Common Doesn't Mean Normal When It Comes To Pelvic Health

Erika Doty
Jun 4
10 min read

What is pelvic health?

What does a Pelvic Floor Physical Therapist do?

Why is pelvic floor health important?

A few weeks after our Balance: A Perimenopause Journey event, Brooke was literally going to the bathroom (TMI) and thought, "It would be great to have a pelvic health expert guest-write an article for Babble!" Hosting our Balance events, Brooke and I learned so much about pelvic health - something we knew nothing about prior. For example, we learned that we shouldn't "push pee" - we should let our pee naturally flow out of us instead of trying to hurry it up. There are so many things we, as women, categorize as "normal" when really they are just accepted.

So we asked Molly Gray at Mountain Mama Pelvic Health if she could help us out with this.

Her response:

"I would absolutely love to write a guest article for Babble!

I am especially passionate about educating women on symptoms that are often normalized by friends and family—or are simply too uncomfortable to discuss, particularly regarding sexual health—but are actually signs that they should seek medical care."

What you're chalking up as "normal" or "it's okay -every woman goes through this" may not be good for your health.

If you're as curious as we were, check out the following article written by Molly Gray, PT, DPT, cert MDT and owner of Mountain Mama Pelvic Health.

Pelvic floor symptoms are incredibly common, especially for women throughout different stages of life. Pregnancy, postpartum recovery, perimenopause, and the menopause transition are some of the most common times for women to begin noticing pelvic health concerns.

As a pelvic floor physical therapist, I've heard it all before:

"This just happens after you have kids."

"I'm just getting older."

"Everyone leaks a little."

While urinary incontinence affects an estimated 40% of adult women, I suspect the true number is even higher. Many women don't bring it up to their healthcare providers, their friends, or even their partners because they have been told, either directly or indirectly, that these symptoms are simply a normal part of being a woman.

The problem with normalizing symptoms is that it makes them less likely to be treated.

I often work with women who seek pelvic floor physical therapy for one concern, only to casually mention that they leak urine sometimes too, but that it "isn't that big of a deal." What many people don't realize is that, like most health conditions, pelvic floor symptoms are often easier to address when they are mild and just beginning. The longer symptoms persist and the more severe they become, the more challenging they can be to resolve.

Just because something is common doesn't mean it's normal, and it certainly doesn't mean you have to live with it.

Why "Just Do Kegels" Isn't a Treatment Plan

For years, and unfortunately still today, many women who bring up urinary leakage to a healthcare provider are told to "just do some Kegels," "Kegel at every stoplight," or even "drink less water."

As a pelvic floor physical therapist, this makes my blood boil.

I often remind people that "just do Kegels" is not a treatment plan. More importantly, it isn't individualized medical care. If our first responsibility as healthcare providers is to do no harm, then offering blanket advice without understanding the root causes of a person's symptoms falls short of that standard.

The reality is that urinary incontinence is complex. Some people experience leakage because their pelvic floor muscles are weak. Others have pelvic floor muscles that are overly tense and unable to relax appropriately. For many people, the issue is less about strength and more about coordination between the pelvic floor, diaphragm, abdominal muscles, hips, and back.

I wish urinary incontinence were as simple as telling someone to do a few Kegels every day. It would certainly make treatment easier. But urinary symptoms rarely exist in isolation.

A person's activity level, hydration habits, stress levels, sleep quality, exercise routine, medical history, bowel habits, and dietary changes can all influence bladder function. These factors matter, and they deserve consideration when creating a treatment plan.

This is one reason why urinary incontinence often requires more than a brief conversation during an annual checkup. It requires a thorough evaluation that looks at the whole person, not just the symptom.

Fortunately, there are healthcare professionals who specialize in exactly this kind of assessment: pelvic floor physical therapists.

Pelvic floor physical therapists are movement and function experts who evaluate how the muscles, connective tissues, breathing patterns, posture, and daily habits all work together to influence bladder health. When additional medical evaluation is needed, we can also help coordinate care with specialists such as urologists, urogynecologists, gynecologists, and primary care providers.

You don't have to guess why you're leaking urine, and you certainly don't have to settle for generic advice. There are experts trained to identify the causes of your symptoms and help you find a solution that fits your body and your life.

How Often Should You Pee?

Another common pelvic floor concern is urinary frequency. The first question we need to answer is: how often is too often?

For most people, depending on fluid intake, it is reasonable to go anywhere from two to four hours between bathroom trips during the day. Of course, this depends in part on how much you're drinking.

We also live in a culture where carrying around a giant water bottle and drinking enormous amounts of water has become the norm. While hydration is important, more isn't always better. For most adults, a daily fluid intake of approximately 60 to 90 ounces is sufficient to support healthy bladder and bodily function. If you're exercising, spending time in the heat, or sweating heavily, you may need closer to the higher end of that range. On less active days, 60 ounces may be plenty.

If you're staying within these general guidelines and still find yourself running to the bathroom frequently, it's worth taking a closer look.

A comprehensive pelvic floor physical therapy evaluation is often the gold standard for identifying the underlying causes.

One of the most common contributors to urinary frequency is habit.

Many people avoid using public restrooms because they're worried about germs or simply prefer to wait until they get home. While I completely understand the hesitation, the benefits of using a public restroom when you need one far outweigh the "gross factor." Research does not support the idea that you're likely to develop a urinary tract infection or sexually transmitted infection from sitting on a public toilet seat. On the other hand, repeatedly going "just in case" or constantly delaying urination can train your bladder to signal the need to urinate more frequently.

So yes, sign me up for public toilet seats.

Many people also assume they have a "small bladder" because they need to urinate frequently. In reality, this is rarely the cause. A great place to start is with a bladder diary. Track your fluid intake and bathroom visits for several days and look for patterns. You may discover that you're drinking significantly more than your body needs, or that you're responding to bladder signals earlier than necessary.

Our bladders function best when we allow them to do their job. Most of the time, that means allowing the bladder to fill appropriately before emptying it.

Typically, we receive several levels of bladder signals throughout the filling process. The first sensation usually occurs around 40% fullness. A stronger signal may occur around 75% fullness. Finally, there is the "I need to find a bathroom soon" signal that occurs when the bladder is approaching its capacity.

If we routinely urinate at the first hint of an urge, we can unintentionally train our bladders to send signals earlier and earlier. Over time, this can contribute to urinary frequency, sometimes leading people to feel the need to urinate every 15 to 30 minutes, or even more often.

So do your bladder a favor: when it's appropriate and comfortable to do so, give it the opportunity to fill before heading to the bathroom. Your bladder is designed to store urine. Let it do its job.

Stop Power Peeing

When it comes to healthy bladder habits, one of the biggest pieces of advice I can give is this: stop power peeing.

What exactly is power peeing?

It's the habit of pushing or bearing down to force urine out more quickly. While it may save a few seconds, it goes against the way the bladder is designed to function.

In a healthy urinary system, the bladder muscle should do the work of contracting and emptying the bladder. When we regularly bear down to speed up the process, we can interfere with the bladder's natural function. Over time, this habit may contribute to incomplete bladder emptying, reduced bladder efficiency, and increased reliance on pushing to urinate.

Repeatedly bearing down can also place unnecessary pressure on the pelvic floor and surrounding structures. Over many years, this increased pressure may contribute to pelvic floor dysfunction and can be a risk factor for pelvic organ prolapse.

Instead, think of urination as a passive process rather than an active one. Sit fully on the toilet seat, yes, that means no hovering, and allow your pelvic floor muscles to relax. Taking a few slow, deep breaths can help your nervous system settle and encourage the bladder to empty more naturally and completely.

Your bladder knows how to do its job. Most of the time, the best thing we can do is get out of its way.

Pain With Sex Is Common, But Treatable

Pain with sex can have a significant impact on relationships, self-confidence, and overall quality of life. Sometimes women begin to wonder if they even want to have sex with their partners anymore. While there can be many factors contributing to this feeling, I often encourage women to consider whether the sexual experiences they're having are pleasurable and fulfilling in the first place.

Sex and intimacy naturally evolve throughout our lives. Hormonal changes, stress, parenting, aging, relationship dynamics, and pelvic floor health can all influence our sexual experiences. While these can be difficult topics to discuss, open conversations with partners often lead to greater intimacy, connection, and satisfaction.

Understanding Female Sexual Function

One important piece of the puzzle is understanding how female arousal and orgasm actually work. The majority of women do not orgasm from penetration alone. Research suggests that approximately 70% of women require direct and consistent clitoral stimulation to reach orgasm. Unfortunately, many of us received limited sex education and learned about sex through media portrayals that don't accurately reflect the experiences of most women.

Arousal also takes time. On average, women require significantly longer than men to reach peak arousal, and many couples simply aren't allowing enough time for this natural process to occur. Slowing down, prioritizing foreplay, and communicating openly about preferences can dramatically improve sexual experiences.

I am also a huge fan of lubricant for women of all ages. Lubrication can reduce friction, improve comfort, and often enhance pleasure during sex. For women experiencing vaginal dryness, additional support may be beneficial. Vaginal moisturizers can be an excellent option and are best thought of as the "chapstick" of vaginal health. Just as many of us use lip balm to support healthy skin, vaginal moisturizers can help maintain healthy tissue and improve comfort throughout daily life, not just during sexual activity.

And for women who decide that sex is not an important part of their lives or relationships, that is completely valid. However, if you experience pain with a Pap smear, tampon insertion, gynecologic examinations, or penetration of any kind, your body may be signaling that something is not functioning optimally. These symptoms are common, but they are not normal, and they deserve attention.

Pain with penetration can be a sign that the pelvic floor muscles, connective tissues, or surrounding structures need support. In some cases, these symptoms appear before urinary or bowel concerns develop. The good news is that effective treatments exist, and pelvic floor physical therapy is often one of the best places to start.

Women Deserve Better

For many of the pelvic health concerns we've discussed, pelvic floor physical therapy should be the first line of treatment.

In my nearly 15 years as a physical therapist, I have worked with countless women who underwent one, two, three, or even more surgical procedures before ever being referred to pelvic floor physical therapy. I often wonder how different their journeys might have been if they had been given access to conservative, evidence-based treatment first.

I've also worked with many women who were preparing for surgery, decided to try pelvic floor physical therapy beforehand, and ultimately found enough improvement that surgery was no longer necessary.

One of my greatest passions as a pelvic floor physical therapist is helping women avoid unnecessary invasive procedures whenever possible. That doesn't mean surgery is never the right choice. For some people, additional medical interventions are absolutely appropriate and necessary. However, every woman deserves the opportunity to explore conservative treatment options before moving on to more invasive ones.

For conditions such as urinary incontinence, urinary frequency, pelvic pain, and many forms of pelvic floor dysfunction, pelvic floor physical therapy is considered a gold-standard treatment. Research also shows that physical therapy before and after surgery, as well as during pregnancy and postpartum recovery, can improve outcomes and support a smoother recovery process.

As women, it's time we start expecting and advocating for high-quality care rather than simply accepting whatever is offered to us.

Women play countless roles in the lives of those around them. We are mothers, partners, daughters, sisters, friends, caregivers, business owners, leaders, employees, and community members. We spend so much of our lives caring for others that it can be easy to place our own health at the bottom of the priority list.

But our health matters.

Imagine what would be possible if more women were living without the constant worry of finding the nearest bathroom every time they left the house. Imagine more women exercising confidently without fear of leakage, enjoying intimacy without pain, and participating fully in the activities that bring them joy.

Women are resilient. Bodies are resilient.

Sometimes they just need the right support, the right information, and the right healthcare team.

And when that happens, incredible things are possible.

About The Author:

Molly Gray, PT, DPT, cert MDT and owner of Mountain Mama Pelvic Health based in Boise, Idaho.

At Mountain Mamma Pelvic Health our mission is to empower women with education and a personalized approach to their most personal healthcare needs. We strive to create a body positive environment for all women and birthing people that advocates for a holistic approach to pelvic health, sexual health, and maternal health. Our goal is to work with our patients and integrate pelvic floor function into full body function to get our patients back to joyful and necessary movement. Specializing in mobile physical therapy for women’s pelvic health in Boise and the surrounding areas.