Latest / Root Cause Conversations / Pelvic Floor Therapy Isn’t Just for Postpartum: Pain, Constipation, Leakage & More with Dr. Stephanie Perez

Transcript

Pelvic Floor Therapy Isn’t Just for Postpartum: Pain, Constipation, Leakage & More with Dr. Stephanie Perez · Root Cause Conversations

• 0:04
  SPEAKER_01: Hey guys, I'm Amanda Mavrokis, your host here on Root Cause Conversations, where we look beyond the symptom, ask better questions, and connect the dots between whole person health and wellness.
• 0:18
  SPEAKER_01: I'm a speech language pathologist, myofunctional therapist, and the owner behind Salt and Light Speech and Language Resources right here in Alabama.
• 0:28
  SPEAKER_01: A quick heads up: this podcast is for educational purposes only.
• 0:32
  SPEAKER_01: It's not individualized medical advice, and it's not meant to diagnose or treat anything.
• 0:39
  SPEAKER_01: So always loop in your own provider for anything specific to you or your child.
• 0:46
  SPEAKER_01: Thanks for pulling up a seat at the table, and let's get into today's conversation.
• 0:57
  SPEAKER_01: Hey guys, welcome back to the podcast.
• 1:00
  SPEAKER_01: This is where we connect the dots between wellness and whole person help.
• 1:05
  SPEAKER_01: Today we have Dr.
• 1:06
  SPEAKER_01: Stephanie Perez, a physical therapist and the owner of Empowered Wellness in Pelham, Alabama.
• 1:12
  SPEAKER_01: And we're going to dig into what the pelvic floor actually is, why tight doesn't necessarily mean strong, and how it connects things like constipation and bedwetting and kiddos.
• 1:24
  SPEAKER_01: And we're also going to talk about why pelvic floor therapy isn't just for postpartum moms, it can be for kids and men too.
• 1:34
  SPEAKER_01: Stephanie, hey, thanks for joining us today.
• 1:37
  SPEAKER_01: Hey, so happy to be here.
• 1:38
  SPEAKER_01: Thanks for inviting me.
• 1:40
  SPEAKER_01: Yeah, I just love that we have connected in the community over the years.
• 1:44
  SPEAKER_01: I was a client at Empowered Wellness a couple of years ago.
• 1:48
  SPEAKER_01: And I just love the connections that we make and how we support each other and our community.
• 1:54
  SPEAKER_01: So we've got a lot of things to cover today.
• 1:57
  SPEAKER_01: So let's just jump into it, okay?
• 1:59
  SPEAKER_01: When we're talking about the pelvic floor, now when I was a client at Empowered Wellness, the therapist that worked with me said, Amanda, everybody has a pelvic floor.
• 2:09
  SPEAKER_01: And I guess that was just kind of lost on me.
• 2:11
  SPEAKER_01: I never put two and two together.
• 2:14
  SPEAKER_01: So can you explain to people what is the pelvic floor?
• 2:19
  SPEAKER_00: Wonderful question.
• 2:20
  SPEAKER_00: And yes, that's something that nobody teaches us.
• 2:23
  SPEAKER_00: It's just about being a human.
• 2:25
  SPEAKER_00: We all have pelvic floors.
• 2:26
  SPEAKER_00: Men have pelvic floors, women have pelvic floors, and it is actually a part of your core.
• 2:32
  SPEAKER_00: So for anyone who's watching, you can actually see I have this pelvis model here, but your pelvic floor is like a muscular hammock that kind of sits at the base of your pelvis on the bottom.
• 2:44
  SPEAKER_00: So kind of thinking it as the bottom of your core.
• 2:47
  SPEAKER_00: And it's very important, not only for helping you not pee on yourself, which I think is the most common thing when people think about with a pelvic floor, but it gives support to your whole core system.
• 2:58
  SPEAKER_00: It helps give you strength to your core, it helps stabilize and support your internal organs.
• 3:04
  SPEAKER_00: It helps you have good, successful, and complete urination trips to the bathroom, bowel movements.
• 3:10
  SPEAKER_00: And then, of course, it helps you not pee and poop on yourself when you don't need to.
• 3:15
  SPEAKER_00: And it has sexual functioning as well.
• 3:18
  SPEAKER_00: And so it's a very important part of your body to understand.
• 3:21
  SPEAKER_00: But yeah, it just sits right there at the base of the pelvic floor or of your pelvis in between those two hip bones at the bottom.
• 3:29
  SPEAKER_00: Um, and it's a part of your core system, along with your glute muscles, your abdominal muscles, and your diaphragm breathing muscle.
• 3:39
  SPEAKER_01: Wonderful anatomy lesson there.
• 3:41
  SPEAKER_01: So this is a kind of a great leeway just into my next few questions.
• 3:46
  SPEAKER_01: When should someone start asking more questions?
• 3:49
  SPEAKER_01: What are they going to be seeing in their pelvic floor that makes them think, hmm, this isn't normal, or I need to get some help?
• 3:57
  SPEAKER_01: Can you kind of walk us through what that might look like?
• 4:01
  SPEAKER_00: So if you are a pregnant woman, this is probably the most easy identified time of life to go ahead and start seeking out pelvic core services.
• 4:10
  SPEAKER_00: It's so beneficial to see a pelvic core therapist during the pregnancy.
• 4:14
  SPEAKER_00: Um, that's another thing.
• 4:15
  SPEAKER_00: No one really even teaches us about what's going on in our body when we're pregnant.
• 4:18
  SPEAKER_00: It's just assumed, oh, you're a woman, you'll just figure it out, you know what's going on.
• 4:22
  SPEAKER_00: I mean, when you're pregnant, you're always like, is this normal?
• 4:25
  SPEAKER_00: And so it's not only a good time to go and, you know, get addressed as far as are you having any aches and pains, problems with your pregnancy, as far as physically, do some labor and delivery preparation, but also it's just a good time to go ahead and learn about your body and the general anatomy.
• 4:43
  SPEAKER_00: Um, if you are postpartum and you are having any leakage, um, if you had a C-section, if you had a vaginal delivery and had any tearing with that delivery, that is another time to go to see a pelvic floor therapist.
• 4:58
  SPEAKER_00: There are people who have never had children that still have challenges.
• 5:03
  SPEAKER_00: So that's another kind of debunking myth that we want to make sure we know it's not you can still have pelvic floor dysfunction and never have had a child or have pregnancy or given birth.
• 5:13
  SPEAKER_00: And so there's actually some really young women who struggle with a diagnosis called vaginism, which is where they actually cannot achieve any type of penetration at all.
• 5:24
  SPEAKER_00: And so, some kind of common signs maybe leading up to even before someone might begin a sexual journey in their life, um, would be difficulty wearing tampons.
• 5:33
  SPEAKER_00: That's one of the biggest signs.
• 5:34
  SPEAKER_00: If they are unable to get one in, or they're not able to keep one in because it feels like he wants to be just pushed right back out, or they are having a leakage.
• 5:44
  SPEAKER_00: Even young girls, young athletes will see ballerinas, gymnasts, crossfitters who are kind of always in this muscular tension, postural type of um practice daily, they will tend to have a lot of tightness in their pelvic floor and will actually have peeing on themselves with jumping on trampolines and laughing, and they've never, they've never even had a pregnancy at all.
• 6:07
  SPEAKER_00: So no one is immune to pelvic floor dysfunction.
• 6:10
  SPEAKER_00: Anyone can get pelvic floor dysfunction, man, woman, young, old.
• 6:16
  SPEAKER_00: And so kind of just having that awareness in your body, is there something going on in that lower part that is bothersome to you, that's making you avoid certain activities or have challenges?
• 6:28
  SPEAKER_00: And then those would be a good time to speak up and advocate for yourself and go get an assessment done.
• 6:34
  SPEAKER_01: So as someone who's never had children or been pregnant, I do, I I can attest to the fact that pelvic flor therapy benefited me greatly from some of the challenges that I was experiencing.
• 6:46
  SPEAKER_01: So I'm glad you kind of debunked that myth because I'm sitting here.
• 6:49
  SPEAKER_01: I'm proof of that.
• 6:50
  SPEAKER_01: So you don't have to have had a baby or been pregnant to have pelvic floor dysfunction.
• 6:55
  SPEAKER_01: And I want to touch back on what you said earlier about the younger girls with some of the issues that they're having.
• 7:03
  SPEAKER_01: So what do you think is driving those issues or what do you think might be happening underneath that?
• 7:09
  SPEAKER_01: Could you give this maybe two or three things?
• 7:12
  SPEAKER_00: Especially in my gymnast population, my ballerina, and my dancers, a lot of that from a very young age, you know, they're taught to constantly be in this uptight, tummy tight, squeezing your muscles all the time.
• 7:27
  SPEAKER_00: Squeeze your butt cheeks, squeeze your belly muscles.
• 7:30
  SPEAKER_00: And that in itself, compounding over time, puts a lot of stress and pressure on the pelvic floor, probably jumping a little ahead here.
• 7:39
  SPEAKER_00: The pelvic floor is a dynamic system.
• 7:41
  SPEAKER_00: So that's another kind of one of those debunked myths that I hope everyone gets from this session today, is that it's not all about keeping it tight and squeezing as far as helping it.
• 7:53
  SPEAKER_00: So culturally commonplace knowledge is thinking like there's something wrong with my pelvic floor that must mean that it's weak.
• 7:59
  SPEAKER_00: So I need to do kaggles or strengthening exercises.
• 8:02
  SPEAKER_00: And that's not the truth.
• 8:04
  SPEAKER_00: And so if someone is constantly squeezing those muscles, like we often see in those populations, then it is going to prevent the muscles from being that dynamic system.
• 8:14
  SPEAKER_00: It has to be able to relax and contract, just like other muscles in your body.
• 8:19
  SPEAKER_00: Uh, we actually like to compare it to more of a trampoline.
• 8:22
  SPEAKER_00: So when you jump on a trampoline, it should have that nice bend down.
• 8:27
  SPEAKER_00: The springs allow for that downward motion.
• 8:30
  SPEAKER_00: And then when you go jump up, it goes up and it kind of does that upward and downward.
• 8:35
  SPEAKER_00: So as pressure hits it, it's able to absorb that pressure.
• 8:39
  SPEAKER_00: And we need to have the movement for the system.
• 8:42
  SPEAKER_00: So, but I mean, even in a lot of just female athletes in general.
• 8:46
  SPEAKER_00: Um, and I think it's just there's such a lack of education on core and pelvic floor in general, and then maybe not even enough time spent on recovery or stretching, either, you know, post-exercise, post-practice, um, yoga, you know, it's all about the strengthening and the go and doing the sport, but there's we're not spending any time on the opposite side of what we should be doing to keep our all of our muscles balanced.
• 9:14
  SPEAKER_01: Yeah, and it really is all connected.
• 9:17
  SPEAKER_01: Thank you for breaking that down for us.
• 9:19
  SPEAKER_01: And you just kind of like debunked a question that I had, and it was, you know, people assume that if your pelvic floor is tight, then it's strong, but that's just not the case.
• 9:29
  SPEAKER_01: So, can you kind of walk us through what a healthy, functional pelvic floor might look like?
• 9:36
  SPEAKER_00: So, your pelvic floor, it should not be causing resistance to things.
• 9:42
  SPEAKER_00: So, simple things like tampons, putting inserting tampons or cups.
• 9:46
  SPEAKER_00: So, that should be one thing.
• 9:47
  SPEAKER_00: Um, it should not be a source of pain with intercourse.
• 9:50
  SPEAKER_00: And this is another population of people who might feel a little more shame or embarrassment talking about it.
• 9:55
  SPEAKER_00: How do I bring this up?
• 9:56
  SPEAKER_00: Who do I talk to?
• 9:58
  SPEAKER_00: But painful intercourse is not normal.
• 10:00
  SPEAKER_00: Um, so it should not be affecting that part of your relationship.
• 10:05
  SPEAKER_00: It we should be able to, a healthy pelvic floor should be able to do jump rope, jumping jacks, sneezing, coughing, laughing without any loss of urine or peeing yourself or needing to go change your underwear afterwards.
• 10:19
  SPEAKER_00: And I, and two, I, you know, I do want to bring up constipation as well.
• 10:22
  SPEAKER_00: I know a lot of times it's we're thinking about peeing on ourselves, but there's a whole other side because your pelvic floor is front and back.
• 10:29
  SPEAKER_00: It helps control bowel movements as well.
• 10:32
  SPEAKER_00: And so um chronic constipation, we can see pelvic floor dysfunction.
• 10:37
  SPEAKER_00: And of course, we want to rule out the nutritional side and hydration side and all of that, but a lot of people actually have a pelvic floor component to their constipation, especially if there's been any habits maybe since childhood of resisting or holding and not going with the urges that are natural to our flow.
• 10:57
  SPEAKER_00: So if you've had this chronic back pain and hip pain that you've done all the things, you exercise, you go to the chiropractor, you get acupuncture, but there's just one piece missing.
• 11:08
  SPEAKER_00: A lot of times the pelvic floor, because it is part of your core, it's giving your hips and your back stability that could be that missing piece as well.
• 11:16
  SPEAKER_01: Oh, okay.
• 11:17
  SPEAKER_01: That's that's really interesting.
• 11:19
  SPEAKER_01: And I'm glad you kind of talked about that because, you know, I worked in physical therapy for about 15 years before I transitioned into the land of speech language pathology.
• 11:30
  SPEAKER_01: And I remember hearing a lot of my older clients, especially females, complaining a lot about hip pain and back pain.
• 11:37
  SPEAKER_01: And it never occurred to me that that could be correlated to pelvic floor issues.
• 11:42
  SPEAKER_00: Absolutely.
• 11:43
  SPEAKER_00: We actually had a patient come in who's been struggling with hip pain for 10 years, and she has seen PTs all over the city.
• 11:53
  SPEAKER_00: And I don't know where she heard about pelvic floor, but it came to her and she came in, and we actually found the source of her hip pain internally.
• 12:01
  SPEAKER_00: And it's like this whole time it was there, but you just had to find that missing piece.
• 12:08
  SPEAKER_01: You had to you dig down through all of the things that were hiding it and find that root cause issue for her.
• 12:14
  SPEAKER_01: Well, I know she was so glad that she came in.
• 12:18
  SPEAKER_01: I can imagine the relief she felt.
• 12:19
  SPEAKER_01: And I know that was just such a blessing for her to land in your office and for you guys to help her that way.
• 12:24
  SPEAKER_00: Yes.
• 12:25
  SPEAKER_00: And I, you know, then the whole mental side of pain.
• 12:28
  SPEAKER_00: And when you can validate someone's pain, it can just create this whole other positive mental cascade, and then they're able to heal and recover and accept treatment even better.
• 12:39
  SPEAKER_01: Yes, definitely.
• 12:41
  SPEAKER_01: So I want to loop back to the pain with intercourse because I'm kind of in that stage of my life where I'm in that perimenopause journey, and I'm in lots of like online groups and Facebook groups, and a lot of the ladies are sharing some very personal, intimate things that they're experiencing.
• 12:59
  SPEAKER_01: So at this stage in our life, I'm seeing lots of women complaining about new issues with pain with intercourse.
• 13:07
  SPEAKER_01: Is there something else happening in the body, pelvic floor-related, that could connect this?
• 13:14
  SPEAKER_00: Sure.
• 13:14
  SPEAKER_00: It's a it's a little bit of a combination.
• 13:17
  SPEAKER_00: And so once again, that's why we want to advocate so strongly for doing pelvic floor therapy before you start having problems, quote unquote.
• 13:25
  SPEAKER_00: And so make sure you go in your 30s before you start doing any type of perimenopausal kind of transition, which traditionally starts around the age of 35, you know, the 35 to 45 range is kind of considered this perimenopausal range.
• 13:39
  SPEAKER_00: But that can help you go ahead and make sure you've got good brain-body connection, strengthen the way you need to strengthen, you know, tweak your workout programs, make sure you have a good strength training program because we need to be doing that as women.
• 13:52
  SPEAKER_00: But then once we start going through our perimenopausal, menopausal journey, we start having fluctuations in our hormones, and especially with the hormone estrogen.
• 14:01
  SPEAKER_00: Estrogen is a hormone that helps with muscular tension and strength.
• 14:06
  SPEAKER_00: So it helps us be strong and gain strength in our muscles and it helps our tissues.
• 14:11
  SPEAKER_00: So our tissues can be more plump and have more blood flow, which is why as we age and we have less estrogen, our skin naturally starts to get more wrinkly and saggy because we don't have as much estrogen on top of all the other effects of aging.
• 14:26
  SPEAKER_00: And so that affects our pelvic floor as well.
• 14:29
  SPEAKER_00: And so a lot of times in this perimenopausal and menopausal and beyond, when we don't have as much estrogen, then our tissues start to become a little more sensitive and thin, which could be a source of the pain.
• 14:43
  SPEAKER_00: But then also it could also be a muscular source of pain, too, from tension that we've been holding in our pelvis over time after babies that we didn't know we had.
• 14:55
  SPEAKER_00: So that's another reason why it is so important to come in and get a pelvic floor assessment done if you are having pain with intercourse, because you have to find out the reason why that is.
• 15:06
  SPEAKER_00: And a traditional medical model is someone goes to the OBGYN with painful intercourse and they're given an estrogen cream, or they are told to use more lube or drink more wine.
• 15:17
  SPEAKER_00: And sadly, this is still happening.
• 15:19
  SPEAKER_00: Like in 2026, medical doctors are recommending this on the phone to women and it drives me nuts.
• 15:27
  SPEAKER_00: It's one of my big pet peeves.
• 15:29
  SPEAKER_00: And so until you do a full exam and figure out the actual state of the person, knowing is this muscular in nature, is this tissue based in nature, um, or what else it could be, then we really don't need to be giving this blind advice of relax more and lube more and take baths.
• 15:48
  SPEAKER_00: I mean, it's just, it's just crazy.
• 15:50
  SPEAKER_00: But yeah, I mean, it's a real thing that's happening and sexual health is not talked about much at all.
• 15:56
  SPEAKER_00: And then it's very they slap that band-aid on it, you know, or even culturally, you know, it's like, you know, it's more about the man, but it's not even about the woman's pleasure.
• 16:06
  SPEAKER_00: And so educating a woman on her anatomy and her sexual functioning is so important because you should enjoy it as well.
• 16:13
  SPEAKER_00: And then men need to understand it too.
• 16:16
  SPEAKER_00: Um that's a whole other talk.
• 16:17
  SPEAKER_00: We could do a whole other podcast episode on that.
• 16:20
  SPEAKER_01: And that's so great that you touched on all of that because I feel like as women, and I I I'm not speaking for everyone, but I'm I'm speaking for my experience.
• 16:30
  SPEAKER_01: There's just things that we're just kind of taught not to really talk about.
• 16:35
  SPEAKER_01: You know what I mean?
• 16:36
  SPEAKER_01: Like your body shouldn't be a shameful thing.
• 16:39
  SPEAKER_01: You should be comfortable talking about your body.
• 16:42
  SPEAKER_01: And I just I really hope that we're getting away from that because I know that was something that I'm not gonna say we were shamed for it, but we were, it was discouraged for you to talk about your period or any kind of discomfort that you were having and for you to share that with other people.
• 16:58
  SPEAKER_01: So gosh, Carl, I hope we're moving out of that.
• 17:01
  SPEAKER_00: Me too.
• 17:01
  SPEAKER_00: And that's what I hope, you know, for you know, you creating a platform like this and us being able to talk about it and just get more information out.
• 17:08
  SPEAKER_00: And social media has been great for it, is we can start breaking the cycle now.
• 17:12
  SPEAKER_00: And as a mom of daughters, I have two daughters, and uh, one of my daughters has started her period.
• 17:18
  SPEAKER_00: So we are going through that journey, and I'm trying to really educate her and educate her from a place not of fear or dread, because I feel like that any of the talk you do see about periods, you know, commercials and such, is always like this woman who's like in a big sweatsuit and she looks sad and gray and you know, and it's always like period pain bad.
• 17:39
  SPEAKER_00: And so I'm trying to try to really teach her from a positive standpoint.
• 17:44
  SPEAKER_00: And then also we need to denormalize that whole message uh that periods are the periods are painful.
• 17:51
  SPEAKER_00: And I mean, you have teenagers getting prescription pain medicine to take on their periods now, like are doing that.
• 17:59
  SPEAKER_00: I'm like, that is not normal, guys.
• 18:01
  SPEAKER_00: Your period should not be painful, it should not be making you take meds or stay home from school or work, like that is a whole other issue as well.
• 18:11
  SPEAKER_00: So I'm trying to teach my children, age appropriate as they are aging, just more about their anatomy.
• 18:17
  SPEAKER_00: And well, you know, we use anatomical language in the house, they know what their their body parts are called.
• 18:22
  SPEAKER_00: And so whenever they do get older and and get married, and I want to have those conversations with them um and make sure their spouse too, so that way hopefully they can go into the start of their relationships on more healthy ground.
• 18:37
  SPEAKER_00: Um because nobody knows what they're doing.
• 18:38
  SPEAKER_00: Everybody just goes into not knowing what they're doing, guessing, I think I'm doing the right thing.
• 18:42
  SPEAKER_00: I don't know.
• 18:43
  SPEAKER_00: So we have to break the cycle, y'all.
• 18:45
  SPEAKER_01: We have to start talking about this.
• 18:47
  SPEAKER_01: We do.
• 18:48
  SPEAKER_01: We absolutely have to start talking about this.
• 18:50
  SPEAKER_01: And I'm glad that we're having these conversations because pelvic floor issues, again, are things that people don't talk about.
• 18:56
  SPEAKER_01: It's discussed a lot among women that are pregnant and women that are postpartum, but I feel like there's a huge demographic there that's kind of left out, like people like me who've never been pregnant or had or had kids or the younger athletes or the kiddos or the men.
• 19:12
  SPEAKER_01: You don't have to, you don't have to suffer in silence or live in discomfort.
• 19:16
  SPEAKER_01: Exactly.
• 19:17
  SPEAKER_00: Yes.
• 19:18
  SPEAKER_01: So I want to circle back to the constipation issue.
• 19:22
  SPEAKER_01: And I want to talk a little bit about that in bed wedding.
• 19:26
  SPEAKER_01: From a myofunctional therapy standpoint, we talk a lot about tongue posture and how our tongue should be resting in the roof of the mouth.
• 19:34
  SPEAKER_01: And at nighttime, if your tongue is resting in the right place, it can stimulate your antidiuretic hormone, which is a signal within your body letting you know that it's not time to go to the bathroom.
• 19:45
  SPEAKER_01: From a pelvic floor standpoint, can you talk about what might be driving constipation in kiddos?
• 19:52
  SPEAKER_01: Because I'm seeing this in my office a lot.
• 19:55
  SPEAKER_01: I have parents come in and it's just like you and I talk in here, like we talk about everything.
• 20:01
  SPEAKER_01: And I feel like the parents that come in, like they're my friends.
• 20:05
  SPEAKER_01: We talk about all kinds of things, and they're telling me that their kiddo is only having a bowel movement every three days.
• 20:12
  SPEAKER_01: They are giving them Miralax and they know that they shouldn't, but they don't know what else to do.
• 20:18
  SPEAKER_01: So can you unpack some of that and maybe like give parents that are listening some direction about what those next steps might look like if their kiddos having constipation?
• 20:27
  SPEAKER_00: Yeah, and I'm so glad that you have connected that relationship because that's one of the first things that I recommend.
• 20:33
  SPEAKER_00: I am not a pediatric pelvic floor therapist, but anytime that a parent does ask me about bed wedding, the very first question is, are they constipated?
• 20:44
  SPEAKER_00: Because that's the biggest thing that we do see with pediatric bed wedding, the number one cause is constipation.
• 20:50
  SPEAKER_00: Um, and I do think so much of it is a lack of education from the from the very beginning.
• 20:56
  SPEAKER_00: This is another thing pediatricians need to do better educating mom or parents on what bowel movement.
• 21:02
  SPEAKER_00: I mean, most adults don't even realize they're supposed to be having a bowel movement every day.
• 21:06
  SPEAKER_00: Let's just, let's just bring that up.
• 21:08
  SPEAKER_00: Right.
• 21:08
  SPEAKER_00: Let that be another educational takeaway from this episode, y'all.
• 21:12
  SPEAKER_00: You need to be pooping every day.
• 21:13
  SPEAKER_00: Please be doing that.
• 21:14
  SPEAKER_00: Yes, every day.
• 21:16
  SPEAKER_00: But yeah, so our kids, our kiddos need to be as well.
• 21:18
  SPEAKER_00: It's our it's our one of our main detoxing pathways.
• 21:21
  SPEAKER_00: We've got to poop every day.
• 21:22
  SPEAKER_00: And so, and and then oftentimes too, when a when a parent takes the kid to the doctor for that, what is the number?
• 21:28
  SPEAKER_00: The first thing they do, give them Miralax.
• 21:30
  SPEAKER_00: And y'all, like, I'll meet people in their early 20s who have literally been on Miralax their entire life.
• 21:38
  SPEAKER_00: So I try to really steer clear of Miralax.
• 21:41
  SPEAKER_00: I like to use it only for a breakthrough situation, like in a true emergency.
• 21:45
  SPEAKER_00: I've tried all these other things.
• 21:46
  SPEAKER_00: It's been, you know, but on a regular basis, it's something we have to be very cautious about using.
• 21:52
  SPEAKER_00: So I like to look at a few things.
• 21:54
  SPEAKER_00: Number one, what's our potty posture?
• 21:56
  SPEAKER_00: And so this is for adults as well, but we want to make sure that.
• 22:00
  SPEAKER_00: That our kiddos have their leg, their feet up on something.
• 22:03
  SPEAKER_00: And so if they're not on a traditional kid's stool or potty that's on the ground, then they're gonna be up on a big potty.
• 22:10
  SPEAKER_00: And depending on the age of the kid, their legs are short.
• 22:13
  SPEAKER_00: They're gonna, their legs are gonna be down.
• 22:15
  SPEAKER_00: And we really wanna have the feet up on propped up on a stool so that the knees are above the hips.
• 22:22
  SPEAKER_00: So playing with some positioning, um, whether we need to just put them back on a little potty that's on the floor or get a better stool situation that's higher, maybe even just stacking some books.
• 22:32
  SPEAKER_00: It doesn't have to be fancy, but we've got to get the feet up so that the knees are up.
• 22:37
  SPEAKER_00: What that does is it gives a more of a posterior pelvic tilt or tips your pelvis backwards on the toilet, which the bottom of your colon is called the sigmoid colon and it kind of curls in.
• 22:50
  SPEAKER_00: And so if you can, if you can tip your pelvis back some, it flattens out the severity of that curl.
• 22:57
  SPEAKER_00: So that way the stool has more of a straight shot to go through.
• 23:01
  SPEAKER_00: And then and this is a process because kids, I have found because my middle child, we had we did have some dance with constipation when she was potty training.
• 23:10
  SPEAKER_00: Then we get into a cycle of of pain and fear.
• 23:14
  SPEAKER_00: Because if it's been days, now you have this hard, compacted, larger stool that does eventually pass.
• 23:20
  SPEAKER_00: They experience that as pain, and then they think, well, I don't want to poop because that hurts.
• 23:24
  SPEAKER_00: So this is holding this test.
• 23:28
  SPEAKER_00: It is not an overnight fix by any means.
• 23:30
  SPEAKER_00: But number one, potty posture.
• 23:32
  SPEAKER_00: Number two, we have to look nutrition.
• 23:34
  SPEAKER_00: Um, how is their hydration level?
• 23:36
  SPEAKER_00: Are they truly drinking enough water?
• 23:38
  SPEAKER_00: And then what types of fiber are we consuming?
• 23:42
  SPEAKER_00: Um, and one of my tried and true constipation solving things is a cup of cooked vegetable soup every day.
• 23:52
  SPEAKER_00: That is kind of my easy home remedies that I love to recommend for my postpartum mamas.
• 23:58
  SPEAKER_00: But anyone that's going through these types of issues, if you're post-surgical and you've been maybe given some pain medication and you want to make sure you don't go down that whole, that whole situation, just, you know, if you got an Instapot, just put a bunch of bone broth in there, a bunch of veggies, cook it up real good so those vegetables are soft.
• 24:15
  SPEAKER_00: Cooked vegetables are great, easy digested fiber that can really help get the bowels moving.
• 24:22
  SPEAKER_00: Um, and then we can also do some powdered magnesium support as well.
• 24:26
  SPEAKER_00: Um, I really like magnesium calm.
• 24:29
  SPEAKER_00: It's that white tub with the blue label.
• 24:30
  SPEAKER_00: It's powder, it's easily digested and absorbed.
• 24:34
  SPEAKER_00: Or um, you know, you can do magnesium citrate for the bowel movements itself.
• 24:39
  SPEAKER_00: But that's another more natural option to supplement.
• 24:43
  SPEAKER_00: You shouldn't have to take it every day, but I would rather choose that than B-Rillax to get us through challenging times.
• 24:51
  SPEAKER_00: Um, and so that's kind of from a dietary nutritional standpoint, I like to look at that.
• 24:57
  SPEAKER_00: And then doing some abdominal massage.
• 24:59
  SPEAKER_00: Abdominal massage is another one of my absolute favorite recommendations for anyone of any age for helping stimulate that large intestine to get the colon moving, get the bowel move, or get the bowels moving.
• 25:12
  SPEAKER_00: And so, even doing a little um I love you massage is what we call it.
• 25:16
  SPEAKER_00: And so when you start on the right side of the lower abdomen and you kind of press and scoop up, you know, 10 times or so, like the letter I, and then you go up and over, like the letter L, and then you go all the way around like the letter U, that's actually following the path of the large intestine as our food digests and travels.
• 25:38
  SPEAKER_00: So that can be paired nicely too with some digized essential oil from young living that can be very stimulating and supportive of the balm system.
• 25:48
  SPEAKER_00: So that's where I usually like to start with constipation, um, with those recommendations and that routine.
• 25:55
  SPEAKER_00: And then let's see, you know, see how it goes.
• 25:58
  SPEAKER_00: And if we need to get a deeper look, maybe even start to work with more of a um functional medicine provider that specializes in pediatrics.
• 26:08
  SPEAKER_01: Okay.
• 26:08
  SPEAKER_01: Yeah.
• 26:09
  SPEAKER_01: All right.
• 26:09
  SPEAKER_01: That was all really great information.
• 26:11
  SPEAKER_01: I do tell my parents, we do talk about potty posture, and I encourage them to make sure that their kids are even even boys when when we're like having bed wedding issues, let's make sure we sit down at night and prop our feet up so we can get good emptying.
• 26:28
  SPEAKER_01: And I even have them blow bubbles and blow pinwheels on the toilets.
• 26:31
  SPEAKER_00: Oh, that's great.
• 26:32
  SPEAKER_00: Yes, that's so good.
• 26:33
  SPEAKER_00: That's right.
• 26:34
  SPEAKER_00: You take releases that abdominal pressure, the intra-abdominal pressure.
• 26:38
  SPEAKER_00: Yes.
• 26:39
  SPEAKER_01: Yep.
• 26:39
  SPEAKER_01: And that way it encourages them to sit there a little longer and let their body relax so it can truly empty.
• 26:45
  SPEAKER_01: And so I feel like if we can give them something fun to do on the potty, it might encourage them to sit there until nature runs its course.
• 26:52
  SPEAKER_01: There you go.
• 26:53
  SPEAKER_01: Well, I want to talk a little bit about men.
• 26:57
  SPEAKER_01: I asked my husband last night, I'm like, hey, I'm having Dr.
• 27:01
  SPEAKER_01: Stephanie on, and we're gonna talk about pelvic floor dysfunction.
• 27:06
  SPEAKER_01: And, you know, have any of your guy friends ever said that they had pelvic floor therapy?
• 27:12
  SPEAKER_01: And girl, the look he gave me.
• 27:16
  SPEAKER_01: So, but it is a very real thing because again, they have pelvic floor too.
• 27:22
  SPEAKER_01: So, what's bringing the men into your office?
• 27:27
  SPEAKER_01: Since apparently people don't realize this is an option for them.
• 27:31
  SPEAKER_00: One of the most common reasons I really like to advocate for pelvic pore therapy in men is anything to do with the prostate.
• 27:39
  SPEAKER_00: So if a man has been diagnosed with prostate cancer, if they're going to be doing any types of prostate treatments, if they have their prostate removed, that's an absolute indication to go see a pelvic pore therapist.
• 27:51
  SPEAKER_00: Ideally, you want to do one before your surgery.
• 27:54
  SPEAKER_00: And this goes for hysterectomy too.
• 27:56
  SPEAKER_00: That's another topic, but you want to do pelvic pore therapy around hysterectomies because the prostate, the male pelvic floor is oriented exactly the same.
• 28:05
  SPEAKER_00: They just have a longer urethra and they have the more external muscles where the shaft of the penis is.
• 28:11
  SPEAKER_00: So their prostate actually provides structure to their urethra.
• 28:17
  SPEAKER_00: And when you remove that prostate, a part of it or all of it, or have, you know, treatments around it, now you have more of this loose or hypermobility around their urethra, which is much more likely to lead them to urinary leakage.
• 28:31
  SPEAKER_00: And so, you know, we think women's health is bad, men's health is even worse with this because they go, they come home from these surgeries and they're given diapers and pills to help their leakage.
• 28:41
  SPEAKER_00: But they really should be acquainted to their pelvic floor, understanding how to connect to it, what it means before their surgery.
• 28:47
  SPEAKER_00: But that way, after their surgery, they know what they can be doing at home.
• 28:51
  SPEAKER_00: Their pelvic floors can get tight as well and cause pain.
• 28:54
  SPEAKER_00: They can have rectal pain, they can have pain with urination, pain with ejaculation, um, or even with erectile dysfunction.
• 29:03
  SPEAKER_00: Thus, research strongly supports pelvic pore therapy, helping with that, because it's not always a hormone issue.
• 29:09
  SPEAKER_00: And once again, a typical medical model is a man has a erectile dysfunction, goes to the doctor, and the doctor immediately starts writing a prescription for some sort of medication.
• 29:19
  SPEAKER_00: But if they're having tension in their pelvic floor that's preventing good flow of blood, that's gonna affect things.
• 29:28
  SPEAKER_00: So if we can get pelvic floor to relax and release, they do some good abdominal massage, some work through their inner thighs, their glutes, that's gonna support the nerves and the vessels working in the area.
• 29:40
  SPEAKER_00: And so that can be a nice thing, especially for men who are trying to avoid medications.
• 29:44
  SPEAKER_00: But I do want to do a caveat, anyone who is struggling with erectile dysfunction, we want to make sure we go get a good cardiac workup first, um, because morning erections are actually one of the um cardiac uh health signs for men.
• 29:58
  SPEAKER_00: And so we do want to make sure that our heart is doing well if we're having issues, kind of down below.
• 30:06
  SPEAKER_00: But um, those are probably the most common ones.
• 30:08
  SPEAKER_00: Sometimes we'll see some nerve pain in men who are cyclists that like to ride bikes from the compression in the nerves in the area.
• 30:17
  SPEAKER_00: But yeah, I mean, this is a way that you can really advocate for, you know, husbands, grandfathers, uncles, if they are gonna have any pelvic surgeries like that, that scar tissue is gonna cause problems.
• 30:29
  SPEAKER_00: So we just want to make sure that we have a healthy start going into it, work through it after so we don't have any residual issues.
• 30:35
  SPEAKER_01: I love that.
• 30:37
  SPEAKER_01: Go before and and work on some things and get maybe a home program and some things established, and then go have your procedure and then your recovery process following that should include a couple of more trips to see your pelvic floor therapist.
• 30:51
  SPEAKER_01: Absolutely, yes.
• 30:53
  SPEAKER_01: I love that.
• 30:55
  SPEAKER_01: If somebody is calling your office and they want to come in, what does that first visit typically look like?
• 31:04
  SPEAKER_00: The first visit is our evaluation and it is just awesome.
• 31:09
  SPEAKER_00: Like it's our wow factor.
• 31:10
  SPEAKER_00: It is when you leave that first appointment, you are just like, wow, I had no idea about this.
• 31:16
  SPEAKER_00: And you usually have a lot, a little confidence boost because our goal with every first visit is for them to leave understanding and knowing, like, yes, I know what my pelvic for is and I know how to work it and connect to it.
• 31:29
  SPEAKER_00: And so we like to sit down and do a good history and then you know, really get to know the person and what they are feeling bothered by, any birth trauma, any just good full history.
• 31:40
  SPEAKER_00: And then we go into a good full body exam.
• 31:43
  SPEAKER_00: So we're checking everything.
• 31:44
  SPEAKER_00: We're checking posture, strength, range of motion, everything externally.
• 31:48
  SPEAKER_00: We're going over, you know, do we have any C-section scars to look at?
• 31:52
  SPEAKER_00: Do we have any diastasis recti we're concerned with, tension and your low back muscles, your hip muscles?
• 31:59
  SPEAKER_00: And then we do an internal pelvic floor muscle assessment.
• 32:02
  SPEAKER_00: So that's the gold standard.
• 32:04
  SPEAKER_00: That's the only way to know about your pelvic floor.
• 32:07
  SPEAKER_00: So that's another little learning, learning thing.
• 32:10
  SPEAKER_00: If you have not, if you're not getting internal work done, then you're not getting pelvic floor therapy.
• 32:15
  SPEAKER_00: Um, because unfortunately, that's some things that's going on out in the community, but that's another talk.
• 32:20
  SPEAKER_00: So we want to make sure that we're actually checking the muscles themselves.
• 32:24
  SPEAKER_00: So you lay on your back, we use one gloved finger, and we just insert vaginally to check the internal muscles.
• 32:31
  SPEAKER_00: This is not a pelvic exam from the OBGYN.
• 32:34
  SPEAKER_00: You're not in stirrups, we're not using speculums, we're not messing with your cervix.
• 32:39
  SPEAKER_00: This is very gentle.
• 32:41
  SPEAKER_00: So even people who have some apprehension or a history of painful gynecological exams usually do very well with our evaluations because it's just very gentle.
• 32:51
  SPEAKER_00: And we're just feeling for muscle tension.
• 32:53
  SPEAKER_00: It feels tight to me.
• 32:54
  SPEAKER_00: Does it feel tight to you?
• 32:56
  SPEAKER_00: Or you might say, oh, it feels tender there.
• 32:58
  SPEAKER_00: And then after we've kind of gotten a good palpation baseline side to side, then we'll have a brain check.
• 33:05
  SPEAKER_00: Like, hey, do you can you squeeze my finger now?
• 33:07
  SPEAKER_00: And so we're having them do their kegal or pelvic for muscle contraction.
• 33:10
  SPEAKER_00: And we want to actually feel those muscles wrap around our finger and squeeze and kind of lift.
• 33:15
  SPEAKER_00: And that will give us a that uh direct information of do they have the coordination?
• 33:22
  SPEAKER_00: Is it strong?
• 33:23
  SPEAKER_00: Is it weak?
• 33:24
  SPEAKER_00: Is it tight?
• 33:24
  SPEAKER_00: All of that.
• 33:25
  SPEAKER_00: And then we'll know exactly what we're working with.
• 33:27
  SPEAKER_00: And after that appointment, we develop a personalized wellness plan that addresses everything that we found in the appointment.
• 33:36
  SPEAKER_00: So it's not a cookie-cutter situation, it's not a one size fits all.
• 33:40
  SPEAKER_00: Some people need to start more this way, other people need to start more that way.
• 33:44
  SPEAKER_00: But everyone gets that foundational baseline information on their body so that like, okay, we know we're working with here, we've got a clear plan going forward, and that helps give you hope.
• 33:53
  SPEAKER_00: It helps give you, you know, something to look forward to.
• 33:56
  SPEAKER_00: I have guidance, which then gets you feeling a little more confident about healing.
• 34:00
  SPEAKER_00: But yeah, so after that, we send them their plan.
• 34:03
  SPEAKER_00: It's got stuff they can be working on at home because we're all busy.
• 34:06
  SPEAKER_00: We can't be coming in the office all the time.
• 34:08
  SPEAKER_00: We try to really meet people where they're at.
• 34:10
  SPEAKER_00: You know, you can bring your kids if you need to.
• 34:12
  SPEAKER_00: There's you don't have to have child care.
• 34:14
  SPEAKER_00: Our front office staff will hold babies, wear babies, feed babies.
• 34:18
  SPEAKER_00: Uh, we change diapers, we do whatever needs to be done so that mama can get the work that she needs done.
• 34:24
  SPEAKER_00: Um, and then we create a plan based off their need.
• 34:26
  SPEAKER_00: Um, and then our follow-up appointments are all hands-on.
• 34:29
  SPEAKER_00: It's just really good time to get the body work done.
• 34:32
  SPEAKER_00: We do more internal work, release work, external release work, some stretches, some exercise, kind of whatever the patient needs.
• 34:39
  SPEAKER_00: Um, so that way they're always getting exactly what they need at their appointment.
• 34:43
  SPEAKER_00: And then they can have their list of things they can be working on at home too.
• 34:46
  SPEAKER_01: I love a good home program.
• 34:48
  SPEAKER_01: So I'm glad that you do that.
• 34:50
  SPEAKER_01: People think I can I can come to therapy and it's gonna solve my problem, but it's not.
• 34:55
  SPEAKER_01: We're gonna give you the tools and we need you to work on these things every day to help yourself be the best version that you can possibly be.
• 35:02
  SPEAKER_01: Oh, yeah.
• 35:03
  SPEAKER_00: We err on the side of overeducating, so we tend to a lot, but I would just rather overeducate than undereducate.
• 35:11
  SPEAKER_00: So that's just my stance.
• 35:12
  SPEAKER_01: Girl, I I feel that in my soul.
• 35:14
  SPEAKER_01: I know my parents get overwhelmed because at Salt and Light, every month we do an education piece.
• 35:22
  SPEAKER_01: I think this month we did diaphragmatic breathing and in the the appropriate way to breathe and making sure we're not using our accessory muscles and how to work on this with your kiddo at home because I see people and they're not breathing properly.
• 35:35
  SPEAKER_01: That's right.
• 35:35
  SPEAKER_01: And so, yep, let's let's do the education.
• 35:38
  SPEAKER_01: That's right.
• 35:39
  SPEAKER_01: We could do a whole podcast session on diaphragmatic breathing, girl.
• 35:42
  SPEAKER_01: Like, yeah, we could do a whole episode on that.
• 35:46
  SPEAKER_01: So we've covered a lot of stuff today, and I really appreciate you sharing all of this information from you know the importance of pelvic floor therapy for our pregnant moms, postpartum, how it can benefit athletes and younger girls, how we can manage pelvic floor discomfort and pain during intercourse, and then like touching a little bit on how this impacts men, like from a prostate standpoint or erectile dysfunction.
• 36:14
  SPEAKER_01: So, girl, I feel like we have covered the gamut of a lot of things today.
• 36:19
  SPEAKER_01: And if you're like me, you could probably take each one of those topics and talk about each one for at least another hour.
• 36:24
  SPEAKER_00: We could do part two, part three, part four to this one.
• 36:28
  SPEAKER_01: Well, I mean, there's a lot to unpack here.
• 36:31
  SPEAKER_01: So before we go today, what's something that you kind of wish people knew about pelvic floor help that you don't think ever comes up?
• 36:41
  SPEAKER_01: Is there something that we haven't talked about?
• 36:43
  SPEAKER_00: I think the main thing is just the underlying message that all women need it.
• 36:48
  SPEAKER_00: And especially as we are going through our different life transitions.
• 36:53
  SPEAKER_00: So if you are a pregnant person or you know a pregnant person, like recommend you need to go to see pelvic floor therapy.
• 36:59
  SPEAKER_00: If you see someone that has just had a baby, you need to be that advocate.
• 37:03
  SPEAKER_00: You need to go see pelvic for therapy.
• 37:05
  SPEAKER_00: Or if if someone has divulged, you know, some information to you about struggling with painful intercourse or leakage, you know, let it be that point to be the advocate for each other because it's not happening in the medical appointment.
• 37:19
  SPEAKER_00: The typical medical appointment is doctors just don't have enough time with patients to really divulge into all these things.
• 37:24
  SPEAKER_00: Sometimes we don't even bring it up because it's so fast.
• 37:26
  SPEAKER_00: And then the doctor leaves, and you go, Oh, no, I forgot to talk about that one thing.
• 37:30
  SPEAKER_00: Or they are just not as proactive with it because they're trained from more of a surgical pharmaceutical standpoint.
• 37:36
  SPEAKER_00: So I think I would really love for the community to just be better advocates for each other, that we can step up and do that.
• 37:44
  SPEAKER_00: That's my stance is that I think we can maybe change women's health from the inside out by being the advocate for each other.
• 37:51
  SPEAKER_00: And so, and know too, if you are someone who is struggling with any of these issues, that to speak up, to not suffer in silent.
• 37:58
  SPEAKER_00: And you can come into public for therapy, you don't have to go to a doctor first.
• 38:03
  SPEAKER_00: Just speak up, call us, email us, we will get you on the phone, figure out what's going on, and and we will help you.
• 38:10
  SPEAKER_00: And so we've got to stop the suffering, the suffering and the silence.
• 38:14
  SPEAKER_00: And so many women that come in here, they're like, I wish I would have known.
• 38:17
  SPEAKER_00: I wish somebody would have told me.
• 38:20
  SPEAKER_00: And so I want to stop that.
• 38:21
  SPEAKER_00: Like, let's stop that to get to the point.
• 38:24
  SPEAKER_00: And maybe, maybe you tell someone and maybe they don't listen, but then at least they'll later on be like, Well, no one told me.
• 38:29
  SPEAKER_00: Because, like, no, we did tell you to send and go.
• 38:31
  SPEAKER_01: So and I love that just advocating for each other.
• 38:36
  SPEAKER_01: I love that you said that because you know, you're talking to your friends and they're mentioning issues and things going on in their health and wellness.
• 38:45
  SPEAKER_01: And I think sometimes people don't want to cross boundaries, but I don't think sharing education and life experience is crossing a boundary.
• 38:54
  SPEAKER_01: I think it's helping your friend.
• 38:56
  SPEAKER_01: Absolutely.
• 38:56
  SPEAKER_01: There's nothing wrong with sharing, you know.
• 38:58
  SPEAKER_01: Hey, I've heard about this before, and I heard that maybe you might could go see this person.
• 39:04
  SPEAKER_01: Maybe that's a path you should take to see if you can find answers for this.
• 39:08
  SPEAKER_01: Yes, exactly.
• 39:10
  SPEAKER_01: Well, Stephanie, I really appreciate you taking time to hop on the podcast and share all of this juicy, meaty, great information with us today.
• 39:19
  SPEAKER_01: I have learned so much.
• 39:21
  SPEAKER_01: And I just want to take a moment to let our listeners know that down in the show notes, we're gonna share where they can follow you on social media.
• 39:31
  SPEAKER_01: We're gonna share your website.
• 39:33
  SPEAKER_01: And guys, uh, Dr.
• 39:34
  SPEAKER_01: Stephanie has a freebie down in the show notes.
• 39:38
  SPEAKER_01: It's the C-section recovery guide.
• 39:40
  SPEAKER_01: And it's just kind of walking through just because you've had a C-section, doesn't mean you don't need pelvic floor therapy, right, Dr.
• 39:48
  SPEAKER_01: Steph?
• 39:48
  SPEAKER_01: That's correct.
• 39:49
  SPEAKER_01: Everybody needs it.
• 39:51
  SPEAKER_01: Everybody needs it.
• 39:52
  SPEAKER_01: So we're gonna link all of that down below in the show notes.
• 39:56
  SPEAKER_01: And I just want to thank you again and thank everybody for joining us on this episode for Root Cause Conversations, and we will catch you guys next time.
• 40:06
  SPEAKER_01: Bye.
• 40:07
  SPEAKER_01: Thank you for joining us on our Root Cause Conversations podcast today.
• 40:12
  SPEAKER_01: If this episode gave you something to think about, please do me a favor and hit subscribe so you don't miss what's coming next.
• 40:19
  SPEAKER_01: And if you've got a few extra seconds, download it and share it with a friend who you think might need it today.
• 40:25
  SPEAKER_01: You never know who's sitting with these exact questions that we talked about in our episode.
• 40:30
  SPEAKER_01: I've got everything we mentioned, plus more, on today's guest and all the ways that you can connect with me sitting right below in the show notes.
• 40:40
  SPEAKER_01: So make sure you check those out.
• 40:42
  SPEAKER_01: And if you're still short on answers after today, I am praying you get the wisdom you need whenever and however you need it.
• 40:50
  SPEAKER_01: Come find me over on Instagram, and I will catch you guys next time.