Maybe you’ve had period pain or pain with intercourse for so long that it’s become a normal part of your life?
Or perhaps you catch yourself doing the just in case pee before leaving the house, even if you went 20 minutes ago?
If you are nodding along, we need to talk about your pelvic floor.
This is an area of the body that has historically been overlooked, shrouded in shame, or dismissed as just part of being a woman. But as I discussed on a recent episode of Phase to Phase with Pelvic Health Physiotherapist Sheela Zelmer, suffering in silence is not a requirement for aging.
Here is the breakdown of what is actually happening down there, why it matters, and why Kegels aren't always the answer.
First, let’s clear up a misconception: Everybody has a pelvic floor. Men, women, children—we all have one.
The pelvic floor is a group of muscles that runs from your pubic bone in the front to your tailbone in the back. Think of it as a hammock or a bowl at the base of your pelvis.
It has four main jobs:
Support: It holds up your bladder, uterus, and rectum.
Sphincter Control: It controls your bladder and bowels (stopping you from leaking).
Sexual Function: It helps maintain arousal and allows for painless penetration.
Stability: It works with your core and diaphragm to stabilize your body.
When these muscles aren't working properly (dysfunction), it shows up in ways you might not expect.
Obviously, bladder leaking is the big one. This can happen when you cough or sneeze (stress incontinence) or when you have a sudden, uncontrollable urge to go (urge incontinence).
But dysfunction can also look like:
Painful Intimacy: Difficulty relaxing or pain during penetration.
Heaviness/Prolapse: Feeling like there is a bulge or a tampon falling out sensation in the vagina.
Constipation: Feeling like you can't fully empty your bowels.
Unexplained Pain: Achiness or congestion in the pelvis, often worsening with high-impact activity.
We grew up hearing jokes like, "Don't make me laugh too hard or I'll pee!" This normalizes dysfunction. We start to believe that leaking is just an inevitable part of aging or motherhood.
Just because it's common and because we've normalized it, does not mean it's normal. You do not have to live with leakage or pain.
If you are nervous about seeing a pelvic physiotherapist, you aren't alone. Many people fear it will be painful or awkward, like a pap test.
Here is the reality Sheela shared:
It’s respectful: You are fully draped, there are no stirrups, and the exam is gentle.
It’s optional: While an internal exam gives the best data, you can start with breathing, posture, and external assessments if you aren't comfortable yet.
It’s not just Kegels: In fact, many people have too much tension (a tight pelvic floor), so doing Kegels might make things worse! Treatment often involves learning to relax and breathe first.
Stop doing just-in-case pees! A healthy bladder should void every 2 to 3 hours (assuming normal fluid intake). If you constantly empty it early, you interrupt the reflex signals, leading to more frequency and urgency in the long run.
If your pelvic floor is stopping you from doing your normal day-to-day things, go get some help. If you have endometriosis, period pain, are in perimenopause, or in postpartum recovery, a pelvic physiotherapist can be an important aspect of your health that may not have ever received attention.
If you are in Innisfil, East Gwillimbury, or Newmarket, and you need support navigating your hormonal health or finding a referral, I’m here to help. I also work with patients virtually across Ontario to get to the bottom of these issues.
Listen to the full episode with Sheela Zelmer here.
Sheela Zelmer is a pelvic health physiotherapist, intimacy coach, and educator in Newmarket, Ontario, which is part of the Greater Toronto Area. She works in private practice treating clients both in-person and virtually.
