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"Common is not the same as normal. And normal is not the same as something you are meant to endure for the rest of your life." - Rachel Carta, RN, CFNC

What Your Body Has Been Trying to Tell You About Your Pelvic Floor

Have you ever leaked a little when you laughed too hard, then brushed it off as just part of being a woman? Have you felt a sharp catch during intimacy and decided to push through, because someone once told you to have a glass of wine and relax? Have you sat in the bathroom, waiting, while your body refused to do the one thing it is designed to do?

If any of that feels familiar, you're not alone and it doesn't have to be this way.

I was in my late thirties before I ever heard the words "pelvic floor therapy." More than three decades in this body, fifteen of them spent working as a personal trainer, and no one had ever told me that there is specific therapy for the pelvic floor. When I went looking for a provider near my rural home, I came up empty. That gap is exactly why this conversation matters so much to me.

On this episode of Living Inspired, I sat down again with Dr. Judy Rossi, a pelvic floor therapist who holds a doctorate in physical therapy and advanced training in pelvic health and orthopedics. Judy was with me once before, on episode 54, where we covered the myths and the basics. This time we went deeper, into the place where the pelvic floor meets the nervous system, the gut, and the parts of our lives we have been carrying in silence.

Pelvic Floor Defined

Your pelvic floor is a group of muscles that run from your pubic bone in the front all the way back to your tailbone. As Judy explained, they have more jobs than you would expect. They have to be strong enough to hold things in that should stay in, like urine and stool. They have to be able to relax and let things out when it is time. They allow for intimacy. They hold your pelvic organs in place, and they give your whole body stability.

Judy points out that the pelvic floor is twenty-five percent of your core. Not a footnote to the core. A full quarter of it. Most of us picture the core as the six-pack muscles on the front of the belly, and yet that muscle group is not even part of the true core at all.

There's a gap in how we are taught about ourselves. We are handed a body and sent out into the world without a manual. So when something starts to go wrong down there, we assume we are the only one, and we stay silent.

The Symptoms We Were Taught to Endure

There is urinary incontinence, and Judy is careful to say there are two different kinds that are actually treated differently. Stress incontinence is the leaking that happens when there is downward pressure on the bladder, the cough, the sneeze, the jump, the big laugh. Urge incontinence is the kind where you leak on the way to the bathroom because the urgency hits like a wave you cannot outrun. Knowing which one you have changes what actually helps.

There is pelvic organ prolapse, where the bladder, uterus, or rectum drops and presses into the vaginal wall. There is chronic constipation and Judy named a specific pattern called dyssynergic defecation, where the pelvic floor muscles clench instead of releasing when stool is trying to pass. The body is essentially putting the brakes on the very thing it is trying to do.

And then there is pain with intimacy, which Judy says makes up thirty to forty percent of her patients. This is the one where I feel the heat rise in my chest, because of what so many women are told when they finally find the courage to mention it. They're told it's just a normal part of aging. They're told to have a glass of wine and relax. They're almost never told that physical therapy could resolve it. Judy's experience is that ninety percent of the time, she can help that pain go away with pelvic PT.

Sit with that for a moment. Ninety percent.

Common is not the same as normal. And normal is not the same as something you are meant to endure for the rest of your life.

A symptom is a signal. Your body is talking to you.

The Bidirectional Highway

I asked Judy how much of what she treats is connected to the nervous system, and her answer was almost everything. The pelvic floor, she explained, is heavily controlled by the nervous system. It is constantly listening to the brain and the spinal cord, adjusting in real time based on stress, on safety, on what it senses happening inside and around you. Picture a two way highway running between your brain and your pelvic floor, messages traveling in both directions all day long.

Now think about what that means when you live in a constant state of go. So many of the women I work with are stuck in fight or flight and do not even know it. Fight or flight is not the enemy. We're designed to move between that state and rest and digest. The trouble starts when we get stuck in the on position and never come down. When that happens, the body grips. Blood flow gets shunted away from digestion, because if you were truly running from a bear, your body would have no business making a bowel movement at the same time. The muscles that are supposed to relax stay clenched instead.

You cannot out-supplement, out-exercise, or out-biohack a nervous system stuck in survival. I learned that the hard way in my own practice. I used to think we could get to the nervous system later, after the diet and the supplements. I was wrong. It has to come first, because nothing else takes hold until it does. When I said that to Judy, she agreed without hesitation.

Judy knows this from the inside, not just from treating it. She shared that ten years ago she developed severe IBS with chronic diarrhea, which created intense tension in her pelvic floor. About a year later that tension contributed to interstitial cystitis, a painful bladder condition that left her feeling like she had a UTI around the clock. After plenty of dismissals and treatments that went nowhere, it was a pelvic floor therapist who finally found the real driver. Her muscles had become so tight and so angry that they were at the center of the whole picture. And underneath the muscles was a nervous system that had never been given a chance to settle.

You cannot out-supplement, out-exercise, or out-biohack a nervous system stuck in survival.

You can listen to the full conversation with Judy on the Living Inspired Podcast player above, and if you want the foundational basics, go back to episode 54 where we covered them in depth.

Where the Body Holds What the Mind Will Not

There are certain places the body tends to store stress. Judy named the pelvic floor, the jaw, and the neck. The pelvic floor, it turns out, is one of the places that holds everything we have been carrying and called fine.

When a potential patient calls and the two of them go back and forth and back and forth because she is too busy to find a single appointment, Judy can already predict what she will find when that woman finally comes in. The tension is there before they have even met. The body of a high-achieving woman who's holding everyone else up tells on her.

Judy mentoned taking a course on holistic care for the pregnant body, and the instructor taught her something she said she was not even sure she believed. The idea was that pain on the right side of the body can connect to a strained relationship with a man in your life, and pain on the left to a relationship with a woman. Judy mentioned it to a patient she had been treating for weeks, a woman with severe pain in her lower right side and chronic constipation. For the first time, the woman went still and said one word. Her son. He had struggled with addiction and had been in jail, and he had just gotten out, and she was about to drive across the country to see him. She had never said a word about him before. She went home after that session and had the largest bowel movement of her life, and her pain dropped dramatically.

I'm not asking you to believe any particular theory about which side means what. Judy held it loosely, and so do I. What I cannot deny is the pattern underneath it. When I work with a woman whose body is in distress, one of the questions I ask is simple. What else was going on in your life when this started? At first there is silence while she thinks. Then it comes. A divorce. A loss. A season that nearly broke her open. And the moment she makes the connection, something shifts. Her shoulders drop. There is an exhale. The nervous system can finally release a weight it has been holding precisely because no one ever named it out loud.

Your body has been keeping the score of everything you carried and called fine.

One of the first things I do with the women I work with is help them create space to be. Not space to do more. Space to be. Because if there is no room in your life to make the appointment, to take the walk, to sit in the sun for five minutes at lunch, the body will find a way to make you stop. There is a book I love called The Ruthless Elimination of Hurry, all about Sabbath rest and the holy permission to slow down. I finished it and immediately wanted to start it again. If your schedule has no white space in it, that is not a badge of honor. That is the thing your body is asking you to look at.

When the Ground Shifts

For women moving through perimenopause and menopause, the body is changing in real ways, and the pelvic floor feels it. Judy explained that as estrogen declines, the tissues in and around the vagina and urethra begin to thin and weaken. More fragile tissue can mean more leakage and more pain with intimacy. This is real, and it deserves real support.

And still, hormones are part of this story, not the whole of it. Your symptoms are signals, not sentences. The nervous system, your digestion, your sleep, the weight you have been carrying, all of it sits upstream of the hormone conversation. Hormones belong in the picture. They just rarely belong at the front of the line, blamed for everything while the foundations go unexamined.

Within that fuller picture, there are tools. Judy often recommends that women ask their provider about topical estrogen, a low dose estradiol cream applied to the tissues. She also pointed to research suggesting that using it regularly can meaningfully reduce urinary tract infections. That matters more than it might sound, especially as we age.

From my years of nursing work, I can tell you that in older women, a UTI often does not show up as burning or urgency at all. It shows up as sudden confusion. Families and even providers sometimes mistake it for dementia, when the real cause is an infection that could be treated. Caring for these tissues is not vanity. It can protect a woman's clarity and her quality of life for years.

What You Can Take With You

The one understanding to carry: your symptom is a signal, and very often the nervous system is the driver underneath it, not a side note. The leaking, the pain, the constipation, they are not random and they are not your fault.

The one next step: if any of this is yours, have it assessed by a pelvic floor specialist. That might mean asking your primary care provider for a referral, or searching for a provider in or near your area. Episode 54 walks through how to find the right one. Judy cautions that months of YouTube videos are not the same as an evaluation, and some women make things worse trying to fix this alone.

The one small shift for today: the next time you finish brushing your teeth, take a little extra water in your mouth and gargle. Judy uses simple vagus nerve practices like gargling, humming, and cold water on the face to help her own nervous system settle. It costs nothing, it takes seconds, and it is a small signal to your body that it is safe to come down out of survival.

And then, take the step. Judy said, so many of us hear something like this, feel the spark of I should do something about that, and then let it slide onto the bottom of a to-do list we never reach. Not this time. Make the call. Send the email. Put yourself on the list.

Your body is not against you. It is speaking. You're allowed to listen. You're allowed to rest. You're allowed to take up space. Breathe in. Breathe out. The river of life flows.

Lots of love,

Rachel

Find Dr. Judy Rossi

https://www.woodstockpelvichealth.com/

Rachel's Free Resources:

Mood Swings? Get the 5 minute audio to calm them now. https://rachelcartarn.com/sos

Do you want to understand more of what's changing in your body in midlife and get a few simple tools to feel better now? Get the free guide: The Real Reason You Still Feel Off.

Ready to Talk: Book a Clarity & Relief Session here.