Your pelvic floor is essential. Here's how to take better care of it
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Okay, so painful sex, urinary leakage, constipation, tailbone pain. What do these unpleasant experiences have in common? They can all be symptoms of pelvic floor dysfunction.

What is the pelvic floor, you ask? It's a basket of muscles that sits at the bottom of the pelvis and supports our internal organs. Your pelvic floor helps you pee and poop. It helps you breathe. It can help you have orgasms. And if you have a vagina, it can help you give birth.

But it's possible, likely even, that no one has ever talked to you about this. Everyone has a pelvic floor and we often don't connect with it. We're never taught about it. We don't get pelvic floor education growing up. And many of us don't know

that these muscles exist and therefore if a problem arises, how to evaluate for it and then how to get treatment for it. Sarah Reardon is a pelvic floor physical therapist and author of the book Floored, a woman's guide to pelvic floor health at every age and stage. Although this book is focused on, I say women and people with vaginas in the very beginning, but I think it's just pelvic health in general is kind of what the hope is that people can start becoming aware of and proactively caring for.

So many women go to the doctor with pelvic floor dysfunction and come back confused and still in pain. They might be having painful sex or painful bowel movements. They might be peeing a little every time they laugh. And then the doctor says, well, you know, you don't have an infection and you don't have cancer. So try lube or panty liners.

Sarah says that's not good enough. For so long, we've kind of normalized pelvic floor problems for women. But what I really want to do is normalize pelvic floor conversations because we don't even talk about these issues. And once we're able to start talking about them, we can start finding real solutions for them instead of talking them up to just a normal part of being a woman or aging or having babies.

The truth is, if you have pelvic floor pain, there's a lot you can do about it. On this episode of Life Kit, we get into the details. From the physical, the stretches and exercises you can do, and how you should go to the bathroom to avoid straining, to the mental and emotional. And one thing we want you to know is your situation is not hopeless. Far from it. You just have to know where to go, who to talk to, and what to do.

What is the pelvic floor and where can I find it? If you were just sitting right now and you put your hands on your hips, those are your pelvic bones. Your pelvic floor is a basket of muscles that sits at the base of that bony outlet. So we've got that ring of bones and at the very bottom, imagine a basket of muscles that attaches from the pubic bone in the front to the sacrum in the back and then side to side. That

That basket of muscles in the female body supports the pelvic organs like your uterus, your ovaries, your bladder, which holds urine, your balls, which hold stool, and

Now, this basket of muscles supports those organs. It contracts and relaxes with breathing. It contracts with your abdominals to support your spine. So we use it all throughout the day when we go to the bathroom, when we're breathing, when we're moving. And particularly, it transforms and goes through changes during pregnancy, postpartum, and then menopause. And so that's when we see more issues with this group of muscles occur.

Okay, takeaway one, the pelvic floor supports our internal organs, including the bladder, the bowels, and reproductive organs like the uterus. It also supports our spines, and it contracts and relaxes when we breathe. If you have a vagina, your pelvic floor can also change as you go through life changes like pregnancy and menopause.

Here are some facts from the book that I think people might find surprising. Tense pelvic floor muscles can cause constipation. Correct. Pushing your pee out, not great for you. Yeah. Just say no to power peeing. Power peeing. So you want to just like relax and let it flow.

You want to sit, relax, and let it flow. Relaxing your pelvic floor allows your bladder, which is a muscle, to push the urine out. And that's really how, you know, you're supposed to pee is you just sit instead of hovering, breathe and chill, and then your bladder muscle contracts and that pushes the urine out. Girl, sit instead of hovering in a New York City public restroom. I know. I know.

I know. And I have been to New York many times. And I, twice, I have been like, I would not sit on this toilet. It was once in a public bathroom in Battery Park and then a McDonald's in Times Square. And I was like, nope, not sitting. We're hovering today. I'll sit at home.

Also, orgasms are pelvic floor muscle contractions. Yes. Those muscles are the ones that contract and relax during an orgasm. And so if you have a pelvic floor muscle issue, it could cause the inability to orgasm, pain with orgasms, weak orgasms. So yes, your pelvic floor muscles are integral to great orgasms. Also...

that your pelvic floor helps you breathe. Correct. So the pelvic floor muscles sit at the bottom of your pelvis and at the very top of your abdominal cavity is your diaphragm, which is your breathing muscle. So when you inhale, that diaphragm contracts and kind of flattens down. It's a dome and then it flattens when you inhale.

And then what that does is it causes the pelvic floor muscles to soften and relax. When you exhale, the diaphragm comes back up and the pelvic floor muscles come back up as well. So even when we breathe, our pelvic floor muscles are contracting and relaxing throughout the day. Which also means we can use our breath to help relax our pelvic floor, right?

That's exactly right. And that's one of the easiest ways I really encourage people to start connecting with their pelvic floor. So just by focusing on your breath, by taking big, deep, rib-opening breaths,

opening up your ribs with your diaphragm and then just you know inhaling and exhaling throughout the day can really help relax your pelvic floor muscles and then you start bringing that breathing into exercise into yoga it's an easy way to really start relaxing your pelvic floor muscles because so many people have tension in this area

Takeaway two, the pelvic floor does so much for us. And one of its functions is that it helps us breathe, right? When we inhale, our diaphragm pushes down and so do our pelvic floor muscles. When we exhale, our pelvic floor ascends. So here's an exercise. Take a deep breath. As you do, try to imagine what's happening in your pelvic floor. Visualize it expanding as you inhale and then rising as you exhale. Take a deep breath.

Doing this purposefully throughout the day can start to relieve pelvic floor tension and just help you get in touch with where your pelvic floor is and what it feels like. Let's talk about some of the symptoms that can indicate pelvic floor dysfunction. And since we've been talking about tension, maybe we can start there. What are some common signs that you might have pelvic floor tightness, tension, overactivity?

So pelvic floor tightness can often occur and lead to things like a hard time starting your urine stream. So say you sit down and you feel like you can't start your urine stream and you have to push to get it started. You may feel like your bladder doesn't empty completely and you pee and then you have to go back to the bathroom 10, 20, 30 minutes later.

You can also get constipation. So, you know, your muscles have to relax fully to empty your balls. And if they're not relaxing because they're overly tight or tense, you can have straining with bowel movements, hemorrhoids, fissures, incomplete emptying, and then even feeling like your stools or your poop is really thin and just kind of comes out. We call it pencil thin poops. So all of those are signs of overactive pelvic floor muscles.

Other common ones are painful intercourse. It feels like something can't enter the vagina. You may also feel that with inserting tampons or pelvic examinations or deeper pain with intercourse vaginally. It feels like your partner is hitting something or it's bruisey, you know, with deeper penetration or pain afterwards.

But even things like tailbone pain, deep hip pain, low back pain, anything kind of where there's tension in the area that can cause muscle aches and pains or difficulty with bowel movements, sexual activity, or emptying your bladder. I want to highlight this because I think it's something that a lot of people don't know and are scared to talk about, that if you're having painful sex, the culprit very likely could be pelvic floor tightness.

Yeah, it's really one of the main motivating factors of why I wrote this book. I mean, I've been in this field for 18 years. And although to someone else, it may seem like, oh, a little leak here or there or some discomfort with intercourse, these symptoms can severely impact your quality of life.

You know, the other thing with painful sex is that, you know, these can cause relationship issues. Someone can have challenges getting pregnant, you know, and it affects your self-esteem. So these issues, the ripples of them go quite far. And I think we've just been, you know, always chalk them up to, oh, you have a vagina. Well, you're going to have pain or you're going to have leakage when that is simply not the case. Because again, these issues are very treatable and therapy and the things I talk about in the book are,

They're not, it's not rocket science. These are muscles that just need to get strengthened or lengthened. And it's quite simple to do it. It just hasn't been integrated into our healthcare system the way it needs to be. ♪

Takeaway three, know the symptoms of pelvic floor tension or overactivity. You may have a hard time starting a urine stream. You may feel like your bladder won't empty. You might have pain or burning when you pee. You might also be constipated and notice hemorrhoids and fissures and thin poops. If you have a vagina, penetration might be painful, whether that's during sex or when you're using a tampon or having a pelvic exam. And if you have a vagina,

And Sarah says you might also notice pain in the areas around your pelvis, like your hips, tailbone, and lower back. What are some of the common symptoms of pelvic floor weakness? So I will say some of the symptoms of weakness, you can also have tension. So again, I think it's really important to kind of be able to assess the muscle itself for tension or weakness. But some of the things we commonly see are urinary leakage with coughing, sneezing, running, jumping, etc.

And other things are pelvic organ prolapse. And this is something where the pelvic organs aren't as supported by that hammock of muscles as we'd like them to be. So they start to kind of drop or push into the vaginal canal. It can feel like rubbing in the vagina, like something's falling out of the vagina. Women often report that they're soaping in their shower and they feel a bulge at the vaginal opening or it's pressure or heaviness.

that's in the vagina and it gets worse at the end of the day or with standing activities. Another thing to even think about is pelvic organ prolapse can pop up like if you're straining with bowel movements and you feel like you're not quite emptying completely and there's kind of stool stuck in a little pocket. Or if you're emptying your bladder and it feels like you know you have urine in there, but you can't get it out all the way because it's kind of stuck. That's like the pelvic organs are pushing into the vaginal canal and they can't quite empty well. And

Alright, takeaway four, know the common symptoms of pelvic floor weakness. Those can include urinary and stool leakage and pelvic organ prolapse, which might feel like a heaviness in the vagina or a bulge at the vaginal opening. Also, we talked about painful sex. Two words to know here. You might have a condition called vulvodynia or pain in the vulva. And you may also have a condition called vaginismus, an involuntary tensing of your vaginal muscles that can be painful as well.

Often women will have both of these conditions at the same time. Other sexual symptoms that can indicate a pelvic floor issue are decreased sensation and weak orgasms. You're...

Outside superficial muscles are responsible for orgasms and those deeper muscles help with sexual sensation. And so if you feel less sensation with intercourse, if you have weaker orgasms, even urinating during intercourse or orgasms, so that's called climacteria. Those can all be other signs of weak pelvic floor muscles.

And again, some people have tension. And once we treat the tension, we find weakness. So you can have a combination of both. These are muscles like any other muscle in your body. You can't just tighten them and think that that's going to fix everything. I think the narrative has always been do your Kegels, but that's one exercise. It's like saying if you have back pain, just do a bunch of crunches. I think pelvic floor health care is much more nuanced than that.

What are some things we can do to prevent pelvic floor weakness or address it if we already have it? So for weakness, I think the biggest thing is I tell people to stop straining and we don't realize how often we're doing that. So if you're peeing, we talked about not pushing to pee. Just sit and relax and let your bladder empty. For bowel movements, I recommend using a stool under your feet.

And when you're having a bowel movement to not strain, but to exhale and use that stool under your feet to put you in the squatting position. Because straining during a bowel movement can actually weaken your pelvic floor over time.

The other thing is to not push into an activity that causes you symptoms. So if you are running, if you were jumping rope and you're having leakage, that means that your pelvic floor tissues can't quite handle the load that you're asking them to. So pull back, work on pelvic floor strengthening exercises. Again, these are key goals, but you want to do

Quick Kegel contractions, longer hold five or 10 second Kegel contractions, making sure you're relaxing afterwards and do them in different positions. I think we all kind of joke about doing them like sitting in the carpool lane, but I'm like, well, that's not really when you leak, right? So you want to use them during exercises like lunges and squats and with movement to get those muscles turning on.

And then also to turn the muscle on before a cough or a sneeze. So I always say like kegel before you cough, squeeze before you sneeze, tighten those muscles before those activities that cause leakage to help prevent the leakage from occurring. And then what about if you have pelvic floor tension?

So one of the biggest things I start for people with tension is to watch your posture. We're, you know, ultimately just sitting too much throughout the day. So really varying your movements. If you're sitting, have your feet flat or cross at the ankles. Try, you know, to avoid turning your thighs in or twisting your legs up. Unclench your butt. You know, I think sometimes we just need to do a butt check and relax your tush and take some big deep breaths throughout the day to soften your pelvic floor muscles.

And then work more on stretching and relaxation. So again, that can start with just taking some big, deep diaphragmatic breaths, but also some yoga poses like child pose or happy baby pose or doing a deep squat. So building those into your day can really help relax the muscles. And there are devices you can use at home for internal massage to the muscles, a therapy wand or what we call vaginal dilators to also help relax the muscles internally.

Takeaway five, start doing the things that can help with pelvic floor dysfunction. Don't push when you pee or hover over the toilet if you can help it. Try not to strain when you poop. Consider putting a stool under your feet to help you go. Do Kegels. You can start lying down and then advance to doing them in sitting or standing positions.

Sit less throughout the day if possible. Start to notice if you're clenching your pelvic muscles or your butt when you're stressed and make an effort to relax in those moments. Do stretches like deep squats. And you might also find vaginal dilators or therapy wands helpful.

You talk about in the book how pelvic floor pain and tightness in particular can have a mental component. Because if you're stressed, you know, you might clench your jaw. You might squeeze your butthole. You might squeeze your thighs together. Just be tensed up. And that can over time cause pain and sort of chronic tension, right? Yeah.

That's correct. There was actually a research study done that looked at assessing if women contract their pelvic floor muscles when they're watching something violent on television. So not sexually violent, just violent. And what they detected was women were over activating or contracting their pelvic floors just watching something violent on TV.

And if we think about watching the news or listening to crime documentaries or just kind of the constant consumption of information during the day and how our bodies start to kind of hold on to that tension and we're not actively doing things to help release it or relax it can put us into this chronic state of pelvic floor muscle overactivity. One of the reasons I bring that up is I think one, when women do have sexual pain or they have tension in their pelvic floor muscles, they're often just told to just relax.

But that's not the answer. And it's also something that's not all in their heads. There's a psychological, emotional component, but there's also a very physical component. So I do help address the physical piece, but I think it's important for women to have resources, whether it's therapy or meditation or, you know, even just recognizing the connection to also address kind of the whole cycle of tension that's created in their bodies. Yeah. Okay. So let's say you are having some of these symptoms and

What's your first stop? I mean, do you go to your internal medicine doctor or your gynecologist or urologist?

The good news is, is that every state in the United States, you can access a pelvic floor therapist for an evaluation without a referral from a physician. So your insurance may require it, but in your state, you can at least have an evaluation and they can tell you whether you have a pelvic floor muscle issue and then communicate with your doctor or connect you with a medical provider who can see you and or write a prescription to continue treatment. And

So I would say that's a first stop. I think some of the other things are there are so many resources. There are telehealth platforms. There are home workout programs to really just give women a baseline of education. The research shows pelvic floor education can help improve someone's symptoms.

Alright, takeaway six. If you're having symptoms of pelvic floor dysfunction, consider a consult with a pelvic floor physical therapist. Keep in mind, though, some of these symptoms can have other causes. Like if it burns when you pee, you might have a UTI. Or if your bowel movements have changed significantly, you might need to be screened for colon cancer. So make sure you see a medical doctor like a gynecologist, a urologist, or a gastroenterologist as well.

I think the most shocking thing about this is that

There really is help, and it's not that hard to fix these issues, but so many people deal with them and never get the help they need. They go to the doctor, they go to multiple doctors, just trying to get a diagnosis of some kind, and no one ever suggested they go to pelvic floor PT or do strengthening exercises or exercises to relax their pelvic floor. It's

It's really upsetting. And I think it is because of, I think it's, well, I think there are probably a lot of reasons, but shame is at the root of it. And the idea that these body parts are obscene and so we shouldn't talk about them. You know, and I think that one of the questions I get asked a lot is like, when should we start educating young women or vagina owners about their pelvic health issues?

And, you know, I think that this isn't something that it's like you sit down and have one conversation with your kids. I think it's information that you drip in over time, whether it's when they're potty training and teaching them how to not push when they pee or when they have bowel movements sitting on a toilet to put a stool under their feet and to go when they have the urge to go. But even, you know, just calling body parts by their names instead of nicknames, I think is step one, identifying their body parts.

Like we don't have another name for an elbow. Right. And so I think, but when we also shut down the conversations, then when things happen, pain with tampon insertion, tailbone pain, urinary leakage, particularly to young women, they start hiding it. They don't know where to go for help. They don't know who to talk to because we've never cracked the door for those conversations. And so I think it's really important to have those conversations ongoing because we

Your pelvic floor changes at every stage of life, whether it's menstruation to menopause to, you know, sexual activity to giving birth, and it requires something different. And so I think if we can be proactive in the education, we can be proactive in the care and also realize it's not just a vagina. It's a whole group of muscles that are really important for day-to-day function. And that's my real hope is that, you know, we don't have shame around this part of our body.

Well, Sarah, thank you so much. Thank you for having me. For more Life Kit, check out our other episodes. We have one on menstruation and another on what to do if you get laid off. We've got range. You can find those at npr.org slash Life Kit. And if you love Life Kit and you want even more, subscribe to our newsletter, why don't you, at npr.org slash Life Kit newsletter.

Also, we love hearing from you. So if you have episode ideas or feedback you want to share, or you just want to say something nice to us, email us at lifekit at npr.org. This episode of Life Kit was produced by Claire Marie Schneider. Our visuals editor is Beck Harlan, and our digital editor is Malika Gharib. Megan Cain is our senior supervising editor, and Beth Donovan is our executive producer. Our production team also includes Andy Tegel, Margaret Serino, and Sylvie Douglas. Engineering support comes from Neil Rauch.

I'm Mariel Seguerra. Thanks for listening.

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