Why Most Pelvic Floor Advice Misses the Point

If you’ve ever Googled “how to stop leaking when I sneeze” or “why does sex hurt after baby,” you’ve probably been told the same thing a hundred different ways: do your Kegels.

Squeeze. Hold. Release. Repeat.

And if Kegels haven’t fixed it — if you’re still leaking on the trampoline with your kids, still bracing before you cough, still avoiding intimacy, still not lifting the way you used to — you’ve probably wondered if something is wrong with you.

Nothing is wrong with you. The advice is wrong.

I’m Nicole, and I’m an occupational therapist who specializes in pelvic health. That distinction matters, and it’s the reason I started writing this newsletter. Most online pelvic floor content comes through a single lens: strengthen the muscle, fix the problem. But the pelvic floor isn’t a bicep. It’s a deeply integrated system that responds to how you breathe, how you stand, how you carry your toddler, how you sit at your desk for nine hours, how you brace when you’re stressed, and how safe your nervous system feels in your own body.

You can do a thousand Kegels a week and still leak because the problem was never that the muscle was weak. Often, it’s the opposite. The muscle is gripping so hard it’s forgotten how to let go.

The difference between treating a muscle and treating a person

Physical therapists are extraordinary clinicians, and many of my closest colleagues are pelvic floor PTs. But occupational therapy asks a fundamentally different question. A PT often asks, “How do we make this body part work better?” An OT asks, “How do we get you back to the life you want to live?”

That’s not semantics. It changes everything about how I treat.

When a postpartum mom comes to me and says she’s leaking, I don’t start with her pelvic floor. I start with how she picks up her baby. How she breathes when she’s nursing at 3 a.m. Whether she’s been holding her breath through every diaper change for the last four months. Whether her C-section scar is pulling on the fascia that connects to her bladder. Whether she’s sleeping. Whether her shoulders live up around her ears.

The pelvic floor is the last stop on a very long road. If we only treat the destination, we never fix the route.

Why I built the RAP Method

After years of watching clients cycle through generic Kegel programs and leave frustrated, I developed a three-phase approach I call the RAP Method: Release, Activate, Perform.

Release comes first because most of my clients don’t have weak pelvic floors; they have overworked, gripping, exhausted ones. You cannot strengthen a muscle that’s already maxed out. We have to teach it to let go before we can teach it anything else.

Activate is where we rebuild the connection between brain and body. Not just squeeze harder, but coordinated activation that works with your breath, your core, your hips, and the demands of your actual life.

Perform is the phase most programs skip entirely. This is where we get you back to running, lifting, jumping, having pain-free sex, sleeping through the night without waking to pee. Performance isn’t extra, it’s the entire point.