Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / It’s Never Too Late for Pelvic Floor Therapy: Why it’s about more than Kegels

Transcript

It’s Never Too Late for Pelvic Floor Therapy: Why it’s about more than Kegels · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:01
  Speaker 1: This is parent data. I'm Emily Oster. Look at this,
• 0:06
  Speaker 1: the kegel Master. What's a kegel muscle? It helps you
• 0:09
  Speaker 1: stay tight down there?
• 0:11
  Speaker 2: And I have one. If you have to ask, you
• 0:13
  Speaker 2: haven't been doing your exercises. What exercises?
• 0:17
  Speaker 1: All you have to do to stay tight is to
• 0:19
  Speaker 1: tighten and release it for ten minutes a day, cagel exercises.
• 0:24
  Speaker 1: I'm doing mine right now.
• 0:27
  Speaker 3: Man, She's good. My first exposure to the kegel exercise,
• 0:38
  Speaker 3: like many women of my age, was in Cosmopolitan magazine,
• 0:42
  Speaker 3: where I was promised that.
• 0:43
  Speaker 1: Doing keegels religiously was the key.
• 0:46
  Speaker 2: To great sex.
• 0:48
  Speaker 3: At the time, I was a decidedly not sex having
• 0:51
  Speaker 3: high school student, so I promptly forgot about them. Keegels
• 0:55
  Speaker 3: then came roaring back during pregnancy, where they promised to
• 0:59
  Speaker 3: preserve my pelvis floor for a great sex later, along
• 1:03
  Speaker 3: with improving my birth experience. Interestingly, in all this discussion
• 1:08
  Speaker 3: of this exercise, no one ever told me about what
• 1:11
  Speaker 3: these exercises were doing or connected.
• 1:13
  Speaker 1: Them to my pelvic floor.
• 1:16
  Speaker 3: I'm not sure I was entirely clear on what a
• 1:18
  Speaker 3: pelvic floor even was, which is why I am delighted
• 1:22
  Speaker 3: that Instagram introduced me to a woman dancing in a
• 1:25
  Speaker 3: volva costume. The vagina whisper Doctor Sarah Reardon. Sarah is
• 1:32
  Speaker 3: an expert in the pelvic floor, and it's safe to
• 1:34
  Speaker 3: say her knowledge goes way beyond Keegel's. The pelvic floor
• 1:38
  Speaker 3: turns out to have a hand in many things, peeing, pooping, sex, pregnancy, labor, birth, postpartum, menopause, etc.
• 1:46
  Speaker 3: Sarah explains all of this online and now in her
• 1:49
  Speaker 3: new book Floored, A Woman's Guide to Pelvic Floor Health
• 1:53
  Speaker 3: at Every Agent Stage, which will be released in June.
• 1:57
  Speaker 1: There's a pre order link in the show.
• 1:58
  Speaker 3: Notes, and seriously, people, this one you have to buy.
• 2:03
  Speaker 3: Today we talk about the book and about the seasons
• 2:05
  Speaker 3: of life with the pelvic floor, from puberty to menopause.
• 2:09
  Speaker 3: We spend quite a lot of time on the optimal
• 2:11
  Speaker 3: ways to pee and poop, and discuss what actually happens
• 2:14
  Speaker 3: when you go to pelvic floor therapy. We discuss keegels
• 2:18
  Speaker 3: and why they are often good but also not a
• 2:21
  Speaker 3: panacea for me. Sarah is special because she does an
• 2:28
  Speaker 3: amazing job shining a light on something which affects everyone
• 2:32
  Speaker 3: and something we ignore because we just don't see it.
• 2:36
  Speaker 1: So here we go.
• 2:38
  Speaker 3: Sit back, relax, do a few keegels if you wish,
• 2:42
  Speaker 3: and let's go.
• 2:44
  Speaker 1: After the break.
• 2:45
  Speaker 3: Doctor Sarah Reardon, Sarah, thank you so much for joining me.
• 2:59
  Speaker 3: Hey a link, great to be here. So we're going
• 3:02
  Speaker 3: to talk all about the pelvic floor today, and I
• 3:03
  Speaker 3: would encourage people to stick around till the end where
• 3:06
  Speaker 3: we're going to talk about why I think about you
• 3:08
  Speaker 3: every time I pee.
• 3:09
  Speaker 1: I don't want to spoil that for people, but it
• 3:11
  Speaker 1: will come up.
• 3:12
  Speaker 3: But before we get into any of that, could you
• 3:15
  Speaker 3: start by just telling us who you are, where you're
• 3:18
  Speaker 3: coming from, a little.
• 3:19
  Speaker 1: Bit, what you do.
• 3:20
  Speaker 2: Absolutely.
• 3:21
  Speaker 4: So, I'm doctor Sarah Ordon. I'm a board certified pelvic
• 3:23
  Speaker 4: floor physical therapist. I live in New Orleans and I've
• 3:26
  Speaker 4: been practicing as a pelvic health PTE for seventeen years.
• 3:30
  Speaker 4: I have a social media presence as the Vagina Whisper,
• 3:32
  Speaker 4: where you'll occasionally see me again showing folks how to
• 3:36
  Speaker 4: pee and educating you while I'm in a Volva costume.
• 3:40
  Speaker 4: And I'm the recent author of a new book, Floored,
• 3:42
  Speaker 4: a Woman's Guide to Pelvic Floor Health at Every agent stage.
• 3:46
  Speaker 1: Which is fantastic.
• 3:48
  Speaker 3: Okay, So I want to start with why you love
• 3:51
  Speaker 3: the pelvic floor so much, and why you chose this
• 3:56
  Speaker 3: part of the body. Where does your passion for the
• 3:59
  Speaker 3: vulva and pelvic floor come from?
• 4:02
  Speaker 4: So I started in this field immediately after grad school
• 4:05
  Speaker 4: in two thousand and seven. I went through regular pelvic
• 4:08
  Speaker 4: floor physical therapy school and thought I was going to
• 4:10
  Speaker 4: be like a trainer for the New Orleans Saints football team,
• 4:13
  Speaker 4: and just was really into sports and activity. And during
• 4:17
  Speaker 4: my grad school education, we had a professor who taught
• 4:22
  Speaker 4: us about the pelvic floor. It's like a two week stint,
• 4:23
  Speaker 4: and I was like, Huh, this is really interesting to
• 4:26
  Speaker 4: learn about this part of my body that I never
• 4:28
  Speaker 4: knew that I had. That everyone has all genders, males, females, everyone,
• 4:33
  Speaker 4: and it's super important, like every time you pee, your
• 4:35
  Speaker 4: pelvic floor is activating, every time you have to pass gas,
• 4:39
  Speaker 4: it's relaxing when you birth, when you run, And I
• 4:42
  Speaker 4: really just loved learning about my own body as a
• 4:44
  Speaker 4: woman and thought everybody needs to know this information. It
• 4:47
  Speaker 4: seems pretty important. And right when I started my career,
• 4:51
  Speaker 4: I jumped right into it in my first job in Austin, Texas,
• 4:54
  Speaker 4: and since then have just I've worked with tens of
• 4:57
  Speaker 4: thousands of patients, I would say, and it's just an
• 5:00
  Speaker 4: incredibly rewarding feel to educate folks about their body and
• 5:03
  Speaker 4: help them prevent issues which are super common yet so
• 5:06
  Speaker 4: rarely talked about.
• 5:08
  Speaker 3: It seems like one of the things I get out
• 5:10
  Speaker 3: of your book is this feeling of some of the
• 5:13
  Speaker 3: time when you tell people things, it seems like magic,
• 5:18
  Speaker 3: like they didn't know a whole area was unknown, and
• 5:21
  Speaker 3: then you can explain something which somebody was struggling with
• 5:25
  Speaker 3: or was painful, or just you illuminate in a way
• 5:28
  Speaker 3: that I'm not sure we get, you know, with dentistry
• 5:31
  Speaker 3: or something, since we all know we have teeth and
• 5:33
  Speaker 3: right things like that.
• 5:34
  Speaker 2: Well, I think that's one of it.
• 5:35
  Speaker 4: You can't see the pelvic floor, so it's hard to
• 5:37
  Speaker 4: even see, like or imagine what is it, what is
• 5:40
  Speaker 4: it doing? It feels very mystical, yet it's super important. Again,
• 5:44
  Speaker 4: it plays this role in peeing, pooping, sexual health, reproductive health, pregnancy, birth, menopause.
• 5:52
  Speaker 4: So there are so many seasons and stages of life
• 5:55
  Speaker 4: where this, you know, this group of muscles is you know,
• 5:58
  Speaker 4: very much impacted, sometimes transformed, and you know one in
• 6:03
  Speaker 4: two women will have a pelvic floor dysfunction later in
• 6:05
  Speaker 4: the later years of life. I'm like, why aren't we
• 6:07
  Speaker 4: talking about this more and giving people tips to prevent
• 6:10
  Speaker 4: these issues.
• 6:11
  Speaker 2: Down the line.
• 6:13
  Speaker 3: So for those people who are listening now and thinking, wait,
• 6:16
  Speaker 3: I also don't know where my pelvic floor is, let's
• 6:18
  Speaker 3: do like a very quick one oh one, Like when
• 6:21
  Speaker 3: you talk about the public floor, what is the muscle
• 6:23
  Speaker 3: group you're talking about?
• 6:24
  Speaker 1: And how would I know that I had one?
• 6:27
  Speaker 3: So?
• 6:27
  Speaker 2: Well, everybody has one, so we'll start the back. You
• 6:31
  Speaker 2: have one, okay, Beck, you have one.
• 6:33
  Speaker 4: So I would say, if you're sitting right now, I
• 6:34
  Speaker 4: want you to or standing. I want you to put
• 6:36
  Speaker 4: your hands on your hips and you can feel those
• 6:38
  Speaker 4: little hip bones that we often feel and we're used
• 6:41
  Speaker 4: to seeing on.
• 6:41
  Speaker 3: Like a I want the listeners to know that both
• 6:44
  Speaker 3: Tomorrow and I are doing this right now, right right,
• 6:46
  Speaker 3: go ahead.
• 6:47
  Speaker 4: And you're used to seeing on like your skeleton. Jammi's
• 6:49
  Speaker 4: for your kiddos, and that's your pelvis. So your pelvis
• 6:52
  Speaker 4: is a ring of bones that you know attaches in
• 6:56
  Speaker 4: the front at the pubic bone, in the back, at
• 6:57
  Speaker 4: the sacred table at the very bottom of that. Imagine
• 7:00
  Speaker 4: this hammock of muscles. So I want you to think
• 7:03
  Speaker 4: about what you would do if you had to stop
• 7:05
  Speaker 4: your urine stream. You tighten a little muscle down there,
• 7:08
  Speaker 4: like you're trying to kink off your urine stream, or
• 7:11
  Speaker 4: if you have to pass gas and you're in an
• 7:13
  Speaker 4: elevator and you're like, oh, squeeze it right. Also, my
• 7:17
  Speaker 4: favorite way to cue people to do this is to
• 7:19
  Speaker 4: take a big, deep breath and then on the Xdale,
• 7:21
  Speaker 4: think about sipping up a smoothie with your vagina. So
• 7:25
  Speaker 4: I'm like, who does that? Every patient of mine imagines it.
• 7:28
  Speaker 4: But when you think about that sipping up maneuver, it
• 7:31
  Speaker 4: activates those pelvic floor muscles. And again, Emily and Tomorrow
• 7:35
  Speaker 4: are both doing this as we're talking, and you get
• 7:38
  Speaker 4: that like, oh, there's something happening down there, and that's
• 7:41
  Speaker 4: your pelvic floor muscles. So it's a way to kind
• 7:44
  Speaker 4: of just start connecting with them. But everybody has them,
• 7:48
  Speaker 4: and again, there are different seasons of life they're affected,
• 7:51
  Speaker 4: and there's just day to day stuff that they do
• 7:53
  Speaker 4: to help us function.
• 7:56
  Speaker 3: So let's talk about a little bit of that day
• 7:57
  Speaker 3: to day stuff before we get into these seasons of life.
• 8:00
  Speaker 1: So the pelvic floor when one is peeing.
• 8:03
  Speaker 2: What is it doing.
• 8:05
  Speaker 4: It's holding p in your bladder so that you don't
• 8:08
  Speaker 4: leak ideally, and then when you sit down to pee
• 8:11
  Speaker 4: again I encourage sitting, not hovering over a toilet, unless
• 8:14
  Speaker 4: it's like super growth. But when you sit down to pee,
• 8:17
  Speaker 4: it relaxes, so the muscle relaxes, and then your bladder
• 8:20
  Speaker 4: pushes the p out for you. So it's helping. You say,
• 8:22
  Speaker 4: what we call continent, which is the ability to hold
• 8:25
  Speaker 4: in urine, and the same thing for pooping. It holds
• 8:28
  Speaker 4: in poop as your rectum fills and your colon fills
• 8:31
  Speaker 4: with waste. And then when you sit down ultimately ideally
• 8:34
  Speaker 4: with a squatty potty or a little poop stool under
• 8:36
  Speaker 4: your feet, you can relax your pelvic floor muscles aka
• 8:40
  Speaker 4: your buttthole, and then you can empty the tank.
• 8:43
  Speaker 1: Okay, so let's talk about pooping.
• 8:47
  Speaker 3: You are online, you show us the use of a
• 8:49
  Speaker 3: squatty potty very frequently.
• 8:53
  Speaker 1: I have a squatty potty. Can you explain why this is,
• 8:57
  Speaker 1: what that is and why people should have one?
• 9:00
  Speaker 4: So, a squatty patty is the designer name for these
• 9:03
  Speaker 4: poop stools, and it's really just a stool you put
• 9:05
  Speaker 4: under your feet. You can use a toddler stool, you
• 9:07
  Speaker 4: can use yoga bot blocks, you can use an old
• 9:10
  Speaker 4: Amazon box.
• 9:11
  Speaker 2: I don't care what you use.
• 9:12
  Speaker 4: But the goal is to get your knees above your
• 9:14
  Speaker 4: hip level. So when you're sitting on a regular toilet,
• 9:17
  Speaker 4: your knees are kind of in line with your hips.
• 9:20
  Speaker 4: If you elevate your feet, then your knees go up
• 9:22
  Speaker 4: and it helps your pelvic floor muffles relax. So squatting
• 9:26
  Speaker 4: is the best position to relax your pelvic flore muscles
• 9:29
  Speaker 4: for pooping. So think about if you're in the woods,
• 9:31
  Speaker 4: or if you're on a runway out in the forest,
• 9:34
  Speaker 4: or you're camping, you squat over the ground, or other
• 9:39
  Speaker 4: Eastern countries you squat over the ground to poop. It's
• 9:42
  Speaker 4: the physiological way to have a bomb movement that's best.
• 9:46
  Speaker 4: What's happened in the Western world is we have these
• 9:48
  Speaker 4: porcelain thrones that are indoors and they're comfortable, and we've
• 9:51
  Speaker 4: got heated bathrooms, and so we've kind of moved away
• 9:54
  Speaker 4: from the physiological way to poop, and now we have
• 9:57
  Speaker 4: to recreate that with a pooping stool under your feet.
• 10:01
  Speaker 3: Is it a good idea to pee with a squatty
• 10:04
  Speaker 3: potty or is that not as important.
• 10:07
  Speaker 4: It's not a bad idea, but it's not a must.
• 10:09
  Speaker 4: So it's really just the butthhole muscles that relax best
• 10:13
  Speaker 4: with squatting. You can use a squatty potty when you pee,
• 10:16
  Speaker 4: but you can also just like sit with your feet flat.
• 10:18
  Speaker 4: That's a great question.
• 10:20
  Speaker 3: I think we should get into a little more about
• 10:23
  Speaker 3: peeing also because I feel like this is the segment
• 10:25
  Speaker 3: of the podcast where people, I.
• 10:26
  Speaker 1: Guess you get a lot of takeaways.
• 10:28
  Speaker 3: Uh okay, So every time I sit down to peanout,
• 10:31
  Speaker 3: I think to myself, don't push the pee out?
• 10:34
  Speaker 2: Because this is a big.
• 10:35
  Speaker 3: Thing in your book, can you please tell people why
• 10:38
  Speaker 3: they should not be first of all, what does that mean?
• 10:40
  Speaker 2: And why should they not be doing that?
• 10:42
  Speaker 4: You know, this is music to my ears because that's
• 10:44
  Speaker 4: a big takeaway from the book is don't push when
• 10:47
  Speaker 4: you pee.
• 10:48
  Speaker 2: I call it power peeing.
• 10:49
  Speaker 4: And we are as busy women, as moms, as parents,
• 10:54
  Speaker 4: as working women, we are notorious for power peeing.
• 10:58
  Speaker 2: The reason you can God so fast?
• 11:01
  Speaker 1: Okay, anyway, go ahead, It's.
• 11:03
  Speaker 4: True, right, we like are trying to rush through everything,
• 11:05
  Speaker 4: including peeing. So when you pee, you really just need
• 11:10
  Speaker 4: to sit and chill because your bladder is the muscle
• 11:12
  Speaker 4: that's pushing the pe out. If you push and like
• 11:16
  Speaker 4: power pee, you are putting extra strain on your pelvic
• 11:19
  Speaker 4: flore muscles, which can weaken them over time, and this
• 11:21
  Speaker 4: can lead to urinary leakage or what we you know,
• 11:24
  Speaker 4: pelvic organ prolapse, which is a scary thing when it's
• 11:27
  Speaker 4: like your organs are falling into your vagina. So it
• 11:30
  Speaker 4: can weaken your muscles over time and lead to other
• 11:33
  Speaker 4: pelvic flore conditions which we want to try to prevent.
• 11:36
  Speaker 4: So don't push when you pee. You just need to
• 11:38
  Speaker 4: sit and chill and breathe, and your bladder actually pushes
• 11:41
  Speaker 4: the p out for you.
• 11:43
  Speaker 3: What if I'm in a hurry, though, is there a
• 11:45
  Speaker 3: situation in which I should be power peeing?
• 11:48
  Speaker 2: Never?
• 11:49
  Speaker 4: Okay, I don't care if there's like little you know,
• 11:53
  Speaker 4: if there's something really no, never, never, Just sit and
• 11:57
  Speaker 4: chill and breathe and it'll it will actually come out
• 12:00
  Speaker 4: faster and better and you'll empty better. If you push,
• 12:04
  Speaker 4: you actually don't even empty your bladder as well, and
• 12:06
  Speaker 4: so then you're gonna have to go back thirty minutes
• 12:09
  Speaker 4: sixty minutes later and pee again. So just really from
• 12:13
  Speaker 4: an efficiency standpoint, Emily, I just recommend chilling. Is it
• 12:18
  Speaker 4: okay to p in the shower? One hundred percent? Totally
• 12:21
  Speaker 4: fine and quite good for the environment.
• 12:24
  Speaker 1: Great?
• 12:24
  Speaker 3: All right, So what I think is a good place
• 12:27
  Speaker 3: to start because peeing and pooping are things that happen
• 12:29
  Speaker 3: for everybody, and it is important to note that the
• 12:33
  Speaker 3: pelvic floor, therefore is important at all ages. The time
• 12:37
  Speaker 3: people most frequently hear about the pelvic floor is during pregnancy.
• 12:43
  Speaker 3: Is there a time before pregnancy where you would say,
• 12:46
  Speaker 3: you know, here's another time of life that you really
• 12:49
  Speaker 3: should be thinking about your pelvic floor a little more,
• 12:53
  Speaker 3: where it's doing other things for you other than peeing
• 12:55
  Speaker 3: and pooping.
• 12:56
  Speaker 2: Yeah.
• 12:56
  Speaker 4: So it's it's interesting because I think as parents we
• 12:59
  Speaker 4: think about what do I need to do for my
• 13:00
  Speaker 4: public floor?
• 13:01
  Speaker 2: But I even think we need to have these tips
• 13:03
  Speaker 2: and tools to.
• 13:03
  Speaker 4: Educate our kids, right Like we're body training them, we're
• 13:06
  Speaker 4: teaching them how to you know, poop in toilets or
• 13:09
  Speaker 4: kids struggle with constipation. So if you're a parent, some
• 13:12
  Speaker 4: of the things that you're going to learn and for
• 13:13
  Speaker 4: you need to be implementing and teaching for your kids,
• 13:16
  Speaker 4: because again, if they don't learn it young, when.
• 13:18
  Speaker 2: Are they going to learn it.
• 13:20
  Speaker 3: So when we think about kids, is bed wetting something
• 13:24
  Speaker 3: that's associated with the public floor or.
• 13:26
  Speaker 2: Is this a totally different issue.
• 13:29
  Speaker 4: It can be and so, but I would say bed
• 13:31
  Speaker 4: wedding and kids is typically multifactorial.
• 13:34
  Speaker 2: Right.
• 13:34
  Speaker 4: It's not just like, hey, they're holding it too long
• 13:37
  Speaker 4: and then they have to pee at night. There's typically
• 13:39
  Speaker 4: some neurodaverdens that can be evolved, some behavioral issues. I
• 13:43
  Speaker 4: will tell you one of the biggest contributing factors to
• 13:46
  Speaker 4: nighttime bed wetting is constipation, which is the most common
• 13:50
  Speaker 4: gi complaining kids. So if you're constipated, and this kind
• 13:52
  Speaker 4: of goes for adults too, you know, think of that
• 13:55
  Speaker 4: basket of muscles holding you know, it only has so
• 13:58
  Speaker 4: much space in it, and if.
• 13:59
  Speaker 2: It's full of poop, that's going to push on your bladder.
• 14:02
  Speaker 4: So some people find like they have more urgency to
• 14:04
  Speaker 4: pee when they're constipated, and that's that's true. The same
• 14:08
  Speaker 4: thing for kids when their bed wetting. One of the
• 14:10
  Speaker 4: first things I do is I actually talk to their
• 14:12
  Speaker 4: parents about curing their constipation and then getting them on
• 14:16
  Speaker 4: an avoiding schedule of going every couple hours during the
• 14:19
  Speaker 4: day and then setting alarms at night. But there's also
• 14:23
  Speaker 4: some kind of behavioral things that can and neurological things
• 14:26
  Speaker 4: that need to be addressed as well. That's outside of
• 14:28
  Speaker 4: PELBLC floor therapy, but some of these tips do help
• 14:30
  Speaker 4: when it comes to addressing pooping and peeing habits.
• 14:33
  Speaker 3: I should say that that until the age of about seven,
• 14:37
  Speaker 3: it is actually pretty typical for kids to just not
• 14:40
  Speaker 3: wake up to pee and to need a pull up.
• 14:42
  Speaker 3: So when we talk about sort of bed wedding you
• 14:44
  Speaker 3: would want to see somebody about it's really if they
• 14:48
  Speaker 3: are still not dry at night after six or seven.
• 14:51
  Speaker 4: Yeah, and that's you know, my son was he'll probably
• 14:53
  Speaker 4: not love me sharing. This was five or six, and
• 14:55
  Speaker 4: he was still in night time both.
• 14:56
  Speaker 2: Completely trying it.
• 14:57
  Speaker 4: During the day, he just was lazy and he didn't
• 15:02
  Speaker 4: want to pay all day, so we'd hold it till
• 15:03
  Speaker 4: the nighttime. And I'm like, dude, I get that. I mean,
• 15:05
  Speaker 4: how many times are we like cold in bed and
• 15:07
  Speaker 4: don't want to get up the key? But then he
• 15:08
  Speaker 4: just grew out of it, and I was like, Okay,
• 15:10
  Speaker 4: if he's nine or ten and we have this issue,
• 15:13
  Speaker 4: we'll get some help.
• 15:14
  Speaker 2: But otherwise they typically do grow out of it.
• 15:17
  Speaker 4: I think the other incremental time when we're thinking about
• 15:21
  Speaker 4: how early is it appropriate to start really learning about this,
• 15:24
  Speaker 4: it's really puberty. When you have a young woman who
• 15:29
  Speaker 4: was going through menstruation, their body is going through significant
• 15:32
  Speaker 4: hormonal changes, and hormones affect our public floor function and
• 15:35
  Speaker 4: our vagina in volva. But also this is their first
• 15:38
  Speaker 4: exploration into their genitalia, into their body, and if we
• 15:43
  Speaker 4: don't talk about it, it can often feel embarrassing or
• 15:47
  Speaker 4: you know, shrouded in shame. But it's also they are
• 15:49
  Speaker 4: learning how to use menstrual hygiene products. They are learning
• 15:52
  Speaker 4: how to find their vaginal opening, perhaps to insert a
• 15:55
  Speaker 4: tampon or a menstrual disc or cup. They're learning about
• 15:59
  Speaker 4: like what is the significance of a painful period? Does
• 16:02
  Speaker 4: that mean something else could be going on, like an
• 16:05
  Speaker 4: endometriosis or something. So really teaching them about their bodies
• 16:08
  Speaker 4: young is where it needs to start because it opens
• 16:12
  Speaker 4: the doors for greater and bigger conversations and curiosity later
• 16:16
  Speaker 4: versus not talking about it at all. So that's just
• 16:18
  Speaker 4: another major time, and I would say after that, it's
• 16:21
  Speaker 4: also when someone becomes sexually active.
• 16:23
  Speaker 2: So the vagina is part of the pelvic.
• 16:25
  Speaker 4: Floor, and one in four women will experience pelvic pain
• 16:28
  Speaker 4: and painful sex at some point in their life and
• 16:30
  Speaker 4: they don't even think of the pelvic floor muscles as
• 16:32
  Speaker 4: a source.
• 16:33
  Speaker 2: Of that pain.
• 16:35
  Speaker 3: Going back quickly to puberty, I think one of the
• 16:39
  Speaker 3: pieces it's very helpful for me in thinking about the
• 16:41
  Speaker 3: book is like, this is a this is a scientific
• 16:44
  Speaker 3: way to approach a topic that with an adolescent is
• 16:47
  Speaker 3: often very uncomfortable to just be like, hey, there are
• 16:52
  Speaker 3: muscles in the pelvic floor, Like let's talk about like
• 16:54
  Speaker 3: inserting a tampon. But rather than talking about it like
• 16:57
  Speaker 3: in an uncomfortable way, at least there's a little bit
• 17:00
  Speaker 3: of a way to come into it with like, you know,
• 17:02
  Speaker 3: here's some interesting cool facts about muscles and the muscles
• 17:05
  Speaker 3: you have and all the cool stuff they can do.
• 17:07
  Speaker 3: And by the way, also, this is where your vagina
• 17:09
  Speaker 3: is in case you want to use a tampon.
• 17:12
  Speaker 2: Right, I mean, And it's so much more.
• 17:14
  Speaker 4: It's kind of like we and that's in a very
• 17:17
  Speaker 4: practical sense of how do we approach pelvic floor health.
• 17:21
  Speaker 4: But I think it has even greater implications about how
• 17:23
  Speaker 4: do we feel comfortable talking about our bodies as women
• 17:27
  Speaker 4: in the greater scheme, like where do we start going
• 17:29
  Speaker 4: to for help? Where do we get education about our bodies?
• 17:32
  Speaker 4: And then when we become sexually active, or we struggle
• 17:35
  Speaker 4: with infertility, or we're pregnant and postpartum, we kind of
• 17:37
  Speaker 4: start keeping all of these things in because we've never
• 17:39
  Speaker 4: talked about them. So I think it just there's so
• 17:43
  Speaker 4: much more we can achieve by having these conversations early
• 17:45
  Speaker 4: that the ripples of that go really far, way far
• 17:49
  Speaker 4: into the later stages of being a woman.
• 17:51
  Speaker 3: So let's talk about sex, either becoming sexually active or
• 17:54
  Speaker 3: just in general problems with sex.
• 17:56
  Speaker 1: Can you be a little bit of a sense.
• 17:58
  Speaker 3: Of what what is the pelvic floor doing during sex
• 18:02
  Speaker 3: that it might fail at.
• 18:07
  Speaker 2: Let's talk about potential fairs but also achieve achievements. Okay, So.
• 18:13
  Speaker 4: I would say, so the vaginal opening is in through
• 18:17
  Speaker 4: is through the pelvic floor muscle. So in order to
• 18:20
  Speaker 4: have anything insert into the vagina, whether it's a penis,
• 18:23
  Speaker 4: a dildo, a finger, ultimately a speculum for pelvic exams
• 18:28
  Speaker 4: or you know again we mentioned tampons.
• 18:31
  Speaker 2: The pelvic floor muscles have.
• 18:32
  Speaker 4: To relax for anything to enter into the vagina, so
• 18:36
  Speaker 4: if those muscles are tight or tense, it can often
• 18:38
  Speaker 4: obstruct insertion. And this is when people complain of something like, oh,
• 18:43
  Speaker 4: it feels like my partner's hitting a wall, or when
• 18:45
  Speaker 4: I put the tamp on, it just feels like I
• 18:46
  Speaker 4: can't go any further. That can often literally just be
• 18:50
  Speaker 4: muscle spasm, and so we really need those muscles to
• 18:53
  Speaker 4: be able to relax at the opening and then even
• 18:55
  Speaker 4: at the deeper level. If someone experiences pain with deeper
• 18:58
  Speaker 4: insertion or certain position, or it feels like they're partner's
• 19:02
  Speaker 4: poking them, or there's a bruise, that can literally just
• 19:04
  Speaker 4: be muscle tension. So as physical therapists, we work with
• 19:08
  Speaker 4: muscles to help relax them, teach you how to breathe
• 19:11
  Speaker 4: different positions and stretches to relieve tension and pain. Also,
• 19:16
  Speaker 4: the outer layer of the pelvic floor muscles, there's two layers.
• 19:19
  Speaker 4: The outer layers are the ones that contract and relax
• 19:22
  Speaker 4: during an orgasm, so we go through stages of arousal
• 19:25
  Speaker 4: which hopefully ultimately lead in the climax, which is an orgasm,
• 19:30
  Speaker 4: and those muscle contractions are what happening during an orgasm.
• 19:33
  Speaker 4: So if you have pain with orgasms or difficulty having
• 19:37
  Speaker 4: an orgasm, or leakage with orgasms, your pelvic floor muscles
• 19:40
  Speaker 4: are also involved.
• 19:42
  Speaker 3: And then if the sex is successful in a different
• 19:46
  Speaker 3: way than the orgasm and you get pregnant, this is
• 19:49
  Speaker 3: the time I think people almost always hear about, or
• 19:52
  Speaker 3: at least well, this is the time people should always
• 19:55
  Speaker 3: hear about the pelvic floor, whether they do or not.
• 19:59
  Speaker 3: So during pregnancy, your public floor is doing a tremendous
• 20:03
  Speaker 3: amount of additional work, correct, right, because it is holding
• 20:08
  Speaker 3: up I'm gonna see if I get it right, having
• 20:09
  Speaker 3: done my little now that you've taught me about the
• 20:11
  Speaker 3: smoothie thing is it's holding the public floor. Muscles are
• 20:15
  Speaker 3: holding up the baby, which is getting larger and larger
• 20:17
  Speaker 3: and larger. And there's a lot of water in there also,
• 20:19
  Speaker 3: and it's a lot of work. Am I roughly correct? Right?
• 20:22
  Speaker 2: You are spot on bad only And so.
• 20:26
  Speaker 4: You know, we're so used to getting these text messages
• 20:28
  Speaker 4: or emails about the size of the baby. It's the
• 20:30
  Speaker 4: size of a blueberry, then it's the size of an avocado,
• 20:33
  Speaker 4: and then it's the size.
• 20:34
  Speaker 2: Of a watermelon.
• 20:35
  Speaker 4: Well, your pelvic floor muscles are ultimately the hammock that's
• 20:38
  Speaker 4: holding up that blueberry, avocado, or watermelon. And so if
• 20:42
  Speaker 4: you can imagine a hammock holding an avocado, it's not
• 20:45
  Speaker 4: going to sink down or stretch that much. But if
• 20:48
  Speaker 4: it's holding a watermelon, it's going to sink lower, it's
• 20:51
  Speaker 4: going to be really stretched out. It's not going to
• 20:52
  Speaker 4: be able to support you as well. So regardless of
• 20:55
  Speaker 4: what type of birth you have, because it's a misconception
• 20:58
  Speaker 4: that you know, only vaginal birth moms need pelvic floor PTE,
• 21:02
  Speaker 4: your pelvic floor change is just through pregnancy itself. And
• 21:05
  Speaker 4: this is when we start to see things like urinary leakage, hemorrhoids,
• 21:09
  Speaker 4: prolapse like all this, you know, vagina stuff starts to
• 21:12
  Speaker 4: pop up that we're like, oh, this is just pregnancy. However,
• 21:16
  Speaker 4: there is research to support that getting pelvic therapy interventions
• 21:20
  Speaker 4: soon or during pregnancy give you better postpartum outcomes. So yeah,
• 21:24
  Speaker 4: your vagina's changing, your pelvic color is changing. You got
• 21:28
  Speaker 4: to get pelviclore therapy during pregnancy.
• 21:30
  Speaker 3: I want to talk about what that looks like, But
• 21:32
  Speaker 3: then I want to, But at first, I want to
• 21:33
  Speaker 3: tell you the most embarrassing story that I have from
• 21:36
  Speaker 3: either of my pregnancies, which is during my second pregnancy,
• 21:39
  Speaker 3: I was in New York and I wanted to get home,
• 21:43
  Speaker 3: and I was a little bit late for the train,
• 21:44
  Speaker 3: and there was a lot of traffic, so I decided
• 21:46
  Speaker 3: to run, and I did have to pee a bit,
• 21:49
  Speaker 3: and so I ran like like a lot of blocks,
• 21:51
  Speaker 3: and I was maybe five months pregnant, and I just
• 21:54
  Speaker 3: the entire time was being on myself as I was running.
• 21:57
  Speaker 1: Through the streets of New York.
• 21:58
  Speaker 3: And thank god I had another pair of pants with
• 22:01
  Speaker 3: me when I got on the train, which I totally made.
• 22:03
  Speaker 2: But it is it is a very.
• 22:06
  Speaker 3: Salient memory of Yeah, and if you think about it,
• 22:10
  Speaker 3: if by pelic floor failed me.
• 22:12
  Speaker 2: You're not alone.
• 22:14
  Speaker 4: Well, you were pregnant, and that's a lot of pressure,
• 22:19
  Speaker 4: and running is extra pressure on your pelvic floor. So again,
• 22:23
  Speaker 4: it's one of these things where I'm like, we have
• 22:25
  Speaker 4: to train these muscles like we do any other muscles
• 22:27
  Speaker 4: in our body. If we're going to ask it to
• 22:29
  Speaker 4: support a five month old baby running through the streets
• 22:33
  Speaker 4: of New York, we have to train it for that.
• 22:36
  Speaker 4: Just like you would run a marathon, you Emily, and
• 22:38
  Speaker 4: you train for months and months and months. Pregnancy is
• 22:41
  Speaker 4: no different, Like we're the demands on our body are different,
• 22:44
  Speaker 4: so we need to train our public floor to meet
• 22:46
  Speaker 4: those demands. And yet we just haven't incorporated this into
• 22:49
  Speaker 4: prenatal care.
• 22:50
  Speaker 3: So in your ideal incorporation of this into prenatal care,
• 22:53
  Speaker 3: when would it start and what happens beyond? I think
• 22:59
  Speaker 3: keeg are the thing people have most frequently heard of, right,
• 23:02
  Speaker 3: the sort of scope of this is much larger than that.
• 23:06
  Speaker 3: So if you weres like like I'm telling someone who
• 23:08
  Speaker 3: is just just found out they're pregnant, like or before,
• 23:11
  Speaker 3: what is the advice about how long and what would
• 23:14
  Speaker 3: that even look like for them?
• 23:16
  Speaker 2: I mean I would start week one.
• 23:18
  Speaker 4: I mean, if you're pregnant week four, like, start getting
• 23:21
  Speaker 4: some education about you know, of course I have all
• 23:24
  Speaker 4: these videos about this, but you know your pelvic floor
• 23:26
  Speaker 4: is going to go through changes even in that first trimester.
• 23:28
  Speaker 4: You're going to have constipation from surging progesterone, You're going
• 23:31
  Speaker 4: to have urinary frequency, you may have some you know,
• 23:35
  Speaker 4: leakage even start right away. So but I would say
• 23:38
  Speaker 4: at the latest you need to really be checking in
• 23:40
  Speaker 4: with a pelvic floor therapist or starting some pelvic floor
• 23:43
  Speaker 4: training at the very beginning of your second trimester, because
• 23:46
  Speaker 4: this is when our body starts to really transform with
• 23:49
  Speaker 4: respect to ligaments, get more soft and lax, and we
• 23:52
  Speaker 4: get some instability in our pelvis. We start getting more
• 23:56
  Speaker 4: stretching up the core muscles, the abdomen and pelvic floor.
• 24:00
  Speaker 4: Trying to stay active but not sure how to modify
• 24:02
  Speaker 4: what workouts we're doing, and aches and pain start to
• 24:05
  Speaker 4: pop up, you know, hit pain, back pain, things like that.
• 24:10
  Speaker 4: So all of those things can be addressed proactively. And
• 24:13
  Speaker 4: if you get pelvic foe muscle training and address issues
• 24:16
  Speaker 4: during pregnancy, it's gonna want optimize your birth. You can
• 24:20
  Speaker 4: get a lot of education on how to prep for birth.
• 24:23
  Speaker 4: Pushing cesarean you know, birth preparation and then postpartum recovery.
• 24:27
  Speaker 4: So I would say as early as your second trimester,
• 24:31
  Speaker 4: check in with a pelvic floor therapist in person or
• 24:33
  Speaker 4: start doing some training to really get your body ready
• 24:37
  Speaker 4: for that long marathon of the next several months.
• 24:40
  Speaker 1: What is ikegel.
• 24:43
  Speaker 2: It's a pelvic clere contraction.
• 24:44
  Speaker 4: Well, first of all, it's an exercise named after a man,
• 24:48
  Speaker 4: which like I'm going to start a revolution to rename it, right,
• 24:53
  Speaker 4: I mean, we just don't. We don't need any more
• 24:54
  Speaker 4: body parts or anything to do with the female genitalia
• 24:57
  Speaker 4: named after a dude. Second, and it's a pelvic floor contraction.
• 25:02
  Speaker 4: So that sipping up the smoothie that we all practiced earlier, that's.
• 25:05
  Speaker 2: A kegel contraction.
• 25:06
  Speaker 4: So it's a closing of the sphincters. It's a lifting
• 25:10
  Speaker 4: of those pelvic organs. And again it's like it's like
• 25:13
  Speaker 4: a bicep curl, it's like a crunch. It's like one
• 25:15
  Speaker 4: exercise you can do for a group of muscles. However,
• 25:19
  Speaker 4: it's the most popular one that we hear about. It's
• 25:23
  Speaker 4: kind of the foundation of pelvic floor training for strengthening. However,
• 25:27
  Speaker 4: you can't just sit in the carpool line and do kegels.
• 25:30
  Speaker 4: You need to do quicker contractions. You need to do
• 25:32
  Speaker 4: longer hold ten second contractions. You need to you know,
• 25:37
  Speaker 4: work this muscle in standing. If you're a runner, kegels
• 25:40
  Speaker 4: in the carpoo lane, it's not going to help you out.
• 25:42
  Speaker 4: You need to do squats and lunges and kind of
• 25:44
  Speaker 4: higher impact stuff while training your pelvic floor. The flip
• 25:48
  Speaker 4: side of this, I'll say is a lot of people
• 25:49
  Speaker 4: actually have tight pelvic floors and we think like, oh,
• 25:52
  Speaker 4: tight vagina, that sounds awesome, But you know, tension can
• 25:56
  Speaker 4: also impair functions, so you can't relax your muscles, well, pee, poop,
• 26:00
  Speaker 4: have sex, or even contract. So you know, I caution
• 26:04
  Speaker 4: people to just start doing other kegels because a lot
• 26:06
  Speaker 4: of people have tension just normal. In today's world, we
• 26:10
  Speaker 4: have tension in our bodies, and you want to address
• 26:12
  Speaker 4: that first before doing strengthening.
• 26:14
  Speaker 3: I think there's a there's a core insight in the
• 26:17
  Speaker 3: book which I found very illuminating, which was, you know,
• 26:21
  Speaker 3: I've gone to physical therapy for other things, and generally
• 26:25
  Speaker 3: when you go to physical therapy, they look at what
• 26:27
  Speaker 3: the issues are that you are personally struggling with, and
• 26:30
  Speaker 3: they give you a set of exercises to deal with
• 26:33
  Speaker 3: those issues. And this is the same thing. It's just
• 26:37
  Speaker 3: not a muscle that you see, uh correct, And to
• 26:41
  Speaker 3: therefore the same logic applies. You figure out what's trying,
• 26:45
  Speaker 3: what's going on, and you develop a set of exercises
• 26:48
  Speaker 3: that are going to train that problem away, which may
• 26:52
  Speaker 3: involve kegels. Just like fits, which like sometimes there are
• 26:55
  Speaker 3: squats or bicep curls or crunches or your regular physically,
• 26:58
  Speaker 3: I think.
• 26:59
  Speaker 2: We want to think about that.
• 27:00
  Speaker 4: And I think that one, I mean, we are kind
• 27:03
  Speaker 4: of illuminating so much more about the pelvic flour now
• 27:05
  Speaker 4: that like, hey, it doesn't need to just tighten, it
• 27:08
  Speaker 4: also needs to relax. But I also think that there
• 27:12
  Speaker 4: is no one size fits all protocol. I always say
• 27:14
  Speaker 4: it's like if you have back pain and your therapist
• 27:17
  Speaker 4: is like, hey, just go do a bunch of crunches,
• 27:18
  Speaker 4: or that's what your physician tells you, You're like, well,
• 27:20
  Speaker 4: that doesn't sound like the right prescription, right. We need
• 27:23
  Speaker 4: to look at how you move and breathe and what's
• 27:26
  Speaker 4: tight and what's weak. And I go through in the
• 27:28
  Speaker 4: book kind of a checklist of if you're doing this
• 27:31
  Speaker 4: at home and not seeing a pelvic four therapist in person,
• 27:33
  Speaker 4: like which kind of pathway do you fall? And how
• 27:36
  Speaker 4: do you know if you have tension? How do you
• 27:38
  Speaker 4: know if you have weakness and need kegels or tension
• 27:41
  Speaker 4: and need relaxation. And I even give you tips on
• 27:44
  Speaker 4: how to explore your pelvic flour, like how do I
• 27:46
  Speaker 4: know if I'm doing a kegel properly, and you know,
• 27:48
  Speaker 4: to give people really to demystify this a little bit,
• 27:52
  Speaker 4: and to also just give them some simple practical tools
• 27:54
  Speaker 4: at home to start addressing these issues.
• 28:01
  Speaker 3: More parent data, including the pelvic floor after menopause, what
• 28:05
  Speaker 3: the pelvic floor is like in men and a lightning
• 28:08
  Speaker 3: round of your most pressing pelvic floor questions. After the break,
• 28:22
  Speaker 3: I want to talk about a third part of life,
• 28:25
  Speaker 3: which is the kind of perimenopause menopause piece, because this
• 28:29
  Speaker 3: is another time in which even people who have not
• 28:34
  Speaker 3: had problems brier with their pelvic floor can develop almost unexpectedly.
• 28:41
  Speaker 3: So things like prolapse can come up in perimenopause or
• 28:45
  Speaker 3: menopause even if it didn't come up before. So can
• 28:48
  Speaker 3: you give us a sense of is this just my
• 28:51
  Speaker 3: pelvic floor is aging and starting to droop like all
• 28:54
  Speaker 3: my other muscles?
• 28:55
  Speaker 1: Is that basically what's happening?
• 28:57
  Speaker 3: As I turned to ash protein, is it something about proteins?
• 29:03
  Speaker 4: So I was thinking about that, it's always about protein.
• 29:06
  Speaker 4: So yeah, I mean yes and no. So muscles weaken
• 29:11
  Speaker 4: over time, they atrophy over time when we don't address them,
• 29:13
  Speaker 4: and when you go through transitions like pregnancy and postpartum,
• 29:17
  Speaker 4: where those are risk factors for developing pelvic four dysfunction
• 29:21
  Speaker 4: because again, you are going through physical changes, hormonal changes,
• 29:25
  Speaker 4: lifestyle changes, and if those don't get addressed at those
• 29:28
  Speaker 4: early stages, then when you hit perimenopause and you don't
• 29:31
  Speaker 4: have your hormonal system to prop you up anymore, things
• 29:34
  Speaker 4: start to take a nose dive. So during perimenopause, you
• 29:38
  Speaker 4: start having less estrogen in your body, and estrogen is
• 29:41
  Speaker 4: the hormone that really plumps up the vagina. It keeps
• 29:44
  Speaker 4: you well lubricated in the evolve in vagina, and it
• 29:47
  Speaker 4: gives you more tone and thickness to your pelvic floor muscles.
• 29:50
  Speaker 4: You also lose testosterone during perimenopause, so you know, you
• 29:55
  Speaker 4: have less muscle strength, the different things like that, more
• 29:58
  Speaker 4: visceral fat, and then you lose colligen so you know,
• 30:01
  Speaker 4: I like put collagen in my coffee and I rub
• 30:03
  Speaker 4: it all over my face. I'm like our vaginas and
• 30:05
  Speaker 4: volvers are also losing collagen. So all of those things
• 30:08
  Speaker 4: do lead to more pelvic floor weakness, less tone in
• 30:13
  Speaker 4: the muscles, which can lead to prolapse and leakage, and
• 30:16
  Speaker 4: vaginal dryness. So One of the biggest things people experience
• 30:19
  Speaker 4: is more vaginal dryness and painful sex and perimenopause and
• 30:22
  Speaker 4: definitely into menopause because you don't have the natural lubrication
• 30:26
  Speaker 4: of estrogen to help, you know, provide moisture down there.
• 30:31
  Speaker 4: So I'm a huge fan of obviously doing exercise, but
• 30:35
  Speaker 4: then and proactively strengthening your pelvic floor. Looking at perimenopause
• 30:39
  Speaker 4: like a runway, like, hey, there's a red flag down there,
• 30:43
  Speaker 4: and you need to kind of like start working to
• 30:46
  Speaker 4: get yourself ready to address that. Like you we have
• 30:48
  Speaker 4: this runway where it feels like things are going bananas,
• 30:52
  Speaker 4: but it's also a warning sign of like your body's
• 30:55
  Speaker 4: changing and you need to make it kind of stay
• 30:58
  Speaker 4: healthy so that when you get there, you're in your
• 31:01
  Speaker 4: tip top pelvic floor shape. The other thing is I
• 31:04
  Speaker 4: do encourage folks to have a volva care routine, just
• 31:09
  Speaker 4: like we have a skincare routine, and not using harsh products,
• 31:13
  Speaker 4: but also thinking about using a you know, all natural
• 31:16
  Speaker 4: moisturizer for their volvet in vagina, using good lubric.
• 31:19
  Speaker 1: Sorry, what can we back up?
• 31:21
  Speaker 3: I like, like, what can you say more about the
• 31:28
  Speaker 3: Please say more?
• 31:30
  Speaker 4: So there are moisturizers that you can use for your
• 31:33
  Speaker 4: volven vagina. And some people use these postpartum when they
• 31:36
  Speaker 4: are lactating and have low estrogen levels, but then also
• 31:39
  Speaker 4: in perimenopause and menopause, and so there are there's a
• 31:44
  Speaker 4: brand called Medicine Mama that has a volva bomb. It's
• 31:47
  Speaker 4: olive oil based, its organic ingredients. Some people just use
• 31:51
  Speaker 4: coconut oil. There's another brand called Kindra. So there's a
• 31:54
  Speaker 4: bunch of these bombs or lotions that are specifically made
• 31:58
  Speaker 4: for the volven vagina that aren't going to alter your
• 32:01
  Speaker 4: pH and put you at risk for infection, but they're
• 32:03
  Speaker 4: going to keep it lubricated. So it's just like we
• 32:08
  Speaker 4: do for our face. And you'll notice, like going through
• 32:10
  Speaker 4: perimenopause and definitely menopause, like it's dry down there, it's itchy,
• 32:13
  Speaker 4: it's uncomfortable, it can even close up. So I'm a
• 32:17
  Speaker 4: big fan of that. And then some people do use
• 32:19
  Speaker 4: a topical estrogen cream as well to help plump.
• 32:22
  Speaker 2: Up the tissues.
• 32:24
  Speaker 1: So much to look forward to.
• 32:27
  Speaker 3: So much more to add to our daily routine, because yes,
• 32:30
  Speaker 3: I'm barely making it as it is with just putting
• 32:32
  Speaker 3: a small metamisturizer and washing my face.
• 32:34
  Speaker 1: So TBD on that. Do men have a pelvic floor?
• 32:42
  Speaker 3: And what is important for I feel we should We've
• 32:46
  Speaker 3: left them out, so I'd like to have this brief
• 32:48
  Speaker 3: discussion of men pull them in.
• 32:50
  Speaker 4: So men absolutely have a pelvic floor. The differences are
• 32:54
  Speaker 4: they have two openings. So when female pelvic floors, we
• 32:57
  Speaker 4: have an opening for urine, the urethra, we have an
• 32:59
  Speaker 4: open for the vagina, and then we have an opening
• 33:01
  Speaker 4: for the anis where poop and gas exit. Male bodies
• 33:04
  Speaker 4: have two openings, one for the urethra, which goes through
• 33:07
  Speaker 4: the penis and exits through the opening of the penis,
• 33:10
  Speaker 4: and then one for the anus, so they have two openings.
• 33:13
  Speaker 4: They obviously don't have a vagina, but the pelvic floor
• 33:16
  Speaker 4: also closes the sphincters. It maintains an erect penis, so
• 33:21
  Speaker 4: blood stains in the penis when those muscles are tighter, tense,
• 33:23
  Speaker 4: and they also contract and relax during climax and orgasm.
• 33:27
  Speaker 4: They support your pelvic organs. They assist with breathing, just
• 33:31
  Speaker 4: like they do in the female body. More often though,
• 33:34
  Speaker 4: men have tension versus weakness, so many more women experience
• 33:38
  Speaker 4: weakness because of the hormonal fluctuations and because of events
• 33:41
  Speaker 4: like pregnancy and birth and menopause. But male bodies typically
• 33:46
  Speaker 4: what I see is much more tension in the area
• 33:49
  Speaker 4: and that needs to focus more in relaxation unless they
• 33:52
  Speaker 4: have like a prostate surgery, which could lead to weakness
• 33:54
  Speaker 4: issues as well. So you know, they have problems just
• 33:57
  Speaker 4: like female bodies do.
• 33:59
  Speaker 3: They also have urinary leakage problems. Is that like an
• 34:02
  Speaker 3: issue for men?
• 34:04
  Speaker 4: I can especially if they have a prostate procedure because
• 34:07
  Speaker 4: the prostate kind of surrounds the urethra. So if they
• 34:09
  Speaker 4: have a procedure to the prostate or a surgery to
• 34:12
  Speaker 4: remove it because of prostate cancer, then it affects the
• 34:16
  Speaker 4: urethra and they can leak urine. They can have a
• 34:18
  Speaker 4: rectile dysfunction because the nerves are impaired, they get a pain.
• 34:22
  Speaker 2: So it is a it is a common issue.
• 34:25
  Speaker 4: It's interesting because as little as we talk about the
• 34:27
  Speaker 4: female pelvic floor, we talk about the male pueblic floor
• 34:30
  Speaker 4: actually a lot less. And I've seen men in my
• 34:32
  Speaker 4: practice my entire career. We have you know, wives coming
• 34:36
  Speaker 4: in like I think my husband needs this too, you know,
• 34:38
  Speaker 4: And so we do see a lot of males as well,
• 34:41
  Speaker 4: and it's a it's an up and coming, you know,
• 34:43
  Speaker 4: sector of pelvic floor therapy.
• 34:46
  Speaker 3: They definitely need more attention in general. Okay, so I
• 34:51
  Speaker 3: want to end with a few rapid fire questions. My
• 34:59
  Speaker 3: favorite Okay, what is your favorite of the pelvic floor muscles,
• 35:05
  Speaker 3: the puba rectalis, which relaxes for pooping.
• 35:10
  Speaker 1: What should I do if the porta potty is really dirty?
• 35:14
  Speaker 4: Hover, lean forward, rest your elbows on your knees, and
• 35:18
  Speaker 4: take some big, deep breath to empty.
• 35:20
  Speaker 3: Is it bad if I hold in my poop for
• 35:23
  Speaker 3: a long time while I'm running asking for a friend hashtag.
• 35:30
  Speaker 4: It's not a deal. If you're running, you have two options.
• 35:32
  Speaker 4: You hold it or you squat on the side of
• 35:34
  Speaker 4: the road. If you are ambitious and courageous enough to squat,
• 35:38
  Speaker 4: go for it. If not, hold it. But when I
• 35:41
  Speaker 4: get back from running, I would drink some hot water.
• 35:44
  Speaker 4: I would maybe eat a little something, and that can
• 35:46
  Speaker 4: stimulate the urge for the poop to go. But it's
• 35:48
  Speaker 4: not ideal to hold it unless you have to.
• 35:51
  Speaker 3: Is it important to pee after sex to prevent you
• 35:53
  Speaker 3: to Yes, it is important to pee after sex.
• 35:57
  Speaker 4: I'm not a fan of what I call just in case,
• 36:00
  Speaker 4: which is like every time you get to target, and
• 36:03
  Speaker 4: then you get home from Target, and then you go
• 36:05
  Speaker 4: pick the kids up from school, and every time you
• 36:07
  Speaker 4: pass a bathroom. However, times that are okay to pee
• 36:10
  Speaker 4: just in case are before sex, after sex, before pelvic
• 36:15
  Speaker 4: floor therapy, after pelvic floor therapy, or if you like
• 36:20
  Speaker 4: know you're not going to be have access to a
• 36:22
  Speaker 4: bathroom for many many hours. Typically you want to pee
• 36:25
  Speaker 4: every two to four hours, but after sex is an
• 36:28
  Speaker 4: important time to go.
• 36:30
  Speaker 3: An issue that many people have raised to me is
• 36:33
  Speaker 3: as they are getting ready for bed, they feel they
• 36:35
  Speaker 3: need to pee many times, and sometimes it's just in
• 36:38
  Speaker 3: case peing, or it's just this feeling of like I
• 36:40
  Speaker 3: just maybe I have to do like a little bit,
• 36:41
  Speaker 3: a little bit is that?
• 36:44
  Speaker 1: Why is that happening? And should I do? Should I
• 36:49
  Speaker 1: give into it?
• 36:50
  Speaker 4: So, No, it's a miscommunication between your bladder and your
• 36:55
  Speaker 4: pelvic floor. So typically you are supposed to pee every
• 37:00
  Speaker 4: two to four hours, right if you have a drink,
• 37:03
  Speaker 4: So if you have like wine or a cocktail or
• 37:06
  Speaker 4: spicy food that could irritate your bladder, that might make
• 37:09
  Speaker 4: you more susceptible to pee more often. If you don't
• 37:13
  Speaker 4: front load your fluids and you drink everything in the
• 37:15
  Speaker 4: evening after getting home, that can make you have to
• 37:17
  Speaker 4: pe more often, or you have a little bit of
• 37:19
  Speaker 4: overactive bladder, and overactive bladder is like your bladder saying
• 37:22
  Speaker 4: I gotta go, I gotta go when it's not really
• 37:24
  Speaker 4: that full. So there's two things that I tell people
• 37:27
  Speaker 4: to do. It's like front your load your fluids earlier
• 37:29
  Speaker 4: in the day, cut off your fluids two hours before
• 37:32
  Speaker 4: you go to bed pe. And then if you go
• 37:35
  Speaker 4: to the bathroom and pee and you still have the urge,
• 37:38
  Speaker 4: I want you to take like five big deep breaths
• 37:40
  Speaker 4: and then five kegel contractions, suck up that smoothie five times,
• 37:45
  Speaker 4: because tightening your pelvic floor tells your bladder to chill out.
• 37:49
  Speaker 4: And so if you do that on repeat, and you
• 37:51
  Speaker 4: can buy yourself fifteen minutes, thirty minutes, and then you're like, shit,
• 37:54
  Speaker 4: I gotta go again, go again, that's fine. But eventually
• 37:57
  Speaker 4: you'll push that urge often enough where you don't have
• 37:59
  Speaker 4: to go every five minutes and keep going because you
• 38:02
  Speaker 4: keep it's a false urge. There's nothing in there.
• 38:04
  Speaker 3: When you have to go again, so can you say
• 38:08
  Speaker 3: a little bit more about when you do physical therapy
• 38:11
  Speaker 3: what what does it involve. Somebody mentioned some kind of
• 38:17
  Speaker 3: zapping of the vagina, and I'm just curious if that's
• 38:21
  Speaker 3: like a core element or just a sometimes extra.
• 38:25
  Speaker 4: You know that vaginal zapping is not standard in pelvic
• 38:29
  Speaker 4: floor therapy, so it's think of traditional physical therapy where
• 38:33
  Speaker 4: you get an assessment. However, the assessment is an internal
• 38:36
  Speaker 4: examination of the pelvic floor, which is either through the
• 38:39
  Speaker 4: vagina or through the anus, and this is obviously with consent.
• 38:42
  Speaker 4: And once we evaluate those muscles, if they're tense, we
• 38:45
  Speaker 4: may work on strengthening exercises, which again can include pelvic
• 38:49
  Speaker 4: floor contractions or key goals. We do use some machines
• 38:52
  Speaker 4: which are called biofeedback, which kind of are like like
• 38:55
  Speaker 4: an EKG for the heart, but it goes around your
• 38:57
  Speaker 4: buttthole or in your vagina and it shows you on
• 38:59
  Speaker 4: a green how your muscles are performing. But then we
• 39:02
  Speaker 4: do squats and lunges and hip strengthening and all kinds
• 39:05
  Speaker 4: of stuff. If it's a weakness issue, I mean, if
• 39:09
  Speaker 4: it's a tension issue, we may do more relaxation like
• 39:12
  Speaker 4: internal vaginal massage to the pelvic floor using trigger point
• 39:16
  Speaker 4: winds or dilators to relax the muscles. There is something
• 39:19
  Speaker 4: called electrical stimulation which can like activate the muscles kind
• 39:24
  Speaker 4: of like I don't know if you remember, like the
• 39:26
  Speaker 4: old Bruce Lee Daisy used to put this thing on
• 39:27
  Speaker 4: his stomach and it would like fire up his six pack.
• 39:30
  Speaker 4: It's that for your vagina. However, the research is really
• 39:35
  Speaker 4: mixed in how effective that is long term. Ultimately, we
• 39:38
  Speaker 4: want you doing these exercises on your own and with
• 39:42
  Speaker 4: different activities during the day. So these vibrating chairs and
• 39:46
  Speaker 4: vagina zappers and lasers are very minimally effective and can
• 39:50
  Speaker 4: be quite expensive, and ultimately you still have to just
• 39:54
  Speaker 4: keep up with these home exercises to give yourself long
• 39:58
  Speaker 4: term relief.
• 39:58
  Speaker 3: But I think it is good for people to know
• 40:00
  Speaker 3: that you go for pelvic floor physical therapy, you are
• 40:03
  Speaker 3: going to there is a physical component of this, an
• 40:07
  Speaker 3: internal exam physical component of this.
• 40:10
  Speaker 2: Yeah, there should be.
• 40:11
  Speaker 4: And the only time we don't do what is maybe
• 40:13
  Speaker 4: during the first trimester with a higher risk pregnancy, or
• 40:16
  Speaker 4: in the first six weeks postpartum, or if somebody you
• 40:20
  Speaker 4: know does not want it obviously, but yeah, there is
• 40:22
  Speaker 4: a the way that we assess the pelvic floor is
• 40:25
  Speaker 4: through the vagina or anus. And it's funny. I mean,
• 40:27
  Speaker 4: I've had people like show up in their workout clothes
• 40:29
  Speaker 4: and they're like I'm ready, and I'm like, you can
• 40:31
  Speaker 4: take those off. You're going to be laying on a
• 40:34
  Speaker 4: bed and we're doing an exam, Like, don't even more
• 40:36
  Speaker 4: about what you're wearing.
• 40:37
  Speaker 2: You don't need a Lila lemon for that.
• 40:39
  Speaker 1: Okay, now we're back to our lightning run. Do pelvic
• 40:42
  Speaker 1: floor problems get worse with each pregnancy if I have
• 40:45
  Speaker 1: multiple pregnancies.
• 40:47
  Speaker 4: If they go unaddressed, Yes, So the research is clear
• 40:52
  Speaker 4: that the majority of dysfunction can happen typically with a
• 40:55
  Speaker 4: first berth. But this is why it's so important to
• 41:00
  Speaker 4: make sure that you are rehabbing your body afterwards, like
• 41:03
  Speaker 4: you have just gone through a huge transformation. So that
• 41:06
  Speaker 4: postpartum period in the first year again, when we're exhausted
• 41:09
  Speaker 4: and sleep deprived and you know, physically just drained, that's.
• 41:13
  Speaker 2: The time to do the public floor pt But yes,
• 41:16
  Speaker 2: it can.
• 41:17
  Speaker 4: Obviously get worse three or more berths, three or more
• 41:20
  Speaker 4: vaginal births are definitely a higher risk factor for peblic
• 41:24
  Speaker 4: floor dysfunction, which is why you want to be proactive
• 41:27
  Speaker 4: about that pelic floor care. But even if you haven't
• 41:30
  Speaker 4: started it, it is never too late, ever, ever, Ever,
• 41:33
  Speaker 4: Like you could be in your third trimester, you could
• 41:35
  Speaker 4: be in your fifty sixty seventies, It's never too late.
• 41:39
  Speaker 2: To start pelblic floor rehab.
• 41:46
  Speaker 3: Sarah, I really think the work you're doing is incredibly important,
• 41:51
  Speaker 3: and I am very grateful for you being here. But
• 41:55
  Speaker 3: I'm very grateful for the book, and I just I
• 41:57
  Speaker 3: think you are going to change the lives of a
• 42:00
  Speaker 3: lot of people, and that's a really special thing. So
• 42:02
  Speaker 3: thank you for sharing with us today and for changing
• 42:05
  Speaker 3: how we pee, and it's wonderful.
• 42:11
  Speaker 4: Thanks Emily, thanks for having me. I'm super grateful for
• 42:14
  Speaker 4: your support. But also I also hope that this changes
• 42:17
  Speaker 4: the lives and vaginas of many many people, because we
• 42:21
  Speaker 4: need it and we deserve it, So I hope that
• 42:23
  Speaker 4: that is what happens as well.
• 42:25
  Speaker 1: No power peeing, Thank you for listening.
• 42:55
  Speaker 3: Parent Data is produced by Tamar Avishai with support from
• 42:58
  Speaker 3: the Parent Data team and pr. If you have thoughts
• 43:01
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• 43:25
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• 43:27
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• 43:31
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