Tag Archive for: PT Tips

How to Use Vaginal Dilators: A Gentle Step-by-Step Guide

Were you told to use vaginal dilators and have absolutely no idea what to do with them?

You are not alone.

Many women are handed a set of dilators by a doctor and sent home feeling overwhelmed, intimidated, or unsure where to even begin.

Sometimes the dilators themselves look huge compared with anything you have comfortably inserted before.

If this mirrors your experience, please hear this:

Your body is not broken.

You do not need to force your body through something painful just because someone told you to use a dilator.

Most women were never taught this: successful dilator work is not about pushing yourself through pain. It is about starting at a level where your body feels comfortable and gradually teaching your pelvic floor that touch and insertion do not have to hurt.

This is about more than symptom management. It is about helping your muscles and your brain become more comfortable with insertion over time.

Why Starting With the Right Size Matters

One of the first problems I see is that women are given dilators that feel far too intimidating.

Some sets stack together almost like Russian nesting dolls, and the smallest option may still be much larger than what your body currently tolerates.

If using a tampon is already painful, jumping directly to something much larger probably is not going to set you up for success.

Instead, start where your body is comfortable.

That might mean:

  • A slim tampon applicator
  • Your own clean finger
  • The smallest size in a gradual silicone dilator set

The goal is to choose something you can use without creating pain or fear.

Once that feels comfortable, you can slowly work your way up.

Why Pain-Free Practice Matters

One of the most important parts of learning how to use vaginal dilators is making the experience as pain-free as possible.

Pauli explains that when you are nervous, anxious, or afraid, your pelvic floor may respond by tightening.

That matters because if every attempt at insertion hurts, your body may begin expecting pain the next time.

Instead, we want to teach your brain and pelvic floor something different:

Touch and insertion do not always have to be painful.

Cleveland Clinic also explains that vaginal dilators can be used in gradually increasing sizes to help make penetration more comfortable over time.

https://my.clevelandclinic.org/health/diseases/15723-vaginismus

That is why forcing a larger dilator into your body before you are ready is not the goal.

Comfort and success come first.

Choose What Feels Comfortable to You

Not every woman needs to begin with a medical-looking dilator.

Some women feel much more comfortable starting with something familiar, like their finger or a tampon applicator.

That is completely fine.

If a silicone dilator feels comfortable to you, use one.

If a finger feels better, start there.

If a slim tampon applicator feels the least intimidating, use that.

The important thing is that you feel comfortable and successful with whatever you are using.

How to Use Vaginal Dilators

Once you have chosen a size or tool that feels manageable, keep the process simple.

1. Wash the Dilator

Wash your dilator with soap before and after use according to the product instructions.

Keeping the tool clean is an important part of using it safely.

2. Use Lubricant

Apply lubricant to help decrease friction and make insertion more comfortable.

You do not need to force a dry tool into sensitive tissues.

3. Start at the Opening

You do not even have to fully insert the dilator on your first attempt.

Let it rest gently at the vaginal opening.

Get comfortable there.

That may be all you do during your first few sessions.

And that is completely okay.

Keep Your Practice Short

Dilator work does not have to become a long, exhausting routine.

Pauli recommends starting with about 30 seconds to two minutes of practice.

You might simply allow the dilator to rest at the opening while you breathe and let your body become comfortable with the sensation.

Then you’re done.

Wash it.

Put it away.

Move on with your day.

You can practice this a couple of times each week rather than turning it into something stressful or overwhelming.

Slowly Progress the Position

Once you are comfortable inserting the dilator and letting it sit, you can begin allowing it to rest in slightly different positions within the vaginal canal.

Again, the goal is not to force a deep stretch.

It is to gradually introduce your tissues to different sensations while staying comfortable.

Once that size feels easy and successful, you can consider moving to the next size.

Then repeat the same process.

Start slowly.

Get comfortable.

Progress when your body is ready.

Bigger Is Not Automatically Better

A common mistake is assuming that the goal is to move through the dilator sizes as quickly as possible.

It isn’t.

The goal is not:

“How fast can I get to the biggest one?”

The better question is:

“Can I use this size comfortably and without pain?”

If the answer is yes, you may be ready to progress.

If the answer is no, stay where you are.

There is no prize for rushing.

Dilators Are a Tool, Not a Test

Vaginal dilators can be helpful because progressive sizes allow you to gradually become comfortable with increasing girth.

But the dilator itself is not the goal.

The goal is helping your body learn that insertion can happen without pain.

That is why your finger or a tampon applicator can also be useful starting points.

Choose the tool that helps you feel the most comfortable and successful.

Understanding your body creates confidence.

You Do Not Have to Figure This Out Alone

If learning how to use vaginal dilators still feels intimidating or scary, that is okay.

You do not have to force yourself through it alone.

A pelvic floor physical therapist can help you understand where to start, what size may be appropriate, and how to progress without simply pushing through pain.

The goal isn’t temporary relief—it’s long-term strength, comfort, and confidence.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

You can also complete Your Pelvic Floor’s Next Step Form here:

https://www.beyondthevbypauli.com/nextstep

Your body is not broken.

Start where you are comfortable.

Progress gradually.

And remember: successful dilator work is not about forcing your body to tolerate pain. It is about helping your body learn that touch and insertion can feel safe and comfortable again.

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Painful Speculum Exam? The Essential Guide to Preparing for a Pap Smear

Is it painful when you have a speculum exam for a Pap smear?

Or are you nervous just thinking about your next appointment?

If so, this is for you.

As a women’s health physical therapist, one thing that frustrates me is that women are expected to go in for important pelvic exams without ever being taught how to prepare for them.

A painful speculum exam can feel intimidating and uncomfortable, especially if your pelvic floor already has difficulty relaxing.

Most women were never taught this: your pelvic floor muscles need to be able to lengthen and accommodate the speculum during the exam.

The good news is that there are practical steps you can practice ahead of time to help you understand the process and feel more prepared.

First, Understand How a Speculum Works

A speculum can look pretty intimidating if you have never actually seen one.

During a Pap smear, the speculum is inserted vaginally and then opened to create enough space for your healthcare provider to perform the exam.

That means your pelvic floor muscles need to be able to lengthen and accommodate both the insertion and the opening of the speculum.

Cleveland Clinic also explains how speculums work, the different sizes available, and why some women may experience discomfort during an exam:

https://my.clevelandclinic.org/health/articles/24238-speculum

One of the first things I recommend is purchasing a small, plastic child-sized speculum.

Even before you use it, simply hold it.

Look at it.

Learn how it opens and closes.

Understanding what is actually being inserted into your body can take away some of the mystery surrounding the exam.

Start Smaller With a Tampon Applicator

Before practicing with a speculum, start with something smaller.

If insertion is uncomfortable, begin with a slim tampon applicator.

Once that feels comfortable, progress to:

  1. A slim tampon applicator
  2. A regular tampon applicator
  3. A super-size tampon applicator
  4. A child-sized speculum

The goal is to gradually become more comfortable with insertion rather than immediately jumping to the largest tool.

Practice Pressing “Around the Clock”

Once the tampon applicator is inserted comfortably, practice applying gentle pressure around the vaginal opening.

Think of the opening like the face of a clock.

You can gently explore different directions around that clock to help your pelvic floor become more comfortable accommodating pressure from different angles.

Once the smaller applicator feels comfortable, move up gradually through the different sizes.

You do not need to rush.

Get Comfortable With the Speculum Before Opening It

Once you feel comfortable using the tampon applicators, you can begin practicing with the child-sized speculum.

Start by simply practicing insertion and removal.

Before trying to open it while it is inserted, practice the mechanism with the speculum outside of your body.

Learn how it clicks open.

Learn how to release it.

Practice operating it from the same angle it would be positioned during a pelvic exam.

The goal is to understand exactly how the tool works so there are fewer surprises.

Try the One-Click Method

Once insertion feels comfortable and you understand how the mechanism works, Pauli recommends progressing gradually.

Insert the lubricated child-sized speculum slowly.

Then give it one click open.

Allow yourself a moment to adjust to that sensation.

Then release the click and slowly remove the speculum.

You do not need to immediately open it to its full capacity.

This gradual practice gives you more control over the experience and allows you to work at your own pace.

Put Yourself in the Driver’s Seat

One of the biggest benefits of preparing ahead of time is that you understand what feels comfortable for your body.

Pauli shares that many of her patients in Utah have brought their own child-sized speculum to their medical appointments.

Some doctors have been willing to use the smaller speculum, and some have even allowed the patient to insert or open the speculum herself.

That can be especially meaningful for women who have a history of trauma or who feel anxious about pelvic exams.

Instead of feeling like everything is happening to you, you can have more input into:

  • The pace of the exam
  • Your comfort level
  • How much time you need
  • The size of the speculum
  • When you are ready to proceed

A Pap smear is important.

But that does not mean you have to completely give up control of your body during the process.

Talk to Your Healthcare Provider

At your appointment, communicate what you need.

You can tell your provider that you have pelvic floor tightness or a history of painful exams.

If you have practiced with a smaller speculum and would like your provider to use it, ask whether they are comfortable doing so.

You may also need a little extra time before the exam begins.

The important thing is that you communicate rather than silently trying to endure discomfort.

Understanding your body creates confidence.

You Do Not Have to Figure This Out Alone

If these steps still feel intimidating or scary, that is important information too.

You do not need to force yourself through the process alone.

A pelvic floor physical therapist can help you work through insertion, pelvic floor relaxation, and preparation for a speculum exam in a more supported setting.

A painful speculum exam does not have to be something you simply dread every time your next Pap smear approaches.

Preparation can help you understand what is happening, become more familiar with the tools involved, and feel more in control of your body.

If you’re tired of conflicting advice online and want a clear roadmap, explore the No Kegels University® Method and learn how to build lasting strength and confidence.

Complete Your Pelvic Floor’s Next Step Form here:

https://www.beyondthevbypauli.com/nextstep

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Why Am I Peeing So Much? What Your Bladder Is Trying to Tell You

Picture this: You wake up in the morning feeling incredibly well-rested. Your head is clear, your energy is high, and you feel ready to take on the day without even reaching for a cup of coffee. For many busy moms and women, this sounds like an absolute fairytale. Often, the reason we aren’t experiencing this level of refreshing rest has everything to do with our bladders.

If you are someone who constantly has to map out where the nearest bathroom is, or if you find yourself peeing every 30 to 60 minutes just to “be safe,” you are not alone. Most women were never taught this, but letting your bladder dictate your schedule can become a long-standing joke among family and friends. It turns into a normal part of your routine, but it is not how your body was designed to function. Understanding your body creates confidence. You don’t have to live in a state where your bladder controls everything you do.

What Is Normal Bladder Capacity?

To reclaim control over your schedule, we first need to establish what a healthy, functioning bladder actually looks like.

On average, a normal bladder capacity is around 16 ounces—which is about two to two and a half cups of fluid. When your bladder fills up to this capacity, the delicate nerves embedded within the bladder wall begin to stretch. This stretching is what triggers a signal up to your brain saying, “Hey, it is time to find a restroom.”

Once you are in the bathroom, your brain sends a signal back down to cause a gentle contraction, allowing you to empty completely. In a healthy system, this entire process should occur roughly every two to two and a half hours during the day. Needing to go every 15, 20, or 30 minutes is a clear indicator that your signaling system is out of sync.

The “Just in Case” Peeing Trap

The biggest myth keeping women stuck in a cycle of frequent urination is the idea that peeing “just in case” before leaving the house protects you from accidents.

The Structural Fact: Emptying your bladder when it is only holding a tiny fraction of its capacity trains the internal nerves to become hypersensitive, effectively shrinking your functional bladder capacity over time.

Another common misconception is that if you have pelvic floor dysfunction, your bladder is simply weak and you have to accept it as part of aging or motherhood. Your bladder is a highly adaptable, muscular organ. Just as it can learn bad habits from frequent, low-volume trips, it can be retrained to hold a normal volume of fluid without triggering panic signals to your brain.

Why Your Bladder Is Tricking You

Why do you feel an overwhelming urge to empty your bladder when it isn’t actually full? It comes down to a root-cause issue of internal signaling errors.

When you get into the habit of running to the bathroom at the very first sign of a minor tickle, your bladder learns to trigger its muscular contractions prematurely. It essentially tricks your brain into believing it is at maximum capacity when it might only be holding 3 or 4 ounces of fluid.

Clinical data shared by the Cleveland Clinic shows that your pelvic floor muscles and bladder must work in a coordinated relaxation and contraction loop. When this loop is disrupted by frequent, anxious voiding, your bladder starts winning the mental game. Root-cause healing matters, and reversing this pattern requires interrupting that false alarm signal before it becomes an automatic reflex.

Action Steps: How to Reclaim Your Bladder Control

You can actively retrain your nervous system and bladder to coexist peacefully. Start with these practical tracking steps:

  1. Track for 24 to 48 Hours: Before you try to change anything, simply write down what you drink, when you drink it, and when you go to the bathroom. Jot down a quick guess of the volume: small, medium, or large.
  2. Look for the Urgency Pattern: Review your notes. If you notice you are peeing every 45 minutes but have only consumed a total of 12 ounces of water over several hours, your bladder is tricking you.
  3. Ask the Capacity Question: The next time you feel a sudden, intense urge to go, pause. Ask yourself: “Have I actually consumed enough fluids in the last hour to fill a 16-ounce cup?”
  4. Delay the Urge: If the answer to the capacity question is no, try to delay your bathroom trip by 5 to 10 minutes. Distract your brain, sit down quietly, or take deep breaths to let the premature bladder contraction pass.

Your body is not broken. Living with constant bathroom anxiety is exhausting, but your bladder capacity can be safely and effectively expanded with the right approach. This is about more than symptom management. It is about regaining the freedom to live your life without checking for a restroom everywhere you go.

You don’t need more random exercises. You need a strategy. Book an appointment and let’s create a plan designed specifically for your body and goals. Start by taking your first intentional step and fill out Your Pelvic Floor’s Next Step Form today to map out your path to long-term strength.

To hear the full story of how resetting my family’s sleep patterns brought these bladder habits to light, listen to Episode 18 of the Beyond the V Podcast with Pauli.

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Straining to Poop? Your Pelvic Floor Might Be the Problem

One of the things I love most about being a pelvic floor physical therapist is helping women understand parts of their bodies that no one ever explained to them.

And yes…sometimes that means talking about poop.

If you’re reading this and thinking, “I can’t believe I’m reading an entire article about bowel movements,” you’re not alone. But here’s the truth:

Your pelvic floor plays a huge role in how you poop.

Most women were never taught that.

Instead, if you’re constipated, you’ve probably heard advice like:

  • Drink more water.
  • Eat more fiber.
  • Take a stool softener.
  • Try a laxative.

While those things certainly have their place, they’re only part of the picture.

As a pelvic floor physical therapist, I always tell my patients there are two pillars to treating constipation. One pillar involves looking at the stool itself—things like hydration, nutrition, and consistency. The other pillar is something many people have never heard of:

How your pelvic floor functions.

In this article, I want to help you understand why your pelvic floor matters every time you have a bowel movement—and why pushing harder may actually be making things worse.

If you’d rather hear me explain it myself, you can also watch Episode 33: Pooping & Your Pelvic Floor on YouTube.

Why Your Pelvic Floor Matters When You Poop

When I explain constipation to my patients—including the children I treat—I use a very simple analogy.

Imagine one of those toddler shape-sorting toys.

You know the ones.

There’s a box with different-shaped holes—a star, a triangle, a square—and your child tries to fit each shape into the correct opening.

One of the hardest things to watch is when they keep trying to push a triangle through the star-shaped hole.

No matter how hard they push…

It isn’t going to fit.

That’s exactly what I think about when someone tells me they’re constantly straining to have a bowel movement.

Sometimes the problem isn’t that you’re not pushing hard enough.

The problem is that the opening isn’t working the way it’s supposed to.

Understanding What Happens Before You Feel the Urge to Go

Let’s simplify what’s happening inside your body.

Think of your intestines like a long series of pipes.

At the end of those pipes is what I like to call a trap door.

This trap door opens automatically and allows stool to move into a “holding room.”

That holding room is your rectum.

As stool fills your rectum, sensors tell your brain:

“It’s time to have a bowel movement.”

Isn’t that incredible?

Your body is designed to wait until there’s enough stool before interrupting your day.

It’s an incredibly efficient system.

But here’s where your pelvic floor enters the story.

At the very end of that holding room sits part of your pelvic floor—the muscles you can control.

These muscles help control whether the outlet relaxes enough for stool to pass comfortably or whether it meets more resistance.

Understanding your body creates confidence.

The Real Reason Straining Doesn’t Always Work

Here’s where I see so many women struggle.

When it’s time to have a bowel movement, your pelvic floor shouldn’t squeeze.

It should lengthen.

I like to describe it like a trampoline.

Imagine stretching a trampoline downward.

As it stretches, the opening in the middle becomes wider.

That’s what should happen with your pelvic floor.

When it lengthens, it creates less resistance so stool can pass more comfortably.

But many people experience pelvic floor dysfunction, where the opposite happens.

Instead of lengthening…

The pelvic floor tightens.

Instead of relaxing…

It pulls upward.

Now imagine trying to push stool through an opening that’s actually getting smaller.

It’s just like trying to shove that triangle through the star-shaped hole.

No wonder it feels frustrating.

Myth: If You Push Harder, You’ll Finally Go

This is one of the biggest misconceptions I hear.

When stool doesn’t come out easily, our natural instinct is to strain harder.

Unfortunately, for some people with pelvic floor dysfunction, that can make the coordination problem worse.

Instead of opening the pathway…

Your body creates more resistance.

That’s why so many people feel like they’re fighting their own bodies every time they sit on the toilet.

Your body is not broken.

It may simply be using the wrong muscle strategy.

Cleveland Clinic explains that pelvic floor dysfunction can involve difficulty relaxing and coordinating the pelvic floor muscles during a bowel movement, which may contribute to constipation and straining.

https://my.clevelandclinic.org/health/diseases/14459-pelvic-floor-dysfunction

This is about more than symptom management.

Root-cause healing matters.

The Missing Piece: Teaching Your Pelvic Floor to Let Go

One of the first things I work on with many of my patients is helping them relearn a movement their bodies were designed to do naturally.

It’s called Balloon Breathing.

You may have heard of diaphragmatic breathing before.

Balloon breathing is my way of helping you understand what’s happening with your pelvic floor while you breathe.

Here’s how I explain it.

Imagine there’s a balloon inside your abdomen connected to a helium tank.

As you inhale:

  • Your belly gently expands.
  • Your ribs widen.
  • Pressure moves downward.

Now here’s the important part.

That gentle pressure should encourage your pelvic floor to drop, just like that stretched trampoline.

When you exhale:

  • Your diaphragm rises.
  • Your belly relaxes.
  • Your pelvic floor naturally comes back up.

This up-and-down motion is part of how your diaphragm and pelvic floor work together.

Pregnancy Can Change This Natural Pattern

One teaching point I want every mom to understand is that pregnancy and childbirth can change breathing, abdominal pressure, and pelvic floor coordination.

As your baby grows, everything inside your abdomen shifts.

Your ribs change.

Your diaphragm changes.

Your breathing changes.

Your organs have less room to move.

After delivery, many women are never taught how to reconnect with that normal breathing pattern.

That’s one reason pelvic floor coordination may become part of the constipation picture after pregnancy.

Most women were never taught this.

One Simple Exercise I Give My Patients

One strategy I often give my patients is to practice Balloon Breathing 60–80 times throughout the day.

The goal is not to force anything.

Instead, focus on noticing whether your pelvic floor gently drops as you inhale.

Once that becomes easier, I have them practice the same breathing while sitting on the toilet.

Instead of straining…

Instead of holding their breath…

Instead of pushing…

I encourage them to use their breath to help the pelvic floor lengthen naturally.

I jokingly tell my patients to “breathe your poop down.”

It usually gets a laugh.

But it also helps make the concept easy to remember.

One of my students once admitted she thought I had completely lost my mind after hearing me teach this.

The next day she came back and said she tried it herself.

She couldn’t believe how much easier—and honestly more satisfying—her bowel movement was.

That’s exactly what I want for my patients.

You should stand up after a bowel movement feeling like your body worked the way it was designed to.

Your Action Steps

If constipation has become your normal, I want you to start with these simple steps:

Practice Balloon Breathing Every Day

Practice multiple repetitions throughout the day and focus on noticing your pelvic floor gently drop with the inhale.

Stop Assuming Straining Is the Answer

If you’re constantly pushing, your pelvic floor may actually need to relax and coordinate better—not simply work harder.

Pay Attention to How You Feel After a Bowel Movement

An efficient, comfortable bowel movement can give you useful information about how well your body is coordinating.

Learn the Root Cause

If you continue to struggle with straining, incomplete emptying, or constipation, pelvic floor physical therapy can help evaluate whether pelvic floor coordination may be part of the problem.

Your Next Step

If constipation has become something you’ve simply learned to live with, I want you to know there may be another answer.

The goal isn’t temporary relief—it’s long-term function.

Healing isn’t about pushing harder.

It’s about helping your body do what it was designed to do.

If you’re ready to stop guessing and start understanding your body, fill out Your Pelvic Floor’s Next Step Form so we can identify what’s really contributing to your symptoms and determine the best path forward.

https://www.beyondthevbypauli.com/nextstep

You deserve better than fear-based advice.

You deserve to understand your body.

And when your pelvic floor functions the way it was designed to, even something as ordinary as having a bowel movement can become easier, more comfortable, and something you no longer have to think twice about.

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Endometriosis Flare: What Is Your Body Trying to Tell You?

If you live with endometriosis, you know the feeling.

You wake up expecting a normal day, and within a few hours, everything changes.

The pain increases.

Your energy disappears.

Simple tasks suddenly feel overwhelming.

Maybe your first thought is, “Not again.”

I’ve been there.

As someone who has lived with endometriosis, I know how discouraging flares can be. They can interrupt work, family time, exercise, travel, and even the plans you’ve been looking forward to all week.

It’s easy to feel frustrated with your body during those moments.

But over the years, I’ve learned something that completely changed the way I approach a flare.

Instead of asking, “Why is my body doing this to me?”

I started asking,

“What is my body trying to tell me today?”

That one question shifted everything.

Your body is not broken.

Learning to listen to your body doesn’t mean giving in to your symptoms. It means responding with curiosity instead of frustration and making choices that support healing instead of working against it.

Your Body Is Always Communicating

Our bodies are incredibly intelligent.

They constantly communicate through signals like:

  • Hunger
  • Thirst
  • Fatigue
  • Pain
  • Muscle tension
  • Energy levels

Pain is one of those signals.

It isn’t always pleasant, but it is information.

When an endometriosis flare begins, your body is telling you that something needs your attention.

That doesn’t mean you’ve done something wrong.

It doesn’t mean your body is failing you.

It simply means your body has different needs today than it did yesterday.

Most women were never taught this.

Stop Fighting the Flare

One of the hardest lessons I’ve had to learn is that fighting my body usually makes things harder.

When symptoms first started years ago, my instinct was to ignore them.

I’d tell myself:

“Just push through.”

“You’ll feel better later.”

“You don’t have time to slow down.”

Sometimes that worked—for a little while.

But eventually, my body always demanded my attention.

The more I resisted, the more exhausted I became.

Eventually, I realized something.

Listening to my body wasn’t weakness.

It was wisdom.

The goal isn’t temporary relief—it’s long-term strength.

Ask Yourself One Simple Question

When a flare starts, I encourage women to pause and ask themselves:

“What do I need today?”

Notice I didn’t say:

“What should I be doing?”

Or,

“What did I do wrong?”

Instead, ask what your body actually needs in this moment.

The answer will look different every time.

Maybe today your body needs:

  • More water
  • A nourishing meal
  • A short walk
  • Gentle stretching
  • A nap
  • A heating pad
  • Quiet time
  • Deep breathing

There isn’t one right answer.

The key is learning to respond instead of react.

Understanding your body creates confidence.

Sometimes Rest Is the Right Choice

There is a misconception that resting means you’re giving up.

I don’t believe that.

Rest is one of the ways your body heals.

If you’re completely exhausted, forcing yourself through an intense workout or a packed schedule may not help your recovery.

Instead, ask yourself:

“Will this help my body heal today?”

Sometimes the answer is yes.

Sometimes the answer is no.

Giving yourself permission to rest without guilt can be one of the healthiest decisions you make.

Other Times, Your Body Needs Gentle Movement

Listening to your body doesn’t always mean staying in bed.

Sometimes your body needs movement.

During a flare, gentle movement may help reduce stiffness, improve circulation, and keep your muscles from becoming more guarded.

That movement might include:

  • A slow walk around the neighborhood
  • Gentle stretching
  • Deep breathing exercises
  • Light mobility work

It doesn’t have to be intense to be beneficial.

The Mayo Clinic explains that endometriosis symptoms vary from woman to woman, which is why treatment and self-care often need to be individualized. Learning how your own body responds to activity can help you make more informed decisions during a flare.

Root-cause healing matters.

Nourishment Matters More Than You Think

During a flare, it’s easy to forget the basics.

You may not feel like eating.

You may forget to drink enough water.

Or maybe you’re so focused on managing pain that nutrition falls to the bottom of the list.

But your body is working hard.

Supporting it with nourishing foods, hydration, and adequate rest gives it the resources it needs to recover.

Healing isn’t about doing one big thing.

It’s about doing many small things consistently.

Be Curious Instead of Critical

It’s easy to criticize yourself during difficult seasons.

You may think:

“I should be doing more.”

“Why can’t my body just cooperate?”

“I’m falling behind.”

Instead, try replacing criticism with curiosity.

Ask questions like:

  • What made this flare different?
  • Have I been getting enough sleep?
  • Am I carrying more stress than usual?
  • Have I been fueling my body well?
  • What helped me feel better the last time?

You’re gathering information—not assigning blame.

That shift changes the entire conversation you have with your body.

Healing Doesn’t Look the Same Every Day

One of the biggest mistakes we make is expecting consistency from a condition that isn’t always consistent.

Some weeks you’ll feel great.

Other weeks will be harder.

That doesn’t mean you’re moving backward.

Healing is rarely a straight line.

The National Institutes of Health (NIH) notes that endometriosis is a chronic condition with symptoms that can vary significantly over time, reinforcing the importance of creating a personalized management plan rather than expecting every day to look the same.

When you stop measuring success by whether you had symptoms and start measuring success by how you cared for yourself during those symptoms, your perspective begins to change.

You Are More Than Your Diagnosis

Endometriosis is part of your story.

It is not your identity.

Yes, there will be difficult days.

But there will also be joyful days.

Days where you laugh.

Move.

Connect with people you love.

Celebrate milestones.

Experience peace.

Don’t let your diagnosis convince you that your future is limited.

You deserve better than fear-based advice that tells you your body is working against you.

Your body is doing the best it can.

And every day, you have an opportunity to respond with compassion instead of frustration.

Your Next Step

If you’re tired of feeling like every flare is a setback, you don’t have to navigate this journey alone.

Start by filling out Your Pelvic Floor’s Next Step Form so we can better understand your symptoms, identify patterns, and create a plan that’s personalized to your body and your goals.

👉 https://www.beyondthevbypauli.com/nextstep

If you’re looking for a step-by-step approach to understanding your body, managing endometriosis, and building lasting strength, explore the No Kegels University® Method.

Healing isn’t about perfection.

It’s about understanding, consistency, and progression.

The next time a flare begins, remember this:

Instead of asking, “Why is this happening to me?”

Try asking,

“What is my body trying to tell me today?”

That simple shift may become one of the most powerful tools in your healing journey.

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Constipation and Pelvic Floor: Why Going Every Day Doesn’t Mean You’re Not Constipated

One of the most common conversations I have with patients starts the same way.

I’ll ask, “Tell me about your bowel movements.”

Almost immediately, they’ll answer, “They’re fine.”

Then I’ll ask a few more questions.

Do you strain?

Does it feel like you completely empty your bowels?

Does it ever feel like you’re working really hard just to have a bowel movement?

How often do you go?

That’s when the conversation usually changes.

Many women suddenly realize that what they’ve considered “normal” for years may actually be signs of constipation or pelvic floor dysfunction.

Some tell me they only have a bowel movement every two or three days but assumed that was normal.

Others tell me they go every single day—but every bowel movement involves straining, pushing, or feeling like they never completely emptied.

That’s why I want to challenge one of the biggest misconceptions I hear:

Just because you go every day doesn’t automatically mean your bowels are healthy.

If you’d like to hear me teach this concept in more detail, you can watch Episode 34: Constipation & Your Pelvic Floor on YouTube.

We Don’t Talk About Bowel Health Enough

One reason this misunderstanding is so common is because most of us simply don’t talk about bowel movements.

It can feel embarrassing.

Too personal.

Maybe even “not ladylike.”

But here’s what I tell my patients:

Your bowel habits are one of the clearest indicators of your overall health.

As a pelvic floor physical therapist, I also believe they’re one of the best indicators of how well your pelvic floor is functioning.

Ignoring bowel habits because they feel uncomfortable to discuss doesn’t make the problem go away.

It simply delays finding answers.

That’s one of the reasons I started talking openly about pelvic floor health. Women deserve to understand their bodies without shame or embarrassment.

Frequency Isn’t the Whole Story

Many people judge bowel health using only one question:

“How often do you go?”

While frequency matters, it doesn’t tell the whole story.

I care just as much about how you’re having your bowel movements.

For example:

  • Are you holding your breath?
  • Are you pushing and straining?
  • Do you feel like you’re fighting your body?
  • Do you leave the bathroom feeling completely empty?

Those answers often tell me much more than simply hearing, “I go every day.”

A healthy bowel movement should feel comfortable.

It shouldn’t feel like a workout.

The Connection Between Constipation and Your Pelvic Floor

Many women don’t realize that constipation and the pelvic floor influence each other.

Sometimes constipation contributes to pelvic floor problems.

Other times, the pelvic floor itself is contributing to constipation.

That’s why I ask every patient about bowel habits—even if they came to see me for leaking, prolapse, or pain.

Everything is connected.

Once my patients understand that relationship, something interesting happens.

Their perspective changes.

Instead of thinking:

“Why is my physical therapist asking about poop?”

They begin asking:

“How can improving my bowel habits also improve my pelvic floor?”

That shift in understanding is incredibly powerful.

Understanding your body creates confidence.

Stop Fighting an Uphill Battle

At the beginning of this episode, I shared a story about becoming a mom.

Before my children were born, I had all kinds of rules about technology.

I was convinced my kids wouldn’t be interested in screens.

Then reality happened.

No matter how hard I tried to fight it, technology was part of the world they were growing up in.

Eventually I realized something important:

I could keep fighting an uphill battle…

Or I could adjust my approach and create healthy habits that actually worked for our family.

That same lesson applies to constipation.

So many women spend years fighting their bodies.

They strain.

They push harder.

They assume discomfort is simply part of life.

But once they understand how the pelvic floor works and how healthy bowel habits support that system, everything becomes less of a struggle.

The goal isn’t to fight your body.

The goal is to work with it.

Better Bowel Habits Protect Your Pelvic Floor

One of the biggest reasons I care about constipation is because repeated straining doesn’t just affect your bowels.

It affects your pelvic floor too.

Every time we bear down excessively, we place additional pressure on the muscles and connective tissues that support our bladder, uterus, and rectum.

Over time, that repeated stress can contribute to pelvic floor dysfunction.

That’s why I don’t look at constipation as an isolated digestive problem.

I see it as part of your pelvic health.

Addressing bowel habits isn’t just about becoming more comfortable.

It’s about protecting the strength you’ve worked so hard to build.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), healthy bowel habits involve more than frequency. Persistent straining or difficulty passing stool can signal constipation even if bowel movements occur regularly.

Small Changes Can Make a Big Difference

One thing I love about pelvic floor therapy is that meaningful progress often starts with simple changes.

You don’t always need a complicated plan.

Sometimes it’s learning to pay attention to your bowel habits.

Sometimes it’s changing your toilet posture.

Sometimes it’s improving your breathing.

Those small adjustments work together to make bowel movements feel easier and place less stress on your pelvic floor.

As I often tell my patients, once your bowels and your pelvic floor begin working together instead of against each other, that uphill battle starts to disappear.

Your Next Step

If you’ve always assumed your bowel habits were “normal,” I encourage you to get curious.

Instead of only asking, “How often do I go?”

Start asking:

  • Do I strain?
  • Do I feel completely empty afterward?
  • Does my body feel relaxed, or am I forcing the process?

Those questions can tell you far more about your pelvic floor than you might expect.

If you’re ready to understand what’s contributing to your symptoms and want a personalized plan for improving your pelvic floor health, I’d love to help.

Complete Your Pelvic Floor’s Next Step Form to discover the next best step for your body.

👉 https://www.beyondthevbypauli.com/nextstep

Remember, your body is constantly giving you information. Learning how to listen to it is one of the greatest gifts you can give yourself.

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Vulva Anatomy Explained: A Simple Guide to Understanding Your Body

Vulva anatomy can feel confusing when no one has ever clearly explained what you are looking at.

Have you ever wanted to understand what is actually happening “down there,” but felt way too nervous to look?

Maybe you have thought about using a mirror but immediately felt uncomfortable. Maybe you have searched online, only to find diagrams that felt way too clinical or confusing.

If that sounds familiar, you are definitely not alone.

Most women were never taught this.

Many women grow up without anyone calmly walking them through the different parts of their external anatomy. That is exactly what this guide is for.

There is nothing strange or embarrassing about wanting to understand your own body.

Understanding your body creates confidence.

What Is the Vulva?

One of the biggest sources of confusion is the word vulva.

A lot of women hear the word vagina and assume it describes the entire outside area.

But it doesn’t.

The vulva refers to the entire external region.

If you were looking at yourself in a mirror, the vulva would include the external tissues from the upper portion of the area down toward the perineum and rectal opening.

The vagina is only one part of that region.

The Labia Majora: The Outer Folds

The first structures to know are the labia majora.

These are the larger outer folds of tissue.

One patient described them as the “big curtains,” which is actually a pretty helpful way to picture them.

They form the outer layer of the vulva.

The Labia Minora: The Inner Folds

Inside the labia majora are the labia minora.

These are the smaller inner folds of tissue.

If you gently move the outer folds aside, these are the tissues you see underneath.

They surround the area containing the urethral and vaginal openings.

The Clitoris

At the top of the vulva is the clitoris.

If you picture the tissues meeting in a “V” shape near the top, this is the general area where the visible portion of the clitoris is located.

This area contains many nerve endings and plays an important role in sexual pleasure and orgasm.

For many women, simply learning where the clitoris is located is a major “aha” moment.

The Urethral Opening

Moving downward, the next structure is the urethral opening.

The urethra is the tube connected to your bladder.

This is where urine leaves your body.

So urine does not come out of the vaginal opening.

They are two separate openings with different functions.

The Vaginal Opening

Below the urethral opening is the vaginal opening.

You may also hear this called the introitus.

This is the opening where:

  • A tampon is inserted
  • A finger may be inserted
  • Penetration during intercourse occurs
  • A baby passes during vaginal childbirth

The Perineum

Below the vaginal opening is an area called the perineum.

This is the area between the vaginal opening and the rectal opening.

If a woman experiences tearing during childbirth or has an episiotomy, this is generally the area being discussed.

A Simple Vulva Anatomy Map

Think of the vulva in two parts:

The folds around the outside

  • Labia majora: the larger outer folds
  • Labia minora: the smaller inner folds inside them

These folds surround and protect the openings underneath.

Then, from top to bottom

  1. Clitoris
    Located near the top where the inner tissues meet.
  2. Urethral opening
    The small opening where urine comes out.
  3. Vaginal opening
    The opening where a tampon, finger, or penis may enter, and where a baby passes during vaginal birth.
  4. Perineum
    The area of skin between the vaginal opening and the rectal opening.
  5. Rectal opening
    The opening where bowel movements leave the body.

So the easiest way to remember it is:

Clitoris → Urethra → Vagina → Perineum → Rectum

Myth-Busting: “Everything Down There Is the Vagina”

This is probably one of the most common anatomy misunderstandings.

Myth: The whole external area is called the vagina

Reality: The whole external region is called the vulva.

The vagina is the opening and canal located within that region.

Myth: Urine comes out of the vagina

Reality: Urine leaves your body through the urethral opening, which is separate from the vaginal opening.

Myth: You should already know all of this

Reality: Many women were simply never taught these terms.

Not knowing does not mean there is anything wrong with you.

It means there was a gap in education.

Why Learning Your Anatomy Matters

Learning these terms is not about making your body feel more clinical.

It is actually the opposite.

The more familiar your anatomy becomes, the less mysterious it feels.

You can look at a diagram and understand what you are seeing.

You can better understand what a healthcare provider is talking about.

And you have accurate language available if you ever need to explain female anatomy to your own children.

For another simple anatomy reference, you can visit:

Cleveland Clinic: Vulva Anatomy

Understanding Your Body Creates Confidence

Your anatomy is not something you need to be afraid to learn about.

It is simply part of your body.

You have a vulva.

You have labia majora and labia minora.

You have a clitoris.

You have a urethral opening.

You have a vaginal opening.

You have a perineum.

Knowing where these structures are gives you a foundation for understanding your health.

Understanding your body creates confidence.

And the more comfortable women become talking about female anatomy, the easier it becomes to change the conversation around women’s health.

If you’re ready to stop guessing and start understanding your body, complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

Vulva anatomy (perineum and rectal opening not shown)

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Abdominal Surgery Recovery: The Truth About Healing Beyond the Incision

Abdominal surgery recovery involves much more than waiting for your skin incision to close.

There is a familiar script that thousands of women experience every single year. You undergo an abdominal or pelvic surgery—perhaps a hysterectomy, an appendectomy, or an exploratory laparoscopy. At your follow-up appointment, your doctor glances at your skin, confirms that your small incisions have closed beautifully, and clears you to begin returning to normal exercise and regular activities.

But as you drive home and try to resume your daily routine, you quickly realize that something is missing.

Your skin might be closed, but things just don’t feel right down there. You feel an underlying stiffness when you bend over, a strange pulling sensation near your core, or perhaps you’ve noticed new bladder leaks or digestive changes.

If this sounds like you, please know this: your body is not broken.

The medical system is wonderful at acute surgical care, but many women receive very little guidance when it comes to comprehensive post-operative rehabilitation.

Most women were never taught this: external healing is only part of the story. What happens beneath the surface can influence how comfortably your entire midsection moves, bends, and functions.

This is about more than symptom management. True abdominal surgery recovery requires looking beyond the visible skin incision and considering what is happening throughout the deeper tissues.

The Myth of the “Fully Healed” Six-Week Clearance

The biggest myth surrounding abdominal surgery recovery is that external healing automatically equals complete internal readiness.

When a surgeon clears you to return to activity, that clearance is incredibly important. But it does not necessarily mean your strength, mobility, coordination, and confidence have completely returned.

When an incision is made, your body lays down collagen and scar tissue to repair the injured area.

Sometimes deeper bands of scar tissue called adhesions can also form after abdominal surgery.

I like to describe this to patients using a “super glue” analogy.

Imagine two surfaces inside your abdomen that normally slide and glide smoothly past one another. Now imagine a section between those surfaces becoming stuck together.

That can help explain what an adhesion does.

It is important to remember that scar tissue is not literally super glue spreading throughout your abdomen, and most abdominal adhesions never cause symptoms.

Cleveland Clinic explains that abdominal adhesions are bands of scar tissue that can form between organs or between an organ and the abdominal wall, most commonly after abdominal surgery. Some adhesions can restrict normal organ movement or contribute to chronic abdominal or pelvic pain. Cleveland Clinic

When you try to jump straight back into typical gym workouts or standard pelvic floor exercises while your abdomen still feels restricted, you may find yourself compensating around those areas instead of moving normally.

It can feel a little like trying to drive your car with the emergency brake partially engaged.

Myth-Busting: “If I Massage My External Scar, I’ve Taken Care of the Scar Tissue”

Many proactive women learn about scar tissue and diligently massage their external surgical scars with oil or lotion.

That can be a great tool for improving comfort and mobility in the skin and more superficial tissues.

But external scar massage and deeper abdominal mobility are not exactly the same thing.

The Reality: External scar massage can improve superficial tissue mobility, but it does not simply remove deep internal adhesions.

This is an important distinction.

True abdominal adhesions cannot reliably be “broken apart” with someone’s hands. Cleveland Clinic notes that surgery is the way adhesions themselves are physically divided when treatment is medically necessary, although some research suggests soft-tissue mobilization may help reduce adhesion-related pain. More research is still needed. Cleveland Clinic

However, when stiffness, pulling, or protective muscle tension remain after surgery, hands-on treatment may be one part of restoring more comfortable movement.

One approach some pelvic floor physical therapists use is called visceral mobilization.

What Is Visceral Mobilization?

Visceral mobilization is a gentle form of hands-on manual therapy used by some pelvic floor physical therapists and other trained providers.

During a session, the therapist uses specific hand placements on the abdomen to assess how comfortably the tissues move and whether certain areas feel restricted or sensitive.

Using slow, controlled pressure, the therapist may work on improving mobility through the abdomen and surrounding tissues.

The goal is not to aggressively “break up” adhesions or force organs into different positions.

Instead, visceral mobilization may help address:

  • Tissue mobility
  • Scar sensitivity
  • Protective muscle guarding
  • Comfortable bending and twisting
  • Breathing and core movement
  • Confidence returning to exercise

Understanding your body creates confidence.

The Root Cause of Your Post-Op Stiffness and Pelvic Changes

Why can surgery higher up in the abdomen sometimes seem connected to symptoms down in the pelvis?

Your core and pelvic floor work together as part of a larger pressure-management system.

Every time you inhale, your diaphragm moves downward, your abdominal contents shift slightly, and your pelvic floor generally lengthens in response.

When you exhale, the system recoils.

If an area of your abdomen feels painful or restricted after surgery, your body may begin protecting it.

Without realizing it, you might:

  • Hold your breath
  • Keep your stomach constantly tight
  • Avoid twisting
  • Move differently on one side
  • Take smaller breaths

Those protective patterns can influence the way your abdominal muscles and pelvic floor coordinate.

Scar tissue after abdominal or pelvic surgery is also one of several factors that may contribute to pelvic pain. APTA Pelvic Health notes that pelvic pain can involve scar tissue, pelvic floor muscle tightness or weakness, nerve irritation, and poor muscle coordination. APTA Academy of Pelvic Health

This does not mean an abdominal adhesion automatically causes bladder leakage, urinary urgency, or painful intimacy.

But if those symptoms appear after surgery, changes in tissue mobility, muscle guarding, breathing, and pelvic floor coordination may be worth evaluating.

Root-cause healing matters.

How to Build Lasting Post-Surgical Strength

The goal isn’t temporary relief—it’s long-term strength.

If you want to fully recover from an abdominal or pelvic procedure, your rehabilitation strategy needs to be deliberate and root-cause focused.

1. Consider Visceral Mobilization

If you continue to experience pulling, stiffness, or limited movement after your incision has healed, consider working with a specialized pelvic floor physical therapist who has experience with post-surgical rehabilitation or visceral mobilization.

They can assess whether your symptoms may involve:

  • Scar sensitivity
  • Reduced tissue mobility
  • Abdominal muscle guarding
  • Breathing patterns
  • Pelvic floor dysfunction
  • Movement compensation

Visceral mobilization may be one tool within that larger treatment plan.

2. Don’t Rush Aggressive Core Workouts

You do not necessarily need to avoid planks, crunches, twisting, or strength training forever.

But forcing your body immediately back into heavy core exercises while movement still feels restricted may cause you to compensate elsewhere.

Focus on restoring comfortable movement first, then gradually layer strength back in.

3. Restore the Diaphragmatic Breath

Spend five minutes each day lying comfortably with your hands on your lower ribs.

Breathe slowly.

Allow your ribs and abdomen to expand naturally as you inhale.

Let everything gently recoil as you exhale.

Do not force your stomach outward or constantly suck it inward.

This gentle movement helps restore normal coordination between your breathing system, abdominal wall, and pelvic floor.

4. Track Your Symptoms

Take note of when you feel tightness or pulling.

Does it happen when you:

  • Take a deep breath?
  • Twist?
  • Reach overhead?
  • Bend backward?
  • Exercise?
  • Have a full bladder?

These patterns can give your physical therapist valuable information.

5. Find the Right Specialist

Look for a pelvic floor physical therapist who has experience with:

  • Abdominal scar mobilization
  • Visceral mobilization
  • C-section recovery
  • Post-surgical rehabilitation
  • Pelvic floor dysfunction

The goal is not to assume every symptom is caused by adhesions.

The goal is to identify what is actually limiting your recovery.

Your Recovery Goes Beyond the Incision

Your body is not broken.

A healed incision is an important milestone, but abdominal surgery recovery does not always end when the skin closes.

Your abdomen needs mobility.

Your core needs coordination.

Your pelvic floor needs to respond appropriately to breathing and movement.

And your body deserves the opportunity to rebuild strength gradually.

You deserve better than fear-based advice that tells you to simply live with post-surgical limitations—or that you need to immediately jump back into everything you were doing before surgery.

This is about more than symptom management.

It’s about helping your body move confidently again.

If you’re ready to stop guessing and start understanding your body, schedule an appointment to create a personalized plan that addresses the root cause—not just the symptoms.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals:

Your Pelvic Floor’s Next Step Form

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Pelvic Floor Therapy for Painful Sex: The Missing Link Most Women Miss

Pelvic floor therapy for painful sex often starts with relaxation, stretching, breathing, or dilator work. But what happens when you’ve been doing all of those things and your progress suddenly stalls?

If you experience sharp pain, burning, or a sensation of hitting a “brick wall” during intimacy, inserting a tampon, or undergoing a routine speculum exam at the gynecologist, you know how incredibly isolating it feels. It’s easy to feel like your body is failing you, or to worry about the toll it’s taking on your marriage.

Even when women finally build up the courage to seek help, they often get stuck in a repetitive cycle of treatment that yields incomplete results.

As a pelvic floor physical therapist, I am on a mission to change this conversation because no woman should have to struggle when there are real answers. Even within the physical therapy world, there is a massive component that can sometimes get missed when treating pain during sex.

If you have been diligently stretching, using dilators, or practicing deep breathing but your progress has completely plateaued, you might be missing another piece of the puzzle: strategic pelvic floor strengthening.

The Core Functions of Your Pelvic Floor

To understand why your current approach might be stalling, we have to look at how muscles actually function. Your pelvic floor is a hammock of muscles sitting at the base of your pelvis. Just like any other muscle group in your body, a healthy pelvic floor must be able to move through a full, dynamic range of motion.

A healthy pelvic floor has three primary movement patterns.

First, it must contract, moving upward and inward to support your organs and maintain continence.

Second, it needs to relax completely back to its resting baseline.

Third, it must be able to lengthen, allowing the muscles to accommodate things like penetration, bowel movements, and childbirth.

When women suffer from pain with penetration, the natural instinct—for both patients and therapists—is to focus heavily on the downward motion. We spend weeks trying to get the tight pelvic floor muscles to relax, unwind, and tolerate insertion.

That makes sense.

Cleveland Clinic explains that a hypertonic pelvic floor occurs when the pelvic floor muscles stay overly contracted and have difficulty relaxing. This can contribute to pelvic pain and pain during or after sex.

Learn more from Cleveland Clinic about hypertonic pelvic floor

While relaxation is absolutely important to breaking the initial pain cycle, most women were never taught this: recovery may eventually require rebuilding more than relaxation alone.

For some women, once the muscles can relax and lengthen more comfortably, restoring strength and coordination can become part of the next phase of healing.

The Paradox: Why Strength and Relaxation Can Work Together

It sounds entirely counterintuitive at first.

If your muscles are already too tight and causing pain during sex, why would you ever want to strengthen them?

The answer is timing.

Healthy muscles need to be able to move through their full range—not just stay clenched and not just stay relaxed.

When the pelvic floor has begun regaining the ability to lengthen and release, gradual strengthening may help restore:

  • Coordination
  • Endurance
  • Support
  • Confidence with movement

The goal is not to squeeze an already guarded muscle harder.

The goal is to help the muscle learn how to contract and then fully let go again.

By strategically strengthening the pelvic floor at the right stage of recovery, some women can begin rebuilding the stability and coordination needed for everyday movement.

Understanding your body creates confidence, and knowing that strength and relaxation can both matter changes how you view your recovery.

APTA Pelvic Health explains that pelvic pain treatment may involve addressing muscle tightness, weakness, flexibility, coordination, breathing, and individualized movement—not just one single exercise.

Learn more from APTA Pelvic Health about pelvic pain and physical therapy

Myth-Busting: “Start Doing Kegels Immediately to Fix Pelvic Pain”

With the rise of pelvic health awareness on social media, there is a common piece of misinformation floating around the internet: the idea that if you have pelvic issues, you should immediately start squeezing your pelvic floor through repetitive Kegels.

The Important Warning: If you have a tight pelvic floor and begin aggressive, unguided strengthening too soon, you may make your symptoms worse.

If your muscles are already locked in a shortened state and struggling to relax, clenching them tighter may reinforce that guarded pattern.

You deserve better than fear-based advice or generalized internet workouts.

The timing of your recovery strategy matters.

Some women need relaxation first.

Others may eventually need strengthening.

Many need both at different stages.

The Rule of 30–40%: When Is It Time to Strengthen?

How do you know when your body is actually ready to transition from pure relaxation into strategic strengthening?

In my clinical approach, I often use 30% to 40% symptom improvement as a practical checkpoint to start thinking about the next phase.

This is not a universal medical rule for every woman.

It is simply a clinical guide I use to help assess whether someone may be ready to add more strengthening and coordination work.

During the initial phase of healing, when you experience high pain with penetration and cannot tolerate tampons, your strategy may need to focus more heavily on:

  • Diaphragmatic breathing
  • Relaxation
  • Gentle mobility
  • Dilator work when appropriate
  • Reducing muscle guarding

Once you begin feeling noticeably better—perhaps around that 30% to 40% range—you may be ready to start gradually building strength.

That might look like:

  • Less pain with insertion
  • Better ability to relax your pelvic floor
  • Less bracing
  • More confidence with touch
  • Better tolerance of movement

The key is not the exact percentage.

The key is that your pelvic floor is beginning to relax and move more normally before you add more load.

Practical Action Steps for Long-Term Strength

If you are ready to move past temporary fixes and build a more resilient body, here is your roadmap:

1. Assess Your Progress Honestly

Ask yourself:

  • Is penetration less painful than when I started?
  • Can I relax my pelvic floor more easily?
  • Are tampons or exams becoming more comfortable?
  • Do I feel less fearful or guarded?

If yes, it may be time to talk with your pelvic floor physical therapist about progressing your routine.

If no, continuing to focus on relaxation and down-training may still be appropriate.

2. Avoid Isolated Squeezing

Do not sit at your desk or in your car mindlessly squeezing your pelvic floor because you assume more contractions will automatically create better results.

Your pelvic floor works with your breathing, core, hips, and movement.

Strengthening should be intentional and appropriate for your stage of recovery.

3. Keep Relaxation in the Program

Adding strength does not mean you stop practicing relaxation.

A healthy pelvic floor needs both.

Continue using:

  • Diaphragmatic breathing
  • Gentle mobility
  • Body awareness
  • Nervous system calming strategies

The goal is a muscle that can contract when needed and relax when needed.

4. Partner With a Specialized PT

The timing of this transition can trip up almost everyone.

A specialized pelvic floor physical therapist can evaluate your resting muscle tone, strength, coordination, and ability to relax and help determine when your body is ready for the next stage.

That is much more effective than trying to guess based on generic advice online.

Building Strength Without Losing Relaxation

Painful intimacy recovery is not about choosing between strengthening and relaxation.

Pelvic floor therapy for painful sex eventually needs to include both relaxation and carefully timed strengthening.

For many women, it is about learning when each one belongs in the process.

Early on, your body may need:

Relaxation. Lengthening. Reduced guarding.

Later, it may need:

Strength. Coordination. Movement.

The goal isn’t temporary relief—it’s long-term strength.

Reclaiming intimacy without fear requires a comprehensive strategy that respects how your body is designed to move.

Your body is not broken.

If your progress has plateaued, it does not mean you have failed.

It may simply mean your recovery plan needs to evolve.

If you’re ready to stop guessing and start understanding your body, schedule an appointment to create a personalized plan that addresses the root cause—not just the symptoms.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

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Visceral Mobilization: How Abdominal Scar Tissue Can Restrict Movement

If you have ever had an abdominal or pelvic surgery—whether it was a gallbladder removal, appendectomy, hysterectomy, or C-section—and things just haven’t felt right since, please hear me:

Your body is not broken.

So many women walk around with a vague sense of stiffness, pulling, deep core discomfort, or changes in movement after surgery, yet they are told their incisions healed perfectly.

But most women were never taught this: external healing is only one part of recovery. The tissues underneath your scar also have to heal and adapt.

If you are experiencing chronic tightness, limited mobility, or subtle pelvic symptoms after surgery, one piece worth exploring with a qualified provider is a manual therapy approach called visceral mobilization.

Understanding Your Body: The Science of “Slide and Glide”

To understand why your body may feel restricted after surgery, we first need to look at how your internal anatomy moves.

Inside your abdomen and pelvis are organs including your:

  • Stomach and intestines
  • Liver
  • Bladder
  • Uterus and other reproductive organs

These structures fit within a relatively small space, but they are not frozen in place.

Many abdominal organs are covered by a smooth membrane called the visceral peritoneum, while another layer lines the abdominal cavity. These surfaces help structures move smoothly as your body changes position.

Think of it as a natural slide-and-glide system.

When you bend forward, twist, breathe deeply, or simply move throughout your day, your abdominal tissues need enough mobility to adapt to those changing forces.

If certain tissues become restricted, you may notice pulling, stiffness, or changes in how comfortably you move.

The “Super Glue” Analogy: What Scar Tissue and Adhesions Actually Do

After surgery, your body naturally creates scar tissue as part of the healing process.

Sometimes internal scar tissue forms adhesions—bands of tissue that connect structures that normally move more freely.

I sometimes explain this to patients using a “super glue” analogy.

Imagine two surfaces that normally slide past one another. Now imagine a small area between them becoming stuck together.

Movement may feel different.

The important distinction is that adhesions are not literally glue spreading throughout your abdomen, and most adhesions never cause symptoms.

Cleveland Clinic explains that abdominal adhesions are bands of scar tissue that can form between abdominal organs or between an organ and the abdominal wall, most commonly following surgery. Many people have adhesions without ever experiencing problems.

Learn more from Cleveland Clinic about abdominal adhesions

But when tissue restriction does contribute to discomfort, you may notice symptoms such as pulling or stiffness during certain movements.

Understanding your body creates confidence.

Myth-Busting: “Small Surgery Means No Internal Scar Tissue”

One common misconception is that a tiny laparoscopic incision means nothing significant happened beneath the skin.

Myth: Small scars mean there was very little internal healing

Reality: Even minimally invasive surgery still involves passing instruments through multiple layers of the abdominal wall and working inside the abdominal cavity.

Laparoscopic surgery generally causes fewer adhesions than open abdominal surgery, but adhesions can still occur after abdominal procedures.

Myth: If the scar looks healed, everything underneath must move normally

Reality: A scar can look completely healed while the surrounding skin and connective tissues still feel sensitive or less mobile.

Myth: Manual therapy can simply “break apart” deep abdominal adhesions

Reality: This is where the language matters.

A physical therapist cannot reliably tear apart or remove a true internal adhesion with their hands. Cleveland Clinic notes that surgery is the method used when adhesions themselves need to be removed, although some research suggests soft-tissue mobilization may help reduce adhesion-related pain. More research is still needed.

So the goal of hands-on therapy is better framed as improving tissue mobility, comfort, movement tolerance, and sensitivity rather than claiming to physically remove adhesions.

What Is Visceral Mobilization?

Visceral mobilization is a type of hands-on manual therapy aimed at improving mobility and comfort within the abdominal and pelvic tissues.

A trained pelvic floor physical therapist may use gentle hand placements on the abdomen to assess how the tissues move and whether certain areas feel restricted or sensitive.

The therapist may then use slow, controlled pressure or movement to work on those areas.

The goal is not to force your organs into a new position.

And it is not to aggressively “break up” internal scar tissue.

Instead, treatment may focus on:

  • Improving comfortable tissue mobility
  • Reducing sensitivity around scars
  • Helping you tolerate movement more easily
  • Restoring confidence with bending, twisting, breathing, and exercise
  • Addressing surrounding abdominal and pelvic floor muscle guarding

This is about more than symptom management.

Root-cause healing means identifying which structures and movement patterns are actually contributing to your symptoms.

How Scar Mobility Can Affect Your Core and Pelvis

Your abdominal wall, breathing system, core muscles, and pelvic floor work together.

If an area around a surgical scar feels tight or painful, you may automatically begin moving differently.

You might:

  • Hold your breath
  • Brace your stomach
  • Avoid twisting
  • Protect one side of your abdomen
  • Move less through your trunk

Over time, those protective patterns can affect how comfortably you use your core and pelvic floor.

This is one reason pelvic floor physical therapy after abdominal or pelvic surgery may involve more than simply strengthening.

Sometimes the first priority is restoring comfortable movement.

What About Scar Massage?

External scar mobilization is different from treating deep abdominal adhesions.

Once an incision is fully healed and your healthcare provider says scar work is appropriate, gentle massage around a scar may help improve comfort and skin mobility.

Cleveland Clinic recommends discussing scar massage with your healthcare provider and notes that gentle massage of a healed surgical scar and surrounding skin may support healing and mobility.

Learn more from Cleveland Clinic about surgical scar care

You should not aggressively dig into a painful or recently healed surgical site.

More pressure is not automatically better.

Practical Steps Toward Root-Cause Healing

1. Track When You Feel Restricted

Notice when the pulling or tightness appears.

Does it happen when you:

  • Take a deep breath?
  • Twist?
  • Reach overhead?
  • Bend backward?
  • Exercise?
  • Have a full bladder?

Those patterns can give your physical therapist useful information.

2. Start With Comfortable Breathing and Movement

You don’t automatically need to avoid planks, crunches, or strength training forever because you have scar tissue.

Instead, rebuild progressively.

Start with movements you can perform comfortably, practice relaxed diaphragmatic breathing, and gradually increase load based on your symptoms and healing stage.

3. Avoid Aggressive Self-Massage

You don’t need to “break up” your scar.

If massage causes sharp pain, significant irritation, or worsening symptoms, stop.

A provider trained in scar mobilization can show you what type of pressure and movement are appropriate.

4. Find a Pelvic Floor Physical Therapist

If you have persistent pulling, pelvic discomfort, pain around a C-section or abdominal scar, or difficulty returning to normal movement, consider a pelvic floor assessment.

Ask whether the provider has experience with:

  • Abdominal scar mobilization
  • Post-surgical rehabilitation
  • C-section recovery
  • Pelvic floor dysfunction
  • Visceral mobilization

The goal is to figure out whether your symptoms are coming from scar sensitivity, muscle guarding, movement patterns, pelvic floor dysfunction, or another issue entirely.

Give Your Body the Support It Needs

Your body is not broken.

Surgery creates real changes within your tissues, and recovery doesn’t always end when the skin closes.

But that also doesn’t mean every symptom after surgery is caused by internal adhesions.

Your recovery deserves an individualized approach.

The goal isn’t temporary relief—it’s long-term strength and mobility.

Understanding how your scar, abdomen, breathing, core, and pelvic floor interact can help you stop guessing and start rebuilding movement with confidence.

You deserve better than fear-based advice.

If you’re ready to stop guessing and start understanding your body, schedule an appointment to create a personalized plan that addresses the root cause—not just the symptoms.

Not sure what your body needs next? Complete Your Pelvic Floor’s Next Step Form for guidance based on your symptoms and goals.

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