Over four years in and I’ve realized that motherhood is one big decision after another. And even though I’m past choosing between home birth or hospital, breastfeeding or bottle, crib or co-sleep, it feels like there are 723 other factors I’m figuring out every single day…and maybe you can relate. My daughter’s health & happiness & headway in this world currently rely on me (!!?!), and that responsibility is both exciting and suffocating to think about.
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As a pelvic rehab therapist, one of ^^those^^ 723 things that’s constantly crossing my mind is my girl’s pelvic health. Because in both my in-person and online clinics, once we do the exam and talk about the findings, the next question is almost always the same…”but why?”. And after we cover anatomy, hormones, and other physical, mental, and emotional factors, the conversation *almost always* circles back to one place – the habits we grew up with.
I’ve seen over and over again that the well-meaning practices that are passed down, the unconscious patterns that are put in place set women up for pelvic health struggles later and actually work against their bodies in the long run. And this doesn’t just apply to my patients, I’ve personally experienced this too.
So I wrote about it. Because not only do I want our daughters to have optimal pelvic health (& honestly, most of this information also applies to sons, so my boy mamas, keep reading!), my guess is that some of these habits may be contributing to the very symptoms you’re dealing with right now too. And let me just say, the thought of setting our daughters up for success and helping you heal all in one blog post…*sigh*…someone pinch me that when I say “in office”, [this] is what I get to do.
Blame < doing better
Now before I continue, I want to be very clear about something: this blog post isn’t about blame or shame. Our moms (shoutout to my mama who reads just about every one of these blog posts!), grandmas, aunts, and caregivers all did the best they could with the information they had. They passed down what they knew, what they were taught, what seemed right at the time.
But here’s what I’ve learned from working with hundreds of women – what happens to our bodies might not always be our fault, but it is our responsibility to address it and stop the misinformation moving forward. We can acknowledge where these patterns came from without staying stuck in them. We can learn new ways of getting through the world, even when it feels weird at first. We can work on our own healing while also making sure the next generation has better facts from the start.
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We have a world full of women with pelvic floors to save, and that can start with our daughters (no matter how old they are). We’ve established again and again on this blog that “common” does not equal “normal” or “correct”, and with things like time, research, and the world wide web on our sides, we’re operating with more access to more information than ever before. [These] are the facts you’ve been looking for, and there’s no excuse not to take advantage, take accountability, and take action.
The habits that can hurt our daughter’s (& our own ;)) pelvic health
When I think of the word “habit”, my mind actually…surprisingly errs towards the positive kind – the morning routines that set your day up for success, the health practices that get you to your wellness goals, and the evening processes that lead to a better night’s sleep. But there are also bad habits, and subconscious, “I didn’t realize I was doing that” or “oh, that’s not good for me?” kinda habits too, and [those] are the ones we’re talking about today.
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Per usual, this is not about overwhelm or setting impossible expectations. My goal with posts like this is that you pick the point (or two) that resonates most with you (and/or your daughter), take action, and add from there. Some of these may surprise you, others might make you think, “oh wow…I totally do that!”, and that’s exactly the point, friend. But understanding where our patterns come from is the first step in changing them and improving or preventing pelvic floor problems.
SUCKING IN STOMACH
My guess is that I mainly have mamas reading this one, and not only is your time precious, but you likely have 18 other things on your to-do list today (same girl…same), so let’s get to what I consider to be the most important point first. Being taught to suck in your stomach is theeeeee worst habit for our pelvic health. The pelvic floor is directly connected to the diaphragm, and both structures should move with the abdomen with every breath we take – lower & expand on inhale, raise & return on exhale. When we hold in our tummies, we breathe with our chests instead of our bellies, the pelvic floor muscles get tight, and this can lead to pain, weakness, and dysfunction “down there” over time.
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Now I’m not saying that we should teach our daughters to walk around with their stomachs hanging out in front of them…posture, strength, and stability are all very, very important! But there’s a difference between engaging the core muscles (good!) and holding our breath (not so much). Breathing into the abdomen and pelvic floor is one of the first things I help patients with because 1) we often need to undo decades of sucking in and 2) things like leakage, urgency, pain, and constipation all magically improve when the pelvic floor muscles can actually move.
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So what does this look like for our daughters’ pelvic health? Well…don’t ever tell them to suck in their stomachs! And when you’re teaching them to stand up straight, model what it looks like to turn on their tummy muscles &&& keep them moving with every breath they take (if you need help with this, I’m right here!). I find this is especially important to address for dancers, gymnasts, horseback riders, and those who are involved in any other activities that preach about posture. Pelvic health really can be as easy as breathing, and it’s never too early (or late) to work on it.
GOING “JUST IN CASE”
Everyone’s bladder has stretch sensors that detect when it’s getting full. When the bladder fills to a certain capacity, it signals the brain, then the brain interprets that signal and responds by causing the bladder to “vibrate”, creating that “gotta go” feeling. Going before you actually feel the urge to pee or “just in case” (we call this “JIC-ing” in pelvic floor world) empties the bladder before it can fully fill, and this decreases the bladder’s ability to stretch over time and can result in a stronger and more frequent urinary urge.
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We’re given the ability to hold our bladders for a reason, and this function can and should be used (but not abused, m’kay!?) regularly. Going immediately at the very first urge (when FYI, the bladder is likely only about two-thirds of the way full) or before it, tells the brain that bladder filling is bad, and again, can worsen urinary urgency and frequency over time. As long as you’re urinating once every two to four hours (or around six to eight times a day), there’s nothing wrong with “holding it” up to half-an-hour after that first urge and it will safely and effectively “exercise” your bladder’s filling abilities.
So what does this look like for our daughters’ pelvic health? Once our kids are fully potty-trained, this means no more go-before-you-leave-the-house pees or might-as-well-go-because-the-bathroom’s-right-there restroom stops. Rather than force my daughter to go to the potty because it’s convenient, I prompt her to pause and listen to her body. Sometimes she goes, sometimes she doesn’t (and sometimes when she doesn’t, we find ourselves pulling over on the side of the road or running through a busy grocery store ten minutes later), but her bladder health is more important to me than convenience every single time.
USING SOAP “DOWN THERE”
There’s one pelvic health tip that gets both the widest eyes and biggest pushback in my clinic, and that’s how to clean the vulva. The vulva (or outer area of the vagina that includes the labia majora and minora, clitoris, and perineum) is full of glands, and cleansing it with soap (yes…even the all-natural, toxin-free, gentle-as-can-be, made-by-an-OBGYN feminine washes) can interrupt the body’s ability to self-sanitize and could be the culprit for the ingrown hairs, folliculitis, odor, and irritation you were using soap for in the first place.
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Because the vulva and vagina are self-cleaning structures that use discharge and mucus to decrease dirt and bacteria, water and your hand are all you need to safely and effectively wash the vulva (trust me on this!). Just fill your hand with water and splash it on and around the vulva while in the shower, or if you take baths, swish it around the area before adding any soaps or shampoos to the mix. And if you’re fancy, you can use a removable shower head on the lowest setting and simply spray away.
WARNING: If you’ve been using soap for a hot minute, it can take a few days for the body to regulate. When you stop using soap (please, for the love of all that is holy…stop using soap), you may notice a change in smell or discharge, but that should normalize and ultimately improve in about a week’s time.
So what does this look like for our daughters’ pelvic health? If yours are younger like mine and you’re still washing their perfect little bodies, then simply use the technique above to clean their vulva (we’ve been using these antimicrobial microfiber cloths on Lolo from head to toe since she’s been born, including her vulva). If your girls are older, take the time to educate them on how the vulva works, the negative side-effects of using soap, and how to do it properly for the best results.
HOLDING BACK GAS
We’re currently at the stage of life where farts are funny, but I know full well that, in the blink of an eye, my girl will be embarrassed of those cute little toots. And while I don’t think we should have zero situational awareness or go around rippin’ it left and right, gas (to an extent) is a normal part of being a human and should be let out as quickly as possible.
Not only can holding back gas cause bloating, abdominal pain, and digestive issues, but from a pelvic floor perspective, it forces the muscles “down there” to tighten. This repetitive and excessive muscle tension can cause chronic pelvic floor tightness over time and ultimately lead to bladder, bowel, and sexual pain and dysfunction. Remember…tight muscles are not a good thing anywhere in the body, and the pelvic floor is no exception.
So what does this look like for our daughters’ pelvic health? I personally don’t shame my daughter for farting because I know she’ll get that out in the real world soon enough. There is a right and wrong place to pass gas, and I want her to know that when she is around people who love and care about her, [that] is a safe place to do it. As she becomes more aware and in control of her body, we’ll start working on walking to a restroom or away from a crowd to toot, but there’s no reason to hold it in longer than necessary. Imagine if we all normalized passing gas…how much better we’d all feel *sigh*.
RUSHING IN THE RESTROOM
We’ve all been guilty of going to the bathroom “real quick”, but hurrying through urinating can lead to bladder and pelvic health issues if you make this practice a habit. Incomplete emptying, straining to finish, frequency, urgency, leakage, and even UTIs can occur when you don’t take your time in the restroom. And as I share with my patients, it’s called a restroom for a reason and there’s rarely an instance that rushing is *truly* necessary.
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You should be spending at leeeeeeast two minutes in the bathroom from start to finish. And whether that seems crazy long or ridiculously short, try setting a stopwatch the next time you go and see where you land. I’ll tell ya now…the average woman spends significantly less time than this; in fact, if I’m not mindful about my toileting practices, I can be in and out in about 30 seconds flat (she admitted with guilt).
So what does this look like for our daughters’ pelvic health? Stop rushing them (seriously…you likely have two minutes, friend). Stop using phrases like “real quick”, “will be just a second”, or “I’ll be right back” around your time on the toilet…a simple “I have to use the restroom” will do. Her (& your) bladder and pelvic health can and should be a priority, even over a busy work schedule, long to-do list, or a screaming babe who prefers not to be put down. Anyone or anything can wait two minutes for you to properly and effectively pee, and that mindset shift starts with you.
SITTING LADYLIKE
For some reason, women have been expected to sit differently than men. While baring it all to the world isn’t the best idea, your average gal doesn’t don a dress 24/7 these days, so the crossed legs or pressed-together knees are no longer necessary. When the legs are placed in these positions for prolonged periods of time, it puts the hips in extreme rotation and pulls on both the back muscles and pelvic floor. I have no research to support this, but I firmly believe that the “lady-like” way of sitting contributes to the epidemic of pelvic floor tightness and pain.
Again, for those in the back, a tight pelvic floor is not a good thing. I think of it like a fist – the hand should be able to make a fist but it shouldn’t be stuck in a fist. A hand stuck in a fist can become painful, weak, and dysfunctional, and the pelvic floor is no different. The same way we shouldn’t walk around with our hands balled in a fist (or jaw clenched tight or shoulders raised to our ears or stomach sucked in), it’s not ideal to sit with our legs clamped together.
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So what does this look like for our daughters’ pelvic health? Like all of the other pointers shared here, it boils down to teaching our girls what’s best for their bodies and modeling these methods and mannerisms ourselves. For the older ones who might have already learned these habits (again…no shame or blame!), work together to break them. For those with littler ones like me, I’m always encouraging shorts under dresses and will never be putting the words “sitting” and “ladylike” together in the same sentence.
PS – I’m not a pediatric pelvic floor physical therapist
As I wrap up a post about our daughters’ pelvic health, let me be very clear that I am NOT a pediatric pelvic rehab therapist. So these points aren’t necessarily made to help of fix complex pelvic floor problems in kids, rather to take what I know about adult pelvic health and apply it to the habits I will (or won’t) be teaching to my girl with both her current & future bladder, bowel, and sexual health in mind. But I must say, if you’re looking for a pediatric pelvic rehab therapist for your child’s toileting issues, @unconstipatedkids on Instagram is a must-follow.
PPS – There’s prooooobably more, but let’s start [here]
I’ve heard from multiple people that parenting will always have its challenges and our kids will always need us, but the types of challenges and needs change over time. That being said, I’m sure this list will grow once Lolo is older and subjects like pubic hair, menstrual cycles, and sex are part of the conversation…stay tuned!. But no matter what stage of life your daughter’s in right now, these “bad” habits are the perfect place to start. Don’t underestimate the big pelvic health results that can come from making the small changes above.
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Imagine a whole generation of women who know what the pelvic floor is, know the best life practices to prevent pelvic floor problems from starting in the first place, and can pass that same information on to their daughters & granddaughters & generations worth of women after them. No pressure, friend, but ^^that^^ all starts with us, and I’m excited to see where our efforts and intentions get us.
– Amanda
Disclaimer: The content provided here does not constitute medical advice, nor is it a substitute for personalized healthcare. I’m a doctor, but I’m not your doctor. If you have concerns about a medical condition, diagnosis, or treatment, you should consult with a licensed healthcare professional.
