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postpartum pelvic pain · From 9 to Mom

• Catie: Welcome back to From Nine to Mom. Danielle: Where we discuss balancing the nine to five hustle with the beautiful chaos that we call motherhood. And a question that we've been getting constantly is what is normal during and after childbirth in the pelvic floor area? The amount of times Katie and I get these questions is unreal. So we've decided it's time to bring on an expert to answer all of your questions. So we're very excited. We have Dr. Beth Guarine today. She's a board-certified physical therapist with more than 20 years of experience, and she's the founder of VivaCore Physical Therapy. VivaCore, right? Hold on, we might want to redo that, Katie, Dr. Beth Guarin: Before, yeah. Danielle: because I'm gonna mark it. Okay. Dr. Beth Gloreen is a board-certified physical therapist with more than 20 years of experience. And she's the founder of VivaCore Physical Therapy in Miami, where she specializes in pelvic fluorapy, postnarm, postpartum, and prenatal care, and vestibular conditions like vertico, which we have to get into because this is a wide variety of things. she's a mom of two herself, two boys, and her message is very simple. Pelvic pain and incontinence may be common during and after pregnancy, but they are not normal. And the earlier that women get help, the better. So Beth, Dr. Beth, thank you so much for coming here today with us to answer all Katie and I's questions and the listeners' questions. Dr. Beth Guarin: Pleasure. Catie: Yes, we're so excited. But before we get into the good stuff, we need to know Danielle mentioned your boy mom. How old are the kids? And like what is the chaos in your household right now? Like what are you guys going through? Dr. Beth Guarin: so I have two boys, ages nine and seven. So my nine year olds entering fourth grade, the seventh year seven year olds entering second grade. so they are constantly, constantly battling one another. They take karate lessons. So I think they try out their moves on each other. so they're they're constantly putting each other in headlocks and wrestling. It's crazy. So Which in my house obviously I don't like, but they were at camp over the summer and one of my younger sons was having a trouble with a bully. so my older son like roundhouse kicked the other kid because he was choking him. So I was like, you know what, thank God for those karate lessons because it's actually Catie: Yeah. Dr. Beth Guarin: turned out to be helpful. Danielle: Listen, I love that they're defending themselves. I'm sure they're always battling it out as brothers. Katie, you see this too, but they're gonna be the first to have each other's backs when needed. Dr. Beth Guarin: Exactly, exactly. They they love each other to death and they stick up for each other when it's most important. So that's what matters most. Catie: So did you have to like discipline him though? Like I'm kinda like I would be like, I'm glad you did that, but Dr. Beth Guarin: Well, honestly, I said, you know, good. I'm glad that you defended yourself. and I did speak to the counselor because the kid had his hands around his neck and his brother said he was Catie: Yeah. Danielle: Yeah. Dr. Beth Guarin: weird about him being choked. So I said, you know what, that's the right thing to do. You use it at the appropriate Catie: Yeah. I mean Dr. Beth Guarin: time and that was definitely warranted. So no, I didn't discipline him. I actually Catie: Good, yeah. Dr. Beth Guarin: said that he did the right thing. Catie: Yeah, no, that's good. It's like one of those things where it's like, How do you not like fight that's a situation where you're like, Yes, like do that, but I can't even think about getting there yet where you're like talking to Dr. Beth Guarin: Yeah. Catie: like we saw try to solve with words, but if there's a big issue, like, yes, you need to get in there, but it's I think it's just part of the boys. They love to fight. I feel like I'm in the same thing. I'm playing referee twenty four seven. Dr. Beth Guarin: All the time. Yeah. And then sometimes you just give up and you say they're gonna work this out on their own. Someone's gonna get hurt so I'm just gonna stop yelling. Catie: Wait till the we're there for the hugs and kisses when someone gets hurt. Dr. Beth Guarin: Yeah. Danielle: Listen, my two roughhouse and it's a boy and a girl, so but I'm sure that Daisy's gonna beat up cool one day, so it's fine. Dr. Beth Guarin: Yeah, I'll make them stronger. Catie: Right. The tables the tables will turn for sure. so we had like we were talking everything pelvic floor. I feel like that's where like a lot of our questions have come in. But will you give us like the but your background? How did you get into the specialty? I know you've had some personal experience as well. Dr. Beth Guarin: Yeah, so my whole career I've been a physical therapist for 20 years. I've done mainly outpatient work in hospital settings. and my board certification was actually in neurology. So working with patients that have Parkinson's, strokes, brain injuries, that's always been my specialty. that's where vestibular therapy came in and I was working with a lot of dizziness and vertigo patients. So that's really been my comfort zone. and then I became pregnant with my first son. he was a very big boy at birth. He was nine pounds nine ounces. I did have a vaginal birth with him, so I experienced pelvic floor symptoms after having him. I went for my regular six-week, you know, checkup postpartum. Nothing was ever mentioned to me about pelvic floor therapy. I'm a physical therapist, so I have Heard of it but didn't actually really know what it was at the time. and I felt like there was something wrong. so I went back to my OBGYN and I said, you know, I'm having a lot of pressure, I think there might be something wrong. Can I go to a polyfloor therapist? So I I did go myself. for several sessions. And then that's sort of what sparked my interest in this specialty. I had several sessions myself. I wanted to learn more about it mainly at the beginning for selfish reasons because I wanted to know how to fix myself. So I I took a course on it and I said, you know, I really feel like this could help so many people and finding a pelvic floor therapist at the time was was very difficult. There was a long waiting list. I, you know, made an appointment and then I couldn't be seen for like a month later. So I I went to study more, take more courses, and then eventually my with my husband's encouragement decided to open my own business and help women in this particular specialty. Catie: Yeah, it's so amazing too because I feel like, like you said, you hadn't heard of pelvic floor or you heard, you know, here and there, but it wasn't like this major thing. And I feel like now there's been a lot more information out there. People are starting to get referred in that. But will you break it down for any of our like new moms or pregnant moms out there? Can you break down what is the pelvic floor and How you can maybe tell when you maybe have some issues. Dr. Beth Guarin: Yeah, sure. So your pelvic floor is a series of muscles that work together to help control a bunch of different functions. So they sit at the base of your pelvis and act very much like a trampoline and shaped like a hammock to help support your pelvic organs, including your bladder, your uterus, and your rectum. So they help as a support system and they also help us to control the sphincters that allow us to not pee and poop ourselves. So So that that is when I think most women decide that maybe I should see somebody when they start laughing, coughing, jumping, and like, uh-oh, I had a Danielle: Yeah. Dr. Beth Guarin: problem here. So I think that that's what typically we think as the number one reason someone would come to see a pelvic floor therapist. but I Deal a lot with pelvic pain in my practice. So a lot of women are just used to set silently suffering, I think. and so maybe postpartum they go back to having intercourse, it doesn't feel right, or maybe it's painful. and I I see a lot of patients with pelvic pain and helping them to resolve those issues. so I think one of the main things that I would say is to not To try to learn a little bit about the pelvic floor while you're pregnant first to see if you're struggling with anything, are there some habits that perhaps we could change, some exercises or stretches we can incorporate to make your pregnancy a little bit more comfortable, prepare you for birth a little bit better. If you're definitely if you're having any kind of leakage of urine or stool, to come see a pelvic floor therapist, and pelvic pain, I would say, is the other major one. one that a lot of pregnant women do have pelvic pain and they just figure it's part of pregnancy. But there is a lot of things that we can do to help alleviate that pain with not with not too much work. Danielle: Think that when you go through all of that, so many of us in life or pregnancy, we all know that you might pee yourself after kids or you laugh too hard. Like, and everyone's like, Kegels. You just got to do your Kegels before preg like when you're pregnant and then after, and that's that's pelvic floor therapy. But as you expand on it, obviously, just even describing the pelvic floor region, there's so many layers to what it is. Kegels are not going to solve the world's problems. and I I think it's funny too that the only two people that talk to me about pelvic floor therapy like prior to being on this podcast were physical therapists in other areas too, because you guys had heard about it a little bit. So as you talk about people coming in, I think there's some embarrassment a little bit about some of these things, even though we all talk about them, but especially the intercourse like piece of it, because we don't know what normal pain is after. having a baby, you assume some of it is normal. How do you tell if that pain is just getting back into it or if it's an abnormality that you should be seeing somebody about? Dr. Beth Guarin: Yeah, so in my practice I do a very thorough history about what they were experiencing before, if they had any symptoms before. To be truthful, a lot of women experience pelvic pain and discomfort prior to pregnancy, and then afterwards it gets progressively worse. So problems that you experience maybe to a smaller extent beforehand are now exacerbated by the fact that you have a lot of stress, less sleep. no time to deal with them and and your body has changed so much. So I mean a lot of a lot of the patients that I see there's normal healing process and there's gonna be scar tissue if they had any tearing. And so we we examine all that. I do an internal examination to tech to test the muscles. We check to see if there's specific areas that are uncomfortable. And we do expect there to be a little bit of discomfort if they did have some tearing. but generalized discomfort all the time is definitely something that's a red flag and we want to address. I've had patients come to me after their six week appointment with their doctor and everyone thinks that they're ready, they're cleared, ready to go for anything, right? and then Danielle: Mm-hmm. Dr. Beth Guarin: their husband's coming at them and then they just kind of sit there Catie: Yeah. Dr. Beth Guarin: and and suffer through it all. But I've had patients come with a lot of redness, their stitches are still in place, they're not healed all the way, and it's and sometimes takes longer. That six week is not a magical time. brain that, you know, everything is back to the way it was before. It certainly is not. Danielle: Yeah, I truthfully had an issue. They t it's a TMI moment, but we're talking about our pelvic floor. After Daisy, I had pain and I thought it wasn't nor like because it didn't happen with Colton. And like you said, I would have never thought this was possible. They did the self-dissolving stitches, but my body wasn't making enough estrogen to dissolve the stitches. And it was just like the most uncomfortable thing ever. And who who knew? But if I didn't go, I would have just been sitting there in pain for how long? Who knows? It's crazy. Dr. Beth Guarin: Yeah. Yeah. And many women, especially those women that breastfeed, they're not producing the same amount Danielle: Mm-hmm. Dr. Beth Guarin: of lubrication or their tissues are different. So really educating them on what how to make themselves more comfortable, how to get past this discomfort is really important. and hopefully your doctor gave you some vaginal estrogen to help you with that. Danielle: She did. She did. She was great. Catie: That's reassuring. You guys were on the right path, Danielle. Dr. Beth Guarin: Yeah. Catie: so I think too, like part of it is like saying, Danielle, you would have sat like who knows how long you would have gone if you didn't. But like, what do you think the stigma is? Why do people why are women so afraid to even even say anything? Or why do we think it's so normal? Or what do you encourage people to do to overcome that? Dr. Beth Guarin: I mean, I think this is an issue that is just there are a lot of factors and like we've only been taught very little about our own bodies from forever. So we we don't know our no own anatomy and what's normal a lot of times. you know, I've had women that come to me in their sixties and they didn't even know where their that your urethra was separate from your vagina. So we did do a very poor job at educating our young girls about their own bodies. That's number one. And number two is we normalize a lot of these things that our mom peed her pants or or you know crossed her legs and we just thought that that was something that's gonna happen and it's normal. So people think it's normal and like you said, they're embarrassed to bring up these issues because they're not told that they could happen or there's something that could be done about it. So they just kind of stop doing those things that maybe cause the problem, maybe they stop running, but then they stop doing so many things and when it becomes really you know disruptive to their life that's affecting a lot more. So you know, we need to do a better job. Our doctors when they see these women need to do a better job explaining that this is an option. and I'll do I'll do the rest. You know, once you get to a pelvic floor therapist, a lot of what we do is talk to women and educate them, but the doctors don't have time for that necessarily. Danielle: Yeah, they're quick appointments, right? You're like in and out, your baby looks fine, you look fine, goodbye. It's not enough time to ask all the things. Dr. Beth Guarin: Yeah. It's not enough time, you know. We have a full hour with people and and have a lot of conversations about what's normal and things that they can do, little tricks. Like my patients always say, You have so many tricks up your sleeve, but that's my job to help make you Danielle: Yeah. Dr. Beth Guarin: comfortable. So Catie: Right. And now you don't always have to have a referral to see a pelvic floor therapist, right? Dr. Beth Guarin: Yeah. Yeah, so as physical therapists, so physical and occupational therapists do this kind of work. So based on your area, you might actually be seeing an OT or occupational therapist. in the state of Florida where I live, we do have something called direct access, which means that patients can come straight to see me. if we do go past a 30 day period, then they might need to get a plan of care signed or a an a you know, a script for therapy. But yes, you can come and right into the office and see me. Catie: Yeah. One of the things that I think was really helpful, we actually just spoke to like a a thyroid expert and she really went into, hey, here's what you should ask your doctor. Can you kinda if you if someone is looking for that referral, what are some of the things they should be communicating to their OB, you know, whichever doctor they're speaking to? How how would you kind of encourage them to seek this referral? Dr. Beth Guarin: Yeah, so I encourage women to come while they're pregnant. So once they enter their second trimester, I would like them to come and see where what are we dealing with at first, because a lot of problems that we could avoid down the line are can be addressed very early on. I have a lot of women that come that have had a history of constipation, pelvic pain, pain with intercourse, and they're very scared because this is their first pregnancy. They're hoping to give birth vaginally, but they want to prepare for that. that event. so really a lot of times when they come in that early we do a lot of education to what to expect, how to make them more comfortable throughout their pregnancy, what exercises should they continue, because I'm not sure how you ladies gave birth, but Pushing a baby out is like an Olympic event sometimes. And it is the hardest thing that your body has ever done. So making sure that people stay active safely throughout their pregnancy with exercise, appropriate exercises, keeping themselves strong is is very important. So I encourage all women to talk to their OBs, you know, during this time. The second trimester is a great time to come in. But then if if it's something that's afterwards, if even if they're not having any symptoms, they should come to say, I'd really like to get back to doing certain activities and do this safely. I'd like to see a public floor therapist. None of the doctors I've talked to would have any objection to that kind of request, even if there is no glaring problem. Catie: Yeah, I feel like that Danielle: You've also mentioned sorry, Katie, but like she's mentioned before that you can even go in before you're pregnant, right? To get your body ready if you're thinking about getting pregnant. Dr. Beth Guarin: Yeah, yeah. So many public floor therapists help women when they're having fertility issues, working on different visceral mobilizations and different myofascial work. But a lot of the women that I see that are trying to get pregnant are those people that are struggling with increased tension in their pelvic floor. So they're having a lot of discomfort with intercourse or anything vaginally inserted. maybe they're going to have egg retrieval and they need to be able to, you know, withstand having the vaginal ultrasound performed. So I do see a lot of women prior to trying to get birth, I'm sorry, to get pregnant. to prepare for that and make them more comfortable. Catie: Yeah. And what are some of the other signs? So like we're talking before, you know, people in the trying to conceive section, but as you go through, obviously, like, I think we had said like constipation's even a symptom or some there's different things. What are some of the like more unique symptoms that maybe would give you the idea that something else is going on other than the main th like the, you know While you're running and that kind of thing that everyone hears like Dr. Beth Guarin: Yeah. Catie: those are the things that we hear about, right? What are some of the underlying ones, I guess? Dr. Beth Guarin: Yeah, so Believe it or not, constipation is one of the major symptoms that I see for both people that have a weak pelvic floor and those that have one that's overactive. So the weak pelvic floor, this constant constipation where you're constantly trying to push your stool out is overstretching those pelvic floor muscles. So constantly doing that and over-stretching muscles weakens them. So you know, the pelvic floor is controlling the sphincters that help keep our stool in as well as those that keep our urine in. So if you're constantly pushing against that and weakening them, that's one of the major symptoms that I would say if you have chronic constipation, you're likely also going to have pelvic floor involvement as well. Another one would be constantly feeling the need or urge to go to the bathroom. You you went to go pee, you get up, and you feel like you still have to go. So that's one of the symptoms that I see oftentimes with people holding it, you know, 30 minutes and feeling like they still have to go. so that's that's something that we work on a lot here. There's actually different types of incontinence so the stress kind is the kind that we all think about most often where you're jumping laughing running and you lose urine but there's also the type that's associated with urgency so that kind is you put a key in the door or you hear running water and then you're I'm in trouble and I have to go. So there's different types of incontinence that we treat as a symptom. Catie: And so I think too, something else that I would love for you to break down is I know I feel like this sometimes. Like I'm like the know it all, right? Like I wanna know exactly what's gonna happen in my appointments. I was the one that like before my first OB, when I like called the office to tell him I was pregnant, I was like, what do I I just call and say I'm pregnant. Can I have an appointment? And I like didn't know. And then I was like researching online, like, what's in your first appointment? Like, how what are they gonna ask me? Like, what are they gonna do? I feel like that's something too people don't know. You mentioned like a little bit of your process, but what would like your first appointment look like with somebody that came to see you? Dr. Beth Guarin: Yeah, so a lot of the time patients come in very scared. So I like to ease their mind and explain everything that we're doing in a session so nothing comes as a surprise. I think that they come in thinking I'm gonna be all in their vagina the whole time. That's Catie: Well that's why I'm like the floor with Danielle: That's what I would think. Catie: me. Dr. Beth Guarin: So so I like to at the very beginning explain that that's not what's going to happen. Yes, we'll get there, but not right away. So I wanna find out if they're having any symptoms, what they are, when they happen, what that looks like. if if they're a mom, I wanna know about their kids. How old are they? you know, how was their labor and birth? what kind of You know, how long were they pushing for? Did they have any tearing? We go into the nitty-gritty. Everyone likes to tell their story about giving birth. and then I'm a physical therapist by trade, so I'm looking at a lot of different things at your posture, your balance, how you take load onto your legs, your range of motion, especially in your hip joints. So we're doing all that with your clothes on. and then I explained to them exactly how the internal exam is going. to look. I have a model where I explain what the public floor does and exactly how I'm going to evaluate it. So we do an assessment if they agree to doing that part of the exam. Everything in my exam is based on what they feel comfortable with. That is the gold standard to do an internal assessment to find out what's going on. But if for whatever reason they don't feel comfortable, we can certainly gather a lot of information without that. but we're we're looking at the tissues to see if if they're dry, red, if they've recently given birth, if there's scar tissue, any stitches in place, if any of that looks un not normal or to be like it's gonna be too uncomfortable, that's where I stop the exam and we start and we start working on some of the things that we've already dis determined would help them. If everything looks good and it's all all lights are green to go for an internal, what I'm doing is really assessing the muscles. So we go layer by layer. There are three layers to the pelvic floor so we're checking all of them. I'm looking to see if they have any discomfort, increased tension, I want to see how those muscles are contracting. So we do kind of a manual muscle test to see how strong they are, both in the endurance of the muscles and how quickly they can contract, as well as if they can relax. So having a healthy muscle, whatever the muscle is in your body, has to both be able to contract and relax. So if it's not doing either of those things appropriately, then that will be part of our treatment plan. That internal part really takes about five to ten minutes of my total exam just to give you an idea of what else we're really looking for. Yeah, yes. Yep, Danielle: It's an hour long and five to ten minutes is spent in in there, right? Catie: Yeah. Dr. Beth Guarin: exactly. There are no speculums, there are no stirrups. It looks very different than when you go to an OBGYN appointment. Danielle: That's what picturing in my head is like you I'm sp like Catie: Yeah. Danielle: spread eagle, you're in there. Like so knowing that is is nice because I do think it's like a private, not that it's a private thing. At the OB, you know it's like quick, quick and dirty, right? Like you're in and out, like Dr. Beth Guarin: Anyhow. Danielle: that's what it's for. But this is like you're trying to investigate what's going on. But I as you're talking through it, it makes so much more sense because everybody is so unique in what's bothering them. And then I'm thinking about the different stages, like I'm older than Katie, weird, but paramenopause is like a big topic and people are saying like it hurts or they're too like talking in friend groups and stuff like that. And I'm a s now that you're saying this, like pelvic floor therapy might help in that case too, right? Dr. Beth Guarin: Absolutely. So I see a lot of perimenopausal and menopausal women that these symptoms are now just popping up when they reach this stage in life, their hormones are changing, their tissues are changing, you know, and a lot of times their partner is changing as well. you know, that maybe they don't have intercourse as often as they used to, so things are reacting a little bit differently. I've treated a lot of women in their late 50s post-menopausal that need to start the appropriate hormone therapy. Thank goodness we're beyond the stage where that's such a taboo and scary thing. But it helps a lot of women to become more comfortable using the vaginal estrogen to make it more comfortable for them. You know, they may have to go back to doing some of the stretches that I would have taught someone much younger them than them with the appropriate hormones. But really every woman that I see is very unique and we just need to find out the things that we need to focus on for them. So, you know, that's why it's so important to do an assessment head to toe to find out all that these things can be connected. Catie: So I I have to ask because so my second delivery was a emergency C section. And so I didn't push nothing. We didn't get to that point. But do you see any differences based on the delivery type postpartum anyway with different issues? Do you see more or less issues with C section deliveries? What any Dr. Beth Guarin: Yeah. Catie: opinions on that? Dr. Beth Guarin: So I d I do. I obviously treat both. a lot of the women that have had C-sections based on the nature of that kind of surgery do have more risk for a diastasis, which is your muscles need to separate, your abdominal muscles need to separate to accommodate the growing human inside of you. So a lot that happens with all of us as we our bellies get bigger and then to varying degrees they close afterwards and it takes several months for that to happen. But I s I do see diastasis more with women that have had C sections like yourself. so why is that a problem? Well, sometimes it's just a cosmetic thing and people don't like having that separation. It makes them have a pooch or their belly isn't coming in like it used to. but sometimes it's putting them at risk for other things like having a hernia or or something like that. So we we want to be able to assess all areas based on that, but get them back to the activities that they want to engage in. So you know there's a lot. lot of pressure on us as women to bounce back to our old selves, our old bodies. And so for example, if someone has a diastasis and they're going in the gym doing a ton of sit-ups, that can make it so much worse. So I see a lot of that with C-section. If if women have had a lot of pelvic tension prior to having a C-section, I do a lot of times see that that actually gets worse after the C-section. You know a A lot of my patients will say to me, you know, I had a C-section, why is it so uncomfortable for me having intercourse now? And it really catches them by surprise. So I I would say that I see a little bit more pelvic tension with that population. And then, you know, what you think of with the vaginal births, I do happen to see more pelvic organ prolapse with that population, particularly if they've been pushed, they were pushing a long time to get the baby out, or they had a s significant tear, or their baby was very large. So we would do we would probably see those issues a little differently. Catie: Interesting. I had to ask. so I know outside of pelvic floor you treat a lot of other things too. Can you kind of go into some of the other things that you focus on? Dr. Beth Guarin: Sure. I'm I like I said I've been a therapist for 20 years, so I've seen almost every kind of patient throughout my career. But I do treat a large majority of patients that have vestibular involvement, which what is that? That's the that's the inner ear, and that is the system that's responsible for helping us keep our eyes focused when our head is in motion, as well as one of our balanced systems. So symptoms of a dysfunction in this area will would possibly be vertigo, dizziness, imbalance. So this is another specialty area that I focus on in my practice. So, you know, I think this happens more frequently with the older population. They, you know, they lay back or they've been avoiding laying back for several years years now because when they do, they get the spins. But they just thought that that was normal and they've just accommodated. For it. So it's the number one reason people get dizzy when they're over the age of 65. So it's definitely something that is prevalent and I do treat a lot of that. And I also still practice seeing patients with neurological conditions. So strokes, MS, Parkinson's, that sort of thing. Danielle: That's a huge like undertaking, I feel like you have so and then you have two little ones at home. Like, how does that work for you? Dr. Beth Guarin: Yeah Catie: Yeah. Dr. Beth Guarin: I like the things that those different types of therapy give my patients. I really feel like the types of therapy that I've chosen to participate in make the largest impact on people's lives. Neurological conditions are usually something that is very devastating to someone and comes out of the blue. So I feel like it make a huge impact in those people's lives. For my patient population. That I'm treating for pelvic floor, you can imagine that someone that would avoid going to every party because they were gonna pee them their pants and now all of a sudden they can do that, what impact that makes. Or you know, I also treat men with pelvic floor dysfunctions. So I had a man that was coming to see me that he had something called pudendal neuralgia. which was caused by several hours of bike riding without shocks and a various other things, but mainly his nervous system was always overworking. So he experienced symptoms of pain and numbness in his penis. So you can imagine the type of symptoms that or how that was affecting his life. So, you know, I feel like Danielle: I would never think that that was like related to pelvic floor. Like as you said that I was like, wait, what? Like that's insane. Catie: Never. Yeah, Mike, wait. Dr. Beth Guarin: Yeah. Catie: Yeah, I didn't put it together. Interesting though. I mean, it is important though to know I think that's the biggest thing, right? Is like knowing that there's specialists out there that can help with different things. And that's a big reason why we wanted you on today to hear about this. So people know what's available and can get the support that they need because there are so many symptoms, as you've said, that aren't normal and you need to feel competent to, you know, get to someone that can help you with them 'cause it's Danielle: Or the symptoms you think like they're so normalized that you think that they're just part of your everyday life. And that's like you said, it's normal to ha it's common to have those symptoms, but it's not normal to live with them forever. Dr. Beth Guarin: Exactly. Danielle: And that's something I think people do need to know because life after kids is not supposed to be peeing your pants, never like having sex because it hurts too bad. Like it's supposed to be like fun after, right? Like that. Like supposed to have a fun Catie: Mm. Danielle: life. And I think so often people are looking at certain things, like you said, not going to parties or not being intimate with their partner and they think it's just there's something wrong with them mentally or whatever and so much of it can be fixed or helped Dr. Beth Guarin: Yeah, absolutely. Danielle: with someone like you. So I think that that's really important that people know. Dr. Beth Guarin: Absolutely. Catie: So if you had to leave all of our moms listening out there with one piece of advice for making time for this type of thing, or you know, thinking of the new mom out there that is like I can't go to another I don't need another appointment or that, what advice would you give them? Dr. Beth Guarin: you know, I think that we always put ourselves last, right? We're trying to help everyone else and you know, it's the same thing as when they say like in the airplane that you have to put your oxygen masks on first before you can help others, right? We are people and we were people before we had these little people in our lives, and we need to be able to get back to that person. so I really think prioritizing yourself both physically and mentally is so important and whatever that looks like, if it includes going to pelvic floor therapy, if it's just doing a meditation for 10 minutes in the morning, I think that being a part of ourselves, finding ourselves again is so important. So making time for that and letting our partners know that that is very important because otherwise, you know, you know, we let all of these things slide and then next thing we know we're 70 years old peeing ourselves and falling down. And that's not what our life is supposed to look like. Danielle: Mm-hmm. Catie: Absolutely. all right. So can you give your list our your list our listeners a little bit of how they can connect with you? We'll obviously link your website and Instagram here, but can you give them a little bit of some of the classes you offer and that type of thing? Dr. Beth Guarin: Yeah, so I offer Quarterly classes at the moment in the community to try to connect with moms. So I usually post those on my Instagram Instagram account vivacore.pt and I also offer some tips for general public floor health there. If you are in the South Florida area and want to come see me, I am located in Miami around the Kendall area. And you can reach out to me on my website. It's www. www.vivacorept.com, and you can also email me at beth at vivacorept.com and I'm happy to answer any questions that any of your listeners or anyone has. Catie: So amazing. well, thank you for all the info. I think it was so important to talk about and you gave a lot of amazing advice. So thank you. All right. We will see you on. Dr. Beth Guarin: Thank you. Yeah, thank you for having me, ladies. Danielle: Thank you so much. Catie: Thank you.