Pelvic Floor Therapy: Why Kegels Aren’t the Answer and What Actually Heals Leaking, Pain & Prolapse Balancing Hormones Naturally Podcast with Leah Brueggemann Seventy percent of people in nursing homes are there because of urinary incontinence. Read that again. The leaking you keep brushing off as “normal” after kids? It is the same thing that lands women in long-term care decades later. And almost nobody is telling you that. In this episode, Leah sits down with pelvic floor physical therapist Koleen Adams (Awaken Pelvic Therapy in Lapeer, Michigan) to unpack the real reason so many women are walking around with leaking, pain with sex, low back pain, constipation, and prolapse, and being told it is just what happens after babies. Spoiler: it is not normal, it is not your fault, and Kegels are probably the worst thing your doctor could have prescribed you. Okay, so. If you have ever been told to “just drink a glass of wine before sex”, if you skip the trampoline park because you might pee, or if you went to one pelvic floor PT and decided it didn’t work, this episode is the one to send to every woman in your life. What You’ll Learn In This Episode • Why 90% of pelvic floor issues are caused by tightness, not weakness, and why Kegels can make them worse • How your pelvic floor is wired into your fight or flight nervous system (and why it clenches when life feels unsafe) • The wild client story of “sister poops” and how a phone call can trigger fecal incontinence • Symptoms you would never connect to pelvic floor: low back pain, hip pain, headaches, prolapse, chronic constipation • Why over 90% of jaw clenchers are also clenching their pelvic floor • The exact questions to ask before booking your next pelvic floor PT so you don’t waste another appointment • Why insurance-based clinics often miss the root cause and how direct pay changes the game • What recovery should actually feel like and the two-to-three visit rule for knowing you’ve found the right practitioner • How to advocate for yourself with your OB without feeling rude or pushy Your Pelvic Floor Is Holding More Than Babies Koleen calls the pelvic floor a “perfect little bowl” for holding trauma. And once you hear it that way, you can’t unhear it. Your pelvic floor is not just a group of muscles. It is part of your fight or flight system. Anytime your body has registered something as unsafe, whether that’s a hard conversation, a traumatic birth, an unwanted touch, or a stressful phone call from your sister, your pelvic floor automatically tightens. That tightening is supposed to be temporary. The problem is most women never come out of it. This is why “just do Kegels” is such terrible advice for so many women. If your muscles are already gripping at a 9 out of 10, contracting them harder is not going to help. You need to learn how to release first. Without that, every other intervention is fighting uphill. The Symptoms Nobody Tells You Are Pelvic Floor Related Most women think pelvic floor therapy is only for peeing your pants and painful sex. Those are real reasons to go. But Koleen also treats: • Chronic constipation and diarrhea, including fecal smearing in kids • Low back pain and hip pain that won’t resolve with regular PT • That “sitting on a softball” pressure feeling (often prolapse) • Tension headaches connected to neck and vagus nerve dysfunction • Jaw clenching (over 90% of jaw clenchers are clenching their pelvic floor too) • Erectile dysfunction and testicular pain in men • Postpartum issues from any kind of birth, including C-sections How interesting that one set of 26 muscles, none of which you can reach without an internal exam, can be silently driving symptoms across your entire body. Why “It’s Normal” Is Costing Women Their Lives Koleen shares the math on one client who leaked from age 40 to age 60. Wearing a size 4 pad, changing it four times a day, 24/7. Total spent on pads in those 20 years: $25,000. And that is just the financial cost. She skipped vacations, was anxious about every bathroom, and almost packed an extra suitcase of pads for a European trip. Then there is the nursing home statistic. 70% of nursing home admissions involve urinary incontinence. Women fall trying to make it to the bathroom in time. They break hips. They lose independence. The thing everyone told them was “just part of being a mom” is the same thing that ends their ability to live on their own. Why are we fighting so hard to keep symptoms that don’t belong to us in the first place? How To Find a Pelvic Floor PT Who Actually Knows What She’s Doing Not all pelvic floor therapists are created equal. If you have been to one and felt like nothing changed, you probably went to the wrong one. Here is what Koleen says to look for: • They listen. You should leave the first visit feeling truly heard, not rushed through a script. • They take a whole-body approach. Posture, range of motion, balance, jaw, neck, sleep, stress, gut, all on the table. • They do internal work. This is the gold standard. Skipping the internal exam means guessing. • They ask permission before every touch. “Can I touch your inner thigh? Can I touch your labia?” Consent every time. • They use real sheets, not paper drapes. The environment should feel safe and respectful. • You see improvement within two to three visits. Not full resolution, but a clear sense that you are on the right track. Interview them. Ask about success rates. Ask how long they have been doing this. Ask if they have treated your specific issue before. You are not being difficult. You are being a good steward of your body. Action Steps From This Episode • Notice when you clench. Throughout the day, check in with your jaw, your shoulders, and your pelvic floor. Awareness is step one. • Stop fighting for your symptoms to be normal. If something feels off, it is information, not an identity. • Find a pelvic floor PT who does internal work and treats the whole body, not just the symptom. • If you have done Kegels and they made things worse, that is a sign of pelvic floor tightness. Stop. Get assessed. • Advocate for yourself with your OB. You can ask for a pelvic floor PT referral at your six-week postpartum visit. You don’t have to wait six months to “see if it gets better.” “Pelvic floor issues can ruin your life. And I have the ability to help them get their life back.” — Koleen Adams, Awaken Pelvic Therapy Connect with Koleen Adams Koleen Adams is the founder and owner of Awaken Pelvic Therapy in Lapeer, Michigan. She works with women, men, and kids using a whole-body ...