Pelvic Floor - The Muscles No One Talks About (But Everyone Needs)
April 21, 2026 | Episode 61
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Marcus Thorpe, Katie Lowe, Guest: Dr. Nicole Book, Urogynecologist, OhioHealth
Marcus Thorpe 0:00
Hi everyone, and welcome back to The Wellness Conversation and OhioHealth Podcast.
Katie Lowe 0:11
I'm Katie Lowe. This is Marcus Thorpe. Today we're talking about something that affects nearly every woman at some point in her life, but not nearly enough people talk about this. We're talking about pelvic floor health, from bladder leaks to core strength to overall confidence, your pelvic floor plays a much bigger role in your health than you really might realize.
Marcus Thorpe 0:32
We have a great expert to talk about this, Dr. Nikki Book is with us. She is a uro gynecologist with OhioHealth Dr. Book, it is so good to see you. Thank you so much for joining us on the wellness conference. Wellness conversation. We are really looking forward to talking with you today. Thank you for having me. Yeah, it's going to be a good conversation. I think pelvic floor, you know, when it comes to our bodies, especially women, it is one of those areas that probably gets taken for granted a lot of times, and there's so many changes over the years that women's bodies go through. So let's just first talk about simplicity sake. What is pelvic floor? What does it actually do inside of the body?
Dr. Nicole Book 1:09
Great. Thank you. Good question, and I brought some models today for Marcus and Katie and anyone who may be able to see the video. If you can't see the video, I will try to use language such that it makes sense, but I do want to start just by acknowledging that both women and men have a pelvic floor. All right, that's the truth. I personally specialize in women's pelvic floor medicine, as do my partners. So we'll spend most of today speaking about women's pelvic floor. But the gentlemen also do have a pelvic floor. So if you imagine a human bony pelvis sitting like this, this is the pubic bone. These would be the hip bones, the hail tail bone, and right here is what people commonly call the sits bones, or the bones you feel when you sit on a chair. In between those bones is just a giant hole, and the purpose of that hole is to allow a fetal head to come through, and eventually for a baby to be delivered, which is great for the act of having a baby, but during the rest of our time, when we are standing on two feet, we have a hole at the bottom of our skeleton, and so the pelvic Floor is simply a network of muscles, connective tissue, nerves and blood vessels that helps to bridge that hole from the front of the pubic bone back to the tailbone, to keep our insides inside when we're standing up, as it does that, it also helps to support some inside organs. The pelvic floor actually is the base that helps to support the lower part of our urinary tract, so the bladder and urethra tube are reproductive tract, so the uterus and vaginal canal and our digestive tract being the colon in the back, this is helpful.
Marcus Thorpe 2:55
I'm a visual learner, so we're going to put the YouTube channel in the link of this story. So if you're trying to find it, we'll make sure that you find it. But this is helpful for me.
Katie Lowe 3:04
I mean, I have all these parts, and yet I'm still learning something today, so that's awesome. Thank you so much, doctor. I'm curious when it comes to, you know, the typical symptoms of pelvic floor issues such as, you know, bladder leakage or pelvic pressure. How common are they, especially when it comes to like after childbirth or as women age, sure,
Dr. Nicole Book 3:29
Yeah, dysfunction of the pelvic floor is actually very common in terms of urinary symptoms. Urinary incontinence probably affects 50% of women at some point in their life. It starts before childbearing, but certainly we see a big increase after women may have had babies, and then another very large increase after menopause. We think that somewhere around 75% of women over the age of 60 may be experiencing urinary incontinence, the other major pelvic floor dysfunction is called prolapse, or a descendant of the organs surrounding the vaginal canal, and that affects about 30% of American women, with 11% needing surgery at some point of their life for prolapse. So I think the conditions are much more common than people might think. We don't learn about them in health class.
Marcus Thorpe 4:22
Yeah, we have done so many kind of focus podcasts on women's health over the last year, year and a half, and a lot of the symptoms that we hear about in a woman's body seems to always be followed with, well, some women just live with it, right? I mean, it's just that's just that's just something that women have always lived with. How much do you find that women who come to you say, Yeah, I'm coming talking to you now, but this is something I've been dealing with for three to five to 10 years. Is that something that you're quite often? Oh sure, yes.
Dr. Nicole Book 4:57
I have people who come and say, I've been dealing. With us for 40 years? Wow. Yeah. So I think because the symptoms are common, a lot of women feel as though that means it's sort of an inevitable part of their aging process. And I also think for a long time, there was almost a stigma or a resistance of women to talk about the symptoms they're experiencing, either with their family unit, with their social support, and certainly with their physicians. And so for many generations, it was something that people just sort of sat at home and dealt with, or, in the worst case scenario, started avoiding doing things that aggravated the symptoms.
Marcus Thorpe 5:39
Yeah, I would say, you know, especially when it comes to, like, bladder leakage, right? That's one of those taboo things. Everybody's like, ooh, whoa. You're having those kind of issues, yikes. I mean, it's
Katie Lowe 5:48
Yeah, I think what I've experienced, though, actually, just talking with other moms, is people will start to joke about it, though, now, but, but almost normalize it, like it, oh, it's just something that you've just got to put up with. Like, you hear moms all the time be like, Oh yeah, just any time you sneeze or cough, you just got to cross those legs and you just laugh it off. But it sounds like that is something that you know if you're experiencing that it's time to talk to your doctor about. So those early symptoms, what? What should prompt you to really address that with your doctor?
Dr. Nicole Book 6:25
Yeah, I think you're right on Katie, I think a lot of people joke about it, and that's not a bad way to approach the symptoms. Most of the time, symptoms of urinary leakage are not going to be a symptom of underlying health problems or more of an anatomic change, but sometimes they do. And so I think if people are experiencing symptoms of urinary incontinence, bowel dysfunction, so either constipation or bowel leakage and or things people will say, especially after childbearing, is just things don't feel the same as they used to. They should talk to that primary care physician or their OBGYN up front to understand how their bodies may be changing.
Marcus Thorpe 7:09
Yeah, let's talk about stages of life and kind of how pelvic floor impacts people differently. I would imagine there's some people who deal with pelvic floor issues who have never had a baby, right? I mean, at the front end of their life as they're starting to, you know, be an older adult, maybe even before then, I'm not sure. I'll ask you that. But let's talk about that stage, the child bearing, ages, perimenopause and then menopause. Can you just walk us through what your quote, unquote, typical woman might see during those stages of their life?
Dr. Nicole Book 7:40
Sure, yeah, I'll start just with your first question. Marcus, I think is very insightful. For many decades, I think most pelvic floor dysfunction was attributed solely to childbirth. And there were some really neat studies done in upstate New York where they did surveys of women who had babies and their sisters who were in a convent, and they were nuns, and so obviously had not had children, and that was our first glimpse into the fact that women who have not had children actually very often do have pelvic floor dysfunction. Interesting. Yeah, that was a really cool, a cool way before we had more sophisticated technology to start dispelling some of those myths that had existed for many decades, we've now gotten a little bit more advanced, where we can actually draw blood work, and we've recognized some chromosomes that can be deficient, that make maybe perhaps family units more or less susceptible to pelvic floor dysfunction. Those are pretty academic at this point, but let us take a glimpse into the fact that, yes, if you have not had a baby, you can still have these problems. But we do see pregnancy, certainly, as a time where there are a lot of changes in our body. The hormones of pregnancy help to relax the ligaments and the bones around the pelvis, and again, they're doing that to make that opening at the bottom of our structure larger so that the baby will be able to come out. But as that structure relaxes, the bones spread, the muscles get torn a little bit. At some point during the second trimester of the pregnancy, the baby's head will come down into the pelvis, and they actually sit for several weeks on the major nerves that feed the pelvic floor and help the organs to function appropriately. So even during that second trimester, before somebody's had a baby, that baby's head is down in the pelvis and causing a little bit of damage. And then, certainly during the birthing process, as the baby comes through the tissue, the muscles and connective tissue are frequently torn and damaged. There is a chance for recovery during and it's not fast, but during the first 12 months after a baby comes out, there's a chance of recovery of both the nerve and muscle function. So some women regain complete function after. The baby comes out and other people don't. The other time that you asked about, I believe, is menopause, and menopause is another time where women's bodies go through dramatic changes. Again, most of those are driven by hormones, but the hormonal changes in menopause are a little bit different than the pregnancy changes. As we experience a withdrawal of estrogen, there are a lot of bone changes, in particular in our spines, and as our spine health deteriorates, that allows compression of the nerves in the spine that are telling the pelvic floor organs and muscles how to function. So a lot of women will start to have more nerve based pelvic floor problems as they go through menopause. And the other big change with menopause is really that all of our skeletal muscles, including these pelvic floor muscles, atrophy and lose their strength. So we see a lot of changes around menopause as well.
Marcus Thorpe 10:58
Yeah, I think it's important for me to say this out loud, you guys are the dominant sex. I will just just all the things you just described, and think to myself, Oh my gosh, these poor women and everything they have to go through. And thank God we have strong women who are able to take on life's challenges. So you are definitely the dominant sex between men. I'm just going to admit it.
Katie Lowe 11:20
Of course, you are correct there. It's so interesting to just hearing you explain things, because now I'm thinking about my second trimester, and what you said happens with the baby dropping into your pelvis? And I'm like, Oh, this explains some of my symptoms, right? I had to go through this pregnancy, so before we go into Okay, so what can we do about this? Let's just talk about any other risk factors that might make one woman more prone to these issues than another, that doesn't have to do with just like, you know, pregnancy or your age?
Dr. Nicole Book 11:55
Sure, yeah. I think as we grow the list, I'm going to tell you up front. I did have a mentor who just told me I think life is a risk factor for people going to your office. And I said, I think that's probably pretty true, but commonly quoted risk factors for developing pelvic floor dysfunction includes the Caucasian race, as I mentioned earlier, genetics, we do believe play a pretty big role. Pregnancy of any type is a risk factor. A vaginal delivery is a risk factor. The larger the baby is, the more damage we believe that they create. So babies over about eight pounds tends to be our cut off on our research studies to look at risk factors, and then the additional risk factors include pelvic surgeries and constipation or straining.
Marcus Thorpe 12:49
Okay, are there factors like exercise or weight, daily habits that you do that could put up a red flag or cause some issues,
Dr. Nicole Book 13:01
Sure, probably the most consistent daily habits we see is just is dietary based, honestly, I think, in our quest to all become healthy and well, something we see frequently in our office is women who come in for appointments because they are voiding very frequently. They can't sleep at night. And when we sit down and look at what they drink, they are tremendously over hydrated. It is possible to drink too much. There's a gentle balance. You don't want to be dehydrated. You don't want to be over hydrated. And in the current state, when you go to Tim Hortons now, you don't get an eight ounce cup. You get a 20 or a 40 or something of this nature. And so we see a lot of people are actually over hydrated and causing some of this dysfunction.
Marcus Thorpe 13:47
She carries it around all the time. And I think to myself, you drink all of that in a day.
Katie Lowe 13:59
Oh yeah. And I always say you gotta the baby's thirsty.
Dr. Nicole Book 14:03
In pregnancy, we give you an exception for that. You get bonus points. But outside of pregnancy, certainly, what we ingest both dietary for fluids, but also in terms of constipation. A lot of American diets are very devoid of fiber, and that doesn't help us?
Katie Lowe 14:21
Yeah, that makes sense. Let's talk about kegels. I feel like everybody has at least heard of that term, but may not exactly know, like, what it is.
Marcus Thorpe 14:33
I'm in that boat. I've heard of it, no idea what it is, necessarily.
Katie Lowe 14:38
Perfect. So for for people who are doing these, like, do you find them helpful? But also, can you just define exactly, like, what exactly is a kegel?
Dr. Nicole Book 14:49
Sure? This is hard. Katie, okay, yes, Kegels are helpful, and men and women can do Kegels.
Katie Lowe 14:57
Oh, all right.
Marcus Thorpe 14:59
Now I'm really listening.
Dr. Nicole Book 15:00
That's right. So a kegel assert is actually named after a gynecologist who attached the significance of how you can contract the pelvic floor to help with issues like urinary and fecal incontinence. And we find them to be very helpful. In a perfect state, we would teach women how to do them before they ever achieved a pregnancy, and they would continue them through a lifetime. They would certainly continue them through that menopausal transition that we talked about, when our muscles just naturally decline in strength and volume as well. That's not necessarily how it works in the United States, but that would be an ideal state. But would you like me to tell you how to do a kegel? Absolutely. Yeah, okay, because there are a lot of women who will come and be very dismissive of the Kegel exercise, because they've been told for many years, do your Kegels. And the challenging thing is, these are very hard exercises to do. They're very easy to do them incorrectly in a lot of different varieties, and in fact, probably in my office, 80% of people do not engage the muscles correctly. So interesting. I'm going to explain to you from a doctor, but not a physical therapy like quick shot on kegels. I will tell you the physical therapist can tell you better, but in order to do the Kegel, what you want to do is you want to pretend like you are shutting off your urine stream. I'm going to pause there and say, I don't want you to do this in the restroom over a toilet, because when you are going to the bathroom, there's a very special signal that goes between your brain and your bladder, and if you do your Kegels on the commode, you're going to mess up that natural signal. So it's just imagining that you're in the bathroom not actually being there. So you want to pretend like you're shutting off the urinary stream, and you should be able for women to feel an inward and upward pull in the vaginal canal. The reason that it's hard to do the Kegels is because you can't see and or feel the muscles like if I told you, hey, you know what, Katie we want to work on strengthening your biceps, I would go, Okay, go to the gym, get a dumbbell, feel your arm, do some curls. You got it, your biceps are going to be good, right? The Kegels or the pelvic floor muscles are in kind of a deep, dark area, so it's hard to do, but So my trick of how to find the muscles is thinking about which muscles your body is going to try to compensate with. So if you're not getting these small, little pelvic floor muscles, you're going to tend to either get your abdominal muscles, the muscles that make your legs squeeze, or your glutes. So as you start doing the Kegels, if you start in a seated position and simply put a hand on your belly, and you picture stopping the urinary stream with an inward and upward pull. You make sure that your belly isn't squeezing, your legs aren't moving, and you're not rising up and down on your chair, then you've got a good start.
Katie Lowe 18:01
That is a great explanation.
Marcus Thorpe 18:03
It is. Have you ever done them?
Katie Lowe 18:05
I was just about to say so I stopped doing my regular workouts at about 35 weeks pregnant, and I started doing exercises that had a heavy emphasis on pelvic floor strengthening as well. And it sounds kind of like easy, but it takes so much concentration.
Marcus Thorpe 18:25
Yeah, it sounds like it, I mean that, yeah, you really have to concentrate. You have to concentrate.
Dr. Nicole Book 18:32
And it's easy to do it incorrectly. It's also easy to over stimulate those muscles. I think a lot of people are aware of the fact that they can be weak, but they can also be spasmed, and so yes, it is possible to do them incorrectly, but that's your short, short tricks.
Marcus Thorpe 18:48
Cool. I was actually tricking you guys. I've been doing them the whole time. We've been doing this podcast. I know. Thank you. Hard to believe. How about some Kegels are one thing, but how about some practical, realistic things that women can do to maybe strengthen or even protect their pelvic floor right now?
Dr. Nicole Book 19:05
Yeah, I think I mean the number one advice I give people, because I mentioned to you like genetics plays a big role with this. So let's say if I'm working with a patient with pelvic floor problems, and she's brought her mother or her sister with her, and when I get to the fact that you know number one risk factor is genetics that visitor frequently gets a very downward turning frown, and I will just tell them the number one like thing to modify in day to day life is just to avoid constipation. As I mentioned earlier, there are lots of parts of our life that put pressure on the pelvic floor, but if you're able to modify your diet and or fluid intake to keep your stool soft and avoids training for that
Marcus Thorpe 19:45
So interesting, because I think of like GLP ones right now, and one of the main problems with GLP one sometimes can be constipation. And so many people have decided that that's the track they want to go. So you might be having some more issues because of that too. That's scary to think about a little bit.
Dr. Nicole Book 20:01
Yeah, absolutely. Although I do think in in certain instances, the GLP ones are going to give us some amazing health benefits in other areas. But as people get started on that journey, I would definitely say, if you're doing any type of medication that tends to slow down the GI tract, and there are a lot of them, right? Make sure you're countering that either with a stool softener or increased fiber, increased fluid, you know, those sorts of things.
Marcus Thorpe 20:27
Yeah, not to scare people away from GLP ones, but at the same time, that's something you have to think about as you're kind of getting started in this process.
Dr. Nicole Book 20:34
Absolutely yes.
Katie Lowe 20:35
We are running out of time. So I wanted to ask we like to give our listeners and viewers something a quick takeaway or an actionable step they can take. So if there's one takeaway that you wanted them to have, or remember about pelvic floor health from this episode, what would it be?
Dr. Nicole Book 20:55
I think I would just encourage women if they're having symptoms of urinary leakage, pelvic pressure or heaviness or fecal incontinence, to talk to your doctor, because there are lots of things that we can do. For a lot of time, people just thought all we could do was surgery. But we actually have lots of tricks in between, do nothing and do surgery. So if you're having issues, talk to your doctor. Consider working with a pelvic floor physical therapist and reach out if you need us.
Marcus Thorpe 21:24
How about for the fellas out there, you said that men have pelvic floors. That was a surprise for me. Tell me a little bit about that.
Dr. Nicole Book 21:30
They do. Yes, men have pelvic floors, and men can have dysfunction associated with that as well. They can experience urinary leakage, premature ejaculation, and a lot of the urologists are pretty well trained to help men like both identify those conditions and the pelvic floor physical therapists to work primarily with women are also trained to work with gentlemen for their pelvic floor health as well.
Marcus Thorpe 21:54
All right, guys, you're saying Don't ignore your pelvic floor area. It's important.
Katie Lowe 21:58
Yeah, so that means so men can just do similar exercises to strengthen that
Dr. Nicole Book 22:03
They can.
Katie Lowe 22:04
Okay.
Marcus Thorpe 22:04
I like it. There you go. Dr book, this has been a great conversation. I really like that you brought kind of show and tell. I think it's really important for people to kind of see and understand and thanks for everything you're doing for patients and families out there. I know this is something that women of all ages and stages in their life are dealing with and I think that even if you listen for five or 10 minutes of this podcast, you're going to get something out of it. So thanks for joining us. We really appreciate it.
Dr. Nicole Book 22:28
Yeah, thank you.
Katie Lowe 22:29
So if you're listening and recognizing some of these symptoms in yourself, know that you're not alone. There are solutions available. You can always find more, including our physicians at ohiohealth.com be sure to subscribe to the wellness conversation wherever you get your podcast and share this episode with someone who might need it. We'll see you next time you.