Are you ignoring your pelvic floor?
We’re talking all things vulvas and vaginas in honor of Mother’s Day
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Many of us avoid crucial conversations about intimate health and did not learn much about it growing up. No more! This Mother’s Day, I asked “the vagina whisperer,” Dr. Sara Reardon, author of the new book Floored: A Woman's Guide To Pelvic Floor Health At Every Age And Stage, to help. In this latest episode of the Raising Good Humans Podcast, we are talking all about vulvas and vaginas, and while it might feel awkward, it is necessary! Not only can we better understand our own health through our various life stages, but we can equip ourselves with the knowledge to support the girls in our lives.
The basics.
First, let’s clarify some terminology. Like many of you, I’ve been using the term "vagina" to describe the entire genital area, despite the fact that this isn’t entirely accurate. I told myself I would use correct terminology but still tend to skip it. That may be a gen x thing. For clarification, the vagina is the internal canal, while the vulva refers to everything external: the labia, clitoris, mons pubis, the area with hair, and the opening of the vagina. Understanding this distinction helps us speak more precisely about our bodies and identify specific issues. For instance, "vaginal pain" is different from "vulva pain," and addressing each requires different approaches.
What actually is happening down there?
The pelvic floor is central to vulva and vaginal health. These muscles sit at the base of the pelvis and support vital organs like the uterus, bladder, and bowels. They also contribute to core strength. Every human, regardless of gender, has a pelvic floor, but for women, its role is particularly significant during pregnancy, childbirth, and in perimenopause/menopause. As Dr. Reardon describes, during pregnancy, the pelvic floor stretches and weakens as it supports a growing baby. She describes a “hammock” that is holding a watermelon. This can lead to pelvic pressure, low back pain, and urinary leakage. After birth, whether vaginal or cesarean, women may experience scar tissue, muscle weakness, and other issues. Then, as we age, the pelvic floor weakens along with the rest of our muscles, which can cause new issues like incontinence and prolapse. And no one discusses ANY of this with us!
What to do:
Address your pelvic floor. It’s important to understand that pelvic floor issues can fall into two main categories: weakness and tension. Figuring out which “basket” you fall into is key to addressing your specific needs. AND, many women may have a combination of both weakness and tension, requiring a nuanced approach.
Weakness: This often manifests as urinary leakage, fecal incontinence, pelvic organ prolapse, and core weakness. Kegel exercises (pelvic floor contractions) can be helpful here, but they need to be done correctly and effectively. Just like doing a few crunches won't give you a six-pack, sporadic Kegels won't magically solve pelvic floor weakness. You need a consistent, targeted approach.
Tension: This can cause difficulty starting urination, frequent urination, pain during bowel movements or sex, tailbone pain, hip pain, and low back pain. If your pelvic floor is tense, doing Kegels can actually make things worse. Instead, you need stretching, relaxation techniques, and massage to release the tension. And, pay attention to how you sit, stand, and move. If you find yourself clenching your buttocks, crossing your legs a lot, or turning your thighs inward, you may be creating unnecessary tension in your pelvic floor.
Brush up on proper urination and bowel movement habits. Turns out, how you go to the bathroom matters. I really thought I would limit potty talk to potty training, but here we are!! Here are Sara’s tips for healthy urination and bowel movements.
Urination: Go when you have the urge, about every 2-4 hours. Avoid going too frequently (which can shrink your bladder) or holding it in for too long (which can overstretch your bladder). Sit down fully on the toilet (no hovering), lean forward onto your elbows, take deep breaths, and relax. Don't push or “power pee,” as this can weaken your pelvic floor.
Bowel movements: Eat a high-fiber diet, stay hydrated, and exercise regularly to prevent constipation. When you go, use a stool to elevate your feet so your knees are higher than your hips. This mimics a squatting position, which is physiologically the best for bowel movements, and relaxes your pelvic floor muscles. Exhale as you bear down to push, rather than holding your breath. A note for potty training: This advice applies to kids, too! Ensure they have a stable toilet seat and a footstool to support their feet. Teach them to exhale while pushing, and even try Sara’s trick of using a "twirly straw" (blowing through a straw) to help relax their pelvic floor while pushing.
Prepare for hormonal changes. Perimenopause and menopause are critical times for pelvic floor health. Hormonal changes, particularly decreased estrogen, can weaken tissues and increase the risk of issues like dryness, incontinence, and prolapse. Treat this as a "yellow light" signal and be proactive.
Proactive strengthening: Start (or increase) pelvic floor exercises before significant symptoms arise. Consistent strength training during this period can help mitigate the effects of hormonal changes.
Vulva care: Just as you adjust your skincare routine as you age, also adjust your vulva care. Use gentle cleansers (water or mild soap) and consider a vulva moisturizer, especially if you experience dryness. You may also discuss topical estrogen cream with your gynecologist if needed.
Seek professional help and advocate for yourself. You don't have to figure this out alone. Pelvic floor therapists are specialized healthcare providers who can offer personalized assessments and treatment plans.
Don't ignore symptoms: If you experience any pelvic floor issues, don't just accept them as "normal." Seek help. Early intervention is crucial to prevent long-term problems.
Find the right therapist: Look for a therapist who specializes in pelvic floor therapy. They can teach you correct techniques, provide manual therapy, and guide you on lifestyle adjustments.
Advocate postpartum: If you're postpartum, be your own advocate for pelvic floor rehabilitation. Don't rely solely on the standard six-week checkup. If you're experiencing issues, insist on a referral to a pelvic floor therapist.
Advice around painful sex. As Dr. Reardon explains, painful sex can stem from various causes, including tight muscles, scar tissue, hormonal changes, and stress.
Using lubricants, especially water-soluble ones, can help. She also recommends talking to your gynecologist about topical estrogen creams to help address dryness, and finding a therapist to (or learning how to) release pelvic floor tension through stretching, massage, and relaxation techniques.
Happy Mother's Day to all the beautiful mamas out there! Thank you for trusting me and thank you for raising good humans!
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