10 things no one tells you about your pelvic floor (until you're already peeing in your pants)
Is yours like a trampoline or a spent rubber band? (Mine's like a stubborn wine opener)
Hi — it’s Micah of Modern Hysteria, a newsletter and podcast revealing the taboo topics of women’s brains and bodies so we can live without shame.
This is a companion piece for this podcast episode:
Tell me how — in the age of Google and WebMD and The Barbie Movie — I only found out I had a pelvic floor an entire year after I pushed my son ALL THE WAY THROUGH mine?
I would happily give back the one hour it took for me in public school to learn how to address an envelope if it meant I could have learned about the pelvic floor.
AS IT TURNS OUT, I’ve got one, you’ve got one — we’ve all got one, and the pelvic floor is a critical network of muscles in your pelvis that keeps your shit together.
No, it, like, LITERALLY keeps your shit together.
I started pelvic floor therapy when my son was three and continued intermittently between hysterectomy and oophorectomy, and, believe me, there’s still work to be done … but I’ve learned a lot that I wish I’d known earlier.
Here are 10 things no one probably told you about the pelvic floor that SHOULD NOT BE NEWS TO YOU (are they? I’m nosy; tell me in the comments!) ↓
1. What your pelvic floor actually is
PSA: You have a floor and it is in your pelvis. 📣📣📣
And, actually, calling it a “floor” doesn’t do it justice; the pelvic floor is a group of 14 muscles that come together under your butt like a hammock to support your bladder, uterus, rectum … whatever you’ve got in there.
Your pelvic floor is also connected to your core muscles, your hips, and your diaphragm (that thing that helps your lungs breathe), so pelvic floor issues can impact a lot of your body functions.
2. *Kegels* aren’t a cure-all
I know Cosmo magazine and 00’s chick flicks probably taught us that kegels are, like, the end-all-be-all of pelvic health. Maybe you’ve even felt very self-satisfied about doing them at stoplights since 1999.
The truth is: Those little stop-your-pee-mid-stream tricks aren’t gonna cut it if you have pelvic floor dysfunction, which is when the pelvic muscles don’t work the way they should.
If your pelvic floor is *dysfunctional*, you may:
Leak pee when you cough, sneeze, laugh, or exercise 💧
Have trouble emptying your bladder or feel like you need to pee all the time 🚽
Struggle with constipation or have trouble controlling gas or poop 💩
Feel pain during sex or inserting a tampon 🩸
Have low back, hip, or tailbone pain that won’t go away 😩
Studies suggest that, most of the time, people aren’t doing kegels correctly, and they don’t have an overall benefit.
3. Peeing yourself after childbirth is common but not *normal*
Maybe you’ve heard your mom and her friends joke about how they can’t help but pee a little.
And, yes, dribbling is common, especially in women who have had a child — 1/3 of women experience urinary incontinence after childbirth — but it’s not something that we should simply be accepting as “normal.”
Common ≠ normal
We can and should do something about it!
4. Your pee problems could mean your pelvic floor is too weak OR too strong
If you’ve got pelvic floor probs, don’t just go assuming it’s because your pelvic muscles are weak. Too-tight — or hypertonic — pelvic floor muscles can cause just as many problems as weak ones.
🚩 Signs of too-tight (hypertonic) pelvic floor:
pain during sex
difficulty emptying your bladder
tailbone and lower back pain
Get assessed by an expert — like a physical therapist who specializes in pelvic floor rehab — to see what’s going on down there!
5. High-impact exercise can stress your pelvic floor, even if you’ve never had a baby
Whether or not you moved a human through that baby chute, you might have pelvic floor issues if you engage in a lot of high-impact exercise, like running or jumping. For example, a startling number of volleyball players experience pelvic floor dysfunction and bladder leakage! 🏐
It’s important to strengthen your core, glutes, and other complementary muscles to keep it all working together.
6. Menopause may be a culprit of pants-peeing
One thing menopause teaches you is that estrogen does a hell of a lot of stuff. When it starts to go away, its effect becomes increasingly apparent!
For example, estrogen plays a role in keeping your pelvic tissue strong and *lubricated* so they remain flexible. When estrogen levels drop, you may notice your pelvic floor muscles getting weaker, like a spent rubber band.
No matter where you are in the journey, though: pre-, peri-, or post-menopausal, you can strengthen and/or stretch your pelvic floor muscles for better control.
7. You can have a c-section and still have pelvic floor dysfunction
Vaginal delivery of a whole-ass baby seems like it would be the Molotov cocktail of pelvic floor trauma. But the alternative — cesarean-section — does not necessarily protect your pelvic floor from damage.
While c-section may lower the risk of prolapse — a condition in which organs like the uterus fall through the vagina, essentially turning inside out — labor still affects your core, nerves, and pelvic stability, which can lead to incontinence and pelvic floor dysfunction.
8. Your mental health and your pelvic floor are connected
I learned from my physical therapist that stress, anxiety, and trauma can have an impact on the function of our pelvic floors. Trauma — like sexual assault — can cause your pelvic floor muscles to involuntarily contract and stay super tight as a defensive mechanism (survivors of sexual assault are prone to hypertonic pelvic floors).
The good news: Therapy, deep breathing, and relaxation techniques can help release the tension.
9. Your pelvic floor is a trampoline
It moves when you breathe and it needs to be bouncy, like a trampoline.
Too-WEAK pelvic floor muscles are like a trampoline with really loose springs; your feet would hit the ground when you jump.
Too-TIGHT pelvic floor muscles are like a trampoline with NO springs; it’s too taut to jump at all.
When you take a deeeeeep belly breath, your pelvic floor naturally expands and contracts, like jumping on a trampoline. If you’re constantly sucking in your stomach or breathing shallowly, you’re putting extra strain on your pelvic floor (too tight!).
Recommendation from my physical therapist: Practice diaphragmatic breathing, or deep belly breaths that help your whole body relax. Notice if the muscles in your pelvic floor relax, too.
10. Pelvic floor function is something you can work on at any age
My fellow pants-peers, it is never too late!
Your pelvic floor muscles can be retrained no matter how long you’ve had issues.
Start small, consistent habits, pelvic floor therapy, breathwork, strength training, and functional movement can help improve pelvic floor dysfunction.
What can you do about pelvic floor dysfunction?
Pelvic floor therapy is a type of physical therapy that helps strengthen (too-weak) or relax (too-tight) muscles that do all that important work supporting your bladder, uterus, and bowels.
If you have leaks or pain, this therapy can help improve your symptoms.
The first step is to get assessed to learn which type of pelvic floor dysfunction you might have.
We have two upcoming Modern Hysteria podcast episodes about pelvic floor dysfunction:
S1E12 Pelvic Floor Dysfunction x Incontinence with Patricia Siegel (this week!) 🎉
S1E22 Painful Sex with Pelvic Floor Therapist Rachel Gelman (May 7, 2025)
Subscribe here to get them sent right to your inbox:
Did this episode resonate with you? Have you experienced any of these things? Tell me in the comments; I read every single one!
Look out for that new episode of the podcast this Wednesday, and, until then, here’s the most-downloaded-ever episode:
'K, that’s it!
Talk soon —
Micah
Sources:
This was so great. My first two sessions of pelvic floor therapy were spent with my jaw gaping wide while learning all this stuff. Common IS NOT normal. Exactly. There are some European countries that prioritize pelvic health so much that women are automatically offered pelvic floor therapy after childbirth. This stuff is widely known there and should be more widely known here (along with everything perimenopause)
Would like to remind everyone that even those with elective cesareans who never labored can experience pelvic damage. I had excruciating pelvic pain (not to mention scar pain) after mine, despite never having labored; pregnancy can do a number on your body completely independent of labor.
I had no idea the pain I was experiencing was related until I read a book about the history of cesareans and connected the dots; my OB, true to the discipline’s form, had just dumped me at 6 weeks with a reminder I was cleared for sex. Real high quality care, there. PT has been extremely helpful to loosen the painful adhesions, release my very tight floor, and bring some sensation and movement back to the area.