Everything You Were Never Told About Your Pelvic Floor

Let me guess: at some point, someone told you to do your kegels. Maybe your OB mentioned it at a prenatal visit. Maybe you read it in a pregnancy app. Maybe a well-meaning friend brought it up after her own birth.

And maybe you did them for a while, weren't totally sure you were doing them right, and then kind of forgot about it.

That's the extent of pelvic floor education most people receive. And it is so wildly insufficient for what your pelvic floor actually goes through — during pregnancy, during birth, and in the years that follow.

I sat down with Dr. Sara Reardon — board-certified pelvic floor physical therapist, author of the bestselling book FLOORED, TED presenter, and the person the internet knows as The Vagina Whisperer — to have the conversation that should happen at every prenatal appointment but almost never does.

Your pelvic floor isn't just for after something goes wrong

Here's the reframe that I want to lead with, because I think it's the reason most people skip this topic until they're already struggling: pelvic floor care is not damage control. It's not something you think about after you leak when you sneeze, or after sex is painful, or after you feel pressure where you shouldn't.

It's something you build awareness of before — during pregnancy, ideally — so that you arrive at birth more prepared, recover more fully, and don't spend the next decade managing symptoms that were preventable.

The earlier you start, the more resourced you'll feel. That's the whole point.

What your pelvic floor is doing trimester by trimester

Your pelvic floor is a group of muscles, ligaments, and connective tissues that form the base of your pelvis. They support your bladder, bowel, and uterus. They're involved in core stability, sexual function, and continence. And during pregnancy, they are working harder than they ever have.

In the first trimester, hormonal changes — particularly relaxin — begin loosening the connective tissues throughout your body, including your pelvic floor. This is necessary for birth. It also means your foundation is less stable than usual.

By the second and third trimester, you have a growing baby, placenta, and increased blood volume all putting downward pressure on those same tissues. Your center of gravity shifts. Your posture changes. The demand on your pelvic floor is significant and constant.

And then birth happens — which is, depending on how it goes, either a prolonged pressure event or a surgical recovery, and sometimes both.

What this means is that by the time you're postpartum, your pelvic floor has been through a lot. A six-week clearance that doesn't include any actual assessment of that structure is not a real clearance. It's a formality.

The kegel conversation we actually need to have

Kegels — pelvic floor contractions — are not bad. They're also not the universal answer they've been made out to be.

Here's the part most people don't hear: for some people, the problem is not a weak pelvic floor. It's a tight one. A pelvic floor that's holding too much tension, that can't fully relax, that's been in a guarded state for months or years.

For those people, doing more kegels makes things worse. The symptoms — leaking, urgency, pain, difficulty with penetration — can actually intensify when you add more contraction to a system that already can't let go.

This is why assessment matters so much more than generic advice. You need to know what your pelvic floor is actually doing before you can know what it needs.

Coached pushing vs. letting your body lead

This is one of the things Sara and I talked about that I think gets almost no airtime in birth preparation — and it should.

The traditional model of coached pushing — chin to chest, hold your breath, count to ten, push — is not evidence-based for most people. It places enormous, concentrated pressure on the pelvic floor and perineum in a very short window.

Allowing the body to lead pushing — following the urge, breathing the baby down, working with your contractions rather than against them — tends to result in fewer perineal tears, less pelvic floor trauma, and a recovery that starts from a better baseline.

This is worth knowing before you're in the room, because once you're there, the culture of the environment often takes over. Knowing what you want — and putting it in your birth preferences — gives you a better chance of getting it.

Perineal massage: what actually works

Perineal massage during pregnancy — specifically in the final weeks — has reasonably good evidence behind it for reducing perineal tearing and episiotomy rates, particularly for first-time birthers. Sara walks through how to actually do it correctly, because the technique matters and most people are either doing it wrong or avoiding it entirely because nobody ever showed them.

The short version: it's less about massage and more about gentle stretching and increasing tissue awareness and tolerance. Done consistently in the last four to six weeks, it can make a real difference in how your tissues respond during birth.

The first 72 hours postpartum

Nobody tells you what to actually do in the immediate postpartum window for your pelvic floor, so here's the practical version:

Ice. Cold reduces inflammation and can significantly decrease pain in the perineal area in the first 24-48 hours. Do it even if you don't have a tear.

Rest horizontally as much as possible. Gravity is not your friend when your pelvic floor is freshly postpartum. Time on your feet — especially extended time — adds pressure to tissues that are trying to recover.

Gentle reconnection. Not kegels yet — just awareness. Can you feel that area? Can you gently breathe into it? This is about re-establishing the neural connection, not building strength.

And please, don't push to have a bowel movement. Use stool softeners, stay hydrated, eat fiber, and let it happen on its own timeline. Straining postpartum is one of the most common ways people create or worsen pelvic floor issues.

Why the six-week clearance isn't enough

The standard postpartum appointment at six weeks involves a brief visual check of your incision or perineum, a conversation about contraception, and a general sense of how are you doing?. If nothing looks overtly wrong, you're cleared for everything — sex, exercise, all of it.

What it almost never includes is any actual assessment of pelvic floor function. Can those muscles contract? Can they release? Is there prolapse? Is there scar tissue affecting mobility? Is the coordination there?

Six weeks is also, frankly, early. Many people feel cleared before they feel ready — and then wonder why resuming exercise or sex is painful or uncomfortable. The answer is often that the timeline was based on a standard, not on their actual recovery.

You are allowed to ask for a pelvic floor PT referral. You are allowed to wait longer than six weeks. You are allowed to decide that cleared on paper and ready in your body are not the same thing.

When to see a pelvic floor PT — and the answer might surprise you

The answer is: during pregnancy. Not after something goes wrong. Not at the six-week visit. During pregnancy, ideally in the second trimester, so you have time to build awareness, address anything that's already showing up, and prepare for birth and recovery with actual support.

If you're already postpartum and reading this — it's not too late. Pelvic floor PT is beneficial at six weeks, six months, six years. The body is remarkably responsive when given the right input.

Symptoms that warrant a visit: leaking of any kind, pelvic heaviness or pressure, pain with sex, difficulty with bowel movements, low back or hip pain that hasn't resolved, a sense that something doesn't feel right even if you can't articulate it.

Symptoms that don't warrant a visit: none. You don't need a symptom. Prevention and education are reason enough.

You don't have to earn care by suffering first

That's really what this conversation with Sara comes down to. The pelvic floor is not a part of your body to ignore until it causes problems and then frantically manage. It's a structure worth knowing, worth tending, worth understanding — through pregnancy, through birth, through postpartum, and beyond.

You've been told to do your kegels. Now you know that's not the whole story. And knowing the whole story means you can actually take care of yourself.

Listen to the full episode with Dr. Sara Reardon on The Be Well Baby Podcast. Find her book FLOORED, the V-Hive App, and her work at @thevaginawhisperer on Instagram and TikTok. And grab our free Postpartum Essentials Guide!