Pelvic Floor Pain & Core Dysfunction: Why Kegels Aren’t the Answer

Why Pelvic Floor Treatment Takes So Long – Breaking the Silence

Joe Lavacca:

Right, right. And, you know, one of the things we wanted to ask you – I think it kind of builds off of this – it’s probably true for both men and females, but it just seems that it takes so long for men and or women to find treatment. So why do you think that is? And maybe what can men and or women look out for to get help sooner?

Lauren Ohayon:

I think if you’re under this idea that, like, this is just what happens to you as you get older, you’re not going to go get help for it. And then when you go – like, this is what so many of my clients tell me – when they go to their doctors with concerns about their pelvic floor, this is what they’re being told, including my male clients. Like, maybe you should go see a physical therapist for that.

I specifically – the surgeon called me yesterday about my husband’s ACL recovery and I said, oh, we’re now day two post-surgery. Is today the day he’s supposed to start flexing his knee? And he was like, I have no idea. There we have it. This is like Miami’s leading surgeon. The Miami Heat and the Dolphins all use him. He’s got like signed shirts on the wall. We are all so much in the hole of what we do, right? These surgeons – he’s phenomenal. I feel like I do expect them to know the answer to that question. That feels like a question you could answer. But that’s where we’re at.

So I think that like what takes a long look – I think with the pelvic floor, especially whenever I teach a group of women and I’m like X amount of women have pelvic floor dysfunction, the floodgates open and everyone’s talking about their pelvic floor issues. But like ten minutes earlier, no one was willing to admit they had a pelvic floor issue. But the minute I’m like, I’m sure almost everyone in here has one. So just somebody talk about your pelvic floor issue. One woman will raise her hand, and then the whole room erupts. Suddenly we go from zero people in the room with an issue to basically 99% of the women in the room wanting to share their issue.

We’re not – there’s just not this invite to talk about these issues. It’s embarrassing to a lot of people. And when people continue to say things like, do you have pain down there? I’m like, fucking define “down there.” The nurse at the hospital was like, to my husband, if you don’t pee, I’m going to have to put a tube up your peepee. I was like, by peepee, you mean his penis? Literally. The floor went quiet. You’re in a hospital where people can’t say the word penis. Just tell him it’s a tube up his penis. Why are you using the word peepee? There’s no such thing in the human body called peepee.

So I think, you know, I always joke – I’m like, I just want people to be more clitoral. And I think that clitoris leads to self-advocacy. Like when you feel safe enough to talk about a body part like it’s no big deal, then you feel safe enough to start asking for help, not the other way around. So we need to start with education. We need to start with people feeling safe in their bodies. When you feel safe in your body, you’ll go get help for your body because you feel safe in it and you want to protect it. And you’re one with your body.

Joe Gambino:

That’s a very fair point. What do you think – for somebody who maybe is in that boat, so to speak, what would be your advice for them? I feel like there’s also a lot of people who don’t even understand that like pelvic floor is something they can work on or go seek help for. So what – if someone’s listening to this, what should they be thinking about? Like, hey, maybe this is an actual problem for me. And where might they go to reach out to get the support they need?

Lauren Ohayon:

Yeah. And I think that if we can rebrand the pelvic floor as your core – like, how about we just lump those two together – then there’d be a lot more incentive to get help or maybe seek understanding. But I think that also understanding that like there is this canister system in your body and it starts with your ribs and your breath, but the ribs are connected to your spine. So actually our spine is involved. Right. So now we’re talking like ribs, breath. Because it’s a pressure system. This canister is managing pressure all the time.

So if you’re experiencing something in your pelvic floor at the base of the system, how about we start looking further afield up the system to see what else we can optimize? A lot of people are really constricted in their breathing. Their ribs don’t – their belly breathing is – so many places in the fitness world talk about belly breathing and I’m like, why? Your diaphragm is in your ribs. Like up here. Your heart sits on your diaphragm. Like it’s that high up and it attaches your diaphragm to your spine. Like, why are we talking about the – people are like, breathe into your diaphragm, and they’re touching their belly. Right?

So there’s all these people doing all this movement in their belly. And if you try it – if you actually try to do nothing but move your belly on your next in-breath – the only way to do that is to lock your ribs down. There is no other way to do that. You have to close your ribs and lock them. You have to immobilize your ribs to move your belly. That’s how most people breathe now.

Or you walk into a porta-potty and it smells like – and your body doesn’t consult you, and it just helps you survive the 45 seconds you need to be in there. Well, what if your life smells like that, right? All of us, at some point in our life, go through a porta-potty moment. Our body creates these patterns to cope, and that coping is usually a constriction of that core canister. So like, we’re just really used to constricting our core canister. And I think that when you over-squeeze your core canister, the more you over-pressurize your pelvic floor, and the more you over-pressurize your pelvic floor, the more tight and tense it can be in response. Because your body is smart and it’s adaptable and it’s adapting to that load.

The simplest thing you can do when you’re thinking about your pelvic floor is: how can I optimize abdominal pressure? Which is very nerdy sounding, but instead of thinking about localized treatment to the pelvic floor in the form of contract, release, contract, release – how about we think about getting the pelvic floor to be responsive and adaptive again by creating mobility and opening through the ribcage, the breath, changing this pattern from belly breathing into more thoracic breathing, and spine mobility?

So I think the first thing is understanding that if you’re having any sort of pain with intercourse, pain post-intercourse, pain with orgasm, difficulty reaching orgasm, even low back pain, deep hip pain, pressure in your vagina, feeling of just totally disconnected from your perineal area – which affects males and females – those are signs of possibly over-pressure. And leaking – if you leak any amount, it’s actually not that normal, but it’s common. And let’s have a look at your pressure system.

It could be that the structures are in fact more weak. Right, like especially for women going through menopause, loss of estrogen can lead to the muscles getting weaker. But that doesn’t mean there’s nothing you can do about it. And that doesn’t mean that kegels are going to solve your problem.

So looking further afield, we can also see that deep glute pain, deep hip pain, and low back pain can often also be a reflection of the pelvic floor or the pelvic floor and core being way too pressurized. Like the pressure is just accumulating there. And we see people gripping through their low back. But when you’re gripping through your low back, you have to grip in your pelvic floor – they are that connected. They’re not separate.

So, you know, a lot of women who wear like shapewear, postpartum binds and corsets – like the pressure is going to go somewhere when you lock down the center of your body. We have to expect that the pressure is going to go somewhere. And so again, people might be feeling it in their low back and not want to believe that their pelvic floor is involved because they’re not leaking when they cough. No. Your pelvic floor is most likely involved when you are bracing through your back, when you’re tightening and tensing.

So I would say that even people with tension responses – just really held in a position where there’s not this fluidity through the spine – we can expect that the pelvic floor is in a state of over-pressure. Does that mean they’re going to have symptoms now? They might not have pelvic floor symptoms. But when you optimize the core canister you optimize the pelvic floor. So in my programs I don’t actually ever talk about the pelvic floor. We don’t do any kegels. We just optimize the core, the spine, the breathing, the ribs, the mobility of that canister – and the pelvic floor is suddenly taken care of. It just starts doing its thing.

Joe Lavacca:

You know, hearing you explain that, Lauren, it makes a lot of sense. And how these sorts of issues around the pelvic floor can affect movement elsewhere in the body – mid-back, hips, right. And then if we start to extrapolate that a little bit more, well now we’re kind of looking at maybe global patterns. We’re talking squats and deadlifts and gait and all these other different things.

And we know that you’ve worked with Dr. Diana and Dr. Courtney, who’ve both been guests on the show. And it sounds like this optimization of the pressure system, or bringing yourself back to breath, is again a big swing from maybe what people are thinking with kegels and strengthening, clenching. Right. So that’s such a great tip for people to walk away with. And sort of understand that it’s not always about adding – maybe it’s a little bit more about subtracting. And I don’t have to get this manual input, which I also probably think is relatively uncomfortable for men and women to think about as treatment.

So I was wondering – through your studies and your research and working with Diana and Courtney – if bringing maybe breath or controlling pressure through the system, are there one or two other tips that we can share with listeners to help them also optimize pelvic health?

Lauren Ohayon:

Yeah. I think that – I loved the work I did with Courtney, and Courtney, as you both know, is Doctor Courtney. I think that it’s impossible that any pattern in your core, which is your pelvic floor, is not probably also a reflection of what’s happening down the chain. Now, again, does it mean that it’s a dysfunctional pattern? No. I hate the word dysfunction. I love to think of the body as just an adaptation, like a series of patterns that form because we’re all so spiral and the way the body moves is like absorbing force, right? Like we absorb force, we offset force, like shock absorption. And so there’s no way that the feet are not involved in that.

And I think that sometimes it’s really hard for people to access their core and pelvic floor. And one beautiful way in is to start accessing your feet. And it’s not about, oh my God, no wonder you have a prolapse – you’ve been wearing heels your whole life. We should never make a client feel guilty about their life choices. It’s more like, okay, maybe it’s triggering to access. Maybe you’re struggling. Like there’s a disassociation here in your core and pelvic floor. How about we play with your feet a little bit.

And then people are like, oh my God, I never noticed I had flat feet. Right. Okay, cool. You have flat feet. Doesn’t mean anything’s wrong with you. You’re not broken. How about we reintroduce the arch a little bit and see what that’s like. And then they’re like, reintroducing the arch, and then they’re noticing, like, my legs are rotating as I reintroduce my arch. Yeah. That’s cool. Did you know that as you rotate your legs, it actually creates a rotation up in your pelvis?

Like, did you know that we could actually do these five exercises for your feet and create really positive outcome in your pelvic floor? I think we need to assume that any time we’re creating three-dimensional movement from the feet to the head, and it’s intentional and mindful, it’s going to affect your pelvic floor. Right? You don’t need to lay in your bed and do 50 kegels. You could actually just play with your toes a little bit. Rotate your legs a little bit. Do a little bit of internal and external rotation. How about that?

I do think that for people who are really suffering with a pelvic floor injury, some more isolated work on dialing in on breathing mechanics makes sense – not because there’s one good way or bad way to breathe, but when we do different, change happens. So just do different. So dialing in on patterns is useful because it’s a different input. And yes, it’s fun to be curious and move three-dimensionally and be flowy and move your toes and play with everything. But also isolating out skills – skills are fun. Learn some skills with your body and your pelvic floor will likely benefit from that too.

But if you really do have a pelvic floor injury, seeing somebody who works with the whole body and does chain work – pelvic floor to whole body – is a great idea as well. Like integrating feet to pelvic floor to core to breath through the spine, the ribs – the arms have something to do with the shoulders, right? Like you’ve got to kind of get everything doing a little bit of movement in a lot of places. This is a great idea for the pelvic floor. A little bit of movement in a lot of places really, really helps the pelvic floor. And unfortunately, a lot of our clients have a lot of movement in just a few places. So that’s kind of like how when I assess a client, I’m like, oh, where are they really good at moving? What’s kind of stuck?

And I’ve seen thousands – I mean, I have over 15,000 people subscribed to my programs and we hear amazing success stories every day. And it’s all done without kegels. And it is integrating like the feet all the way up. So I send people to Courtney all the time when I feel like I think you could use a little bit more skill work in your feet – let’s hone in on what’s happening in your feet a little bit more. See if that helps up the chain.

Joe Lavacca:

Yeah. Super interesting. So I don’t think people are expecting to hear like breath and foot work. And I like what you said about a little bit of movement in a lot of places. Again, I think all of that stuff seems very, very approachable, and I hope listeners are able to kind of take away a few bits of that. So that was great. Thanks for that.

Lauren Ohayon:

Thanks. Yeah, I got in big trouble when I first started on my soapbox about the pelvic floor. I was like, why are you looking at kegels? Why aren’t you looking at breath first? And now I see all sorts of pelvic floor therapists talking about breath and the role of the pelvic floor. But like back then, this is going like 20 years ago – all of the Brooklyn pelvic floor therapists were like, we do not. She’s talking about the breath and you should be doing your kegel. And I was like, no, you should be optimizing your core canister and looking at your breathing patterns. They did not like that. Now it’s very, very widely accepted. But back then it wasn’t.

Joe Gambino:

Yeah, I always think like with anything, a holistic approach is always the best way. So nothing works by itself in a sense. But I’m curious – I mean, I know you kind of work globally and that helps the pelvic floor. But have you seen maybe any specific examples where you go through all of that and you have to like specifically target strengthening through the pelvic floor, whether it’s kegels or some other way to get that area stronger? In a sense?

Reconnecting with the Pelvic Floor: Body Mapping and Embodiment

Lauren Ohayon:

Absolutely. But I would say that my way of getting people to strengthen is – I work in a kind of a different way. I first make sure that people are mapped to their pelvic floor. So like it’s really easy with your hand, right? Like you can see your hand and feel your hand. And I could even tell you with your eyes closed, I could talk about all these scenarios and you would know exactly how your hand would feel in that scenario. Pick up a glass, grab a baseball, pick up a pencil, pick up something cold. You know like you don’t need to do it to have that full knowing.

Now we talk about the pelvic floor and people – it’s like there’s zero mapping. No point of reference, no ability to describe what it does when it does what it does. Like what is your hand doing when your hand does what it does? You know, you feel you have a knowing on multiple layers of your brain. Pelvic floor? People are like, I don’t know, I can stop my pee if I have to. I can do that. That’s like their frame of reference. Think about that.

And it’s partly because it’s not a hand, it’s not a leg, it’s not a swinging limb. It’s not appendicular. It’s axial. So that changes things. But yet – axial. You can do a lot of cool things with your spine. I could talk about your spine, cat and cow, roll over a ball, do a Roman chair, and you know, like you can embody that without doing it. You can have it and you can have this sense on multiple layers of your brain. You can feel it, you can taste it, you can see it. You know how your spine feels in that shape. You know how your spine feels against the bed. That’s a lot of knowing. That’s a lot of GPS happening. People have no GPS to their pelvic floor. None. And then we’re like, let’s work on strengthening it.

And they’re like, okay, my PT told me to squeeze my pee mid-pee. I’m like, okay, can you wag your clitoris? And they’re like, I don’t even know. And some people are like, I don’t even know where that is. Right. So it’s like, can you move your clitoris? Did you know that your clitoris has this function that it can move? It can nod. Nope. Didn’t know that. Did you know that your tailbone can move? It’s not a big movement, but your tailbone can move. There are a bunch of muscles attached to your tailbone. It moves, right? So now we’ve got from the front – clitoris can move. From the back – tailbone can move. How about we get that happening.

That’s an amazing cue. Like better than a kegel right there is accessing that. How about your sitting bones? Did you know that your sitting bones – you can actually widen and narrow them? Get people moving from their sitting bones. Lie on your back, narrow your sitting bones. That’s going to pull you into a posterior tilt. Widen your sitting bones and that’s going to entirely tilt you. But I’m not using that language. I’m not saying posteriorly tilt your pelvis. No. I’m dropping people into the bones of their body. And so I love to drop people out of vague instruction – contract this, squeeze that – and more into feeling your anatomy. And it gets you into the same muscular action without speaking muscle to someone.