Latest / Outside The Therapy Room / Episode 70: Period Pain & Your Pelvic Floor with Laura Holland

Transcript

Episode 70: Period Pain & Your Pelvic Floor with Laura Holland · Outside The Therapy Room

• 0:04
  SPEAKER_00: I'm Yvonne Hamid, registered social worker and donor of Human Counseling.
• 0:08
  SPEAKER_00: At Out of the Office, I'm a mom, wife, daughter, sister, and friend.
• 0:13
  SPEAKER_00: Join me each week as I sit with a special guest to discuss everyday things that impact our mental health.
• 0:18
  SPEAKER_00: We'll be chatting about everything from mental health and relationships to media and current events.
• 0:23
  SPEAKER_00: As well as personal experiences and reflections, all in the hopes of normalizing our humanness and helping you see that you're not alone.
• 0:31
  SPEAKER_00: This is Outside the Therapy Room.
• 0:34
  SPEAKER_00: Hi everyone, welcome back to Outside the Therapy Room season three.
• 0:39
  SPEAKER_00: Today we have Laura back, pelvic floor specialist, to talk about like I think something that a lot of women experience, which is period pain.
• 0:49
  SPEAKER_00: Um, so I thought we could talk a little bit about how the pelvic floor kind of fits in this.
• 0:55
  SPEAKER_00: Um, and so Laura, you were here in season two, but for those who are maybe just tuning in now for season three, can you please introduce yourself?
• 1:03
  SPEAKER_01: Yeah, thank you so much for having me back.
• 1:04
  SPEAKER_01: So my name is Laura.
• 1:06
  SPEAKER_01: I am a pelvic floor physiotherapist in Kitchener, Waterloo.
• 1:09
  SPEAKER_01: I have been a physio for many years, eight years now, I think.
• 1:15
  SPEAKER_01: Um, and when I was in school, I discovered women's health, and that's kind of what led me to specialize in pelvic flora therapy.
• 1:23
  SPEAKER_01: Um I have a little girl who is the absolute light of my life, and yeah, I'm super passionate at just about spreading awareness because I think that's the biggest thing that women in particular don't have or just aren't aware of this part of their bodies, even though you get a period every month or you have babies or you go through menopause.
• 1:42
  SPEAKER_01: And so I just love doing these types of things to help make people more aware and normalize these conversations.
• 1:49
  SPEAKER_00: So I'm really happy to be here.
• 1:51
  SPEAKER_00: Yeah, thank you so much for coming back.
• 1:53
  SPEAKER_00: Your first one, so please go back to season two, listen to Laura's episode on just pelvic floor and what why it's important for us, how it can show up when we're feeling a lot of stress and anxiety.
• 2:06
  SPEAKER_00: It's such an informative episode, so make sure to tune into that one.
• 2:10
  SPEAKER_00: Okay, so today, like I said, let's start with the basics.
• 2:14
  SPEAKER_00: Period pain, I think it's very common for a lot of women.
• 2:17
  SPEAKER_00: Um, it doesn't necessarily mean it's normal.
• 2:21
  SPEAKER_00: I think sometimes people are like, oh, period pain, that's just part of your PMS symptoms.
• 2:25
  SPEAKER_00: That's just what's supposed to happen.
• 2:27
  SPEAKER_00: Um, but not really.
• 2:29
  SPEAKER_00: Yeah, Charlie.
• 2:32
  SPEAKER_01: Okay, so period pain can happen for a variety of reasons.
• 2:37
  SPEAKER_01: Um, so there's some conditions like endometriosis or PMOS, it's now called.
• 2:41
  SPEAKER_01: They recently changed that diagnosis from PCOS to PMOS.
• 2:46
  SPEAKER_01: Um, or you can just have painful periods.
• 2:49
  SPEAKER_01: Some people have fibroids, some people have no real good reason, but their periods are painful.
• 2:55
  SPEAKER_01: And this is where it becomes, as you said, like a very normalized conversation because in you know, literature, mainstream media, in talking to your friends, and sometimes too, like some things can be genetic fibroids or can be genetic components to endometriosis.
• 3:10
  SPEAKER_01: So sometimes the only example you have in your house, which is your mom, may also have the same thing as you.
• 3:17
  SPEAKER_01: So you're having the same experience, but that still doesn't mean that it's normal, it's just really common.
• 3:23
  SPEAKER_01: So period pain can be kind of any, I would say, variety of definitions, but for most people, it's pain during their menstrual cycle.
• 3:32
  SPEAKER_01: So pain like cramping, backaches, pain that shoots down the legs during the time of your bleed.
• 3:38
  SPEAKER_01: And of course, having a period is inherently, I would say, uncomfortable because your uterine lining is shedding.
• 3:46
  SPEAKER_01: So just biologically, like that can be uncomfortable, but that actual like process doesn't take very long.
• 3:55
  SPEAKER_01: So I really tell people like what is considered kind of normal is maybe like a two, three, four out of ten.
• 4:03
  SPEAKER_01: So some discomfort for a couple hours.
• 4:06
  SPEAKER_01: And that should be it.
• 4:08
  SPEAKER_01: So if your pain is exceeding like a five out of 10, if you have to take advilant tylenol, if your pain goes on for multiple days, and if the pain is not just isolated to kind of like where your uterus is, like that cramping, if the pain is wrapping around your back, shooting down your legs, making you feel nauseous, making you have the period flu, all of that stuff is really common, but it's not actually normal.
• 4:33
  SPEAKER_00: That is such great information because I think a lot of the I remember in high school having a friend like on the floor crying and she couldn't get up, and everyone was like, you know, you're being a baby, it's just regular period cramps.
• 4:47
  SPEAKER_00: Like, we don't really know what someone else is experiencing.
• 4:49
  SPEAKER_00: Yeah.
• 4:50
  SPEAKER_00: Um, or a lot of people calling in sick for period pain, which is really then difficult at work because you're taking a sick day, yes, or you know, probably once or twice a month for your period pain.
• 5:02
  SPEAKER_00: But a lot of people are like, This is normal, this is what it is to be a woman, is you're constantly in pain once a month, but it's not.
• 5:09
  SPEAKER_00: And the difference between something being common doesn't necessarily mean that it's normal.
• 5:17
  SPEAKER_00: That's how it's supposed to be.
• 5:18
  SPEAKER_00: And I think sometimes that gets confusing for people.
• 5:20
  SPEAKER_01: Yes, and I think also as you said, everyone has a different experience, and so number one, everyone has a different pain tolerance, right?
• 5:28
  SPEAKER_01: So you can't really like tell someone that their pain is not painful, like it's subjective to them, it's their experience, and if it is painful to them, it's painful to them, right?
• 5:38
  SPEAKER_01: And some people don't experience.
• 5:41
  SPEAKER_01: I think some people don't realize how like wide the range of period pain can be.
• 5:48
  SPEAKER_01: Like some people get cramps and they find that's manageable.
• 5:53
  SPEAKER_01: I'm gonna start that over.
• 5:55
  SPEAKER_01: Some people get cramps and they find that that's manageable and they can kind of deal with it without taking Tylenol or Advil, they just use a little bit of heat pack.
• 6:03
  SPEAKER_01: Whereas some people are like doubled over in pain, like your friend.
• 6:07
  SPEAKER_01: And so I think because pain encompasses such a broad category, especially when it comes to talking about periods, it you can't you can't really judge someone else's experience.
• 6:18
  SPEAKER_01: And then also some people genuinely don't have pain.
• 6:20
  SPEAKER_01: Like, you know, I've had patients because I ask I screened for period pain with all of my patients when they come in.
• 6:25
  SPEAKER_01: And some people are like, Yeah, no pain, like regular 28-day cycle, just bleeding, no pain, no whatever.
• 6:31
  SPEAKER_01: And I'm like, Well, that's such an interesting experience because I like I always know when it's day one of my period because I always have cramps, like always.
• 6:39
  SPEAKER_01: And so I think unless you've actually experienced debilitating period pain, it's hard to conceptualize what that feels like too.
• 6:48
  SPEAKER_00: Yeah, yeah, yeah.
• 6:49
  SPEAKER_00: And vice versa.
• 6:51
  SPEAKER_00: Right?
• 6:51
  SPEAKER_00: Like it's not like too much.
• 6:53
  SPEAKER_01: Exactly.
• 6:54
  SPEAKER_01: The other thing, too, just to say, is that a lot of people's periods change as they go through phases of life.
• 7:00
  SPEAKER_01: Yeah.
• 7:00
  SPEAKER_01: So sometimes when you're a teenager, and I would say this is super common for like our kind of era, is that um it's actually common for teenagers to have really painful debilitating periods because your hormones are still kind of stabilizing.
• 7:16
  SPEAKER_01: So a lot of people, when they're teenagers, have really bad periods, and then as they kind of go through a couple years of having cycles, they it kind of can stabilize.
• 7:24
  SPEAKER_01: But for a lot of people in like in our age bracket, a lot of us were prescribed birth control for period pain and then didn't have periods or had birth control periods, which is not a real period.
• 7:34
  SPEAKER_01: It's actually called a withdrawal bleed if you're bleeding when you're on birth control, because birth control keeps your hormones like at a consistent level so you don't ovulate.
• 7:44
  SPEAKER_01: That's how it works for birth control.
• 7:46
  SPEAKER_01: But then if you're not ovulating, you're not going through kind of that phase of your menstrual cycle.
• 7:51
  SPEAKER_01: And so the bleed that you get is called a withdrawal bleed when you start the sugar pills.
• 7:56
  SPEAKER_01: It's not actually like a true period.
• 7:59
  SPEAKER_01: So a lot of people, the pill kind of masked some of those symptoms.
• 8:04
  SPEAKER_01: And then when people came off of it, some people found it was worse, some people found it was better, but you you kind of not having that like a true period for that length of time.
• 8:13
  SPEAKER_01: And then some people too notice their periods get better or worse when they have kids.
• 8:17
  SPEAKER_00: I was just gonna say really common.
• 8:20
  SPEAKER_00: Yeah, too.
• 8:21
  SPEAKER_00: I never really had very painful periods, but I again my friend, so painful in high school.
• 8:28
  SPEAKER_00: Um, and then her doctor prescribed her birth control, and then she decided to start having children, got off birth control, it was worse again, and then after that she had her daughter, things evened out eventually, you know.
• 8:41
  SPEAKER_00: Like you usually don't get your period a little while after you have a child.
• 8:44
  SPEAKER_00: Yeah, but she said it was much more manageable, it was it turned more regular, yeah.
• 8:50
  SPEAKER_00: Like her whole kind of cycle completely shifted into something that for her worked a little bit better.
• 8:54
  SPEAKER_00: Yes, but I'm sure the opposite can also be true.
• 8:56
  SPEAKER_00: It can, yeah.
• 8:57
  SPEAKER_01: Yeah.
• 8:58
  SPEAKER_01: So a lot of like old school treatment for endometriosis doctors used to tell people to get pregnant.
• 9:03
  SPEAKER_01: And you'll yeah, and you'll still sometimes hear that recommendation be thrown around, which is a little sad because A, not everyone wants kids.
• 9:12
  SPEAKER_01: Um, and B 50% of people who struggle with infertility have endometriosis.
• 9:17
  SPEAKER_01: So a lot of people who struggle with endometriosis also struggle with infertility.
• 9:21
  SPEAKER_01: So, like, of course, it's something that they would want, but it's they maybe can't get pregnant, which is very painful then when someone's saying, Well, just get pregnant.
• 9:29
  SPEAKER_01: Um, like it's so easy, exactly.
• 9:31
  SPEAKER_01: But for some people, pregnancy almost like resets the body.
• 9:35
  SPEAKER_01: Well, for most people, it resets the body, and sometimes that can be positive.
• 9:39
  SPEAKER_01: And I've seen it go the other way where people may have had like something like silent endo or no problems, and then they have a pregnancy, and now all of a sudden their symptoms are really debilitating.
• 9:48
  SPEAKER_01: The other thing, too, is as people are in perimenopause, women go into perimenopause, and approaching menopause, sometimes periods get heavier and closer together as you approach that phase, right?
• 9:59
  SPEAKER_01: So sometimes people have had no issues, and then all of a sudden they're enter perimenopause.
• 10:03
  SPEAKER_01: I actually have a new client where that is her primary concern.
• 10:06
  SPEAKER_01: She's 43, never had really issues, and now all of a sudden her periods are a real struggle.
• 10:12
  SPEAKER_00: Yeah.
• 10:12
  SPEAKER_01: And so it can also change over the course of a woman's period life cycle, if we can call it that.
• 10:20
  SPEAKER_01: And so I think it's also just important to understand that that's not because you did something wrong.
• 10:26
  SPEAKER_01: It's just, it's just how bodies are.
• 10:28
  SPEAKER_01: They do change over time.
• 10:29
  SPEAKER_01: And it's that's why it's important to know that it's not necessarily normal because just because you didn't have painful periods as a teenager doesn't mean it's always going to be that way.
• 10:38
  SPEAKER_00: Yeah, yeah.
• 10:39
  SPEAKER_00: And I think you know, something that again people maybe didn't know when they were when they're just starting out their period is that some of the things that you mentioned.
• 10:49
  SPEAKER_00: So some diagnosis that women can get um around their period that gives like a reason or um a cause of why they're experiencing that.
• 10:59
  SPEAKER_00: So what are some of those?
• 11:00
  SPEAKER_01: You mentioned a couple endometriosis and yeah, so I would say endometriosis is the biggest one.
• 11:06
  SPEAKER_01: Um, so endometriosis is where you have endometrial-like tissue, so tissue that is like the endometrial lining that actually grows outside of the uterus.
• 11:15
  SPEAKER_01: So it can come in the form of cysts, um, or it can come in the form of endometriomas, and it essentially attaches to tissue typically within the pelvis.
• 11:24
  SPEAKER_01: So normally where we see it is on the uterus, the ovaries, the bowel, the bladder.
• 11:29
  SPEAKER_01: Um, but it can also, there's been cases of like thoracic endometriosis, so up into the diaphragm, the ribs, like it, it's a very, it's a whole body condition.
• 11:40
  SPEAKER_01: It's not just specifically isolated to the pelvis.
• 11:42
  SPEAKER_01: And so with endometriosis, typically people have very painful periods because when you have the bleed, like your hormones drop, and you have the bleed that causes your uterine lining to shed, that also affects the endometrial tissue that is outside the uterus because it is similar to the endometrial lining, so it's going to respond in a similar way.
• 12:03
  SPEAKER_01: So you get inflammation over time, you can get scarring.
• 12:06
  SPEAKER_01: So people a lot of times have a lot of pain, and sometimes that can go hand in hand with bowel symptoms, bladder symptoms as well.
• 12:15
  SPEAKER_01: Um, so I would say endometriosis is probably the most common one.
• 12:19
  SPEAKER_01: The next one would be um PCOS.
• 12:22
  SPEAKER_01: So that is polycystic ovarian syndrome, which was only within the last few months renamed to PMOS.
• 12:29
  SPEAKER_01: I'm gonna have to look up the name because I can't remember exactly what it stands for.
• 12:34
  SPEAKER_01: This is like brand new within the last three weeks.
• 12:37
  SPEAKER_01: It's like the basically the change now encompasses not just the ovaries, but again, looking at PMOS as a whole body issue, um, not just something specific to the pelvis.
• 12:50
  SPEAKER_01: Yeah.
• 12:51
  SPEAKER_00: Did you find it?
• 12:52
  SPEAKER_00: Yeah, it's polyendocrine metabolic ovarian syndrome.
• 12:58
  SPEAKER_00: Um, and it's been driven by a lot of advocacy for the name change, um, and it corrects the misconception that the condition is solely a reproductive or cis-based issue.
• 13:09
  SPEAKER_00: So yeah, more full body.
• 13:11
  SPEAKER_01: More full body.
• 13:12
  SPEAKER_01: So similar to endometriosis.
• 13:14
  SPEAKER_01: So as um research in women's health is finally starting to happen, and we're yay, and we're finally starting to study women and these concerns and conditions, what we're learning is that these things are full body, you know, they affect the whole body, they don't just affect the reproductive organs.
• 13:34
  SPEAKER_01: So PCOS used to be a really tricky one to diagnose because the the hallmarks of PCOS, if I can use air quotes around that, would be irregular periods, cysts on your ovaries, and then I can't remember what the the third like biggest criteria was, but but it was basically like an androgen.
• 13:55
  SPEAKER_01: So androgens are the like testosterone sex hormones.
• 14:00
  SPEAKER_01: So people with PCOS or PMOS tend to have higher levels of like the testosterone or male sex hormones, which drives symptoms like weight gain, hair growth in areas like chin, on your belly, things like that.
• 14:13
  SPEAKER_01: So those would be kind of a constellation of symptoms.
• 14:15
  SPEAKER_01: So you basically had to have like a constellation of symptoms in order to meet the criteria for PCOS.
• 14:22
  SPEAKER_01: And now with PMOS, what they're saying is that constellation of symptoms can include things outside of the ovaries.
• 14:29
  SPEAKER_01: So actually, one of the most common things I see with PMOS is insulin resistance.
• 14:34
  SPEAKER_01: And I've actually seen people with PCO, PCOS, PMOS where that's their only symptom.
• 14:39
  SPEAKER_01: So they present in a way that's hard to diagnose, and so there ends up being a long time to diagnose, a lot of gaslighting for why they have their symptoms, they struggle for a long time.
• 14:49
  SPEAKER_01: So I'm hopeful that this diagnostic criteria will help capture more people in like what is actually the true clinical picture of PMOS.
• 14:58
  SPEAKER_01: And I would say PMOS doesn't is not as known for causing painful periods as endometriosis, but a lot of times because they both are like dysfunctional hormone conditions in a way, they can often go hand in hand.
• 15:12
  SPEAKER_01: So sometimes people who have endometriosis also have PMOS.
• 15:17
  SPEAKER_01: Um, and so sometimes if if someone has been diagnosed with PMOS and they have kind of like some endometriosis sounding symptoms, I recommend they go back to their doctor or gynecologist and kind of maybe have that conversation.
• 15:30
  SPEAKER_01: Obviously, physiotherapists can't diagnose those types of medical conditions.
• 15:34
  SPEAKER_01: Um so yeah, those are the two biggest ones.
• 15:36
  SPEAKER_01: And then I would say kind of the third biggest condition is fibroids.
• 15:39
  SPEAKER_01: So fibroids are like tissue um growths that can be either inside the uterus, embedded in the wall of the uterus, or around the uterus, and they can cause pain with periods as well.
• 15:53
  SPEAKER_01: Um, those are pretty easy to pick up on an ultrasound.
• 15:56
  SPEAKER_01: So if you where endometriosis and PCOS are um trickier to diagnose, fibroids are a pretty clear diagnosis, I would say.
• 16:06
  SPEAKER_01: Um, and so those those would be kind of the three main ones that I clinically see that cause period pain.
• 16:13
  SPEAKER_00: Yeah, yeah.
• 16:13
  SPEAKER_00: Thank you for that.
• 16:15
  SPEAKER_00: So informative.
• 16:15
  SPEAKER_00: But I think, yeah, a lot of the times it's the advocacy part.
• 16:19
  SPEAKER_00: Yes, it's the you know, going to your family doctor saying, hey, something feels wrong, and the doctor actually listening to you and taking you seriously and running all of those tests.
• 16:29
  SPEAKER_00: And I know we see it online a lot um with women, women who are sharing their story of trying to get an endodiagnosis and the challenges that that can bring.
• 16:39
  SPEAKER_00: Um, but you know, that's like the sad frustrating part of it.
• 16:45
  SPEAKER_00: But at what point do you recommend to your patients to seek support um if they are noticing some you know strong painful periods?
• 16:53
  SPEAKER_01: I normally tell people like right away because as you said, so the average time to diagnose endometriosis is 10 years.
• 17:00
  SPEAKER_00: That's awful.
• 17:01
  SPEAKER_01: Can you imagine?
• 17:02
  SPEAKER_01: Like, imagine having like you know, high cholesterol for 10 years or high blood pressure for 10 years, and no one did anything about it.
• 17:10
  SPEAKER_01: Like that would never happen.
• 17:11
  SPEAKER_01: Yeah, you know what I mean?
• 17:12
  SPEAKER_01: But for painful periods, the ability of the medical community to be aware and understand and diagnose it is I would say generally poor.
• 17:23
  SPEAKER_01: So I normally tell people, like, if you suspect, and in my experience of treating women, most women are very intuitive.
• 17:34
  SPEAKER_01: And I think people in general, but I my caseload is only women, so I can really only speak to what I see, but most people are very intuitive about their bodies.
• 17:42
  SPEAKER_01: And I think that people will always tell you what is wrong with them if you are willing to hear what they're saying.
• 17:48
  SPEAKER_01: And I think hearing and listening are not always the same thing in the medical space.
• 17:52
  SPEAKER_01: So I normally tell people if you think that you have painful periods, start the conversation with your doctor.
• 17:59
  SPEAKER_01: Right now in Kitchener Waterloo, it takes about two years to get a gynecologist if you're not pregnant.
• 18:04
  SPEAKER_01: So if you're going for a non-obstetrical concern, if you're going for a gynecology concern, it's one to two years, depending on what your concern is.
• 18:12
  SPEAKER_01: So that's already now two years that you're waiting to even just speak to a gynecologist, right?
• 18:18
  SPEAKER_01: The thing about endometriosis is that not all OBGYNs specialize in endometriosis.
• 18:24
  SPEAKER_01: So I normally encourage people to see a gynecologist that actually specializes in endometriosis because the the traditional way to diagnose endometriosis is with a laparoscopic surgery.
• 18:38
  SPEAKER_01: And endometriosal endometriosis tissue is hard to distinguish.
• 18:43
  SPEAKER_01: So unless you're seeing someone that's kind of been trained or is a specialist in endometriosis, even if they go in and do a laparos laparoscopic surgery, they might not easily be able to identify the endometrial tissue and remove it.
• 18:55
  SPEAKER_01: And so you could have a surgery and they either say, no, I didn't see any endo, even if you do have it, or they see some endo and they excise the excise as in remove the endometriosis, but then you still have persistent symptoms because they didn't get all of it.
• 19:11
  SPEAKER_01: So you should see someone who has like enough clinical experience and specializes in in endometriosis to to actually treat you properly once you are seen.
• 19:21
  SPEAKER_01: And so these specialists, of course, because this is coming becoming more um known that you should see a specialist, they take even longer, right?
• 19:30
  SPEAKER_01: So if anyone is listening to this and you are thinking you have endometriosis, I normally recommend looking at the endometriosis network of Canada for a physician because they have a specific section on their website that filters physicians by area who actually specialize in endometriosis.
• 19:45
  SPEAKER_01: So you can find a doctor in your area that you know has been, you know, approved, I guess I could say, like by the endometriosis community.
• 19:54
  SPEAKER_01: Um, so because it takes so long in Canada, which is, you know, the the privilege of public health care is that we have, you know, you don't have to go through your insurance or or think about mortgaging your house to see a specialist, but subsequently means that it takes a long time.
• 20:10
  SPEAKER_01: So I always recommend starting that process as soon as you can because if you go to the specialist and they do all the appropriate testing and they don't find anything wrong with you, great.
• 20:19
  SPEAKER_01: But then at least you didn't wait five years to be like, okay, this isn't getting better, and now I want to initiate the process, and it's gonna be another couple years before I get seen.
• 20:28
  SPEAKER_00: Yeah, yeah, it's a good plan for the future kind of thing, which again, unfortunate that we have to do, but um, and we're gonna include that link in our show notes so folks can easily access it if you need to find an endospecialist.
• 20:41
  SPEAKER_00: I think just even the fact of waiting like two to five years for any kind of confirmation or you know, any information about symptoms obviously is going to have a direct impact on your mental health.
• 20:56
  SPEAKER_00: 100%.
• 20:57
  SPEAKER_00: So stressful.
• 20:58
  SPEAKER_00: I mean, besides the pain alone, which we'll touch on on how mental health is incorporated and all of that, but just having to advocate for yourself, yeah, and to be maybe shut down or turned away or gaslit intentionally or unintentionally by healthcare professionals, like all of that can be so debilitating.
• 21:19
  SPEAKER_00: Yes, you know, you lose that spark, you're exhausted from having to continuously advocate for yourself, and so it's professionals like you that we can sometimes have as like you know, people on our team to help advocate, therapists too can help advocate.
• 21:36
  SPEAKER_00: That's pretty much all that we can do to support, besides like helping you cope with symptoms and things like that.
• 21:42
  SPEAKER_00: Um, because at the end of the day, we can't offer the diagnosis like you mentioned, right?
• 21:46
  SPEAKER_00: Um, which again, there's reasons for that, but we can definitely help to advocate for um a letter to your family doctor, anything like that, um, just to give you that extra push if you need, but it can be so.
• 22:00
  SPEAKER_00: So, so hard, and same with folks living with chronic pain, yeah, and going to doctors and specialists to try to figure out what the heck is going on.
• 22:08
  SPEAKER_00: It's just so challenging to sit in those rooms.
• 22:11
  SPEAKER_00: So anxiety inducing to you know sometimes have to speak up and be assertive and communicate what you want that can be really uncomfortable for people.
• 22:20
  SPEAKER_00: Um, and then to be turned down or turned away, it's just frustrating, annoying.
• 22:25
  SPEAKER_00: So much anger can come from that.
• 22:26
  SPEAKER_00: So there's a lot of just like the waiting part that impacts our mental health, and we'll talk about the pain later, like I said.
• 22:34
  SPEAKER_00: Um, but are there any myths about periods or period pain that you wish people would stop believing?
• 22:39
  SPEAKER_00: Let's debunk them now.
• 22:41
  SPEAKER_00: What are some of those?
• 22:42
  SPEAKER_01: Yeah, I mean, I think the biggest one, which we've already debunked, is that period pain is normal.
• 22:47
  SPEAKER_01: Um, it's common and normal are not the same thing.
• 22:49
  SPEAKER_01: We talked about that in the first time I was here.
• 22:51
  SPEAKER_01: I'm gonna get that printed on a t-shirt, maybe.
• 22:55
  SPEAKER_01: Um, but yeah, that's the biggest thing is like period pain is uh not not normal.
• 23:00
  SPEAKER_01: It's common, but there is something you can do about it.
• 23:03
  SPEAKER_01: And then I think kind of again, that sort of genetic component of I don't know if it's a myth, but it's just kind of like more of an acceptance.
• 23:11
  SPEAKER_01: Oh, my mom had this, my grandmother had this, you know, it's just the the way it is.
• 23:16
  SPEAKER_01: And okay, maybe there's a you know a familial or genetic component, and so it makes people feel like it's just the way it is, but that doesn't mean there's not steps that you can take to um, you know, intervene.
• 23:29
  SPEAKER_01: And then other other things I would say, I don't know that I would call them myths, but just more so like you know, expectations.
• 23:36
  SPEAKER_01: Like if you have to wear a pad and a tampon because you're concerned about bleeding through, like, please go to your doctor.
• 23:43
  SPEAKER_01: You know what I mean?
• 23:44
  SPEAKER_01: That's a lot of blood.
• 23:45
  SPEAKER_01: Like that is that is a heavy amount of bleeding, right?
• 23:48
  SPEAKER_01: If you're bleeding in the middle of your cycle, that's not normal.
• 23:51
  SPEAKER_01: You should be going to your doctor.
• 23:53
  SPEAKER_01: If your period is less than 24 days, or it's longer than like 35, even that I would say is long 32, 33, you should be going to your doctor.
• 24:03
  SPEAKER_01: So less myths, but more so understanding like what are we accepting as normal and what are we accepting as not normal?
• 24:12
  SPEAKER_01: And I think sometimes when it is your own cycle and you don't have anything to compare to because you've never had a different period other than what you have.
• 24:20
  SPEAKER_01: And if you're not comfortable talking to your friends or family or whatever, you don't actually know that some things are actually a concern, like having a short period, right?
• 24:30
  SPEAKER_01: Or having spotting around ovulation.
• 24:32
  SPEAKER_01: Oh bleeding for a really long time.
• 24:34
  SPEAKER_01: Right.
• 24:34
  SPEAKER_01: Yeah.
• 24:34
  SPEAKER_01: Bleeding for a long time, bleeding after intercourse, like all those things are not normal, and you should be addressing them because they A, you'd A, don't have to live with them, and B, there could be a sign of something else going on.
• 24:49
  SPEAKER_01: So I think do you have any myths that you know about periods?
• 24:54
  SPEAKER_00: I think that last one, I think a lot of people are like, well, this is normal for me.
• 24:59
  SPEAKER_00: Okay, cool, but maybe we should still have a doctor at least it's not clinically normal.
• 25:05
  SPEAKER_00: Yeah, exactly.
• 25:06
  SPEAKER_00: Yeah, but I think I think again from a mental health perspective, I think sometimes that's a little bit of denial or just acceptance that this is how it is.
• 25:14
  SPEAKER_00: That's us trying to cope with the fact that maybe periods are 12 days instead of four to five or four to seven.
• 25:22
  SPEAKER_00: Yeah.
• 25:22
  SPEAKER_00: Um, and it's like, well, this is just how it is.
• 25:25
  SPEAKER_00: I have to just live with this.
• 25:26
  SPEAKER_00: This is my normal, and it is we're trying to cope.
• 25:29
  SPEAKER_00: We're trying to cope with the fact that this doesn't feel normal or it's really painful, or it's a really long time, or it gets in the way, or whatever it is.
• 25:36
  SPEAKER_00: Yeah.
• 25:36
  SPEAKER_00: Um, and so we just discredit it.
• 25:38
  SPEAKER_00: But I think like that's when we need to pay attention to and be like, this may have been our normal in the last however many years we've kind of started bleeding and having periods, like it this may have been how it's always been for us, but that doesn't necessarily mean that it's clinically normal.
• 25:55
  SPEAKER_00: Yeah.
• 25:56
  SPEAKER_00: Um, and again, if people aren't having open communications, because again, period talk can be really taboo for some families.
• 26:02
  SPEAKER_00: Very much, yeah.
• 26:02
  SPEAKER_00: If people don't talk about that, then we don't actually know what to compare it with, like you pointed out.
• 26:08
  SPEAKER_00: And so I think just anytime it should be a mandatory questionnaire, like you mentioned, you kind of run a screen with your patients.
• 26:16
  SPEAKER_00: It should be that all kinds of medical professions, you know, even with family doctors, that should be a question that's asked during your physical.
• 26:25
  SPEAKER_00: I don't know if it is everywhere.
• 26:27
  SPEAKER_00: I'm sure there's some doctors who do ask it all the time, like you do.
• 26:30
  SPEAKER_00: Um, but there's I'm sure there's times when people aren't being asked, and so then there's no conversation about to be had.
• 26:38
  SPEAKER_01: Yeah.
• 26:39
  SPEAKER_01: Yeah.
• 26:39
  SPEAKER_01: And I think I think some family doctors too just also they don't know.
• 26:46
  SPEAKER_01: Yeah.
• 26:47
  SPEAKER_01: Like they might not know, or they they might not feel comfortable, or they just don't like what are they gonna, how are they gonna intervene if someone says yes, right?
• 26:56
  SPEAKER_01: Like what steps are they then gonna take?
• 26:58
  SPEAKER_01: I think the other thing too, going back to what you said about kind of the anxiety around periods, is that I think a lot of discussion and discourse around period health also ties in with fertility.
• 27:10
  SPEAKER_01: And so I think sometimes d teenagers and like, you know, women in their early 20s are maybe kind of like, well, my period doesn't need to be good until I want to have kids.
• 27:21
  SPEAKER_01: Yeah, right.
• 27:22
  SPEAKER_01: Like they we think about periods as like only a means to an end.
• 27:25
  SPEAKER_01: Um, and then some people too, like that can be a source of anxiety, like knowing, you know, I've had patients that were told in like their teens and twenties by by a gynecologist that they would have a hard time having kids, which is a really devastating thing to tell someone.
• 27:39
  SPEAKER_01: It's a very confusing time to tell someone that because they're still very young and impressionable, and like that may or may not be true.
• 27:45
  SPEAKER_01: I mean, like I said, a lot of people with infertility do have endometriosis, but I've also seen people with endometriosis and pre-PCOS get pregnant the first month they try.
• 27:53
  SPEAKER_01: Like, fertility is such a complex and thing in and of itself that you could, you know, not struggle, you could struggle, you're not really gonna know until you do you do that.
• 28:03
  SPEAKER_01: So I think sometimes people maybe fear seeking that care because they don't want to know the answers to those questions until they're forced to confront it.
• 28:11
  SPEAKER_00: Again, they're coping.
• 28:12
  SPEAKER_01: They're coping, exactly.
• 28:14
  SPEAKER_00: They don't need to address that.
• 28:15
  SPEAKER_00: Right.
• 28:16
  SPEAKER_00: But you're completely right.
• 28:17
  SPEAKER_00: It's like, well, I don't really plan on having kids for another five years, so I'll deal with it.
• 28:20
  SPEAKER_00: I'll deal with it then.
• 28:21
  SPEAKER_00: But then it could be if there is an issue, it could just extend that time.
• 28:25
  SPEAKER_00: But again, it's a little bit of denial, a little bit of like, you know, choosing not to see the thing because of the fear or the um like now we have to now we have to deal with it.
• 28:36
  SPEAKER_00: Right.
• 28:36
  SPEAKER_00: Now we have to feel I don't have time to deal with this, or exactly too scary, too heavy of the few.
• 28:40
  SPEAKER_00: Too scary.
• 28:41
  SPEAKER_01: Exactly.
• 28:42
  SPEAKER_01: Yeah, this could affect my future.
• 28:43
  SPEAKER_01: I'm just gonna kind of, yeah, like ignorance is bliss kind of the situation, right?
• 28:49
  SPEAKER_01: But what I would say is that I think the conversation around period health needs to kind of like unlatch itself from fertility a little bit because you'll and you will hear this um from some, you know, more particularly um some specialists kind of in the states and things like that, um, who talk a lot about women's health in maybe a more holistic way, that your period is like your fifth vital sign.
• 29:10
  SPEAKER_01: And so if you have, you know, spotting between cycles, short periods, like that's kind of like a way of your body trying to tell you something.
• 29:18
  SPEAKER_01: And that's what I often tell people about symptoms.
• 29:20
  SPEAKER_01: Like symptoms in and of themselves don't have to be scary or viewed as bad, but it is your body's way of trying to communicate to you that something is going on.
• 29:28
  SPEAKER_01: So, regardless of whether or not you want to have kids, your body still deserves to be healthy.
• 29:33
  SPEAKER_01: And sometimes your period can be an indicator of that, especially because you have it every month.
• 29:39
  SPEAKER_01: And like I talked about with endometrosis and PCOS, we're learning now that these are systemic whole body conditions.
• 29:46
  SPEAKER_01: So your period, even if you don't have endometrosis or PMOS, I should say now, even if you don't have one of those conditions, it's still gonna affect your whole body.
• 29:54
  SPEAKER_01: It affects your hormones.
• 29:56
  SPEAKER_01: It can, you know, your your sex hormones interface with your hunger and satiety hormones, interface with your sleep and cortisol, your stress hormones, your mood, your mood, right?
• 30:06
  SPEAKER_01: So it can impact a lot of things in your body beyond just your bleed.
• 30:10
  SPEAKER_01: And so I think that we need to make people more aware for people who A like want to be should be taken seriously in in the healthcare system when they have these types of symptoms, even when they don't want to have kids, and B people who, you know, are like just basing their period health off of fertility.
• 30:31
  SPEAKER_01: Like, yes, it is important, but now your body deserves to have a healthy period now, even if you don't want to have kids for five years.
• 30:39
  SPEAKER_01: And that conversation also just isn't had, I think, very much, and people don't really kind of understand because as we've talked about in the beginning, so many people just accept this as like what it is to be a woman, right?
• 30:51
  SPEAKER_00: Yeah, 100%.
• 30:53
  SPEAKER_00: And I think similarly to like in my profession, we talk to clients like listen to your body, listen to those somatic symptoms that are happening.
• 31:01
  SPEAKER_00: It's exactly kind of like what you said: listen to what your period signs are, like what's happening there.
• 31:07
  SPEAKER_00: Your body's trying to be heard, yeah, trying to give you a little warning, so it's our job to be aware of it and actually listen and pay attention to it.
• 31:15
  SPEAKER_01: Yep.
• 31:16
  SPEAKER_00: Um, switching gears now.
• 31:18
  SPEAKER_00: Um, we had an episode all about pelvic floor, but for this one, I think we should have a little segment on it just so folks can understand what exactly the pelvic floor is.
• 31:28
  SPEAKER_00: I learned so much from our last one.
• 31:31
  SPEAKER_00: Um, and so yeah, I think many people, the term pelvic floor, like I mentioned it in our previous episode, it sounds like a new concept.
• 31:41
  SPEAKER_00: It's now kind of gotten a lot more attention to it than I think it has in previous years, but a lot of people maybe aren't entirely sure what that is, or might only associate that women have a pelvic floor.
• 31:53
  SPEAKER_00: But as we talked about last time, everybody, boy, like men, kids, women, anyone have everyone I mean has a pelvic floor.
• 32:01
  SPEAKER_00: So, what exactly is the pelvic floor?
• 32:04
  SPEAKER_01: Yeah, so the pelvic floor is a group of muscles that sits inside the bowl of the pelvis.
• 32:08
  SPEAKER_01: So they are responsible for a lot of different functions that a lot of times just run in the background that we don't want to have to think about.
• 32:15
  SPEAKER_01: So they're responsible for sphincter control, so they help control our bowel and bladder to keep us continent.
• 32:21
  SPEAKER_01: They're responsible for um supporting your core, so it works with your diaphragm, your deep core muscles to provide structural support to your trunk.
• 32:29
  SPEAKER_01: It works as a some pump function, so it helps to pump fluid back up to the heart.
• 32:33
  SPEAKER_01: It works as um support for your pelvic organs.
• 32:36
  SPEAKER_01: So if you're a biologically female, that is a bladder, a uterus, and usually and a rectum, usually a uterus unless you've had a hysterectomy.
• 32:44
  SPEAKER_01: Um, and for males, biologically, that's just the um bladder and the rectum as well as the prostate.
• 32:50
  SPEAKER_01: So your pelvic floor is like a little hammock that sits under those organs to help lift them up from the bottom.
• 32:55
  SPEAKER_01: And then your pelvic floor also plays a role in sexual function.
• 32:58
  SPEAKER_01: So these muscles work um to contract during an orgasm.
• 33:02
  SPEAKER_01: So lots of different things that this pelvic floor has to be able to do.
• 33:06
  SPEAKER_01: The muscles have to be strong, so we want to be able to contract them properly, but they also have to be flexible.
• 33:12
  SPEAKER_01: Um, so a lot of times like tightness in the pelvic floor can contribute to different types of symptoms or different types of dysfunction.
• 33:19
  SPEAKER_01: And these muscles are under both voluntary and involuntary control.
• 33:23
  SPEAKER_01: So that means that the brain can contract these muscles without us having to think about it, which is obviously important because we wouldn't want to have to think about every time we need to close our sphincters, right?
• 33:32
  SPEAKER_01: Um, but then also they're under voluntary control.
• 33:34
  SPEAKER_01: So we can also contract them by connecting and sort of cueing into the pelvic floor, which is something a lot of people struggle with because as you mentioned, a lot of people just don't connect well or are even aware that they have this muscle, this group of muscles.
• 33:49
  SPEAKER_01: And then that is the last thing is I think many people, if they have heard about the pelvic floor, have heard about kegels, and kegels kind of make us think that there's like one muscle in there that just you know goes up and down.
• 33:59
  SPEAKER_01: But your pelvic floor is actually a group, so there's three layers to it, there's different muscles that move in different directions, and so there's it it's a pretty fascinating little section of the body, in in my biased opinion, obviously.
• 34:13
  SPEAKER_01: But um, it's it's a little powerhouse and it does a lot for us.
• 34:17
  SPEAKER_01: Um, and it often needs a little bit of love and attention.
• 34:20
  SPEAKER_01: As you said, men, women, children, everyone has one, everyone has a group, the the the pelvic floor.
• 34:26
  SPEAKER_01: Um, and so a lot of people, yeah, just need to give their pelvic floor a little more love.
• 34:31
  SPEAKER_00: Yeah, yeah.
• 34:32
  SPEAKER_00: I guess I again, because people may not know about the pelvic floor, what are some signs that the pelvic floor may not be functioning optimally?
• 34:43
  SPEAKER_01: So normally when I'm talking about signs and symptoms, I kind of break it down into different categories.
• 34:48
  SPEAKER_01: It just makes it a little easier.
• 34:50
  SPEAKER_01: So if we're thinking from a bladder perspective, so signs that your pelvic floor is maybe not working the best is leaking.
• 34:57
  SPEAKER_01: So leaking urine when you cough, laugh, or sneeze, when you have the urge to go pee when you exercise.
• 35:02
  SPEAKER_00: Another thing that people say is very normal on the kids, yeah.
• 35:06
  SPEAKER_01: Which is not, it's common, but it's not normal.
• 35:09
  SPEAKER_01: Um, and urgency with your bladder, so sudden urge to go pee, and then you feel like you have to go right away, you can't hold it, and bladder frequency.
• 35:17
  SPEAKER_01: So going pee a lot.
• 35:18
  SPEAKER_01: Um, so every two to three hours is what is normal, and not overnight under the age of 50, up once over the age of 50.
• 35:25
  SPEAKER_01: That's kind of so five to seven times a day.
• 35:27
  SPEAKER_01: If you go pee more than that, that could be a sign of pelvic floor dysfunction.
• 35:31
  SPEAKER_01: Um, in terms of the bowels, chronic constipation, difficulty emptying, incomplete emptying, really thin stool, um, hemorrhoids, recurrent hemorrhoids, recurrent fissures, those can all be signs of pelvic floor dysfunction in the bowel.
• 35:45
  SPEAKER_01: In terms of sexual function, pain with intercourse, um, inability or difficulty having orgasms, cramping after like pain with intercourse constitutes anything before, during, or after.
• 35:57
  SPEAKER_01: So if you have like cramping after intercourse, even if it feels fine during, that could be a sign of pelvic floor dysfunction.
• 36:03
  SPEAKER_01: And then in general, just pain.
• 36:05
  SPEAKER_01: So back pain, tailbone pain, hip pain, pain anywhere in the pelvis could be a sign of of pelvic floor dysfunction.
• 36:14
  SPEAKER_00: Again, important things for us to pay attention to.
• 36:17
  SPEAKER_00: And in terms of um, in terms of period pain, how can pelvic floor dysfunction contribute to that?
• 36:25
  SPEAKER_01: So when we talked a little bit about this in our episode last time, but your pelvic floor is very integrated with your nervous system, which is partially how it's under involuntary control.
• 36:34
  SPEAKER_01: So our pelvic floor is part of our autonomic nervous system, which we could break down into like fight or flight and digest and rest.
• 36:42
  SPEAKER_01: So our sympathetic and parasympathetic nervous systems.
• 36:45
  SPEAKER_01: When you are in a state of fight or flight, your body contracts your pelvic floor.
• 36:50
  SPEAKER_01: Because if we think about this evolutionary from an evolutionary perspective, if I was trying to run away from a threat, I don't want to have to pee.
• 36:58
  SPEAKER_01: Like that's super not ideal timing, right?
• 37:00
  SPEAKER_01: So your your pelvic floor is going to contract in response to a perceived threat.
• 37:06
  SPEAKER_01: When you have pain, particularly pain that is not acute.
• 37:11
  SPEAKER_01: So what I mean by that is pain that doesn't just like come on and go off because you stubbed your toe.
• 37:17
  SPEAKER_01: So most period pain is chronic because it persists for hours or days and it persists on a recurring cyclical basis.
• 37:25
  SPEAKER_01: And sometimes it's even happening mid-cycle, like a lot of people who have um, you know, period dysfunction have um mid-cycle pain as well around ovulation.
• 37:35
  SPEAKER_01: So because you're getting this pain so frequently, your pelvic floor is kind of always in this state of contraction because your body is so frequently in a state of fight or flight.
• 37:45
  SPEAKER_01: And then the ironic thing is when your pelvic floor is tight, it can actually cause referral into the abdomen, the low back, the pelvis, and it can create that cramping feeling.
• 37:54
  SPEAKER_01: One thing I always tell my patients at the first appointment is it is normal to feel achy or crampy after your treatment and assessment.
• 38:01
  SPEAKER_01: And that's because when we palpate the pelvic floor, it can produce that sensation like period cramps and period pain.
• 38:07
  SPEAKER_01: So sometimes period pain, the level of pain that you experience is also coming from the fact that the pelvic floor is tight, not able to relax.
• 38:16
  SPEAKER_01: And that is super common.
• 38:18
  SPEAKER_01: It's a bit of a cycle that feeds into itself, right?
• 38:21
  SPEAKER_01: But it is super common when pain is recurrent, like the way period pain is.
• 38:26
  SPEAKER_01: So that's actually something we can help address to bring period pain down, is improve the flexibility and tightness in the pelvic floor so that your cycles, like the cramping that you have is hopefully just related to that uterine lining shedding that I talked about earlier, and not because your pelvic floor is tight and your connective tissue is tight and all these other things.
• 38:46
  SPEAKER_00: Yeah, I think just like the body, we talked about this in the last episode.
• 38:49
  SPEAKER_00: Just like the body, when we are in fight or flight mode, normally we tense, or when we're feeling stress or anxiety for long periods of time, our muscles are tense, right?
• 39:00
  SPEAKER_00: We feel shoulder, neck pain, you know, all of that.
• 39:03
  SPEAKER_00: And one of the things is that we need to kind of like relax our body.
• 39:06
  SPEAKER_00: But I think we when we talk about that, even again in the therapy room, it's okay, how can you relax your shoulders?
• 39:12
  SPEAKER_00: How can you relax like your diaphragm?
• 39:15
  SPEAKER_00: How can you relax these things?
• 39:16
  SPEAKER_00: But it's it can be, I'm imagining, really difficult to like just focus on your pelvic floor and try to relax it.
• 39:24
  SPEAKER_00: It is right, yeah.
• 39:25
  SPEAKER_00: And so when when we are feeling stress for a really long time, that is a muscle, as you described, that is now holding on to a lot of tension, yeah, because we might be in a heightened state of stress.
• 39:37
  SPEAKER_00: And when we are feeling pain, our body is in a level of stress, yeah.
• 39:41
  SPEAKER_00: And so that again, that that tension in your pelvic floor in your body, wherever it is that you're holding that tension to, it's it's really hard to kind of like relax when you're feeling a lot of pain.
• 39:52
  SPEAKER_00: Yep.
• 39:52
  SPEAKER_00: And again, the pelvic floor, like it's not something like our shoulders that we can just kind of like roll back unless we're educated on how to do that.
• 40:00
  SPEAKER_00: Exactly, yeah.
• 40:01
  SPEAKER_00: So yeah.
• 40:02
  SPEAKER_01: And it takes again, because as I mentioned, the pelvic floor is under involuntary control, it takes a conscious checking in.
• 40:09
  SPEAKER_01: Yeah.
• 40:10
  SPEAKER_01: And so sometimes it it's a it's a process of even if you can do it, remembering to touch base with your pelvic floor and say, where is well, you know, where is it at now?
• 40:19
  SPEAKER_01: Like, can I unclench it?
• 40:21
  SPEAKER_01: Can I relax it?
• 40:22
  SPEAKER_01: Like what you know.
• 40:23
  SPEAKER_01: So it's a skill and it's a skill to relax it, and it's a skill to remember to check in with it because it doesn't always feel tight like the way our shoulders feel tight.
• 40:33
  SPEAKER_01: What happens is our back starts to ache.
• 40:36
  SPEAKER_01: We start to get bladder urgency, our tailbone starts to hurt.
• 40:39
  SPEAKER_01: It's it pr its symptoms present in less obvious ways.
• 40:42
  SPEAKER_01: So sometimes it takes us longer to realize that the pelvic floor is actually just permanently in this state of contraction.
• 40:49
  SPEAKER_00: Yeah, exactly.
• 40:50
  SPEAKER_00: And so can pelvic floor tension develop because of chronic pain and stress?
• 40:54
  SPEAKER_01: Yeah, big time.
• 40:55
  SPEAKER_01: Yeah, and and then as I said, it's a bit of a cycle that feeds into it, right?
• 40:59
  SPEAKER_01: Feeds into each other because then once your pelvic floor is tight and you have more symptoms, you feel more stressed, you have more pain.
• 41:05
  SPEAKER_01: So then they kind of go hand in hand.
• 41:08
  SPEAKER_01: Yeah, yeah, yeah.
• 41:09
  SPEAKER_00: So if someone is struggling with painful periods, um, like pelvic pain or other symptoms, that I guess maybe they're not realizing maybe continent like connected to the pelvic floor.
• 41:21
  SPEAKER_00: Um, pelvic floor physio can help.
• 41:24
  SPEAKER_00: So, what happens during an initial visit?
• 41:26
  SPEAKER_00: I guess I know you mentioned a little bit about having an assessment, talking about it, asking questions about periods, but then can you just let our listeners know like what is kind of the process of an initial pelvic floor physio um assessment?
• 41:41
  SPEAKER_01: So um, we always start off by going through the subjective history, so chatting about you know your health history, your symptoms, your um pelvic health history, so bowel function, bladder function, sexual function, menstrual history, pregnancy history if it's relevant.
• 41:55
  SPEAKER_01: So I want to know all the things I always tell people.
• 41:58
  SPEAKER_01: Yeah.
• 41:58
  SPEAKER_01: Um, but you don't have to obviously answer questions you don't feel comfortable with.
• 42:02
  SPEAKER_01: So that's how we start um a little bit for you know for me to get to know you, and and that will help obviously guide the objective portion of the assessment.
• 42:10
  SPEAKER_01: So that comes next.
• 42:11
  SPEAKER_01: So with pelvic physio, I always look everywhere between the shoulders and the knees.
• 42:15
  SPEAKER_01: So it's it's important to look at the whole trunk, not just the pelvis specifically.
• 42:20
  SPEAKER_01: So we check the range of motion of your back, your hips, look at your breathing patterns.
• 42:24
  SPEAKER_01: I always assess the abdomen because particularly for people with period pain, I want to know what the connective tissue is like around the uterus, the ovaries, the bladder.
• 42:32
  SPEAKER_01: I want to know what the connective tissue is like around the colon.
• 42:35
  SPEAKER_01: Is it tight?
• 42:36
  SPEAKER_01: You know, if you're someone that deals with like constipation around your period, I want to know what's happening around the colon.
• 42:44
  SPEAKER_01: So that abdominal assessment is kind of like a hands-on assessment.
• 42:48
  SPEAKER_01: And then after that, we take a look at the pelvis, which of course is only if you feel comfortable with it.
• 42:53
  SPEAKER_01: It's not a PAP test.
• 42:54
  SPEAKER_01: There's no instruments, it's just an assessment, like a palpation, which means touching, but palpation sounds more clinical.
• 43:01
  SPEAKER_01: So that's how I normally say it.
• 43:03
  SPEAKER_01: It's a palpation assessment of the external pelvis.
• 43:06
  SPEAKER_01: So we take a look at the tissue health externally, the first layer of muscles externally.
• 43:10
  SPEAKER_01: So as I mentioned, the pelvic floor is a group of muscles, right?
• 43:13
  SPEAKER_01: So I want to know what the outside layer of the muscles are doing.
• 43:16
  SPEAKER_01: And then the internal exam is typically done vaginally with no instruments.
• 43:21
  SPEAKER_01: And again, we palpate the pelvic floor.
• 43:24
  SPEAKER_01: So is there any tension in different sections of the pelvic floor?
• 43:27
  SPEAKER_01: And then check the strength.
• 43:29
  SPEAKER_01: So can you contract?
• 43:30
  SPEAKER_01: Can you relax?
• 43:31
  SPEAKER_01: You know, can you differentiate the front and back of your pelvic floor?
• 43:34
  SPEAKER_01: Um, and that kind of helps us figure out like, is there something that could be contributing to the symptoms?
• 43:39
  SPEAKER_01: Oftentimes with period pain, I check the mobility of the cervix.
• 43:42
  SPEAKER_01: So some people, um, particularly with things like endometriosis, their cervix can be kind of stuck, and that can be a contributing factor to pain.
• 43:50
  SPEAKER_01: So you can actually mobilize this the cervix by kind of stretching the ligaments around it to help.
• 43:57
  SPEAKER_01: I always call it like giving the tissues room.
• 44:00
  SPEAKER_01: To breathe.
• 44:01
  SPEAKER_01: Like when tissues are so tight like that and they're not moving, um, they don't get good blood flow, they don't get good oxygenation, so that tightness can perpetuate.
• 44:10
  SPEAKER_01: And so if we can relieve some of that tension, improve the mobility of muscles, connective tissue, and in some cases, like you know, cervical or uterine mobility, you can improve symptoms pretty dramatically, which is really cool that we have the ability to do that.
• 44:25
  SPEAKER_01: So those are all things that we would kind of check for in the assessment.
• 44:28
  SPEAKER_01: And then a lot of times in the first appointment, if I kind of treat as I'm checking a little bit just to see, you know, if we can see any immediate change.
• 44:36
  SPEAKER_01: Um, and then at the end we chat about a treatment plan.
• 44:39
  SPEAKER_01: Sometimes you get exercises to go home.
• 44:41
  SPEAKER_01: Sometimes I want to see how the body's responded to what I've done.
• 44:44
  SPEAKER_01: So we kind of, you know, just leave it so we can narrow down, you know, what's helping, what's not helping.
• 44:50
  SPEAKER_01: So sometimes we don't start off with anything at home right away.
• 44:52
  SPEAKER_01: So it it just kind of depends.
• 44:54
  SPEAKER_01: I would say it's super, super individual, but we do all that in an hour.
• 44:58
  SPEAKER_00: Yeah, that's a lot of things in an hour.
• 45:00
  SPEAKER_00: I can I also want to normalize that that sounds like it can be really scary or nerve-wracking, right?
• 45:06
  SPEAKER_00: For people, but like like you pointed out, it sounds like um they have the autonomy to choose what they're comfortable or uncomfortable with, yeah, and that you create like as safe of a place as possible through the assessment and just getting to know each other.
• 45:22
  SPEAKER_00: Because again, like that can be really nerve-wracking.
• 45:25
  SPEAKER_01: Yeah, totally.
• 45:26
  SPEAKER_01: And as you alluded to earlier, a lot of people have medical trauma when they've dealt with something for a long period of time.
• 45:33
  SPEAKER_01: And so a lot of people just inherently don't trust you, which I understand.
• 45:37
  SPEAKER_01: Yeah.
• 45:37
  SPEAKER_01: Um, and so sometimes we just have to spend the appointment chatting, the first appointment, so that people can develop the trust to know that I'm gonna take them seriously and that I'm gonna hear what they're saying.
• 45:48
  SPEAKER_01: Um, and I think that that is more important than doing any type of treatment in the sh in the short term, right?
• 45:53
  SPEAKER_01: So um it's it is a super individual appointment.
• 45:57
  SPEAKER_01: It's always um, I can't remember if I said this on the last podcast, but there I have a Peloton at home, and one of the instructors, Dennis, is always like, I make suggestions, you make decisions.
• 46:08
  SPEAKER_01: And that's kind of how I try to approach it.
• 46:10
  SPEAKER_01: Like I can suggest something as the healthcare professional, but ultimately it's your choice, it's your body.
• 46:15
  SPEAKER_01: So I know it can feel intimidating to seek care when you feel like you haven't been heard, when you've dealt with something for a long time and no one's ever been able to help you.
• 46:25
  SPEAKER_01: It it feels vulnerable to go, not not only to like have a pelvic exam, that is inherently vulnerable.
• 46:31
  SPEAKER_01: I think everyone feels that way, but it can just feel vulnerable in and of itself just to go to an appointment and ask for help when no one has helped you.
• 46:39
  SPEAKER_01: That is a hard thing to do.
• 46:40
  SPEAKER_01: So I totally get that.
• 46:42
  SPEAKER_00: Yeah, if the door has been closed to your face, or if you told if you've been told like there's nothing we can do for you, yeah, you're right.
• 46:48
  SPEAKER_00: It's like this huge, I mean, not only vulnerable, but also this opportunity to build trust, yeah.
• 46:54
  SPEAKER_00: Um, to see if they are gonna be taken seriously.
• 46:56
  SPEAKER_00: Yeah.
• 46:57
  SPEAKER_00: I think like the fact that you're like people in your profession and you here, because you're speaking about your own experience and how you like do your job.
• 47:05
  SPEAKER_00: Um, I think it's really important for you to know how scary that can be for people.
• 47:09
  SPEAKER_00: Yeah.
• 47:10
  SPEAKER_00: Because then that's gonna slow down the process, like you said, right?
• 47:13
  SPEAKER_00: Like, then we might just chat.
• 47:14
  SPEAKER_00: Yeah.
• 47:15
  SPEAKER_00: So you can build that level of trust.
• 47:17
  SPEAKER_00: And I think that can be really helpful for our listeners to know that there's no pressure.
• 47:21
  SPEAKER_00: Yeah.
• 47:22
  SPEAKER_00: I think sometimes what I've heard from a lot of my clients has been like, the doctor only sees me for like 10 minutes, and I try to get as much as I can out, but then it's like, oh, 10 minutes is up, okay, bye.
• 47:33
  SPEAKER_00: And they leave.
• 47:34
  SPEAKER_00: And so knowing that they have the opportunity to slow down if they need to, and just have like a chat without that pressure of like your agenda or what you would like to do in the hour, I think that's really that's really important, and I think that hopefully that makes it feel a little bit easier to go to the appointment knowing that they're the ones that are running the show.
• 47:53
  SPEAKER_00: Yes.
• 47:53
  SPEAKER_00: Um, and it's on their time and on their comfort level and not not so much on yours as a professional.
• 48:00
  SPEAKER_01: Yeah, and I think the other thing too, that I think the the context of what different healthcare professionals do is also important.
• 48:07
  SPEAKER_01: So I always tell people, like, in physio, my job is to make a treatment plan for you that it that is specific to your body.
• 48:15
  SPEAKER_01: And so I always tell people when, especially when we're dealing with pain or you know, painful intercourse, painful periods, vaginis, trauma, like my goal for this appointment is to see what is your baseline.
• 48:27
  SPEAKER_01: And if your baseline is that you don't want me to touch you, that's your baseline.
• 48:30
  SPEAKER_01: Like, I'm not trying to, you know, push past that.
• 48:35
  SPEAKER_01: I'm not trying to get a pap test because I have to do the cervical swab like a doctor.
• 48:39
  SPEAKER_01: And I don't mean this in a disrespectful way towards doctors.
• 48:41
  SPEAKER_01: They're trying to achieve something different.
• 48:44
  SPEAKER_01: What I'm trying to achieve in my appointment is always like, how can we help you get better?
• 48:50
  SPEAKER_01: And to know how to help you get better, we have to know where we're starting.
• 48:53
  SPEAKER_00: Yeah.
• 48:53
  SPEAKER_01: And so we're starting where we start.
• 48:55
  SPEAKER_01: Like, I can't tell you where we're starting.
• 48:57
  SPEAKER_01: You have to tell me where we're starting.
• 48:58
  SPEAKER_01: Right.
• 48:58
  SPEAKER_01: And then we make a plan from there.
• 49:00
  SPEAKER_01: And so I think I hope people, and I'm sure it's the same thing with therapy.
• 49:05
  SPEAKER_01: Like, you're not gonna come into the first appointment and be like, tell me about your deepest, darkest secret.
• 49:09
  SPEAKER_01: Like, you have to kind of feel the layers back to to help people, right?
• 49:13
  SPEAKER_01: So I just hope people understand that like the first appointment is really to just establish how we can help you.
• 49:20
  SPEAKER_01: And if the best way to help you is to build that trust through conversation for the first couple of appointments, that is absolutely not a problem.
• 49:28
  SPEAKER_01: That's that's what you need, that's what we do.
• 49:31
  SPEAKER_01: Yeah, yeah, yeah.
• 49:32
  SPEAKER_00: No, that's perfect.
• 49:33
  SPEAKER_00: And that again, I think people need to know that, right?
• 49:36
  SPEAKER_00: Assumptions and all of these things could come in, especially if their experience has been mostly negative with seeking support.
• 49:42
  SPEAKER_00: So that's good to kind of highlight here.
• 49:45
  SPEAKER_00: Um, so in in your kind of treatment room, what are some types of conditions that you treat when it comes to period pain?
• 49:54
  SPEAKER_01: So I would say the most common thing is endometriosis.
• 49:57
  SPEAKER_01: I think just because statistically, for people who have period pain, that's probably statistically the biggest reason why in the general population, and so then therefore that's the thing I see the most.
• 50:07
  SPEAKER_01: Um, probably nextly followed PMOS, probably third by fibroids, and then just general period pain.
• 50:16
  SPEAKER_01: But typically, people who are coming for general period pain is normally coming, you know, with maybe they also have back pain or maybe they have hip pain.
• 50:25
  SPEAKER_01: So um the more debilitating period pain I see is typically condition-driven.
• 50:31
  SPEAKER_01: The maybe more mild period pain that I see is more I think uh it's not always the one thing that's bringing them in, it's kind of coming in with other, you know, maybe cycle-related things, like, oh, I get this cramping during ovulation or I get really bad back pain during my period, and I want that to get better.
• 50:47
  SPEAKER_01: Um, so it kind of varies, I would say, depending on what's driving the period pain, but those are the biggest things.
• 50:54
  SPEAKER_00: And how can pelvic plearophysio help someone who's experiencing pelvic or period pain?
• 50:59
  SPEAKER_01: So a lot of times it can help just bring down the symptoms over the course of the month.
• 51:04
  SPEAKER_01: So, as I've uh mentioned a few times, period pain conditions, and I just think period health in general is super systemic.
• 51:12
  SPEAKER_01: So it's related to your whole body.
• 51:14
  SPEAKER_01: So oftentimes, to be super candid, physiotherapy is not enough on its own to resolve period pain.
• 51:20
  SPEAKER_01: It's more about symptom improvement in in conjunction with other holistic things.
• 51:25
  SPEAKER_01: So maybe that's therapy, maybe that's naturopath, maybe that is medication like birth control or something that's being hormone therapy that's being prescribed by your doctor.
• 51:33
  SPEAKER_01: Um, so it's normally part of a whole team, I would say, that is needed to address period pain.
• 51:38
  SPEAKER_01: But specifically what we work on is improving the function of the pelvic floor, improving connective tissue tightness, improving mobility if we can of like uterus, cervix, ovaries, um, to try to give those tissues a little bit more oxygenation, a little bit more space to breathe, um, so that you have better symptoms over the course of the month.
• 52:00
  SPEAKER_01: And then I would say a lot of my people who deal with period pain, we we sort of work maybe more closely together for a couple of sessions to try to get the pain down.
• 52:10
  SPEAKER_01: And then sometimes it's just like a maintenance treatment.
• 52:12
  SPEAKER_01: So every four to six weeks, we we kind of get on a bit of a maintenance schedule where it's like we're just trying to keep the pelvic floor happy because as I mentioned with chronic pain, you're kind of always in this cycle where things are tightening up.
• 52:24
  SPEAKER_01: But once we get the the tissue tension down to a level that's less symptomatic and we can space our appointments out, then sometimes our goal is just to maintain um and kind of kind of like you know, maintenance therapy.
• 52:37
  SPEAKER_01: Like you kind of come in, you have a you know, you know, you have a chat, but you're in like that less acute symptomatic stage, and so your appointments can be further apart.
• 52:45
  SPEAKER_00: Okay, that's good that they can get to that and still like get the support that they need on that kind of more maintenance stage, right?
• 52:53
  SPEAKER_00: Yeah, because that's good to know.
• 52:54
  SPEAKER_00: Yeah.
• 52:55
  SPEAKER_00: Um, okay, I know this can totally vary depending on the client, but what improvements do you have you heard from your patients um that they notice maybe right after treatment?
• 53:07
  SPEAKER_01: So I would say um, some people like I had someone a couple weeks ago who basically was like, I didn't know this is what it felt like to have a normal pelvis.
• 53:17
  SPEAKER_01: So her cervix was so stuck.
• 53:20
  SPEAKER_01: And she this was her first appointment.
• 53:22
  SPEAKER_01: She had been absolutely gaslit by doctor, gynecologist, whatever.
• 53:27
  SPEAKER_01: And I was like, Oh my gosh, your like your abdomen is like crying for like relief.
• 53:33
  SPEAKER_01: Like it's just so tight.
• 53:35
  SPEAKER_01: So we I did sort of assessed and treated at the same time, obviously, with her consent and permission.
• 53:40
  SPEAKER_01: And when she stood up from the table, she was like, I've never, my pelvis has never felt like this, like it has never felt so like mobile and like free.
• 53:49
  SPEAKER_01: So that was really amazing.
• 53:50
  SPEAKER_01: Sometimes we can see those improvements right away.
• 53:52
  SPEAKER_01: Yeah, sometimes for people it takes, you know, more time.
• 53:56
  SPEAKER_01: And sometimes we have a bad month, like sometimes we have a bad period, right?
• 53:59
  SPEAKER_01: Um, but for most people, I would say like intensity of cramps goes down, pain out of the legs.
• 54:04
  SPEAKER_01: So if you have shooting pain down your legs, that tends to resolve, back pain tends to get better, reduction in mid-cycle cramping, improved bowels.
• 54:12
  SPEAKER_01: Like there's a lot of times people with period pain have bowel dysfunction that correlates to when they get their periods.
• 54:18
  SPEAKER_01: Um, so improved like bowel movements around their periods, which obviously also just improves quality of life.
• 54:24
  SPEAKER_01: So I would say those are probably the biggest things that we typically notice over maybe the first one to two cycles.
• 54:31
  SPEAKER_01: Yeah.
• 54:32
  SPEAKER_01: So it sometimes it's pretty big.
• 54:33
  SPEAKER_01: It's pretty big.
• 54:34
  SPEAKER_01: Yeah.
• 54:34
  SPEAKER_01: Yeah, it's pretty big.
• 54:35
  SPEAKER_01: It can sometimes take a couple sessions.
• 54:38
  SPEAKER_01: But I would say, like, like when people have been dealing with this for years, like we can normally see improvement like after the first or second menstrual cycle from when we start treatment, depending on where you fall in your period when you start.
• 54:50
  SPEAKER_01: Yeah.
• 54:50
  SPEAKER_00: That's amazing.
• 54:51
  SPEAKER_00: Yeah.
• 54:51
  SPEAKER_00: I'm sure just like therapy, there's things that you do in the room, and then probably things that you send them home with to practice, like exercises.
• 54:59
  SPEAKER_00: What are some of those components that are involved?
• 55:02
  SPEAKER_01: So sometimes we talk about, you know, um, stretching for the pelvic floor, positions of comfort when you're on your period.
• 55:10
  SPEAKER_01: Sometimes it's like how can who do, you know, sometimes if there are if I'm the first line of of defense, we'll call it in in sort of like a holistic allied health team.
• 55:21
  SPEAKER_01: Sometimes it's conversations about like maybe your homework is we need to find you a naturopath or a dietitian.
• 55:27
  SPEAKER_01: Like I think a lot of times people think about physio as very exercise-based, but sometimes like I I always kind of look at myself also as an educator.
• 55:37
  SPEAKER_01: And so sometimes we need to get you the education from another allied health professional.
• 55:43
  SPEAKER_01: So sometimes my job is to help you build that team, right?
• 55:46
  SPEAKER_01: And help get you the right resources that are not necessarily within my scope of practice or area of expertise to help with.
• 55:52
  SPEAKER_01: But like, you know, say for example, bloating and bowel dysfunction, I think is a huge problem in terms of why it's they're correlating to their symptoms.
• 56:00
  SPEAKER_01: That's not something that I can address.
• 56:02
  SPEAKER_01: They need to see naturopath or dietitian for that.
• 56:05
  SPEAKER_01: And so then maybe their time and resources outside of the clinic is better spent going to those appointments and getting support there instead of you know stretching every day.
• 56:14
  SPEAKER_01: So it's kind of a clinical decision.
• 56:16
  SPEAKER_01: I think it depends like how much capacity people have that because again, we talked about right chronic pain.
• 56:21
  SPEAKER_01: Sometimes your capacity is very limited.
• 56:23
  SPEAKER_01: You only have a I know the chronic pain community calls them spoons, but you only have a certain amount of spoons to do things.
• 56:29
  SPEAKER_01: And so I think as a healthcare professional, sometimes you have to make the those, you know, clinical decisions of like what is the most value for you to do at home.
• 56:38
  SPEAKER_01: And sometimes it's things like pain management, like we talk about, you know, how do we incorporate tools like castor oil packs or cramp cream or heat packs or you know, how do we incorporate some of those things for pain management as well at home?
• 56:52
  SPEAKER_01: Maybe it's daily walking, maybe it's breath work.
• 56:55
  SPEAKER_01: It really depends on the patient, but I would say it's not just limited to exercise or stretching.
• 57:02
  SPEAKER_00: Yeah, yeah, I'm sure it changes from like case to case, like person to person.
• 57:07
  SPEAKER_00: Um, but for listeners who may be experiencing period pain right now, let's talk about some practical strategies.
• 57:14
  SPEAKER_00: So, um, what are some things that people can do at home to maybe support their pelvic health during their cycle?
• 57:21
  SPEAKER_01: So, a couple of my favorite things when you have your period are I call them positions of comfort for the pelvic floor.
• 57:28
  SPEAKER_01: So the pelvic floor does a lot of work, and as we talked about for most people with chronic pain, it tends to be tight.
• 57:34
  SPEAKER_01: So we want to put the body into positions where it can decompress and and offload essentially.
• 57:40
  SPEAKER_01: So a two of my favorite ones are um what we call Z lying.
• 57:45
  SPEAKER_01: So laying on your back with your legs on like a couch, a chair, a yoga, big yoga ball, so that your hips and knees are stacked right above each other, and then your shins are kind of parallel to your knees.
• 57:56
  SPEAKER_01: So you your legs look like a bit of a Z.
• 57:58
  SPEAKER_01: And then if you put a pillow under your hips, that actually helps to kind of totally offload the pelvis.
• 58:04
  SPEAKER_01: So it it basically gives the pelvis an opportunity to breathe and relax.
• 58:08
  SPEAKER_01: And then you would want to focus on diaphragmatic breathing.
• 58:11
  SPEAKER_01: I think.
• 58:12
  SPEAKER_01: Did we talk about box breathing in the last one?
• 58:15
  SPEAKER_01: I love box breathing for down-regulating the nervous system and and kind of moving us into that digestion rest era.
• 58:22
  SPEAKER_01: It's a good one.
• 58:24
  SPEAKER_01: Yeah.
• 58:24
  SPEAKER_01: So for those of you that don't know, box breathing is a four-second inhale, a four-second breath hold, a four-second exhale, and a four-second breath hold.
• 58:32
  SPEAKER_01: So you're kind of following, like, you know, breathing around a box, if you can think about it that way.
• 58:37
  SPEAKER_01: And you would just repeat that in, you know, 10 or 15 minutes.
• 58:41
  SPEAKER_01: You could repeat that in a couple cycles and then take some diaphragmatic breaths.
• 58:45
  SPEAKER_01: The other um position of comfort that's really good is just legs up the wall.
• 58:49
  SPEAKER_01: So if you pillow under your hips, you scoot your bum right up to the edge of the wall.
• 58:53
  SPEAKER_01: And then if you put your legs straight up and then just let them kind of fall out to the side, but being supported by the wall, again, it helps to kind of unload the pelvis a little bit, gives the body a little bit of an opportunity to have a break.
• 59:05
  SPEAKER_01: And then same thing, you're focusing on that diaphragmatic breathing in that position to move into that digest and rest.
• 59:12
  SPEAKER_01: But that I find like those two positions kind of help elevate the bang for your buck beyond just laying down and breathing because you're actually just also putting the pelvis in a position where it can have a break and where it's being fully supported by you know, the wall, by the chair, by the pillow, so your body can relax.
• 59:30
  SPEAKER_00: I think breath work, we hear a lot about breath work in pelvic floor care and also in therapy.
• 59:37
  SPEAKER_00: So that's where you know our professions kind of overlap when it comes to breath work.
• 59:42
  SPEAKER_00: But I think something important to maybe keep in mind also is that breath work is like your it's I don't know if you found this, but some of my clients will just like breathe and keep it like all in their chest, but we really need to kind of connect it to our core.
• 59:56
  SPEAKER_00: Yes, the diaphragm.
• 59:57
  SPEAKER_00: Yeah, and like blow up our belly so our belly's actually extended and then really like bring our belly down so our belly buttons kind of like touching our spine.
• 1:00:06
  SPEAKER_00: Yep.
• 1:00:06
  SPEAKER_00: Um, and so some of that is just also checking in and being aware, like, how am I breathing?
• 1:00:12
  SPEAKER_00: Yes.
• 1:00:12
  SPEAKER_00: Am I laying down with my legs up, but really like having shallow breaths?
• 1:00:16
  SPEAKER_00: Yeah, um, those are really important things to keep in mind too.
• 1:00:18
  SPEAKER_01: I think also a lot of people are like breath work.
• 1:00:22
  SPEAKER_01: It sort of seems like the thing that's a bit overdone right now.
• 1:00:25
  SPEAKER_01: Like everyone's like, Oh, I just have breathing exercises.
• 1:00:27
  SPEAKER_01: I'm like, yeah, great, those are fundamental.
• 1:00:29
  SPEAKER_01: Like we all need to we all need to breathe better and properly.
• 1:00:32
  SPEAKER_01: So it's something that I think a lot of people kind of like at, but it's foundational and it it actually in and of itself can make a huge change.
• 1:00:41
  SPEAKER_00: Yeah, it totally can.
• 1:00:44
  SPEAKER_00: So we talked about some things that could be helpful.
• 1:00:46
  SPEAKER_00: What are some common habits that maybe in unintentionally worsen our symptoms?
• 1:00:52
  SPEAKER_01: So I would say anything that like worsens the tightness in your pelvic floor could unknowingly, excuse me, worsen your period pain.
• 1:00:59
  SPEAKER_01: So if you're chronically constipated, if you're pushing all the time to go pee, if you're um like breath holding throughout your day, if you're always kind of like a physical clencher, like physically clenching your body, all of those things can elevate the tension in your pelvic floor beyond what it's already being elevated at because of the period pain.
• 1:01:20
  SPEAKER_01: And then, like I said, when your pelvic floor is more tight, it can exacerbate pain.
• 1:01:24
  SPEAKER_01: So it's it's sometimes zooming out a little bit and looking at those five areas that I talked about earlier in terms of your pelvic floor function, making sure that you're not, you know, doing things in one area that like your bowel habits, like your bladder habits that could be unknowingly contributing to tightness and then therefore your pain.
• 1:01:45
  SPEAKER_00: Yeah, yeah.
• 1:01:46
  SPEAKER_00: Those are good things to kind of keep in mind, and again, like a lot of awareness into your body and also like emotionally what's happening.
• 1:01:53
  SPEAKER_00: Yes, because that can lead to that body tension, like we talked about.
• 1:01:56
  SPEAKER_00: For sure.
• 1:01:57
  SPEAKER_00: Yeah.
• 1:01:58
  SPEAKER_00: So as we're like wrapping up, is there a final message that you would like listeners to know from our conversation today?
• 1:02:04
  SPEAKER_01: I think the one thing that I always want people to know when we talk about the common but not normal situation, I think sometimes that can also feel defeating because it's like, okay, well, great, what am I supposed to do?
• 1:02:14
  SPEAKER_01: Yeah.
• 1:02:15
  SPEAKER_01: Then if it's common but not normal, how do I fix it?
• 1:02:18
  SPEAKER_01: And I think what I want people to know about most things related to pelvic health, but especially period pain, is that it can get better.
• 1:02:24
  SPEAKER_01: And I think a lot of people don't believe that because they're so used to living with pain that it just becomes the acceptance of their reality.
• 1:02:32
  SPEAKER_01: But you actually can take steps to improve your symptoms, and I have seen it happen time and time again.
• 1:02:37
  SPEAKER_01: So you're not gonna be the exception to the rule that doesn't get better.
• 1:02:40
  SPEAKER_01: Yeah, like you just need the right team and the right supports, and it might take a little bit longer, it might be quick, but it is possible for you to have a better quality of life with your period.
• 1:02:50
  SPEAKER_00: Yeah, yeah, and like don't lose hope because there is support out there, right?
• 1:02:54
  SPEAKER_00: Like again, this is like where paths cross with our body and then our mental health is that there's always support.
• 1:03:02
  SPEAKER_00: We need to access it, we need to be aware of our symptoms, we need to like, yeah, actually participate in what our body's trying to tell us.
• 1:03:10
  SPEAKER_00: So, yeah, that's all really, really important.
• 1:03:14
  SPEAKER_00: Um, thank you so much for joining us today.
• 1:03:16
  SPEAKER_00: We're having to find you if people really are noticing that maybe this would be helpful for them.
• 1:03:22
  SPEAKER_01: Yeah, so um, you can find me on Instagram at pelvic physio by Laura or my website, Pelvic Physio by Laura, if you have questions or want more information.
• 1:03:30
  SPEAKER_01: If you want to see me in clinic, I practice at Encompass Health and Wellness in Kitchener.
• 1:03:35
  SPEAKER_01: Um so you can book directly online.
• 1:03:38
  SPEAKER_01: And I also see people virtually if you are an Ontario resident.
• 1:03:42
  SPEAKER_01: So if you don't live in Kitchener Waterloo but you still want to see me, you can book a virtual appointment online as well through Encompass Health and Wellness.
• 1:03:49
  SPEAKER_00: Amazing.
• 1:03:50
  SPEAKER_00: We will have all of that in our show notes.
• 1:03:52
  SPEAKER_00: Um, and yeah, so if you want to learn more about Laura's work, if you want to book any of these appointments that she just mentioned, um links in the show notes, and we'll also have your Instagram there so people can kind of see you.
• 1:04:04
  SPEAKER_00: Um, but like I said, thank you so much.
• 1:04:06
  SPEAKER_00: This was so informative.
• 1:04:07
  SPEAKER_00: Always have fun with you here, and uh yeah, thank you.
• 1:04:11
  SPEAKER_00: Thanks for having me.
• 1:04:12
  SPEAKER_00: All right, everyone, we will see you next time.
• 1:04:15
  SPEAKER_00: Um, and make sure to follow us also on Outside the Therapy Room Pod on Instagram and TikTok.
• 1:04:20
  SPEAKER_00: Bye.
• 1:04:21
  SPEAKER_00: Thank you for listening to Outside the Therapy Room.
• 1:04:23
  SPEAKER_00: This podcast is intended for educational and entertainment purposes only.
• 1:04:28
  SPEAKER_00: If you reside in Ontario and are interested in working with one of our therapists, please visit our website in the show notes.
• 1:04:35
  SPEAKER_00: If you reside outside of Ontario, a quick Google search or search through psychology today will help you find a therapist near you.