The Truth About Leakage, Prolapse, and Pelvic Floor Muscle Care with Dr. Sara Reardon

No amount of leakage or pain is normal. It's information from our bodies that something's not working the way it should be.

Okay, so someone listening right now and they're going, uh-oh, what should they do first? Should they immediately go to a pelvic floor therapist?

The basics are like when you're peeing, if you push when you pee, you cannot empty your bladder completely and it can actually weaken the ligaments that support your pelvic organs and contribute to prolapse and leakage over time. Muscles are responsible for all of these issues or involved, and yet nobody's talking about them. How do they evolve if you don't do anything about it? Well, they typically get worse. It's unfortunate because the narrative for women's healthcare and pelvic healthcare in particular is just give it more time, it's a normal part of aging, which is ultimately gaslighting. Wow.

Yes. I've been talking a lot lately about pelvic floor health, some powerful conversations. Most recently we had Dr. Rena Malik on about what's going on anatomically, and then earlier with Kim Bottineau on how movement and lifestyle can support to these critical muscles. And today I, I'm gonna go one, one level deeper and really talk about what's happening with pelvic floor disorders. The reality is these are super common, and that's what you're gonna hear about today. It's like this silent epidemic that's leaving millions of women suffering unnecessarily. You don't need to. And there's some simple things that you can do at home that are very memorable that I'm gonna be sharing with you with my guest today. She's Dr. Sarah Reardon, and she is known online known as the Vagina Whisperer. You're going to hear how that name came about. She's a board-certified pelvic floor therapist with over 18 years of experience. She is an educator now to millions through her social media channels and the author of the book Floored, which is a rally cry for women to reclaim their pelvic floor health at every age and every stage. She's also the founder of the V-Hive. This is an online on-demand pelvic floor fitness platform, and you are going to get 30 days free on this app, which is super exciting. I'm going to put that and the links to all our social platforms at jjvirgin.com/reardon, and I'll be right back with Sarah for this fun and powerful and provocative conversation. Stay with me. Welcome, Sarah, to the show.

Thanks for having me, JJ.

I was telling you offline, I've become obsessed with pelvic floor therapy. I've had Kim Vopny on, who's a pal of yours. I've had Dr. Reena Malik on, and I've been just listening to everybody talking about this. I love everything you're putting out there and you've called the pelvic floor disorders, all of them, a silent epidemic. And what I'd love to know is what was that moment? Like, when did you realize this was bigger than like, oh, people are having little pelvic floor issue? When did you realize that this is like, I kind of feel like it's a cultural blind spot.

It is, it's a medical blind spot as well. And so I've been practicing as a pelvic floor physical therapist for over 18 years. I started, this as my early in my career. It's the only thing that I've done, and it's been really incredible to see the field grow, to have more awareness about pelvic floor health pop up. However, you know, when I was in physical therapy school myself, we started learning about the pelvic floor and, you know, women's health and, you know, pregnancy changes. And I'm going, why have I never learned this? Like, I'm a woman, and to learn more about my own body is really fascinating and helpful, but I feel like every woman should know these things, and all people have pelvic floor, so every person should know these things. And so I did my first clinical rotation in graduate school and working with women of every age and stage, whether it was, you know, a young college woman who was having painful sex, or, you know, another woman recovering from breast cancer and had radiation and she was having discomfort with intercourse and some bladder health issues, or, you know, another woman struggling with constipation. And I'm going, muscles are responsible for all of these issues, or involved, and yet nobody's talking about them. And seeing how helpful it was for them to have a place where they could share these really intimate details about their to get therapy and help for them. And to see their quality of life really change and transform was really when I was hooked of like, okay, this is the type of therapy that people need. And I jumped right into it upon graduation. And that was in 2007.

There aren't very many of you, are there? Like, that must have been, especially back then.

Oh, it was so, you know, I loved it. I mean, to me, working with a pelvic floor and a vulva and vagina is working, is like working with an ankle or a foot. But I was the only one in my graduating class. I went to Washington University in St. Louis. Out of 67 who specialized in pelvic floor health. Now I would say there's maybe 5 to 8 of us who are in this field. So it's definitely increasing over time. Oftentimes I think therapists get into it when they've had their own experiences, whether they've been pregnant or postpartum or had some challenges, but also there's just more of a demand because people are aware of it. But, you know, back in those days I would tell someone what I did for work and they would scoot 2 chairs over and say like, oh, that's kind of weird, you know? And now when I tell someone, they're like, wait, can we talk later? You know? So it's totally changed.

So are you saying, Oh, I'm the vagina whisperer. What are you saying?

I mean, I'm like, oh, I'm a pelvic floor physical therapist. And they're like, what is that? And so I'll tell them like, I do internal pelvic floor assessments on the muscles through the vagina, through the anal opening to help with urinary leakage or painful sex or pooping problems. And they're like, wait, what? I thought you were a physical therapist. I'm like, oh, I am, but we don't talk about this part of the body. And so when we start talking really openly about it, I think people often feel embarrassed. But to me, this is really important healthcare for, you know, women in particular that we really need to kind of normalize these conversations.

So was that part of like naming yourself the Vagina Whisperer? Was, was, uh, was normalizing it and, and deciding to bring it online? Like how did that all progress?

What's amazing about my journey from as the Vagina Whisperer and now having a book out and launching an app is that it's all happened really organically. And I think that that's really a testament to women wanting and needing, needing this information and not really having a place place to get it. So I started my Instagram account in 2017. I was pregnant with my second son, and going through pregnancy and birth, I would say, was another huge kind of pivot point for me where I had really great births, I had really good postpartum recoveries, and I was thinking, gosh, I've worked with women for a decade who really struggled, but I think if more women had these tips and tools, we would have better outcomes postpartum. So I started my Instagram account just for my group of girlfriends. We're all getting pregnant and having babies around the same time, and they're the ones who called me the vagina whisperer. Just because of the nature of my work. I had been practicing for 10 years, so I called the account that because it was just for my group of friends. And over the years it's just grown so much. So, you know, that's kind of my nickname now and my brand, but it really happened just from, you know, or an organic nickname from my group of friends.

So it makes sense to me now that you're saying it, like, wouldn't it be amazing? Imagine a world where you get pregnant and part of what you do with pregnancy is you go do some pelvic floor work. I think of, I went to these like pregnancy classes and they were so dumb that I stopped going. You know, it was like, it was just like, it's like, this is not useful. And postpartum, like the same thing. I'm wondering, what are the indications? Like, how would someone know? You mentioned issues with painful sex or constipation, but what, what are some of the things that someone should be thinking about going to a pelvic floor therapist for, or symptoms?

I think it's helpful to know what the pelvic floor does, like the function it has in our day-to-day lives. So this basket of muscles that sits at the bottom of your pelvis supports your pelvic organs. So in a female body, it supports your uterus, your ovaries, your bladder, which holds urine, your bowels, which holds stool. Um, it also has the openings for urine to exit the body through the urinary sphincter, the anal opening for bowel movements, and the vaginal opening for menstruation, vaginal birth, and vaginal intercourse. This is also a postural muscle. So we talk about our deep core muscles. Your pelvic floor is part of your deep core. It contracts and relaxes with breathing. It supports your spine. So there's a lot of different functions it has. So if you're experiencing anything from like different types of pain, it could be low back pain, hip pain, painful sex, tailbone pain, vaginal pain, all of those things, the pelvic floor muscles related. Anything with bladder health with respect to urinary leakage with coughing, sneezing, laughing, overactive bladder, painful bladder syndrome, difficult time starting your urine stream or feeling like you're not emptying completely. Also with bowel movements, it's not just constipation, it's straining with bowel movements, hemorrhoids, fissures, fecal staining in your underwear, fecal urgency or leakage. And then sexual health issues like discomfort with intercourse, changes in sensation. You know, after birth we often feel like something's changed down there. It could be weakness, it could be weaker orgasms or the inability to have an orgasm. Pain after orgasms, and then also pelvic organ support. So if you have pressure, heaviness, pelvic organ prolapse, the pelvic floor muscles also play a role. So it's pretty important. And again, we don't often even know it exists until we have a problem. And so I really love educating women about their bodies and saying, hey, this really important muscle— group of muscles is there. It's responsible for all of these things. And our medical system is set up right now where we see a doctor for our uterus, we see a doctor for our bladder, we see a doctor for colon, but the muscles are involved in all of those areas. And that's where a pelvic floor specialist really comes in.

It is still mind-blowing to me that this is not like, it's just not a common thing yet. So someone, you know, doesn't know, like great example would be me, 62, and goes through life, maybe has kids, has a hysterectomy. What happens if you've got some of these things? How do they evolve if you don't do anything about it?

Well, they typically get worse. Right? So, you know, I think it's unfortunate because the narrative for women's healthcare and pelvic healthcare in particular is just give it more time. It's a normal part of aging. It's a normal part of, of giving birth, which is ultimately gaslighting because these issues are common, but they're actually not normal. No amount of leakage or pain is normal. It's information from our bodies that something's not working the way it should be. And because we go through huge physical transformations as women, pregnancy's a transformation, giving birth, childbirth, menopause is a huge transformation, and those are all risk factors for developing a pelvic floor problem and great opportunities to kind of really fold in pelvic floor healthcare for women, either proactively or afterwards, because we know the pelvic floor changes are gonna occur.

So no amount of leakage is normal? Correct.

Wow. Yes. It's information that our muscles and sphincters are not responding to the demands that are being placed on it. It's kind of like saying, is Is any amount of back pain normal? Like, is a 1 or 2 out of 10 normal, or does it have to be a 10 out of 10 to get help? It's the same thing. I think with leakage is that it starts off pretty small, typically a little leak with a cough or sneeze, and then it starts getting progressively worse. So if you start exercising more or lifting weights, or, you know, with aging, the estrogen levels in your body change, and lower estrogen levels affect the pelvic floor muscles and tissues. They get thinner, weaker, they have less tone. You have more urinary urgency and frequency. And therefore you start to have more bladder symptoms. So these issues only get worse with time, they don't get better.

Okay, so someone listening right now and they're going, uh-oh.

No, I'm like, there's hope, hold on.

What should they do first? Should they immediately go to a pelvic floor therapist? Is that step one? What do they do?

I think the first thing is really looking at, kind of do an audit of your daily practices because you could do Kegel exercises till the cows come home, but if you have habits that are, kind of progressing the dysfunction, that's not gonna help you. So the basics are like when you're peeing, if you pee, some of my kind of rules for peeing are only pee when you have the urge to go. Don't go just in case. There's a lot of just in case peeers out there, but that can actually cause your bladder to shrink and then you'll have more frequency over time.

Well, so how much should you have to go before you pee?

Every 2 to 4 hours is considered normal. So if you just went an hour ago, JJ Virgin, and then you're gonna leave the house right after this and, you don't really have the urge, but you're like, I'm just gonna go just in case. Those are the kind of pees you wanna avoid. The times it's okay to, you know, use the restroom and you don't have a strong urge is maybe before a workout, before a pelvic exam, before sexual activity. But otherwise, you wanna wait until you have the urge to go. The other thing is when you do go to the restroom, I encourage sitting down instead of hovering over the toilet. I know there are times it will be a really yucky toilet and sitting down is not an option, but your habit should be sitting instead of hovering. That helps your pelvic floor muscles relax so you can empty better. And lastly, don't push when you pee. I was one before too, so I've been there, but I call us power peeers because we want to push our pee out as fast as you can, and we want to be so efficient at everything. But when you urinate, you should really sit down, lean forward, and take some big deep breaths, even if your stream is slow, and allow your bladder to push the urine out for you. If you push when you pee, you cannot empty your bladder completely, and it can actually weaken the ligaments of that support your pelvic organs and contribute to prolapse and leakage over time. So sit, chill, breathe, don't push when you pee. Wow. Right. Simple. But nobody teaches us, right? I mean, so many people are like, wait, I push all the time. I'm like, why would stop?

You know, I never thought about pee pushing.

Yeah. Well, now I'm gonna be with you in the bathroom every time you go.

But I mean, who doesn't? Like, I, I think about it too. It's like if you're going out, you're like, oh, I'll just pee before because I'm going out.

Right. Wow. And so it's one of those habits that over time it can kind of get more exacerbated. And then at nighttime, the normal is 0 to 2 times at night. So those are kind of just, I think it's important for us to know what normal is. So if we're outside of that normal range and we're like, huh, maybe it is a pelvic floor issue. And then I think the second step is knowing if we need pelvic floor strengthening or we need pelvic floor relaxation. Many, many people think that Kegels are just the holy grail of pelvic floor therapy, but that's just a strengthening contraction. It's like, like flexing your bicep and then relaxing it, right? It's just one little move. But if you need strengthening, you need to put that contraction into other activities that you do. So when you go to the gym, JJ, I would say you wanna engage those— we always talk about engaging our core muscles or our deep abs. You wanna engage your pelvic floor as well, kind of lift that basket of muscles up.

All right. So how exactly— I'm at the gym, how do I do that? And how do you know you're doing it?

So before you even hit the gym, I would say there's two things you can try. One is called the stop pee test. So if you're urinating, you're peeing, I want you just to kind of try to stop your urine stream. And if you can completely cut off your urine stream, that's a Kegel contraction. You're closing that urinary sphincter, and then you relax it all the way, and your stream should start again. That's a full contraction and relaxation. Now, you should only try that once. I don't like for people to do Kegels while they're peeing. They should be relaxed. But then when you go to the gym, it's that same maneuver. It's as if you're stopping your urine stream or holding in gas. It's the front and the back part of your muscle together.

And when should you do that? Like what part of the exercise? You do that on the hard part?

You pre-contract. So before you start your movement, say you're just doing a squat, I want you to pre-contract with your pelvic floor. My favorite cue is to think about sipping up a smoothie with your vagina. So it's like a sipping up. Mm-hmm. Just get that visual right there. I know. Sip up and then do your movement. And you're thinking about that sipping up throughout the movement. Eventually you won't need to think about that. It'll kind of be automatic, but initially we're training this muscle to fire and turn on before the movement. And then the second piece is make sure that you're not holding your breath. So like if you are lifting heavy weights, we often tend to hold our breath and like strain to kind of lift heavy, but that puts pressure down on our pelvic floors, which we don't want. So contracting and engaging the pelvic floor muscles and exhaling through out the exertion part of the exercise is what we're really going for.

So how do you know, and this is where I mentioned, I've like, I've been doing a lot of pelvic floor research now, 'cause I was like, okay, how do, and bringing everyone on the show, but I'm still confused as to how do you know if you've got tight pelvic floor muscles or weak pelvic floor muscles? And then what do you do? Like, it seems pretty clear what you do if they're weak.

Right.

But what do you do if they're tight? Like how do you stretch them? So how do you know?

Many, many people have tension. Some of it can be symptom-based. So one, if you go see a pelvic floor therapist, they will examine you and they do an intravaginal muscle assessment, and they'll press on the sidewalls of the vagina, which is where the pelvic floor muscles lie. And if it's tender, tense, non-relaxing, those are all signs that there is some pelvic floor muscle tension in the area. And then also it's symptom-based. So different things like pain. So anything like vaginal pain, painful bowel movements, Tailbone pain, hip pain, abdominal pain, even all of those are typically related to tension in the muscles. Other things like having to strain or push to start your bladder stream, straining during bowel movements, pencil-thin stools, or feeling you're not emptying completely. Those are all signs of kind of tension in the area. If you have pelvic floor tension, pause the Kegels is step one. You don't want to be doing a ton of tightening, tightening, tightening to Kegel to muscles that are already tense. The second thing is work on your breathing. When you can take big, deep diaphragmatic breaths, which is like opening up your ribs like an umbrella and relaxing just throughout the day or between workout sets, that's going to help your pelvic floor muscles relax. A lot of folks are like— I call them breath holders or butt clenchers. Like, we're just stressed and tight all the time, and our buttholes are literally tight, right? So I'm like, how do you walk around with a butt clencher? How? Oh my God. Oh my God. If you sit all day on Zoom calls, your, your booty hole's probably tight, right? So it's like, oh my goodness. And you can see people, like if I examine them in my clinic and their glutes are just tucked under, it's like they're just, it's like a guarding mechanism.

Huh.

And we all live in a very upregulated world where nervous systems are upregulated. We're constantly connected, we're anxious, and that has an effect on the muscles and tissues in our body. So we're just kind of clenching a lot. Same thing with jaw pain, with migraines. Your pelvic floor can hold that tension as well. So looking at your posture, breathing exercises, and then a lot of yoga-type stretches. So different stretches like child's pose, happy baby pose, a deep squat can relax the pelvic floor muscles. I think giving birth, you are in a squatting position because it relaxes the pelvic floor muscles. If you're in the woods and you're pooping, you are squatting because it relaxes the pelvic floor muscles. So lots of squatting-type stretches. And we also do massage to the muscles, so externally to the hips and the the glutes, and then internally to the pelvic floor muscles as well. Just like you would get massage to your neck muscles if you had tension, it's the same thing to the pelvic floor.

Wow.

I know, a lot.

But it seems like the first thing you'd really need to figure out is, are you, are you tight or are you weak?

Correct.

Correct. And if someone's going to a pelvic floor therapist, what would they expect to have them do?

Pelvic floor therapy sessions are typically one-on-one, so they're in a private treatment room. So you're not going to be in those big therapy gyms like you may have experience if you had just gone to regular physical therapy. And then we sit down there. The sessions are about 45 minutes to an hour, one-on-one, and we ask you questions. So you could be there, JJ, and you say like, I leak a little bit when I laugh and sneeze. I'm saying, okay, but I also want to hear about your childbirth history, your medical history, your pooping process, your, you know, menstrual cycles historically, your menopause, everything that's related to your pelvic floor health. So I can get a good sense of if anything else is going on. Then we do an external physical assessment. So this is often with clothes on. I can look at your low back, your hips, and your pelvis, test the strength of your glute muscles and your abdominal wall. I'll look at your abdominal wall if you have any scars or kind of core weakness in the area. And then we do an internal examination, and that's with clothes off on the way from the waist down. So the therapist steps out, the patient changes either into a gown or just lies down on a comfortable mat with a sheet draped over them so everything's covered. And then to do the pelvic floor muscle assessment itself, we observe externally first. So I'll pull the sheet back, I'll look externally at the vulva, and I'll say, okay, JJ, I want you to contract and do that sipping up the smoothie maneuver like you're doing a Kegel. Then I want you to relax. That lets me know if you can contract and relax properly, because a lot of people don't do Kegels properly. And so that's our first sign to know. And then I want you to push your bear down like you're having a bowel movement. That again lets me know if you can lengthen and relax your pelvic floor. And then we do— I look to see if there's any, you know, the tissues look of the vulva look irritated, red, like low estrogen, anything like that, if there's any scar tissue. Then we do the intravaginal exam. I put a gloved lubricated finger into the vaginal opening, and then I repeat that same test. Squeeze, relax around my finger, push my finger out, and then I press on the sidewalls of the pelvic floor muscles. Um, through the vagina. And then again, if there's tension, tenderness, anything like that. And with all of that information based off of what you told me about your history and your symptoms and the physical exam, that's really how we determine if there's tension, weakness, and often both. Like, you can have tension, and once we release that, we can find some underlying weakness there. Or maybe there's just a little bit of incoordination, like your body is saying squeeze, but what you're doing is actually pushing. So sometimes it's just connecting mind and body because we haven't really ever connected with this part of our body. So we're kind of teaching it how to function properly.

Yeah, I see that as one of the biggest challenges, honestly. It's like, you know, it's hard enough. You see people at the gym and they're doing an exercise and you're like, "Oh, form's a little off. You're not recruiting the muscles you think you're recruiting." But boy, it's even more challenging pelvic floor-wise.

Right. And I think it, you know, everyone that comes in to see us, I think they're like, "Oh my goodness, I didn't even know that you could feel what this is like." Or, "I didn't realize I was holding so much tension or that those muscles were painful." Oh, you know, I felt like it was weak. I just couldn't tell. And now this confirms it. So I think it really just helps people feel more connected to their core, connected to their bodies. And then when they are, say, preparing for birth and they're like, oh, I am pushing, but I actually was squeezing. I was doing the opposite. So now you taught me how to properly push. Or when you're going to the gym and you're like, okay, I'm gonna start doing my contractions. And you're like, oops, I'm doing the wrong thing. Just squeezing my tush. So it just is like a trainer for your pelvic floor, right? It's like helping you train how to use these muscles you've never really been connected to before.

So if you were gonna look at like, okay, couple things that someone could start incorporating in, is this, are these daily things you wanna be doing or is it more like resistance training where you do it every other day? Like what, what would a good routine look like?

You know, I think the best thing that you said is it's a routine. It's not a one and done. Magic exercise or stretch. It's really kind of a couple of pieces of the puzzle that you're gonna put together. Some of them you'll do daily. Like daily, you're not gonna push when you pee, right? Daily, you're gonna exhale when you're exerting effort instead of holding your breath. You're gonna use a Squatty Potty or a little pooping stool under your feet so that you aren't straining during bowel movements.

How important is the Squatty Potty thing? So literally when I first talked to Kim Bottme, I'm like, okay, I got a Squatty Potty for travel. I'm like, it's at some point we travel with red lights, a coffee maker. I'm like, okay, now I have to bring this thing too.

You know, I don't poop without one. I'll say that every bathroom in my house has one. It just facilitates an easier bowel movement. And the reason I focus so much on bowel movements is one, we have one, you know, ideally once a day, but straining during bowel movements puts more pressure on a female pelvic floor than jumping, coughing, snapping, laughing, sneezing, crunches. So if you're straining with bowel movements, that could be the cause of your leakage. That could be the cause of your prolapse. So it's always about getting to the root cause of what's contributing to something. So you could go have your prolapse surgery and get everything repaired, but if you're still straining 'cause you're constipated, those, it's gonna return. So I'm a big fan of a Squatty Potty. So yes, pack it with you. Wow. And if you're on the road at a hotel, just turn the trash can sideways. That's my hack.

Okay, so wait, so you mentioned prolapse. Let's just define prolapse, the different stages, I think, aren't they stages? And how one would know, and is this something that always requires a surgical intervention at some point or not?

So prolapse is when that basket of muscles, your pelvic floor muscles, are not supporting your pelvic organs as well as we'd like, and the organs start to drop down and push into the vaginal wall. So it's often described like something feels like it's falling out of your vagina. There's a bulge in the vagina, there's pressure or heaviness. It feels like something's rubbing in there. It typically gets worse at the end of the day, or if you've been standing for a long time or do a lot of physical activity. So it's, it's a support issue. Now it can be improved with exercise and kind of lifestyle modifications like not straining and things like that. But if the prolapse is a stage 1 or 2, therapy is helpful. Definitely a great way to go. You can also use internal supports like a pessary. But if you have a stage 3 or 4 prolapse, which is when the vaginal walls are pushing past the vaginal opening, that's typically a referral for surgery. We still do therapy to, again, get to the root cause of what caused the prolapse. Was it straining? Was it power peeing? Was it weakness? Was it hormones? But then if you have the prolapse repaired surgically, it, it should be repaired if it's a 3 or a 4. And then you can also do pelvic floor therapy or training after the surgery as well.

Okay. So we went back to, I will never forget the don't push and pee, like ever.

And then the Squatty Potty, when you pee.

Squatty Potty, not train. What was the one in between push, pee, squat? Oh, exhale exertion.

Exhale exertion.

All right.

And then your question was about like how often to do this. So those are the daily habits. When it comes to exercise, if you're working out in the gym 4 to 5 times a week, bring your pelvic floor contractions into the workouts you're already doing. Engage those deep pelvic floor and core muscles, just like we tell people like, oh, pull your belly button towards your spine or zip up. You can hypertrophy and strengthen your pelvic floor just incorporating that small subtle contraction into your workouts you're already doing. But the trick is you have to balance it with relaxation. So if you know you're a person who tends to have tension in their muscles, to hang on to tension, you've got to do some of the breathing and stretching either after your workouts or on the alternate days or kind of peppered in, you know, throughout your day to help those muscles relax after you've been tightening, tightening, tightening.

And the relaxing ones were child's pose, happy baby. Yeah. Any other ones?

A deep squat, single knee to chest stretch, cat-cow. Um, there's a bunch of 'em. Like I have a whole kind of relaxation series on my website to help people really get into some of these stretches that release the hip, and you can do like massage to your hips with a little massage ball, lacrosse ball, do a little foam rolling. Just like if you think if you had tense shoulder muscles and you got a massage, it's the same thing. You're just doing it to your abdomen, your inner thighs, and your glutes.

One of the things I've noticed since this pelvic floor awakening, I'm going to call it, is that I wasn't hip hinging the way I needed to. Like that was kind of locked. And is that, could that be part of this?

Totally. You know, I think 36 muscles attached to your pelvis, including your hip flexors, your glutes, your hamstrings. And so the way that we're moving all plays a role into how your muscles are firing. So if you weren't hip hinging properly, it could be that you were, you know, relying too much on your back versus your hip flexors or your hamstrings versus your glutes. So a lot of these kind of finesse techniques Tweaks really go into, are we using the right muscles at the right time? And you can be like an amazing workout person, but these are really small muscles, right? And again, if we're not trained on how to, you know, properly contract or relax them, they can get off balance. But this is with anything, like, nope, you're not doing anything wrong. It's just kind of another tweak that can give you a benefit in another way.

I am going to advocate hugely for pelvic floor because literally I think about what I was taught in grad school and doctoral school, and it was, you know, IT bands and hip flexors and things, but we never really addressed this.

Right. So, and all of that affects your pelvic floor. Like if you have a weak glute med muscle, your hip is rotating in on squats and lunges and single leg stance, and then that's gonna overfire your pelvic floor and lead to tension on that side. So it's kind of like we got part of the way up the chain and then just stopped going deeper and didn't quite get to that last dot, which is the pelvic floor until you kind of start seeing like, oh gosh, It hurts on the left side when I have sex, right? Or when I sit in, you know, a certain way, it's like I have tailbone pain. So you can start noticing these small symptoms and we don't even think like, oh, there are muscles in our pelvic floor that could be contributing to that.

I also wonder too, you know, I've been a longtime advocate of chiropractic. Some of the, you know, dysfunction you have there actually probably is more pelvic floor related. That's throwing off your spine.

It's all connected. So I think that adjustments can be helpful, but eventually we don't want to have to rely on them all the time. Like, we want stability in an area and not having to constantly kind of adjust into that. And so I think what's important is that if you have a really tight overactive muscle and then you constantly are adjusting, that's great, but that muscle stays tight. So you have to go one level deeper to really get to the root of what's causing that misalignment or causing you to need that adjustment. So it's always like getting to the root of the issue, which we can kind of trace back down to, I think, more muscular nervous system tissue issue in pelvic floor dysfunction cases.

So I think back to school, I'm trying to remember when it was, maybe it was junior high, like when sex education happened. And you think about sex education should have been pelvic floor education. Yes. Like when ideally, if you could, If you could be like the health goddess, what would you do to like, what would pelvic floor education look like for, and not just for girls? Again, one of the funniest things I ever did was sit in a lecture. It was an entrepreneur event and this gal taught pelvic floor and it was like 80% men who were like, what? I have a what?

I love that. You know, for me it would be, 100%, as you mentioned, like in middle school, like there should be pelvic health education just like there's period education or sex education. But I really think that pelvic health education should be peppered into every stage of our life. So it's even when you're potty training your kids, like after the ages of 6 or 7, like you cut out the just in case pees. You don't tell them to push when they're peeing. You teach them how to use a stool under their feet and blow out for pooping, you know? And then when they're menstruating, like, the basic anatomy. You have 3 openings in the pelvic floor. One of them is for menstruation. This is where you insert menstrual hygiene products and how you use them. And then when they become sexually active, that sex shouldn't be painful, that the clitoris is a sexual organ only for pleasure, that, you know, so different things about like— and then when you become pregnant, then postpartum, then perimenopausal. So every stage of life, there are different ways that are pelvic health needs care and it changes. I think one of the challenges of educating the next generation is we don't— we have to know better to educate them. So we're at the stage where we're all raising children or even grandchildren and we're thinking, how can I teach them those things? I mean, that was one of the most common questions when I put out this book is like, should my daughter read this book? And I said, she should read the period chapter, read the pelvic health chapter, read the period chapter. And then at every stage of life, she has another chapter to go back to. That is relevant to where she is in her life stage.

Seems like we need new, like new kids' books for potty training. Yeah. Totally different potty training. You know how they have Everybody Poops?

Yeah, yeah.

You know, it's like we need new of those.

And it's like how to poop. I mean, just the 101 of how to poop.

Yeah.

How to pee.

No one talks about how to poop. Like this is not a thing.

I mean, I talk about it all the time. My kids are like, that's enough, mom.

You know?

But it's, you know, I have two sons and I think that we often think to your point about only women or young girls need to know this, but my kids know more about the female body than I think most females because they're just, they've grown up with it. And so I think even educating, you know, young boys and teens about like what is a period, you know, this is how the menstrual cycle works and how many holes you have in the female vulva. It's just, there's the basics of anatomy that we're just not teaching. And I think ultimately what that leads to is that it's not just not understanding our bodies, but it creates an aura of secrecy and shame around our bodies so that when we have a problem, we don't talk about it. And we also don't know who to go to for help.

Yeah. Well, I don't think we think, I think part of it is you might even think it's normal. Like that whole thing you said about leakage, that no amount of leakage is normal. It's like, oh, you know, and then you do, you don't know who to go to.

Right. Or even if you finally work up the courage to go to a medical provider, it's again, it's often dismissed like, oh, well, you're aging, JJ Virgin, or, oh, you started a new workout routine, or, oh, you know, your daughter just had a baby and that's why she's got this problem. But the reality of it is pelvic health issues affect every space in our life, whether it's our ability to work, to care for our kids, to have intimate relationships, to exercise. And there's so much great conversation right now about exercising for perimenopause and menopause. And in my head thinking, you can't do 2 minutes of jump rope when you're peeing your pants. Yeah. You can't wear a weighted vest to go for your walks when urine is leaking down your leg or you've got prolapse. So I think the reality of it is we need to really identify that these issues exist and, and address them so that women really can live their best lives as we age. Amen. Amen.

I love that. And I love that you have an app you're putting together. So we're gonna give everyone 30 days of free access.

Tell us about this. So I, you know, I started these workouts during COVID times when people were home and not going to gyms and they were like, we need some pelvic floor work to do at home because we can't see our therapist. So I created a community and now it's gonna be an app. It's getting released on November 3rd and it's called the V Hive and it's got pelvic floor workouts for every age and stage. So whether you are trying to conceive, whether whether you're pregnant and postpartum, perimenopausal, postmenopausal, whether you need to work on strengthening, whether you need to work on relaxation. There are workouts and they're not incredibly long. They're 10 to 15 minutes up to 30 minutes. So they're not full, you know, intense workouts, but it shows you how to incorporate pelvic floor contractions into the workouts you're doing and then to get stronger in those areas or relaxation. Like what does a pelvic floor workout look like? You can check it out and see. And there's tons of tips on there for like menopause, pain beautiful sex, pooping, bladder health. There's tons of videos. It's really like a pocket pelvic floor therapist. You can get this information, these exercises at home. It's accessible and it's affordable.

That is amazing. Plus, we're going to link to the quiz too. So that— although I will tell you all, like, because I was like, how do you find a pelvic floor therapist? Then I started to look around. I'm like, they're around.

They're definitely around. And nothing beats seeing an in-person therapist. I I think the great thing about medicine right now is that there are different avenues to access care. You can see a pelvic floor therapist in person, you can do home workouts on an app, you can read my book, you can do telehealth sessions with some therapists. So there's a lot of entryways. I think the biggest thing is we need to give people options because there aren't enough pelvic floor therapists out there. There's definitely more, but it's growing and it's always— sometimes it's hard to reach a therapist. It could be distance, it could be cost, it could be time off. So we wanna give people a lot of options for starting points to really start working on this part of their body.

And it sounds like you can start now.

You can start today. You can start now. And it's small changes you can make that will have a really big impact.

I've been amazed at the little things that I've shifted that have made a big difference.

I love that. It's that travel Squatty Potty, JJ.

That's the final frontier. That's it. Now I just know it's a trash can.

I can do it.

I was like trying to hack it with toilet paper rolls.

I was like, how do I do this?

That's amazing. You are incredible. You're such a powerful voice for women out there. And I think the important thing for all of us listening is like, this is pretty common, but not normal.

Like, that's the thing. It's very common. It's very common. And it's also very treatable, you know? And I think that it's also never too late. I think often people feel like, I've had these issues forever. It's probably too late. I'm like, it's never too late. It's like, is it ever too late to address back pain? No, it's really when you feel ready, the resources are there for you.

I mean, once you know these things have been nagging could just be this and they could get fixed. Like, why wouldn't you do that? So we'll put the link to your book, "Floored." We'll have all your social platforms and the app and the quiz. And I'm gonna put that all at jjvirgin.com/reardon. That's kind of funny that your last name is Rear.

Rear, R-E-A-R-D-O-N. You know, my nickname was Rear End when I was little. So who knew that that could have been like, you know, the path I was headed on.

It's like this, this, you were— this was going to be you whether you wanted to do it or not.

Exactly, exactly.

How everyone just made you the vagina whisperer. Well, I am so glad you're doing the work you're doing. Thank you, thank you, thank you. And again, jjvirgin.com/rearedin to grab all of the things we've talked about. All right, it's JJ back here because I just wanted to reiterate a couple action items from this conversation. And the first one that will be with me for the rest of my life is don't push when When you pee, don't push when you pee. Oh my gosh. And exhale on the exertions. We all know that from working out, but I think that whole idea of engaging, contract your pelvic floor when you get there, I'm gonna start dialing that one in too. And then use that Squatty Potty or create a hack when you travel, which I'm now going to do. These are some simple things. And again, it's the habits that you do all the time that ultimately are gonna determine your health. So if you are one of the people suffering in any way with pelvic floor issues, from painful sex to leakage to constipation to back pain to hip pain. You owe yourself this for you. And again, jjvirgin.com/reardon for all the cool stuff that Sarah talked about during the interview. All right, I will see you in the next edition of Well Beyond 40.