, more irritable bladder, and you may have more urgency. If you're going in that two to four hour range, there's no need to delay. But if you're going more frequently and you need to space it, I would say, yes, practice that.

But again, people don't even know these muscles exist and how to connect with them. So to just say like, oh, just delay, we need to give them tools. So some of those tools can be distraction where they listen to a podcast or read a book or scroll on their phone. Some of it can be breathing techniques, which can quiet the bladder urges down.

And some of it can be pelvic floor muscle contractions, also known as Kegels, which can help quiet the bladder and delay the urge as well. So we want to give people the tools to control their bladder instead of just saying like, oh, hey, you should work on this. So you mentioned Kegels. And I feel like from my limited knowledge of this subject, it's like Kegels. I think many people think the same thing. Pelvic floor or Kegels. So can we talk about Kegels? Like what?

A primer, what they are, like, let's just go there. I don't have a lot to say. So a Kegel is a pelvic floor muscle contraction. It was actually named this by a researcher and gynecologist, Arnold Kegel, who did a research study on women after giving birth to test their pelvic floor muscle strength to help prevent leakage. And he named it after himself. Of course, right? I'm a man.

I discovered this thing. I'm going to name this after myself. I'm going to give myself a legacy related to the female genitals. So we, I know, they're due for a rebrand.

However, it's a contraction of these muscles. So it's a squeeze, like you're stopping urine, holding in gas, and it's a lift. So it's a contraction and lift of the pelvic floor. And the pelvic floor is like a basket of muscles that sit at the base of your pelvis. Again, they support your pelvic organs and they hold in pee and poop and then relax when we need them to.

So Kegels are a strengthening exercise for the pelvic floor, but not every person needs strengthening. And I think that this narrative of Kegels will give you better bladder control, better sex, stronger orgasms, more pelvic floor support is an outdated myth because it's like saying if you have back pain, just do a bunch of crunches. Like you can't give one exercise and think it's going to be a panacea for every pelvic floor problem. Right.

Many women actually have pelvic floor tension, which means their pelvic floor muscles are tight. They're not relaxing well. They have a hard time starting their bladder. They have frequent urination. They have straining with bowel movements. They have painful sex. And doing Kegels can actually make that condition much worse. So I think it's really important to kind of know which bucket you fall into, strengthening or relaxation. Yeah, I think that's interesting because you could be

You could be very strong, but very inflexible, and that's bad. On the other hand, you could be very weak and very flexible. So you want the combination of strength and flexibility. That's a great way to put it. It's really about balance, you know, and I think we live in a culture where we've been fed a

pull in your abs and tighten your core and hold everything tight, but there's no focus on the relaxation portion. And when you're doing these kind of higher intensity, you're strengthening exercises. So it really is in order for a muscle to function well, which is what we're really focused on in the pelvic floor world. We want it to contract, but we also want it to relax at appropriate times. So is there like a quick and dirty test that someone can do to assess the

Is strength my opportunity or is flexibility my opportunity? You know, I go over this in the book because this is probably the most common question is like, how do I know what to do? So in the book, I kind of give you two buckets of symptoms and it's not, you know,

that one size fits all, but I would say one size fits most, where if you're experiencing some of the symptoms of urinary leakage, pelvic organ prolapse, fecal staining, you know, a core weakness that likely falls into you need to strengthen category. Other times are you have pain with sex or you have a hard time emptying your bladder well or starting your stream. You strain with bowel movements.

Any type of pain like tailbone pain, hip pain, low back pain that likely falls into the tension category and they need to work on relaxation. However, I do go over in the book as well how to self-examine yourself, like get a mirror, kind of watch what your muscles are doing, contracting or relaxing. If you're feeling really brave, you can do an internal assessment, you know, inserting a finger into the vaginal canal. And that's how we as pelvic floor therapists assess pelvic floor strength and tone and relaxation.

And so kind of really giving you the tools to how am I doing? Can I contract? Is it weak or is it really tight or tense in there? And that gives you some idea as to kind of which protocol to follow. And I think about a lot of women are doing resistance training and they're looking to build muscle and get toned. And again, I think of this tension between strength and flexibility. And how do you think about pelvic floor training training?

there's the strength piece. And then if I think about flexibility and relaxing oneself, I think of breath work. How do you think, can we talk about breath and strength? How do you think about, because I think someone's listening and they're saying, okay,

How can I incorporate this into what I'm already doing at the gym? Right. Which is exactly what you can do. I mean, you can really incorporate these workouts and this strengthening or relaxation work into things you're already doing. It's so great that you bring up breath because it's really the basis of pelvic floor health. If you were holding your breath, you are locking in pelvic floor tension and not giving this muscle the flexibility it needs.

So to kind of break it down, your diaphragm, which is a breathing muscle, sits underneath your rib cage and your pelvic floor muscles sit at the very bottom of your pelvic cavity. So it's like the top of a soda can and the bottom of a soda can. When you take a breath in, your diaphragm flattens out and pushes down and your pelvic floor muscles at the bottom of that soda can relax and let go. And then you inhale, that diaphragm comes up, and then your pelvic floor muscles can contract and lift.

So the way that we can best tune into our pelvic floor is really breathing. The first thing I teach people is don't hold your breath. If you're working out at the gym, you need to be exhaling with every repetition that you take. You should not be holding your breath.

And if you need to work on flexibility and relaxation, it's hard to just talk to your pelvic floor and be like, relax down there. I teach people how to do diaphragmatic breathing by like opening up their ribs, getting their diaphragm to expand and just breathing in a nice neutral spine to allow their pelvic floor to let go. Many of us are holding tension all throughout the day. I mean, it's just the world that we live in with sitting and travel and work and stress.

And we're holding tension down there. And the way to let it go is to start with your breath and then move in mobility like yoga and body work and different things like that.

So it sounds like if you're doing core work at the gym, whatever you do, don't just mindlessly push through crunches. No, you should. Well, crunches are like one type of exercise you can do for core strengthening. What I tell everyone to do is you just take a deep breath in and on the exhale, you should do the movement. So do the crunch, but you should be exhaling out when you do that and pulling your pelvic floor up and in. So it's inhale, exhale, contract pelvic floor.

Inhale, exhale, contract pelvic floor. So you're pre-contracting your pelvic floor, but you're doing an exercise with it, a crunch, a pushup, a squat, a lunge.

So, but the inhale also helps relax. So you're not doing a bunch of pushups, holding your breath. You're not pulling in your tummy and not pulling in your pelvic floor. It's a few more things to think about your breathing and your pelvic floor contraction, but you can really train yourself easily to just automatically start doing this. I mean, when I work out in the gym, I'm,

You know, I'm perimenopausal, so everybody's like, strength train, strength train. I'm like, you have to work on your pelvic floor too. It's a muscle like every other muscle in your body. It needs to be strengthened and it needs to function well, but you have to focus on it. It's not just going to happen on its own. You mentioned you're perimenopausal. How do you think about pelvic floor health?

by decade? Because I'm sure someone's listening and someone would say, well, I'm in my 20s. I'm good here. Can we talk about pelvic floor health and the things we should be focused on and how it changes from 20s, 30s, 40s, 50s and beyond? Absolutely. And I think that goes back to the very first question you asked, like, what do people misunderstand about the pelvic floor? And it's that

It is changing at every decade of life. I, you know, called this book a woman's guide to pelvic floor health at every age and stage because it really is changing in every decade. And, um,

It requires different things during these times. So maybe when you're in your teen years, you're getting your first menstrual cycle, understanding that periods should not be painful. They should not be debilitating. That's actually an early indicator of endometriosis or adenomyosis, which is a pelvic pain disease. And you should be educated on how to insert menstrual hygiene products.

In your 20s, if you are becoming sexually active, understanding sex should not be painful. How does an orgasm work? Should you be using lubricant? I think sex education is like sperm meets egg, and that's how a baby arrives. And I'm like, wait, there's so much more to it. And we're not given pelvic health education during these early years of being a woman. And I think that makes it really difficult to

approach issues as they occur later down the line. During pregnancy, your pelvic floor muscles get weaker. This is like a hammock that gets stretched and lengthened over the 10 months of pregnancy. And then during childbirth, whether it's a vaginal or cesarean birth, you can have pelvic floor dysfunction with scar tissue, spasm, weakness, different things like that.

And then, you know, I'm in my early 40s when we're hitting perimenopause and then postmenopause, our estrogen and testosterone levels are decreasing. Estrogen receptors are located in the vulva and vagina. And when estrogen is low, we get vaginal dryness, thinning, bladder irritation, and more chronic urinary tract infections, frequent peeing. Like if you've, you know, been able to sleep through the night historically, and then you start waking up one or two times to pee, those are perimenopausal hormone changes, right?

And you also lose pelvic floor muscle tone. You know, as we age, our muscles get weaker. And so you have to proactively strengthen your pelvic floor, right?

You know, we've always talked about perimenopause like it's this like doom and gloom period because our bodies are going to be like kaput after menopause. But I really look at perimenopause as like a yellow light. It's a runway where we have an opportunity to see this is what's coming. Build your strength now. Take care of your pelvic floor now. Optimize your peeing and pooping habits now so that when you hit menopause, you're already in really great shape and

to navigate the next 20, 30, 40 years. So you mentioned peeing and pooping habits. Any best practices for when we're on the toilet? What to do, not to do? Well, when we think about peeing, it's something we do six to eight times a day. So I'll address females and their peeing habits first.

But when you pee, you should sit. I think that's the biggest thing is sometimes we hover over the toilet because it's yucky or we're in a public place. But really sitting best relaxes your pelvic floor for your bladder to empty. And the next thing is I think moms and women are notorious for this is you should not push when you pee.

We all do this thing called power peeing, where you push as hard as you can so you are as inefficient of a peer as possible. And that can weaken your pelvic floor. Your bladder is a muscle that pushes the pee out for you. You don't need to push. That can lead to leakage or prolapse. So, you know, sit, lean forward, take some deep breaths to help your pelvic floor relax and just let your bladder empty.

And if you aren't done or if you feel like a little bit left, you do what's called double voiding. So you wipe, you stand up, and then you sit down again and see if a little bit comes out. If not, then you walk away. For pooping, I really encourage everyone to get a squatty potty or a little stool underneath their feet.

What that does is it puts you in more of a squatting position. So it brings your knees up higher when you're sitting on the toilet. You lean forward. With pooping, you can push, but you need to not hold your breath. Again, use that breath to help you. You exhale like you're blowing out a bunch of candles as you bear down to poop, and that's going to also help your pelvic floor empty and relax.

minimize the risk of weakness over time. This episode of the MBG podcast was created in partnership with MassMutual. Prioritizing your well-being is about more than getting enough sleep, eating high quality protein, or practicing mindfulness. Although, don't get me wrong, those are very important too, but it's also about making sure you're financially healthy.

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For example, past offerings included access to blood test screenings for cancer and genetic risk detection. MassMutual believes in helping people live well so they can live more. Learn more at massmutual.com slash wellness. That's massmutual.com slash wellness. So if hovering is a no-no,

on your list, what are some other no-nos, what you should not do? For peeing and pooping or just in general? Generally for pelvic floor health, like do not hover when you're trying to go to the bathroom. What else should you absolutely not do? You shouldn't over delay the urge.

And when people have to pee, and I see this a lot with people who are in meetings or medical providers or teachers, like they'll hold their bladder for two, four, six hours. And that not only creates a ton of tension in their pelvic floor, but then their bladder gets really big and boggy. They increase risk of urinary tract infection. And then they also can't empty when they're ready to go because there's so much tension in there. So between two to four hours is your normal range to go.

Um, with pooping, I always say like, you know, don't hold your breath. If you need to give a little bit of push to it, just make sure that you're exhaling as you do it. I'm also a big fan of taking magnesium citrate, which is a natural supplement you can take at nighttime to help soften your stool. And then, you know, when it comes to sex,

this is a really huge issue. One in three women will experience sexual pain at some point in her lifetime, which is a lot. And I think that that's an underreported number. But I also, a big no-no is not accepting that pain is normal. I think that we often don't want to talk about it or we just say, I'll avoid this. But, you know,

proactively use a lubricant. You may have muscle tension that's preventing entry or deeper pain. And so really addressing these issues can make sex much more pleasurable and comfortable. I don't feel like it's something we should just have to tolerate or get through. I think it's something that we really should tell ourselves we deserve a better, pleasurable experience and do some of the things that can help

You're absolutely right. One in three is a significant number. What other numbers jump out to you?

that are directly related to pelvic floor health. It's pretty wild, to be honest with you, that after the age of 65, 50% of women leak urine. So what starts as little leaks when we are postpartum or pregnant become full-blown incontinence issues when we're older. So I think 50% of women are walking around with leakage in diapers after 65. And we're living to 80, 85 now. So you're talking about 15, 20 years of your life incontinent. It's

It's also urinary leakage is one of the primary risk factors for ending up in a nursing home. And so we're thinking like these things start small, but then can really snowball and affect your quality of life. I remember I gave a TED talk on postpartum care or postpartum recovery about five years ago, and my mom was in the audience and she heard that statistic of, you know,

Urinary leakage is one of the primary risk factors for being in a nursing home later in life. And she was like, oh, you know, I've been doing this for 15 years already. But that was the number one stat that was like kind of opened her eyes of like, oh, this is kind of worth addressing if you experience it. One of the other things is that more women experience urinary leakage than osteoporosis, diabetes or high blood pressure. And when we watch TV, we see commercials for that.

osteoporosis medications, diabetes care, you know, these are well-funded health initiatives in the United States and more people leak urine and yet they're less likely to get care. And that can be associated with, you know, depression, anxiety, you know, leaving the workforce. There's a high cost of, you know, purchasing these products and incontinence care. And so I think we don't see the ripple effects of these and how much it can really impact our life.

And I think one of the other significant statistics is that 68% of menopausal women and 58% of pregnant and postpartum women feel like they are undereducated about their pelvic floor health. Yet only yet one hour of pelvic floor education can improve their symptoms. One hour.

So we're not getting it. You know, we're not getting it from our childbirth prep and postpartum recovery classes. We're not getting it from the brochure in the doctor's office about Kegels and menopause. But yet one hour of education can really help them. And yet it's just not being disseminated in our health care system, which is, I think, unfortunate and why so many women are suffering. A lot to unpack there, because if I think if leakage is leading to a loss of independence, we know that

That's going to cause you to probably be depressed. That's going to shorten your lifespan and health span. Like it's, you could do be doing all the things, you know, you can have a great VO two max and grip strength and, and cardiovascular markers. But like if you're incontinent and you end up in a nursing home, unfortunately you're probably going to suffer from depression. And we all know, you know, then unfortunately it's probably not going to lead to

To a very long life from that point on. In your view, how much of this could be avoided altogether for women? Because I do think there's a fact like we're going to live longer. You're going to live longer. Like the generation, like we're doing all the right things. And so this can this be avoided altogether in your view? No, I don't think it can be avoided altogether, but I think it's completely.

it can be one significantly improved. I mean, as I mentioned, you know, at every stage of being a woman, whether it's your first period to your last, whether it's pregnancy and postpartum, whether it's sexual pain to, you know, bladder function, like these are all missed opportunities to educate women about their bodies and to help them be proactive about taking care of themselves.

You know, it's interesting because one of the reasons I started my Instagram account, The Vagina Whisperer, was I was, this was maybe eight years ago, I was working in a hospital and seeing a lot of women who had these mesh surgeries put in to fix pelvic organ prolapse. So prolapse is when your pelvic organs kind of start to drop into your vaginal canal and they need to be relifted if strengthening or exercise doesn't work. The FDA had cleared this mesh to sling and tack up their bladders.

That mesh started disintegrating in their vaginas. Like threads of this were coming out. They were getting infected. Their partners were feeling it during sexual activity. I mean, these women were in significant pain and undergoing multiple surgeries to try to repair this.

And I was thinking and I was seeing them in my PT clinics and I was like, I feel like I'm just doing damage control. Like, why weren't these women given exercises before their prolapse? Why weren't they given better birth practices to minimize the prolapse even happening in the first place? Why weren't they taught how to pee and poop so they weren't straining for years that led to the prolapse?

So there are so many missed opportunities that I think can really prevent issues. And it's not happening. Our health care system is set up to just like put a bandaid on a problem, do a surgery, give you a medication. And it's not really giving you help to address the root cause of an issue.

So I think that there's a ton of work that can be done to educate women to improve their symptoms, to utilize pelvic floor therapy and exercise earlier. And then if you have to have a surgery, they should be seeing pelvic floor PT afterwards, you know, because we need to extend the life of that surgery, just like we do with a hip replacement or a ACL repair. You get more pelvic floor therapy, I mean, you get more physical therapy for a broken pinky than you do for having a C-section, you know, so yeah.

I think a lot of this can be prevented. And I also think a lot of medicine can be changed to just better inform and educate women. So if symptoms do arise, we can help them sooner instead of them becoming chronic issues. So you mentioned perimenopause and menopause. A lot of women are taking hormone replacement therapy. The world's changed in a very powerful way.

What's your view on HRT and how it could impact women here? So from a pelvic floor perspective, you know, I think it's very individualized. There's two different ways that you can really consume hormone replacement therapy. One is systemic. It can be pills, pellets, injections.

patches, things like that. And I really, you know, I tell folks, go to your gynecologist, go to your menopause specialist, get some blood work done, which is in itself kind of a, you know, some people agree on blood work and don't. I'm a data nerd. I like to see data and I want to know what's helping and what's not. So I think it's a very individualized choice. I have some patients who don't want to be on HRT and they'd rather manage their symptoms without it. And I have some that are like, put me on it and I'm staying on it till death do I part.

So it's really an individualized choice. I don't think that we can say everybody should do this because that's just not the case for anything. When it comes to the pelvic floor, I am a fan of using topical estrogen cream on the vulva and vagina. And the reason for that is because that is a very localized area. Studies have shown that

Topical estrogen cream does not enter the bloodstream in a significant way to affect your hormone levels, but it can improve pelvic floor tone and endurance. It can decrease the risk of urinary tract infections. It can improve vaginal dryness, which can help make sex more pleasurable. So very locally, I see a lot of benefit to using a topical estrogen cream. And I recommend it actually during perimenopause, not waiting until your postmenopausal,

But outside of that, I can, I think it's also, if women don't want to use that, there's natural oils you can use for, you know, lubrication and moisture, different things like that. So it's very individualized. I'm not all like, oh, you have to do this, but there are benefits to a local estrogen. I think that's very practical. And from where I sit, I think we went from no HRT, it's going to, it's going to kill you, to HRT for all. And

I think maybe we swung a little bit too far and it's clear that HRT can benefit a lot of women who are suffering. But to your point, it is individualized and you got to talk to your doctor and there's various approaches to it.

Your note on here's a cream which can benefit, but it's not really getting in the bloodstream. So I just think there's a lot of nuance here. And maybe we swung a little bit too far. I would agree with that. And I think it's also, you know, everything, unfortunately, in this day is very polarized. It's, you know, we have somebody on this side and somebody on this side. It's like all HRT or no HRT. And I think that is much more nuanced than that. I think medicine and health care is much more nuanced than that. But it's become kind of like,

for or against in a lot of capacities. And so,

But what do I think we all want? I think we all want better outcomes for women. I think we want improved health care. I think we want more attention to what their needs are instead of a complete dismissal of their experiences. So I do think we need to kind of go somewhere in the middle. We need to individualize it more. And I also think we need to give women more education on the side effects of these things. Like, yes, if you have a prolapse repair, this could be helpful, but here are some things that could also happen.

If you get an HRT, they can benefit you in these ways, but here are also some things that could happen. We need to give women the information and inform them and allow them to make informed decisions with their healthcare provider and on their own.

And so, but right now I think we're just kind of blanket saying, don't do anything, less is more, wait as long as possible, or like get on all of these things and it's going to be rocket fuel for your hormone system. But like there could be some wonky effects as well. I think it's, we really need to be a little bit more, I think, patient and patient.

giving more information during the process. Well said and noted. We do live in a world of extremes because that's what the algorithm rewards and that's what we see in our feeds. And you also mentioned you're a data nerd. I am. What data sticks out to you that maybe isn't getting the attention it deserves on social media? You know, this is a great question. And I think that, you know, I'm a

pelvic floor physical therapist. So for me, I mean, one of the biggest, the three biggest times that women experience pelvic floor dysfunction is during pregnancy, postpartum, and menopause. And there's a huge menopause movement right now, which I think is wonderful. Women are going to be living again into their 80s and 90s. They're going to be in postmenopause half of their lives.

But what I think isn't getting enough attention, to be super honest, is the birthing practices in the United States, because that's one of the primary risk factors for developing pelvic floor disorders. You know, over the cesarean section rates are 20 or 32, 33 percent in the United States. It's climbing every year. We have the worst postpartum maternal health care statistics. More women are dying in their first year after given birth than any other developed country.

We have no postpartum support. You know, at six weeks postpartum, when we're all clear to go back to regular exercise and sex at our six-week doctor visit, your pelvic floor is functioning at less than 50%. So we're sending women back to all of these duties and, you know, saying, work out for your mental health and, you know, go running and you can do everything you did pre-pregnancy when that's not true. They're literally functioning at less than 50%.

And so I think that this is where I see a lot of pelvic floor problems arise and that persist into postpartum. And then when you have multiple babies and you have less health care, it just it perpetuates. And then I see them again.

women are having babies later in life. More women are having babies in their 40s and their teens right now, which means we're going from postpartum to perimenopause in one blur. We don't know where one season ends and another starts. Well, especially if you're a woman who's giving birth in her mid-30s and you're having multiple children and you're just waiting on an average, say there's like two years or three years between child, you're not really not recovering between children. Right. Even if they were

Even if you were younger, I mean, there is no recovery plan. It's kind of you go home and it's like, you did great. Good luck. There is no standardized care pattern. So what would you do? What would you change? You've got the attention of...

of the world, what would you change in this process? I would have women starting to see pelvic floor therapists during pregnancy. I would teach them how to birth. Women don't know how to push. They don't know they have options. They don't know how to relax their pelvic floor. We've been tightening and doing Kegels for decades since we were reading Cosmo when we were 17. So do you have a beef with the Pilates industry here? No, I love Pilates, but it's a balance. We

We have great Pilates instructors, but it's a balance, right? You have to also educate people that it's as much as we tighten, we need to lengthen. We need to lengthen and strengthen.

And, oh, it's not on Pilates at all. It's more like the stress of the day-to-day world and sitting in Zoom meetings, I think, that, you know, overactivates our pelvic floor. But I would really help women during the birthing process. And then I would have, as a standard of care, every postpartum woman check in with a pelvic floor therapist at six weeks, right? When you see your doctor or midwife, you go see a pelvic floor therapist as well. And then we're able to intervene earlier, educate earlier.

and rehab earlier so that they have a better recovery. And so that whole first year is really important. And I think that I would integrate pelvic floor PT earlier. I would obviously have paid maternal leave so people can stay home and not return to work, you know, within two weeks, which 25% of women do after giving birth. So that's where I would really start

integrating pelvic floor therapy into healthcare. And then also during perimenopause, like check in with a pelvic PT, like you do a dentist, you know, make sure that you're not having issues, address them sooner, get education on how to pee and poop and strengthen during that runway we have leading into menopause. What's been game changing for you personally? Strength training and incorporating pelvic floor therapy into, or pelvic floor exercises into my strength training workouts.

I have a whole fitness program on how to do pelvic floor strengthening and their 10 minute workouts. But I started hitting the gym one year ago, once a week with a trainer and

And I have trained myself to do a pelvic floor pre-contraction and exhale with every repetition, every squat, every lunge, every jump, everything. And I can feel my pelvic floor getting stronger. You're able to hold in tampons better. Sex feels more pleasurable. No leaks when you're playing tennis. So it's really just integrating it into something you're doing has made a world of difference. And

The strength training is just giving my body something I didn't realize it needed, and it feels great. It's been amazing to see that shift culturally. It's just really incredible to see. We covered a lot today. Other than picking up the book, which I'll hold up, it's called Floored. Great read. Following you on social media, The Vagina Whisperer. Is there anything we didn't cover that you'd like to cover before we close?

Well, what I would say is, you know, if you have listened to this one, I applaud you. We're talking about topics we don't often talk about so candidly. But I also want people to know that it's never too late. If you've experienced these issues for, you know, months, years, decades.

It is never too late to get help. I've had women in their 60s, 70s and 80s come see me and see the benefits. And I just want to encourage everyone that with some consistency and some education and real commitment to this, I mean, it can really improve and change your life in many ways. So I think everyone deserves that. Amazing. Thank you, Sarah. Thanks for having me.