Peeing When You Sneeze? The #1 Pelvic Floor Specialist Explains Why

Summary

Episode Summary: "Peeing When You Sneeze? The #1 Pelvic Floor Specialist Explains Why"

Podcast: The Tamsen Show
Host: Tamsen Fadal
Guest: Dr. Sarah Reardon, Leading Pelvic Floor Physical Therapist
Release Date: June 4, 2025

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1. Introduction to Pelvic Floor Health

The episode kicks off with Tamsen Fadal introducing the critical topic of pelvic floor health, emphasizing its often-overlooked significance in women's overall well-being. She highlights that most women become aware of their pelvic floor only when issues arise, which are frequently dismissed as normal aspects of aging or womanhood.

Notable Quote:
Tamsen Fadal [01:42]: "This conversation is going to change the way you pee forever."

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2. Understanding the Pelvic Floor

Dr. Sarah Reardon provides a comprehensive explanation of the pelvic floor, describing it as a hammock-like structure of muscles that support vital organs such as the bladder, uterus, and bowel. She underscores that the pelvic floor is integral to various bodily functions, including urination, bowel movements, and sexual intercourse.

Notable Quote:
Dr. Sarah Reardon [03:09]: "It's muscles that support your organs, like your uterus and your ovaries, your bowel and bladder. And it also has the openings for urine to exit, for bowel movements, and then also for vaginal intercourse, vaginal birth, and menstruation."

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3. Impact of Life Stages on Pelvic Floor

The discussion moves to how different stages of a woman's life impact pelvic floor health. Dr. Reardon breaks down the effects of menstruation, sexual activity, pregnancy, childbirth, and menopause on the pelvic floor, emphasizing the need for proactive maintenance and targeted exercises during each phase.

Notable Quote:
Dr. Sarah Reardon [16:50]: "During perimenopause, your estrogen levels are decreasing. Estrogen is what plumps up and tones the vagina, which is part of the pelvic floor. It also provides vaginal lubrication to the vulva and vagina."

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4. Common Pelvic Floor Issues

The conversation delves into prevalent pelvic floor problems, their causes, and their implications.

a. Urinary Leakage

Urinary leakage, especially during actions like coughing or sneezing, is discussed as a common yet manageable issue. Dr. Reardon explains the muscle mechanics behind it and offers practical solutions to mitigate leakage.

Notable Quotes:
Dr. Sarah Reardon [08:13]: "Almost 50% of women have some sort of pelvic floor issue. And it gets worse with aging."
Tamsen Fadal [09:36]: "Do not power pee."

b. Painful Sex

Pain during intercourse is addressed, linking it to pelvic floor dysfunction and hormonal changes. Dr. Reardon emphasizes that painful sex is not a normal part of aging and provides strategies to alleviate discomfort.

Notable Quote:
Dr. Sarah Reardon [12:03]: "There's a lot that you can do. But we should not accept pain as normal for sex at any point in our life."

c. Pelvic Organ Prolapse

Pelvic organ prolapse is defined and explained as a condition where the pelvic floor muscles weaken, causing organs to descend and create a bulge in the vagina. Dr. Reardon discusses the symptoms and the importance of seeking therapy.

Notable Quote:
Dr. Sarah Reardon [14:04]: "Pelvic organ prolapse is when that hammock of muscles is not as supportive as it needs to be."

d. UTIs vs. Pelvic Floor Issues

The episode clarifies the distinction between urinary tract infections (UTIs) and pelvic floor dysfunction, warning against misdiagnosis and encouraging listeners to seek professional advice when symptoms overlap.

Notable Quote:
Dr. Sarah Reardon [28:11]: "The symptoms of pelvic floor changes and estrogen changes in the tissue can also mimic a urinary tract infection."

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5. Solutions and Therapies

a. Pelvic Floor Exercises (Kegels)

Kegel exercises are highlighted as a fundamental method to strengthen the pelvic floor. Dr. Reardon provides a creative analogy to demonstrate the correct technique, ensuring listeners perform them effectively.

Notable Quote:
Dr. Sarah Reardon [19:00]: "Think about your vagina sipping up a thick smoothie through a straw. If you think about a sip up, you squeeze and you lift."

b. Proper Bathroom Habits

Proper techniques for urination and bowel movements are discussed to prevent pelvic floor strain. Dr. Reardon advises sitting down to pee and adopting a squatting position for bowel movements to facilitate muscle relaxation.

Notable Quote:
Dr. Sarah Reardon [10:01]: "Do not power pee."

c. Lifestyle Adjustments

Incorporating pelvic floor exercises into daily routines, such as during workouts or while performing everyday tasks, is recommended. Additionally, adopting relaxation techniques like deep breathing and yoga can aid in maintaining muscle flexibility.

Notable Quote:
Dr. Sarah Reardon [19:49]: "Doing three times a week, five to 10 minutes of exercises is sufficient."

d. Products and Tools

The use of specific products, such as menstrual aids and moisturizers, is suggested to support pelvic floor health. Dr. Reardon also mentions tools like a therapy wand for internal muscle relaxation.

Notable Quote:
Dr. Sarah Reardon [34:30]: "Medicine Mama Balm is soothing. It's all natural and just really, really so effective in moisturizing the tissue."

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6. Encouragement and Empowerment

Dr. Reardon passionately encourages women of all ages to take proactive steps in managing their pelvic floor health. She dispels myths, normalizes seeking help, and emphasizes that it's never too late to start strengthening these essential muscles.

Notable Quote:
Dr. Sarah Reardon [20:50]: "It is never too late. It's a muscle like any other muscle in your body. You can train it until the day that you die."

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7. Rapid Fire Myths Debunked

In a lively segment, Dr. Reardon and Tamsen tackle common misconceptions about pelvic floor health, reinforcing accurate information and empowering listeners to take informed actions.

Myths Addressed:

• Everyone leaks a little: "Myth. Total myth. Not acceptable." [40:25]
• Kegels fix all pelvic floor issues: "Absolutely not." [40:35]
• Pelvic floor issues only happen after childbirth: "They can affect you at any age or stage." [40:44]
• Peeing just in case is good bladder training: "You should only pee when you have the urge to go." [41:24]

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8. Conclusion and Resources

The episode wraps up with Tamsen sharing resources for listeners to further explore pelvic floor health, including Dr. Reardon's book "Floored" and her online presence as the "Vagina Whisperer." She reiterates the importance of education and community support in overcoming pelvic floor challenges.

Notable Quote:
Tamsen Fadal [37:29]: "If this conversation was helpful, keep the questions coming."

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Key Takeaways:

• Pelvic Floor Awareness: Understanding the location and function of the pelvic floor is crucial for maintaining overall health.
• Proactive Maintenance: Incorporating pelvic floor exercises and proper habits into daily routines can prevent and alleviate common issues.
• Seek Professional Help: Pelvic floor dysfunction is prevalent but manageable with the right therapies and support systems.
• Empowerment Through Education: Breaking societal stigmas and myths surrounding pelvic health encourages women to seek the necessary care and treatments.

Further Resources:

• Book: Floored by Dr. Sarah Reardon
• Website: thevaginalwhisperer.com
• Social Media: Instagram and TikTok as the "Vagina Whisperer"

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This episode serves as an essential guide for women navigating pelvic floor concerns, offering expert insights and actionable steps to enhance their quality of life.

Transcript

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[Tamsen Fadal]

This conversation is going to change the way you pee forever.

[Sarah Reardon]

We are talking about pelvic floor, leaky.

[Tamsen Fadal]

Bladder and how to have better sex.

[Dr. Sarah Reardon]

How do I pee? How do I poop? How do I cough? How do I exercise? It really can be so amazing to learn more about your body at any age or stage.

[Tamsen Fadal]

Most of us don't even know about our pelvic floor until something goes wrong. And even then we're often told just deal with it. But the truth is this is your core. It holds everything and it deserves your attention.

[Dr. Sarah Reardon]

This is a muscle like any other muscle in your body. You can train it until the day that you die.

[Tamsen Fadal]

Dr. Sarah Reardon is gonna break it all down for us. She's a leading pelvic floor physical therapist.

[Dr. Sarah Reardon]

There's so much that we can do to help women have a better quality of life as we age.

[Tamsen Fadal]

She's also known as a vagina whisperer online and she's out with a new book titled Floored. It is a must read for every woman at every stage when it comes to pelvic floor health.

[Dr. Sarah Reardon]

That one change can make a world of difference. To protect your pelvic floor, let's go.

[Tamsen Fadal]

Ahead and get some answers.

[Sarah Reardon]

Sarah, I am so excited you are here and I love the book, which as soon as I saw you put this up, I was like, oh, I.

[Tamsen Fadal]

Have to read this and we have.

[Sarah Reardon]

To talk about this book.

[Dr. Sarah Reardon]

Thank you for having me, Tamsen. I'm so excited about this and just really thrilled to talk with your community about all of the things pelvic floor, particularly with perimenopause and menopause, but at every life stage of a woman, pelvic.

[Sarah Reardon]

Floor is one of the top asked questions that I get all the time. So first of all, where's our pelvic floor? Because I think, I think that that's the second. That's my question. That's my top question. Where's our pelvic floor?

[Dr. Sarah Reardon]

You know, it's interesting. People don't even know we have one and we're using it all throughout the day. So if you think about the bony pelvis that we see on skeleton jammies or on the anatomy model in your doctor's office, it's a ring of bones. And at the very bottom of that ring of bones is a basket of muscles that attaches from the front to back and side to side, and it sits like a hammock. And where your pelvic floor is, that is your pelvic floor. It's muscles that support your organs, like your uterus and your ovaries, your bowel and bladder. And it also has the openings for urine to exit, for bowel movements, and then also for vaginal intercourse, vaginal birth, and menstruation. So it's really important. Everyone has one. And it requires different types of maintenance and exercise for all different stages of a woman's life.

[Sarah Reardon]

And we only just started talking about it.

[Dr. Sarah Reardon]

I know.

[Sarah Reardon]

Is that weird? Is that. I mean, it feels like it's. It does a lot of things.

[Dr. Sarah Reardon]

It does. And, you know, I've been in this field for 18 years, so I was a pelvic floor therapist. When people would hear what I did for a living and they would scoot two seats over and be like, oh, that's really weird. And now they're like, hey, can I talk to you later?

[Tamsen Fadal]

Yeah.

[Dr. Sarah Reardon]

And I think it's really women who are demanding more care for their bodies. They're hearing about pelvic floor therapy from social media, from shows like yours, and they're saying, I didn't know this was an option for these issues that I'm experiencing that they thought were just a normal part of aging or being a woman. And they're not.

[Sarah Reardon]

Yeah. And you talk about it for every age and every stage, because it's not just as you get older that we need to be talking about this. I really want to drill down into it. Well, first of all, let's find it. Can you. Can you show us how to find it or tell us where to find it?

[Dr. Sarah Reardon]

Well, I think some of it can't be on camera. So one of the easiest ways I tell people to kind of identify with it is if you're urinating and you want to stop your urine stream, that's a pelvic floor contraction. So you're closing your urinary sphincter. Or if you're in an elevator and you have to pass gas and you want to hold it in, you close the sphincter. That's a Kegel contraction or a pelvic floor contraction.

[Tamsen Fadal]

Okay?

[Dr. Sarah Reardon]

So it's there, and you can contract it, but you also have to relax it for urination, for bowel movements, for vaginal birth and intercourse. So you can also use a mirror. You can use your finger. I go over it in the book in depth of how to kind of find it. But, you know, I think if you just use some of those, you can really kind of see. Oh, yeah, that's what it is.

[Sarah Reardon]

That's a real basic what it is. We've got to take care of it. And I guess that's the real question of how to exactly do that. When should you start paying attention to your pelvic floor?

[Dr. Sarah Reardon]

So in the book, I cover every stage of life because really, at every stage, there's something important that you need to know to keep it healthy and also to identify if you have a problem. So say we're talking about a young woman who's having a period. She needs to know how to insert menstrual hygiene products, like a tampon or a menstrual disc or cup. She needs to know that period should not be painful, really. They might be cramping, but period pain is really an earlier sign of something like endometriosis. When someone's becoming sexually active, they need to know that, you know, sex ED is something like sperm meets egg, baby's mate. But it's really, you know, vaginal intercourse, again, is muscle relaxation. There's lubrication, there's pleasure and arousal. Your pelvic floor plays a role in that. Again, you shouldn't have pain with sex. That's a indicator of pelvic floor dysfunction as well. And then other particular times are pregnancy, childbirth, and menopause. Those are the most significant times for pelvic floor changes in women, when we really need to be proactive about strengthening and relaxing and preparing for the changes that our body are going through.

[Sarah Reardon]

And for all of those stages, is preparing and strengthening the same type of exercises?

[Dr. Sarah Reardon]

It varies. So for pregnancy, I really focus on strengthening during the first and second trimester. Again, this muscle's like a hammock, and as baby grows, so that muscle stretches and it lengthens and gets weaker. So a lot of women experience leakage and back pain during pregnancy, which are pelvic floor issues as well. In the last trimester of pregnancy, I really focus on lengthening and relaxing because you don't want really tight pelvic floor muscles going into a birth. You want relaxed pelvic floor muscles. And then postpartum, we focus more on strengthening and rehab. For menopause and perimenopause, it's much more of a strengthening regimen. We know how much muscle mass we lose, how much collagen changes, and you want to be really proactive about strengthening during that later phase in life.

[Sarah Reardon]

Okay, so I want to go through each one of the things that the pelvic floor does now, because I think that it's important to be aware of it. If we don't know whether or not we're having a pelvic floor issue, can we assume or not? Or do we need to pay attention to certain things we might not be aware of?

[Dr. Sarah Reardon]

Unfortunately, the research is showing that almost 50% of women have some sort of pelvic floor issue. And it gets worse with aging. So over 50% of women leak urine after the age of 65. One out of three women have pain with sex at some point in their lifetime. So I would say it's not unusual to experience these issues, but we want women to get help for them sooner. It's like having back pain or, you know, a knee injury. You shouldn't just have to suffer. You should be able to get help for it. I would say if you are experiencing urinary leakage, constipation, painful sex, pelvic organ prolapse, heaviness, or pressure in the vagina. Those are all common signs of pelvic floor dysfunction that I would say just go ahead and get therapy or get help.

[Sarah Reardon]

Okay, so let's go through each one of those. So urinary leakage can be one that's really embarrassing, right? And you know, we do a little like, oh, urinary leakage, but it's not funny. I mean, if you, if you sneeze or you are just not, you know, being completely aware or just, if you are being aware and can't help it, it can be really embarrassing. And really especially, you know, I've talked to so many people that are going through menopause right now and at work and have urinary leakage and can't even believe this has happened and don't even know where it's come from. So can we talk about urinary leakage first?

[Dr. Sarah Reardon]

Yeah. So you know, your pelvic floor muscles support your bladder and they also have the sphincter that keeps urine in. So as your bladder fills, that muscle gets tight and it kind holds the contents of the bladder in until you get to the restroom and then your muscles relax to empty. Now if that muscle isn't quite strong enough or coordinated to hold in the bladder, a full bladder, or when there's pressure from a cough or a sneeze, you get a leak. What happens is that over time with pregnancy, birth, hormonal changes, straining from workouts, straining from constipation, that muscle gets weaker and it gets harder and harder to hold those leaks in. No amount of urine leakage is normal, not a little bit with a cough or sneeze. And, and it ends up becoming full blown as we age, which is something I really want people to be aware of. I think it's okay to laugh off the little leaks, but I'm also like, let's get you help for that because we want it to improve. It won't get better by itself.

[Sarah Reardon]

Well, let's talk about that. So no, little bit is okay?

[Dr. Sarah Reardon]

Correct.

[Sarah Reardon]

So what do you do if you're like, okay, well, I'm listening to this right now and I've had this for, I don't know, three months.

[Dr. Sarah Reardon]

So a couple things are, I tell everyone to watch how you're peeing because oftentimes we may not be emptying our bladder? Well, so the first thing I tell people to sit down when you pee, don't hover over the toilet. If you sit down, you empty better and don't push when you pee. I call this power peeing. And women Are notorious for this. We want to be.

[Sarah Reardon]

Do not power pee.

[Dr. Sarah Reardon]

Do not power pee. Okay, so sit, lean forward, take some big deep breaths, and just let your muscles relax, and your bladder will push the urine out for you. You don't have to push when you pee. It really can weaken your pelvic floor muscles and lead to more leakage. And then the other thing is to only go to the bathroom when you have the urge to go. If you prolong your bladder, trips your trips to the bathroom too long or you're going too frequently, it can cause more bladder dysfunction. And the last tip is a really easy one. It's called the nac. And it's when you feel a cough or a sneeze coming on, and you do a Kegel before the cough or sneeze, and it just prevents the leakage from happening. And if you can't do it, you work on strengthening and then keep trying that.

[Sarah Reardon]

How can we not? We were never taught really how to pee.

[Dr. Sarah Reardon]

Great question, Tamsin. I know.

[Tamsen Fadal]

Where were we?

[Sarah Reardon]

And I missed that.

[Dr. Sarah Reardon]

No, I mean, that's one of the things is, I think, you know, if we can really educate ourselves and educate the next generation, we can prevent so many of these issues. We're not taught how to pee, and yet something we do six to eight times a day could really be weakening and, you know, damaging our pelvic floors.

[Sarah Reardon]

Is that why there's the little stool I saw in the book? You have like the, you know, the images. You have little stools, whatever. I can't remember what they're called. Are those good? Those are great for you.

[Dr. Sarah Reardon]

Well, those are great for your pelvic floor. And those are used for bowel movement. So those are used for pooping, but it puts. When you use them under your feet for bowel movements, it puts you in a squatting position. And that's the best position to relax, to minimize straining, which, again, can weaken your pelvic floor. So I just want to say, I love that we're talking about pee and poop like this. This is a joy for me. Oh, my gosh.

[Sarah Reardon]

Well, you're so welcome to come here anytime.

[Dr. Sarah Reardon]

I'm like, I love this.

[Sarah Reardon]

I'm so happy to have you talking about, you can come back. I'll think of some new questions. Okay, so that's urinary leak. Then we have painful sex. We do know that in perimenopause and menopause, as the estrogen decreases, as our hormones decrease, there is oftentimes painful sex.

[Dr. Sarah Reardon]

Yes.

[Sarah Reardon]

Is that different from why we're having painful sex here with pelvic floor.

[Dr. Sarah Reardon]

It's completely related, and it's really unacceptable. I mean, I am someone who believes that we should be able to have pleasurable, enjoyable sex throughout our entire lives. For males, there's a little pill they can take to keep on going. And I don't think that it's fair that we don't have that. But what I do think is that, you know, as we are getting older and these. This can also happen during other times, like postpartum, when you're breastfeeding or if you're taking birth control. If your estrogen levels change and decrease, your vagina gets drier, it gets thinner, and it can cause a raw or painful sensation during intercourse. So the recommendations are to, one, do pelvic floor therapy to improve blood flow to the area, to strengthen the muscles and tissues, and then also use vaginal moisturizers to help moisturize the skin. We have skin care routines that are 10 steps, and you can also have a vulva care routine where you're applying lotions or moisturizers that are specific for the vulva and use a lubricant during intercourse. And you can also use topical estrogen on the area. So there's a lot that you can do. But we should not accept pain as normal for sex at any point in our life, whether it's after giving birth or with perimenopause or menopause.

[Sarah Reardon]

I was in a bookstore for the book tour I was on, and people were raising their hand in the middle of Barnes and Noble asking questions all about pelvic floor and sex. And, you know, I had Dr. Emily Morse on there. So there was a lot of conversation going on in the middle of Barnes and Noble.

[Dr. Sarah Reardon]

Well, and one of the things I'll say is that, you know, women are hungry for help.

[Sarah Reardon]

Yes.

[Dr. Sarah Reardon]

And they're really coming to. They're not going to their medical providers. They're coming to experts and specialists and social media to really find out about their bodies, which is really a demonstration of they're not getting it in the healthcare system. And so they are well due for support.

[Sarah Reardon]

Yeah, I couldn't agree with you more about that. And that's what we hope to keep getting them here. And obviously, if you have questions, send them our way, because we want to keep getting experts like you on here to talk about these things. All right, prolapse. Can you tell me what that word is again? It's something. Something prolapse. It sounds really scary.

[Dr. Sarah Reardon]

Yes, it's pelvic Organ prolapse, and it does sound really scary. So pelvic organ prolapse is when that hammock of muscles is not as supportive as it needs to be. So your bladder, your rectum, your bowels, all rest inside of there. And if that pelvic floor gets weaker, which happens with aging, with straining during bowel movements or vaginal birth, with high impact exercises, those organs drop and it can feel like a bulge in your vagina. Women often say that they're showering and they feel like a bulge at the opening of their vagina, which is really scary. They can feel pressure, heaviness in the vagina. At the end of the day, it feels like something's falling out or if they can't empty their bladder or bowels well. And it's really a support issue. So those muscles just aren't as supportive. So pelvic floor therapy comes in to help strengthen the muscles, to show them how to minimize straining and things like that. But one in, one out of two women will have prolapse if they walk into a doctor's office.

[Sarah Reardon]

So where do you find a pelvic floor specialist or therapist if they can't find you at?

[Dr. Sarah Reardon]

So there are pelvic floor physical therapists located all over the country. If you literally just go to Google and type in pelvic floor physical therapy, they'll pop up. There's also a PT locator on our academy's website, which is called the Academy of Pelvic Health. And then I say, ask your girlfriends. I mean, they are the best referral sources to say, like, hey, do you know a pelvic floor therapist? And they can tell you, like, who's a good one or if they've seen one or heard of one. I mean, I think that we really are all trying to help support one another. I mean, I ask my friends for referrals as well. It's the best way to find a good one.

[Sarah Reardon]

I couldn't agree more. So if 50% of women have some kind of issue at the pelvic floor, should we all be going proactively to a physical therapist or a specialist to find out?

[Dr. Sarah Reardon]

Right. In my dream world, yes, it would be. And I talk about this in the book, if going to a pelvic floor therapist could be like going to the dentist, I think we would prevent a lot of issues because it would be proactive.

[Sarah Reardon]

And so what would happen when you go to that appointment? What, what?

[Dr. Sarah Reardon]

So what we do is we chat. I'm going to ask you everything, Tamsin, about your Peeing habits, your, you know, your sexual health, your bowel habits, if you've had babies, what your exercise routine looks like. And just get a lot of information to see if there's anything I need a screen for. And then I do an external assessment. I look at your low back and your hips just like a regular physical therapist. And then to assess the pelvic floor, we do an internal vaginal exam. So that's how we access the muscles. And we ask you to squeeze and do a Kegel contraction. Relax. We check if there's tension or spasm in the muscles. And that just gives us a good idea. Is there weakness? Is there tension? Is there incoordination? And then we can help guide you with exercise.

[Sarah Reardon]

It affects the pelvic floor health, correct?

[Dr. Sarah Reardon]

Yes.

[Sarah Reardon]

How does it do that? And what should women in midlife or during this time? We have to be aware of a hundred things, right? And we're just. We'll just add this one to the list. What should women in midlife be aware of as they enter into perimenopause and menopause?

[Tamsen Fadal]

Because perimenopause can start in your late 30s, right?

[Sarah Reardon]

So it's not, you know, when we say midlife, we're talking about a very wide range, right?

[Dr. Sarah Reardon]

And then postmenopause is, you know, 40 years, sometimes the rest. So, you know, I will address this in two ways. One, I think we need to be proactive. So, you know, I really look at perimenopause as this Runway, this opportunity we get to prepare our bodies for this big shift. But during perimenopause, and then, obviously post menopause, your estrogen levels are decreasing. Estrogen is what plumps up and tones the vagina, which is part of the pelvic floor. It also provides vaginal lubrication to the vulva and vagina. And estrogen also helps create a protein called collagen. And we think about collagen when we think of our skin and our hair and our nails, but it's also in our vulvar skin. And that collagen decreases with aging, and we lose, you know, almost 50% of it after, you know, in the vulva and vagina after we age. This is sounding like, terrible, but, however, I would say be proactive about strengthening your pelvic floor during perimenopause, just like we are educating women to, you know, lift weights, do strength training, wear your weighted vests, eat protein. They need to be incorporating pelvic floor exercises into their workouts as well. And it's really simple. If you're already going to the gym, just pull in your pelvic floor with that, you know, and maintain some of these exercises throughout the day.

[Sarah Reardon]

Pelvic floor exercises. What do they look like?

[Dr. Sarah Reardon]

So for strengthening, the most popular one we know about is called a Kegel, which is named after a male gynecologist from the 70s.

[Sarah Reardon]

We need one named after you. We need one named after a woman.

[Dr. Sarah Reardon]

The Sarahs? No, the Sarah.

[Sarah Reardon]

Do the Sarah. Okay, I know we have a pink straw here. Can you tell me what it's for? It matches the book very well.

[Dr. Sarah Reardon]

Well, that's. We've already talked about it. So two things. So this straw, there's two things I would tell somebody to do with it. One is when you're pooping, I would blow out through the straw. So when I actually keep one of these in my kid's bathroom. So when they go to the bathroom. Yes, when they go to the bathroom. Because, again, we have to teach our kids how to go to the bathroom properly. So when they're pooping, I put their feet on the stool, and I say, okay, buddy, blow through the straw and can you feel your pelvic floor? Push down and let go. And that's what we want to happen during a bowel movement.

[Sarah Reardon]

Wow.

[Dr. Sarah Reardon]

Okay. Now we don't need to do anything for the next one, but the way that I explain to do a Kegel contraction is to think about your vagina sipping up a thick smoothie through a straw. And if you think about a sip up, you squeeze and you lift. So it's a closing and a lifting up. It's not tightening your butt. It's not curling your toes, which so many do as Kegels. It's thinking about your vagina sipping up a smoothie through a straw. And that really gives you the visual of how that contraction should be.

[Sarah Reardon]

I feel like I'll never look at straws the same way again, but I'll understand.

[Dr. Sarah Reardon]

But I really want people to bring it into function. I want you to do it before a cough or sneeze. I want you to do it when you're lifting weights at the gym. Tamsen. I want you to do it when you are lifting groceries or putting something in your car. Use the muscle when you need it, and also bring it into your strength training routines.

[Sarah Reardon]

So with pelvic floor exercises, how often should you be doing them?

[Dr. Sarah Reardon]

So think of this like a strength training regimen that you have at the gym. The research really shows that doing three times a week, five to 10 minutes of exercises is sufficient, which is amazing. It's not a huge lift for women to really focus on these pelvic floor contractions. And I give you exercises in the book to kind of walk through and how to do them. But if you have an exercise routine that you're already doing, Pilates, bar strength training, you can bring that pelvic floor contraction into it, and that really can be your pelvic floor workout.

[Sarah Reardon]

Yoga, Pilates, those help.

[Dr. Sarah Reardon]

It's a balance. So if you're doing Pilates, which is kind of a lot of tightening and pulling in and strengthening, you want to just make sure that you're relaxing it after. We don't want to walk around with tight pelvic floors and vaginas all day. That doesn't. That's not a functional pelvic floor. You can have tight, you can have pelvic floor tension, but that doesn't mean it's strong. So it needs to contract and relax. Yoga is also amazing, but you still need to do some strengthening on top of that.

[Sarah Reardon]

All right, so, Sarah, if we have somebody that is 55 or 60 or 70, listening, saying, is it just too late for me even start this right now? Is it already weekend? What is the answer to that?

[Dr. Sarah Reardon]

Not even close. It is never too late. It's never too late. I mean, it's like saying, you know, I'm 60 and I want to strengthen my muscles. Should I just give up now? Like, absolutely. This is a muscle like any other muscle in your body. You can train it until the day that you die. And even learning about it will empower you to understand more about how your body works. How do I pee? How do I poop? How do I cough? How do I exercise? It really can be so amazing to learn more about your body at any age or stage.

[Sarah Reardon]

Yeah, I couldn't agree more. And I think that especially when these are basic things we probably should have been talking about, you know, at a very, very young age, across the board.

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[Sarah Reardon]

A TikTok, don't push when you pee. And it really struck a chord, right? Well, how did you know to do that one? Was it something you'd been asked over and over again?

[Dr. Sarah Reardon]

You know, it's interesting because I just occasionally drop in these little tips, you know, like, don't push when you pee or squeeze before you sneeze. That one I just posted, it was literally me sitting on a toilet, which I do in a lot of my videos, and just said things your mom didn't tell you. Don't push when you pee. And it just exploded. And it was surprising how many people don't know this. And it's just a real testament to how much we need to keep doing this education, because that one change can make a world of difference. To protect your pelvic floor, talk about.

[Sarah Reardon]

Your Instagram account, because I think that you are extremely bold and I love it. And I can't wait for a time where it's not bold, it's just normalized.

[Dr. Sarah Reardon]

So my Instagram account is called the Vagina Whisper, which is actually a name that my girlfriends gave me after graduate school when I was practicing in this field and we would get together during the summers. And one summer, I ended up like, chatting with all the older moms in a hot tub about their bladders. And they were like, she's like the Vagina Whisperer. And so they named me that. And when I started the account, it was really for my group of girlfriends. We were all pregnant and postpartum so as to share tips with them. But, you know, I share everything on there from, you know, childbirth tips, menopause strengthening tips, obviously peeing and pooping tips, but also a lot of advocacy. I mean, I think it's really important to have these conversations. I always say, I wanna normalize pelvic floor conversations. I don't wanna normalize pelvic floor problems. I think the narrative has been for so long that leaks are just part of being a lady. Or, you know, just wear liners if you've got a little leakage. And I'm like, that is not acceptable. I will not accept that diapers are my destiny. And they're much that we can do to Help women have a better quality of life as we age.

[Sarah Reardon]

I mean, we do think about all these years, and we talk about postmenopause, as, you know, could be a third to half of your life. And you better figure out how you want to live that.

[Dr. Sarah Reardon]

Right? And we don't think about how even things that are happening in our 20s or 30s, whether it's pain with sex or, you know, the inability to have sex. Some women can't have sex and they're not able to get pregnant, or they've had pelvic floor trauma and they don't want to have another baby. Or they're leaking now, and I'm like, what is that going to look like? You know, at 30, it's a little bit. But what about 40, 50, 60, when we don't have our hormones to prop us up anymore? And I just say that to really encourage women to make small changes now, it does not have to be a complete overhaul. We all have really long to do lists. But just some small changes and incorporating some exercises just go a really long way so that you can travel later in life. You can hang out with your girlfriends, you can hike, you can have sex. I mean, really live a fulfilling life in whichever way you imagine it to be.

[Sarah Reardon]

Okay, so we did power peeing, right? That's like trying to force yourself to pee. So what's the right way?

[Dr. Sarah Reardon]

Sit, chill, lean forward, and breathe to poop. Yeah. So the right way to poop. I love this. Again. Okay, the right way to poop is sit down. Obviously elevate your feet. So put them on a squatty potty. Put them on a step stool. Put them on an Amazon box. I don't care what it is. But you want your knees to be above your hips level so you're in a squatting position. And then when you're pooping, instead of holding your breath, I want you to bear down. So it's okay to push when you're pooping, but exhale like you're blowing out a bunch of of candles. So it's like, so you're breathing, but you're also bearing down. You're just not holding your breath. Gosh.

[Sarah Reardon]

Okay.

[Dr. Sarah Reardon]

Who knew?

[Sarah Reardon]

Who knew?

[Dr. Sarah Reardon]

Who knew? Now everybody knows now.

[Sarah Reardon]

Toilets are so weird to me. There's a lot of confusion about UTIs.

[Dr. Sarah Reardon]

Yes.

[Sarah Reardon]

Can we talk about that misdiagnosis of them and actually a fear of misdiagnosis of them, because that could be really serious.

[Dr. Sarah Reardon]

They can be, too. Yes.

[Sarah Reardon]

So just tell me about UTIs with regard to pelvis.

[Dr. Sarah Reardon]

So urinary tract infections are when bacteria kind of creeps up the urinary tract or is there's a high bacteria count in the urine and it becomes obviously filled with bacteria and you get an infection. The way to treat it is antibiotics. But there's two things. One, they are more frequently occurring when you are perimenopausal and postmenopausal. Because the the epithelial layers of the tissues change with less estrogen, you're more prone to infections. However, the symptoms of pelvic floor changes and estrogen changes in the tissue can also mimic a urinary tract infection. So if you're going in and it's like, oh, it doesn't say that you have bacteria, the infection's negative. But just take the antibiotics anyway, you don't have an infection. You could have a pelvic floor issue where there's tension in the area, nerves are irritated, there's pain, and then it feels like a urinary tract infection, but it's not right. The other thing that happens is frequent urination. You know, people will go to pee in the middle of the night once or twice when they never used to, or they'll have to wake up three to four times before, you know, actually going to sleep to empty. Cause they feel like it's not emptying. These are all bladder and pelvic floor changes that really need to be addressed. Cause they don't get better.

[Sarah Reardon]

So what do you do if you don't know the difference between it being a urinary tract infection or pelvic floor issue?

[Dr. Sarah Reardon]

I always recommend getting it checked out. I would go to a physician and get it screened and make sure that you get a test done for first. Second, I would also check in with the pelvic floor therapist. Because having muscle overactivity or tension can mimic a urinary tract infection. It could literally be just a muscle spasm that's causing you to have more nerve sensitivity in the area. So get it screened and then also get it treated. Or I've got tips in the book about pelvic floor relaxation and stretches and even internal massage that you can do that can relieve bladder pain.

[Sarah Reardon]

We'll go into that a little bit. What are some of the things that you can do to help with that?

[Dr. Sarah Reardon]

So it's interesting because we often talk about strengthening the pelvic floor, which is the Kegel contractions. But you also need to lengthen and relax the pelvic floor. In order for these muscles to really function well, we need to contract them, but relax Them. The way that we can do that is internally with massage. In our therapy offices, we often use a finger, but at home, you can use a therapy device called a wand that's inserted to release the muscle. You can also do stretches and breathing exercises like yoga or child's pose, happy baby pose, and just taking some big, deep breaths. Our. Our pelvic floor relaxes when we take big, deep diaphragmatic breaths. Yet we live in a day where we're all tensing our muscles, we're holding our breath, we're, you know, breathing with our chest, you know, in shallow breaths. And really, if you just uncross your legs, sit up nice and tall, unclench your butt, and just take these big, deep breaths. It's a way to really naturally relax your pelvic floor muscles without, you know, having to strain. You can't see these muscles. It's not like you can tell them to relax. So just breathing can help with that.

[Sarah Reardon]

That sex.

[Tamsen Fadal]

What.

[Sarah Reardon]

What can that help with? With sex moving forward? I mean, we. We've talked about this. Not only painful sex, but low libido is also one of the issues that a lot of women deal with. Can pelvic floor or working on your pelvic floor and strengthening help that?

[Dr. Sarah Reardon]

Well, if you have pain with sex, you're going to have a little libido. Yes, for sure, there's a hormonal issue, but when there's a pelvic floor issue, what can happen is there are two different layers of muscles to the vagina. There's an entryway set of muscles, and there's deeper muscles, which are that bowl. If you have tight, tense muscles, you're not. And nothing is allowed to enter the vagina. So it could be a tampon, it could be a pelvic exam, but it can also be something during vaginal intercourse. And it feels like something's hitting a wall, like the vagina is closed. Another type of pain is deeper pain with penetration. So it feels like somebody's hitting something, like it's tender or bruisy in there. And it can be a deep pelvic floor or hip muscle. So just like we get knots in our shoulders and our neck, and we get headaches or migraines. It's just like having tension in your pelvic floor that needs to be released. So I would work on the muscle component with some of the things we describe, like stretches or internal massage. But then I would also, you know, think about using a good lubricant. I think we used to think that lube Was like, only if you're not aroused. That's not the case. Using a great water soluble lubricant proactively can also be helpful.

[Sarah Reardon]

I think there's a of lot of shame and embarrassment about things like that. As if, like, if you use lube, it's like you're not good enough at sex or it's. It's only for play.

[Dr. Sarah Reardon]

Yeah.

[Sarah Reardon]

And I, I think we've got it. We've got to remove that. I mean, there's so much shame and stigma wrapped around a lot of these conversations.

[Dr. Sarah Reardon]

You know, there really is. And I think that's why we don't talk about them and we don't know that there's help for them. Which was kind of the whole mission behind this book was to say, like, this is something that so many women experience. You know, I share stories in there that of all the patients I've seen, you know, so many of them over the 18 years I've been practicing, and so many of them felt like it was just them. And I go, girl. I see 40 patients a week and all of them are experiencing pelvic floor issues. So you're not alone. And I think that we just want to really feel like there's help for these issues. But the shame and the stigma goes way back to when we are young girls and we're not educated about our periods. We're slipping tampons up our shirt sleeves. We're hiding kind of who we are as women from the age that we really become a woman.

[Sarah Reardon]

It's funny, I used to anchor the evening news and I would have to run, you know, between commercial breaks to run to the bathroom if I had my period. And I'd put my tampon right in my cleavage to hide it because I was like in a she in a dress. There was no place to hide it, you know. And then I think to myself, I can't. What. What was I doing? Why was that? But that was very how we. I was ingrained to do that. Like, don't let anyone know that this is a private thing and you're not alone.

[Dr. Sarah Reardon]

I mean, I've done that as well. And you know, tampons and pads should be accessible like toilet paper. You know, I mean, if we think about this is just kind of a natural. But so I think that it starts when we're younger. There's also kind of cultural and religious context that sometimes we're told that talking about this part of our body is bad or we should hide it or be ashamed of it. And we also just, even if we are comfortable talking about it, we don't even know who to go to. What doctor do you see? What specialist do you go to?

[Sarah Reardon]

Are there any other products that are helpful aside from lube?

[Dr. Sarah Reardon]

You know, one of my favorite things to recommend to women is Evolv or Balm or moisturizer. Just like we use something on our face for moisture, my favorite one is called. Called it's by Medicine Mama. It's a vulva.

[Sarah Reardon]

I was just gonna tell you that. I was gonna say. If you didn't say that, that was gonna be what I was gonna tell you. It's amazing.

[Dr. Sarah Reardon]

It's amazing because it's an all natural organic oil. There's no hormones in it. I am, you know, comfortable with folks using topical estrogen on the vulva and vagina. But if you aren't, or in addition to the Medicine Mama Balm is soothing. It's all natural and just really, really so effective in moisturizing the tissue. And you can use it every day as often as you'd like. What's interesting is she started treating breastfeeding cancer patients. And so this really evolved into. When you go through breast cancer treatment, you are pretty much postmenopausal, and so you experience those same changes with the lack of estrogen. And now we can see how it can benefit women at every stage.

[Sarah Reardon]

Yeah. Let's talk about underwear too. Is there a certain type of underwear? I know that, you know, over the years things can change a little bit. Might not be floss anymore, but what do you recommend?

[Dr. Sarah Reardon]

So to your point, especially if tissues become more sensitive or irritable, I would avoid thong underwear. Just anything really close to the area can harbor bacteria and can be uncomfortable to sit with. Obviously, all cotton is best organic. You know, I wear those kind of all cotton granny panties at nighttime and then. Or you can go completely commando at night and just let it breathe. So. But obviously the more natural the materials are gonna be, the better ones.

[Sarah Reardon]

Yeah, I like no underwear at night for sure. Yeah, I've always. Yeah, I've always thought that was confining, so.

[Dr. Sarah Reardon]

No, and I think it's a great thing. And especially if you have dryness, irritation, sensitivity, I just say don't wear underwear at all, especially at nighttime. But even some women opt to do it during the day just because they feel like everything is too constricting or irritating.

[Sarah Reardon]

Yeah, I agree. Going back to sex for a second, will strengthening your pelvic floor lead to better sex and orgasm?

[Dr. Sarah Reardon]

Yes, it actually can. So pelvic Floor strengthening can tone the vagina, give you more sensation during sexual intercourse. And orgasms are actually pelvic floor muscle contractions. So those contractions are waves that you feel are your pelvic floor muscles contracting and relaxing. So having stronger, more coordinated muscles can help with intercourse and also give stronger orgasms.

[Sarah Reardon]

Okay, so that's good news.

[Dr. Sarah Reardon]

Yes, great news. That's incentive for you to do your exercises.

[Sarah Reardon]

That is some incentive for all exercises. So for women who are feeling a little nervous about it or a little scared or discouraged about it, what do you recommend to them? What is the first piece of advice you would share?

[Dr. Sarah Reardon]

So first thing I would say is start doing something about it. There is no reason to suffer silently. There are so many resources for help. This is why I wrote the book as well, is because if you can't access a pelvic floor therapist, if you aren't ready to see one, just start learning and educating yourself about your body. And in the book, I give you all of the normals, like, this is how you should pee. This is how you should poop. This is what sex should feel like, you know, and just really introduce you to this part of your body that you've never been familiar with. And then I think that there are a lot of online programs as well. There's, you know, I have an online exercise program. There's a lot of information on social media. But I think that women really need a menu of options to access health care. And it's amazing that we're in a day that that really is possible.

[Tamsen Fadal]

So this is something I have been wanting to say ever since I started this podcast. I couldn't find the right answers when I needed them most for years. So I wrote them down. I wrote down questions, I wrote down, wrote down research. How to menopause. My book came from that place of searching, stumbling, figuring it all out. This podcast is me giving voice to everything I put in my book. If you're listening and feeling a little less alone, that's exactly the point. If you want to grab a copy of the book how to menopause, go to howtomenopause.com so listen, I was standing in front of my closet a few weeks ago, heat rising, calendar pack. And I realized, realized I had nothing I actually wanted to wear. Everything felt either, I don't know, too trendy, too worn out, or just wasn't me anymore. That's when I ordered a few summer staples from Quince. And they have honestly changed how I feel getting dressed every day. They're 100 European linen shorts and a lightweight button down have already been on rotation. Brunch, casual meetings, even for my travel. Their fabric is breathable and beautifully made. And especially still can't believe I paid under $50 for each piece. Quince gives you luxury without the markup by working directly with top artisans and cutting out the middlemen. I use Quince. You should too. It's one of the few brands where style, quality and price all align. Go to quince.comtamsen for free shipping on your order and 365 day returns. That's Q-U-I-N C E.comtamsen to get free shipping and 365 day returns. Quince.comtamsen Let me tell you, I used to think socks were just socks until I was on my feet all day long. Filming, traveling, or just running around the city and realizing how much the wrong pair can throw off your entire day. Blisters, sweat, sweaty feet, discomfort. It's just not worth it. That's why I completely switched to Bombas. Their socks are different. They're like the perfect playlist for your feet. They're running socks, wick away, sweat, keep my feet cool and actually help prevent blisters. And they've got specialized options whether you hike, play, tennis, travel, you name it, they've got it. But here's what really sold me. For every item you buy, Bombas donates one to someone in need. It's quality, quality with real purpose, and I really love that. Head over to bombas.com tamsen and use the code tamson for 20 off your first purchase. That's B O-M-B-A-S.com tamsin code tamsen at checkout bombus.com tamsin and use code Tamsen.

[Sarah Reardon]

Okay, let's do some rapid fire. Misses you before I let you go.

[Dr. Sarah Reardon]

This.

[Sarah Reardon]

This book is so good. I like every woman needs to read this book. Seriously, it is so good. Okay, everybody leaks a little. Just part of being a woman. That's a myth, right?

[Dr. Sarah Reardon]

Myth. Total myth. Not acceptable. There's something you can definitely do about it. No amount of leakage is normal.

[Sarah Reardon]

Just do Kegels fixes all pelvic floor issues myth.

[Dr. Sarah Reardon]

Absolutely not. It's like saying doing crunches fixes back pain. It's very nuanced what you should do to address your pelvic floor, which is what I cover in the book. What exercise path should you take?

[Sarah Reardon]

Pelvic floor issues only happen after childbirth myth.

[Dr. Sarah Reardon]

They can affect you at any age or stage from periods to Sex to perimenopause and post menopause, there is a.

[Sarah Reardon]

Right way to sit on the toilet.

[Dr. Sarah Reardon]

Truth.

[Sarah Reardon]

We know that way, right? Weak muscles equal weak pelvic floor.

[Dr. Sarah Reardon]

True.

[Sarah Reardon]

Explain that.

[Dr. Sarah Reardon]

So when your pelvic floor's muscles and when you think about weak bicep muscles and you have a hard time lifting something, it's the same thing for the pelvic floor. If these muscles are weak or lengthened, you can't close the sphincters to hold in urine and stool. You can't contract for sexual health or orgasms, and you can leak or have your or have pelvic organ prolapse.

[Sarah Reardon]

Peeing just in case is good bladder training myth.

[Dr. Sarah Reardon]

You should only pee when you have the urge to go. We women are notorious for going to the bathroom every time we cross one. And that can train your bladder to actually shrink. And then you have to go to the bathroom more often. So only pee when you have the urge to pee. The normal range is between two to four hours during the day.

[Sarah Reardon]

Really? So I always do the just in.

[Dr. Sarah Reardon]

Case you gotta stop.

[Sarah Reardon]

No just in case bathroom. I see it, I'm like, I better do it just in case there's not another one somewhere else.

[Dr. Sarah Reardon]

Before bed, before sex and before exercise are the only just in case pees allowed.

[Sarah Reardon]

Should you pee before sex or after sex? Or both? Okay, both, yeah. Why?

[Dr. Sarah Reardon]

Well, one, it cleanses the urinary retractive bacteria. And sometimes if you have a full bladder, it can make sex feel like you might pee.

[Sarah Reardon]

Holding your pee is bad for your pelvic floor.

[Dr. Sarah Reardon]

Truth? You should again go to the bathroom when you have the urge to go. It should be between that two to four hour mark. During the day or at nighttime, it should be once or twice or none at all, but not more than that.

[Sarah Reardon]

Sarah, you're so wonderful. We're gonna show this book, obviously, so people know where to get it. But where can people find you?

[Dr. Sarah Reardon]

As we mentioned, I'm on social media as the vagina whisperer on Instagram and then as the vag whisperer on TikTok, because TikTok doesn't like the word vagina. Oh, let's talk about that real fast.

[Sarah Reardon]

It's still going on, huh?

[Dr. Sarah Reardon]

They still don't like the word vagina. They won't even accept the account with vagina. So I'm the vag whisperer on TikTok.

[Sarah Reardon]

Instagram will accept it.

[Dr. Sarah Reardon]

Yeah, Instagram will accept it. But I'm like a dinosaur on Instagram, so I've been there forever. So maybe I just got grandfathered in and then my website with a ton of blogs, pelvic health exercises and all about the book where you can pre order it is thevaginawhisperer.com and everybody who pre orders the book gets 30 days of pelvic floor workouts along with it. So you can start your journey right away.

[Sarah Reardon]

Really, it's just incredible. It really is the guide that you need for your pelvic floor. If you have any questions about it whatsoever, however. All right. It's so good to see you. Thank you so much. I'm so glad we made this happen.

[Dr. Sarah Reardon]

Thanks for having me.

[Sarah Reardon]

I was like we need Sarah.

[Dr. Sarah Reardon]

Thank you.

[Sarah Reardon]

So thank you.

[Dr. Sarah Reardon]

Pleasure.

[Tamsen Fadal]

If this conversation was helpful, keep the questions coming. You can email us podcast tamson fidel.com and of course you can help us by subscribing to the Tamson show wherever you get your podcasts or on YouTube.

[Sarah Reardon]

Until next time.

[Tamsen Fadal]

The Tamson show is an original production by Authentic Wave executive producers Scott Weinberger, Kevin Bennett and Rebecca Grierson. Brand director Johanna Ofznick. Our line producer is Sabrina Sarre, editing by Zach Smith and Marquis Harris. The views and opinions and information shared by guests on the Tamsen show are their own and do not necessarily reflect the views of Tamsen, Fadal or the production team. This podcast is for informational purposes only and is not a substitute for professional medical, legal or financial advice.