Pelvic floor dysfunction, bladder health, and the surprising connection between your nervous system and pelvic health—with Dr. Jen Le Coguic.
Have you ever peed immediately before leaving the house, even though you didn't really need to? Do you have a mental map of the bathrooms at your favorite stores, restaurants, and movie theaters? Or perhaps you've crossed your legs before sneezing because you weren't entirely confident your bladder would cooperate.
Maybe you've been told that leaking a little urine is simply part of getting older or having children, that pain during sex is something you just have to deal with, or that whatever is happening with your pelvic floor could probably be fixed by doing more Kegels. We tend to accept an awful lot of things about our bodies without questioning whether they're actually inevitable—or whether there's something we can do about them.
In this episode of But For Real, we're joined by Dr. Jen Le Coguic, pelvic health physical therapist and founder of Nashville Pelvic Health, to talk about an area of our bodies that does a whole lot of important work while receiving remarkably little attention. Jen has more than 15 years of experience as a physical therapist and specializes in pelvic floor dysfunction, with a particular passion for treating chronic pelvic pain. Her approach emphasizes whole-person, inclusive, trauma-informed care, which aligns beautifully with the way we think about mental and physical health at The Gaia Center.
We get into everything from urinary urgency and bladder habits to the relationship between pelvic floor tension, chronic stress, and the nervous system. Along the way, Jen challenges some of the misconceptions that keep people from recognizing symptoms and seeking appropriate treatment. And perhaps most importantly, we talk about why something can be incredibly common without being something you should simply have to live with.
What Exactly Is Your Pelvic Floor, Anyway?
Most of us have only a vague understanding of what the pelvic floor actually does. We might associate it with childbirth, bladder control, or sexual function, and some of us have probably attempted a Kegel exercise or two without being entirely sure which muscles we're supposed to be contracting. But the pelvic floor is a much more complex system than most people realize, and its function affects several aspects of our everyday lives.
The pelvic floor is an essential group of muscles and connective tissues at the base of the pelvis that helps support our pelvic organs and contributes to bladder and bowel control, sexual function, and core stability. Like other muscles throughout the body, these muscles need to be able to contract, relax, and coordinate appropriately with surrounding structures. When that system isn't functioning as it should, people can experience a wide range of symptoms, including urinary leakage, frequency or urgency, constipation, and pelvic pain.
One of the important distinctions Dr. Jen makes is that pelvic floor dysfunction isn't necessarily a matter of having weak muscles. Sometimes the muscles are overly tense or have difficulty relaxing, which can interfere with their ability to function effectively. This is an important piece of the puzzle because the treatment for a pelvic floor that's struggling with excessive tension may look very different from treatment for one that's experiencing weakness.
Why Kegels Aren't Always the Answer
For decades, Kegel exercises have been the go-to recommendation for just about anyone experiencing a pelvic floor concern. And to be clear, Kegels can absolutely be helpful in certain circumstances, particularly when muscle weakness is contributing to symptoms. But the idea that everyone with pelvic floor dysfunction needs to strengthen those muscles is an oversimplification that can sometimes do more harm than good.
Consider how we approach muscle tension in other parts of the body. If someone has chronically tight shoulders or a jaw that's constantly clenched, our first instinct probably wouldn't be to tell them to repeatedly contract those muscles throughout the day. We'd want to understand why the tension is happening and what might help those muscles function more comfortably. The same principle applies to the pelvic floor, even though we rarely hear it discussed that way.
Jen explains that symptoms like urinary frequency and urgency can sometimes be associated with pelvic floor muscles that are already too tight. In these cases, additional strengthening exercises may not address the underlying issue and could potentially make symptoms worse. Instead, treatment might focus on learning to relax those muscles, improving coordination, and addressing other factors that may be contributing to the problem. The takeaway here isn't that Kegels are bad or that strengthening your pelvic floor is unnecessary. It's that pelvic floor health is about appropriate function, not simply maximum strength, and the right approach depends on what's actually happening in your body. This is one of the many reasons an individualized evaluation from a qualified pelvic health physical therapist can be so valuable.
When Your Bladder Starts Running Your Life
During our Step Into My Office segment, we hear from a 34-year-old listener who's become increasingly frustrated by how much of her life revolves around her bladder. She avoids drinking too much water before going out, plans bathroom trips around movies, and worries about leaking when she laughs, sneezes, or exercises. Because she's never had children and isn't experiencing pain, she's unsure whether what she's dealing with even qualifies as a problem worth bringing to a healthcare professional.
Jen explains that this is an incredibly common misconception: You don't have to have given birth to experience pelvic floor dysfunction. While pregnancy and childbirth can certainly contribute to pelvic floor concerns, people of different ages and genders can experience these symptoms for a variety of reasons. And the absence of pain doesn't mean that something isn't worth investigating, especially when it's beginning to interfere with your quality of life!
One particularly interesting part of our conversation centers on the behavioral patterns that can develop around bladder function. Jen explains that when we habitually go to the bathroom just in case, even when our bladder isn't particularly full, we may inadvertently train ourselves to respond to smaller and smaller amounts of urine. Over time, this can contribute to a cycle of increasingly frequent bathroom trips and greater sensitivity to the sensation of needing to go.
There's also an emotional component to consider. If you've experienced urinary urgency or leakage, it makes sense that you might become more vigilant about bathroom access, monitor physical sensations more closely, or avoid situations where you worry you won't be able to get to a toilet quickly enough. Unfortunately, those understandable attempts to prevent an uncomfortable experience can sometimes reinforce the very patterns you're trying to manage.
And then there's the issue of hydration. Our listener mentions limiting her water intake in hopes of reducing how often she needs to urinate, but Jen explains that this can actually be counterproductive in some circumstances. Concentrated urine can irritate the bladder, potentially contributing to symptoms rather than resolving them. Because urinary concerns can have several different medical and behavioral causes, it's important to seek individualized guidance rather than simply trying to manage them through restriction or avoidance.
Your Nervous System and Pelvic Floor Are More Connected Than You Think
One of the most fascinating parts of our conversation is the relationship between the pelvic floor and the nervous system, which Jen identifies as an area she's particularly passionate about. We often talk about psychological and physical health as though they exist in separate categories, but the reality is that our minds and bodies are constantly influencing one another. What's happening psychologically can affect how our bodies function, and physical experiences can profoundly shape our emotional states. Think about what happens when you're stressed or anxious. You might notice your shoulders creeping toward your ears, your jaw tightening, your breathing becoming shallower, or your stomach feeling unsettled. These physical responses are part of how our nervous systems react to perceived threats and demands, whether those threats are immediate physical dangers or the accumulated stressors of everyday life.
The pelvic floor can respond to stress in similar ways. For some people, chronic nervous system activation can contribute to increased muscle tension or guarding in the pelvic region, which may play a role in pelvic pain, urinary symptoms, or sexual discomfort. And because these physical experiences can themselves become stressful or anxiety-provoking, it's possible to develop a cycle in which physical symptoms and psychological distress reinforce each other!
This is especially relevant for people who have experienced chronic stress, anxiety, or trauma. Our nervous systems are shaped by our experiences, and sometimes our bodies develop patterns of protection that persist long after the original circumstances have changed. While pelvic floor tension isn't inherently evidence of trauma, and not every pelvic symptom has a psychological component, understanding the relationship between nervous system activation and muscular function can be an important part of treatment.
As therapists, this conversation is right up our alley because it illustrates why we care so much about integrative, embodied approaches to healing. We frequently work with people who intellectually understand their experiences but continue to notice persistent patterns of tension, hypervigilance, or discomfort in their bodies. Learning to recognize and work with those patterns can be an important complement to the cognitive and emotional work of therapy.
Importantly, acknowledging the mind-body connection does not mean that pelvic pain or other symptoms are somehow imaginary or "all in your head." These are real physical experiences that deserve appropriate medical attention, even when psychological or behavioral factors are part of the picture. Understanding how different systems interact allows us to move beyond the false division between physical and mental health and toward care that considers the whole person.
Just Because It's Common Doesn't Mean You Have to Live With It
One of the biggest themes throughout this episode is the distinction between something being common and something being normal—or, more specifically, inevitable. There are plenty of physical experiences that have become so normalized in our culture that people assume they're simply part of having a particular kind of body or reaching a certain stage of life. Urinary leakage after childbirth, pain during sex, and increasing bladder urgency are just a few examples.
This normalization can be especially pronounced in conversations about women's and reproductive health, where pain and discomfort have historically been minimized or dismissed. People may be told that their symptoms are a natural consequence of aging, hormonal changes, or having children without being offered much information about potential treatment options. And when these experiences aren't openly discussed, it's easy to assume that everyone else is dealing with the same thing and simply keeping quiet about it.
Of course, there are a number of reasons someone might hesitate to seek care. Pelvic symptoms can feel embarrassing or difficult to describe, and the prospect of discussing bladder habits, bowel movements, or sexual discomfort with a stranger isn't necessarily appealing. Some people have also had experiences with healthcare providers who dismissed their concerns, which can understandably make them reluctant to bring up another issue.
But one of Jen's most important messages is that symptoms don't have to reach a certain level of severity before they deserve attention. If you're spending significant time worrying about bathroom access, avoiding activities you enjoy, or experiencing discomfort that affects your daily life, those concerns are worth discussing with a qualified professional. You don't have to wait until something becomes unbearable to decide it's worth addressing.
What Does Pelvic Floor Physical Therapy Actually Involve?
Part of the reason pelvic floor physical therapy isn't more widely utilized may simply be that many people don't know what it is or what to expect. Despite growing awareness, there's still a tendency to associate physical therapy primarily with sports injuries, orthopedic rehabilitation, or recovering from surgery. The idea of seeing a physical therapist for bladder concerns, pelvic pain, or sexual dysfunction may not occur to someone who hasn't been introduced to this specialty.
Pelvic health physical therapy focuses on evaluating and treating conditions involving the muscles, connective tissues, and related systems of the pelvic region. Depending on someone's symptoms and medical history, an evaluation may include discussing bladder and bowel habits, movement patterns, pain experiences, and how symptoms affect daily activities. A pelvic health physical therapist may also assess muscle function and coordination, with examination procedures determined by the patient's needs, preferences, and informed consent.
Treatment can take a variety of forms, including education, exercises, movement-based interventions, manual therapy, relaxation strategies, and behavioral approaches. For someone experiencing muscle weakness, strengthening might be part of the plan, while someone with excessive muscle tension may benefit more from learning to release and coordinate those muscles. The goal is to understand the factors contributing to a person's symptoms and develop an approach that fits their particular situation.
Jen's philosophy at Nashville Pelvic Health emphasizes treating people as whole human beings rather than reducing them to a collection of symptoms. This includes considering the relationship between physical and emotional well-being, recognizing the influence of a person's history and lived experiences, and approaching care through a trauma-informed lens.
That last piece is especially important when working with intimate areas of the body. Pelvic healthcare can involve vulnerable conversations and examinations, and patients deserve clear communication, meaningful choices, and an ongoing sense of autonomy throughout treatment. Trauma-informed care isn't simply about assuming someone has experienced trauma; it's about creating an environment in which people feel respected, informed, and empowered to participate in decisions about their bodies.
Learning to Listen to Your Body Without Trying to Control Everything
At The Gaia Center, we talk a lot about embodiment and what it means to develop a more connected, compassionate relationship with our physical experiences. So much of modern life encourages us to treat our bodies as things to manage, optimize, or discipline rather than as integral parts of who we are. When something isn't functioning the way we'd like, our instinct is often to look for a quick fix or another strategy for getting things under control.
Pelvic health offers an interesting opportunity to reconsider that approach. If you've spent years attempting to manage urinary urgency by limiting your water intake, avoiding certain activities, or constantly using the bathroom preventively, it's understandable that you've developed those habits. They likely emerged as attempts to cope with discomfort or uncertainty. But sometimes the strategies that make sense in the short term aren't particularly helpful over time.
Similarly, when we assume that a muscle-related problem must be solved by strengthening, we may overlook the possibility that our bodies are asking for something different. Perhaps a muscle needs better coordination, greater flexibility, or simply the ability to relax. Perhaps our nervous systems have become accustomed to a level of tension that we barely recognize anymore.
This doesn't mean that every physical symptom is a message carrying some profound psychological meaning, and we certainly don't want to turn embodiment into another opportunity for self-monitoring or self-criticism. It means that approaching our bodies with curiosity rather than judgment can help us notice patterns, ask better questions, and seek support when something isn't working.
There's also something valuable about recognizing that healing doesn't always mean trying harder. Sometimes it involves developing greater awareness, allowing for more flexibility, and learning how to respond to our bodies in ways that support rather than override their needs. And sometimes the most useful thing we can do is work with someone who has the specialized knowledge to help us understand what's happening.
The Bottom Line: Your Pelvic Health Matters
One of the things we hope listeners take away from this conversation is that pelvic floor health deserves far more attention than it typically receives. Whether you're experiencing urinary urgency, leakage, pelvic pain, sexual discomfort, or simply wondering whether something you've been dealing with is worth getting checked out, you deserve access to accurate information and thoughtful, individualized care.
You don't have to be postpartum, older, or experiencing severe symptoms to benefit from an evaluation. And you don't have to accept significant disruptions to your quality of life simply because the symptoms you're experiencing happen to be common. Our conversation with Jen is also a reminder of how interconnected our bodies and minds really are. Understanding pelvic health requires looking beyond a single muscle group or isolated symptom and considering the various physical, psychological, and behavioral factors that can influence our experiences. It's an approach that reflects something we believe deeply at The Gaia Center: meaningful healing often requires paying attention to the whole person, not just the part of them that seems to be having a problem.
So if your pelvic floor has been giving you reasons to pay attention lately, perhaps it's worth getting a little more curious about what's happening. And before you commit to doing a hundred Kegels a day, consider talking to someone who can help you figure out whether that's actually what your body needs.
About Our Guest: Dr. Jen Le Coguic
Dr. Jen Le Coguic, PT, DPT, is a pelvic health physical therapist and founder of Nashville Pelvic Health. With more than 15 years of experience as a physical therapist, she specializes in pelvic floor dysfunction and has a particular interest in treating chronic pelvic pain. Her work emphasizes individualized, evidence-informed, and trauma-informed care that considers the relationship between physical health, the nervous system, and a person's overall well-being.
Learn more about Jen and Nashville Pelvic Health: https://www.nashvillepelvichealth.com/team
