Pelvic Floor Dysfunction: How I Stopped Suffering in Silence

For eleven years I had suffered in silence with pelvic floor dysfunction. What started out as leaks with coughs or sneezes shortly after the birth of my second son soon turned into pant-soaking leaks when lifting, jumping rope, doing pull-ups, and sprinting. Because of pelvic floor dysfunction, I had to pull back on my intensity long before the rest of my body needed to. I lost YEARS of being the biggest bad-ass I could be. And I suffered in silence.

I started buying clothing that would hide my leaks which meant I couldn’t wear solid or light colored leggings, shorts, pants or skirts. My biggest concern when clothes shopping was, “Will it show when I leak?” “Will I be afraid to cough, sneeze, or laugh if I wear this on a date?” I was in my 30’s. And I suffered in silence.

Finally, I decided to mention it to my general care provider during one of my annual exams. When I told her – yes, a her – about the stress incontinence I was experiencing during my track workouts, in Utah, in the summer, she gave me two choices:

1)     I could undergo a surgery in which they would cut me open and “install” a mesh sling to support my bladder

-or-

     2) She could prescribe me a medication that would dehydrate me so I wouldn’t leak.

This left me with a very poignant thought:

Why on earth would a medical professional suggest dehydrating an athlete during a workout…period? Let alone a high intensity sprint workout that lasted an hour, outside, on a track, in the Utah summer where it routinely gets into the triple digits? This idiotic, sloppy, lazy, and downright dangerous suggestion by my “healthcare” provider was one of my earliest “Fuck It. Fuck You” moments. Clearly this woman knew less about the human body than I did and I fired her.

What this sorry excuse for a doctor failed to mention was pelvic floor therapy and the fact that it is extremely effective in treating pelvic floor dysfunction. Much more so than cutting open the human body to “install” a sling and much more so than dehydrating someone – I still get livid when I think about it. Whether the doctor even knew about pelvic floor therapy I’ll never know but even if she didn’t, there is no forgiveness for a doctor not even being aware of this life changing science. I’m tired of women being an afterthought in the medical field and I won’t accept “I just didn’t know” as an excuse anymore. We make up 50% of the goddamn population and we’ve had the same body parts for hundreds of thousands of years. “I didn’t know” doesn’t cut it.

So what changed? When and why and where did I finally seek help?

         It was Thanksgiving 2024. My ex had the kids and I was spending the day with my partner, his ex, and their three wonderful little boys. After dinner (which was steaks by the way, ‘cause “Fuck Turkey”) we went outside to let them burn off some energy and get blood pumping again. It wasn’t too long into this little excursion, that the boys suggested a game of tag.

 Y’all….I LOVE tag, like, A LOT. I’m fast, powerful and nimble. I’m hardly every “it” and when I am it’s not for very long. I also just really love running – fast.

Unfortunately, I was wearing solid colored pants and had not brought a change of clothes with me, so I opted out because I was “too full” – which was a lie -- sat down on a bench and watched these people I love play a game I love. And I suffered in silence.

But this time, the silence was so deafening I decided to take action. The following Monday I did an internet search of pelvic floor therapists in my area and gave a couple of them a call. When I found one that felt right, I set my first appointment. For the first time in 11 years –I refused to suffer in silence.

My experience with the pelvic floor therapist was fantastic and the tools they gave me have helped me reduce my leaks significantly. They’re not all gone, it’s a work in progress but I now have many more workouts with no leaks than I do with and when I do leak it isn’t nearly as severe…all without cutting me open or dehydrating me.

As you can probably guess, I listen to a lot of health and fitness podcasts and one of my favorites is The Ready State with Dr. Kelly Starrett and his wife Juliet. Recently, they did an episode with Dr. Sara Reardon – a pelvic floor therapist known as “The Vagina Whisperer” – and it was phenomenal. I am going to give you the Cliff’s Notes version of that hour long podcast but I am linking to the full episode because it really is worth listening to what she has to say.

Podcast Link: Dr. Sara Reardon: Fixing Pelvic Floor Dysfunction - Expert Advice from The Vagina Whisperer • The Ready State Podcast

This podcast was absolutely filled with empowering one-liners but, given my recent article and podcast on Osteoporosis, the one that really stuck out to me was the fact that more women suffer from pelvic floor dysfunction than from osteoporosis. How many might that be you ask? According to Dr. Sara Reardon – 1 in 3.

What makes us so susceptible to pelvic floor dysfunction? Like the answer to almost everything else: our physiology and anatomy. While all humans have a pelvic floor, which is basically just a basket of muscles that holds our major organs and acts as the “floor” of our core, only women have a third weak spot, or opening – our vaginas. This means that even from a structural standpoint, our pelvic floor is not as strong as men’s.

As if that isn’t enough of a structural issue, even our spine is built differently than our male counterparts, and the difference is not favorable to a strong pelvic floor. The human spine has wedge shaped vertebrae that help maintain the natural curve of our lower back. In geek-y circles, we call this the lordotic curve and its function is to help our spine absorb shock and maintain posture (there is also one in the spine by your neck). Well, in men, there are only two wedge shaped vertebrae, in women there are three. Why? The answer to almost everything ladies is…babies. This third wedge-shaped vertebrae allows us to lean back further to counter balance a growing pregnant tummy. This third wedge also tips our pelvis forward, creates a swayback, and compromises the integrity of our pelvic floor muscles (Sims. Next Level p 223).

The problem continues with some obvious culprits: pregnancy, childbirth, and hormones. I don’t think I need to go too in-depth as to why pregnancy and childbirth create problems with the pelvic floor. That is what most women are familiar with and, for a large majority of it, have actively felt it in our lives. There is no denying your pelvic floor is getting stretched out and compromised during those two events.

Hormones are another story and one that is not quite so often told because, let's face it, we don’t really know anything about our hormones because no one has ever really cared to do any research on them until recently. Here, we are in the area of groundbreaking science and research. In menstruating women, you may notice your pelvic floor dysfunction acting up more around the time of your period. Coincidence? You know by now it’s not. During our periods, our estrogen is at its lowest and guess what one of estrogen’s functions is? It helps to maintain urethral closure pressure, and blood flow and collagen production (and thus plumpness and tension) in the pelvic floor muscles. Now, knowing that about the role of estrogen in the pelvic floor, extrapolate that out to peri and post menopausal women. The picture ain’t pretty.

*It is important to note that progesterone also plays a part in pelvic floor health. It has been linked to increased urinary tract discomfort (increased urgency). Progesterone is at its highest during our luteal phase (right before menstruation) so you may experience increased dysfunction during this time as well.

So, what’s a girl to do? Our anatomy and physiology are so obviously working against us that it IS tempting to throw our hands in the air and say, “The doctor was right, this is just my fate” but I’d like to propose another course of action. GO SEE A PELVIC FLOOR THERAPIST!!

A visit to a pelvic floor therapist should be a routine part of  healthcare for any vagina owning person and should be done annually if there are no problems present and in accordance with instructions from your pelvic floor therapist if there are.

How to know if you should see a pelvic floor therapist:

·       You have a vagina (honestly, men can also benefit from pelvic floor therapy as they are notoriously tight – but this ain’t about them)

·       You have ANY KIND OF LEAKING

·       You suffer from uncomfortable intercourse (or when inserting anything into your vagina)

·       You have constipation or ANY KIND OF BOWEL DYSFUNCTION (skid marks included)

·       You suffer from low back or hip pain

“Pelvic floor dysfunction is NOT NORMAL but it is common.”

                                                                                 -Dr. Sara Reardon

Why Kegels Are Not The Answer:

Like so many other things related to women, the medical community and the media have been as lazy as possible when it comes to pelvic floor dysfunction. When a woman complains of pelvic floor dysfunction, the first thing out of the other person’s mouth is almost always, “Are you doing your kegels?” Hard truth of people who know what they’re talking about: Kegels are not always the answer and they can actually make the problem worse.

Kegels are effective IF the issue is pelvic floor weakness but all too often – that is not the problem or, at least not the only problem. For a lot of women, tightness is the primary issue and weakness is secondary. According to Dr. Sara Reardon, the first course of action is very often getting the muscles to relax and then, and only then, should work begin to strengthen them – and the best way to do that is not always kegels.

*Of special note: Sara and a colleague (and me too!) have taken to calling Kegel’s “puss-ups” because it is SUPER irritating that this exercise is named for a man. Can men do them? Yes. They have the same muscles. Is this a predominately female issue? Yes. And Dr. Arnold Henry Kegel has no place in my pelvic floor. Hard stop.

While it is tempting for me to keep going, I think it’s time to call it quits on this blog article. There’s just so much emotion wrapped up in this topic and such a desperate need for this information in the world! If nothing else, I hope you take what you learned here and schedule an appointment with a pelvic floor therapist and find a personal trainer (like me) who can help put those orders and exercises into a fitness plan that will improve your healthspan for the rest of your life.

Please also consider picking up a copy of Dr. Sara Reardon’s book “Floored”here.