I mean honestly who does not like a list? And this one is going to tell you things to STOP doing to have a happier pelvic floor - what could be better?! Pelvic health has become all the rage lately thanks to social media so sometimes it is hard to figure out what to believe. Trust me, we hear all sorts of interesting suggestions on Google from patients trying to help themselves. Lucky for you, this list is evidence-based and coming to you directly from a Doctor of Physical Therapy (not that this is medical advice, always consult with your own medical team for specific questions). 1. Hovering Recently I was in a pilates class and the instructor cued us to squat like we are hovering in a porta potty. And you know what? Everyone knew exactly what she was referring to! But it isn’t just porta potties that we squat over. This happens frequently over standard toilets as well - but why? I get it, you don’t want to sit on someone else’s pee - eww . But the solution for that is simple: wipe it off. Or if you have enough time, build yourself a little nest out of toilet paper (or use one of those toilet covers that most bathrooms tend to be out of). The issue with hovering is that your pelvic floor muscles are not able to fully relax making it hard to go to the bathroom. It is also worth noting that hovering over a toilet is very different from squatting like people in other countries do when using the facilities. Getting into that deep of a squat is actually a great position for pelvic floor relaxation. So ditch the squat, take a few seconds to wipe off the seat or build a TP nest and sit down so your pelvic floor can relax. 2. ‘Just In Case’ Voiding We hear this ALL THE TIME! Patients frequently report they go to the bathroom ‘just in case’ when they are out in public, going for a roadtrip, or before they leave home for any type of activity. The ‘just in case’ comes from a fear of finding a bathroom when you need it the most. The issue here is that you are not necessarily allowing your bladder to fill all the way up. This will start to train your bladder and your brain that the volume of pee needed to send the ‘time to go’ signal is reduced. In turn you may find yourself going to the bathroom even more often which puts you into a cycle of frequent urination. If you aren’t sure how often you should be going to the bathroom check out our blog post How Much Should I Be Peeing? Spoiler alert: It won’t tell you to go before you leave the house, when you are switching from Target to the grocery store, or right before a road trip - ‘just in case.’ Aim for going every 2-4 hours and if you aren’t able to wait that long then it is definitely time to get some pelvic floor help! 3. Waiting to Pee I’m looking at all of my nurses, teachers, and parents right now (among other professions). See last sentence above (“aim for going every 2-4 hours”) which does not mean go once all day long or wait until the end of your shift to find the bathroom. You need to prioritize yourself by going to the bathroom once every 2-4 hours! Waiting to go places unnecessary stress on your pelvic floor and impacts the sensitivity of your bladder muscle to signal the brain that it is time to pee. Prolonged waiting can negatively impact the bladder and the pelvic floor which may lead to urinary retention or leakage due to a lack of signal to go - we don’t want that! If you wait too long due to factors that feel outside of your control, then you may also be guilty of avoiding water - see #6 for more! 4. Using Vaginal Washes Say it with me: The vagina is self-cleaning! You do not need to buy any fancy soaps or cleansers promising to make you smell like a bouquet of roses or a summer meadow. Truly you don’t need anything more than water! Now for the external vulva tissue you can certainly use a very mild, unscented soap to clean outside, but nothing should be placed inside of the vagina. Using soaps with scents, polishing beads, or lotions will throw off the pH in your vagina and can lead to issues like yeast infection or BV. Why risk it? (For my post-op vaginoplasty girlies, chat with your surgeon about the best douching routine to keep your vaginal tissue happy and healthy!) The truth in the matter is, bodies have scents and smells. Vulva and vaginas are not supposed to smell like flowers. And if you start to notice a scent or smell that seems off, that is your body’s way of saying ‘Hey something is not right down here and you should get it checked out!’ 5. Blindly Doing Kegels (or any other pelvic exercise) We all have that ‘friend’ from highschool who drops into our DMs to tell you about this amazing product they’d love you to test out for them! Well as a pelvic floor therapist we get the friends and family sliding into our DMs to ask if they should be doing kegels because they saw some influencer talking about it on social media. Or even better, they saw someone testing out a pelvic floor product, shorts, or chair and wonder if that will help them too. So will these things help you? The answer is: it depends! Do you have a tight pelvic floor? A weak pelvic floor? Do you have any pelvic floor symptoms that you are worried about? How are your breathing mechanics? Can you even coordinate a pelvic floor contraction without cheating with your core and glutes? If you cannot answer these questions then no, you should not be doing kegels , using a pelvic floor insertable/shorts/chair promising you a strong pelvic floor and less leakage. It is vital that you have your pelvic floor assessed by a pelvic floor expert (read: physical therapist or occupational therapist with extensive training in external and internal pelvic floor assessment). 6. Avoid Drinking Water Okay so you feel like you need to pee all the time or you leak some amount of urine with a couch, laugh, sneeze, jump, or big need to pee. The solution is clearly to drink less water so you have less urgency/leakage, right? WRONG! By decreasing the amount of water you ingest, the contents in your bladder are more concentrated. Picture this: You fill a clear glass up with 80% coffee and 20% water - can you imagine the color of the contents in the cup? Now imagine you reversed that and filled it with 20% coffee and 80% water - it should be much lighter brown now, right? Think of the coffee as your concentrated urine which is more irritating to the bladder lining. When you dilute it with water, the irritation on the bladder lining is decreased. So while in theory it makes sense that drinking less means you need to pee less or have less to leak, the reality is that your bladder is just more irritated and you will still have urgency. And if your pelvic floor is not firing appropriately during activities of increased stress like coughing, sneezing, laughing, or jumping, then you will still leak the concentrated urine you do have in your bladder. 7. Thinking Constipation Doesn’t Impact the Pelvic Floor Many of our patients come in with pelvic floor concerns and after a few questions find out that while they did not check off ‘Constipation’ on their intake forms and report the consistency of their stool is ‘normal’, they do in fact have signs of constipation. The normal frequency of bowel movements is anywhere from three times per day to every three days. But even for our patients that go daily (and multiple times per day) they still may lean towards the constipated side. We don’t just look for hard, dry, difficult to pass stools as an indication of constipation. We also ask things like “Do you feel fully empty after having a bowel movement?” which we get a surprisingly high number of yeses to. The issue with ignoring your constipation is that the bowel has a major impact on the bladder and can be a sign of pelvic floor dysfunction. When the rectum has stool just sitting in it waiting to get out, it puts pressure on the vaginal walls and bladder which can lead to the feeling of pelvic heaviness/fullness or urinary urgency. The reason the stool may be difficult to pass could be related to tension in the levator ani muscle group or the external anal sphincter (all pelvic floor muscles). These are things that should be assessed by a pelvic floor therapist to help manage your constipation for a happier pelvic floor. 8. Trying to Grin & Bear It During Intimacy If we had a nickel for every time a patient was told to “just drink alcohol” before navigating intimacy, well we would have A LOT of nickels! So often our patients try to grin and bear it when experiencing pain during intimacy, with pelvic exams, or inserting a tampon. Drinking alcohol or just living with the pain is not an option & it should not be taken seriously if advised by a medical professional, or anyone really! Trying to push through the pain will just create a negative feedback loop where you anticipate pain and then feel pain. At some point you start to wonder who is the chicken and who is the egg - the pain or the anticipation. In every instance it is best to get to the root cause of the pain which is likely coming from tension in the pelvic floor and definitely warrants further assessment. 9. Gripping Your Abs & Glutes Much like people watching in a mall or airport, pelvic therapists can spot an ab or glute gripper in every crowd. Developing these habits comes from a few places - some sport or activity that cued a lot of core engagement, someone in your life hyperfocused on appearance cuing you to hold it in, or standing in what we affectionately call the baseball coach stance where the hips jut forward and the glutes are tucked under. There are certainly more reasons beyond this but you get the point. Sometimes we don’t even know we are gripping our abdominals or gluteus muscles until someone points it out or we develop discomfort in these muscles due to their state of always being ‘on.’ The issue with being an ab or glute gripper is that the tension in these muscles will negatively affect the pelvic floor through either tension or poor coordination. We need the abdominals and gluteus muscles relaxed and ready to fire when we need them, not always in a state of engagement. So the next time you notice that your abs or glutes are firing while you are just standing there try to do a body scan: Take a deep breath in. As you exhale unclench your jaw, drop your shoulders, let your belly soften, let go of your glutes and drop your pelvic floor. 10. Holding your stress in your pelvic floor Finally, and maybe the hardest but most important one: stop holding stress in your pelvic floor! Okay so this truly is tough and it will take a team approach to figure out if you are holding your stress in your pelvic floor (hello pelvic therapy) and why you are holding your stress there (and welcome to the party mental health therapy). While many people hold their stress in their neck and shoulders, I’d say probably an equal amount hold their stress in their pelvic floor. Why? There are so many reasons we can speculate on but the top reasons we see in the clinic are that the pelvic floor is so close to our core and these muscles both protect your most delicate organs but also engage to bring us into fetal position which feels the most safe or that there is some type of trauma or past experience that impacts the pelvic floor and draws our subconscious attention to this area with the desire to guard. But what can be done about this? The answer brings us the the #1 thing you SHOULD be doing for your pelvic floor. #1 Thing You Should Be Doing for Your Pelvic Floor: Seeing a Pelvic Floor Therapist We see a dentist for our oral health, a gynecologist for our reproductive health, primary care provider to manage our full body health, a mental health therapist for our brain chemistry health, so why not see a provider for our pelvic floor health? Afterall, these muscles are the ones responsible for preventing urinary and fecal leakage, urgency, hesitancy, or retention. When they are in good working order (and absent of any underlying conditions that result in chronic pain/dysfunction like Endometriosis, PCOS, EDS, etc) you don’t experience pelvic pain and can have enjoyable intimacy in whatever way that looks for you. So whether you have a current issue you need support with or you just want to be seen for proactive or wellness care, find a great pelvic floor therapist near you and get started! Not sure where to find one or if they are a good fit? Check our blog post: How To Find A “Pelvic Floor Specialist Near Me”