Q&A: Pelvic Floor Health at Every Age and Stage

Origin Co-Founder + CEO Carine Carmy sat down with pelvic floor experts Sara Reardon and Liz Miracle and to discuss everything you need to know about pelvic floor health throughout life's stages. The three spoke several days before the nationwide release of Sara's groundbreaking book FLOORED—a comprehensive guide designed to empower women with the knowledge they need about their pelvic floor health.

Watch the recording here: 

Meet the experts

Sara Reardon, PT, DPT, WCS, BCB-PMD  is a board-certified pelvic floor physical therapist on a mission to change the way we care for women and their pelvic floors. Known as The Vagina Whisperer on social media, Sara is passionate about helping women overcome intimate issues and improve their quality of life. She recently launched her first book, FLOORED.

Liz Miracle, PT, MPT, WCS is the Head of Clinical Quality and Education at Origin, the leading provider of physical therapy for maternity, menopause and sexual health, with deep expertise in the pelvic floor and full body.

Carine Carmy is Co-Founder and CEO at Origin. She has focused her career on increasing access to products and services that improve lives, from healthcare to 3D printing. Carine's passion for women's health started in her twenties, when she struggled with painful sex for nearly a decade. Following years of misdiagnoses, ineffective treatment options, and hearing “that’s just the way it is,” Carine discovered the power of pelvic floor physical therapy to treat, not only pelvic pain, but dozens of conditions and symptoms that impact some 40 million U.S. women and individuals with vaginal anatomy, every year. She is honored to be able to work at the forefront of a major cultural shift to help women feel their best.

Getting started: Understanding the Pelvic Floor

Q: Can you explain what exactly the pelvic floor is and its critical role in overall health?

Sara: The pelvic floor is basically a basket of muscles at the base of your pelvis that provides support for your organs. It's involved in so many functions we take for granted: bladder and bowel control, sexual function, and core stability. What inspired me to write FLOORED was realizing just how many women are suffering in silence with pelvic floor issues, not knowing that help is available.

[insert pelvic floor infographic]

Q: What does it mean to have pelvic floor dysfunction, and what's the role of pelvic floor therapy?

Liz: Pelvic floor dysfunction basically means your pelvic floor muscles aren't working the way they're supposed to. This can show up in different ways - the muscles can be too tight, causing difficulty with penetration, or too loose, leading to pressure in the vagina, urinary leakage, or strong bowel urgency.

The primary role of physical therapists is to help people who are in dysfunction gain function. If something is happening more than a one-time occurrence and you can't find a clear reason why, that's when PT can provide education and tangible solutions.

Pelvic health throughout life's stages

Q: Sara, many people think pelvic floor issues only happen around childbirth. Can you share the bigger picture?

Sara: This is such an important myth to bust! While pregnancy, birth, and menopause are three seasons of life that are risk factors for developing pelvic floor issues, you have a pelvic floor at every age and stage of life.

Starting from when you begin learning to use menstrual hygiene products, to becoming sexually active and potentially experiencing discomfort with intercourse, through pregnancy and postpartum, and into perimenopause and menopause, your pelvic floor needs attention throughout all these stages.

Q: What are the most common issues patients come to Origin for?

Liz: Interestingly, only about 40% of our patients are actually coming in with pregnancy-related issues. Most are seeking help for urinary incontinence and pelvic pain. But here's what might surprise you - when we conducted a pelvic health study with Ipsos last year, we found that constipation was actually the number one pelvic floor-related symptom that people have.

Sara: People don't realize that your anal area is part of your pelvic floor. Hemorrhoids, anal fissures, constipation, even skid marks in your underwear - these are all pelvic floor related. We either ignore them or just use creams and procedures to manage them, but in many cases they’re related to pelvic floor issues that can be treated.

Aging, menopause and pelvic health

Q: What role does the pelvic floor play in healthy aging, particularly during menopause?

Sara: During perimenopause, your estrogen levels start to decline. Estrogen helps produce collagen. We talk about collagen a lot for our face and skincare routines, but not necessarily for your pelvic floor. But, when you have less estrogen, the decrease in collagen production leads to less support of your pelvic floor organs. This leads to more pelvic floor weakness, thinning, and dry tissues, which can cause pain with sex. 

You’ll start to see symptoms like more frequent urination, little bladder leaks with a cough or sneeze, more pelvic organ prolapse (that feeling of heaviness and pressure in the vagina), and pain with sex because of dryness and sensitivity.

The narrative historically has been for us to just deal with these problems; use more lube, accept that our sex lives are over, or start wearing liners. But these are totally treatable conditions! 

Pelvic self-assessment and when to seek help

Q: How can people assess the current state of their pelvic floor health?

Sara: Pain or leakage are good pieces of information from your body. No amount of leakage and no amount of pain is normal. As women we get used to brushing things off, but symptoms typically don't get better on their own.

In my book FLOORED, I talk about what normal bladder function looks like, what normal bowel health is, and list out common experiences. If you experience leakage, frequent waking at night to pee, or straining to start your stream, these aren't normal.

I also encourage women to find out what their ‘normal’ is when it comes to their vulva and vagina. It’s likely that other people have probably seen this part of your body more than you have (physicians, partners, etc.). You need to know what your normal is so that if something changes, whether it's the size of your labia, color of the skin, or descent of your perineum, you can recognize that change. 

Liz: Origin’s Pelvic floor self-check is also a good place to start. 

Q: What signs indicate it's time to see a pelvic floor PT?

Liz: If there's something happening that's more than a one-time occurrence and doesn't make sense to you - you can't find a clear reason why it's happening - that's when you should consider seeing someone who can provide education and tangible solutions.

Also, I want people to know that many don't identify with the term "urinary incontinence" - they think that's their grandma's problem. But if you break it down and ask, "Do you leak any urine, even just a little bit?" - that's what urinary incontinence is, and there is help available.

Treatment: What to expect

Q: Many people are unsure about what happens in a pelvic floor therapy visit. Can you address those concerns?

Liz: Nothing happens in a pelvic floor therapy visit without your consent. A lot of people think that if they show up for a visit, they definitely have to get a pelvic exam, but that's not something you have to do on day one. You can express that concern, and your therapist will totally understand.

There are no speculums or stirrups! We can assess you over your clothes if that's your starting point. I've had patients who were fully clothed with a blanket over their lap while we talked about the pelvic floor until we worked to a place where they felt comfortable.

Q: How does virtual pelvic floor therapy work?

Liz: Virtual care has been amazing for accessibility. I had a patient who said, "I have always wanted to come in for pelvic floor therapy, but I was so afraid because of my trauma history that once I got in that room, I would lose all my power. This virtual option is giving me a chance to see how I feel about you and get comfortable."

In virtual sessions, we do education, teach you exercises, and can see how you move, your posture, how you breathe. You don't have to have your camera showing intimate areas - we provide instructions for you to follow on your own and report back. It's a really safe space.

The mind-body connection

Q: How does the pelvic floor relate to sexual health and orgasms?

Liz: Your pelvic floor muscles have to contract and relax in a rhythmical fashion to propagate an orgasm. Those muscles that create orgasms connect to the clitoris and help restrict blood flow to keep that organ erect, just like how a penis works.

Sara: Your orgasm is muscular contractions of your pelvic floor muscles. There are nerves involved and a psychosocial component, but there are muscles. If muscles are weak, you may have weaker orgasms, leakage during orgasms, pain with or after orgasms, or difficulty reaching orgasm.

Sometimes the inability to orgasm is thought to be just a mental component, but having functional pelvic floor muscles is absolutely part of the puzzle. And ladies - explore your clitoris! The majority of orgasms happen with clitoral stimulation, not just internal penetration.

Holistic health connections

Q: How do other musculoskeletal issues like back pain and hip pain connect to pelvic floor health?

Sara: There are 36 muscles attached to your pelvis - your abdominal wall, low back muscles, pelvic floor, hip muscles, hamstrings, quads. We can't just look at one symptom in isolation. Hip pain can be due to a pelvic floor issue. So many people with urinary incontinence and pelvic organ prolapse also have back pain.

As pelvic floor therapists, we have to look at the whole pelvis and put it back in the body - posture, breathing, abdominal wall, scar tissue, hip mobility, even how your feet are positioned.

Age and treatment

Q: Is it ever too late for pelvic floor therapy?

Sara: Hands down, it's never too late. We've worked with women in their 70s, 80s, and 90s to help them improve their symptoms and quality of life. I never promise we can cure anyone, but I 100% promise we can give you tips and tools to improve what you're experiencing.

Practical pelvic floor tips for everyone

Q: What's one thing everyone can do for better pelvic floor health?

Sara: Watch how you pee and poop! Learn the basics of your body because we haven't been taught. Try to do things to support your pelvic health long-term: like peeing properly while sitting down, not pushing, not going "just in case," pooping without straining with a stool under your feet.

And… buy my book! 

Liz: Focus on your breath. It doesn't matter who you are - you can breathe. The pelvic floor and breathing diaphragm work together. When you inhale, both relax. When you exhale, both come back to their resting state. Getting that connection is a really good starting place.

Sara: Breath is our superpower! It can calm our sympathetic nervous system and optimize pelvic floor function. It's incredibly powerful when we know different ways to use it.

Carine: Kegels aren't appropriate for everyone! That's a myth we've been told - don't just go straight to Kegels without understanding what your pelvic floor actually needs.

Breaking down barriers

Q: How can pelvic floor care become more accessible?

Carine: These are healthcare issues, not lifestyle issues. One of the reasons Origin was started was to build an insurance-based model to make care affordable and accessible. There are amazing pelvic floor therapists across the country, and we're excited to see more offering accessible care.

Sara: Education is the best tool we have for women's health. Not everyone can access in-person pelvic floor care - we don't have enough therapists to treat all the women in this country. People need a starting point, and not everyone's comfortable going in person initially. That's why resources like books and virtual care are so important.

Looking forward

The conversation around pelvic floor health is shifting from niche to mainstream. We're moving from "your pelvic floor exists" to "we need to make this the standard" so every person has access to this education and care.

Remember: You're not alone in experiencing pelvic floor issues, help is available, and it's never too late to start taking care of this crucial part of your body.

Looking to learn more about your pelvic floor? Check out Sara’s new book FLOORED - it's designed as an accessible entry point for anyone wanting to learn about their pelvic floor and start their journey toward better health and follow her on social media @the.vagina.whisperer. 

Ready to get started with pelvic floor physical therapy?Book a visit with Origin - we offer both in-person and virtual care options to meet you where you are.

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