Get To Know Your Pelvic Floor

founder of the Pelvic Health and Rehabilitation Center. And then I'm gonna be talking to Pria Campbell Sarrago. She is a birth doula and a pelvic floor specialist who takes more of a holistic and embodied approach to pelvic floor rehab. So let's get started, you guys. We are on the topic of the pelvic floor, which I have slowly begin to realize that the reason I was most excited about recording this episode about this topic is that it's just secretly my way of talking talking about my own pelvic

floor what's going on? Because maybe I've been a little bit scared to make an appointment and see what's going on. Stephanie, I am so happy you're here. You are, I mean, you are one of the tops of this situation and I am so excited to meet you and talk about my pelvic floor. But also I'm sure this will be super helpful to our listeners. So welcome, Stephanie prendor Gast. Did I say your last name correctly? You did? And think, Oh, we're so happy to be here. Um, tell us a

little bit about yourself. So I my background is I'm a physical therapist, but for since two thousand and one, I've been specializing in publvic floor disorders and so in relevance to this podcast, we deal with a lot of women during pregnancy to try to optimize their public floor for delivery, make them more comfortable, as well as help you see women during pregnancy and before too. We do. We do, and in recent years people are coming in more to get a better or control of their public

floor muscles before birth. But historically it used to be that women would come in with complaints if they had pelvic girdle pain or incontinence or some sort of pain issue may have led them to PETE before. But now that women are becoming more informed. We also can help women prepare themselves, have the confidence they need to go into labor and delivery knowing their body is as ready for it as it can be. Oh my, I mean literally, why did I not go to you before having a baby.

This is insane because I mean, before I had a baby, I was the person who would like sneeze and if it caught me off, guarden, I had a super full bladder, like a liate little bit of Mike about And I know a lot of friends that are in the same boat. Um, and we don't really talk about it much. Um. So can you tell us about the Pelvic Health and Rehabilitation Center. Yes. So, we have been a company since two thousand and six.

We have four offices in the Bay Area. I practice in our Los Angeles location, and we also have two offices on the East Coast in New England. We specialize in men, women and children, try and gender, all sexes, all ages. These problems can start affecting people in their teenage years or in the pediatric years with bedwetting and constipation, and continue all the way through menopause. So we're happy to specialize in solely these disorders and treat everybody across

the lifespan. WHOA, Okay, tell us a little bit about what the pelvic floor muscles do, Like, let's let's talk about the pelic floor muscles, like what they do normally, and then what do they do during pregnancy and maybe labor? Great, so they most people don't even know they have the pelvic floor. The muscles run from your pubic bone to your tailbone, and they're responsible for kind of a lot

of big deals. They help us maintain continents, urinary and bell as well as the let us evacuate urine stool. They're responsible for sexual function, for orgasm and for keeping our orgasms are orgasms keeping our organs supported, so they also spans supported to Okay, like why it's like, why am I in the gym working so hard on my biceps and I'm not in this gym like working so hard on these pelviic floor muscles that do all the

things you just described. That's a great question. Most women, until you've had a baby, don't necessarily need to strengthen their public floor muscles because they are always under some sort of tone. It's one of the only muscles in the body innervated by a nerve that has autonomic function, meaning you don't have to think about it most of the time. You're not going to leak if you sneeze because you have reef. It's just holding it and it's

holding in your organ like it just does it. So it is big myths in Cosmo and these other magazines that suggest younger women should be doing kegles to improve their orgasm. That it's simply not true. What right you guys, I'm running out the door. I'm wait a second. Wait. That is not true. Regular activity often strengthens our public floor muscles. From day to day activities. There's always some tone and in younger women and women who have not given birth, most of the time they do not need

to strengthen their pelvic floors. When you do have a baby and you basically run a marathon with your pelvis all those hours that you're in labor pushing the baby through the pelvic floor, now the muscles are lengthened, their weakened.

There may actually be neuropathy then. Sorry, when you when you're trying to push the baby through the second stage of labor, there's a lot of tension both on the pelvic floor muscles and also the pudendal nerve that innervates them, and in certain cases there can be transient issues with the pudendal nerves. Sometimes it can be more serious than that, depending on what has happened during the birth. But if you think about it, of course you need rehabilitation after

going through everything that. It's like you would do physical therapy if you got your angle. You're doing physical therapy if you have any sort And this is even bigger, and yet we're supposed to just like carry on folks. No wow, um, so I think you started to hit on this a little bit. But so having a baby, I guess in my terms Katie's terms, pelvic floor just

gets blown out. But even if you don't give birth vaginally, like because what I'm learning is that the pelvic floor has held up additional weight for ten months, which makes it also exhausted. This is true, so regardless of the method of delivery, the pelvic floor is involved in a

number of changes that happened during pregnancy period. But it's so surprisingly resilient it just often needs a little bit or I should say, women would function better with more appropriate rehab after to just help get things more normalized after the changes that happen. Is this, like does insurance cover this? Like? It does? It is just in the last month that the American College of Obstetrics and Gynecology is acknowledging that maternal postparm care in the United States

is last in line of all industrialized countries. We were given one six week postpartum checkups it to check for postparm depress and make sure you don't have an infection, make sure your uterus is returned to normal, and that's it, see you later. So finally they're acknowledging the fourth trimester needs to be more comprehensive than that. Women need more visits and we've been given and that are covered by insurance, Like we need more visits for physical health obviously, mental

chickens for postpartum um wowze. That most physicians, unfortunately have been paid one lump sum for pregnancy and delivery and that includes one postpartum visit and has not included any additional visits that a mother may need if it had

anything to do with her birth. So that's an interesting thing that I just it's like I've just got punched in the gut and it makes perfect sense because you guys, like you know, when you right before you have the baby, you're in your obie's office all the time getting these stress tests, they're monitoring the heart, they're monitoring your health all stuff. And then as soon as the baby's out, it's like it's like the biggest breakups ever. And it's

in no way she formed like my obie's faults. She's just like great things so much like I'll see you in six weeks and you're like, wait, well, we'll wait, wait, wait what I'm sitting on a doughnut and I'm in a diaper, Like, hold up a second, I'm super confused, And most women feel that way. And the recent survey, the majority of women feel like their concerns that their care was not adequately addressed during that six week visit, and most people felt like they were kind of floundering,

I mean rightfully so. In other countries, and as early as five women were required in countries like France to have ten postpartum pelic floor physical therapy visits required. And this is because insurance companies have been in the way and dictating coverage. In the United States, That's exactly why. Because other countries understand the impact that the birth and then the support that mothers need is greater than what we've been given so far. So hopefully we're on the

cusp of change. So you think maybe this this you we admit that there's something called forth trimester could maybe lead us on a path towards maybe better care. It's supposed to set the guidelines for all O, B G l N s and the standard of kare in America. Now, whether insurance companies decide that they're going to pay for or not, it is going to be interesting because it's being strongly suggested that they do great. Um. So when do women typically come to see you? Is it? Are

most of your clients patients postpartum? Are they in the majority? I would assume well, in our practice, we actually see a wide range of things. What's interesting about this is because public floor physical therapy historically has not been included in the standard of postpartum care. Many women find us

on their own when something's wrong. They have stress and continents, they have severe vaginal pain, they have rectal pain, urinary urgency frequency, they can evacuate their stools, they can't orgasm, and they're furious why didn't my doctor tell me? Is what happens now in more recent years, with the presence of social media and things like that, many women are finding out that they should be going to public floor pt even if they're not noticing immediately to bother some

symptoms that I mentioned. I'm definitely going like next week, what's available because obviously think about what what pregnancy and birth entials. This is a no brainer. But it just hasn't been standard of care until now. No, it's really never made so much sense to me. Like you say, if you ever had a sprained ankle, you would go to the doctor and go to all the visits you'd need until you know your dislocated shoulder was back or

whatever it was needed. And how um so, can you take us through a little bit what what happens in the first appointment with you? Yes, and I hope you will't be nervous when you come to see me, making me go way better. So we take a history. We also want to hear what your urinary vale sexual function was like before pregnancy, because there can also be factors that may have influenced your delivery and things that are

influencing your rehab. Now, um we do a manual examination that includes looking at the abdominal area for what's called a diastesis wrecked i A. Many women associate that with mommy tummy, which is when the muscles separate naturally due to the advancing pregnancy. Sometimes they reduce on their own, sometimes they don't. It's important because not only for esthetic reasons, but it will impair woman's ability to have optimal pelvic floor muscle function if her abdominal wall is not intact.

These muscles work together. How do you know the percentage of women that that happens to. So there's a wide range in the literature from thirty to Sometimes it reduces, sometimes it doesn't, And how people measure it has kind of been varied, and so the study show it's kind of a wide range. And again some people it closes naturally, some people it doesn't. If it doesn't, it can be associated with stress and continents pro lapse and back pain later in life. So it is important to address it

even if you don't realize it's there. We also will examine the other muscles of the pelvic girdle. Typically the muscles of your hip widened to allow the baby to come out there maybe what do you mean examine, So we will manually examine them to see their length, their strength,

if they're tender, and the same thing. Internally. We need to know if you could contract your muscles, if you can relax them, relax them, if there's pain, if there's been an episiotomy, pain at the C section scar, and basically making sure the muscles can functionization what do you put in there to see So we don't use the speculum.

We use a single gloved lubricated finger, and we also use that as feedback to help the mother figure out where her muscles are in space, because it's kind of like a big black box too many people, and often in the postpartum period it can be what I call a hybrid where some muscles are tight and some are overstretched, and we've got to really do specific things to help

get that functioning again as a unit. WHOA. So you're literally laying on the table with someone's finger in your vagina, a gloved lubricated finger in vagina, and then you go through exercises and you try to really help someone feel inside themselves like different areas of the vagina and and strengthen it like do reps almost like like a workout. And it's interesting because the majority of women, just two are told to cagel actually do them incorrectly and in

a way that could make things worse. So, my god, you guys am literally losing my mind right now. We need to help fix that. What this is? This is just completely blowing my mind. Um. So, how is physical therapy different from how a doctor might address pelvic floor disorder?

So it's interesting because most kynecologists will tell you that they had very little pelvic floor training in medical school, and that is shocking since they have to push right through those muscles to get to the cervix and the eiterus and all the things that are important. So a physical therapist is going to more specifically examine each of the muscles and different areas of the pelvic floor, the

prudental nerve and tissue. So when doctors come into play, usually when things are more dire, and will hear pelic ladder specialist or prolapsed rectum or wait what did you just say? So they're considered surgeons for a pelvic floor reconstruction and is that a surgery that you have to be put out for? Yes, you have to go under anesthesia. If there is significant bladder prolapse, uterine prolapse rectal, it

may require surgical reconstruction. Usually this is something that happens later in life that could be prevented if we put the pelvic floor muscles back. I think some of the older women in my family though, I've heard yeah, like things just falling out and meeting his direct means and things like that, and so possibly had they done pelvic floor work earlier on, that might not have been the case. Because the one risk factor for pelvic organ prolapse later

in life his childbirth. Who see you, guys, this is it's like you're not even here. This is just my appointment with Stephanie Prendergast. So, uh, you see all sorts of patients and clients. Um, how are issues facing pregnant and postpartum women different? Are they the same? Like when you see a woman who might be about to get pregnant, or woman who is pregnant, or a woman who is post pregnancy, um, what how do you treat them differently?

So if pregnancy, we want to optimize their public floor muscle function, give them the confidence that they're ready to go into labor. And delivery and just help support the birth that they want, prepare them with things that maybe feel different after so when it does happen, it's not alarming. And basically provide education to the pregnant woman when they can get in and that can vary from six weeks

to five years postpartum about doing public floor physical therapy afterwards. Again, if there's more acute issues that happen during delivery, like women are in retention or they can't pee on their own um significant medical things, and we can help sooner rather than later in the postpartum period, but ideally after the six week check up with the o B which is now three weeks um. Women once cleared, can start physical therapy that soon. My observation is they're overwhelmed with

the baby, especially first time moms. Just know we're there when they're ready. Um. I think it's hard when they need weekly appointments and we're telling them more to do when obviously they have to care for another human. Yeah, and their weekly appointments are their first you know, they're with their pediatrician and it's all about the baby. And chaotic one are the different types of pelvic pain and

disorders that you treat. I think you've listed all of them, but in case we missed any real fun sounding ones. So pregnancy related. I mean, it's astounding because at eighteen months, in a very large study, there was still sixty of women who had painful intercourse, regardless of their method of delivery. So that's that's telling of what happens with post baby women were still in pain having sex. That's just a nightmare, and we have to help all those women. That's not okay.

I'm not down with that high percentage. And so even if there's non obstetric related disorders, we do treat a lot of painful intercourse. People can have provoked or unprovoked vaginal pain, clural issues, interlabial itching, rectal problems, urinary urgency. Frequency feels like it's an infection, when in fact it's the muscle. So you feel like you have a U T I or something and you don't something else going on,

often the cold floor, WHOA, what's the labia one? So interlabial itching is a common symptom that women can get or what's called unprovoked or provoked full of adinia, so women can have pain in that area. Also unrelated to childbirth, but childbirth can also provoke some of these changes that do need treatment. How do you how does some of the prolapse bladder or uterus or rectum, like can it be fixed through physical therapy or does everyone end up

having to have surgery? Or do you recommend if someone might have had a prolapse after baby one but they plan on having another baby, like what do you do? Good questions? So it can vary, And there's multiple factors that affect prolapse, including genetics, weight, other metabolic things, diabetes and whatnot. But the pelvic floor is a big one

and that's the one we can control. And so if somebody has impaired public floor muscle function and core function together, it's not just about the public floor um, they will be more likely to develop pro lapse as time goes on because the muscles provide some support to those organs, But so do the ligaments. And again we can't control

the ligaments. That's our genetic composition, but we can improve our public floor muscle function to kind of take up the slack of gravity of natural age related changes, etcetera. If a woman does have pro lapse immediately postpartum, it is not advised to have surgery until they are done having children, and so depending on the severity of it, like they skip. They score prolapse one to three, four and the most oversimplified version of this um categories one

and two. It can be helped with physical therapy Categories three and for mean that organs are coming towards the opening of the vagina or out of the vagina itself, and those are almost always a surgical situation, but can still benefit from getting as rehabbed as possible before and also addressing your function after, just like with any other surgery and any other part of the body, you want

to go into that as prepared as possible. I have a friend who had a prolapse, who has a prolapse bladder and and wants to have another baby, and she's been she did a lot of physical therapy, but was also putting around with like maybe a diaphragm or putting something up there that could hold her stuff in until I mean, is that a thing. It's called a pessary. Yes,

And so those are the classes. Over the counter now, poise makes am almost like a super tampon called the Impressive, which you can purchase over the counter that can help provide some support if it's a minor prolapse um and then a medical device called a passery is something that you're a gynecologist or euro gynecologists can fit to help

provide support to the organs. Once you take it out, the organs are going to come back down, but they can provide a basis of support while people are trying to either delay surgery or do other things in life. This is a really stupid question, but like, if you're having a pro lapse and your bladders like out, which I have another friend that that was the case, isn't there major risk of infection or like like if your bladders just hanging out of your vagina hole, like how

on like a cotton underwear is that dangerous. I've been doing this for eighteen years and I still don't think. I think the same way you do. I see every time I see a uterus on my table, I'm like that you see a uterus on your table, Yes, this happened that I'm literally losing it doesn't look like that's okay, but apparently it's kind of okay. I don't know. She's like, I'm sitting on my bladder literally like I have a

friend that it's coming out of for vagina. Really, you know, having a baby is so sucking crazy, Like this is crazy, like' literally having a conversation about carrying your bladder around outside your body. But like so that is that is the thing, and it and it's okay. It doesn't cause as much risk of infections as you would think. And even still I think it just does not look okay to me. And so usually we do advise that women wow sempressory

and work with their doctors about surgical intervention. What are some of the telltale signs that women might be facing post baby That would be like, okay, you you should go see you if you can't. Leaking urine is never normal but extreme you guys, yes, so if you maybe I think everybody should be evaluated. But I mean things like leaking normal leaking your may not be bothers them, but that's indicative that there's something wrong opposite. End urinary urgency, frequency,

diminished orgasm, painful sex, difficulty with bowel movements. All of those factors um can be addressed and not to mention the more simple things like hip pain and back pain and you know, sciatica. Some of the normal things. I feel like we haven't even covered. But those are things you guys cover. Two Yes, because psiotic. I didn't have that a lot during my pregnancy, but I heard about it constantly from all the women in my like yoga class or in my swim club, Like that is a

big trigger thing that a lot of women. It's like very debilitating, yes, because your publvic muscles start to get tighter as your ligaments loosen, and sometimes I can push on your sciatic nerve, causing symptoms down the leg and it's very painful and you can lose some motor control. So it's important to address it for the women like me.

While that singing continence is like, oh yeah, whatever. Like I was saying, I was on a I think I was at a holiday party and I got a little drunk and I was jumping up and down on a dance floor and every single time I jumped and landed, like a little bit of bee came out. And I was like, that's totally fine. I just had a baby. For those of us that are in a similar boat where you would think that's normal, you're saying that's not normal,

not normal, but very common. Oh but can't we just pretend it's normal so that I don't have to address it and I can just live and denial that everything is fine. We'll think about it this way. What if it continues to get worse? You're you're so right, and that's why we're doing an episode about this. Guys, you're going through a visit with me um so and also you would say similarly, anyone, thank god, this is not me. But people who are having pain during sex, even a

little bit of pain that is not normal as well? Correct? What are the kind of pains that women complain about during sex? Is it like a sharp like? Is it a burning sharp? What? What are we looking for here? Often it's often entry pain, which is like insertional pain for women. Either can be issues neuromas, things that the episiotomy scar, but also the second thing that's very important,

and we catch it in pulvic floor pt is. The doctors will often provide you with estras or a topical hormone to put on that bolvar vestibule air you a postpartum and many women actually don't use it. But if you continue to breastfeed, and you do breastfeed, then basically that tissue is essentially in menopause, and it will become frail and atrophied, and that topical is prescribed for a reason. But as one of my patients said, I couldn't even mean eat boloney when I was pregnant. Why would I

think I could put on a hormone? Good question, good point. But they do prescribe that for a reason, and often women are a little worried about it or they don't totally understand why they're getting it. But it's important to know that those tissues will respond to the lack of estrogen that's happening that allows a woman to breastfeed, and so that can be a major leading clause of pain within our course is drying and dryness. This is what

I heard mostly from just friends. We were all breastfeeding and and yeah, that was the room where I heard from most friends. Was like, oh, yeah, good luck, you're never getting wet. And I was like what. And they're just like your bodies in a metopausal state when you're breastfeeding, and so your body doesn't lubricate itself like it would or used to, And I think can be exercised visit. You may not talk to your doctor about that you're

thinking about a million other things. But ask your people should ask their doctors, and now it's safe to use, and then that can help during that breastfeeding period. Very interesting, So tell me the exercises that you, I don't know would like when people come and see you and you evaluate how they're doing. Then is it just tons of homework and daily practice? But is it now that we do kegles like I know we talked about eegles earlier, but would that be something you would suggest once someone

learns how to do it correctly with you? They it is, but it's not just the kegle in isolation. We want to make sure women can control the pelvic floor muscles. But then we actually are giving more individualized exercise based on their entire core and so some people have a strong transverse abdominance, other people don't, and so it's about lengthening all the muscles that are too tight and strengthening and a coordinated, correct contraction of the core muscles together,

which includes a pelvic floor. Especially in Los angele. Most people are active, and so what we want to do is incorporate specific exercises into their regular routines so they're not having to do with two in fifteen minutes is too much for some women. And so it may be doing a kegal when you're getting on and off the toilet, or when you're bending down to pick up your baby and standing up like things that you're doing already. We want to teach you how to incorporate safer biomechanics and

proper neuromuscular motor control. I was always told you P and then who tell these things I have learned from their moms? Is like so insane? But like you P and then just stop your P two or three times during a P session? Is that what is my face doing? Her face is looking at me like she is completely horrified. That is one way that I think inexperienced people told people how to kegal. That's not correct. You should never stop your hurine stream. It can lead to bladder infections.

Then you need to be on antibiotics, and you get a yeast infection, and now you've got bolvar pain. You don't want to do at There's other ways that told me that I don't know, but it was a rumor that I was doing for a little bit. It is definitely a popular rumor, So that is not it. What are the exercises that women can do on their own to help their pelvic floor pain and are there any products or aid other than the possibly for some people the lotion that you talked about. Yes, that's a that's

a prescription, prescription what you need. Um. I think there's a device out there that I personally I am a huge fan of. It's called the elv Yes, I just got it, guys. It came in a Mother's Day like swag bag that I got and I will report back

to you guys. It looks like a little vibrator thingy it does that goes in and what happens and and also what's interesting about it is it connects to your phone and it will basically I'm gonna start playing video games with your heelvet floor muscles using your elving on your phone. And what I like about it is it confirms that you're doing it properly, which is the number one reason why women don't do UK goals is because they're not even sure if they're doing them properly. It

will reinforce it you are. It will measure your strength, how fast you are, your control, and it will remind you that you need to do this over time, and you can actually document your progress. And so what you'll see with that is that you can also tell that your muscles are improving, your symptoms should be going down. And I think for a home tool that's really useful, So the LV And then and then also I got from a friend the Yoni egg. What it is? This

like whatever? Okay, So Stephanie's face is like, well, you don't need to hold a weight in your vagina for it to improve. It's really about neuromuscular control with your other muscles, and the idea of just squeezing independently around a weight for a period of time is questionable, and so is the cleanliness of that is there's been some debate about if it can actually promote or not. I have not tried the Yoni egg, but I have one next to my bedside. I think it's pink um. I

have to it. How do women feel about Like, see, I'm going to try to avoid this and not come to you because I'm going to be super embarrassed that I have to go and like have some person's finger in my vagina and like do exercises? How do you talk? Or yeah, like make women feel comfortable. Is it the kind of thing like once you get started, it's just not a big deal and women don't care or like or is it a really big hang up for some? Like I say, more often than not, it's not. I mean,

so many moms have already been through so much. We're not that different and we're not in big gyms. I mean, in particularly in our clinic, everyone is in a private treatment room. Um. I think hopefully that from the moment people call, our staff knows people are calling with sensitive issues, and so from the beginning, hopefully the education process starts to make people feel more comfortable. But it's really helpful

to know that you do feel nervous. And my question for you would be what can we do to make it easier? Thanks? Definitely, Well, I think I just have to bite the bullet and like do it, and I also have to kind of change my you know, what I think is so interesting about this work is that you know, we're raised your vagina is your your private part. It's like really like you know, sensitive and brings up

a lot of different feelings. So to come at it at a more kind of physical therapy way, which is like, no, this is a muscle that you need to take care of, like the other muscles in my body. Um, you know, I was all about when I was pregnant, Like you know, I was all about doing a million squats because I had heard that, like my legs were going to be so important during labor because they're my strongest mulse as I've got and I'm going to be pushing like crazy.

And it didn't even occur to me once that my pelvic floor was something that was going to take such a hit and was going to be something that let needed to be worked on. But yeah, I think it's like putting on my big girl pants and I just have to go. And after a minute, I'll tell you guys, and I'll be like, it was so not a big deal if it makes you feel any better. All the people that are pelvic floor physical therapist, how do you

think we learn on each other? Right, So, every time we hire a new employee, guess whose hands are in my public floor? Really yes, So hopefully that will ease it a little bit because we've all been through it and that's how they learn. And so and what's crazy really not that big a yeah? And also every single thing I felt with pregnancy you thought was a big

deal and then wasn't. Like I remember when someone was like, you have to get an internal exam and me being like, oh my god, this is gonna be so terrible, and they did, and I was like, Oh, that wasn't that bad. You know, it's almost so much bigger in my brain than when I do it. It's just not let's do some advice to expecting mothers that aren't having any issues, and let's talk, and then let's give some advice to

women who are having issues. So the expecting mothers, I think, just knowing this information, they may not feel normal at that six week check up or now three weeks, and that's typical. Their bodies go through a lot, both with pregnancy and delivery, and regardless of the time that they do come in. Once they do, I think that they can learn enough to make sure or that they are taking care of themselves for the rest of their lifespan

and just addressing issues that may arise very treatable. We try to make it functional, easily integrated into your life as it already is. We don't want to give you one more thing that's going to make you feel incompetent. And the one thing mom say often is that they just don't feel like, you know, they're doing as well enough job as they can. So our roles to set new moms up for success. This is like so mind blowingly helpful. I can't even thank you enough for being here.

And I'm going to keep all of you listeners have like so updated on my pelvic floor health in case you're interested in care. Thank you all my heart for being here and for being on Katie's Grip. Hello, Korea, Hello, thank you so much for coming on the show. Thank you for having This is, guys, my selfish attempt of just getting to hang out with Priya and ask her all the personal questions I want ask about my pelvic floor.

I'm so fascinated by this subject because the pelvic floor is like a whole thing that I never thought about before. It just got completely wrecked during childbirth. What is having a baby due to the pelvic floor muscles? Where do they go so during besides bye bye, besides totally different? Um. Yeah, So the pelvic floor muscles, as you can imagine, they're holding the weight of your tors so they're holding the weight of your organs. So when you have a baby

growing inside, they start to receive more weight from the baby. Um. So some of the things that can happen is the pelvic floor muscles can stretch out, um which is what causes you know, when people have pelvic floor weakness from them stretching out. And that can happen from the pregnancy. So even people who have c sections can have weakened

pelvic floor muscles. Interesting, even if they didn't give birth vaginally, your pelvic floor muscles and still be kind of blown out because you've been carrying around in some cases pound baby exactly, plus all the extra weight from your just gaining weight, gaining weight, all the extra fluids in your body from pregnancy. Um, So they can stretch out. They can also overtighten. Why can they overtighten? They'll get strong, they'll like tighten to try and hold more of the weight.

I don't know if you experience like tight glutes pregnancy, So that's the same kind of thing. The glutes are also holding the weight of your torso um so muscles will try and respond to the extra weight by tightening. So yeah, and there can actually be i um like what would be called like a muscle spasm which is basically where the muscle can't relax where it's overtight. That can happen to your pelvic floor. Yeah, oh why yeah, but that would also even though the muscles are holding

in are tight, it could come across. You could still be experiencing a pelvic floor weakness because if you think of like a scar tissue, scar tissue doesn't move, it's almost like it's like a spasm where it's overly tight tissue, and there's usually weakness in a place where they're scarring. So most people deal with incontinence in regards to the pelvic floor. That could also be UM pain with sex, so pain with intercourse, and that would be from the overtightening,

and that could both be UM. That could both be from the actual physicality of holding the weight and then the muscles overly tightening. It could also be holding emotional trauma. So as we all know, birth is a very intense experience, whether you have a c section or you know, pregnancy in and of itself is intense, So the tightening could also be or the pain could also be from an emotional holding on. Whoa, yeah, so that's why I can't wait to hear about how you treat all this up?

So would you say that there are women who are maybe more at risk for a pelvic floor disorder post birth than others? Like why do some women have? I mean, like you said, I think you've already listed and continents can happen because of emotional trauma and how you hold the baby and if you're tight or loose. But are there any preventative measures that women can take that would

have the outcome be different or maybe better? Yeah, I feel like the best thing is to exercise, you know, like weight bearing exercises are really good, Squats are really good. I'd say in general, people who have a more active lifestyle before they get pregnant or even during pregnancy, have a better chance of, um not having as many problems, but also being able to bounce back more like their body is already kind of accustomed to working out and exercising,

so it's easier to kind of get back into that. Um. It's a lot of points for working out, but it doesn't necessarily guarantee it. Like I've had clients before who are super in shape, who are really into exercise and still have issues afterwards. So you know, it depends a lot on also how the labor went. Um. You know sometimes if if you if you have to push and like get the baby out really fast, that could cause

some both trauma in the body and also more physical damage. Um. So that would be an example of like someone could be in really good shape but still have a problem. So it's kind of like birth where it's there's no really any guarantee, right, but you know, having a healthy lifestyle that's healthy and active is gonna you're gonna have better chances. I think we've all heard about kegel exercises

like our whole life. I mean, I love like, I've definitely been in classes though, prenative classes where women were like I have to admit, like I don't even know what the hell that is or how to do it. Um, just explain for people who are listening what a key goal is. Sure. Um, So they're part of the pelvic floor as the vaginal canal, which is where you have intercourse, and so there's muscles their circular muscles um, inside of the vagina. So a keegel is a traditional keegel would

be squeezing that muscle and releasing it. What about those eggs that people all, yeah, Yon eggs, the Yoni eggs. Yeah, you like put an egg of different sizes depending on how ripped and strong your vagina is, and you put the egg up there and you can hold onto it. Oh wait, wasn't this in that movie Fifty Shades of Gray? Doesn't she have to like he insert something and like walk around with it in dinner? I don't remember something like that. I'm pretty sure it was like, Yon, can

you explain what that is and doesn't actually work? Should I be doing that and it will help it? Not even tell me? Yeah? Well, I wanted to say with the yes you can. The Yoni eggs are good. I need to get it up there and it's gonna get lost forever. Okay. Then there are ones that have holes in the bottom and you can thread like um strength tamper it, or you can stread thread like a piece of floss or something like that. Yeah, so you could pull it out missing make it hang out. Um so, yeah,

the Yoni eggs are really good. One of the reasons they're good is because, like you're saying, she had to walk around with it, you can walk around with it and your muscles are going to be grabbing onto it

without you having to think about it. So that's one thing that's good about the Yoni eggs um, whereas so the I think the reason why people have such a hard time with the key GOLs is because it's not that you know, you can say like, oh yeah, squeeze your vagina, but most people, the pelvic floor is such a it's like a whole landscape world of its own um.

Which is some of the work that I do. I take people more deeply into being able to not just squeeze your vagina and let it go, but to be able to to feel muscles in different parts of the pelvic floor, which I call pelvic floor mapping, and it's every you know, every place that you're able to find, it's a different it gives kind of different feeling through your body. So and it's you have to take people into a very deep like it's a it's a strange place to feel. It's not just like it's not just

like feel your elbow. You know, it's really deep in there, and people don't usually spend time thinking about it feeling it. And on top of it, there's tons of people have tons of shame around that area, you know, shame, embarrassment, or whatever. Luck people store all sorts of stress feeling stress in the area, so it's a it's a difficult place for people to go, which is why you know when someone just says, like do a key goals? Like

what is that? Like? You can't just oh, let me just move my a lot about the work you do? Which is you do? How would you phrase it? Is it? Is it it's a holistic approach to pelvic floor health or yeah, yeah, I would say it's an embodied approach. It's a it's a mindful approach. So at what point does a woman make an appointment to see you? Generally speaking? Like, do most blumen come to see you when it's too

late or no? I mean I have women who I work with who are like in their fifties and sixties and even you know, Um, but most people come to me sometime in they're like early postpartum time. Um. I've had someone come to me four days after their labor, which is fine. Um, this woman in particular was like the worst incontinents case I've seen where she had to wear diapers, Like every time she stood up, it was just he and she. She's gotten it back, She's gotten

it back. I worked with her regularly for maybe three or four months, and she was like back to wearing a thong. So what would happen, for example, at a first appointment? Take me through like her story? Like what do you do when you see a first appointment, you know, someone who has never been to you before? Like, yeah, I do an intake so I find out kind of what they're story was? What are their issues? Um? I

asked questions to find out whether there's um overtightness or weakness. UM. So like painful sex, if someone's having painful sex or just pain in general, Um, I would you know, diagnose them more in that they're overly tight and they need help with the relaxation side of things. Um. If someone's having issues with incontinence or any kind of like back or hip pain, then they're going to need more loose strengthening side. And then what would you do for either?

Like what are the techniques during a session with you where people are what would you do for a tight case versus a loose um? For I mean a lot of the exercises are similar because I emphasize both the squeezing the tightening of the muscles and the relaxation. Um. But with someone who is overly tight, I might just focus on the relaxation side, so I wouldn't bring them into the contraction contracting the muscles until maybe later on. Um. Sometimes you know, it's like when you work out and

then after words you're able to rest more. So sometimes even with the tight, with the people who are overly tight, it's like, okay, well, I'm gonna work with the with the contracting of the muscles, just so that you're able to feel the other side, which would be the letting go. But when you say, like work on it, what does that mean? They're like laying on a table. So how people lay down? Um, I always start people laying down

because it's easier to feel when you're doing less. So if you think about, um, you know, you're like rushing to get out of the house and like you're more likely to drop things and stub your toe or forget something, forget something. But when you start overly doing or overly working, you're not as aware and you can't feel yourself as much. You know, you might like hit your hand on the wall or you know. Um, So it's the same thing with our body is the more you can let go

and do less. The more you can feel inside of your body, which is one of the you know, if you can feel an area of your body, you can work, you can learn to use the muscle in the area of your body. So you have them laid down and then um, it's different exercises, but I first always guide

people into a state of relaxation and feeling their breath. Again, like with the where you can feel your breath in your body, you can also feel more, especially in our torso I mean it's like, well, yeah, I can feel my toe or whatever, and I don't necessarily I'm not necessarily breathing into my toe right now, But like in the belly and in the pelvis, particularly, if I can get people to start breathing into that area and feeling their breath in that area, then there's a heightened sensing

and a heightened awareness, which then means that they have more access to those muscles, both relaxing them and contracting them working them. So what do you do that's different is different from a traditional physical therapist. So I take people more into a meditative um being able to guide themselves in feeling and sensing and working their muscles. From a place of embodiment. Do they do like reps? Like you're literally like counting how many times? I don't count.

I usually will with different people. I'll do it until I sense that they're um getting it, So repeat, repeat, repeat, until I can feel that their body is actually getting what's happening. I also do a lot of verbal check in because it's such a like, you know, I can't see their pelvic floor working, So I be like, okay, I'll ask part you know, how did that feel? What? Like what were you able to feel? Um? Does do you feel your muscles? Also? You know cues in the

body of like did you feel any warmth? Do you feel tingling? Do you feel a lot of times when people use their muscles, it's just like a feeling of spaciousness in that area. Um, But I don't know if you experienced this after birth, but a lot of women have like really no sensation down here, like kind of

a loss of or like almost like an empty feeling. Oh, I don't even like I wasn't even alive, like I just I mean, I was like in a diaper, uh spring witch hazel on my vagina, Like I don't even know, Like and I was waddling around and I was sitting on like a doughnut, like it was horrible, and like nobody told me. I mean maybe they did it. I just didn't listen, but like, oh my god. All I

can remember is I had given birth. And it was like maybe an hour later we had had the Golden hour at theaters where I had like skin to skin time with my son and my husband did and then this lovely nurse like came and stood me up and started walking me over to the toilet, and I just started peeing all over the floor like I didn't even make it there. She was like, wait, wait, wait, we have to put in like a bucket thing or something.

And I didn't make it there. I just started peeing everywhere. Um, and that's what I was like, oh my and I couldn't feel anything. And I don't know if that was the a dural or whatever it was, but I couldn't feel anything. And I and then you are. And then I continued being on the toilet and then this lovely lady just started spraying down my private parts with water because you can't wipe, and I was like, what's your name? So, yeah,

how long do you typically work? With a patient like how long I mean you said you're your worst case, like in four months you could even see some sort of And how often were you seeing this person? Like how often is it once a week? Because it will see people once a week? Yeah, I do, UM, I have I do have people who I see twice a week. Um. A lot more improvement happens when I see people twice

a week. Yeah. But I find, you know, with the postpartum schedule and you know everything, it's for people once a week even sometimes once a week. It's really difficult with you know, breastfeeding and everything. So UM, I recommend twice a week if you really want to get you know, because also it's hard to practice things on your own, anything like any kind of discipline. With doing a new practice, I find it's difficult without having someone they're telling you

what to do and holding the space for you. But how long there is an appointment and then there's going to be check in time like okay, what's going on? What did you do last week? What are you anything that's changed? You know? Um? And then time for practicing and doing repetitions, and then based on where your progress is, I'll add more. Um, you know, more exercises. How did you get into this? Like what this is? So? Like? How did you get here? Um? I kind of don't

even really know. No, I am did you have your own public floor? No? No? Um, so I let's see my whole life. I've been very embodied, very into my body, feeling my body. I've always been a dancer and um, when I moved to l A, I was intensity studying yoga and tantra um not the kind of like tontra that you think of, like you know, it's like a class about having sex. But that's exactly where learn to have really good sex now. But it does come with

pelvic floor health, doesn't it. It It does. That's the benefit of the pelvis. If I go around with a Yoni egg and my pelvic floor muscles get really strong, like I'm going to have better orgasms? Is that just fact? Yeah? Well the thing is so if you think about what I've got here, it's true. Yeah, I mean definitely for sure, Yes, for sure. I mean I've had people who you know, I'm working with them on other things like in continents and also and they're like, oh my god, I was

so not interested in having sex with my husband. And then like we had the best sex ever, like you know, so it happens, it's so collected. Okay. So that reason being is that you're bringing by doing the exercises, you're bringing more blood flow into your pelvic floor, into your vagina, and so basically rectile tissue, like when tissue becomes erectile, either the cltterest the clarter ist becomes erect or the penis obviously there's more sensation in that area erectile. All

that is is there's more blood in the tissue. The tissue gets erect from blood flow. So if you're having more, if you're able to circulated are, then you're going to have more exactly. So Okay, you studied, Okay, back it up, we're not talking about tantra sex. What are we talking about? UM? Talking about traditional like very tantras are really it's one of the first religions from South India and so the

very old old practices which are based in UM. I mean, obviously it makes your connection with another person or your sexual connection with another person better, but the focus of it being to learn how to circulate energy in your body. UM, how did become that you specifically moved into pelvic floor.

So while I was doing that training, which I went to India twice for and studied up you know, the ostram with the guru and you know, learn all these exercises that are you know, learned a lot of learned exercises for doing UM basically what someone might call what I what are my version of a keegel, but they're much deeper and more deeply sensed, so not just like squeeze, really squeeze realized, like not really thinking about it, but really using the breath UM in coordination with the squeezing

and finding the different parts of the pelvic floor UM. And so in conjunction, what I was doing at the same time was I did a dula training UM, so

I started assisting women through childbirth. This is such a I feel like one of the many topics that women feel like embarrassed, ashamed, UM, uncomfortable to talk about A. Is there any advice that you have for women and how to talk about this stuff and how tom I'm assuming it's all connected like that if you feel shamed, you're probably it's going to be a harder road to get better, because it's sounding like the holistic approaches that

it's all super connected. Is there any advice that you would give to women who are struggling with incontinents who may not even have babies yet, or struggling and haven't seek out help. The biggest thing would just fed to know that you're not alone and that it's very common. And yeah, I mean, if you're having a hard time talking about it, I would say, like, find another woman friends to share with about first, just so like you know, I think that for men because they don't usually I mean,

some men do have pelvic floor issues. That's definitely not un you know, unseen, but I think women experience it more more regularly, sure, And so finding a close friend that you can talk to about it just to start kind of sharing and getting it. You know, sharing helps so much, being able to talk and have someone listen. Do you find so much mental Like you said, the shame part that it can be super connected and that's why you have to get them to a meditative state

is a lot. What you do is sort of therapy sometimes I do. It depends on the degree of openness that the person has. I do find that people who um can share more about what's going on will heal more.

Quickly because it's like every it is so connected, and so if you are kind of putting your physical symptoms separate from your emotional experience, um, it's like you're you're more disconnected inside of yourself, Like you're kind of creating a disjointedness and so not that you have to be like, oh my god, I'm having these issues because I had

this feeling. You know, you don't have to like over dramatize it, but UM, I find that if people are more comfortable just like, oh, yeah, this is being honest with themselves, like this was my experience, or this is how I'm feeling, or I'm feeling horrible about this, or I feel really regretful that this happened, or you know that that you're going to have an easier time healing because you're not bottling everything up inside. Yeah, what are

the exercises that you recommend people doing? So I always work with the first thing I always work with people on is breathing into their belly and learning how to do uh what I call belly breathing or diaforgmatic breathing. UM. So people breathe up into their chests and do very shallow breathing. So I first teach people how to breathe into their bellies and then use their abdominal muscles to exhale, to like press their breath out. So you're both using

the abdominal muscles. You're also strengthening the diaphragm um with just a muscle that's the primary muscle for your breathing sits right underneath your rib cage. Um. You start there, start there, and that exercise because you're using your abdominals to exhale and really working up towards strongly using your abdominals to exhale um, those muscles get strong. The abdominals get strong without doing sit ups, So when you have diathesis, you don't want to do sit ups or any kind

of crunches. It makes the separation worse. UM. So by using the valley to breathe, you're you're strengthening the abdominal wall, the transverse abdominous muscles um, which helps bring the rectus abdominus closer or the six pack muscles closer together to heal the game. By doing that breathing, you're you know a lot of times right after labor, even if someone's had a baby years before um. A lot of times people can't feel their breath, like kind of pass their ribs.

So I start by helping people get their breath lower and lower and lower until they can start to feel their breath and they're actually in their pelvis or in the pelvic floor. Whoa. And then once you can feel that kind of expansion, so I think again of the jellyfish, the expansion of the breath and the pelvic floor. Then from there, it's like when you exhale without even contracting, like you could try it right now, when you exhale, you generally feel kind of like everything sinks or comes

closer together. Ye. Yeah, and that's the beginning of a contraction. So contract actually means to squeeze, right, you do gentle like breathing, opening up your pelvic floor, and then as you exhale, you let all the breath go, including down there, so then it comes and starts to come back together. And then once you can start to feel the everything kind of coming closer, oh, that's the beginning of the contraction.

So then from there begin to squeeze, and you want to hold that squeeze through your whole exhale, and that's doing it right now, guys doing it right now. So learning to um doing these kinds of exercise, and you know,

and that's kind of the basic. Then I'll work with different areas of pelvis, so more in the back muscles of the pelvic floor, the vaginal muscles, and then up in the front by the pubic bone or around like the clutters, because they're all different, and yet here we are like I can't feel the difference, really, you know what I mean? For me, I'm I'm definitely one of those cases of a person who's like, oh, it's just squeeze, release, squeeze, you know, like it's not like varying areas of stuff

down there. You know. I just got my first period back after having a baby, which because I've been breastfeeding, your body goes into a menopausal state and you don't get your period for a long time. So I'll be's almost eight months and I just got my first period. So it was my first time I ever like using a tampon um, which I was so scared to do because my group of mom girls, um my swim club, they all are there, my group of mommies, and they were all saying, oh God, wait till you get your

first period, it is not fun. And they allowed them had already gotten it, so I was like ready and I got it. And I have to say the tampon was fine, but I do think something might be happening in the pelvic floor because I was walking around with it and it was like kind of falling out and I've never had that happen before. Is that a thing? I mean, yeah, great, Like I remember walking like halfway down the street and being like, oh my god, I think my tampon is like halfway out, and I know,

like I put it in really well. But so is that a case of like your pelvic floor muscles are not able to hold up because of the trauma, stretched out, not necessarily from the trauma, but they're some more stretched out and they're not like holding squeezing it. Except when I have sex with my husband he says it feels

the same. I'm just going on records saying, well, that's great, And I asked the vagina is a mystery, you guys, It is really insane, Like I don't so, but what you could try is, have you ever heard of the Diva cup? Explain this to me. So it's a little like silicon cup that you put up there period, right, So it's like round, like you know, maybe like an inch diameter, and you fold it in half and hold it again and then you vagina and you make sure there's like a section so that it's you know, um.

And they have different sizes, so they have a size for um before you've had a baby and then for after you've had a baby. And the one that for after you had a baby is bigger because the vagina is bigger. I don't know, maybe maybe, And and you know, it is a vaginal canal, so there's different parts of it. There's the opening, there's the middle, there's the backup by your cervix. Maybe Adams just trying to be so well no,

I mean it could be it could be more. It could be more open or tight in different parts of the vagina. And maybe that's what he's feeling, and that maybe like more the opening of your vagina. Everyone's loving this diva cup. Yeah, so you put it up there and it holds your period. And then do people who come to see you are some of them in pain when they have to insert tampons? Is that? Oh my god?

Being a girl is so insane. I mean, I'm sorry for the few men that you also see that have problems, but it sounds like it's mostly women, and it's just yeah,

it's like it is insane. Yes, Like I can't tell you how many times it happens to me now where I if I feel a sneeze coming on and I haven't emptied my bladder in like a little bit of you know, like I p every one or two hours whatever, But like if I if it's you know, been three or four hours, I'm gone to bathman I sneeze, Like, I definitely p a little bit and I definitely have

to go change my underwear. Like what a bummer. And I'm not even and I think I want to have another kid maybe, so like what, oh, that's a good question. Is it worth getting it back before you're thinking about having another baby or is it just like blow the whole thing out and come see you later. It's kind of you know, it's kind of like for the women who are more physically fit, they're going to have an easier time afterwards. So it's the same thing you want

to work to get it. I mean, unless you're having kids, like right off the after the other, it's better if you work on strengthening before you have another baby. Um. Generally it's more difficult after a second baby. It's just you know, more stretching more. So it's better if you can do some work on it before having a second baby. So fascinating. Are there other things that you recommend besides

the Yoni egg that like? Um, I tell people to practice so with the you know, we'll work with the different areas of the pelvic floor, but when we're working with the vaginal canal, I work with feeling being able to squeeze in the different parts of the vaginal canal, which for most people is really really difficult to feel. Um, the opening okay, by your cervix, you know, it's it's challenging.

And so what I tell people to do is to get some kind of a dildo or like a wand they have really nice you know, like you get like a crystal want you know, so to you is that just insert it and then squeeze against that to be able to feel the different like, okay, now I'm squeezing this wand towards the top. Now I'm squeezing it towards

the bottom, and is there even a middle? Good Lord, I mean exactly, and people can do that, yes, yeah, I mean that's how I started learning all this stuff because that was what that was one of my that was one of my country yoga exercises. So um yeah.

And the reason being it's like, you know, you can do air push ups right, or you can do like a push up against the wall or the floor, and you're going to feel your muscles a lot more when you have that resistance suppress against the same thing inside of your vagina, which is even even if you're not working on trying to find the different locations, even just to field the squeeze, that's going to help. And you're like, oh, I can feel my vagina squeezing because I can feel

it pushing against something. Yeah, so that helps build your muscles strong, like you're going to have a little bit quicker of a of access rate with that. So that's one of the things I tell people to do. There's also um the LVY. It looks kind of like a unique I mean, it's not like a stone, but it's around thing that you put inside and it has an app where you can test, like it'll test like your

strength level. Is there any other things you want to touch upon or yeah, I mean, I would say, just started talking about it with your friends, like, just get the conversation going. And because we are not alone. You're not alone and you know it, and and there was a lot of women don't even know yet that there's people that they can see and exercises that they can do. And if your girlfriend hasn't experiences, she's not, I'm sure

she'd be interested or probably knows other people. So I would just encourage everyone to start talking about it and sharing. And the more you talk, the more you know, the more that collectively people can get help and heal and not have to live their lives paying in their pants. Yeah, having pains and enjoying sex more, enjoying sax feeling actually you know, just helps with connectivity to yourself feeling more.

You know, you put so much energy into your baby, it's like it's a it's huge self care and giving your own body attention that your body really craves and needs. So amazing. Thank you so much, thank you. That's all we've got for you for this episode. I can't wait for you guys to hear what's next. Thanks for listening to do I do watch watch wat