Speaker 1: Oh, baby, baby, belof I need you, Oh how I
Speaker 1: need you? What do you expect? As a production of
Speaker 1: My Heart Radio, I'm your host Heidi Murkoff, and I'm
Speaker 1: a mom on a mission, a mission to help you
Speaker 1: know what to expect every step of the way. Sure,
Speaker 1: you've had a vagina your whole life, but how much
Speaker 1: do you really know about it? If you're like most women,
Speaker 1: not all that much beyond some of the obvious stuff.
Speaker 1: Chances are you know even less about the miraculous muscles
Speaker 1: that support your vagina. Along with your uterus, your bladder,
Speaker 1: and your bowels, your pelvic floor muscles. Not surprisingly, your
Speaker 1: pelvic floor muscles are pretty pivotal when you're pregnant and
Speaker 1: when there's a lot more that meets supporting. And even
Speaker 1: if your baby doesn't end up exiting the building via
Speaker 1: your vagina, pregnancy can take a toll on your pelvic floor.
Speaker 1: Pee when you laugh for cough, had hip back, pelvic
Speaker 1: or pubic pain or pressure, that's your pelvic floor muscles talking.
Speaker 1: It's time to listen up and to listen to today's guest.
Speaker 1: You may have heard of the vagina Whisperer, but her
Speaker 1: real name is Sarah Reardon, and she's a pelvic floor
Speaker 1: therapist and she's a mom of two boys, so she
Speaker 1: and her pelvic floor have been there and done that.
Speaker 1: Today she'll talk about pregnancy aches and pains, what's normal,
Speaker 1: what's not, and how to prepare your pelvic floor for childbirth,
Speaker 1: postpartum and beyond. So welcome Sarah, Hi, Heidi, Thanks for
Speaker 1: having me, Thanks for being here. And I have to
Speaker 1: say our vaginas and pelvic floors also, thank you. Happy
Speaker 1: to be of service. I have to say it's the
Speaker 1: first person to say penis on national televisi. I'm really
Speaker 1: jealous about your title. How did you become the vagina Whisperer?
Speaker 1: So it was actually a title given to me, so um.
Speaker 1: I started in the field of pelvic floor physical therapy
Speaker 1: right out of grad school in two thousand seven, and
Speaker 1: there weren't a lot of pelvic floor physical therapist back then.
Speaker 1: And I would see my college friends every summer and
Speaker 1: I would end up in the hot tub with their
Speaker 1: moms talking about bladder issues and leakage. And all of
Speaker 1: my friends said, she's like the vagina whisper. And then
Speaker 1: when I started my Instagram account a few years later,
Speaker 1: it was for that group of friends. So I kind
Speaker 1: of started, you know, just as a joke, and then
Speaker 1: here we are, you know, four years later. Today we're
Speaker 1: going to focus on caring for your pregnant pelvic floor
Speaker 1: and all the wise in house. But before we get
Speaker 1: into that, can you give us just a little bit
Speaker 1: of pelvic floor? One oh one? Like, what's down there
Speaker 1: on the floor? Why is it there? Why do you needed?
Speaker 1: I mean, is it a case of you don't know
Speaker 1: what you god till it's gone. So a little bit
Speaker 1: of all of those things, And I think this is
Speaker 1: a great place to start because a lot of people
Speaker 1: don't know what is the pelvic floor, what does it do,
Speaker 1: and how the heck is their physical therapy for it.
Speaker 1: So all people have a pelvic floor, female, male, all genders,
Speaker 1: and the pelvic floor is actually a basket of muscles
Speaker 1: that sit at the base of the pelvis. So we're
Speaker 1: all familiar with, you know, the bones of the pelvis,
Speaker 1: but at the very basis a hammock of muscles that
Speaker 1: support your organs like your bladder, your rectum in females
Speaker 1: uterus and ovaries and males to prostate, and those muscles
Speaker 1: support those organs and they also have stinkers that help
Speaker 1: hold in p hold in poop and then assist with
Speaker 1: vaginal birth and vaginal intercourse. So how do you know
Speaker 1: if you need to see a pelvic floor therapist? Is
Speaker 1: it something that should be routine for all pinnor women?
Speaker 1: Is it covered by insurance? Is it something your your
Speaker 1: doctor should refer you or your midwife? Right, so, you know,
Speaker 1: we see folks coming in if they find us online,
Speaker 1: if they hear about us from our friend or oftentimes
Speaker 1: referred by physicians O b G, y m s and midwives.
Speaker 1: The way that you should see one is that if
Speaker 1: you have any issues with bladder health like urinary leakage,
Speaker 1: overactive bladder difficulty emptying your stream, chronic urinary trucked infections,
Speaker 1: pooping issues like constipation, fecal incontinence, or sexual health with
Speaker 1: respect to painful intercourse or the inability to have intercourse
Speaker 1: or painful orgasms. So the muscles play a role in
Speaker 1: bowl health, bladder health, and sexual health, but they also
Speaker 1: go through a huge transformation during pregnancy and birth, as
Speaker 1: you and I both know. So that's really where I
Speaker 1: feel like physical therapy should be standard care for women
Speaker 1: during pregnancy to prevent issues, help them prepare for childbirth,
Speaker 1: and then postpartum to help with recovery. So helveic for
Speaker 1: physical therapy really falls under physical therapy. So if your
Speaker 1: insurance covers physical therapy, which most of them do, and
Speaker 1: you find a clinic that does take insurance, and you
Speaker 1: can absolutely go and see a physical therapist and it's
Speaker 1: covered under insure rents. Oftentimes some clinics or what we
Speaker 1: call out of network, which means they don't contract with insurances,
Speaker 1: but we provide you or receipt or what we call
Speaker 1: a super bill that you can send into your insurance
Speaker 1: for out of network reimbursement. So there are a lot
Speaker 1: of options out there to help support moms if you
Speaker 1: have insurance, and also if you're working with a therapist
Speaker 1: who doesn't accept it. And you know, I talk a
Speaker 1: lot about keygels, and in fact I'm doing them right
Speaker 1: now because I can't talk about them without doing them.
Speaker 1: But can you explain from a physical therapists perspective, how
Speaker 1: keegel's work, who they're right for, and how we can
Speaker 1: make sure we're doing them correctly. It's a great question
Speaker 1: that could be an entire episode because but to start
Speaker 1: with the basics. Keegels are contractions of the pelvic floor.
Speaker 1: So when we think about a muscle in our body,
Speaker 1: like our bicep, you bend your elbow and your bicep
Speaker 1: contracts with the pelvic floor. A kegel is like you're
Speaker 1: squeezing and lifting that hammock of muscles. So you're closing
Speaker 1: the sphinc or where you're an exit, closing the anus
Speaker 1: where gas or poop exits, and kind of you know,
Speaker 1: lifting up. My favorite queue to tell people is think
Speaker 1: about your sipping up a smoothie with your vagina, because
Speaker 1: it's not a tightening, it's really kind of a pulling
Speaker 1: up and lift and it's a totally weird que but
Speaker 1: it somehow works. Um, So you know, that's just strengthen
Speaker 1: the pelvic floor. And you bring up a great point, Heidi,
Speaker 1: that not everybody maybe needs to do strengthening. A lot
Speaker 1: of us have weakness, but a lot of us also
Speaker 1: have tension, and kegels would not be the appropriate exercise
Speaker 1: for that person, so they need to relax instead. Yes,
Speaker 1: and I would say that a lot of folks out
Speaker 1: there have pelvic floor attention and need to relax before
Speaker 1: they start strengthening. That's a great point. Does that mean
Speaker 1: that a mom moves already had a baby or two
Speaker 1: will benefit more from keegeles than the first time mom that.
Speaker 1: I think it's hard to say. We do know that
Speaker 1: more often we have weakness postpartum, because again, if we
Speaker 1: think about those muscles like a hammock, a hammock holding
Speaker 1: an avocado and week ten is different than hammock holding
Speaker 1: a watermelon in week forty. So just by the course
Speaker 1: of pregnancy, our muscles get lengthened and relaxed and aren't
Speaker 1: as supportive or strong. However, again, a lot of folks
Speaker 1: still have tension after a cesarean birth, after paraneal tearing,
Speaker 1: there can be muscle tension. Um Again, keels may not
Speaker 1: be the first thing to start with. So we see
Speaker 1: second time moms a lot who want to prepare for birth.
Speaker 1: Oftentimes they have weakness, but then they also may have
Speaker 1: tension and want to kind of just prevent some issues
Speaker 1: along the way. So we've talked about just about every
Speaker 1: pregnancy symptom at some point in this show, and I
Speaker 1: can say pretty much most of them suck. Most of
Speaker 1: them are not a fan of pregnancy symptoms. UM. Maybe
Speaker 1: with the exception of bigger boobs or better hair um,
Speaker 1: but a lot of the hair. The hair is definitely
Speaker 1: a good side effect of pregnancy. But let's get into
Speaker 1: some of the symptoms that might be impacted by your
Speaker 1: pelvic flour. And of course there's peeing, and there are
Speaker 1: lots of reasons why you p up a storm when
Speaker 1: you are pregnant. I mean, there's all those hormones. There's
Speaker 1: the position of your uterus, which is one of the
Speaker 1: reasons why you piece so much early in pregnancy. And
Speaker 1: you know, if you're peeing a lot, or you have
Speaker 1: that urgency all the time, or you're having burning sometimes
Speaker 1: you might have a U T I. So there's lots
Speaker 1: of different reasons. But what is normal and what is
Speaker 1: not when it comes to pregnancy p and how is
Speaker 1: it related to your pelvic floor? Yeah, urinary function is
Speaker 1: a big one when it comes to pregnancy, and we
Speaker 1: often do find ourselves going more often again because of
Speaker 1: pressure on the bladder, more fluid in our bodies. Urinary
Speaker 1: leakage is a common symptom, but I wouldn't say it's
Speaker 1: a normal symptom. So when you start experiencing urinary leakage
Speaker 1: with a call for a sneeze or with exercise, it's
Speaker 1: those muscles aren't holding in p as well as we
Speaker 1: would want them too, So that means there's a muscle issue.
Speaker 1: And that's when I would really say start working with
Speaker 1: a physical therapist, because that means that's not necessarily going
Speaker 1: to get better after childbirth and then postpartum, and so
Speaker 1: it's something that you want to start addressing what it happens,
Speaker 1: and it won't necessarily just go away. So I think
Speaker 1: urinary leakage is probably the most common. Another common issue
Speaker 1: is prolapse. So this is sounds scary, and it's not
Speaker 1: as scary as it sounds, but the bladder shirts to
Speaker 1: kind of drop down a little bit into the pelvic
Speaker 1: floor muscles, so it feels like pressure, heaviness, something's falling out.
Speaker 1: That's again common because of all the pressure from above,
Speaker 1: or if we have a high intensity athlete who does
Speaker 1: running and jumping, it's just more pressure over time. That's
Speaker 1: another common bladder symptom that people may experience. How common
Speaker 1: is that and how would you know? So we go
Speaker 1: often based by symptoms and then of pressure, heaviness, back pain,
Speaker 1: it feels like there's a tampon in your vagina when
Speaker 1: there isn't And then we do a pelvic floor assessment
Speaker 1: where we look through the vaginal opening, asked them to
Speaker 1: bear down, and we can often see the kind of
Speaker 1: the wall of the vagina where the bladder is supported
Speaker 1: kind of pushing through. So you can tell by symptoms
Speaker 1: and then again confirm with an evaluation, because lots of
Speaker 1: pregnant women and you know, when they reach you know,
Speaker 1: maybe thirty five, thirty six weeks, they're feeling that pressure anyway,
Speaker 1: they're peeing a lot again anyway, but the leaking. Is
Speaker 1: there really a way to train a pregnant bladder to
Speaker 1: do new tricks like cold in p you'd be surprised
Speaker 1: how to the pelvic floor can always do new tricks. So,
Speaker 1: I mean, it's it's gonna be hard, But I think
Speaker 1: a lot of what we want to do is help
Speaker 1: prepare women also for postpartum. So teach them to contract,
Speaker 1: tighten those pelvic floor muscles before a call for a sneeze,
Speaker 1: so they get in the habit of doing that, so
Speaker 1: postpartum they already have that maneuver in place. Teaching them
Speaker 1: how to pee without pushing, So a lot of times.
Speaker 1: A lot of moms are power peers, which means they
Speaker 1: sit down and they like push really hard when they pee,
Speaker 1: and that can cause more weakness so in muscles that
Speaker 1: may already be weak. So we teach them to sit
Speaker 1: and breathe and relax so that they don't cause more
Speaker 1: weakness to their muscles. So teach them a lot of
Speaker 1: really basic things that maybe no one's ever taught them,
Speaker 1: but can help prevent issues from getting worse as well. Huh,
Speaker 1: that's a lot of new tricks I just learned. Although
Speaker 1: I'm not sure I ever pushed when I was paying.
Speaker 1: I'm gonna have to think about that. So speaking of
Speaker 1: things that are literally impacted by pregnancy, of course, you
Speaker 1: know where I'm going. Constipation, Yes, and it's there for
Speaker 1: a good reason. It's a purposeful symptom like most are
Speaker 1: in pregnancy, and that's the slowing down of digestions so
Speaker 1: your baby can absorb more nutrients. Also, you might be
Speaker 1: taking iron, and iron can be constipating. And you know,
Speaker 1: we know all about and we've heard over and over
Speaker 1: about staying hydrated and eating the right foods, you know,
Speaker 1: foods that are high end fiber, taking magnesium, but well,
Speaker 1: we often don't talk about is how the pelvic floor
Speaker 1: is associated with pooping, and clearly it is, so would
Speaker 1: you like to enlighten us a bit us? And I
Speaker 1: love talking about poop because I don't think we realize
Speaker 1: the you know, no pun intended impact it has on
Speaker 1: our health. I mean, if you take a good poop,
Speaker 1: you're the rest of your day is can be amazing.
Speaker 1: But if you don't take a good poop, then you're like,
Speaker 1: all right, I'm already grumpy and it's eight am. So
Speaker 1: you know, your pelvic floor muscles, just like with your bladder,
Speaker 1: your pelvic flor muscles have to relax in order to
Speaker 1: empty the balls where poop is kind of stored, and
Speaker 1: if those muscles are not relaxing, well, it will get
Speaker 1: backed up. What happens during pregnancy is again your colon
Speaker 1: is slowing down, the poop gets really hard and difficult
Speaker 1: to empty. So now I've got this really painful baseball
Speaker 1: of poop and your muscles aren't relaxing to get it out,
Speaker 1: and it can be excruciating. And that's another thing that
Speaker 1: can lead to hemorrhoids, to fishers, to prolapse. So all
Speaker 1: of the tips you mentioned probably taking natural call magnesium
Speaker 1: is one of my favorites, staying hydrated, you know, avoiding
Speaker 1: constipating foods, but a lot of us want carbs and
Speaker 1: sweets and things like that. But the proper way to
Speaker 1: poop is also helpful. So we teach folks to put
Speaker 1: a little stool under their feet when they're pooping, so
Speaker 1: that their knees get above their hip heights, so it
Speaker 1: puts you in a squat, which is the best position
Speaker 1: to relax your pelvic floor. And then we also teach
Speaker 1: them to exhale when they're pushing poop out versus holding
Speaker 1: their breath. When you hold your breath, you almost tighten
Speaker 1: up a little bit, which makes it harder. So we
Speaker 1: teach them to exhale and breathe out with their feet
Speaker 1: on that stool. And that can make a huge difference
Speaker 1: during pregnancy pooping. And it's really easy to remember because
Speaker 1: stool for your stool, stool for your stool. You got it.
Speaker 1: I would say everybody hurt sometimes, right, but pregnant women
Speaker 1: seems to hurt a hole up more than anybody else,
Speaker 1: especially in the third time ster that load you're carrying
Speaker 1: gets bigger and heavier and pregnancy can be a pain,
Speaker 1: a lot of pains. Yeah, it's a pain with a
Speaker 1: purpose because your body is getting ready for childbirth. But
Speaker 1: that's still must we accept it. Why does it happen?
Speaker 1: What can we do about it? That is such a
Speaker 1: great question, and you really nailed it that we don't
Speaker 1: have to accept it. I think so often we hear
Speaker 1: that leaking part of pregnancy, back pain, part of pregnancy,
Speaker 1: pooping problems. But there are so many things that we
Speaker 1: can do to help that we're just not automatically made
Speaker 1: aware of. And that's where I think physical therapists are
Speaker 1: really trying to advocate that there is support and help
Speaker 1: for people during pregnancy. So we talked a little bit
Speaker 1: earlier about the pelvis as that ring of bones and
Speaker 1: then the muscles are at the very base. Well, you
Speaker 1: have your abdominal muscles in the front, which we know
Speaker 1: are getting stretched out, lengthening and offering you less support
Speaker 1: during pregnancy, which can contribute to back pain and postural changes.
Speaker 1: And you also have little ligaments in that pelvis in
Speaker 1: the very front at the pubic bone and in the
Speaker 1: very back at the sacrum, and those ligaments are getting softer.
Speaker 1: Because we want the pelvis to expand to accommodate the
Speaker 1: growing baby, but that also means a little less stability,
Speaker 1: a little more loosey goosey joins, and that can cause
Speaker 1: pain with you know, getting out of bed, rolling over,
Speaker 1: getting out of the car, you know, bending over to
Speaker 1: pick up a toddler. And there are things that can help.
Speaker 1: We really encourage people to learn how to use their
Speaker 1: core muscles when they're doing those day to day activity,
Speaker 1: so kind of doing a little pelvic floor and pulling
Speaker 1: in their bellies to give them some core support. We
Speaker 1: also teach people how to get out of bed so
Speaker 1: they're not like hiking up with their abs, they're rolling
Speaker 1: to their side, and you know, how to get out
Speaker 1: of a car by keeping their knees together so that
Speaker 1: not stressing the pubic bone. And then also I really
Speaker 1: encourage folks to wear these little belly supports, you know,
Speaker 1: that is so helpful. It's literally just like a little
Speaker 1: back breath or a little belly support, but it takes
Speaker 1: some of the weight off so that you're not carrying
Speaker 1: this heavy load all the time and you have something
Speaker 1: that can help make it more comfortable. So that can
Speaker 1: definitely give your backup break Now, the hip pain, especially
Speaker 1: at night, is super uncomfortable for a lot of bombs
Speaker 1: and getting into a comfortable sleeping position, which you would
Speaker 1: say is lying on your side with a pillow between
Speaker 1: your knees down to your ankles, so it's kind of
Speaker 1: sandwich the whole way through your shins um. I like
Speaker 1: to have one to two pillows under your head, so
Speaker 1: sometimes we need a little bit more support under the head,
Speaker 1: a little small pillow underneath a belly, especially during the
Speaker 1: third trimester. And then I always needed something behind my back.
Speaker 1: I tended to roll into my back a lot, so
Speaker 1: when I would kind of get into my cozy position
Speaker 1: on my side with all of my pillows, i'd have
Speaker 1: my partner like shove a pillow behind my back. So
Speaker 1: if I kind of rolled over in the middle of
Speaker 1: the night, I was just still like sideline a little
Speaker 1: bit versus all the way on my back. So that
Speaker 1: just gave me some more options. And again, if that
Speaker 1: hip is in a position where it's kind of cranked forward,
Speaker 1: or you know, your knees are pressed together, over time
Speaker 1: those muscles get tight and tense, which can lead to
Speaker 1: hip paint. But using some pillows for adjustment really help.
Speaker 1: Was there room for your partner on that bed with
Speaker 1: all those pillows? We got a bigger bed. Okay, good,
Speaker 1: we upgraded to a king Okay. So um, what exercises
Speaker 1: should pregnant women avoid that might exacerbate those pains in
Speaker 1: the back end? Hips? Are there any you can really
Speaker 1: exercise all throughout pregnancy? Some things to start avoiding kind
Speaker 1: of right around the second trimester, or crunches, double leg
Speaker 1: list when you're lying on your back, most exercises lying
Speaker 1: on your back. We try to encourage you to lie
Speaker 1: on your side just to avoid any compression down on
Speaker 1: you know, your vessels down below baby, but really holding
Speaker 1: off on anything that causes that kind of sit up
Speaker 1: maneuver with your abdomen because that will cause it to
Speaker 1: stretch and lengthen and sometimes lead to a separation called
Speaker 1: the diastasis recti, which looks like a little football or
Speaker 1: coning at the midline of your belly. So that's helpful.
Speaker 1: And then you know modifications if you're doing planks, you know,
Speaker 1: get down on your knees and do planks. If you're
Speaker 1: doing push ups, to them on the wall instead of
Speaker 1: the ground. And then avoiding like deep lunches, where you
Speaker 1: might stress some of those joints that are a little
Speaker 1: bit more lax. Like we talked about earlier, a lot
Speaker 1: of moms complain about severe pain in their pelvis in
Speaker 1: their hips, and how do you know when it's time
Speaker 1: to get help for that. I always recommend by the
Speaker 1: way that you go see a pelvic for therapist. That's
Speaker 1: always my go to. But how do you know it's
Speaker 1: not something more serious like pelvic girdle pain that can
Speaker 1: be excruciating. I feel like your entire pelvis is ripping apart.
Speaker 1: So a little bit about that, absolutely, and ideally I
Speaker 1: think this is where we want to change the narrative
Speaker 1: for pregnant moms that if you are having sciatic pain
Speaker 1: or pubic bone pain, we know that, Okay, let's send
Speaker 1: that mom to see a pelvic PT and literally within
Speaker 1: one to two sessions it can be such a quick
Speaker 1: fix so they don't get to the point of debilitating pain.
Speaker 1: But my rule of thumb is if something is, you know, painful,
Speaker 1: and it's causing distress in your life, if it's causing
Speaker 1: psychological or physical angst changes and it's affecting you, then
Speaker 1: it's worthy of your attention. It's worthy of you seeking
Speaker 1: care for it. A lot of the times, I think,
Speaker 1: you know, I can speak for myself as a woman,
Speaker 1: as a mom, I think I just have to deal
Speaker 1: with stuff and I don't have time for it. But
Speaker 1: when it starts impacting my quality of life of socializing
Speaker 1: with friends or having endemoucy, use my partner, playing with
Speaker 1: my kids, that's something that I really should be addressing,
Speaker 1: no matter if it's a one out of ten pain
Speaker 1: or a ten out of ten pain. Absolutely, and you
Speaker 1: know you can be strong but still ask for help. Yes,
Speaker 1: I think that that's really what takes strength, is saying
Speaker 1: I need help exactly. You can use that in you know,
Speaker 1: when it comes to pains, when it comes to other
Speaker 1: pregnancy symptoms, that also when it comes to your emotions,
Speaker 1: don't forget you can be strong and ask for help. Absolutely,
Speaker 1: painful sex. There are reasons for painful sex that really
Speaker 1: you know that might not be involving your pelvic muscles.
Speaker 1: Maybe you have an infection for instance, you know, having
Speaker 1: had sexual trama in your life that can cause painful sex.
Speaker 1: Is this something that you hear about a lot? You know,
Speaker 1: the research is really showing us that one in four
Speaker 1: women will experience painful sex at some point in their lifetime,
Speaker 1: which is a pretty astounding number. And I think I
Speaker 1: share that to let women know that it's much more
Speaker 1: common than we realize, and we're just not talking about it.
Speaker 1: And we read a lot that you may have increased
Speaker 1: libido or increased sexual desire or more vaginal lubrication during pregnancy.
Speaker 1: But if you're not having that and you even have pain,
Speaker 1: you start to think, is something wrong with me? Is
Speaker 1: everybody else like this? And some of the common causes
Speaker 1: we see of painful sex or some of the things
Speaker 1: you already mentioned hip pain, back pain, it's difficult to
Speaker 1: get into some of those positions and just kind of
Speaker 1: awkward and uncomfortable. The other thing is muscle tension. You know,
Speaker 1: these are muscles that if they are tighter tense, it's
Speaker 1: gonna make it difficult for something to enter the vagina.
Speaker 1: It can feel like something's getting bruised or is tender.
Speaker 1: With deeper insertion, you can have pain afterwards, so that
Speaker 1: can be uncomfortable. And even if they're scar tissue from
Speaker 1: a previous cesarean birth or a previous perennial tear, that
Speaker 1: can also be a cause of pain even during pregnancy.
Speaker 1: So if one and for experience it probably far fewer
Speaker 1: actually get treatment for it. In that right, it shouldn't
Speaker 1: have to hurt. It should never hurt. And you know,
Speaker 1: I think even we start to think, oh, well, maybe
Speaker 1: it's a little bit normal, but it doesn't necessarily just
Speaker 1: go away. I mean, I am a pelvic for physical therapist.
Speaker 1: I've had two kids, and even this year I started
Speaker 1: experiencing painful sex and I was like, Okay, I need
Speaker 1: to go see one of the therapists in my office.
Speaker 1: I need to get worked on I've been doing too
Speaker 1: much cycling. And it was you know, four sessions. But
Speaker 1: and I was so grateful that I knew this, But
Speaker 1: it goes to show you. You know, everyone's pelvic floor
Speaker 1: is susceptible to pelvic floor issues. We just don't always
Speaker 1: know where to get help. So um, it should not hurt.
Speaker 1: And if you are having pain with sex, I would
Speaker 1: encourage you to report it to your medical provider and
Speaker 1: seek the help of physical therapists. Certainly men would if
Speaker 1: they had painful I think about that all of the time,
Speaker 1: and even with respect to like periods and menstrual health,
Speaker 1: and like if a quarter of their lives were affected
Speaker 1: by their periods or something in their public floor, it
Speaker 1: would be a different story. I'm not male bashing, by
Speaker 1: the way. I'm just supporting my mom's sisters here. I'm
Speaker 1: with you now. The separation that you spoke of, a
Speaker 1: lot of people associate the separation of your abdominal muscles
Speaker 1: with a postpartum sometimes gets diagnosed, sometimes it doesn't even
Speaker 1: but you mentioned um doming and coraine shapes, which you
Speaker 1: can also get when you're having bracts and hicks. Though, so,
Speaker 1: how do you know the difference, How do you know
Speaker 1: you have a separation, and is it too early to
Speaker 1: start thinking about healing it? So during pregnancy, one of
Speaker 1: the telltale signs is that you know, I tell we
Speaker 1: have people lying on their back and they do a
Speaker 1: little curl up. Their legs are straight, they're lying on
Speaker 1: their back and they curl up their head and shoulders
Speaker 1: off the ground. And if you look down at your
Speaker 1: tummy and you see like a little cone in the middle,
Speaker 1: you'll know exactly what it looks like. It looks like
Speaker 1: a little red loaf in the middle of your tummy.
Speaker 1: That's likely a separation of your abdominals and there's a
Speaker 1: little bit of pressure coming through behind it, So it's common.
Speaker 1: There's research to show seventy to ninety Some studies show
Speaker 1: a hundred percent of women have it during pregnancy, which
Speaker 1: I think that that's a little bit of inflated number,
Speaker 1: but it shows us that the pressure isn't being managed well.
Speaker 1: And I think about diastasis rector your abdominal separation the
Speaker 1: same way I think about proaps or pelvic floor weakness.
Speaker 1: The hammock is getting stretched. But are there things that
Speaker 1: we can avoid to minimize that, Not doing the sit ups,
Speaker 1: not getting out of bed, curling up, you know, watching
Speaker 1: your core exercises, and then learning to kind of tighten
Speaker 1: and engage those muscles during day to day activities when
Speaker 1: they could be getting stressed. You know, that's one way,
Speaker 1: and then Brexton Hicks is a little bit later. We
Speaker 1: typically have that happening during third trimester. The Brexton Hicks
Speaker 1: would just be showing you that it's there versus it
Speaker 1: causing it. So it just kind of shows you, well,
Speaker 1: there's more pressure in the tummy. You may see it happen. Yeah,
Speaker 1: they are not fun sometimes not fun. Ever, I don't
Speaker 1: think that's true. That's true. Well, they can be entertaining
Speaker 1: to watch, like at least they were for me, but
Speaker 1: they definitely were not fun to experience. So you also
Speaker 1: work with women on how to prepare for birth. Yes,
Speaker 1: what do you think helps most when you're trying to
Speaker 1: get your body ready for the big day? Should you
Speaker 1: get a birthing ball, should you do stretches? What are
Speaker 1: your best tips? So I think a patient of mine
Speaker 1: actually put it best when she said, gosh, it's actually
Speaker 1: nice to learn what to do before you actually have
Speaker 1: to do it. And during birth, what we are asked
Speaker 1: skiing women to do, our birthing person to do is
Speaker 1: to relax their pelvic floors and open them up so
Speaker 1: that a baby can come on down the birth canal.
Speaker 1: But if we've never been taught, first of all, we
Speaker 1: don't even know that there are muscles down there sometimes,
Speaker 1: and if you've never been taught how to relax them
Speaker 1: and voluntarily push them open, and you're in the middle
Speaker 1: of this really vulnerable birthing situation, it's a really difficult
Speaker 1: thing to do. So during our childbirth preparation and we
Speaker 1: do this virtually and we also do it in person,
Speaker 1: is that we teach women a couple of things. We do.
Speaker 1: Teach them how to do parenneal massage, which is kind
Speaker 1: of softening the tissue at the base of the vaginal opening.
Speaker 1: That's in an effort to just help relieve some muscle
Speaker 1: tension if they do have tightness down there or some
Speaker 1: previous card. Can we talk about that real quick before
Speaker 1: you may do it? Sounds like a crowd pleaser, you know,
Speaker 1: massage peneum, but lots of moms just can't get behind
Speaker 1: the idea. Can you just give us a little tutorial
Speaker 1: on peranneal massage and would you say it's a d
Speaker 1: I Y project or you know, should you enlist a
Speaker 1: friend kind of thing? Both you can do both, so
Speaker 1: you know, at the start of COVID a year ago,
Speaker 1: we actually did an online course teaching people how to
Speaker 1: do this because all of the childbirth classes were canceled
Speaker 1: and so it really showed us that, wow, people really
Speaker 1: don't know how to do this. And the paradeum is
Speaker 1: the area between the vaginal opening and the anal opening.
Speaker 1: There are a lot of nicknames for it. However, the
Speaker 1: way you massage the paradeum is actually by inserting a
Speaker 1: finger into the vaginal opening and pushing down, so you're
Speaker 1: kind of pushing into that muscle through the vagina. And
Speaker 1: I like to think about the vaginal opening like a clock,
Speaker 1: so you're thinking about from three o'clock all the way
Speaker 1: to nine o'clock that lower half. You insert your finger
Speaker 1: and just kind of push at different points in those clocks,
Speaker 1: pull down, take a couple of deep breaths. It will
Speaker 1: feel a little bit burnie. Once that burning starts to
Speaker 1: soften and the muscle relaxes, you go to another spot
Speaker 1: between three to six until you can kind of sweep
Speaker 1: all the way across, almost like you're making a little
Speaker 1: smiley face. I have folks do it starting around thirty
Speaker 1: four weeks of IVAN. See. You can do it to yourself. Um,
Speaker 1: you can do it while you're in the shower with
Speaker 1: one leg up and like that Captain Morgan position. Or
Speaker 1: you can enlist a partner and friend and have them
Speaker 1: do it to you as well. So a lot of options,
Speaker 1: and it's not a must. You know, the research is
Speaker 1: showing it's variable the effectiveness. But I think any way
Speaker 1: that we can learn how to connect with our bodies,
Speaker 1: learn how these muscles work, is beneficial, and you know
Speaker 1: you will be using these muscles. I mean, unless you
Speaker 1: have a c section, but still those muscles are impacted.
Speaker 1: So I feel either way you win. I agree. I agree,
Speaker 1: And it's something commonly performed during childbirth, so it's it's
Speaker 1: also helpful for them to know what to do prior
Speaker 1: to birth exactly. And if nobody's giving you a perennial
Speaker 1: massage during childbirth, should you ask for one? Is that
Speaker 1: one of the best reasons to have a duela for instance?
Speaker 1: You know, I think if it's something that you feel
Speaker 1: like is effective for you, I don't see why not asking.
Speaker 1: Other things that have been helpful to soften the pyreneum
Speaker 1: are using a warm compress or even a warm wash
Speaker 1: cloth over the area. Uh. And again, you know, back
Speaker 1: to what we teach women what to do to prepare
Speaker 1: for birth, as we teach them how to breathe when
Speaker 1: they're pushing, we're finding that a lot of folks are
Speaker 1: holding their breath when they're pushing, and that's not helping
Speaker 1: the muscles relax to get out of the way. And
Speaker 1: so we're teaching them to push while they're breathing. They're
Speaker 1: not exhausted or they're not giving themselves hemorrhoids and prolapse,
Speaker 1: and they feel like they can effectively relax these muscles.
Speaker 1: Your pelvic floor muscles don't push your baby out. Your
Speaker 1: uterus does. And we just want the muscles to get
Speaker 1: out of the way. And so that's what we're trying
Speaker 1: to help women do well. I guess that's a wrap
Speaker 1: for pregnancy. We just had the baby leave the building,
Speaker 1: so we're gonna pick back up with you when it's
Speaker 1: time to talk postpartum. But we can't thank you enough
Speaker 1: for being on today with What to Expect community. This
Speaker 1: is so great. Thank you so much. Thank Sarah, baby
Speaker 1: baby Off, need you, Oh how I need you. Thanks
Speaker 1: for listening. Remember I'm always here for you. What to
Speaker 1: Expect is always here for you. We're all in this together.
Speaker 1: For more on what you heard on today's episode, visit
Speaker 1: what to Expect dot com slash podcasts. You can also
Speaker 1: check out What to Expect when You're Expecting, What to
Speaker 1: Expect the First Year, and the What to Expect app.
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