Frequently Asked Questions

The pelvic floor is a group of muscles that form a hammock-like structure at the base of your pelvis. These muscles stretch from your pubic bone in the front to your tailbone in the back.

Think of it as a supportive sling that holds up your bladder, uterus, and bowel. These muscles help control urination, bowel movements, support your organs, and play a role in sexual function and core stability.

Several factors make pelvic floor issues more common after 40:

• Menopause: Declining estrogen weakens pelvic tissues and reduces muscle tone
• Childbirth effects: Years or decades after giving birth, the impact on pelvic floor muscles becomes more apparent
• Natural aging: Like all muscles, pelvic floor muscles weaken with age if not exercised
• Cumulative strain: Years of heavy lifting, chronic constipation, or high-impact exercise take their toll

The good news? These issues are treatable at any age with proper exercises and care.

While it's common (affecting 1 in 3 women), it's not "normal" in the sense that you should just accept it. This is called stress incontinence, and it's a sign that your pelvic floor muscles need strengthening.

The good news: stress incontinence is highly treatable with pelvic floor exercises (Kegels) and lifestyle changes. Most women see significant improvement within 8-12 weeks of consistent exercise. Don't suffer in silence - it's fixable!

Absolutely yes. While childbirth is a major risk factor, many women who've never been pregnant experience pelvic floor dysfunction. Other causes include:

• Menopause and hormonal changes
• Natural aging process
• Chronic constipation or straining
• High-impact exercise (running, jumping)
• Heavy lifting over time
• Chronic coughing (from smoking or illness)
• Genetics and connective tissue disorders

The same treatments and exercises work regardless of whether you've had children.

Common signs include:

• Leaking urine when coughing, sneezing, laughing, or exercising
• Sudden, urgent need to urinate
• Frequent urination (more than 8 times per day)
• Feeling of heaviness or bulging in your vagina
• Lower back pain that doesn't go away
• Pain during intercourse
• Difficulty emptying your bladder or bowels
• Accidentally passing gas or stool

If you experience any of these symptoms regularly, it's worth seeing a healthcare provider or pelvic floor physical therapist.

Note: Many women have both types (called "mixed incontinence"). Both are treatable!

Women with prolapse often describe:

• A feeling of heaviness or pressure in the pelvis
• Feeling like something is "falling out" of your vagina
• A bulge you can see or feel in your vagina
• Symptoms that worsen during the day or after standing for long periods
• Lower back discomfort
• Difficulty with urination or bowel movements

Prolapse ranges from mild (barely noticeable) to severe (bulge extends outside the body). Many cases can be managed with exercises and devices called pessaries. See a healthcare provider if you suspect prolapse.

See a healthcare provider if:

• Symptoms interfere with your daily activities or quality of life
• You're avoiding activities you love due to leaks or discomfort
• You notice a bulge in your vagina
• You have pain with sex or daily activities
• Home exercises haven't helped after 8-12 weeks
• You have blood in your urine or stool
• Symptoms worsen suddenly

Best specialist to see: A pelvic floor physical therapist or urogynecologist. They specialize in these exact issues and can provide targeted treatment.

Step-by-step guide:

1. Find the right muscles: Imagine stopping urine mid-stream or holding in gas. Those are your pelvic floor muscles.
2. Empty your bladder before starting
3. Squeeze and lift: Tighten those muscles and pull them upward (like an elevator going up)
4. Hold for 3-5 seconds (work up to 10 seconds)
5. Relax completely for 3-5 seconds
6. Repeat 10 times
7. Do this 3 times per day

Most women notice improvement within 4-6 weeks of consistent daily exercises. Significant improvement typically takes 8-12 weeks.

Timeline:

• Week 1-2: Getting the technique right, building awareness
• Week 3-4: Muscles starting to strengthen, may notice small improvements
• Week 6-8: Noticeable reduction in leaks and symptoms
• Week 12+: Significant improvement for most women

Key: Consistency is everything! Doing exercises occasionally won't help. Think of it like going to the gym - you need regular workouts to see results.

Yes! Overdoing Kegels can cause problems:

• Muscle fatigue: Tired muscles that can't function properly
• Tightness: Overly tight pelvic floor (hypertonic) causing pain
• Difficulty with sex: Painful intercourse due to tight muscles
• Worsened symptoms: Paradoxically, too-tight muscles can worsen incontinence

Recommended frequency: 3 sets of 10 repetitions per day is plenty. More isn't better!

⚠️ Important: If you have pelvic pain, see a pelvic floor PT first. You might have tight muscles that need relaxation, not strengthening!

Yes, they can be very helpful! Kegel trainers provide:

• Biofeedback: Shows you when you're doing exercises correctly
• Resistance: Like adding weights at the gym, strengthens muscles faster
• Motivation: Tracking progress keeps you consistent
• Proper technique: Ensures you're engaging the right muscles

Popular types:

• Weighted vaginal cones: Simple, effective, affordable ($20-40)
• Smart trainers with apps: Like Elvie or Perifit ($100-200)
• Electronic muscle stimulators: For severe weakness ($150-400)

Bottom line: You don't need a device, but many women find them helpful, especially if they struggle with proper technique or staying motivated.

It depends on your needs:

Pro tip: Many women prefer reusable underwear for daily protection and disposable pads for heavy activity or travel.

A pessary is a removable device (usually silicone) that's inserted into the vagina to support pelvic organs. Think of it as a supportive bra for your pelvic floor.

Who needs one:

• Women with pelvic organ prolapse
• Stress incontinence that doesn't improve with exercises
• Those who want to avoid or delay surgery
• Support during exercise or activities

Types:

• Ring pessary: Most common, easy to insert/remove
• Gellhorn: For severe prolapse
• Cube: Maximum support

Important: Pessaries must be fitted by a healthcare provider. Don't buy one online without professional fitting!

Yes! Many women over 40 experience vaginal dryness due to menopause. Using lubricant can help with:

• Comfortable intercourse
• Using pelvic floor trainers or pessaries
• Reducing irritation

Types of lubricants:

Recommendation: Start with water-based lubricant (safe for everything) and consider adding a vaginal moisturizer for ongoing dryness.

A pelvic floor physical therapist (PT) is a specialized physical therapist with advanced training in treating pelvic floor dysfunction. They're THE expert you want to see for pelvic floor issues.

What they do:

• Internal examination: Assess pelvic floor muscle strength and coordination
• Personalized treatment plan: Exercises specifically for YOUR body
• Biofeedback training: Learn proper muscle activation
• Manual therapy: Release tight muscles, improve flexibility
• Electrical stimulation: Wake up weak muscles
• Education on bladder habits, posture, and lifestyle

When to see one:

• Kegels aren't working or you're not sure you're doing them right
• Moderate to severe symptoms
• Pelvic pain
• Prolapse
• Before or after pelvic surgery

Good news: Most insurance covers pelvic floor PT! Check with your provider.

Usually not! The majority of pelvic floor issues can be managed conservatively without surgery.

Conservative treatments (try these first):

• Pelvic floor exercises
• Physical therapy
• Lifestyle modifications (weight loss, avoiding constipation)
• Pessaries for prolapse
• Bladder training
• Medications (for overactive bladder)

Surgery may be considered if:

• Conservative treatments haven't helped after 3-6 months
• Severe prolapse causing significant symptoms
• Complete urinary retention (can't empty bladder)
• Quality of life is severely impacted

Important: Even if you do need surgery eventually, doing pelvic floor exercises beforehand improves surgical outcomes!

Cost breakdown (US prices):

Pro tip: Start with free Kegel exercises and lifestyle changes. If that doesn't help in 8-12 weeks, invest in physical therapy. It's worth it!

Yes, especially if your issues are related to menopause. Declining estrogen weakens pelvic tissues, and hormone therapy can help.

Options:

⚠️ Important: Hormone therapy alone won't fix pelvic floor problems. It works best combined with exercises and physical therapy.

⚠️ Not for everyone: Women with history of breast cancer, blood clots, or certain other conditions may not be candidates. Always discuss with your doctor.