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Stress, pain with sex, leaking pee, pelvic floor dysfunction with Amy Hill Fife 


In this interview, Laurie and Amy Hill Fife discuss Stress, pain with sex, leaking pee, pelvic floor dysfunction and how the life of a women struggling with such issues might look like, as well as what you can do to improve your pelvic and overall health.

Amy Hill Fife, MPT, WCS, BCB-PMD, the founder of the online Pelvic Health PT (Private Talk) forum, is passionate about educating, encouraging and empowering women to overcome pelvic health problems, become active again and live the life they love. Amy recognizes each woman has a unique story, a unique problem and a unique set of needs in order to overcome personal, private and problematic pelvic health challenges. Having over 22 years worth of experience as a women’s & pelvic health physical therapist, owning a private clinical practice and developing an online education forum, has allowed Amy to help tens of thousands of women overcome embarrassing, limiting and painful pelvic health issues. Her experience gives her the extraordinary insight and proven methods to guide women to success. Amy received her Master’s degree from the Medical College of Georgia. She is double board certified as a Women’s Certified Specialist and Pelvic Muscle Dysfunction Biofeedback Associate Fellow.

This is a transcription of an Instagram live conversation. You can find the full video on Laurie’s IGTV tab on Instagram and on soon on YouTube.


I’m excited to be here today with Amy Hill Fife. So we’re going to go into it and talk about what the connections are to some of these common pelvic health issues that we have and what we can do about it. 

I love solutions and in my practice I often have clients tell me that they have never heard this or told anyone about these issues. I am sure you get that too.


I do. I’ve been doing this work for 22 years and only now we’re starting to really get women talking more about these issues. 

People tell me, “I’ve never even told my doctor or my spouse about this. They have no idea what is going on. I just keep it hidden.”  

The next thing that I always hear is , “Why didn’t anybody tell me that there are people like you, who talk about pelvic health, incontinence, leaking pee and how stress affects us?”

So there are more women out there, who know about these topics and can help you. But most women are suffering in silence really.


Yes. Before we get into it, let me have you just introduce yourself.

How did you get into this work and the specific direction that you went with your work, because you’re so passionate about it. I love that.


I am. Actually I was very fortunate. 22 years ago, while I was in physical therapy school, I had a professor, who has since passed away. I had one class on women leaking urine. And I thought, “You’re telling me that someone can be walking through the grocery store and pee their pants, when they sneeze. How is nobody talking about this?” 

I took her class and she had two or three more on pelvic health, which is not common. It’s not in every single program. 

Once I graduated, I did a lot of orthopedics. As in how hip problems can affect pelvic floor problems, your bladder or your bowel. And I took classes. Every class I could get. I did everything I could to gather as much information as possible. Then I just really dove in and I started creating programs in Georgia and California.

I just did it on my own and made a lot of mistakes. Colleagues weren’t really connected over social media like now, so I learned from the women I helped honestly. If there were more classes, then I would always take them.


You’re also just so passionate about it. You make it fun. This topic is something that we don’t talk about everyday, but talking to you is always fun.


We have to break the taboos. There’s so much shame revolving around the pelvis, because of sex. Let’s take the shame away. I’m really excited to talk with you today because you’ve got muscles, nerves, your bladder, your colon and your GI system in there. A lot of your abdomen is sitting into your pelvis. 

Think about it that way and let’s ease into it. Don’t freak out and think that I will imediatly talk about which positions to get into during sex.

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I love starting with the five most common pelvic health issues that women are dealing with.


I say the top five, include leaking urine, whether you leak when you cough or sneeze or you leak when you have urges. That’s a very common one.

A lot of women have pain with sex. 

I’m going to sort of break that down. When our hormones are imbalanced, we can have vaginal dryness and it doesn’t only have to happen when you’re in menopause at 50. This can be anyone with hormone issues and imbalances.

Then there’s pain with sex that is musculoskeletal. So it’s actually the muscles. Maybe someone had an injury, they fell on their tailbone. Maybe they had an hysterectomy and have scar tissue down there. 

Then we have sexual trauma and the issues that happened with the actual physical tissue. So that’s another way we can have pain. 

A lot of women suffer from prolapse. That’s when the organs sort of droop down and out. 

You can have sexual dysfunction. A lot of people say pelvic floor muscle dysfunction. I tell people it’s similar to when you clench your jaw and get TMJ, your muscles get tight. Same as when you always shrug your shoulders and have shoulder and neck pain. We have to teach those muscles how to relax. That can be a response to trauma, to stress, to anxiety and things like that. So pelvic floor dysfunction encompasses a lot of different things. 

I see a ton of women with constipation or poor gut health. They either have constipation or diarrhea, but constipation is a lot more common. We have women who have chronic UTIs (urinary tract infections). Chronic meaning three, four, five a year. If you’re pregnant, you can have low back pain, pelvic pain and discomfort, which can create problems with labor and delivery. So you actually can prep for labor and delivery. 


Already you’ve touched on some of the connections, like stress. What’s the most important thing to start with right now?


Let’s start pelvic floor dysfunction. Say you have a stressful job and kids running around. Your head’s ready to pop off. Your spouse is wanting to have sex and you’re not in the mood. 

You’re walking around like a clenched up ball of nerves. So your pelvic floor muscles, your jaws and your shoulders are clenched.

Say you need to pee. First you’re working so much you forget to pee. Then you get a sudden urge, but you’ve been holding it the whole time. So your bladder is way up and your pelvic floor muscles are tightening around it. 

Let me take a step back. You’ve got 26 pelvic floor muscles and they’re responsible for giving you stability. They work with your abdominal muscles. Their function is to tighten around your urethra, which is where you pee, your anus and your rectum, so you don’t leak poop. They have sexual function and they go into rhythmic contraction when you have an orgasm. 

If we’re working, we’re really stressed and we’re forgetting to go to the bathroom, your pelvic muscles are tightening to hold your pee in. When you realize that you need to pee, you jump up and you go sit on the toilet. You sit up on your toes, knees squeezed together and your olympic speed peeing. You’re trying to go as fast as you can, because you’re so busy. 

What can happen is that you get a bladder infection, because the urine starts to come down out of your bladder, but it can’t get out, because you’re holding it. Your bladder gets sort of turbulent and picks up bacteria and goes back up and in. That’s when you can get a bladder infection. 

That’s just one thing going on. On top of it, maybe you had six cups of coffee that day. So your bladder’s already irritable.

We always talk about gut health. I wonder when we’re going to start talking about bladder health, the two just go together. I mean a bladder infection can also happen with constipation.

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I want to throw in blood sugar. When you’re stressed all day, every time you have a moment of stress, your blood sugar is going to spike, no matter what you’ve had to eat.

That’s going to influence what’s coming out and sitting in your bladder, because your body wants to pee out the extra, what you’re not going to use. That’s making that environment much more prone to having infections and also inflammation. 


Exactly. So you’ve been holding your pee, but maybe you were rushing around so much, you didn’t have a chance to have a bowel movement. So your pelvic floor muscles are on lockdown.

If you constantly hold in your poop and pee, you’re sending signals to your body that it’s not time to go. Over time your natural reflex of needing to go starts to shut down. So you start thinking, “Oh I don’t have to poop anymore.” Then it just keeps getting backed up and backed up and backed up. That isn’t good for us.

Then you go home for the night and you run around doing errands. You’re picking up your kids, getting them fed and into bed. On top of that you are still doing some things for work until you collapse into bed.

That’s when your spouse wants to have sex and you think that you’re way too tired, so you just want to get it over with. So you aren’t looking forward to it and it’s sort of only a quick thing. There’s not a lot of foreplay, you’re not getting relaxed and ready for sex. Your mind is running and still thinking of 12 other things. Therefore your pelvic muscles and clitoris don’t fill up with blood, so you are a lot less likely to have an orgasm.

When you are in this high level of stress, you’re in the sympathetic mode of the nervous system. That’s also the freeze, fight or flight. If you’re in that mode it’s really unlikely that you will have an orgasm. The parasympathetic nervous system, the relax, rest and recovery makes it more likely for you to orgasm. 

That’s my view from a pelvic health world. What would it look like to you from your perspective?


If I had the same woman, I would be seeing gut issues, low libido, probably skin issues, hair issues, like hair falling out, as well as weight, energy or mood issues and fatigue. That has a lot to do with what’s going on with stress levels throughout the day. Are they able to get those stress levels down throughout the day? 

Is their cortisol high in the morning and then goes down throughout the day or is it just going up? Which means that when they get to bed, they’re not able to get that quality sleep to recharge and for melatonin to rise, so that they can wake up in the morning feeling refreshed, recovered and renewed. 

That stress that’s going on throughout the day is probably creating a blood sugar rollercoaster. The blood sugar isn’t stable. That roller coaster is having an effect on all the other hormones, which are causing all these other symptoms. 

There are lots of pelvic health issues that can be going on there, that are all connected. We touched on constipation. There’s a connection to bladder infections as well and also connections to your fascia and its health. 

There’s so many connections there and it’s great. When you realize it’s all connected you recognize that when somebody comes to you with a pelvic pelvic health issue, you’re not just looking at their muscles. You’re going beyond that because it is all connected like a spider web.


I’m glad you touched on that, because that is something that has evolved over my career. I only know the basics of nutrition, but you need to drink water. You need to have a certain amount of fibre and when introducing fibre you have to go in slow increments or you’re going to get bloated and gassy. 

We want you to be able to have a bowel movement, but we want you to be comfortable having a bowel movement. I started looking into having women tested for their micronutrient level. I had them tested to see if they had food sensitivities. Interestingly some of these sensitivities go away when you get a healthier gut.

If you have a healthy blood sugar hormone balance, it’s going to affect everything. Throughout the years, I’ve had people say that I can’t say that to a patient, because I’m not a dietician or what have you. I understand that, but I need my patients to poop, because if they don’t have a bowel movement, it’s going to press on their bladder. 

It’s like having a water balloon with someone sitting on half of it. You’re not going to be able to fill up with urine as much. So you’re going to have to go more often. You’re going to create other problems, possibly some discomfort with sex. 

Your vagina is like right next to your bowel and your bladder is in the front. So it’s all connected. 

It started with some of that and then moved into, let’s work on some relaxation techniques and some breathing techniques to help get my patients central nervous system to come down. 

I want to leave you with some tips. First you have to drink your water, because that helps your bladder and it helps with your bowls. The recommendation for fibre here in the U.S. is 25 to 35 grams a day. For some women it feels like a full-time job getting that in. So learn how much fibre you need and where to find that fiber in fruits, vegetables, nuts, seeds, ect.

Also just start paying attention. Check in with your body. What is your body doing? How are you sitting? 

Do a kegel exercise, try to pull your anus up and in close around your vagina. Tighten those pelvic muscles and see if you can even do it.

During the day pay attention, are you clenched? Are you on lockdown? Are you clenching your jaw or shrugging your shoulders. You can start at the top of your head and ask yourself, “What are my eyebrows doing? Am I clenching my shoulders? Am I clenching my belly, my pelvic floor muscles, my feet, my hands?” Then work on letting go. 

The last I want to leave people with is my Zen-peeing, just because it helps you get in touch. So when you pee ladies, you sit on the toilet, feet flat and legs wide. Let your pelvic floor muscles go and let them relax. Then take some deep breaths and that will help empty your bladder all the way, which lessens the chances of getting a bladder infection or a urinary tract infection. It starts connecting you every time you pee with what’s going on down there. 

Those are just some simple thigs that I think everyone should be doing and that are a really good place to start.


Those things are helpful for all sorts of things outside of pelvic health issues too. So great advice Amy. Thank you for joining me.

Find out more:

Connect with Amy Hill Fife on Instagram @amyhillfife and on facebook in her Plevic Health 911 group and check out her website.

This information is for educational purposes only and is not intended to diagnose, manage, or treat disease or serious conditions. Always check with your doctor before making any changes. It’s important to consult a well-informed health practitioner for personal advice about your situation before relying on general information we’re all wonderfully unique.

Laurie Villarreal, FNLP, CHWC, FNS, LMC, CPT, RYT

Hi, I'm Laurie, a functional nutritionist and board certified health coach, athlete, dog-mom, and biohacking adventure-lover. After having struggled for years to find lasting solutions for my own debilitating hormone-related symptoms, I created my online practice to begin helping other active, driven women get the support they need. I now help  women around the world elevate their health, energy, business and life by optimizing their hormones with personalized nutrition and lifestyle tweaks. Together, we discover new tools and strategies that keep you showing up at your best so you can play even bigger in your life and work.

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