WEBVTT - Get To Know Your Pelvic Floor 0:00:05.440 --> 0:00:09.520 Hi, everybody, and welcome back to Katie's crib. In this episode, 0:00:09.520 --> 0:00:12.400 you guys, we are going to talk about the pelvic floor. 0:00:12.560 --> 0:00:15.280 What is even happening down there? I sure as hell 0:00:15.360 --> 0:00:18.560 don't know. We spend so much time worrying about the baby, 0:00:18.720 --> 0:00:21.680 but what about us? What about the moms? So we 0:00:21.720 --> 0:00:23.560 have two guests today who are going to help break 0:00:23.560 --> 0:00:25.640 down what every new mom needs to know about the 0:00:25.640 --> 0:00:28.760 pelvic floor post birth. First, we're gonna be talking to 0:00:28.800 --> 0:00:31.680 Stephanie Prendergast. She is a physical therapist and the co 0:00:31.800 --> 0:00:35.520 founder of the Pelvic Health and Rehabilitation Center. And then 0:00:35.920 --> 0:00:38.280 I'm gonna be talking to Pria Campbell Sarrago. She is 0:00:38.320 --> 0:00:41.120 a birth doula and a pelvic floor specialist who takes 0:00:41.159 --> 0:00:44.320 more of a holistic and embodied approach to pelvic floor rehab. 0:00:44.520 --> 0:00:50.159 So let's get started, you guys. We are on the 0:00:50.200 --> 0:00:53.840 topic of the pelvic floor, which I have slowly begin 0:00:53.920 --> 0:00:55.920 to realize that the reason I was most excited about 0:00:55.960 --> 0:00:58.400 recording this episode about this topic is that it's just 0:00:58.600 --> 0:01:01.040 secretly my way of talking talking about my own pelvic 0:01:01.080 --> 0:01:03.480 floor what's going on? Because maybe I've been a little 0:01:03.520 --> 0:01:08.199 bit scared to make an appointment and see what's going on. Stephanie, 0:01:08.280 --> 0:01:12.040 I am so happy you're here. You are, I mean, 0:01:12.160 --> 0:01:15.000 you are one of the tops of this situation and 0:01:15.040 --> 0:01:17.600 I am so excited to meet you and talk about 0:01:17.920 --> 0:01:20.480 my pelvic floor. But also I'm sure this will be 0:01:20.480 --> 0:01:23.559 super helpful to our listeners. So welcome, Stephanie prendor Gast. 0:01:24.200 --> 0:01:28.920 Did I say your last name correctly? You did? And think, Oh, 0:01:28.959 --> 0:01:31.480 we're so happy to be here. Um, tell us a 0:01:31.560 --> 0:01:34.800 little bit about yourself. So I my background is I'm 0:01:34.800 --> 0:01:37.480 a physical therapist, but for since two thousand and one, 0:01:37.520 --> 0:01:41.160 I've been specializing in publvic floor disorders and so in 0:01:41.319 --> 0:01:44.200 relevance to this podcast, we deal with a lot of 0:01:44.200 --> 0:01:47.400 women during pregnancy to try to optimize their public floor 0:01:47.440 --> 0:01:50.320 for delivery, make them more comfortable, as well as help 0:01:50.960 --> 0:01:55.360 you see women during pregnancy and before too. We do. 0:01:56.000 --> 0:01:58.320 We do, and in recent years people are coming in 0:01:58.560 --> 0:02:01.120 more to get a better or control of their public 0:02:01.120 --> 0:02:04.560 floor muscles before birth. But historically it used to be 0:02:04.600 --> 0:02:06.840 that women would come in with complaints if they had 0:02:06.840 --> 0:02:10.040 pelvic girdle pain or incontinence or some sort of pain 0:02:10.160 --> 0:02:13.040 issue may have led them to PETE before. But now 0:02:13.040 --> 0:02:15.639 that women are becoming more informed. We also can help 0:02:15.680 --> 0:02:18.919 women prepare themselves, have the confidence they need to go 0:02:19.040 --> 0:02:21.440 into labor and delivery knowing their body is as ready 0:02:21.440 --> 0:02:24.440 for it as it can be. Oh my, I mean literally, 0:02:24.440 --> 0:02:26.400 why did I not go to you before having a baby. 0:02:26.480 --> 0:02:28.840 This is insane because I mean, before I had a baby, 0:02:28.880 --> 0:02:31.400 I was the person who would like sneeze and if 0:02:31.400 --> 0:02:33.320 it caught me off, guarden, I had a super full bladder, 0:02:33.360 --> 0:02:35.520 like a liate little bit of Mike about And I 0:02:35.560 --> 0:02:39.000 know a lot of friends that are in the same boat. Um, 0:02:39.040 --> 0:02:41.079 and we don't really talk about it much. Um. So 0:02:41.560 --> 0:02:46.239 can you tell us about the Pelvic Health and Rehabilitation Center. Yes. So, 0:02:46.400 --> 0:02:48.640 we have been a company since two thousand and six. 0:02:48.880 --> 0:02:52.240 We have four offices in the Bay Area. I practice 0:02:52.240 --> 0:02:54.840 in our Los Angeles location, and we also have two 0:02:54.840 --> 0:02:58.200 offices on the East Coast in New England. We specialize 0:02:58.200 --> 0:03:02.200 in men, women and children, try and gender, all sexes, 0:03:02.240 --> 0:03:05.600 all ages. These problems can start affecting people in their 0:03:05.600 --> 0:03:09.680 teenage years or in the pediatric years with bedwetting and constipation, 0:03:10.200 --> 0:03:13.160 and continue all the way through menopause. So we're happy 0:03:13.200 --> 0:03:16.560 to specialize in solely these disorders and treat everybody across 0:03:16.560 --> 0:03:21.440 the lifespan. WHOA, Okay, tell us a little bit about 0:03:21.440 --> 0:03:24.160 what the pelvic floor muscles do, Like, let's let's talk 0:03:24.160 --> 0:03:26.280 about the pelic floor muscles, like what they do normally, 0:03:26.360 --> 0:03:30.760 and then what do they do during pregnancy and maybe labor? Great, 0:03:31.000 --> 0:03:33.519 so they most people don't even know they have the 0:03:33.560 --> 0:03:36.560 pelvic floor. The muscles run from your pubic bone to 0:03:36.600 --> 0:03:39.640 your tailbone, and they're responsible for kind of a lot 0:03:39.680 --> 0:03:43.040 of big deals. They help us maintain continents, urinary and 0:03:43.120 --> 0:03:46.600 bell as well as the let us evacuate urine stool. 0:03:46.880 --> 0:03:51.120 They're responsible for sexual function, for orgasm and for keeping 0:03:51.240 --> 0:03:55.440 our orgasms are orgasms keeping our organs supported, so they 0:03:55.480 --> 0:04:01.720 also spans supported to Okay, like why it's like, why 0:04:01.720 --> 0:04:03.440 am I in the gym working so hard on my 0:04:03.480 --> 0:04:06.480 biceps and I'm not in this gym like working so 0:04:06.520 --> 0:04:08.640 hard on these pelviic floor muscles that do all the 0:04:08.640 --> 0:04:11.960 things you just described. That's a great question. Most women, 0:04:12.080 --> 0:04:16.200 until you've had a baby, don't necessarily need to strengthen 0:04:16.279 --> 0:04:20.039 their public floor muscles because they are always under some 0:04:20.200 --> 0:04:22.919 sort of tone. It's one of the only muscles in 0:04:22.920 --> 0:04:25.880 the body innervated by a nerve that has autonomic function, 0:04:26.360 --> 0:04:28.279 meaning you don't have to think about it most of 0:04:28.279 --> 0:04:30.640 the time. You're not going to leak if you sneeze 0:04:30.640 --> 0:04:32.880 because you have reef. It's just holding it and it's 0:04:32.920 --> 0:04:35.680 holding in your organ like it just does it. So 0:04:35.800 --> 0:04:38.400 it is big myths in Cosmo and these other magazines 0:04:38.400 --> 0:04:41.560 that suggest younger women should be doing kegles to improve 0:04:41.560 --> 0:04:45.839 their orgasm. That it's simply not true. What right you guys, 0:04:45.960 --> 0:04:50.560 I'm running out the door. I'm wait a second. Wait. 0:04:50.880 --> 0:04:54.760 That is not true. Regular activity often strengthens our public 0:04:54.800 --> 0:04:57.560 floor muscles. From day to day activities. There's always some 0:04:57.640 --> 0:05:00.080 tone and in younger women and women who have not 0:05:00.240 --> 0:05:02.960 given birth, most of the time they do not need 0:05:03.000 --> 0:05:06.080 to strengthen their pelvic floors. When you do have a 0:05:06.120 --> 0:05:09.279 baby and you basically run a marathon with your pelvis 0:05:09.320 --> 0:05:12.279 all those hours that you're in labor pushing the baby 0:05:12.279 --> 0:05:15.760 through the pelvic floor, now the muscles are lengthened, their weakened. 0:05:15.839 --> 0:05:20.600 There may actually be neuropathy then. Sorry, when you when 0:05:20.600 --> 0:05:22.720 you're trying to push the baby through the second stage 0:05:22.720 --> 0:05:25.159 of labor, there's a lot of tension both on the 0:05:25.160 --> 0:05:28.840 pelvic floor muscles and also the pudendal nerve that innervates them, 0:05:28.880 --> 0:05:32.599 and in certain cases there can be transient issues with 0:05:32.680 --> 0:05:35.440 the pudendal nerves. Sometimes it can be more serious than that, 0:05:35.960 --> 0:05:38.520 depending on what has happened during the birth. But if 0:05:38.560 --> 0:05:41.000 you think about it, of course you need rehabilitation after 0:05:41.080 --> 0:05:43.760 going through everything that. It's like you would do physical 0:05:43.800 --> 0:05:47.239 therapy if you got your angle. You're doing physical therapy 0:05:47.320 --> 0:05:49.760 if you have any sort And this is even bigger, 0:05:49.839 --> 0:05:52.320 and yet we're supposed to just like carry on folks. 0:05:52.680 --> 0:05:56.680 No wow, um, so I think you started to hit 0:05:56.680 --> 0:05:58.520 on this a little bit. But so having a baby, 0:05:59.520 --> 0:06:04.000 I guess in my terms Katie's terms, pelvic floor just 0:06:04.000 --> 0:06:09.960 gets blown out. But even if you don't give birth vaginally, 0:06:10.160 --> 0:06:13.200 like because what I'm learning is that the pelvic floor 0:06:13.279 --> 0:06:16.640 has held up additional weight for ten months, which makes 0:06:16.640 --> 0:06:19.880 it also exhausted. This is true, so regardless of the 0:06:19.960 --> 0:06:22.719 method of delivery, the pelvic floor is involved in a 0:06:22.800 --> 0:06:26.680 number of changes that happened during pregnancy period. But it's 0:06:26.720 --> 0:06:30.279 so surprisingly resilient it just often needs a little bit 0:06:30.600 --> 0:06:33.600 or I should say, women would function better with more 0:06:33.680 --> 0:06:36.880 appropriate rehab after to just help get things more normalized 0:06:36.920 --> 0:06:39.919 after the changes that happen. Is this, like does insurance 0:06:39.960 --> 0:06:42.279 cover this? Like? It does? It is just in the 0:06:42.360 --> 0:06:45.680 last month that the American College of Obstetrics and Gynecology 0:06:45.839 --> 0:06:49.920 is acknowledging that maternal postparm care in the United States 0:06:50.040 --> 0:06:54.880 is last in line of all industrialized countries. We were 0:06:54.920 --> 0:06:59.039 given one six week postpartum checkups it to check for 0:06:59.120 --> 0:07:01.920 postparm depress and make sure you don't have an infection, 0:07:02.080 --> 0:07:05.200 make sure your uterus is returned to normal, and that's it, 0:07:05.400 --> 0:07:08.880 see you later. So finally they're acknowledging the fourth trimester 0:07:09.000 --> 0:07:12.000 needs to be more comprehensive than that. Women need more 0:07:12.120 --> 0:07:15.640 visits and we've been given and that are covered by insurance, 0:07:16.280 --> 0:07:19.239 Like we need more visits for physical health obviously, mental 0:07:19.320 --> 0:07:26.640 chickens for postpartum um wowze. That most physicians, unfortunately have 0:07:26.680 --> 0:07:30.080 been paid one lump sum for pregnancy and delivery and 0:07:30.120 --> 0:07:34.400 that includes one postpartum visit and has not included any 0:07:34.440 --> 0:07:36.960 additional visits that a mother may need if it had 0:07:37.040 --> 0:07:40.960 anything to do with her birth. So that's an interesting 0:07:41.000 --> 0:07:44.440 thing that I just it's like I've just got punched 0:07:44.480 --> 0:07:46.559 in the gut and it makes perfect sense because you guys, 0:07:46.560 --> 0:07:48.640 like you know, when you right before you have the baby, 0:07:48.680 --> 0:07:50.960 you're in your obie's office all the time getting these 0:07:50.960 --> 0:07:53.720 stress tests, they're monitoring the heart, they're monitoring your health 0:07:53.720 --> 0:07:55.520 all stuff. And then as soon as the baby's out, 0:07:55.600 --> 0:07:59.320 it's like it's like the biggest breakups ever. And it's 0:07:59.360 --> 0:08:01.600 in no way she formed like my obie's faults. She's 0:08:01.680 --> 0:08:03.400 just like great things so much like I'll see you 0:08:03.440 --> 0:08:06.160 in six weeks and you're like, wait, well, we'll wait, wait, 0:08:06.200 --> 0:08:09.560 wait what I'm sitting on a doughnut and I'm in 0:08:09.600 --> 0:08:12.520 a diaper, Like, hold up a second, I'm super confused, 0:08:13.320 --> 0:08:16.000 And most women feel that way. And the recent survey, 0:08:16.240 --> 0:08:19.559 the majority of women feel like their concerns that their 0:08:19.600 --> 0:08:22.560 care was not adequately addressed during that six week visit, 0:08:22.640 --> 0:08:24.920 and most people felt like they were kind of floundering, 0:08:25.480 --> 0:08:29.600 I mean rightfully so. In other countries, and as early 0:08:29.600 --> 0:08:33.599 as five women were required in countries like France to 0:08:33.679 --> 0:08:38.400 have ten postpartum pelic floor physical therapy visits required. And 0:08:38.640 --> 0:08:42.600 this is because insurance companies have been in the way 0:08:42.880 --> 0:08:46.640 and dictating coverage. In the United States, That's exactly why. 0:08:46.720 --> 0:08:51.520 Because other countries understand the impact that the birth and 0:08:51.559 --> 0:08:54.640 then the support that mothers need is greater than what 0:08:54.720 --> 0:08:56.760 we've been given so far. So hopefully we're on the 0:08:56.760 --> 0:09:00.120 cusp of change. So you think maybe this this you 0:09:00.800 --> 0:09:03.880 we admit that there's something called forth trimester could maybe 0:09:04.040 --> 0:09:07.839 lead us on a path towards maybe better care. It's 0:09:07.840 --> 0:09:10.160 supposed to set the guidelines for all O, B G 0:09:10.320 --> 0:09:12.439 l N s and the standard of kare in America. Now, 0:09:12.480 --> 0:09:14.840 whether insurance companies decide that they're going to pay for 0:09:14.920 --> 0:09:16.880 or not, it is going to be interesting because it's 0:09:16.960 --> 0:09:21.160 being strongly suggested that they do great. Um. So when 0:09:21.160 --> 0:09:24.520 do women typically come to see you? Is it? Are 0:09:24.559 --> 0:09:28.679 most of your clients patients postpartum? Are they in the majority? 0:09:28.679 --> 0:09:31.080 I would assume well, in our practice, we actually see 0:09:31.400 --> 0:09:34.200 a wide range of things. What's interesting about this is 0:09:34.200 --> 0:09:37.559 because public floor physical therapy historically has not been included 0:09:37.600 --> 0:09:40.559 in the standard of postpartum care. Many women find us 0:09:40.600 --> 0:09:43.960 on their own when something's wrong. They have stress and continents, 0:09:43.960 --> 0:09:47.120 they have severe vaginal pain, they have rectal pain, urinary 0:09:47.240 --> 0:09:50.600 urgency frequency, they can evacuate their stools, they can't orgasm, 0:09:50.840 --> 0:09:53.560 and they're furious why didn't my doctor tell me? Is 0:09:53.600 --> 0:09:57.040 what happens now in more recent years, with the presence 0:09:57.040 --> 0:09:59.400 of social media and things like that, many women are 0:09:59.480 --> 0:10:02.800 finding out that they should be going to public floor 0:10:02.880 --> 0:10:05.840 pt even if they're not noticing immediately to bother some 0:10:05.880 --> 0:10:10.680 symptoms that I mentioned. I'm definitely going like next week, 0:10:10.760 --> 0:10:16.600 what's available because obviously think about what what pregnancy and 0:10:16.720 --> 0:10:19.040 birth entials. This is a no brainer. But it just 0:10:19.080 --> 0:10:22.080 hasn't been standard of care until now. No, it's really 0:10:22.080 --> 0:10:23.600 never made so much sense to me. Like you say, 0:10:23.640 --> 0:10:25.400 if you ever had a sprained ankle, you would go 0:10:25.440 --> 0:10:27.040 to the doctor and go to all the visits you'd 0:10:27.080 --> 0:10:30.080 need until you know your dislocated shoulder was back or 0:10:30.080 --> 0:10:33.360 whatever it was needed. And how um so, can you 0:10:33.360 --> 0:10:35.040 take us through a little bit what what happens in 0:10:35.080 --> 0:10:37.280 the first appointment with you? Yes, and I hope you 0:10:37.280 --> 0:10:40.080 will't be nervous when you come to see me, making 0:10:40.120 --> 0:10:43.880 me go way better. So we take a history. We 0:10:43.920 --> 0:10:46.520 also want to hear what your urinary vale sexual function 0:10:46.600 --> 0:10:49.040 was like before pregnancy, because there can also be factors 0:10:49.040 --> 0:10:51.280 that may have influenced your delivery and things that are 0:10:51.320 --> 0:10:55.319 influencing your rehab. Now, um we do a manual examination 0:10:55.559 --> 0:10:58.640 that includes looking at the abdominal area for what's called 0:10:58.640 --> 0:11:01.360 a diastesis wrecked i A. Many women associate that with 0:11:01.480 --> 0:11:05.319 mommy tummy, which is when the muscles separate naturally due 0:11:05.360 --> 0:11:07.920 to the advancing pregnancy. Sometimes they reduce on their own, 0:11:07.960 --> 0:11:11.640 sometimes they don't. It's important because not only for esthetic reasons, 0:11:11.640 --> 0:11:14.640 but it will impair woman's ability to have optimal pelvic 0:11:14.679 --> 0:11:17.680 floor muscle function if her abdominal wall is not intact. 0:11:17.920 --> 0:11:20.800 These muscles work together. How do you know the percentage 0:11:20.800 --> 0:11:23.920 of women that that happens to. So there's a wide 0:11:24.000 --> 0:11:28.479 range in the literature from thirty to Sometimes it reduces, 0:11:28.520 --> 0:11:31.720 sometimes it doesn't, And how people measure it has kind 0:11:31.760 --> 0:11:34.520 of been varied, and so the study show it's kind 0:11:34.520 --> 0:11:38.280 of a wide range. And again some people it closes naturally, 0:11:38.280 --> 0:11:41.000 some people it doesn't. If it doesn't, it can be 0:11:41.080 --> 0:11:44.280 associated with stress and continents pro lapse and back pain 0:11:44.400 --> 0:11:47.120 later in life. So it is important to address it 0:11:47.200 --> 0:11:50.560 even if you don't realize it's there. We also will 0:11:50.640 --> 0:11:54.360 examine the other muscles of the pelvic girdle. Typically the 0:11:54.480 --> 0:11:57.000 muscles of your hip widened to allow the baby to 0:11:57.040 --> 0:11:59.840 come out there maybe what do you mean examine, So 0:12:00.040 --> 0:12:03.520 we will manually examine them to see their length, their strength, 0:12:03.520 --> 0:12:06.240 if they're tender, and the same thing. Internally. We need 0:12:06.320 --> 0:12:08.200 to know if you could contract your muscles, if you 0:12:08.200 --> 0:12:11.160 can relax them, relax them, if there's pain, if there's 0:12:11.160 --> 0:12:15.360 been an episiotomy, pain at the C section scar, and 0:12:15.440 --> 0:12:18.400 basically making sure the muscles can functionization what do you 0:12:18.440 --> 0:12:20.920 put in there to see So we don't use the speculum. 0:12:20.960 --> 0:12:24.480 We use a single gloved lubricated finger, and we also 0:12:24.600 --> 0:12:27.360 use that as feedback to help the mother figure out 0:12:27.360 --> 0:12:29.520 where her muscles are in space, because it's kind of 0:12:29.559 --> 0:12:32.400 like a big black box too many people, and often 0:12:32.440 --> 0:12:34.280 in the postpartum period it can be what I call 0:12:34.320 --> 0:12:37.880 a hybrid where some muscles are tight and some are overstretched, 0:12:37.920 --> 0:12:40.400 and we've got to really do specific things to help 0:12:40.600 --> 0:12:45.640 get that functioning again as a unit. WHOA. So you're 0:12:45.800 --> 0:12:51.360 literally laying on the table with someone's finger in your vagina, 0:12:51.720 --> 0:12:54.960 a gloved lubricated finger in vagina, and then you go 0:12:55.080 --> 0:12:59.720 through exercises and you try to really help someone feel 0:13:00.559 --> 0:13:04.640 inside themselves like different areas of the vagina and and 0:13:04.760 --> 0:13:08.360 strengthen it like do reps almost like like a workout. 0:13:08.440 --> 0:13:10.760 And it's interesting because the majority of women, just two 0:13:10.800 --> 0:13:16.120 are told to cagel actually do them incorrectly and in 0:13:16.120 --> 0:13:19.480 a way that could make things worse. So, my god, 0:13:19.520 --> 0:13:21.679 you guys am literally losing my mind right now. We 0:13:21.720 --> 0:13:25.040 need to help fix that. What this is? This is 0:13:25.120 --> 0:13:30.240 just completely blowing my mind. Um. So, how is physical 0:13:30.320 --> 0:13:34.920 therapy different from how a doctor might address pelvic floor disorder? 0:13:35.720 --> 0:13:38.840 So it's interesting because most kynecologists will tell you that 0:13:38.880 --> 0:13:42.640 they had very little pelvic floor training in medical school, 0:13:42.800 --> 0:13:45.520 and that is shocking since they have to push right 0:13:45.520 --> 0:13:47.520 through those muscles to get to the cervix and the 0:13:47.520 --> 0:13:50.120 eiterus and all the things that are important. So a 0:13:50.120 --> 0:13:53.480 physical therapist is going to more specifically examine each of 0:13:53.480 --> 0:13:55.960 the muscles and different areas of the pelvic floor, the 0:13:56.000 --> 0:13:59.920 prudental nerve and tissue. So when doctors come into play, 0:14:00.120 --> 0:14:02.880 usually when things are more dire, and will hear pelic 0:14:03.800 --> 0:14:07.960 ladder specialist or prolapsed rectum or wait what did you 0:14:08.000 --> 0:14:11.080 just say? So they're considered surgeons for a pelvic floor 0:14:11.160 --> 0:14:14.120 reconstruction and is that a surgery that you have to 0:14:14.120 --> 0:14:17.480 be put out for? Yes, you have to go under anesthesia. 0:14:17.520 --> 0:14:22.120 If there is significant bladder prolapse, uterine prolapse rectal, it 0:14:22.200 --> 0:14:26.400 may require surgical reconstruction. Usually this is something that happens 0:14:26.480 --> 0:14:29.680 later in life that could be prevented if we put 0:14:29.680 --> 0:14:34.560 the pelvic floor muscles back. I think some of the 0:14:34.720 --> 0:14:37.920 older women in my family though, I've heard yeah, like 0:14:38.040 --> 0:14:41.560 things just falling out and meeting his direct means and 0:14:41.600 --> 0:14:44.600 things like that, and so possibly had they done pelvic 0:14:44.640 --> 0:14:47.200 floor work earlier on, that might not have been the case. 0:14:47.240 --> 0:14:50.680 Because the one risk factor for pelvic organ prolapse later 0:14:50.720 --> 0:14:55.840 in life his childbirth. Who see you, guys, this is 0:14:55.880 --> 0:14:57.640 it's like you're not even here. This is just my 0:14:57.720 --> 0:15:03.360 appointment with Stephanie Prendergast. So, uh, you see all sorts 0:15:03.400 --> 0:15:07.160 of patients and clients. Um, how are issues facing pregnant 0:15:07.200 --> 0:15:09.920 and postpartum women different? Are they the same? Like when 0:15:09.920 --> 0:15:13.720 you see a woman who might be about to get pregnant, 0:15:13.760 --> 0:15:15.400 or woman who is pregnant, or a woman who is 0:15:15.440 --> 0:15:20.160 post pregnancy, um, what how do you treat them differently? 0:15:20.520 --> 0:15:23.560 So if pregnancy, we want to optimize their public floor 0:15:23.640 --> 0:15:26.120 muscle function, give them the confidence that they're ready to 0:15:26.160 --> 0:15:28.600 go into labor. And delivery and just help support the 0:15:28.600 --> 0:15:32.800 birth that they want, prepare them with things that maybe 0:15:32.840 --> 0:15:35.560 feel different after so when it does happen, it's not alarming. 0:15:35.800 --> 0:15:38.880 And basically provide education to the pregnant woman when they 0:15:38.880 --> 0:15:41.600 can get in and that can vary from six weeks 0:15:41.640 --> 0:15:47.320 to five years postpartum about doing public floor physical therapy afterwards. Again, 0:15:47.360 --> 0:15:49.960 if there's more acute issues that happen during delivery, like 0:15:50.000 --> 0:15:52.440 women are in retention or they can't pee on their 0:15:52.480 --> 0:15:57.080 own um significant medical things, and we can help sooner 0:15:57.200 --> 0:16:00.600 rather than later in the postpartum period, but ideally after 0:16:00.640 --> 0:16:03.080 the six week check up with the o B which 0:16:03.120 --> 0:16:06.600 is now three weeks um. Women once cleared, can start 0:16:06.680 --> 0:16:10.320 physical therapy that soon. My observation is they're overwhelmed with 0:16:10.320 --> 0:16:13.160 the baby, especially first time moms. Just know we're there 0:16:13.200 --> 0:16:15.840 when they're ready. Um. I think it's hard when they 0:16:15.880 --> 0:16:17.800 need weekly appointments and we're telling them more to do 0:16:17.840 --> 0:16:20.280 when obviously they have to care for another human. Yeah, 0:16:20.400 --> 0:16:22.880 and their weekly appointments are their first you know, they're 0:16:22.920 --> 0:16:25.640 with their pediatrician and it's all about the baby. And 0:16:26.160 --> 0:16:30.160 chaotic one are the different types of pelvic pain and 0:16:30.240 --> 0:16:33.440 disorders that you treat. I think you've listed all of them, 0:16:33.440 --> 0:16:36.800 but in case we missed any real fun sounding ones. 0:16:37.080 --> 0:16:40.920 So pregnancy related. I mean, it's astounding because at eighteen months, 0:16:40.920 --> 0:16:43.920 in a very large study, there was still sixty of 0:16:43.960 --> 0:16:48.320 women who had painful intercourse, regardless of their method of delivery. 0:16:48.360 --> 0:16:52.720 So that's that's telling of what happens with post baby 0:16:53.160 --> 0:16:56.680 women were still in pain having sex. That's just a nightmare, 0:16:56.720 --> 0:16:58.360 and we have to help all those women. That's not okay. 0:16:58.360 --> 0:17:01.040 I'm not down with that high percentage. And so even 0:17:01.120 --> 0:17:04.359 if there's non obstetric related disorders, we do treat a 0:17:04.359 --> 0:17:08.080 lot of painful intercourse. People can have provoked or unprovoked 0:17:08.160 --> 0:17:14.480 vaginal pain, clural issues, interlabial itching, rectal problems, urinary urgency. 0:17:14.520 --> 0:17:17.280 Frequency feels like it's an infection, when in fact it's 0:17:17.280 --> 0:17:18.520 the muscle. So you feel like you have a U 0:17:18.600 --> 0:17:21.560 T I or something and you don't something else going on, 0:17:22.280 --> 0:17:27.600 often the cold floor, WHOA, what's the labia one? So 0:17:27.720 --> 0:17:30.680 interlabial itching is a common symptom that women can get 0:17:31.000 --> 0:17:34.119 or what's called unprovoked or provoked full of adinia, so 0:17:34.160 --> 0:17:38.560 women can have pain in that area. Also unrelated to childbirth, 0:17:38.560 --> 0:17:41.840 but childbirth can also provoke some of these changes that 0:17:42.000 --> 0:17:45.760 do need treatment. How do you how does some of 0:17:45.800 --> 0:17:49.520 the prolapse bladder or uterus or rectum, like can it 0:17:49.600 --> 0:17:52.159 be fixed through physical therapy or does everyone end up 0:17:52.160 --> 0:17:55.640 having to have surgery? Or do you recommend if someone 0:17:56.080 --> 0:17:58.159 might have had a prolapse after baby one but they 0:17:58.200 --> 0:18:00.080 plan on having another baby, like what do you do? 0:18:00.520 --> 0:18:03.920 Good questions? So it can vary, And there's multiple factors 0:18:03.960 --> 0:18:09.240 that affect prolapse, including genetics, weight, other metabolic things, diabetes 0:18:09.280 --> 0:18:11.280 and whatnot. But the pelvic floor is a big one 0:18:11.280 --> 0:18:13.800 and that's the one we can control. And so if 0:18:13.840 --> 0:18:17.880 somebody has impaired public floor muscle function and core function together, 0:18:17.960 --> 0:18:21.240 it's not just about the public floor um, they will 0:18:21.280 --> 0:18:24.600 be more likely to develop pro lapse as time goes 0:18:24.640 --> 0:18:27.440 on because the muscles provide some support to those organs, 0:18:27.480 --> 0:18:29.800 But so do the ligaments. And again we can't control 0:18:29.840 --> 0:18:32.879 the ligaments. That's our genetic composition, but we can improve 0:18:32.880 --> 0:18:34.959 our public floor muscle function to kind of take up 0:18:34.960 --> 0:18:38.720 the slack of gravity of natural age related changes, etcetera. 0:18:39.119 --> 0:18:42.879 If a woman does have pro lapse immediately postpartum, it 0:18:43.000 --> 0:18:45.720 is not advised to have surgery until they are done 0:18:45.720 --> 0:18:49.000 having children, and so depending on the severity of it, 0:18:49.080 --> 0:18:52.400 like they skip. They score prolapse one to three, four 0:18:52.440 --> 0:18:56.439 and the most oversimplified version of this um categories one 0:18:56.480 --> 0:18:59.680 and two. It can be helped with physical therapy Categories 0:18:59.680 --> 0:19:01.840 three and for mean that organs are coming towards the 0:19:01.840 --> 0:19:04.320 opening of the vagina or out of the vagina itself, 0:19:04.640 --> 0:19:07.760 and those are almost always a surgical situation, but can 0:19:07.760 --> 0:19:12.119 still benefit from getting as rehabbed as possible before and 0:19:12.200 --> 0:19:14.840 also addressing your function after, just like with any other 0:19:14.880 --> 0:19:16.719 surgery and any other part of the body, you want 0:19:16.760 --> 0:19:19.080 to go into that as prepared as possible. I have 0:19:19.160 --> 0:19:21.520 a friend who had a prolapse, who has a prolapse 0:19:21.560 --> 0:19:25.520 bladder and and wants to have another baby, and she's 0:19:25.640 --> 0:19:28.119 been she did a lot of physical therapy, but was 0:19:28.160 --> 0:19:31.800 also putting around with like maybe a diaphragm or putting 0:19:31.840 --> 0:19:35.200 something up there that could hold her stuff in until 0:19:35.440 --> 0:19:38.200 I mean, is that a thing. It's called a pessary. Yes, 0:19:38.320 --> 0:19:41.240 And so those are the classes. Over the counter now, 0:19:41.320 --> 0:19:45.000 poise makes am almost like a super tampon called the Impressive, 0:19:45.600 --> 0:19:47.840 which you can purchase over the counter that can help 0:19:47.880 --> 0:19:51.639 provide some support if it's a minor prolapse um and 0:19:51.680 --> 0:19:54.840 then a medical device called a passery is something that 0:19:54.880 --> 0:19:57.720 you're a gynecologist or euro gynecologists can fit to help 0:19:57.760 --> 0:20:00.640 provide support to the organs. Once you take it out, 0:20:00.920 --> 0:20:02.840 the organs are going to come back down, but they 0:20:02.840 --> 0:20:06.359 can provide a basis of support while people are trying 0:20:06.359 --> 0:20:09.359 to either delay surgery or do other things in life. 0:20:09.520 --> 0:20:12.240 This is a really stupid question, but like, if you're 0:20:12.240 --> 0:20:15.800 having a pro lapse and your bladders like out, which 0:20:15.840 --> 0:20:18.879 I have another friend that that was the case, isn't 0:20:18.880 --> 0:20:22.280 there major risk of infection or like like if your 0:20:22.280 --> 0:20:25.280 bladders just hanging out of your vagina hole, like how 0:20:25.880 --> 0:20:30.120 on like a cotton underwear is that dangerous. I've been 0:20:30.160 --> 0:20:33.200 doing this for eighteen years and I still don't think. 0:20:33.800 --> 0:20:36.720 I think the same way you do. I see every 0:20:36.720 --> 0:20:39.040 time I see a uterus on my table, I'm like 0:20:39.800 --> 0:20:42.960 that you see a uterus on your table, Yes, this 0:20:42.920 --> 0:20:49.040 happened that I'm literally losing it doesn't look like that's okay, 0:20:49.040 --> 0:20:52.439 but apparently it's kind of okay. I don't know. She's like, 0:20:52.480 --> 0:20:54.919 I'm sitting on my bladder literally like I have a 0:20:54.920 --> 0:20:58.040 friend that it's coming out of for vagina. Really, you know, 0:20:58.160 --> 0:21:02.040 having a baby is so sucking crazy, Like this is crazy, like' 0:21:02.160 --> 0:21:05.679 literally having a conversation about carrying your bladder around outside 0:21:05.680 --> 0:21:08.600 your body. But like so that is that is the thing, 0:21:08.720 --> 0:21:12.720 and it and it's okay. It doesn't cause as much 0:21:12.800 --> 0:21:15.720 risk of infections as you would think. And even still 0:21:15.760 --> 0:21:18.280 I think it just does not look okay to me. 0:21:18.520 --> 0:21:22.439 And so usually we do advise that women wow sempressory 0:21:22.560 --> 0:21:26.000 and work with their doctors about surgical intervention. What are 0:21:26.040 --> 0:21:30.520 some of the telltale signs that women might be facing 0:21:30.680 --> 0:21:34.160 post baby That would be like, okay, you you should 0:21:34.200 --> 0:21:37.480 go see you if you can't. Leaking urine is never 0:21:37.560 --> 0:21:43.320 normal but extreme you guys, yes, so if you maybe 0:21:43.359 --> 0:21:46.320 I think everybody should be evaluated. But I mean things 0:21:46.320 --> 0:21:48.960 like leaking normal leaking your may not be bothers them, 0:21:49.000 --> 0:21:53.920 but that's indicative that there's something wrong opposite. End urinary urgency, frequency, 0:21:54.560 --> 0:21:58.919 diminished orgasm, painful sex, difficulty with bowel movements. All of 0:21:58.960 --> 0:22:02.600 those factors um can be addressed and not to mention 0:22:02.600 --> 0:22:04.879 the more simple things like hip pain and back pain 0:22:04.960 --> 0:22:07.720 and you know, sciatica. Some of the normal things. I 0:22:07.760 --> 0:22:10.240