10 Things You Should Know About Your Pelvic Floor

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Written by Rachel Smith

Chances are, you may not be that well acquainted with something you were born with, your pelvic floor. Join author Rachel Smith as she shares “10 Things You Should Know About Your Pelvic Floor.

Written by Rachel Smith


Pssst…your pelvic floor, pass it on!

I’m not a doctor. I’m a mother who knew too little about her pelvic floor, had two very normal births and then experienced debilitating symptoms that stumped doctors. Over time as I learned more and more about what was going on with my body through my own research, I also learned that it was more common than I’d previously thought. The bigger problem was that women weren’t talking about it. When I’d bring up my experience however, women would start sharing their own experiences. Read on to find out what I wished I’d known about my pelvic floor, and share it with your women friends. It’s time for women to talk more about women’s health.

Chances are, you may not be that well acquainted with something you were born with, your pelvic floor. It’s supported you your whole life, and plays a pivotal role in the day to day quality of your life. I certainly wasn’t taught anything about my pelvic floor, and boy do I wish I could turn back time. But, I can’t, so I’ll pay it forward and give this piece of advice- get to know your pelvic floor and respect it.

What am I talking about here? Your pelvic floor plays many different and important roles, like holding up your guts. Did you read that right? Yes, you did. If you didn’t have a pelvic floor, or if yours was compromised (called prolapse), your internal organs would fall out. Think its impossible? It’s estimated that 1 in 5 women will undergo surgery for prolapse in their lifetime.

But, that’s not all. You birth babies via your pelvic floor, you go to the bathroom via your pelvic floor, and you enjoy sex (or experience painful sex) all thanks to your pelvic floor.

The Pelvic Floor deserves so much more respect than we give it in the States.   You’ve probably heard how every woman in France get 8-10 weeks postpartum rehabilitation. Why do you think that is? Because they understand that like any body part that goes through trauma (and birth is traumatic to the pelvic floor) should be rehabilitated. Australia also has some great resources, my favorite being Hold It, Sister.

Here’s my story. Two back to back pregnancies and no knowledge of the workings of my pelvic floor set me up for some problems after giving birth (very quickly) twice. Two pushes was all it took to create havoc for my pelvic floor. At first it felt like something was falling out when I walked, and then soon after it developed into basically charlie horses, in my pelvic floor. Yeah, it hurt.

Fast forward 14 months of chronic pain, being told I was imagining it, nerve damage, prescription drugs, 5 doctors, and Physical Therapy, my family doctor said “Hey, you should write an article called ‘What I Wish I’d Known About My Pelvic Floor’!” I shrugged and laughed it off but by the time I got home I knew I would do just that. Simply for the reason that ALL of it was preventable. It was time I told every woman what I’d wishes I’d known.

I hope you will share this with your daughters, friends, aunts, mother, grandmother, and coworkers. And check out the resources I found along the way that I’ve linked here for you. Here we go:

Normalize Pelvic Health

First of all, stop calling the parts of your pelvic floor names. It’s not Va-jayjay or down there. There’s a vagina, urethra, anus, perineum, labia, clitoris, and much more. Call it what it is, normalize it, and stop making it all mysterious. Teach your daughters the word vagina and stop acting like its taboo to talk about your own body by calling it its real name. Seriously, women will take better care of themselves if they know what it is in the first place and don’t make it so awkward. Get over it!

Learn what is normal for YOUR pelvic floor.

Let’s just say its good to have a baseline. If post-vaginal birth is the first time you’ve ever seen your vagina in daylight you might pass out. Every one is so different and that’s normal. Things will change over time and after birth and its hard to know if it was always like that or not if you didn’t pay attention previously. Yes, I’m saying grab a mirror and have a face to face meeting. If you want a lesson in diversity, visit the art installation from UK artist Jamie McCartney entitled, The Great Wall of Vagina.

Exercise. Regularly and safely.

As a Pilates teacher, I advocate what we call intelligent exercise. Don’t do Rocky-style sit ups or even a Pilates  teaser after recently having a baby. Go slowly and do exercises correctly. Doing proper exercise over a lifetime is not just to manage stress, control baby weight gain, or menopausal muscle loss, although it achieves that as well. Exercise keeps your pelvic floor engaged and toned, among many other health benefits. Walking is great for your pelvic floor. If you have SI joint laxity and consequent pain like I did in pregnancy, do prenatal water aerobics that lessens the strain on your joints but still provides safe exercise. And see no. 4 below.

Discover PFilates. Yes, that’s Pilates with a PF- Pelvic Floor Pilates.

If you don’t know how to do a Kegel, this is where to turn. Begin pelvic floor exercises such as Pfilates before pregnancy, continue them through out pregnancy and resume them once cleared for exercise as your first step back into getting in shape. Don’t do the high impact bootcamp style exercise until you’ve regained pelvic floor and core strength first or you put yourself at risk for injury and improper healing. I know you want to lose the baby weight but it won’t come off if you are side lined with other injuries, incontinence or pelvic pain like I was. Women who have children are at a higher risk for pelvic organ prolapse and dysfunction, but with age every woman’s chances increase. Pelvic floor fitness is the best way to combat this, and it only takes 10 minutes a day.

In delivery, only push when you have an urge.

Don’t be impatient like me and push with no regard for your poor pelvic floor. Its like stomping on a rubber band that’s already taut. Someone described having a “devil woman” on your shoulder during the pushing phase yelling “who cares- just PUSH!!” when you really should be breathing and waiting for the next urge. Waiting to push allows your perineum to have time to adjust to the baby’s head size. Yes, it means you may be in the pushing stage longer. I pushed twice, about 5 minutes. And as a result, damage that took way more than those minutes I saved. Months longer. Some swear by perineal massage in pregnancy, ask your midwife/doula/doctor/OB about it if you are interested in learning more. Other products out there include pelvic floor trainers such as the EPI-NO (stands for ‘no episiotomy’).

Pelvic Floor Fitness doesn’t have to wait until after the 6 week check up (and shouldn’t).

At my six-week check up my doctor asked two questions: “How’s your zip and pep?” (huh?) and “Are you doing your Kegels?” (again, huh?) After birth, especially if you tear or are concerned there is nerve damage (because you can’t tell if you are even doing a pelvic floor contraction or not), know that you can begin gentle pelvic floor contractions (imagine drawing your tailbone to your pubic bone) and lower abdominal work (like sucking your belly in on all sides, NOT crunches) can begin after 48 hours of normal birth and may help with healing by increasing circulation to the area and activating nerve fibers that have been recently damaged. One session with a Physical Therapist or knowledgeable postpartum fitness professional can do wonders to educate you on how you should best retrain your pelvic floor.

The muscles of the pelvic floor are best trained by frequent, short “workouts.” You really only need 10 minutes a day, or ten minutes added to your already existing fitness routine to see results. If you feel like that’s an inconvenience try surgery when you are 50 and you have bigger issues.

Most people think of a weak pelvic floor in those individuals who have pelvic floor dysfunction. This is true, but a very tight pelvic floor doesn’t mean strong, it means weak as well. Tight or high tone pelvic floors can cause pain in intercourse or even spasming. Tight pelvic floors should NOT do Kegels (despite what my doctor told me) until they see a Women’s Health Physical Therapist to assess and help lengthen the muscle fibers, release trigger points (much like knots in your neck) and relieve pain.

Once pain free, tight pelvic floors should begin a pelvic floor fitness regime such as Pfilates to gain strength and balance, paying equal attention to practicing relaxing the pelvic floor as to contracting. Think supple and strong, not tight and weak.


Learn what’s normal and what’s not. (Spoiler alert: peeing when you sneeze is not normal).

Know that incontinence (poop or pee), pain with intercourse, muscle spasms, and the sensation that something is falling out, also known as prolapse (internal organs coming through the facia of the pelvic floor and poking into the vaginal wall), are common, but not normal and they CAN be prevented and/or treated.

Advocate for yourself in any medical situation.

Ask any questions you can think of. Get a second opinion and only agree to drugs or surgery as last resorts because surgeries are often simply a bandaid to the problem. Often times pelvic floor dysfunction can be a muscular-skeletal issue, like mine. We are just learning now the extent that prevention can help, and its a lot. Especially when you consider that many surgeries only have a mediocre success rate and many women have repeat surgery as a result.

If you experience anything you are concerned or even wondering about, seek your local Uro-Gynocologist or Women’s Health Physical Therapist. What may seem completely baffling to you is an area they specialize in and can help you to feel better again. Don’t let your doctor suggest its just in your head, you know your body better than anyone.

Practice good bathroom habits from a young age.

  • You should only go to the bathroom once a night, if at all.
  • You shouldn’t pee more than once every few hours, shoot for 7 times a day maximum. You’ve waited long enough if you can pee for 8 seconds or longer.
  • Don’t stop your flow of pee more than once in a blue moon. Do it once to see if you can contract your pelvic floor (that’s a Kegel!) then refrain from doing it again for awhile.
  • Lean forward with a tall back, forearms on thighs/knees, and relax your belly. Even better is to have a stool nearby for your feet so your knees are higher than your hips. We use Squatty Potty at my house.
  • You can train your bladder (see b.). Wait at least 2-3 hours in between trips to the bathroom. If you go more frequently you’ll train your bladder to have to go more frequently.
  • Don’t push to poo. Don’t push to pee either.


Talk about your experiences and help raise awareness among all women.

My mission is to tell women that pelvic health is very misunderstood but it doesn’t need to be. I was astounded at how many stories from women I’ve known a long time came out of the wood work simple because I shared my experience openly.

Issues with pelvic health are very common and often preventable. Pelvic health is important because it has a huge effect on your quality of life, and you may not know that because you’ve always taken your physical quality of life for granted. That was a huge lesson to me. For the women I spoke with after my own experience, you immediately suffer when your pelvic floor suffers, whether its embarrassment and shame at leaking during your annual 5k charity race, pain with sex so you avoid intimacy, or a really freaky feeling of something literally hanging out of your body.

All in all I spent nearly 14 months in pain ranging from distressing to debilitating. It affected my relationships, my mental health, my ability to work, and my desire to have more children. With a little knowledge, faith, and consistent effort I achieved great pelvic floor health and you can too. I teach Women’s Health Pilates privately and in groups and workshops to women ranging from new mothers to breast cancer survivors to grandmothers. You can find me and read more about what I do at bettermentstudios.com.

What have you accepted in your life that took time, physically or mentally?

I’ve accepted that I’m pretty sensitive inside and out. I have sensitive skin on the outside that matches a pretty sensitive interior as well. When I was pregnant I was so porous to everything I couldn’t hear about violence or eat red meat as it felt violent. I can’t watch really disturbing movies, or be in super chaotic environments for long without feeling frazzled and spent. I don’t even really like the hairdryer. I’ve learned that my anecdote is to snuggle under the covers with a good book in silence when I need it. I used to be more anxious when I didn’t know this about myself but over time I’ve learned that I can control it more than I’d originally thought. Recharging does me wonders!

Identity Magazine is all about empowering women to get all A’s in the game of life — Accept. Appreciate. Achieve.TM Every contributor and expert answer the Identity 5 questions in keeping with our theme. As a team, we hope to inspire and motivate ourselves and inspire you to get all A’s.

What do you appreciate about yourself and within your life?
I appreciate that I am not what I seem on the outside and that’s perfectly fine. On the outside I seem very “mom,” “suburban,” “blond,” etc. There’s nothing wrong with those but they don’t really reflect my quirks and individuality, or what people assume I’m like when they see me. If they know me, they’d know I speak Chinese, I write dark poetry, I love electronic music, I practiced Kung Fu. If people don’t know me, they treat me like a doll or assume I drive a mini-van and watch Dr. Phil. But, I know I’m not like that. I also love meeting people who aren’t what they seem at first glance as well.

I also appreciate that I met a man who is very devoted to his family, even if it took me awhile to see that he was doing it in his own way, by achieving success in the early years of our marriage and at times being very, very absorbed in his work. He is truly a super-dad/husband. I think having a strong and capable partner to weather through life is extremely important.

What is one of your most rewarding achievements in life? What goals do you still have?
One of my most rewarding achievements in my life was giving birth twice and now, being a mom. It’s such a great responsibility and is at times chaotic but I can’t imagine my life without my daughters. They changed me for the better and I hope I earn their love as much as I freely give mine.

My goals include writing more and helping more women with their bodies to achieve health, possibly launching a nonprofit. Articles, or possibly a young adult book centering on some formative experiences from my teenage years. Possibly a children’s book, or a cookbook as I love all things food. Or all the above. I want to travel more internationally when my girls get older. Garden some heirloom  varieties  for cooking. I want to produce some music or own a small restaurant/pub with my husband as a retirement gig.

What is your not-so-perfect way? What imperfections and quirks create your Identity?
If you saw my kitchen or my linen closet, you’d see I’m not a neat freak. Now, I love it when everything’s in its place, but it just doesn’t take a high priority in my day to day.   There are so many more important things in life! I’ll do towel stacking and sheet folding if I have to, but if I don’t, well, I don’t. Yes, I sleep on wrinkly sheets. Maybe that’s why I love hotels so much.

I’m also highly critical of myself. As much as I am a “slacker” in the folding sheets and towels department I am neurotic at times in the self improvement department. In Confession once a Priest told me to “relax” as my penance. Enough said.

How would you complete the phrase “I Love My…?”
I love my reflective side. It gives depth to my life, relationships and conversations.   How many times have I heard from a friend, colleague, relative “I never thought of that…” I love that I can somehow enhance their life too, by reflecting on my own.  I’m convinced if we all told our real stories more often we would all benefit. This is the main reason why I wanted to write for Identity Magazine.

About the author

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Rachel Smith

Rachel is a staunch advocate for women’s issues, a CASA, writer, reader, Pilates teacher, avid cook and music devotee. Having lived and worked overseas, Rachel sees life through a diverse cultural lens that doesn't always align to popular thought. She has a Boston Terrier, two daughters, and a husband who is incredibly supportive of her passions. She is an introverted thinker and finds her true voice amplified through writing after experiencing episodes of both depression and anxiety in her 20’s. She wants to help others question the norm in order to make the world a better place for themselves so they can create good in other's lives. Rachel owns Betterment Studio Pilates near Seattle, WA and works with mothers, women with pelvic floor dysfunction, and breast cancer survivors to transition to healthier relationships with their bodies from the inside out.

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