Pelvic Floor Habit Check: “This seems to be working, but is it?”

Did you ever get into the habit of doing something in a certain way for a certain situation and then continue to do it that way, even when it was not necessary?

Some examples that come to mind:

• Driving to work on autopilot on a day off or once retired. 
• Going to find something in a specific cabinet even after you have rearranged them and the item is no longer in that location. 
• Always sitting in the same seat in a classroom or restaurant.

I find people fall into the same patterns when it comes to pelvic floor things. Today’s blog will dive into some pelvic floor habits people have. We will talk about what they are and some variations. We will dive into why people usually have developed these habits. We will also evaluate if they are worth keeping or replacing.

Urinary Incontinence Pads or Underwear

In a society that has labeled and accepted peeing when you sneeze, cough, laugh, or jump after you have birthed a baby as normal, this one makes sense to me. Leaking urine is not seen as a big deal. It comes with the territory of perinatal life. It is something to be dealt with or that we should wish away. Please do not accept this as the truth. PLEASE!

 In reality, urinary incontinence, in any form, is a sign of a system problem. It may be an issue specific to the bladder, brain, or abdominal canister. But if a person is leaking urine without the ability to control it, then wearing a pad or absorbent underwear kind of makes sense. It keeps leaks from going through to the outer layer of clothing. It is more convenient than having to change a person’s underwear and pants multiple times a day. It is also better than urine leaking onto furniture, car seats, or out in public. It is a fair bandaid to a stressful, embarrassing problem.

Do I like this habit or adaptation? Nope, not really. It is not great for perineal health. It makes me think about the poor airflow and germs. Also, these products do not address the underlying issue, and perpetuate the notion that leaking urine is something normal a person should have to live with. The actual price of incontinence pads is astronomical. The price of reusable underwear is not inconsequential, but they are reusable and have a better environmental impact. 

Wearing one pad per day costs an average of $182 per year. 2 pads = $364, 3 pads = $546, 4 pads = $728, and so on. I hope that doing the math on how much you spend on pads motivates you to find a pelvic health provider near you. Pelvic floor therapy helps to eliminate incontinence. Think of all the money you would save in a lifetime.

Body Deodorants, Deodorizers, Scented Personal Cleansers 

Imagine if my house smelled like kitten poop because kittens had pooped all over it. To get rid of the smell, I would clean up the kitten poop. I would not expect that leaving the kitten poop and spraying a deodorizer would fix the problem. I’d also work on getting the kitten to poop in her litter box so there would not be poop around my home, constantly being a problem. 

I am amazed at people who are using products to cover up the odor of their incontinence without also seeking help to STOP the incontinence. I get that no one wants to be stinky. But a more functional goal in my mind is to eliminate the leakage, not just the smell. In doing that, the smell of stale urine will be a distant memory anyway! 

My soapbox about soaps for the genitals is also that they’re totally, completely unnecessary. Genitals should smell and taste like genitals. Putting other things on them to make them smell and taste like e like vanilla cupcakes and rainbow fairies is just nonsense. I find this is even more true for vulva/ vagina owners, but still all the “ball cleaner” products out there say the marketing geniuses of the world are tapping into making ALL genital owners feel self-conscious about their natural odor.

Now, incontinence can cause an odor, as urine or feces are leaving the body when not planned and landing in a person’s undergarments. If this is not cleaned regularly, it can lead to an odor. My solution? Stop the problem at the source and eliminate the leakage so that odor is not even part of a problem! Bottom line – the professional’s answer is to ditch the Febreeze and Vagisil, and do some pelvic floor rehab instead.

Commode or Urinal Next to the Bed

I see this habit born from a few different specific scenarios. I’ll describe each below. See if any of them ring a little bit true to yourself or someone you know.

The first thought would be uncontrolled urge incontinence. A person gets the urge to void and cannot get to the bathroom in time. They may be peeing along the way or leak as they’re undressing over the toilet. Either way, it’s frustrating and messy. They ingeniously think “I’ll bring the bathroom closer to my bed so it won’t happen.” It’s not the worst solution, BUT who wants to sleep next to a commode?

Functional incontinence is the second thought. A person gets the urge to go to the bathroom and they literally can’t get there in time. This sometimes happens during pregnancy, after a major surgery or injury, or for people who have a hard time moving around in general, for whatever reason. 

Overactive bladder or urinary frequency are the third time I see people sleeping with urinals or commodes next to their bed. They have to go so often and so frequently that it gets exhausting and agonizing to get up to urinate so often. So they bring the potty to themselves so they can cut down the time it takes to pee. I get this, but this just teaches your brain that your bladder is in charge and then it makes the problem worse and worse! Its a short-term solution that makes things worse in the long run!

My professional answer here is to find someone to help you tackle the underlying issue, whether it is urge, mobility, or overactivity, and then wean away from the crutch of a bedtime potty place! There are so many things we can do to help you including changing bladder habits, changing foods and drinks to decrease urgency and exercises for better pelvic floor control.

Reading on the Toilet 

My job is to talk about poop. Here is the thing most people do not seem to understand. Pooping should be a quick and easy process. It should come out like soft serve ice cream. Soft squishy blobs, easy to pass, coming out quite soon after the urge to go is felt. We should not have to sit and poop for longer than 5 minutes. Therefore, we should not have time to be reading, watching TikToks, or doing whatever it is people do for 30+ minutes on the toilet, multiple times a day. 

When we distract ourselves with things like being on our phone or reading a good book, we limit our ability to feel what is happening in our bodies. Are you thinking about that rumble in your tummy and the feeling of poop moving through your system? If you’re watching or reading something that has your attention, the answer is probably not. The pelvic specialist’s answer here is that the only thing you should be doing on the toilet is breathing, relaxing, and working on doing your business!

Purposeful Dehydration 

I see this adaptation happen when people have urine leakage or frequency. They are tired of having to go to the bathroom or leaking, and they think the following: “If I drink less, I’ll make less pee. If I make less pee, I won’t leak or have to go to the bathroom as often.” It makes sense, and before I was a pelvic health provider, I believed this. But here is why this is a poor habit and does not do you any favors.

When you drink less, your urine becomes more concentrated. Concentrated urine is a HUGE bladder irritant. What happens when the bladder is irritated? It becomes urgent and frequent with a side of leaky. So this habit actually causes the same problem, if not a worsening of the problem. It also deprives the body of the fluid it needs, leading to things like constipation, which further worsens pelvic floor symptoms!

Instead, try to drink the right amount of water a day. If you find you have issues with leakage or urgency related to drinking, try small sips, and more water versus coffee, tea, and other irritants. 

Peeing in the Shower 

What is the harm in this one? Its saving water! Its good for the environment! Its saving time! I’d love to agree as it does all of those things, but when I talk about the bladder, I frequently compare it to a 2 year old. I’m going to go on a tangent for a second.

When my daughter was 2, she was recently potty trained and we went to the beach. She had to pee, and I told her to go in the ocean. She looked at me like I was crazy, but then went and happily went about her day. A little while later, we went to a lake and I noticed she never asked to pee. he told me, “I went in the lake.” A few weeks later, we were at a local pool. She told me she had to poop, and asked if she could do so in the pool. I quickly told her no, and asked her why she’d do that. “I pottied in the ocean and the lake, why not the pool?”

It’s that simple for our bladder. We pottied in shower once, why not every time? And while we’re at it, how about the brain/bladder send the urge to go everytime we touch running water? That’s going well? How about everytime we see or hear it? Or even when we think about how we might have to go? All of the sudden, we have an urge issue that we developed all by peeing in the shower! So keep the pee in the toilet to avoid any confusion for your bladder that is very much the intellectual equivalent of a two year old. 

Power Peeing

When I think about peeing speed, I will always hear my grandfather saying he’s “pissing like a racehorse!” after a night of Rob Roys. Peeing (and pooping) should be a process of relaxation, where the pelvic floor muscles relax and let the natural things happen. There should be a flow to urine, but it should be caused by the bladder’s automatic contraction, not the person bearing down, trying to push pee out. Why do people power pee? They are in a hurry to get somewhere. They don’t have time. They’re rushing back to kids or work. Is this the worst habit? No. Would I prefer you not do it? Yes.

When we abuse the bladder for years and years, it tends to talk back. That is in the form of leakage, urgency, frequency, and night time wake ups. Nobody has time for that. In saving yourself all that time with power peeing, you’re opening yourself up to problems later on!

Lubricant for Sexy Times

Have you ever heard the term assbackwards? Well people’s views on the use of lube are just this. Many people think lube is only for old people and butt stuff. This is not the case. There is never too much lube, and lube can always be a great choice for ANY intimate activity, not just intercourse. 

People, particularly vulva/vagina owners are afraid that if they ask to use lube, their partner will think they are not into the sexual encounter. This comes from the idea that “wetness” or “hardness” is equal to sexual arousal. Long story short, the only way to guess someone’s arousal is to ASK THEM. Arousal comes from the brain, and although sometimes our body’s respond physically, this is not the only marker.

 

“Won’t my body stop making lube or get ‘addicted’ to it?” Nope. Your body will respond to pleasurable intimacy by wanting more pleasurable intimacy – meaning improved blood flow to the areas and increased lubrication. We want more intimacy worth having. If it feels great, we’ll want to do more of it. If it hurts, because we avoid using something to help us, we’re not going to jump back into that activity. 

So as a pelvic health specialist, I am all in for all the lube. I want to caveat this with the recommendation to pick a good lube! I love Slippery Stuff, Good Clean Love, Uberlube and good old olive oil.  Use something compatible with your birth control choice and/or toy selection. Look for something with minimal additives, fragrance and upsells. You really don’t need cooling, heating, enhancing, etc. unless it’s been prescribed by a medical professional. Please remember not to try to make a penis taste like a lollipop, for the love of all holy pelvic floor things!

Poop Medication

Some people live and breathe by their Miralax, Magnesium CALM, Metamucil, Benefiber, or prunes, and this is actually a habit I can get behind! I’m obsessed with poop. Nothing fixes a pelvic floor faster than a happy GI system. I need a sign in my office that says, “Constipated until proved otherwise.” Almost everyone has some underlying problems with their pooping that they didn’t even know they had. Usually, the poop is too firm and takes too long to come out. I love to add in helpers for this with a doctor’s approval. 

People always balk. “Won’t I get addicted?” “Shouldn’t my body do this naturally?”

The only poop meds you can get addicted to are the classification of stimulant laxatives. These help promote peristalsis and muscle movement, and can be habit-forming. All others are not terrifying. I like some laxatives more than others, and as a pelvic health provider, my two favorites are osmotic laxatives and bulking laxatives. If I had to choose only one, osmotic laxatives would win by a landslide. 

These help to pull water into the small intestine to make poop softer and squishier so it passes much more easily. Osmotic laxatives don’t affect the natural movement of the bowels, and they don’t typically cause cramping, pain, or gas. They just make the poop the right consistency so it can come out like it needs to. 

Bowel medications should always be very carefully monitored, prescribed, and titrated by your medical providers, but they can be really helpful in making your pelvic floor happier!

Squatty Potty 

My last habit is getting into a squatting position for pooping. This can be in a variety of ways, but my favorite is seated on a toilet using a step stool or squatty potty. This is a wonderful way for most people to poop, and I truly support this technique. From a muscular standpoint, it helps to relax muscles in the pelvic floor to let pee and poop come out easily from a relaxed pelvic floor. You won’t become addicted to a squatty potty, but you will find yourself replicating its position when you travel away from it.

I hope these topics have made you think. Just because it’s the way you, someone else, or society has always looked at it, thought about it or done it, does not mean that it is the correct way, or the incorrect way!

A pelvic health provider is always a great resource to discuss these topics with to help decide the best plan of care for you and your pelvis. 

Dr. Mo