9 Secrets Pelvic Floor Specialists Wish Women Over 50 Knew—Including the Kegel Mistake To Avoid
Plus learn why those 'just in case' pee breaks can backfire
Key Takeaways
- Kegels aren’t right for everyone, especially if your pelvic floor muscles are overactive.
- Going to the bathroom ‘just in case’ and restricting fluids may worsen urinary urgency.
- Symptoms are common after 50, but treatments can help with leaks, urgency and discomfort.
Pelvic floor specialists help with everything from bladder leaks and urgency to pelvic pain and Kegels—and they’re brimming with useful insights. But most appointments are too short for all the advice they want to share. We asked leading surgeons, gynecologists and pelvic floor physical therapists to reveal their best tips to ease discomfort and help you enjoy better pelvic floor health every day.
9 surprising secrets from pelvic floor specialists
Your pelvic health plays an important role in your overall wellbeing. A pelvic floor therapist can work with you to develop a personalized treatment plan for everything from pelvic pain to bladder leaks. In the meantime, here’s what they wish more women knew:
Toss outdated advice on Kegels
You may have learned to practice Kegels by stopping your urine mid-stream, but that advice is worth retiring. “Normal urination depends on the pelvic floor relaxing and lengthening so the bladder can empty all the way,” says Greg J. Marchand, MD, ob-gyn, minimally invasive gynecological surgeon and founder of the Marchand Institute for Minimally Invasive Surgery in Mesa, Arizona. Contracting these muscles while peeing can leave urine behind.
“This can lead to incomplete bladder emptying and a higher risk of urinary tract infections, along with the possibility of training the muscles to stay tense when they should release,” he adds. If you need help identifying the right pelvic floor muscles for Kegels, Dr. Marchand suggests gently tightening as if stopping the passage of gas. Or use a clean finger to feel the lift inside the vagina as the pelvic floor engages, then practice these exercises away from the bathroom while sitting, standing or lying down. (Learn more about how to do Kegels the right way.)
Kegels aren’t for everyone
Some pelvic floor issues come from weak muscles—and that’s where Kegels, the squeeze-and-release exercises, can help. But other problems stem from muscles that are already overworked. In those cases, Kegels can make symptoms worse. “If the muscles are already tight or overactive, extra strengthening can heighten tension, pain and sometimes even urgency or leakage,” says Dr. Marchand.
Signs your muscles may be tense include worsening symptoms after starting Kegels, pain during intimacy or trouble fully emptying your bladder or bowels. “Balance matters greatly here, since the pelvic floor needs to both contract and release well,” he says. If you’re not sure if Kegels are right for you, ask a pelvic floor physical therapist for guidance.
Ask about hormone therapy
Menopause doesn’t just spark hot flashes and night sweats—it also impacts the pelvic floor. “As estrogen declines, women lose collagen, blood flow, elasticity and tissue resilience in the vagina, vulva, urethra and pelvic support structures,” says gynecologic oncologist and hormone optimization specialist Lorna Brudie, DO, medical director of Fem Excel. These changes can contribute to vaginal dryness, urinary urgency, recurrent UTIs, painful intercourse, prolapse and incontinence, she notes.
The good news? “Local vaginal estradiol—and in most women, systemic hormone therapy—can help preserve tissue quality, improve symptoms and support long-term pelvic and bladder health.” Make an appointment with your doctor to find out if this option is right for you.
‘Just in case’ peeing creates urgency
Making it a habit to go to the bathroom before every outing to avoid a sudden interruption can backfire. “It teaches your bladder to signal ‘full’ at smaller and smaller volumes, which trains urgency,” explains pelvic floor physical therapist Caroline Packard, DPT, founder of ConnectPelvicFloorFitness.com. The result? You end up getting that gotta-go sensation even sooner. Packard recommends voiding every three to four hours as needed rather than going at every opportunity.
Tummy-tightening can trigger leaks
A lot of us were taught to suck in our belly to look slimmer, and now we often do it without even noticing. But this habit has one big downside: “A constantly held stomach means a constantly tensed pelvic floor that never gets to relax,” says Packard. Over time, that nonstop clenching can fatigue supporting pelvic muscles, making it harder for it to do its job, like holding in urine when you sneeze.
Sipping more curbs pee breaks
“One mistake I see constantly is women drinking less water to cut down on bathroom trips,” says Packard. Sounds counterintuitive, but skimping on fluids can make you feel like you have to go more often. Less water makes urine more concentrated, which irritates the bladder, creating urgency. To avoid this, aim for 8 to 10 cups of hydrating beverages (like water, juice and herbal tea) throughout the day.
Even healthy options can spell trouble
Some good-for-you foods and drinks can be surprisingly irritating to the bladder. Common culprits include coffee and tea (including decaf), sparkling water, artificial sweeteners, citrus, tomato-based foods and even vitamin B and C supplements, says Packard. Thankfully, you usually don’t have to give them all up. “Keep a simple log, notice your personal triggers, then decide what’s worth it,” she recommends. “You can also try over-the-counter Prelief, which reduces the acidity of food and drinks before they hit your bladder.”
Better posture helps you stay dry
Hunching over your computer or phone doesn’t just affect your back, it can also contribute to urgency and leaking, says Packard. When you’re upright (with your rib cage over your pelvis and your ears over shoulders over hips), your pelvic floor and diaphragm move together and manage the pressure of your body effectively, she points out. But when you round forward or pop your ribs up, that “stack” collapses, and the pressure shifts downward right onto the pelvic floor and bladder.
Most issues are treatable
Leaking, urgency and discomfort aren’t inevitable side effects of aging you have to put up with. “Almost every pelvic floor issue is fixable with either medication, surgery, pelvic therapy, Botox and nerve stimulators by themselves or in combination,” assures Alan Garely, MD, chair of obstetrics and gynecology and director of urogynecology at Mount Sinai South Nassau in Oceanside, NY.
Tried to treat pelvic floor dysfunction a while ago and didn’t get relief? Try again now. “Older therapies from even 10 or 15 years ago are often outdated, and current treatments work very well with very limited risk and downside,” he reveals. This includes newer options that can often help women avoid hysterectomy for prolapse.
A version of this story appears in the September 14, 2026, issue of Woman’s World.
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