Speaker 1: Hi, everybody, and welcome back to Katie's crib. In this episode,
Speaker 1: you guys, we are going to talk about the pelvic floor.
Speaker 1: What is even happening down there? I sure as hell
Speaker 1: don't know. We spend so much time worrying about the baby,
Speaker 1: but what about us? What about the moms? So we
Speaker 1: have two guests today who are going to help break
Speaker 1: down what every new mom needs to know about the
Speaker 1: pelvic floor post birth. First, we're gonna be talking to
Speaker 1: Stephanie Prendergast. She is a physical therapist and the co
Speaker 1: founder of the Pelvic Health and Rehabilitation Center. And then
Speaker 1: I'm gonna be talking to Pria Campbell Sarrago. She is
Speaker 1: a birth doula and a pelvic floor specialist who takes
Speaker 1: more of a holistic and embodied approach to pelvic floor rehab.
Speaker 1: So let's get started, you guys. We are on the
Speaker 1: topic of the pelvic floor, which I have slowly begin
Speaker 1: to realize that the reason I was most excited about
Speaker 1: recording this episode about this topic is that it's just
Speaker 1: secretly my way of talking talking about my own pelvic
Speaker 1: floor what's going on? Because maybe I've been a little
Speaker 1: bit scared to make an appointment and see what's going on. Stephanie,
Speaker 1: I am so happy you're here. You are, I mean,
Speaker 1: you are one of the tops of this situation and
Speaker 1: I am so excited to meet you and talk about
Speaker 1: my pelvic floor. But also I'm sure this will be
Speaker 1: super helpful to our listeners. So welcome, Stephanie prendor Gast.
Speaker 1: Did I say your last name correctly? You did? And think, Oh,
Speaker 1: we're so happy to be here. Um, tell us a
Speaker 1: little bit about yourself. So I my background is I'm
Speaker 1: a physical therapist, but for since two thousand and one,
Speaker 1: I've been specializing in publvic floor disorders and so in
Speaker 1: relevance to this podcast, we deal with a lot of
Speaker 1: women during pregnancy to try to optimize their public floor
Speaker 1: for delivery, make them more comfortable, as well as help
Speaker 1: you see women during pregnancy and before too. We do.
Speaker 1: We do, and in recent years people are coming in
Speaker 1: more to get a better or control of their public
Speaker 1: floor muscles before birth. But historically it used to be
Speaker 1: that women would come in with complaints if they had
Speaker 1: pelvic girdle pain or incontinence or some sort of pain
Speaker 1: issue may have led them to PETE before. But now
Speaker 1: that women are becoming more informed. We also can help
Speaker 1: women prepare themselves, have the confidence they need to go
Speaker 1: into labor and delivery knowing their body is as ready
Speaker 1: for it as it can be. Oh my, I mean literally,
Speaker 1: why did I not go to you before having a baby.
Speaker 1: This is insane because I mean, before I had a baby,
Speaker 1: I was the person who would like sneeze and if
Speaker 1: it caught me off, guarden, I had a super full bladder,
Speaker 1: like a liate little bit of Mike about And I
Speaker 1: know a lot of friends that are in the same boat. Um,
Speaker 1: and we don't really talk about it much. Um. So
Speaker 1: can you tell us about the Pelvic Health and Rehabilitation Center. Yes. So,
Speaker 1: we have been a company since two thousand and six.
Speaker 1: We have four offices in the Bay Area. I practice
Speaker 1: in our Los Angeles location, and we also have two
Speaker 1: offices on the East Coast in New England. We specialize
Speaker 1: in men, women and children, try and gender, all sexes,
Speaker 1: all ages. These problems can start affecting people in their
Speaker 1: teenage years or in the pediatric years with bedwetting and constipation,
Speaker 1: and continue all the way through menopause. So we're happy
Speaker 1: to specialize in solely these disorders and treat everybody across
Speaker 1: the lifespan. WHOA, Okay, tell us a little bit about
Speaker 1: what the pelvic floor muscles do, Like, let's let's talk
Speaker 1: about the pelic floor muscles, like what they do normally,
Speaker 1: and then what do they do during pregnancy and maybe labor? Great,
Speaker 1: so they most people don't even know they have the
Speaker 1: pelvic floor. The muscles run from your pubic bone to
Speaker 1: your tailbone, and they're responsible for kind of a lot
Speaker 1: of big deals. They help us maintain continents, urinary and
Speaker 1: bell as well as the let us evacuate urine stool.
Speaker 1: They're responsible for sexual function, for orgasm and for keeping
Speaker 1: our orgasms are orgasms keeping our organs supported, so they
Speaker 1: also spans supported to Okay, like why it's like, why
Speaker 1: am I in the gym working so hard on my
Speaker 1: biceps and I'm not in this gym like working so
Speaker 1: hard on these pelviic floor muscles that do all the
Speaker 1: things you just described. That's a great question. Most women,
Speaker 1: until you've had a baby, don't necessarily need to strengthen
Speaker 1: their public floor muscles because they are always under some
Speaker 1: sort of tone. It's one of the only muscles in
Speaker 1: the body innervated by a nerve that has autonomic function,
Speaker 1: meaning you don't have to think about it most of
Speaker 1: the time. You're not going to leak if you sneeze
Speaker 1: because you have reef. It's just holding it and it's
Speaker 1: holding in your organ like it just does it. So
Speaker 1: it is big myths in Cosmo and these other magazines
Speaker 1: that suggest younger women should be doing kegles to improve
Speaker 1: their orgasm. That it's simply not true. What right you guys,
Speaker 1: I'm running out the door. I'm wait a second. Wait.
Speaker 1: That is not true. Regular activity often strengthens our public
Speaker 1: floor muscles. From day to day activities. There's always some
Speaker 1: tone and in younger women and women who have not
Speaker 1: given birth, most of the time they do not need
Speaker 1: to strengthen their pelvic floors. When you do have a
Speaker 1: baby and you basically run a marathon with your pelvis
Speaker 1: all those hours that you're in labor pushing the baby
Speaker 1: through the pelvic floor, now the muscles are lengthened, their weakened.
Speaker 1: There may actually be neuropathy then. Sorry, when you when
Speaker 1: you're trying to push the baby through the second stage
Speaker 1: of labor, there's a lot of tension both on the
Speaker 1: pelvic floor muscles and also the pudendal nerve that innervates them,
Speaker 1: and in certain cases there can be transient issues with
Speaker 1: the pudendal nerves. Sometimes it can be more serious than that,
Speaker 1: depending on what has happened during the birth. But if
Speaker 1: you think about it, of course you need rehabilitation after
Speaker 1: going through everything that. It's like you would do physical
Speaker 1: therapy if you got your angle. You're doing physical therapy
Speaker 1: if you have any sort And this is even bigger,
Speaker 1: and yet we're supposed to just like carry on folks.
Speaker 1: No wow, um, so I think you started to hit
Speaker 1: on this a little bit. But so having a baby,
Speaker 1: I guess in my terms Katie's terms, pelvic floor just
Speaker 1: gets blown out. But even if you don't give birth vaginally,
Speaker 1: like because what I'm learning is that the pelvic floor
Speaker 1: has held up additional weight for ten months, which makes
Speaker 1: it also exhausted. This is true, so regardless of the
Speaker 1: method of delivery, the pelvic floor is involved in a
Speaker 1: number of changes that happened during pregnancy period. But it's
Speaker 1: so surprisingly resilient it just often needs a little bit
Speaker 1: or I should say, women would function better with more
Speaker 1: appropriate rehab after to just help get things more normalized
Speaker 1: after the changes that happen. Is this, like does insurance
Speaker 1: cover this? Like? It does? It is just in the
Speaker 1: last month that the American College of Obstetrics and Gynecology
Speaker 1: is acknowledging that maternal postparm care in the United States
Speaker 1: is last in line of all industrialized countries. We were
Speaker 1: given one six week postpartum checkups it to check for
Speaker 1: postparm depress and make sure you don't have an infection,
Speaker 1: make sure your uterus is returned to normal, and that's it,
Speaker 1: see you later. So finally they're acknowledging the fourth trimester
Speaker 1: needs to be more comprehensive than that. Women need more
Speaker 1: visits and we've been given and that are covered by insurance,
Speaker 1: Like we need more visits for physical health obviously, mental
Speaker 1: chickens for postpartum um wowze. That most physicians, unfortunately have
Speaker 1: been paid one lump sum for pregnancy and delivery and
Speaker 1: that includes one postpartum visit and has not included any
Speaker 1: additional visits that a mother may need if it had
Speaker 1: anything to do with her birth. So that's an interesting
Speaker 1: thing that I just it's like I've just got punched
Speaker 1: in the gut and it makes perfect sense because you guys,
Speaker 1: like you know, when you right before you have the baby,
Speaker 1: you're in your obie's office all the time getting these
Speaker 1: stress tests, they're monitoring the heart, they're monitoring your health
Speaker 1: all stuff. And then as soon as the baby's out,
Speaker 1: it's like it's like the biggest breakups ever. And it's
Speaker 1: in no way she formed like my obie's faults. She's
Speaker 1: just like great things so much like I'll see you
Speaker 1: in six weeks and you're like, wait, well, we'll wait, wait,
Speaker 1: wait what I'm sitting on a doughnut and I'm in
Speaker 1: a diaper, Like, hold up a second, I'm super confused,
Speaker 1: And most women feel that way. And the recent survey,
Speaker 1: the majority of women feel like their concerns that their
Speaker 1: care was not adequately addressed during that six week visit,
Speaker 1: and most people felt like they were kind of floundering,
Speaker 1: I mean rightfully so. In other countries, and as early
Speaker 1: as five women were required in countries like France to
Speaker 1: have ten postpartum pelic floor physical therapy visits required. And
Speaker 1: this is because insurance companies have been in the way
Speaker 1: and dictating coverage. In the United States, That's exactly why.
Speaker 1: Because other countries understand the impact that the birth and
Speaker 1: then the support that mothers need is greater than what
Speaker 1: we've been given so far. So hopefully we're on the
Speaker 1: cusp of change. So you think maybe this this you
Speaker 1: we admit that there's something called forth trimester could maybe
Speaker 1: lead us on a path towards maybe better care. It's
Speaker 1: supposed to set the guidelines for all O, B G
Speaker 1: l N s and the standard of kare in America. Now,
Speaker 1: whether insurance companies decide that they're going to pay for
Speaker 1: or not, it is going to be interesting because it's
Speaker 1: being strongly suggested that they do great. Um. So when
Speaker 1: do women typically come to see you? Is it? Are
Speaker 1: most of your clients patients postpartum? Are they in the majority?
Speaker 1: I would assume well, in our practice, we actually see
Speaker 1: a wide range of things. What's interesting about this is
Speaker 1: because public floor physical therapy historically has not been included
Speaker 1: in the standard of postpartum care. Many women find us
Speaker 1: on their own when something's wrong. They have stress and continents,
Speaker 1: they have severe vaginal pain, they have rectal pain, urinary
Speaker 1: urgency frequency, they can evacuate their stools, they can't orgasm,
Speaker 1: and they're furious why didn't my doctor tell me? Is
Speaker 1: what happens now in more recent years, with the presence
Speaker 1: of social media and things like that, many women are
Speaker 1: finding out that they should be going to public floor
Speaker 1: pt even if they're not noticing immediately to bother some
Speaker 1: symptoms that I mentioned. I'm definitely going like next week,
Speaker 1: what's available because obviously think about what what pregnancy and
Speaker 1: birth entials. This is a no brainer. But it just
Speaker 1: hasn't been standard of care until now. No, it's really
Speaker 1: never made so much sense to me. Like you say,
Speaker 1: if you ever had a sprained ankle, you would go
Speaker 1: to the doctor and go to all the visits you'd
Speaker 1: need until you know your dislocated shoulder was back or
Speaker 1: whatever it was needed. And how um so, can you
Speaker 1: take us through a little bit what what happens in
Speaker 1: the first appointment with you? Yes, and I hope you
Speaker 1: will't be nervous when you come to see me, making
Speaker 1: me go way better. So we take a history. We
Speaker 1: also want to hear what your urinary vale sexual function
Speaker 1: was like before pregnancy, because there can also be factors
Speaker 1: that may have influenced your delivery and things that are
Speaker 1: influencing your rehab. Now, um we do a manual examination
Speaker 1: that includes looking at the abdominal area for what's called
Speaker 1: a diastesis wrecked i A. Many women associate that with
Speaker 1: mommy tummy, which is when the muscles separate naturally due
Speaker 1: to the advancing pregnancy. Sometimes they reduce on their own,
Speaker 1: sometimes they don't. It's important because not only for esthetic reasons,
Speaker 1: but it will impair woman's ability to have optimal pelvic
Speaker 1: floor muscle function if her abdominal wall is not intact.
Speaker 1: These muscles work together. How do you know the percentage
Speaker 1: of women that that happens to. So there's a wide
Speaker 1: range in the literature from thirty to Sometimes it reduces,
Speaker 1: sometimes it doesn't, And how people measure it has kind
Speaker 1: of been varied, and so the study show it's kind
Speaker 1: of a wide range. And again some people it closes naturally,
Speaker 1: some people it doesn't. If it doesn't, it can be
Speaker 1: associated with stress and continents pro lapse and back pain
Speaker 1: later in life. So it is important to address it
Speaker 1: even if you don't realize it's there. We also will
Speaker 1: examine the other muscles of the pelvic girdle. Typically the
Speaker 1: muscles of your hip widened to allow the baby to
Speaker 1: come out there maybe what do you mean examine, So
Speaker 1: we will manually examine them to see their length, their strength,
Speaker 1: if they're tender, and the same thing. Internally. We need
Speaker 1: to know if you could contract your muscles, if you
Speaker 1: can relax them, relax them, if there's pain, if there's
Speaker 1: been an episiotomy, pain at the C section scar, and
Speaker 1: basically making sure the muscles can functionization what do you
Speaker 1: put in there to see So we don't use the speculum.
Speaker 1: We use a single gloved lubricated finger, and we also
Speaker 1: use that as feedback to help the mother figure out
Speaker 1: where her muscles are in space, because it's kind of
Speaker 1: like a big black box too many people, and often
Speaker 1: in the postpartum period it can be what I call
Speaker 1: a hybrid where some muscles are tight and some are overstretched,
Speaker 1: and we've got to really do specific things to help
Speaker 1: get that functioning again as a unit. WHOA. So you're
Speaker 1: literally laying on the table with someone's finger in your vagina,
Speaker 1: a gloved lubricated finger in vagina, and then you go
Speaker 1: through exercises and you try to really help someone feel
Speaker 1: inside themselves like different areas of the vagina and and
Speaker 1: strengthen it like do reps almost like like a workout.
Speaker 1: And it's interesting because the majority of women, just two
Speaker 1: are told to cagel actually do them incorrectly and in
Speaker 1: a way that could make things worse. So, my god,
Speaker 1: you guys am literally losing my mind right now. We
Speaker 1: need to help fix that. What this is? This is
Speaker 1: just completely blowing my mind. Um. So, how is physical
Speaker 1: therapy different from how a doctor might address pelvic floor disorder?
Speaker 1: So it's interesting because most kynecologists will tell you that
Speaker 1: they had very little pelvic floor training in medical school,
Speaker 1: and that is shocking since they have to push right
Speaker 1: through those muscles to get to the cervix and the
Speaker 1: eiterus and all the things that are important. So a
Speaker 1: physical therapist is going to more specifically examine each of
Speaker 1: the muscles and different areas of the pelvic floor, the
Speaker 1: prudental nerve and tissue. So when doctors come into play,
Speaker 1: usually when things are more dire, and will hear pelic
Speaker 1: ladder specialist or prolapsed rectum or wait what did you
Speaker 1: just say? So they're considered surgeons for a pelvic floor
Speaker 1: reconstruction and is that a surgery that you have to
Speaker 1: be put out for? Yes, you have to go under anesthesia.
Speaker 1: If there is significant bladder prolapse, uterine prolapse rectal, it
Speaker 1: may require surgical reconstruction. Usually this is something that happens
Speaker 1: later in life that could be prevented if we put
Speaker 1: the pelvic floor muscles back. I think some of the
Speaker 1: older women in my family though, I've heard yeah, like
Speaker 1: things just falling out and meeting his direct means and
Speaker 1: things like that, and so possibly had they done pelvic
Speaker 1: floor work earlier on, that might not have been the case.
Speaker 1: Because the one risk factor for pelvic organ prolapse later
Speaker 1: in life his childbirth. Who see you, guys, this is
Speaker 1: it's like you're not even here. This is just my
Speaker 1: appointment with Stephanie Prendergast. So, uh, you see all sorts
Speaker 1: of patients and clients. Um, how are issues facing pregnant
Speaker 1: and postpartum women different? Are they the same? Like when
Speaker 1: you see a woman who might be about to get pregnant,
Speaker 1: or woman who is pregnant, or a woman who is
Speaker 1: post pregnancy, um, what how do you treat them differently?
Speaker 1: So if pregnancy, we want to optimize their public floor
Speaker 1: muscle function, give them the confidence that they're ready to
Speaker 1: go into labor. And delivery and just help support the
Speaker 1: birth that they want, prepare them with things that maybe
Speaker 1: feel different after so when it does happen, it's not alarming.
Speaker 1: And basically provide education to the pregnant woman when they
Speaker 1: can get in and that can vary from six weeks
Speaker 1: to five years postpartum about doing public floor physical therapy afterwards. Again,
Speaker 1: if there's more acute issues that happen during delivery, like
Speaker 1: women are in retention or they can't pee on their
Speaker 1: own um significant medical things, and we can help sooner
Speaker 1: rather than later in the postpartum period, but ideally after
Speaker 1: the six week check up with the o B which
Speaker 1: is now three weeks um. Women once cleared, can start
Speaker 1: physical therapy that soon. My observation is they're overwhelmed with
Speaker 1: the baby, especially first time moms. Just know we're there
Speaker 1: when they're ready. Um. I think it's hard when they
Speaker 1: need weekly appointments and we're telling them more to do
Speaker 1: when obviously they have to care for another human. Yeah,
Speaker 1: and their weekly appointments are their first you know, they're
Speaker 1: with their pediatrician and it's all about the baby. And
Speaker 1: chaotic one are the different types of pelvic pain and
Speaker 1: disorders that you treat. I think you've listed all of them,
Speaker 1: but in case we missed any real fun sounding ones.
Speaker 1: So pregnancy related. I mean, it's astounding because at eighteen months,
Speaker 1: in a very large study, there was still sixty of
Speaker 1: women who had painful intercourse, regardless of their method of delivery.
Speaker 1: So that's that's telling of what happens with post baby
Speaker 1: women were still in pain having sex. That's just a nightmare,
Speaker 1: and we have to help all those women. That's not okay.
Speaker 1: I'm not down with that high percentage. And so even
Speaker 1: if there's non obstetric related disorders, we do treat a
Speaker 1: lot of painful intercourse. People can have provoked or unprovoked
Speaker 1: vaginal pain, clural issues, interlabial itching, rectal problems, urinary urgency.
Speaker 1: Frequency feels like it's an infection, when in fact it's
Speaker 1: the muscle. So you feel like you have a U
Speaker 1: T I or something and you don't something else going on,
Speaker 1: often the cold floor, WHOA, what's the labia one? So
Speaker 1: interlabial itching is a common symptom that women can get
Speaker 1: or what's called unprovoked or provoked full of adinia, so
Speaker 1: women can have pain in that area. Also unrelated to childbirth,
Speaker 1: but childbirth can also provoke some of these changes that
Speaker 1: do need treatment. How do you how does some of
Speaker 1: the prolapse bladder or uterus or rectum, like can it
Speaker 1: be fixed through physical therapy or does everyone end up
Speaker 1: having to have surgery? Or do you recommend if someone
Speaker 1: might have had a prolapse after baby one but they
Speaker 1: plan on having another baby, like what do you do?
Speaker 1: Good questions? So it can vary, And there's multiple factors
Speaker 1: that affect prolapse, including genetics, weight, other metabolic things, diabetes
Speaker 1: and whatnot. But the pelvic floor is a big one
Speaker 1: and that's the one we can control. And so if
Speaker 1: somebody has impaired public floor muscle function and core function together,
Speaker 1: it's not just about the public floor um, they will
Speaker 1: be more likely to develop pro lapse as time goes
Speaker 1: on because the muscles provide some support to those organs,
Speaker 1: But so do the ligaments. And again we can't control
Speaker 1: the ligaments. That's our genetic composition, but we can improve
Speaker 1: our public floor muscle function to kind of take up
Speaker 1: the slack of gravity of natural age related changes, etcetera.
Speaker 1: If a woman does have pro lapse immediately postpartum, it
Speaker 1: is not advised to have surgery until they are done
Speaker 1: having children, and so depending on the severity of it,
Speaker 1: like they skip. They score prolapse one to three, four
Speaker 1: and the most oversimplified version of this um categories one
Speaker 1: and two. It can be helped with physical therapy Categories
Speaker 1: three and for mean that organs are coming towards the
Speaker 1: opening of the vagina or out of the vagina itself,
Speaker 1: and those are almost always a surgical situation, but can
Speaker 1: still benefit from getting as rehabbed as possible before and
Speaker 1: also addressing your function after, just like with any other
Speaker 1: surgery and any other part of the body, you want
Speaker 1: to go into that as prepared as possible. I have
Speaker 1: a friend who had a prolapse, who has a prolapse
Speaker 1: bladder and and wants to have another baby, and she's
Speaker 1: been she did a lot of physical therapy, but was
Speaker 1: also putting around with like maybe a diaphragm or putting
Speaker 1: something up there that could hold her stuff in until
Speaker 1: I mean, is that a thing. It's called a pessary. Yes,
Speaker 1: And so those are the classes. Over the counter now,
Speaker 1: poise makes am almost like a super tampon called the Impressive,
Speaker 1: which you can purchase over the counter that can help
Speaker 1: provide some support if it's a minor prolapse um and
Speaker 1: then a medical device called a passery is something that
Speaker 1: you're a gynecologist or euro gynecologists can fit to help
Speaker 1: provide support to the organs. Once you take it out,
Speaker 1: the organs are going to come back down, but they
Speaker 1: can provide a basis of support while people are trying
Speaker 1: to either delay surgery or do other things in life.
Speaker 1: This is a really stupid question, but like, if you're
Speaker 1: having a pro lapse and your bladders like out, which
Speaker 1: I have another friend that that was the case, isn't
Speaker 1: there major risk of infection or like like if your
Speaker 1: bladders just hanging out of your vagina hole, like how
Speaker 1: on like a cotton underwear is that dangerous. I've been
Speaker 1: doing this for eighteen years and I still don't think.
Speaker 1: I think the same way you do. I see every
Speaker 1: time I see a uterus on my table, I'm like
Speaker 1: that you see a uterus on your table, Yes, this
Speaker 1: happened that I'm literally losing it doesn't look like that's okay,
Speaker 1: but apparently it's kind of okay. I don't know. She's like,
Speaker 1: I'm sitting on my bladder literally like I have a
Speaker 1: friend that it's coming out of for vagina. Really, you know,
Speaker 1: having a baby is so sucking crazy, Like this is crazy, like'
Speaker 1: literally having a conversation about carrying your bladder around outside
Speaker 1: your body. But like so that is that is the thing,
Speaker 1: and it and it's okay. It doesn't cause as much
Speaker 1: risk of infections as you would think. And even still
Speaker 1: I think it just does not look okay to me.
Speaker 1: And so usually we do advise that women wow sempressory
Speaker 1: and work with their doctors about surgical intervention. What are
Speaker 1: some of the telltale signs that women might be facing
Speaker 1: post baby That would be like, okay, you you should
Speaker 1: go see you if you can't. Leaking urine is never
Speaker 1: normal but extreme you guys, yes, so if you maybe
Speaker 1: I think everybody should be evaluated. But I mean things
Speaker 1: like leaking normal leaking your may not be bothers them,
Speaker 1: but that's indicative that there's something wrong opposite. End urinary urgency, frequency,
Speaker 1: diminished orgasm, painful sex, difficulty with bowel movements. All of
Speaker 1: those factors um can be addressed and not to mention
Speaker 1: the more simple things like hip pain and back pain
Speaker 1: and you know, sciatica. Some of the normal things. I
Speaker 1: feel like we haven't even covered. But those are things
Speaker 1: you guys cover. Two Yes, because psiotic. I didn't have
Speaker 1: that a lot during my pregnancy, but I heard about
Speaker 1: it constantly from all the women in my like yoga
Speaker 1: class or in my swim club, Like that is a
Speaker 1: big trigger thing that a lot of women. It's like
Speaker 1: very debilitating, yes, because your publvic muscles start to get
Speaker 1: tighter as your ligaments loosen, and sometimes I can push
Speaker 1: on your sciatic nerve, causing symptoms down the leg and
Speaker 1: it's very painful and you can lose some motor control.
Speaker 1: So it's important to address it for the women like me.
Speaker 1: While that singing continence is like, oh yeah, whatever. Like
Speaker 1: I was saying, I was on a I think I
Speaker 1: was at a holiday party and I got a little
Speaker 1: drunk and I was jumping up and down on a
Speaker 1: dance floor and every single time I jumped and landed,
Speaker 1: like a little bit of bee came out. And I
Speaker 1: was like, that's totally fine. I just had a baby.
Speaker 1: For those of us that are in a similar boat
Speaker 1: where you would think that's normal, you're saying that's not normal,
Speaker 1: not normal, but very common. Oh but can't we just
Speaker 1: pretend it's normal so that I don't have to address
Speaker 1: it and I can just live and denial that everything
Speaker 1: is fine. We'll think about it this way. What if
Speaker 1: it continues to get worse? You're you're so right, and
Speaker 1: that's why we're doing an episode about this. Guys, you're
Speaker 1: going through a visit with me um so and also
Speaker 1: you would say similarly, anyone, thank god, this is not me.
Speaker 1: But people who are having pain during sex, even a
Speaker 1: little bit of pain that is not normal as well? Correct?
Speaker 1: What are the kind of pains that women complain about
Speaker 1: during sex? Is it like a sharp like? Is it
Speaker 1: a burning sharp? What? What are we looking for here?
Speaker 1: Often it's often entry pain, which is like insertional pain
Speaker 1: for women. Either can be issues neuromas, things that the
Speaker 1: episiotomy scar, but also the second thing that's very important,
Speaker 1: and we catch it in pulvic floor pt is. The
Speaker 1: doctors will often provide you with estras or a topical
Speaker 1: hormone to put on that bolvar vestibule air you a
Speaker 1: postpartum and many women actually don't use it. But if
Speaker 1: you continue to breastfeed, and you do breastfeed, then basically
Speaker 1: that tissue is essentially in menopause, and it will become
Speaker 1: frail and atrophied, and that topical is prescribed for a reason.
Speaker 1: But as one of my patients said, I couldn't even
Speaker 1: mean eat boloney when I was pregnant. Why would I
Speaker 1: think I could put on a hormone? Good question, good point.
Speaker 1: But they do prescribe that for a reason, and often
Speaker 1: women are a little worried about it or they don't
Speaker 1: totally understand why they're getting it. But it's important to
Speaker 1: know that those tissues will respond to the lack of
Speaker 1: estrogen that's happening that allows a woman to breastfeed, and
Speaker 1: so that can be a major leading clause of pain
Speaker 1: within our course is drying and dryness. This is what
Speaker 1: I heard mostly from just friends. We were all breastfeeding
Speaker 1: and and yeah, that was the room where I heard
Speaker 1: from most friends. Was like, oh, yeah, good luck, you're
Speaker 1: never getting wet. And I was like what. And they're
Speaker 1: just like your bodies in a metopausal state when you're breastfeeding,
Speaker 1: and so your body doesn't lubricate itself like it would
Speaker 1: or used to, And I think can be exercised visit.
Speaker 1: You may not talk to your doctor about that you're
Speaker 1: thinking about a million other things. But ask your people
Speaker 1: should ask their doctors, and now it's safe to use,
Speaker 1: and then that can help during that breastfeeding period. Very interesting,
Speaker 1: So tell me the exercises that you, I don't know
Speaker 1: would like when people come and see you and you
Speaker 1: evaluate how they're doing. Then is it just tons of
Speaker 1: homework and daily practice? But is it now that we
Speaker 1: do kegles like I know we talked about eegles earlier,
Speaker 1: but would that be something you would suggest once someone
Speaker 1: learns how to do it correctly with you? They it is,
Speaker 1: but it's not just the kegle in isolation. We want
Speaker 1: to make sure women can control the pelvic floor muscles.
Speaker 1: But then we actually are giving more individualized exercise based
Speaker 1: on their entire core and so some people have a
Speaker 1: strong transverse abdominance, other people don't, and so it's about
Speaker 1: lengthening all the muscles that are too tight and strengthening
Speaker 1: and a coordinated, correct contraction of the core muscles together,
Speaker 1: which includes a pelvic floor. Especially in Los angele. Most
Speaker 1: people are active, and so what we want to do
Speaker 1: is incorporate specific exercises into their regular routines so they're
Speaker 1: not having to do with two in fifteen minutes is
Speaker 1: too much for some women. And so it may be
Speaker 1: doing a kegal when you're getting on and off the toilet,
Speaker 1: or when you're bending down to pick up your baby
Speaker 1: and standing up like things that you're doing already. We
Speaker 1: want to teach you how to incorporate safer biomechanics and
Speaker 1: proper neuromuscular motor control. I was always told you P
Speaker 1: and then who tell these things I have learned from
Speaker 1: their moms? Is like so insane? But like you P
Speaker 1: and then just stop your P two or three times
Speaker 1: during a P session? Is that what is my face doing?
Speaker 1: Her face is looking at me like she is completely horrified.
Speaker 1: That is one way that I think inexperienced people told
Speaker 1: people how to kegal. That's not correct. You should never
Speaker 1: stop your hurine stream. It can lead to bladder infections.
Speaker 1: Then you need to be on antibiotics, and you get
Speaker 1: a yeast infection, and now you've got bolvar pain. You
Speaker 1: don't want to do at There's other ways that told
Speaker 1: me that I don't know, but it was a rumor
Speaker 1: that I was doing for a little bit. It is
Speaker 1: definitely a popular rumor, So that is not it. What
Speaker 1: are the exercises that women can do on their own
Speaker 1: to help their pelvic floor pain and are there any
Speaker 1: products or aid other than the possibly for some people
Speaker 1: the lotion that you talked about. Yes, that's a that's
Speaker 1: a prescription, prescription what you need. Um. I think there's
Speaker 1: a device out there that I personally I am a
Speaker 1: huge fan of. It's called the elv Yes, I just
Speaker 1: got it, guys. It came in a Mother's Day like
Speaker 1: swag bag that I got and I will report back
Speaker 1: to you guys. It looks like a little vibrator thingy
Speaker 1: it does that goes in and what happens and and
Speaker 1: also what's interesting about it is it connects to your
Speaker 1: phone and it will basically I'm gonna start playing video
Speaker 1: games with your heelvet floor muscles using your elving on
Speaker 1: your phone. And what I like about it is it
Speaker 1: confirms that you're doing it properly, which is the number
Speaker 1: one reason why women don't do UK goals is because
Speaker 1: they're not even sure if they're doing them properly. It
Speaker 1: will reinforce it you are. It will measure your strength,
Speaker 1: how fast you are, your control, and it will remind
Speaker 1: you that you need to do this over time, and
Speaker 1: you can actually document your progress. And so what you'll
Speaker 1: see with that is that you can also tell that
Speaker 1: your muscles are improving, your symptoms should be going down.
Speaker 1: And I think for a home tool that's really useful,
Speaker 1: So the LV And then and then also I got
Speaker 1: from a friend the Yoni egg. What it is? This
Speaker 1: like whatever? Okay, So Stephanie's face is like, well, you
Speaker 1: don't need to hold a weight in your vagina for
Speaker 1: it to improve. It's really about neuromuscular control with your
Speaker 1: other muscles, and the idea of just squeezing independently around
Speaker 1: a weight for a period of time is questionable, and
Speaker 1: so is the cleanliness of that is there's been some
Speaker 1: debate about if it can actually promote or not. I
Speaker 1: have not tried the Yoni egg, but I have one
Speaker 1: next to my bedside. I think it's pink um. I
Speaker 1: have to it. How do women feel about Like, see,
Speaker 1: I'm going to try to avoid this and not come
Speaker 1: to you because I'm going to be super embarrassed that
Speaker 1: I have to go and like have some person's finger
Speaker 1: in my vagina and like do exercises? How do you talk?
Speaker 1: Or yeah, like make women feel comfortable. Is it the
Speaker 1: kind of thing like once you get started, it's just
Speaker 1: not a big deal and women don't care or like
Speaker 1: or is it a really big hang up for some?
Speaker 1: Like I say, more often than not, it's not. I mean,
Speaker 1: so many moms have already been through so much. We're
Speaker 1: not that different and we're not in big gyms. I mean,
Speaker 1: in particularly in our clinic, everyone is in a private
Speaker 1: treatment room. Um. I think hopefully that from the moment
Speaker 1: people call, our staff knows people are calling with sensitive issues,
Speaker 1: and so from the beginning, hopefully the education process starts
Speaker 1: to make people feel more comfortable. But it's really helpful
Speaker 1: to know that you do feel nervous. And my question
Speaker 1: for you would be what can we do to make
Speaker 1: it easier? Thanks? Definitely, Well, I think I just have
Speaker 1: to bite the bullet and like do it, and I
Speaker 1: also have to kind of change my you know, what
Speaker 1: I think is so interesting about this work is that
Speaker 1: you know, we're raised your vagina is your your private part.
Speaker 1: It's like really like you know, sensitive and brings up
Speaker 1: a lot of different feelings. So to come at it
Speaker 1: at a more kind of physical therapy way, which is like, no,
Speaker 1: this is a muscle that you need to take care of,
Speaker 1: like the other muscles in my body. Um, you know,
Speaker 1: I was all about when I was pregnant, Like you know,
Speaker 1: I was all about doing a million squats because I
Speaker 1: had heard that, like my legs were going to be
Speaker 1: so important during labor because they're my strongest mulse as
Speaker 1: I've got and I'm going to be pushing like crazy.
Speaker 1: And it didn't even occur to me once that my
Speaker 1: pelvic floor was something that was going to take such
Speaker 1: a hit and was going to be something that let
Speaker 1: needed to be worked on. But yeah, I think it's
Speaker 1: like putting on my big girl pants and I just
Speaker 1: have to go. And after a minute, I'll tell you guys,
Speaker 1: and I'll be like, it was so not a big
Speaker 1: deal if it makes you feel any better. All the
Speaker 1: people that are pelvic floor physical therapist, how do you
Speaker 1: think we learn on each other? Right, So, every time
Speaker 1: we hire a new employee, guess whose hands are in
Speaker 1: my public floor? Really yes, So hopefully that will ease
Speaker 1: it a little bit because we've all been through it
Speaker 1: and that's how they learn. And so and what's crazy
Speaker 1: really not that big a yeah? And also every single
Speaker 1: thing I felt with pregnancy you thought was a big
Speaker 1: deal and then wasn't. Like I remember when someone was like,
Speaker 1: you have to get an internal exam and me being like,
Speaker 1: oh my god, this is gonna be so terrible, and
Speaker 1: they did, and I was like, Oh, that wasn't that bad.
Speaker 1: You know, it's almost so much bigger in my brain
Speaker 1: than when I do it. It's just not let's do
Speaker 1: some advice to expecting mothers that aren't having any issues,
Speaker 1: and let's talk, and then let's give some advice to
Speaker 1: women who are having issues. So the expecting mothers, I think,
Speaker 1: just knowing this information, they may not feel normal at
Speaker 1: that six week check up or now three weeks, and
Speaker 1: that's typical. Their bodies go through a lot, both with
Speaker 1: pregnancy and delivery, and regardless of the time that they
Speaker 1: do come in. Once they do, I think that they
Speaker 1: can learn enough to make sure or that they are
Speaker 1: taking care of themselves for the rest of their lifespan
Speaker 1: and just addressing issues that may arise very treatable. We
Speaker 1: try to make it functional, easily integrated into your life
Speaker 1: as it already is. We don't want to give you
Speaker 1: one more thing that's going to make you feel incompetent.
Speaker 1: And the one thing mom say often is that they
Speaker 1: just don't feel like, you know, they're doing as well
Speaker 1: enough job as they can. So our roles to set
Speaker 1: new moms up for success. This is like so mind
Speaker 1: blowingly helpful. I can't even thank you enough for being here.
Speaker 1: And I'm going to keep all of you listeners have
Speaker 1: like so updated on my pelvic floor health in case
Speaker 1: you're interested in care. Thank you all my heart for
Speaker 1: being here and for being on Katie's Grip. Hello, Korea, Hello,
Speaker 1: thank you so much for coming on the show. Thank
Speaker 1: you for having This is, guys, my selfish attempt of
Speaker 1: just getting to hang out with Priya and ask her
Speaker 1: all the personal questions I want ask about my pelvic floor.
Speaker 1: I'm so fascinated by this subject because the pelvic floor
Speaker 1: is like a whole thing that I never thought about before.
Speaker 1: It just got completely wrecked during childbirth. What is having
Speaker 1: a baby due to the pelvic floor muscles? Where do
Speaker 1: they go so during besides bye bye, besides totally different? Um. Yeah,
Speaker 1: So the pelvic floor muscles, as you can imagine, they're
Speaker 1: holding the weight of your tors so they're holding the
Speaker 1: weight of your organs. So when you have a baby
Speaker 1: growing inside, they start to receive more weight from the baby. Um.
Speaker 1: So some of the things that can happen is the
Speaker 1: pelvic floor muscles can stretch out, um which is what
Speaker 1: causes you know, when people have pelvic floor weakness from
Speaker 1: them stretching out. And that can happen from the pregnancy.
Speaker 1: So even people who have c sections can have weakened
Speaker 1: pelvic floor muscles. Interesting, even if they didn't give birth vaginally,
Speaker 1: your pelvic floor muscles and still be kind of blown
Speaker 1: out because you've been carrying around in some cases pound
Speaker 1: baby exactly, plus all the extra weight from your just
Speaker 1: gaining weight, gaining weight, all the extra fluids in your
Speaker 1: body from pregnancy. Um, So they can stretch out. They
Speaker 1: can also overtighten. Why can they overtighten? They'll get strong,
Speaker 1: they'll like tighten to try and hold more of the weight.
Speaker 1: I don't know if you experience like tight glutes pregnancy,
Speaker 1: So that's the same kind of thing. The glutes are
Speaker 1: also holding the weight of your torso um so muscles
Speaker 1: will try and respond to the extra weight by tightening.
Speaker 1: So yeah, and there can actually be i um like
Speaker 1: what would be called like a muscle spasm which is
Speaker 1: basically where the muscle can't relax where it's overtight. That
Speaker 1: can happen to your pelvic floor. Yeah, oh why yeah,
Speaker 1: but that would also even though the muscles are holding
Speaker 1: in are tight, it could come across. You could still
Speaker 1: be experiencing a pelvic floor weakness because if you think
Speaker 1: of like a scar tissue, scar tissue doesn't move, it's
Speaker 1: almost like it's like a spasm where it's overly tight tissue,
Speaker 1: and there's usually weakness in a place where they're scarring.
Speaker 1: So most people deal with incontinence in regards to the
Speaker 1: pelvic floor. That could also be UM pain with sex,
Speaker 1: so pain with intercourse, and that would be from the overtightening,
Speaker 1: and that could both be UM. That could both be
Speaker 1: from the actual physicality of holding the weight and then
Speaker 1: the muscles overly tightening. It could also be holding emotional trauma.
Speaker 1: So as we all know, birth is a very intense experience,
Speaker 1: whether you have a c section or you know, pregnancy
Speaker 1: in and of itself is intense, So the tightening could
Speaker 1: also be or the pain could also be from an
Speaker 1: emotional holding on. Whoa, yeah, so that's why I can't
Speaker 1: wait to hear about how you treat all this up?
Speaker 1: So would you say that there are women who are
Speaker 1: maybe more at risk for a pelvic floor disorder post
Speaker 1: birth than others? Like why do some women have? I mean,
Speaker 1: like you said, I think you've already listed and continents
Speaker 1: can happen because of emotional trauma and how you hold
Speaker 1: the baby and if you're tight or loose. But are
Speaker 1: there any preventative measures that women can take that would
Speaker 1: have the outcome be different or maybe better? Yeah, I
Speaker 1: feel like the best thing is to exercise, you know,
Speaker 1: like weight bearing exercises are really good, Squats are really good.
Speaker 1: I'd say in general, people who have a more active
Speaker 1: lifestyle before they get pregnant or even during pregnancy, have
Speaker 1: a better chance of, um not having as many problems,
Speaker 1: but also being able to bounce back more like their
Speaker 1: body is already kind of accustomed to working out and exercising,
Speaker 1: so it's easier to kind of get back into that. Um.
Speaker 1: It's a lot of points for working out, but it
Speaker 1: doesn't necessarily guarantee it. Like I've had clients before who
Speaker 1: are super in shape, who are really into exercise and
Speaker 1: still have issues afterwards. So you know, it depends a
Speaker 1: lot on also how the labor went. Um. You know
Speaker 1: sometimes if if you if you have to push and
Speaker 1: like get the baby out really fast, that could cause
Speaker 1: some both trauma in the body and also more physical damage. Um.
Speaker 1: So that would be an example of like someone could
Speaker 1: be in really good shape but still have a problem.
Speaker 1: So it's kind of like birth where it's there's no
Speaker 1: really any guarantee, right, but you know, having a healthy
Speaker 1: lifestyle that's healthy and active is gonna you're gonna have
Speaker 1: better chances. I think we've all heard about kegel exercises
Speaker 1: like our whole life. I mean, I love like, I've
Speaker 1: definitely been in classes though, prenative classes where women were
Speaker 1: like I have to admit, like I don't even know
Speaker 1: what the hell that is or how to do it. Um,
Speaker 1: just explain for people who are listening what a key
Speaker 1: goal is. Sure. Um, So they're part of the pelvic
Speaker 1: floor as the vaginal canal, which is where you have intercourse,
Speaker 1: and so there's muscles their circular muscles um, inside of
Speaker 1: the vagina. So a keegel is a traditional keegel would
Speaker 1: be squeezing that muscle and releasing it. What about those
Speaker 1: eggs that people all, yeah, Yon eggs, the Yoni eggs. Yeah,
Speaker 1: you like put an egg of different sizes depending on
Speaker 1: how ripped and strong your vagina is, and you put
Speaker 1: the egg up there and you can hold onto it.
Speaker 1: Oh wait, wasn't this in that movie Fifty Shades of Gray?
Speaker 1: Doesn't she have to like he insert something and like
Speaker 1: walk around with it in dinner? I don't remember something
Speaker 1: like that. I'm pretty sure it was like, Yon, can
Speaker 1: you explain what that is and doesn't actually work? Should
Speaker 1: I be doing that and it will help it? Not
Speaker 1: even tell me? Yeah? Well, I wanted to say with
Speaker 1: the yes you can. The Yoni eggs are good. I
Speaker 1: need to get it up there and it's gonna get
Speaker 1: lost forever. Okay. Then there are ones that have holes
Speaker 1: in the bottom and you can thread like um strength
Speaker 1: tamper it, or you can stread thread like a piece
Speaker 1: of floss or something like that. Yeah, so you could
Speaker 1: pull it out missing make it hang out. Um so, yeah,
Speaker 1: the Yoni eggs are really good. One of the reasons
Speaker 1: they're good is because, like you're saying, she had to
Speaker 1: walk around with it, you can walk around with it
Speaker 1: and your muscles are going to be grabbing onto it
Speaker 1: without you having to think about it. So that's one
Speaker 1: thing that's good about the Yoni eggs um, whereas so
Speaker 1: the I think the reason why people have such a
Speaker 1: hard time with the key GOLs is because it's not
Speaker 1: that you know, you can say like, oh yeah, squeeze
Speaker 1: your vagina, but most people, the pelvic floor is such
Speaker 1: a it's like a whole landscape world of its own um.
Speaker 1: Which is some of the work that I do. I
Speaker 1: take people more deeply into being able to not just
Speaker 1: squeeze your vagina and let it go, but to be
Speaker 1: able to to feel muscles in different parts of the
Speaker 1: pelvic floor, which I call pelvic floor mapping, and it's
Speaker 1: every you know, every place that you're able to find,
Speaker 1: it's a different it gives kind of different feeling through
Speaker 1: your body. So and it's you have to take people
Speaker 1: into a very deep like it's a it's a strange
Speaker 1: place to feel. It's not just like it's not just
Speaker 1: like feel your elbow. You know, it's really deep in there,
Speaker 1: and people don't usually spend time thinking about it feeling it.
Speaker 1: And on top of it, there's tons of people have
Speaker 1: tons of shame around that area, you know, shame, embarrassment,
Speaker 1: or whatever. Luck people store all sorts of stress feeling
Speaker 1: stress in the area, so it's a it's a difficult
Speaker 1: place for people to go, which is why you know
Speaker 1: when someone just says, like do a key goals? Like
Speaker 1: what is that? Like? You can't just oh, let me
Speaker 1: just move my a lot about the work you do?
Speaker 1: Which is you do? How would you phrase it? Is it?
Speaker 1: Is it it's a holistic approach to pelvic floor health
Speaker 1: or yeah, yeah, I would say it's an embodied approach.
Speaker 1: It's a it's a mindful approach. So at what point
Speaker 1: does a woman make an appointment to see you? Generally speaking? Like,
Speaker 1: do most blumen come to see you when it's too
Speaker 1: late or no? I mean I have women who I
Speaker 1: work with who are like in their fifties and sixties
Speaker 1: and even you know, Um, but most people come to
Speaker 1: me sometime in they're like early postpartum time. Um. I've
Speaker 1: had someone come to me four days after their labor,
Speaker 1: which is fine. Um, this woman in particular was like
Speaker 1: the worst incontinents case I've seen where she had to
Speaker 1: wear diapers, Like every time she stood up, it was
Speaker 1: just he and she. She's gotten it back, She's gotten
Speaker 1: it back. I worked with her regularly for maybe three
Speaker 1: or four months, and she was like back to wearing
Speaker 1: a thong. So what would happen, for example, at a
Speaker 1: first appointment? Take me through like her story? Like what
Speaker 1: do you do when you see a first appointment, you know,
Speaker 1: someone who has never been to you before? Like, yeah,
Speaker 1: I do an intake so I find out kind of
Speaker 1: what they're story was? What are their issues? Um? I
Speaker 1: asked questions to find out whether there's um overtightness or weakness. UM.
Speaker 1: So like painful sex, if someone's having painful sex or
Speaker 1: just pain in general, Um, I would you know, diagnose
Speaker 1: them more in that they're overly tight and they need
Speaker 1: help with the relaxation side of things. Um. If someone's
Speaker 1: having issues with incontinence or any kind of like back
Speaker 1: or hip pain, then they're going to need more loose
Speaker 1: strengthening side. And then what would you do for either?
Speaker 1: Like what are the techniques during a session with you
Speaker 1: where people are what would you do for a tight
Speaker 1: case versus a loose um? For I mean a lot
Speaker 1: of the exercises are similar because I emphasize both the
Speaker 1: squeezing the tightening of the muscles and the relaxation. Um.
Speaker 1: But with someone who is overly tight, I might just
Speaker 1: focus on the relaxation side, so I wouldn't bring them
Speaker 1: into the contraction contracting the muscles until maybe later on. Um.
Speaker 1: Sometimes you know, it's like when you work out and
Speaker 1: then after words you're able to rest more. So sometimes
Speaker 1: even with the tight, with the people who are overly tight,
Speaker 1: it's like, okay, well, I'm gonna work with the with
Speaker 1: the contracting of the muscles, just so that you're able
Speaker 1: to feel the other side, which would be the letting go.
Speaker 1: But when you say, like work on it, what does
Speaker 1: that mean? They're like laying on a table. So how
Speaker 1: people lay down? Um, I always start people laying down
Speaker 1: because it's easier to feel when you're doing less. So
Speaker 1: if you think about, um, you know, you're like rushing
Speaker 1: to get out of the house and like you're more
Speaker 1: likely to drop things and stub your toe or forget something,
Speaker 1: forget something. But when you start overly doing or overly working,
Speaker 1: you're not as aware and you can't feel yourself as much.
Speaker 1: You know, you might like hit your hand on the
Speaker 1: wall or you know. Um, So it's the same thing
Speaker 1: with our body is the more you can let go
Speaker 1: and do less. The more you can feel inside of
Speaker 1: your body, which is one of the you know, if
Speaker 1: you can feel an area of your body, you can work,
Speaker 1: you can learn to use the muscle in the area
Speaker 1: of your body. So you have them laid down and
Speaker 1: then um, it's different exercises, but I first always guide
Speaker 1: people into a state of relaxation and feeling their breath. Again,
Speaker 1: like with the where you can feel your breath in
Speaker 1: your body, you can also feel more, especially in our
Speaker 1: torso I mean it's like, well, yeah, I can feel
Speaker 1: my toe or whatever, and I don't necessarily I'm not
Speaker 1: necessarily breathing into my toe right now, But like in
Speaker 1: the belly and in the pelvis, particularly, if I can
Speaker 1: get people to start breathing into that area and feeling
Speaker 1: their breath in that area, then there's a heightened sensing
Speaker 1: and a heightened awareness, which then means that they have
Speaker 1: more access to those muscles, both relaxing them and contracting
Speaker 1: them working them. So what do you do that's different
Speaker 1: is different from a traditional physical therapist. So I take
Speaker 1: people more into a meditative um being able to guide
Speaker 1: themselves in feeling and sensing and working their muscles. From
Speaker 1: a place of embodiment. Do they do like reps? Like
Speaker 1: you're literally like counting how many times? I don't count.
Speaker 1: I usually will with different people. I'll do it until
Speaker 1: I sense that they're um getting it, So repeat, repeat, repeat,
Speaker 1: until I can feel that their body is actually getting
Speaker 1: what's happening. I also do a lot of verbal check
Speaker 1: in because it's such a like, you know, I can't
Speaker 1: see their pelvic floor working, So I be like, okay,
Speaker 1: I'll ask part you know, how did that feel? What?
Speaker 1: Like what were you able to feel? Um? Does do
Speaker 1: you feel your muscles? Also? You know cues in the
Speaker 1: body of like did you feel any warmth? Do you
Speaker 1: feel tingling? Do you feel a lot of times when
Speaker 1: people use their muscles, it's just like a feeling of
Speaker 1: spaciousness in that area. Um, But I don't know if
Speaker 1: you experienced this after birth, but a lot of women
Speaker 1: have like really no sensation down here, like kind of
Speaker 1: a loss of or like almost like an empty feeling. Oh,
Speaker 1: I don't even like I wasn't even alive, like I
Speaker 1: just I mean, I was like in a diaper, uh
Speaker 1: spring witch hazel on my vagina, Like I don't even know,
Speaker 1: Like and I was waddling around and I was sitting
Speaker 1: on like a doughnut, like it was horrible, and like
Speaker 1: nobody told me. I mean maybe they did it. I
Speaker 1: just didn't listen, but like, oh my god. All I
Speaker 1: can remember is I had given birth. And it was
Speaker 1: like maybe an hour later we had had the Golden
Speaker 1: hour at theaters where I had like skin to skin
Speaker 1: time with my son and my husband did and then
Speaker 1: this lovely nurse like came and stood me up and
Speaker 1: started walking me over to the toilet, and I just
Speaker 1: started peeing all over the floor like I didn't even
Speaker 1: make it there. She was like, wait, wait, wait, we
Speaker 1: have to put in like a bucket thing or something.
Speaker 1: And I didn't make it there. I just started peeing everywhere. Um,
Speaker 1: and that's what I was like, oh my and I
Speaker 1: couldn't feel anything. And I don't know if that was
Speaker 1: the a dural or whatever it was, but I couldn't
Speaker 1: feel anything. And I and then you are. And then
Speaker 1: I continued being on the toilet and then this lovely
Speaker 1: lady just started spraying down my private parts with water
Speaker 1: because you can't wipe, and I was like, what's your name? So, yeah,
Speaker 1: how long do you typically work? With a patient like
Speaker 1: how long I mean you said you're your worst case,
Speaker 1: like in four months you could even see some sort
Speaker 1: of And how often were you seeing this person? Like
Speaker 1: how often is it once a week? Because it will
Speaker 1: see people once a week? Yeah, I do, UM, I
Speaker 1: have I do have people who I see twice a week. Um.
Speaker 1: A lot more improvement happens when I see people twice
Speaker 1: a week. Yeah. But I find, you know, with the
Speaker 1: postpartum schedule and you know everything, it's for people once
Speaker 1: a week even sometimes once a week. It's really difficult
Speaker 1: with you know, breastfeeding and everything. So UM, I recommend
Speaker 1: twice a week if you really want to get you know,
Speaker 1: because also it's hard to practice things on your own,
Speaker 1: anything like any kind of discipline. With doing a new practice,
Speaker 1: I find it's difficult without having someone they're telling you
Speaker 1: what to do and holding the space for you. But
Speaker 1: how long there is an appointment and then there's going
Speaker 1: to be check in time like okay, what's going on?
Speaker 1: What did you do last week? What are you anything
Speaker 1: that's changed? You know? Um? And then time for practicing
Speaker 1: and doing repetitions, and then based on where your progress is,
Speaker 1: I'll add more. Um, you know, more exercises. How did
Speaker 1: you get into this? Like what this is? So? Like?
Speaker 1: How did you get here? Um? I kind of don't
Speaker 1: even really know. No, I am did you have your
Speaker 1: own public floor? No? No? Um, so I let's see
Speaker 1: my whole life. I've been very embodied, very into my body,
Speaker 1: feeling my body. I've always been a dancer and um,
Speaker 1: when I moved to l A, I was intensity studying
Speaker 1: yoga and tantra um not the kind of like tontra
Speaker 1: that you think of, like you know, it's like a
Speaker 1: class about having sex. But that's exactly where learn to
Speaker 1: have really good sex now. But it does come with
Speaker 1: pelvic floor health, doesn't it. It It does. That's the benefit
Speaker 1: of the pelvis. If I go around with a Yoni
Speaker 1: egg and my pelvic floor muscles get really strong, like
Speaker 1: I'm going to have better orgasms? Is that just fact? Yeah?
Speaker 1: Well the thing is so if you think about what
Speaker 1: I've got here, it's true. Yeah, I mean definitely for sure, Yes,
Speaker 1: for sure. I mean I've had people who you know,
Speaker 1: I'm working with them on other things like in continents
Speaker 1: and also and they're like, oh my god, I was
Speaker 1: so not interested in having sex with my husband. And
Speaker 1: then like we had the best sex ever, like you know,
Speaker 1: so it happens, it's so collected. Okay. So that reason
Speaker 1: being is that you're bringing by doing the exercises, you're
Speaker 1: bringing more blood flow into your pelvic floor, into your vagina,
Speaker 1: and so basically rectile tissue, like when tissue becomes erectile,
Speaker 1: either the cltterest the clarter ist becomes erect or the
Speaker 1: penis obviously there's more sensation in that area erectile. All
Speaker 1: that is is there's more blood in the tissue. The
Speaker 1: tissue gets erect from blood flow. So if you're having more,
Speaker 1: if you're able to circulated are, then you're going to
Speaker 1: have more exactly. So Okay, you studied, Okay, back it up,
Speaker 1: we're not talking about tantra sex. What are we talking about? UM?
Speaker 1: Talking about traditional like very tantras are really it's one
Speaker 1: of the first religions from South India and so the
Speaker 1: very old old practices which are based in UM. I mean,
Speaker 1: obviously it makes your connection with another person or your
Speaker 1: sexual connection with another person better, but the focus of
Speaker 1: it being to learn how to circulate energy in your body. UM,
Speaker 1: how did become that you specifically moved into pelvic floor.
Speaker 1: So while I was doing that training, which I went
Speaker 1: to India twice for and studied up you know, the
Speaker 1: ostram with the guru and you know, learn all these
Speaker 1: exercises that are you know, learned a lot of learned
Speaker 1: exercises for doing UM basically what someone might call what
Speaker 1: I what are my version of a keegel, but they're
Speaker 1: much deeper and more deeply sensed, so not just like squeeze,
Speaker 1: really squeeze realized, like not really thinking about it, but
Speaker 1: really using the breath UM in coordination with the squeezing
Speaker 1: and finding the different parts of the pelvic floor UM.
Speaker 1: And so in conjunction, what I was doing at the
Speaker 1: same time was I did a dula training UM, so
Speaker 1: I started assisting women through childbirth. This is such a
Speaker 1: I feel like one of the many topics that women
Speaker 1: feel like embarrassed, ashamed, UM, uncomfortable to talk about A.
Speaker 1: Is there any advice that you have for women and
Speaker 1: how to talk about this stuff and how tom I'm
Speaker 1: assuming it's all connected like that if you feel shamed,
Speaker 1: you're probably it's going to be a harder road to
Speaker 1: get better, because it's sounding like the holistic approaches that
Speaker 1: it's all super connected. Is there any advice that you
Speaker 1: would give to women who are struggling with incontinents who
Speaker 1: may not even have babies yet, or struggling and haven't
Speaker 1: seek out help. The biggest thing would just fed to
Speaker 1: know that you're not alone and that it's very common.
Speaker 1: And yeah, I mean, if you're having a hard time
Speaker 1: talking about it, I would say, like, find another woman
Speaker 1: friends to share with about first, just so like you know,
Speaker 1: I think that for men because they don't usually I mean,
Speaker 1: some men do have pelvic floor issues. That's definitely not
Speaker 1: un you know, unseen, but I think women experience it
Speaker 1: more more regularly, sure, And so finding a close friend
Speaker 1: that you can talk to about it just to start
Speaker 1: kind of sharing and getting it. You know, sharing helps
Speaker 1: so much, being able to talk and have someone listen.
Speaker 1: Do you find so much mental Like you said, the
Speaker 1: shame part that it can be super connected and that's
Speaker 1: why you have to get them to a meditative state
Speaker 1: is a lot. What you do is sort of therapy
Speaker 1: sometimes I do. It depends on the degree of openness
Speaker 1: that the person has. I do find that people who
Speaker 1: um can share more about what's going on will heal more.
Speaker 1: Quickly because it's like every it is so connected, and
Speaker 1: so if you are kind of putting your physical symptoms
Speaker 1: separate from your emotional experience, um, it's like you're you're
Speaker 1: more disconnected inside of yourself, Like you're kind of creating
Speaker 1: a disjointedness and so not that you have to be like,
Speaker 1: oh my god, I'm having these issues because I had
Speaker 1: this feeling. You know, you don't have to like over
Speaker 1: dramatize it, but UM, I find that if people are
Speaker 1: more comfortable just like, oh, yeah, this is being honest
Speaker 1: with themselves, like this was my experience, or this is
Speaker 1: how I'm feeling, or I'm feeling horrible about this, or
Speaker 1: I feel really regretful that this happened, or you know
Speaker 1: that that you're going to have an easier time healing
Speaker 1: because you're not bottling everything up inside. Yeah, what are
Speaker 1: the exercises that you recommend people doing? So I always
Speaker 1: work with the first thing I always work with people
Speaker 1: on is breathing into their belly and learning how to
Speaker 1: do uh what I call belly breathing or diaforgmatic breathing. UM.
Speaker 1: So people breathe up into their chests and do very
Speaker 1: shallow breathing. So I first teach people how to breathe
Speaker 1: into their bellies and then use their abdominal muscles to exhale,
Speaker 1: to like press their breath out. So you're both using
Speaker 1: the abdominal muscles. You're also strengthening the diaphragm um with
Speaker 1: just a muscle that's the primary muscle for your breathing
Speaker 1: sits right underneath your rib cage. Um. You start there,
Speaker 1: start there, and that exercise because you're using your abdominals
Speaker 1: to exhale and really working up towards strongly using your
Speaker 1: abdominals to exhale um, those muscles get strong. The abdominals
Speaker 1: get strong without doing sit ups, So when you have diathesis,
Speaker 1: you don't want to do sit ups or any kind
Speaker 1: of crunches. It makes the separation worse. UM. So by
Speaker 1: using the valley to breathe, you're you're strengthening the abdominal wall,
Speaker 1: the transverse abdominous muscles um, which helps bring the rectus
Speaker 1: abdominus closer or the six pack muscles closer together to
Speaker 1: heal the game. By doing that breathing, you're you know
Speaker 1: a lot of times right after labor, even if someone's
Speaker 1: had a baby years before um. A lot of times
Speaker 1: people can't feel their breath, like kind of pass their ribs.
Speaker 1: So I start by helping people get their breath lower
Speaker 1: and lower and lower until they can start to feel
Speaker 1: their breath and they're actually in their pelvis or in
Speaker 1: the pelvic floor. Whoa. And then once you can feel
Speaker 1: that kind of expansion, so I think again of the jellyfish,
Speaker 1: the expansion of the breath and the pelvic floor. Then
Speaker 1: from there, it's like when you exhale without even contracting,
Speaker 1: like you could try it right now, when you exhale,
Speaker 1: you generally feel kind of like everything sinks or comes
Speaker 1: closer together. Ye. Yeah, and that's the beginning of a contraction.
Speaker 1: So contract actually means to squeeze, right, you do gentle
Speaker 1: like breathing, opening up your pelvic floor, and then as
Speaker 1: you exhale, you let all the breath go, including down there,
Speaker 1: so then it comes and starts to come back together.
Speaker 1: And then once you can start to feel the everything
Speaker 1: kind of coming closer, oh, that's the beginning of the contraction.
Speaker 1: So then from there begin to squeeze, and you want
Speaker 1: to hold that squeeze through your whole exhale, and that's
Speaker 1: doing it right now, guys doing it right now. So
Speaker 1: learning to um doing these kinds of exercise, and you know,
Speaker 1: and that's kind of the basic. Then I'll work with
Speaker 1: different areas of pelvis, so more in the back muscles
Speaker 1: of the pelvic floor, the vaginal muscles, and then up
Speaker 1: in the front by the pubic bone or around like
Speaker 1: the clutters, because they're all different, and yet here we
Speaker 1: are like I can't feel the difference, really, you know
Speaker 1: what I mean? For me, I'm I'm definitely one of
Speaker 1: those cases of a person who's like, oh, it's just squeeze, release, squeeze,
Speaker 1: you know, like it's not like varying areas of stuff
Speaker 1: down there. You know. I just got my first period
Speaker 1: back after having a baby, which because I've been breastfeeding,
Speaker 1: your body goes into a menopausal state and you don't
Speaker 1: get your period for a long time. So I'll be's
Speaker 1: almost eight months and I just got my first period.
Speaker 1: So it was my first time I ever like using
Speaker 1: a tampon um, which I was so scared to do
Speaker 1: because my group of mom girls, um my swim club,
Speaker 1: they all are there, my group of mommies, and they
Speaker 1: were all saying, oh God, wait till you get your
Speaker 1: first period, it is not fun. And they allowed them
Speaker 1: had already gotten it, so I was like ready and
Speaker 1: I got it. And I have to say the tampon
Speaker 1: was fine, but I do think something might be happening
Speaker 1: in the pelvic floor because I was walking around with
Speaker 1: it and it was like kind of falling out and
Speaker 1: I've never had that happen before. Is that a thing?
Speaker 1: I mean, yeah, great, Like I remember walking like halfway
Speaker 1: down the street and being like, oh my god, I
Speaker 1: think my tampon is like halfway out, and I know,
Speaker 1: like I put it in really well. But so is
Speaker 1: that a case of like your pelvic floor muscles are
Speaker 1: not able to hold up because of the trauma, stretched out,
Speaker 1: not necessarily from the trauma, but they're some more stretched
Speaker 1: out and they're not like holding squeezing it. Except when
Speaker 1: I have sex with my husband he says it feels
Speaker 1: the same. I'm just going on records saying, well, that's great,
Speaker 1: And I asked the vagina is a mystery, you guys,
Speaker 1: It is really insane, Like I don't so, but what
Speaker 1: you could try is, have you ever heard of the
Speaker 1: Diva cup? Explain this to me. So it's a little
Speaker 1: like silicon cup that you put up there period, right,
Speaker 1: So it's like round, like you know, maybe like an
Speaker 1: inch diameter, and you fold it in half and hold
Speaker 1: it again and then you vagina and you make sure
Speaker 1: there's like a section so that it's you know, um.
Speaker 1: And they have different sizes, so they have a size
Speaker 1: for um before you've had a baby and then for
Speaker 1: after you've had a baby. And the one that for
Speaker 1: after you had a baby is bigger because the vagina
Speaker 1: is bigger. I don't know, maybe maybe, And and you know,
Speaker 1: it is a vaginal canal, so there's different parts of it.
Speaker 1: There's the opening, there's the middle, there's the backup by
Speaker 1: your cervix. Maybe Adams just trying to be so well no,
Speaker 1: I mean it could be it could be more. It
Speaker 1: could be more open or tight in different parts of
Speaker 1: the vagina. And maybe that's what he's feeling, and that
Speaker 1: maybe like more the opening of your vagina. Everyone's loving
Speaker 1: this diva cup. Yeah, so you put it up there
Speaker 1: and it holds your period. And then do people who
Speaker 1: come to see you are some of them in pain
Speaker 1: when they have to insert tampons? Is that? Oh my god?
Speaker 1: Being a girl is so insane. I mean, I'm sorry
Speaker 1: for the few men that you also see that have problems,
Speaker 1: but it sounds like it's mostly women, and it's just yeah,
Speaker 1: it's like it is insane. Yes, Like I can't tell
Speaker 1: you how many times it happens to me now where
Speaker 1: I if I feel a sneeze coming on and I
Speaker 1: haven't emptied my bladder in like a little bit of
Speaker 1: you know, like I p every one or two hours whatever,
Speaker 1: But like if I if it's you know, been three
Speaker 1: or four hours, I'm gone to bathman I sneeze, Like,
Speaker 1: I definitely p a little bit and I definitely have
Speaker 1: to go change my underwear. Like what a bummer. And
Speaker 1: I'm not even and I think I want to have
Speaker 1: another kid maybe, so like what, oh, that's a good question.
Speaker 1: Is it worth getting it back before you're thinking about
Speaker 1: having another baby or is it just like blow the
Speaker 1: whole thing out and come see you later. It's kind
Speaker 1: of you know, it's kind of like for the women
Speaker 1: who are more physically fit, they're going to have an
Speaker 1: easier time afterwards. So it's the same thing you want
Speaker 1: to work to get it. I mean, unless you're having kids,
Speaker 1: like right off the after the other, it's better if
Speaker 1: you work on strengthening before you have another baby. Um.
Speaker 1: Generally it's more difficult after a second baby. It's just
Speaker 1: you know, more stretching more. So it's better if you
Speaker 1: can do some work on it before having a second baby.
Speaker 1: So fascinating. Are there other things that you recommend besides
Speaker 1: the Yoni egg that like? Um, I tell people to
Speaker 1: practice so with the you know, we'll work with the
Speaker 1: different areas of the pelvic floor, but when we're working
Speaker 1: with the vaginal canal, I work with feeling being able
Speaker 1: to squeeze in the different parts of the vaginal canal,
Speaker 1: which for most people is really really difficult to feel. Um,
Speaker 1: the opening okay, by your cervix, you know, it's it's challenging.
Speaker 1: And so what I tell people to do is to
Speaker 1: get some kind of a dildo or like a wand
Speaker 1: they have really nice you know, like you get like
Speaker 1: a crystal want you know, so to you is that
Speaker 1: just insert it and then squeeze against that to be
Speaker 1: able to feel the different like, okay, now I'm squeezing
Speaker 1: this wand towards the top. Now I'm squeezing it towards
Speaker 1: the bottom, and is there even a middle? Good Lord,
Speaker 1: I mean exactly, and people can do that, yes, yeah,
Speaker 1: I mean that's how I started learning all this stuff
Speaker 1: because that was what that was one of my that
Speaker 1: was one of my country yoga exercises. So um yeah.
Speaker 1: And the reason being it's like, you know, you can
Speaker 1: do air push ups right, or you can do like
Speaker 1: a push up against the wall or the floor, and
Speaker 1: you're going to feel your muscles a lot more when
Speaker 1: you have that resistance suppress against the same thing inside
Speaker 1: of your vagina, which is even even if you're not
Speaker 1: working on trying to find the different locations, even just
Speaker 1: to field the squeeze, that's going to help. And you're like, oh,
Speaker 1: I can feel my vagina squeezing because I can feel
Speaker 1: it pushing against something. Yeah, so that helps build your
Speaker 1: muscles strong, like you're going to have a little bit
Speaker 1: quicker of a of access rate with that. So that's
Speaker 1: one of the things I tell people to do. There's
Speaker 1: also um the LVY. It looks kind of like a
Speaker 1: unique I mean, it's not like a stone, but it's
Speaker 1: around thing that you put inside and it has an
Speaker 1: app where you can test, like it'll test like your
Speaker 1: strength level. Is there any other things you want to
Speaker 1: touch upon or yeah, I mean, I would say, just
Speaker 1: started talking about it with your friends, like, just get
Speaker 1: the conversation going. And because we are not alone. You're
Speaker 1: not alone and you know it, and and there was
Speaker 1: a lot of women don't even know yet that there's
Speaker 1: people that they can see and exercises that they can do.
Speaker 1: And if your girlfriend hasn't experiences, she's not, I'm sure
Speaker 1: she'd be interested or probably knows other people. So I
Speaker 1: would just encourage everyone to start talking about it and sharing.
Speaker 1: And the more you talk, the more you know, the
Speaker 1: more that collectively people can get help and heal and
Speaker 1: not have to live their lives paying in their pants. Yeah,
Speaker 1: having pains and enjoying sex more, enjoying sax feeling actually
Speaker 1: you know, just helps with connectivity to yourself feeling more.
Speaker 1: You know, you put so much energy into your baby,
Speaker 1: it's like it's a it's huge self care and giving
Speaker 1: your own body attention that your body really craves and needs.
Speaker 1: So amazing. Thank you so much, thank you. That's all
Speaker 1: we've got for you for this episode. I can't wait
Speaker 1: for you guys to hear what's next. Thanks for listening
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