Podcast Summary: The mindbodygreen Podcast

Episode 602: What you need to know about pelvic floor health | Sara Reardon, PT, DPT
Date: June 15, 2025
Host: Jason Wachob
Guest: Dr. Sara Reardon (PT, DPT, “The Vagina Whisperer”)

Overview

This episode spotlights the often-overlooked world of pelvic floor health, highlighting why it's central to women's well-being from puberty through menopause and beyond. Dr. Sara Reardon—PT, DPT, and celebrated pelvic floor specialist—joins Jason Wachob to debunk myths, offer practical tests and exercises, and chart how pelvic floor needs evolve across the decades. Discussions tackle the reality of urinary leakage, sexual dysfunction, common bathroom mistakes, and why both strength and flexibility matter.

Key Discussion Points & Insights

1. Understanding the Pelvic Floor

• Lack of Awareness:
  • “Most people aren't even aware that they have one and that there is a group of muscles that are responsible for some really important day to day functions like peeing and pooping and sexual health and menstruation and pregnancy and birth.” – Dr. Sara Reardon [01:17]
  • The pelvic floor supports organs (uterus, rectum, bladder) and enables continence, sexual health, childbirth, and more.
• Assessment:
  • Symptoms-based diagnosis: Leaks (urine or fecal), pain with sex, constipation, hemorrhoids, etc.
  • Functional test: Try stopping urine flow (demonstrates contraction); relaxing while having a bowel movement.
  • “Can I use this muscle? Can I connect with it, contract and relax it? But also look at the symptoms…you thought were normal for being a woman, and they're actually related to your pelvic floor health.” – Reardon [02:49]

2. Bathroom Habits as a Pelvic Floor Indicator

• Frequency Matters:
  • Normal urination: Every 2-4 hours during the day; zero to two times at night.
  • If going more often, gradually delay urination (“urge delay”) to train the bladder.
  • Tools to help: Distraction, breathing techniques, pelvic floor muscle contractions (Kegels). [04:29–06:03]

3. Kegels: Benefit & Limitations

• What are Kegels?
  • “A Kegel is a pelvic floor muscle contraction…a squeeze, like you're stopping urine, holding in gas.” – Reardon [06:21]
• Outdated One-Size-Fits-All Approach:
  • Not everyone needs strengthening; some need relaxation.
  • “Doing Kegels can actually make [pelvic floor tension] much worse. So I think it's really important to kind of know which bucket you fall into, strengthening or relaxation.” – Reardon [07:27]
• Balance Over Rigidity:
  • “You could be very strong but very inflexible…and that's bad. On the other hand, you could be very, very weak and very flexible. So you want the combination of strength and flexibility.” – Wachob [08:03]

4. How to Determine Your Needs: Strength or Flexibility?

• General Guide:
  • Strengthening needed: Urinary leakage, prolapse, core weakness.
  • Relaxation needed: Pain with sex, difficulty emptying bladder, pain conditions.
  • Self-examination: Use a mirror, observe muscle contractions and relaxation, or use internal assessment.
  • “If you're feeling really brave, you can do an internal assessment…can I contract? Is it weak or is it really tight or tense in there?” – Reardon [09:31–10:07]

5. Incorporating Pelvic Floor Work Into Existing Routines

• Integration with Strength Training and Breathwork:
  • “If you are holding your breath, you are locking in pelvic floor tension and not giving this muscle the flexibility it needs.” – Reardon [10:49]
  • Diaphragmatic breathing: Inhale (pelvic floor relaxes), exhale (pelvic floor contracts).
  • During exercise: “You need to be exhaling with every repetition…Do the crunch as you exhale and pull your pelvic floor up and in.” – Reardon [12:23]
  • Strengthen and train like any other muscle but pay special attention to both contraction and relaxation.

6. Pelvic Floor Health Across the Lifespan

• Key Changes by Decade:
  • Teens: Menstruation, pain (indicator of disorders like endometriosis).
  • 20s: Sexual debut, education on consent, pleasure, and lubrication.
  • Pregnancy/Postpartum: Pelvic floor stretches and weakens.
  • Perimenopause/Menopause: Estrogen drops, vaginal dryness, increased urinary symptoms.
  • “It really is changing in every decade, and it requires different things during these times.” – Reardon [13:44]
• Proactivity is Key:
  • “Perimenopause…is a Runway where we have an opportunity…Build your strength now. Take care of your pelvic floor now.” [15:25]

7. Optimal Bathroom Habits

• Peeing:
  • Sit (don’t hover) to fully relax.
  • Don’t rush or “power pee”; don’t push.
  • Practice double voiding if needed.
• Pooping:
  • Use a squatty potty, lean forward.
  • “Exhale like you're blowing out a bunch of candles as you bear down to poop.” [17:51–18:38]

8. Top ‘No-Nos’ for Pelvic Floor Health

• Don’t over-delay urination (creates tension, infection risk).
• Don’t hold your breath while pooping.
• Don’t accept pain during sex as normal—seek help!
• Use lubricants and address tension if sex is painful.
• “We really should tell ourselves we deserve a better pleasurable experience and do some of the things that can help with that.” – Reardon [19:32]

9. Crucial Statistics & Societal Impacts

• Half of women over 65 experience urinary leakage [20:18]
• Leakage is a primary risk factor for nursing home admission
• More women experience urinary incontinence than osteoporosis, diabetes, or hypertension—but receive less care or education.
• “68% of menopausal women and 58% of pregnant and postpartum women feel like they are undereducated about their pelvic floor health…one hour of pelvic floor education can improve their symptoms.” – Reardon [21:56]

10. Prevention & Medical System Gaps

• Many issues can be improved or prevented with education, early intervention, and physical therapy—not just surgery or medication.
• “There are so many missed opportunities that I think can really prevent issues, and it's not happening. Our healthcare system…put a band aid on a problem…it's not really giving you help to address the root cause of an issue.” – Reardon [24:58]

11. Hormone Replacement Therapy (HRT) and Local Estrogen

• HRT is highly individualized; consult a specialist.
• Topical estrogen creams: Evidence for efficacy in improving pelvic floor tone, decreasing UTIs, reducing dryness, with minimal systemic absorption.
• Nuance is required; medicine is not “all or none.” [26:02–30:05]

12. Gaps in Maternal and Postpartum Care

• “One of the primary risk factors for developing pelvic floor disorders [is] the birthing practices in the United States.” – Reardon [30:25]
• Cesarean section rates rising; poor postpartum care.
• Women are sent back to activity when pelvic floor still under-functioning.
• No standardized postpartum recovery plan.

13. Sarah’s Vision for Change

• Every woman should see a pelvic floor PT during pregnancy and postpartum (at 6-weeks).
• Add pelvic floor education to birthing and postpartum care.
• Paid maternal leave, ongoing pelvic floor check-ins through lifespan. [32:44]

14. Personal Game-Changers & Final Encouragement

• Integrating pelvic floor exercises into regular strength training was transformative for Sarah.
• “It is never too late to get help…with some consistency and some education and real commitment…it can really improve and change your life in many ways.” – Reardon [35:33]

Notable Quotes

• On Being Unaware: “The fact that we don’t even know this part of our body exists…just really sheds some light on how uninformed we are about our bodies and how important it is to be educated about the pelvic floor.” – Reardon [01:20]
• On Kegels: “Doing Kegels can actually make [pelvic floor tension] much worse…it's really important to kind of know which bucket you fall into, strengthening or relaxation.” – Reardon [07:27]
• On Medical System: “You get more physical therapy for a broken pinky than you do for having a C-section, you know.” – Reardon [25:38]
• On Menopause Education: “One hour of pelvic floor education can improve their symptoms. One hour.” – Reardon [21:53]
• On Optimism: “It is never too late to get help…I just want to encourage everyone that with some consistency and some education and real commitment to this…it can really improve and change your life in many ways.” – Reardon [35:33]

Key Timestamps

• [01:17] – Why most people are unaware of the pelvic floor’s importance
• [02:49] – How symptoms reveal pelvic floor health
• [06:21] – Kegels explained & their limits
• [08:54] – Self-assessment: Do you need strength or relaxation?
• [10:40] – Integrating breathing and pelvic floor work with gym routines
• [13:44] – How pelvic floor health shifts across decades
• [16:16] – Optimal peeing and pooping posture/habits
• [18:38] – Major no-nos for pelvic floor health
• [20:18] – Startling statistics on incontinence and societal costs
• [24:58] – Systemic gaps and the need for prevention-first care
• [26:02] – The spectrum of hormone therapies and topical estrogen
• [30:25] – Maternal care gaps: birthing, postpartum, and recovery
• [32:44] – What should change in healthcare for pelvic floor health
• [34:26] – Personal game-changer: Strength training with pelvic floor focus
• [35:33] – Final encouragement: It’s never too late to seek help

Conclusion

This honest and empowering discussion cuts through silence, shame, and misinformation about pelvic floor health. Dr. Sara Reardon gives practical tools for self-assessment, actionable advice for every decade, and hope that it’s never too late for improvement—no matter your age or stage. The biggest barrier is lack of awareness and education, which, as this episode demonstrates, can change with just one conversation.

For more resources, check out Dr. Sara Reardon's book "Floored" and her Instagram @the.vagina.whisperer.