There are no stupid questions when it comes to your health, but when it comes to the state of things “down there,” asking for advice can be a bit awkward. I hit up four women’s health physical therapists to answer some of the more uncomfortable, complex questions you may have about pelvic health. My hope with this post is that it not only provides information regarding some common concerns, but also that it encourages you to ask your doctor or women’s health PT questions of your own.
The first five questions are below. Stay tuned for Part 2!
Sources: Sarah Haag, PT, DPT, Entropy Physical Therapy; Danielle Duley, PT, DPT, Shirley Ryan Ability Lab; Balance Fitness for Life; Dannan Siano, PT, Viva Physical Therapy; Elizabeth Dodd-Henley, PT, OCS,
MGM: If sex sometimes hurts, but only in certain positions, what does that mean?
Sarah Haag: I’d like to start by stating that sex shouldn’t hurt – ever. If sex is painful (and it’s something lubrication or a position change doesn’t fix), it’s important to talk to your healthcare provider and get a plan that is more helpful and sustainable than having a glass of wine and enduring it. There is help so that you can have pain-free sex!
If sex only hurts in certain positions, working out why it hurts would necessitate knowing which positions hurt and which ones don’t. Depending on the anatomy of you and your partner, and the position of you and your partner in any given position, your pelvic floor may be more or less relaxed and the position of your pelvis, low back and legs may impact what you’re feeling. Some positions may increase the likelihood of your bladder or cervix being poked (which isn’t comfortable for anyone!). My advice would be to take it slow and experiment! If one position is good, start there and then try to progress into more challenging positions. If you’re not able to have pain-free sex in the positions you want, there is help! Women’s health physical therapists can help you with a plan to achieve your very worthwhile goals!
MGM: Occasionally I have to strain during a bowel movement. Could I be doing harm to my pelvic floor?
Danielle Duley: The bowel system can be complex. Many factors determine the density, quantity and frequency of having a bowel movement. Physiologically, during a bowel movement, pelvic floor muscles (specifically the puborectalis muscle surrounding the anal sphincter) are supposed to relax. In doing so, you are able to have a bowel movement. Stools change consistently based on food and fluid intake, which may cause you to have to strain to have a bowel movement. If this is happening occasionally, it is not causing harm to the pelvic floor. If this is happening on a regular basis you may want to evaluate your diet or get a consult to determine if the pelvic floor muscles are relaxing effectively. Straining on a regular basis increases pressure through the abdominal wall. This can lead to lower back pain, hemorrhoids and descent of the rectum or other pelvic organs which is called prolapse. If you think it is dietary items causing trouble, track your food and fluid intake. Your system may be sensitive to some foods, which may make stools harder to pass. You can also try using a Squatty Potty, which will help increase the rectal canal angle and may make it easier to have a bowel movement.
MGM: I sometimes feel wetness when I exercise, but I can’t tell if I’m leaking. How would I know? And if I’m not leaking, what’s causing the wetness when I work out?
Dannan Siano: Leaking during exercise is a common problem for women. Many of us have been out for a run, done jumping jacks, lifted weights or even coughed and felt ourselves leak, sometimes a lot. You may actually feel the moment that you leak. Usually you can tell if you are leaking urine by the smell and amount of wetness.This leaking is called stress urinary incontinence and can occur for different reasons, including a weak or tight pelvic floor.It is important to determine the nature of the cause before treating the symptom.
Other causes of wetness during exercise could be sweating or vaginal discharge, both of which can be normal. It is normal to have an increase in vaginal discharge following exercise. Clear/watery discharge without associated odor, itchiness or pain is normal. Vaginal discharge is the body’s way of cleaning and regulating the pH of the vagina. You may also experience an increase in vaginal discharge around the time of ovulation due to an increase in estrogen levels.
MGM: When I pee, it does not come out in a steady stream. Should I be concerned?
Elizabeth Henley: Many factors create even flow when it comes to urination but primarily the tension in the pelvic floor muscles and the amount of pressure in one chamber (the bladder) in relation to the tube carrying the urine (urethra) outside your body in combination with intra – abdominal pressure (above) will create a flow or stream of urine. If you have a very full bladder it may take several seconds for urine to start to flow fully and may take an extended amount of time to fully empty. If you have less urine in your bladder, the sensation may be diminished resulting in less pressure or desire to relax fully and void. Often times constipation leads to altered urine flow due to the pressure increase within the pelvic cavity. It is normal to stop and start urine flow before and after having a bowel motion.
Pressure around the bladder and urethra from tension or tight muscles or a smaller urethral opening all contribute to pressure or flow variations. All within normal variations of urination.
If you feel pain, stinging or burning sensations accompanying a variation in your normal urine stream, odor or dark or inconsistent color of urine, you may have a urinary or kidney infection or just be dehydrated. Check with your physician if you are concerned and report any changes to your voiding frequency or amount.
MGM: Why does my cervix sometimes feel lower? Is this related to prolapse?
Sarah Haag: Uterine prolapse is something that usually occurs in post-menopausal women who have had at least one vaginal delivery, though there are other times a younger woman could develop a uterine prolapse. If the uterus loses support and begins to descend, it’s possible you would be more aware of your cervix. However, uterine prolapse is not the first thing that pops into my head if a woman is feeling that her cervix is a bit lower than usual.
Many women don’t realize this, but the cervix changes position over the course of our cycle! During menstruation, the cervix tends to be lower and firmer. During ovulation the cervix is softer and feels higher. So depending on when you are noticing your cervix is lower, try to not panic and consider where you may be in your cycle. If you do find yourself with more questions, definitely check in with your gynecologist to make sure everything is OK!
Have more questions? Stay tuned for Part 2!