Your Pelvic Floor Reality Check

Most of us were never taught what “normal” actually looks like downstairs, so the first postpartum mirror check can feel like a jump scare. I’m Christina, a pelvic floor physical therapist and strength athlete, and I’m going straight into the anatomy most people avoid talking about: what your vagina looks like, why vaginal walls touch, and how movement is built into the design, not a sign you’re broken. 

We unpack why things can look and feel different throughout the day with gravity, coughing, workouts, pregnancy, vaginal delivery, and age and why that shift can trigger real fear around pelvic organ prolapse. I also explain why it’s rarely accurate to blame a single run, lift, or “doing too much too soon” as the sole cause of new pelvic floor symptoms. Like many overuse injuries, the full story usually includes recovery, stress, strength, and how your body is adapting to a new baseline. 

Then we get practical with pelvic health basics that change everything: how often you should poop, why toilet posture matters, and how pelvic floor relaxation is just as important as pelvic floor strength. I also dig into the messy side of diagnosis language, including diastasis recti cutoffs and how a label can sometimes create more alarm than clarity if it’s not paired with good education and a function-first plan. 

If you want calm, evidence-informed postpartum recovery guidance that supports both real life and strength training, hit subscribe, share this with a friend who needs it, and leave a review so more moms can find the show.

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Transcript

Welcome And Medical Disclaimer

SPEAKER_00 0:07

Hello everyone and welcome to the Barbell Momless Podcast. My name is Christina Fruit. I'm a public school physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in prostate, powerlifting, or weightlifting, pregnant, post-partum, or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise. Whether you're a recreational exerciser or an athlete, we want to talk about all of the things that we go through as females going into this motherhood journey. We're gonna talk about fertility, pregnancy, and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist, and know that this podcast does not substitute medical advice. Alright, come along for this journey with us while we navigate motherhood

Why You Should Look

SPEAKER_00 1:04

together. And I can't wait to get to Hello everyone and welcome to the Barbell Mamas podcast. Christina Private here, and today I'm gonna talk about your body, like your genitals. I want to talk about your vagina and what to expect if you are looking at your vagina for the first time and why this truly matters so much when we are thinking about changes or thinking about symptoms around the pelvic floor and in that urogenital system. I'm gonna start this off by saying when I came into pelvic health, now, you know, approaching 10 years ago, I thought I was coming from a pretty educated place. And I still learned a massive amount around my body. Okay.

The Anatomy Education Gap

SPEAKER_00 2:05

Embarrassing story for me. I don't know if I've said this on the podcast before, but I was like 15 years old when my boyfriend at the time's mom told me that I could pee with a tampon in. And why this is so embarrassing, obviously, we were talking about periods and menstrual cycles and stuff, but it was because I truly hadn't realized or understood that the pee hole and the vagina blood hole were different. And this is not an abnormal finding. We used to talk about a study around education in Pelvic Live that was showing that the majority of 17 to 18-year-olds couldn't identify how many holes they had in their own body. And many of them admitted to being sexually active. And so when it comes to our bodies, women's bodies, there is a huge black box around the pelvis. And, you know, another tangent I could go on is that unless you're a pelvic floor physical therapist in rehab, that black box extends into how you screen lower extremity injuries. But it is so important for us to be thinking about what this means when we're trying to make health decisions. So, first, before we kind of go in why this matters and how this helps us to make truly informed health decisions, I want to talk about a couple things around the pelvis.

Vaginal Walls Touch And Move

SPEAKER_00 3:36

Number one, I have done many, many vaginal exams at this point in my career, and I have never seen a vagina that is a hollow tube. Okay. When we look at our anatomy pictures, and this is why this matters, right? When we look at our anatomy pictures, it looks like we have the uterus and the fallopian tubes that look like they're coming off the uterus kind of like a tree, with the ovaries kind of being like the leaves, and then the stump of the tree is this vaginal tube. But our vagina, the walls of our vagina, are not cartilaginous rings. They are not stiff and structured. They are meant to move and wiggle with the body's position, with gravity, with the way our organs shift throughout the day. And that means that if you are looking up with a mirror, or if you're kind of like using your phone to visualize the opening of your vagina, whatever it might be, you are going to see that your vagina touches. And when we are thinking about that in relation to our body, and if it's the first time we are seeing this, is when we are inspecting our genitals, for example, postpartum, and you see that and you aren't aware of that, it can make it so that it feels very alarming. Feels very alarming. The second part that I want, so one, our vaginal walls touch. Two, our vaginal walls move and they are supposed to move. So when you cough, they move down. We say caudal or towards the tail, um, which is towards our tailbone. And they also move throughout the day, right? I always joke with my clients, there is a reason why you take your sexy selfie pictures in the morning before you've eaten, drinken, drink, and after you've gone to the bathroom because you feel our leanest. And then as we go through our day, we get a little bit more bloated. Our body feels a little bit more um or less lean and our body gets shorter because with gravity, our discs take water out of them and we actually are tallest in the morning. And our body changes throughout the day with gravity, and then it kind of resets at night when we sleep. And this is true of our vaginal walls as well. And so if I'm evaluating you first thing in the morning when you haven't really done a lot, haven't done a lot of standing, haven't done a lot of movement throughout the day, you will have one range. And then towards the end of the day, or if I see you after a workout, our body will have responded to that and our vaginal walls will move more. That is a normal thing to happen. We also know that that movement increases with pregnancy, vaginal delivery, and with age. And so, one, that vaginal wall movement can start to approach the outside of our body, which is kind of where that prolapse diagnosis comes in. Um, but it can also be that our body has to become accustomed to a new normal. And that is what can really uh freak women out when they're in that early postpartum phase, right?

Postpartum Sensations And Prolapse Fear

SPEAKER_00 6:59

And so part of the things that I talk to my clients about in pregnancy is hey, what you're gonna notice towards the end of your pregnancy and in your early postpartum period is that you're gonna feel more movement down there. And that can be really alarming. And it can feel like tension because you're trying to resist against that new change of movement. Part of that is early healing, and it can feel like there's just like a lot of like dragging and blood flow around the opening of your vagina. For some people, like that becomes more significant, but for the vast majority of people, um, it does kind of your body does get used to that change in range and you kind of adjust as part of your healing process. And then if you are having a hard time adjusting to that range of motion or you're starting to feel a lot more uh symptoms or sensations around that movement, that's when we'll go in and deep dive into a bit more rehab, um, more intensive rehab when it comes to your kind of recovery. And that can be, you know, people all of a sudden feel that sensation after menopause or whatever, like that vaginal wall range of motion change that does happen with life. Um, it can sometimes hit just like critical thresholds where it was moving like this for a really long time, but all of a sudden your body became symptomatic. And I say that because we don't have any research that talks about your vaginal walls that permanent change in vaginal wall range of motion, other than birth. Like your workout is not causing irreparable changes to your range of motion. And it sometimes is just like an overuse injury. Like it wasn't that pull-up workout that hurt your shoulder. It was all of the rest, recovery, stress. And eventually that one workout was when it finally, you know, your body was like, I can't handle this amount of stress that you're putting on my shoulder anymore. I'm gonna send you a pain signal. Um, the same thing can be like conceptualized or thought about in the pelvic health space. And I harp on this because oftentimes people will blame, like, I went on a run too early, or I did a biseclone workout at two weeks postpartum, or I was told that I did too many deadlifts, you know, 12 months postpartum, and now all of a sudden I'm symptomatic. And they kind of blame one type of exercise or kind of blame their behavior. And it's it's way more multifactorial than that. Yes, exercise may be something where it's a precipitating event where you feel it after, but I just have a hard time believing that it's like one event outside of vaginal birth that that can kind of lead to some of those changes.

Poop Frequency And Toilet Position

SPEAKER_00 9:43

When it comes to the ins and outs of our urodenital system, we should be pooping every day, right? If the odd day, you don't poop in a day and it's every other day, that's okay. But if you are waiting three or four days, five days, I even some of my clients who are over the age of 65, people have told them every five to seven days is okay, incorrect. I do not prescribe to that narrative that pooping every five to seven days should be considered your normal. Um, and when you are pooping, having your hip crease um in a uh more flexed position or knees over your hip crease ideally is probably the best position for you to poop. And for my um older clients who sometimes use raised toilet seats or really have really high toilet seats in their rooms, um, this can be tough because they are actually putting themselves in a really tough spot to poop and straining, which can be really tough on the pelvic floor, especially if the next part, which is that your pelvic floor isn't relaxed when you are peeing or pooping, I think is really important.

Pelvic Floor Relaxation Vs Kegels

SPEAKER_00 10:52

When we think about our pelvic floor, it's often not until something goes wrong with the pelvic floor, your pregnant postpartum, that even the idea of like kegels in the pelvic floor becomes a topic of discussion. Um, the pelvic floor is a muscle that works within the system, that is our effort system, and it has isolation functions where it can, we can take it under our mind's control, volitional control, and it can contract or we can try and facilitate its contraction at the right time or at the right um, trying to increase strength of that muscle. And so when your pelvic floor contracts, either just low grade contraction or we're like really trying to squeeze it, um, that is when we don't want to be peeing or pooping. And then our pelvic floor relaxes when we want to be. And our pelvic floor needs to relax in childbirth as well. And it's something from a birth prep perspective that I have mentioned a lot with regards to many of my athletes who are very used to closing their holes in high effort, right? And that's not just lifters, right? Runners too, and other, you know, uh multi-sport athletes. But you need to learn to relax your pelvic floor. And this is where kind of the anti-Kigo movement in birth has come from is this understanding that the pelvic floor needs to relax for childbirth, except that pelvic floor strengthening in pregnancy is not advocated from a birth prep perspective. It's advocated from a prevention of stress urinary incontinence perspective. So the interpretation has been a little bit um, it's a little bit more nuanced than that. And I truly believe that my clients can contract their pelvic floors when they need to contract them and can learn to relax them during pregnancy and that one isn't damaging or are causing um issues with the other. So things we've kind of talked about already. Vaginal walls touch, they change with age, stage, symptomal injury, they move throughout the day and they increase the amount of movement in our um in our day and with activity. We have three holes with my embarrassing story of not realizing the pee hole and the baby hole were different when I was younger, right? We know about our ins and outs where peeing and pooping, pelvic floor is relaxed. When we are contracted, that is when we are trying to not pee and poop. We should be pooping every day, ideally, or every other day at the um lower end. Um, people sometimes poop more than once a day. That's okay too, as long as they aren't like struggling with uh diarrhea or something like that or having urgency. And then that pelvic floor relaxation that is required for peeing and pooping is also required for childbirth. So a couple of things that we've just kind of oriented to the pelvic floor. I've kind of already alluded to this next step about why this matters. When we are trying to make health decisions, right? And we are talking about things like prolapse or we are talking like about things like diastasis rectus abdominis, um, that lengthening of the linea elbow muscle, I think these are two areas where you we have to recognize two things. Number one is deviations from your normal. And two, kind of when we slap a diagnosis of diastasis recti or prolapse on a person. The diagnosis piece is when I'm talking to clinicians. The new normal piece requires us to have an understanding of our previous level of function and how our body was responding before. So I'm gonna talk about both. Let's talk about the

Diastasis Recti Diagnosis Gets Messy

SPEAKER_00 14:36

clinician piece first. There is a very big conversation happening in the academic and medical spaces specifically about these two diagnoses. And the reason why is number one, diastasis recti has a current diagnosis of on a headlift, on an active contraction of the abdominal wall, greater than a one-inch difference, or roughly two fingers between the two rectus, six-pack muscles, coming together at the top of the movement. The difficulty with this, or let's take a next step. The reason why this was seen as an issue is number one, it was looked at as something that changes around pregnancy and postpartum, right? With a recognizing of the abdominal wall lengthening to make room for a baby in the second and third trimesters as baby comes out of the pelvis and into the abdominal content and organs out of the way that like grows that is different postpartum and may be a change that women experience from preconception to new postpartum body. So we've kind of had to slap uh what what difference are we looking at here? And two finger breadths was like kind of the first iteration of this. However, with diastasis recti, the original belief was this idea or hypothesis, which is part of the scientific method, right? You have to generate a hypothesis, is that this could be a way to assess a person's risk for things like persistent pelvic girdle pain and urinary incontinence postpartum, because these are also things that show up in the postpartum period. And what we have seen and what our data is now showing is that for every study that looks at diastasis recti and urinary incontinence and finds a positive association, there's another one that doesn't find an association at all. And so we we kind of had to go back to the drawing board. And if I had to take a guess, right, what we can see is that there's a weakness, underlying confounding variable that could respond or show up in both of these issues, and is more common postpartum as your body is uh adjusting and regaining strength in the postpartum period, right? Where some of Nicole Beamish's work is saying that diastasis recti, one of the modifiable factors is rectus weakness, six-back weakness, and oblique weakness. So kind of re-establishing that deep core and flexion extension strength. And um, weakness around like the glutes and pelvis, et cetera, is also a known risk factor for more significant and persistent pain when it comes to like pregnancy and pelvic girdle pain. So weakness can be an underlying consideration for both, and could understand you could understand why that relationship may seem like it exists, but really the I hate using the word root cause because I feel like it's so weaponized right now, but the root cause is actually the weakness of in in this the effort system in general, right? And so that was kind of like where that first thing came from. The second piece that's really important is that we never looked at um severity of symptoms with different uh finger breadth distances and understanding if the two-finger breadth is a good cutoff score or not a good cutoff score. Right. And so there was a study that was done on a urology clinic. So they weren't coming in for anything related to the abdominal wall, and they did a classic like headlift assessment of your batch or your rectus distance, and they showed like 50% of people had a two-finger breadth difference between their rectus muscles. And we see this in kids, like newborns have like coning, my older adults, like there is, especially if they have more central waking, um, have bigger distances between those two rectus muscles on a headlift. And it really like calls into question like, is this a sign of pathology? And I'm kind of finger air quoting um, to slap a diagnosis on people. That's one part of the equation, because we may actually be diagnosing somebody with something that's wrong. And again, I'm like kind of air-quoting this air wrong when really it is very much within normal ranges, right? The second piece to that, and I want to be sensitive to this, and this is gonna be really important in the prolapse conversation, is that oftentimes education begins when the diagnosis is given. And

Labels That Create More Alarm

SPEAKER_00 19:41

especially around prolapse, where this very similar conversation is happening, where vaginal wall range of a stage two is now very much being advocated as normal range of motion. And a lot of people have pushed back on me and said, like, Christine, like I have prolapse of like, and it's not about that. It's about when the the label gets slapped on you. And when we think that we have a dysfunction on something that is very much a normal range, it can also create its own sense of sensitization, right? Where we think that there is something wrong with us when really there isn't. Um, and but the other piece of it is that oftentimes an understanding of how your body changes in a feeling like my symptoms or how I'm feeling within my own body are described well with this diagnosis. It is not meant to take that away. And understanding, you know, how your body has changed postpartum and why you might be feeling these changes in symptoms, doesn't need a diagnosis, right? It needs an understanding provider that is going to explain to you why you're feeling this way, validate your experience, and then help you to wiggle around your new range of motion or create a care plan with you. Um and so we see this too, right, in shoulder pain. Like if you had a partial tear of your rotator cuff, we are seeing you're seeing a provider to manage your symptoms. And the expectation isn't that we're going to reattach that muscle that has a partial tear in it, right? And so the same thing is true often with prolapse is like we're trying to allow your body to feel strong and supported around this change in how your body feels in that postpartum period. And the goal isn't to reverse that range of motion, though, you know, some evidence can support that pelvic floor muscle training can a little bit um mitigate range of motion. And I think that's that's kind of a strained conversation which I've had in the past on the podcast. And so this conversation becomes really multi prong, right? Around are we diagnosing people that have normal variation with something that is considered dysfunctional? And two, how do we change where those buoys are? But understand that this is a change from baseline for the human that we are working with, the mom who that we are working with postpartum, and not say this in a way that is dismissive to the way that they are feeling in their body. When it comes to this understanding of your own anatomy, why I talk about how important this is is that oftentimes people don't know what their vaginal wall range of motion was until they pop that baby out. Like it may not have changed, or maybe it only changed five or 10%, but you never looked. You didn't have any kind of baseline. And so it feels very alarming that something that you weren't noticing before is something you are noticing now. And in pregnancy and postpartum, when we talk about pelvic girdle pain, for example, Chinee DeFor is an incredible researcher out of Big Master. And she says in almost every case, there is some amount of heightened sensitivity to the pelvis. And I could not agree more, right? Because our body, when we become pregnant in postpartum, it literally rewires to pay attention to this growing baby inside, right? Like it really does re-change, like it just changes our thought process. And so we are spending a lot of cognitive energy, like thinking about our bellies and thinking into our pelvises. And so when something feels abnormal, it is very easy for that to take up a lot of our mental space. And it is supposed to, right? Because our job is to protect baby. But what it can do is it can flip into this heightened sensitivity to any change and it can create this sensation that is hard to ignore. And so understanding that and understanding, you know, what your anatomy is, what your anatomy should be, and what your baseline is, is one way to understand that changes that happen in pregnancy and postpartum to allow yourself to recalibrate when symptoms arise. And it's just such an important part of sexual health, pelvic health, pregnancy and postpartum education. I'm thinking about it with my kids and how my son and daughter know that, you know, a girl has three holes, boy has two holes, and doing this age-appropriate layering, even with them, so that they do feel like they're informed, like consumers of health information about their own bodies. Um, and and they are less likely to have these like threat responses to information because they don't know what a normal is, or because they don't understand the the way that their body functions. And so, you know, they can um they can have a hard time processing information that seems like it's it's a big shift away from what their normal

Preemptive Pelvic Health Education

SPEAKER_00 24:56

is. This is something that I've been thinking a lot about when it comes to my own like treatments of individuals. Um, I treat a lot of pregnant postpartum moms, and um, women who come in really do feel like they oftentimes are coming in for the first assessment as like a I have all these questions. And is this normal is such a front of mind conversation in pregnancy and postpartum. And so, how can I tackle that early? I did a reel on this is how your body is like five facts about your downstairs. And I think that information, getting that information out to the masses is gonna be really important. And so I'm excited for this podcast to get released because I think it's a part of that preemptive education. And there's even conversations now about how to do this pre-conception. Like, how do we get this information about how your body is gonna change? Like, I think we talk a lot about how the belly is gonna change. Like there's that expectation how your boobs are gonna change if you decide to nurse, and even if you don't, um, how pregnancy and postpartum can just change breast tissue. But the idea of like, how do we really layer in the pelvis as well, so that a lot of people don't feel like I wish somebody would have told me. And so this podcast is uh me telling you in the preconception window. All right. I hope you all found that helpful. Please let me know if you have any other questions. Um, I will see you all next week. Um, I have an idea about what already about what I want my podcast next week to be, and cannot wait to to chat again. Talk soon.