Why Kegels Aren't Always the Answer
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Maya came to me frustrated and a little embarrassed. She is 51, and she has been a runner her whole life. Then she started leaking on her runs. Then came a heaviness she couldn't explain, and pain that made intimacy something to avoid. Her knees and hips ached too.
Everywhere she turned, she heard the same thing. It's normal after kids. It's just aging. Do your kegels. So she did them, faithfully, for a year. It got worse.
What no one had told Maya is that her pelvic floor was not simply weak. In her case it was too tight, while the muscles meant to support it had gotten weak. She was doing the one exercise that made her feel worse.
Maya is not unusual. She is a pattern. So on this week's episode of Endocrine Matters, I sat down with Dr. Alexis Shoope, an orthopedic and pelvic floor physical therapist, to talk about what standard care keeps missing in women's bodies, and what actually helps.
This was such an important topic to bring to the podcast. If you prefer to watch or listen, you can catch the full episode on my channel.
Why "Just Aging" Is the Most Expensive Thing Women Are Told
"It's just aging" sounds harmless. It is not. It is the sentence that ends the conversation right before the helpful part. It tells a woman to stop asking, stop looking, and quietly absorb a symptom that often has a name and a treatment.
Aging is real. So is the fact that most midlife symptoms women are told to accept are treatable. Both things are true, and only one of them gets said out loud.
Leaking and Pelvic Floor Symptoms: Common Does Not Mean Normal
Leaking when you run, sneeze, or lift. Heaviness or pressure. Pain with sex. Constipation that won't resolve. These are common in midlife, especially after pregnancy and through perimenopause.
Common is not the same as normal, and it is definitely not the same as untreatable. Pelvic floor physical therapy exists for exactly these symptoms, and most women are never referred.
Why "Just Do Your Kegels" Is Often the Wrong Advice
The truth: the pelvic floor is a group of muscles, and like any muscle, it can be trained.
The overgeneralization: every pelvic floor problem is a weak pelvic floor, so the answer is always more kegels.
For many women, the pelvic floor is not too weak. It is too tight. Adding more squeezing to an already tight, overworked muscle can make leaking and pain worse, not better. Sometimes the work is learning to lengthen and relax it, while strengthening the muscles around it. That is why a proper assessment matters more than a generic instruction.
Midlife Joint Pain Is Often Hormonal
Estrogen helps protect your joints and connective tissue. As it shifts in perimenopause, new aches and slower recovery can show up, and women are routinely told it is just wear and tear. The hormonal piece is real, and it is worth raising with your doctor, because it changes what actually helps.
The Two Muscle Groups That Protect Your Pelvic Floor
Your glutes and your adductors, the muscles of your hips and inner thighs, do a great deal of the work of supporting your pelvic floor. Strength training that includes them is not separate from pelvic health. It is part of it. This is one more reason the answer to midlife symptoms is so often strength, not restriction.
The Insurance Problem No One Mentions
Here is the part that rarely gets said. The number of visits you are offered, and how thorough they are, is often shaped by what insurance will reimburse, not by what your body needs. That is why so many women get a quick instruction instead of a real plan, and why cash-pay and direct models exist. Knowing this helps you advocate for the care you actually need.
What Actually Helps
Get assessed by a pelvic floor physical therapist before you assume your symptoms are permanent. Strength train consistently, including your glutes and adductors. Ask your doctor whether perimenopause and estrogen could be driving new joint pain, and whether estrogen therapy is worth exploring for you. And stop accepting "just aging" as a complete answer.
The Bottom Line
Most of what women are told to just live with in midlife is treatable. Strength is medicine, and the right specialist can change your life.
Your symptoms are real. The explanation you were sold may not be.
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FAQs
Is it normal to leak urine in midlife? It is common, especially after pregnancy and through perimenopause, but common is not the same as normal or untreatable. Leaking is a symptom that pelvic floor physical therapy can often improve significantly.
Do kegels fix pelvic floor problems? Sometimes, but not always. Kegels help a pelvic floor that is genuinely weak. Many women have a pelvic floor that is too tight, and for them more kegels can worsen symptoms. A proper assessment tells you which situation you are in.
Can perimenopause cause joint pain? Yes. Estrogen helps protect joints and connective tissue, and as it shifts in perimenopause, new aches and slower recovery are common. It is worth discussing with your doctor rather than assuming it is only wear and tear.
What does a pelvic floor physical therapist do? They assess and treat the muscles of the pelvic floor and surrounding areas for issues like leaking, pain with sex, pelvic pain, prolapse, and constipation, using hands-on techniques and targeted exercise rather than a one-size-fits-all routine.
Do I need a referral to see a pelvic floor PT? It varies by state and clinic. Many practices accept self-referrals. If cost or visit limits are a barrier, ask about cash-pay options, which are sometimes more flexible than insurance-limited visits.
Will strength training help my pelvic floor? Often yes. The glutes and adductors support the pelvic floor, so a strength program that includes them can be part of the solution, alongside guidance from a pelvic floor PT.
