The Breakaway Experience Podcast | Episode 3

Many people suffer from pelvic floor dysfunction, which includes symptoms like pelvic pain, incontinence, and constipation. These symptoms can be caused by imbalances in the pelvic floor muscles, which support the bladder, bowels, and sexual health. Pelvic floor dysfunction is more common in women due to anatomical factors like a shorter urethra. Diagnosing and treating pelvic floor dysfunction can be challenging because the muscles are internal and require invasive testing. It is important to seek help and not wait for symptoms to improve on their own. Morning, ladies. Morning. Why don't we get started? I know we might have a few people coming in. Yeah, some stragglers, but no worries. So how many of you, and you don't have to raise your hand, but are sitting in the audience and you're sitting there struggling with some pelvic floor symptoms? Thank you for the hand raiser. Appreciate that. This is a safe space, ladies. How many of you have struggled for a really long time and are feeling a little bit frustrated that you haven't been able to get the help that you deserve? So as you can see, there's so many people that are struggling with pelvic floor dysfunction, and it's kind of a hidden symptom. So I'm Shayna Clemmons. I'm a pelvic floor physical therapist, and thank you for allowing me the opportunity to talk with you ladies this morning. Really appreciate your time and appreciate you taking time out of your weekend to come in, as well as to just learn about Breakaway Physical Therapy and the positive impact that we have on the community. We work really closely with the Crofton community and helping people work through these pelvic floor dysfunctions, and as we said earlier, spreading awareness so that people know that they can get help, right? Okay. So what we want to go through today is some of the myths, some of the things that maybe we don't know about pelvic floor dysfunction, or we think, oh yeah, that's totally normal. Doesn't everyone struggle with that? We're going to go through some of those things this morning. We're going to talk a little bit about why people suffer for so long without getting help. We're going to talk through why does leakage happen in the first place, okay? I'm going to teach you a little bit about your body. The anatomy is one of my favorite things, so I love to teach my patients kind of what's going on, where these pelvic floor muscles are, okay? All right. So to start off, right, and I'm going to have some questions throughout this, so I want to make sure that we get a little participation from the audience. There will be prizes. So who knows what are some of the functions of the pelvic floor? What is the purpose of these muscles? And there's more than one answer. I saw a hand. Yep. Okay. Yep. Absolutely. Uh-huh. Right. I heard another one. Stability. Stability. Okay. What do you guys think these muscles support? There we go. And more. Uh-huh. Yep. There we go. All right. We're missing one organ. Yep. There we go. Okay. Yep. Yeah. It's going to say come on, Sheila. You have to know this answer. Uh-huh. All right. So many of you have seen this. This is the pelvis, okay? So these are our hip bones that we feel on either side of our body. So if I was to place this in my body, it would go right here, okay? Now, I'm going to kind of tilt this down so you guys can see. In the front, we have the bladder, okay? Right behind that bladder, we have the uterus. And then sitting right behind that uterus, it's kind of smooshed in there, is the rectum, okay? So this area is so jam-packed, right? And the beautiful thing about this pelvis is it shows all of the muscles on the inside of the pelvis. But what it doesn't show are all the muscles that surround the pelvis, okay? So when we think about pelvic floor dysfunction and some of these symptoms that you may be suffering through, there are a lot of muscles and areas of the body that we need to take a look at, okay? So looking at the abdominals to see what's going on there. Looking at our paraspinal muscles to see what's happening with those. Our big glute muscles, they sit on top of our pelvic floor, super important. Our adductor muscles, those muscles on the inner thigh, okay? So all of these muscles need to be in balance with the pelvic floor. Now, you might be thinking, where are these muscles? So again, if we look on the inside of that pelvis, there's a layer deep right there, there's a layer right here, and then there's a layer right here. So it's actually three layers of muscle. So I always say it forms a bowl or a hammock at the bottom of the body. So you guys were spot on with your answers of what these muscles do and what they support, right? So the pelvic floor muscles, they support and allow the bladder to function properly. They allow our sexual health to function properly, as well as our rectum or our bowels to be able to easily empty. So when we start to have different symptoms, when we have leakage, when we have urgency, frequency, pelvic pain, constipation, things like that, we start to say, ooh, on my end, what's going on with these muscles? Because these muscles are the ones that help allow all of these systems to work, okay? Questions about the anatomy piece? So the red part is the bladder. Okay, got it. Yep, and the reason why the bladder is red is because there's a muscle around it, okay? So when we empty our bladder, this muscle, without us really knowing about it, contracts, okay? Right? So there's a lot of things that happen inside our body that is very unconscious. So some of what we do in pelvic floor physical therapy is sometimes we need to remind the body of what it was supposed to do and things got kind of confused because maybe we had an injury, maybe we had a surgery, maybe there was a fall, maybe it was just our habits that over time just kind of added up. And then we just need some good reminders to get these muscles to function properly, okay? Yeah, it's a good question. All right, so as I mentioned, some of the most common things that we see that we would put under that umbrella of pelvic floor dysfunction would be pelvic pain, pain with intimacy, prolapse of an organ, meaning our organs internally have kind of fallen down, creates a lot of pressure and heaviness, really uncomfortable. Leakage, that means of the bladder or the bowels. Urgency or frequency, again, of the bladder or the bowels. Constipation, also in our postpartum population, which postpartum is anyone that's had a baby. So if you've had any children, you're postpartum for the rest of your life, right? It's a good thing, it's a good thing. So what that looks like in the end of pregnancy, our abdominals actually separate to be able to create space for the baby. And again, for some of you this might have been a long time ago, but what's going on with those abdominals and has anyone kind of helped you work through to kind of rehabilitate your body, okay? So those are just to name a few. Oh, tailbone pain too, that's another one. And I'll tell you why I put, bring up tailbone pain. So when we look at the bottom of the pelvis, okay, here are our deepest pelvic floor muscles and you'll notice they attach to the tip of the tailbone, right? So when people have a tailbone injury or they fall and they say, oh man, like I broke my tailbone or it sometimes happens with a car accident or with having a baby and then they say, man, now like things are just not working right. Well, it's because these muscles attach to the tailbone. So it would be impossible for them to work properly when we have an injury like that. We have to work through those restrictions and help to allow those muscles to work better, okay? So did you guys know that about 32% of women will have some sort of pelvic floor dysfunction over the course of their life, right? And as we get older, that percentage increases, right? Now, in terms of incontinence, such a big percentage of the population, about 13 million Americans suffer with incontinence, with it being twice as more likely for women than men, right? So it's not that we didn't invite any men to come today, right? But as you can see, Ian showed up. Ian. So why do you guys think, who has an idea of why do you think it's so much more common in women than men? There we go, right? What else? Thank you. You got a prize, right? What else? Thank you, Juanita. I'm gonna give this to you. You're welcome. And I've got one more for Juanita. So, Juanita said a shorter urethra, right? So the urethra in women is so much shorter than it is in men. You're welcome. So, anatomically, right, we're kind of at a little bit of a disadvantage, except we're not. We're women, right? I don't understand why the shorter urethra is, I know it affects bladder infection. Right. So, when you think about that the urine comes down the urethra, so then if there's a longer time for it to travel, there's more of a chance for us to have that sensation that that urine is about to come out, right? So for men, they have a much longer warning period than we do, right? And again, it's not to say that men don't struggle with incontinence, right? We do see that, but much more likely in women, okay? All right. Now, as well as chronic pelvic pain, that affects about 26% of the population, with it increasing if it's acute, meaning if it just happened, right? So if you just had an injury and you're suffering with pelvic pain, but then what we see is it continues on, okay? All right. So, pelvic floor dysfunction being so difficult to diagnose. Now, when I just showed you where these muscles are, right, they're kind of hard to see, right? And it's kind of a small area. So I always say, well, if you take your pants off and you grab a mirror, you still can't see a whole lot, right? And when we use our muscles properly, we can see them working, but it's really difficult. And because a lot of these muscles are internal, that a lot of times then requires invasive testing, right? Which people don't really always want to go through, or it's a lengthy process, right? And then going through that causes more trauma and worsens your symptoms, right? I see a lot of head shaking, meaning like you've been there. I think that a lot of people are guided to just give it time and see what happens, right? Which is the worst thing. Yeah, all for that. Beautiful. I love that. So think about when we're kids, right? And you're like, oh mom, like I hurt my elbow, I hurt my elbow. And you're like, okay, okay. All right, let's, we'll put some ice on it and you know, okay, let's get you relaxed. All right, have a good night's sleep and we'll see how you are in the morning. When we're young, our body heals so rapidly, right? We're just, we're growing at such a rate that we see those changes really improve. But as we age, we add in all the things that have happened to us. So all of those children that we've had, all those amazing birthing experiences, all of the car accidents, the fender benders, the falls when we just kind of trip and lose our footing, right? All of those injuries to maybe our pelvic floor, maybe our lower back, maybe our tailbone, which again, then affects these muscles. How about surgery? Sometimes patients will say, oh, I haven't really had any surgeries. Oh, well, which ones have you had? And they say, oh, well, it's not really related to my pelvic floor. Well, you know, just, just let me know and I'll just jot it down. And then they say, oh, well, actually it was an abdominal surgery, right? So, which again, in my mind, I'm like, oh, that's so related, right? Because these muscles are so connected. But again, that's not commonly promoted and it's not known that these pelvic floor muscles have to work with the abdominals, with the muscles of the back and the glutes, okay? So this is a really difficult area of the body to diagnose. And what I see from a patient standpoint is that they go from provider to provider to provider until we finally are able to connect with them, right? So I had a patient who, who went to see a GYN, was having some pain with intimacy and they said, oh, you know, it's, it's just cultural for you. Yeah, terrible, right? Terrible thing to say to that patient, right? So she went to another provider and told them the same story and they said, oh, you know, I really want to refer you to a mental health provider. And so she, she came to see me and she was crying as she was telling me this story, which I was on the verge of crying myself because it was such a terrible story of how she really had not gotten the help that she deserved, right? Yeah. And so let's be honest, the more that we struggle with these things and the longer that we live with them, it does wear on us, right? And you start to feel really frustrated. And so it's not to say that, you know, getting help and getting that support from a mental health provider can be really beneficial in your treatment, right? But it doesn't mean that there isn't a problem, right? So again, that's, that's what I'm here to do is promote awareness because those sorts of stories really, they upset me. Yeah, absolutely. Absolutely. Yeah. So, so when we think about pelvic pain, right? What we sometimes think is like, oh, again, maybe there was a trauma to those muscles. Again, maybe there was a fall, maybe we had a baby, maybe there was an accident, like there was something that kind of set off that cascade of events, surgery. Sometimes we hold our stress in that area of the body. And by sometimes, I mean, many times we talk about this a lot with our patients. Okay. So let's be honest. Let's say you've had a really stressful day and you're like, oh man, it was a rough one. We expect to feel tight in our upper traps, right? We expect to feel tight in our neck and shoulders. That's just kind of known, right? Someone will come up to you, my oldest will come up to me and he'll start like massaging my shoulders, you know, super sweet. So what we don't though normally realize is that when we're stressed, we hold tension in these pelvic floor muscles. Okay. Yeah. And it's totally natural. Like this is our body's way of protecting us. It's not a problem that these muscles tense, right? So when we're stressed, when we're scared, when we're anxious, when we're nervous, any like heightened emotion, these muscles, they activate. So they tighten. And that's okay. But what's not okay is that they stay tight all day long. Right? I always say if our muscles are living on the ceiling, how can they function properly? Right? So if you were guided to do a thousand Kegels a day, and then you say, man, this is now I've got this like pain. I don't, I don't know what's going on. Right? That's too much. And I ask that because in year 2020 was a terrible year on all levels, right? Yes. It was an adventure. Like sharp pain and pain and the OBGYN. Absolutely. Right. So we saw an increase in that in 2020. Right. That was the extremely stressful year. And it affected people in many different ways, but even affected, you know, family relationships and just life in general. It was a lot on our bodies. Right? So one of the things that we do and where we come in as pelvic floor physical therapists is we help people to first understand where in the world are these muscles? And then what are they doing? People come all the time and they say, well, I don't, I don't really know how to do a Kegel. Like what, what exactly is that? Or, you know, what am I supposed to be doing? That's again, that's where we come in, right? This doesn't have to be a guessing game. We want you to understand and know what is your body doing throughout the day and for you to be able to have that awareness that your brain can connect with these muscles, these muscles that are super hard to see. Right. But again, have really important functions. And so I would say, um, a lot of people don't even realize that, you know, these are real problems. And part of that is because when everything's working properly, well, who's really like thinking about their bladder? It's just like, oh, okay, cool. Got the urge. Gotta go. Right. Oh, yep. Morning. Had my coffee. All right. Ready to go have a bowel movement. Right. People are just not thinking about this whole area of the body. We find that there's a big disconnect with the pelvis, but then all of a sudden you're like, oh my gosh, like I'm rushing to the bathroom all the time or like, oh man, I tried to be intimate and like, it was so painful. Like I don't even know what's happening with my body. Right. And then can we add in that stress component and then that makes our muscles tense even more. But again, that's when we start to have that awareness of like, well, I don't know there's something wrong. I need to get some help. Okay. All right. So good question. Now, what I see a lot on my end is that, um, doctors prescribe medications. Right. And I kind of just wanted to address this a little bit. I know you're smiling in the back. Um, there's a time and a place for everything. Right. So I say to people, you know, Hey, sometimes you need something to help you get over the edge of something. Sometimes our patients come in and they're in so much pain that we can barely put our hands on them. Right. Well, then how, how can we help them? How can we work through that? So I want people to know that there's a time and a place and there's nothing wrong if you've opted to, you know, get some medications to assist you. Right. But when we look at really identifying what is the underlying cause, what's the root problem, how can we really fix this and how can we not only have changes now, but how can we have those long-term changes, which is what we want, right? We want to be able to address it and move on and then live the rest of our life. That's where we come in. Right. So it's okay that we've opted at times to, you know, get that help. And again, from the provider standpoint, you know, that's, that's their wheelhouse, right? That's what they, that's what they have to provide. And, and also, right, we do live in a society of, of instant gratification and man, I'm on a toilet paper. Oh, no worries. I'll just order it on Amazon and it'll be at my house in like two hours. Right. We're, we're used to that sort of a response. So sometimes, you know, we say, cool, I want a little bit of a quick fix. Right. But I'm here to tell you that you don't have to live the rest of your life being on these medications. There are things you can do, right? Want you to be motivated, right? And we work together with our patients. It's very much a partnership, but we see really big changes. Okay. All right. Questions so far. Well, we help people to connect with these muscles and we have to figure out really what's going on. Are your muscles tight? Are they weak? Are they able to activate when we need them to? And again, then we take a broader perspective of it's not just those pelvic floor muscles, right? What's going on with the abdominals? What's going on with our lower back? What's our posture? Right. That's a big one that sometimes we stand and we say, Oh, yep. This is like really comfortable for me. So I have four children, right? So I've been through four pregnancies. So yep, my hips are a little wider, right? Than they were 11 years ago. But again, when we stand in these postures where we stick our stomach forward and we stick our butts out or when we tuck under and we just hold everything tight all day long, our muscles can't function properly, right? So we talk a lot about alignment, right? And finding those muscles and activating them properly through movement. So it's a lot of things that we look at. Now, so who knows on kind of a separate note, so this whole area of the body, right? Sometimes we'll see people that come in with recurrent UTIs or yeast infections and things like that. And then they start to get some pelvic pain and they're just like, I don't know what's going on with this area of the body. So I wanted to talk a little bit about hygiene and how we take care of this area. So who knows what is the best way to clean the pelvic floor or to clean the vaginal tissues? And it's not a trick question. Okay, correct. What should we, that was, sorry. Clean water, that's it, right? So did you guys hear that? Just water. Down there. Okay, you're going to love this one. The vagina is a self-cleaning oven, right? It does all the things it needs to do for us, right? Kind of amazing. So all we really need is warm water to clean those tissues. Now, I would say sometimes people want to be able to use maybe a soap or some sort of a cleanser. So I guide people, if they're going to head that route, dove sensitive skin and Cetaphil are the two closest to the vaginal pH, right? So when we start to see people that have lots of infections and they start to get, you know, itching and burning and all these symptoms, and then we start to work through, hey, well, you know, what kind of cleaner are you using, right? What kind of detergent are you using on your clothes that are then in contact with the skin, right? These things can affect our body. And what I see clinically is the more conditions that we have or more sensitivities, some of my patients that have autoimmune conditions, their systems tend to be a little bit more sensitive. So their body can't tolerate, right? The aisles of the perfumes and the douching and the wipes and all these things. It's not necessary at all. Not needed. You had a question? You were talking about internally. The internal cleanser thing, vaginal thing? Yeah, so think about like how people have like the, they buy the vaginal wipes, right? Or they buy the cleaners to put, let's say it's on the outside or just on the inside of the vaginal tissues, right? So like if you were to clean this area in the shower, right? That's kind of what I'm talking about. What would you use? Okay, does that make sense? Again, if you choose soap, only dead sensitive skin or Cetaphil, right? Or just water is great. I have autoimmune skin issues. I can't even walk down the sensitive soap or laundry aisle in the store. Because it sets you off. Yeah, I mean I get migraines just from smelling it. But I only use a certain washcloth that's dedicated to that purpose and water. Yeah. I tend not to use Aspirin. Yes, you got the answer to that question. Oh, thank you. Absolutely. Yeah, so our system actually is really basic. So the question was, does that pertain to the bowels or the rectum as well? Your wording was better than mine. She said the back door. Right, so what I recommend, right? Buy a bar of dead sensitive skin, have that again. You can just use it for your whole body. Or if you have a different favorite that you want to use for your legs and your arms, go for it, right? But what I'm saying is the pelvic floor, these tissues, they're sensitive, right? And so the more that we put all these perfumes and all these different things, the more that it kind of adds up and it can contribute to a problem, right? All right. So now, go ahead. Yeah. Yeah, so anything that's going to be, you know, free of scents, free of dyes. I don't have one top of my list. I'll talk with you a little bit after this, too, about there's a website that I like to utilize for kind of finding cleaners and things like that that are more non-toxic. Like, there's, you know, based on your system, you can kind of head that route. But yeah, you're looking for one that doesn't have the dyes, that doesn't have the artificial colors and scents and things like that, right? And again, some people absolutely couldn't even go that route because like lavender sometimes can, right, I see some, can just, yep, stop people off in like an allergic reaction. I can't even wear makeup anymore. It's like a dryer sheet, but it's for the washing machine. A sheet that you use is only enzyme. Enzymes clean your clothes. So, there's no detergent at all. That's interesting. Really good for like all over because your skin is becoming contact. Clothes have been washed. Okay. So, I want to talk a little bit about leakage, right? So, just a little bit, right? So, one of my patients, I asked her, this is the very beginning. I said, hey, do you have any leakage of urine, right? Just general question. And she said, no, not at all. Great, right? That's fantastic. I said, but do you have any if you jump or if you have a really strong cough or a really big sneeze? And she said, oh, yeah. Well, of course I do. She was like, and she was like, well, I mean, I had kids. So, I mean, I'm a mom. Isn't that just what happens? Again, why we're here today, right? It may be common, but this is not normal in that you shouldn't have to live with this, right? Just because you've been through some different things in your life does not mean that you have to sit there and struggle with leakage, okay? Now, I wanted to show you my ball. Everyone knows that I travel with a purple ball. So, what happens like when we cough or we sneeze, okay? So, imagine now the top of the ball is my mouth. The bottom, this hand, is my pelvic floor. So, when we cough, when we sneeze, we get a lot of pressure in our body, okay? So, what happens is with these pelvic floor muscles being on the bottom, so sometimes they're maybe just not strong enough, right? Or they're not activating when we need them to. So, we get that strong cough and we're like, oh, that's kind of hard. And the muscles let go, right? And we leak. Now, sometimes our muscles are living on the ceiling all day long because we thought, oh, you know, I've been told I just need to hold in this whole area all day long and I'll be taller and skinnier or, you know, or again, maybe we have a lot of stress and we're just holding on to that tension. We don't even know. But so, these muscles are holding on for dear life and then we get that cough or we get that sneeze and they can't go anywhere else, right? They're already at the ceiling. So, we end up getting leakage because they can't support us. So, my point is when people are guided, oh, just do a bunch of kegels, just go home and, you know, do them all day long, do them in the car, at the stoplight, you know, and you'll be fine, right? There's a time and a place and again, we need to make sure that we're doing them properly but sometimes that's not the answer, right? Again, that's where we come in and I just always want people to know that you don't have to live with leakage, right? It's not something that you should have to endure for the rest of your life. The commercial of the people dancing around with their incontinence pads and they're so happy and they're twirling, right? And I'm like, so wouldn't we be a lot happier if we didn't have to wear a bulky, gross pad? Wouldn't that be more fun, right? I don't know, that's just my thought. But and again, you know, the idols of all of these cleaners that we just talked about, like a lot of it's, most of it's kind of unnecessary, right? So what do you guys, does anyone know, kind of, so okay, let me back up. So when our bladder has to empty, what happens is we start to get an urge, right? Now I always say the urge is the knock, knock, you're going to need to pee in 20 minutes or so, right? And that's what we want. We want our bladder to give us that warning and then we have a time and we're able to kind of make that decision of if it's a good time or not to go. But sometimes what happens is it's bam, bam and you're like, all right, I gotta run, I gotta run. Can't control it, right? Urgency, right? So that's kind of the difference. Now what I see when patients come in and they're dealing with leakage or urgency, they, and we talk about water, right? You guys notice, I love my water. Have to practice what I preach. So who knows how much water we should drink on a daily basis? And I would love someone who's not a patient, someone who I haven't told this answer to, right? But how much water should we drink each day? Okay, anyone else have, go ahead. Yep, that's right. Half of your weight, you gotta book for this one because you know I love my water, right? So if you take how much you weigh, I know we don't always like to think about that, how much do I weigh? Oh golly, right? But just take that number, okay? You don't have to tell anyone, but then divide that in half. That's about how many ounces our body needs to be able to thrive, right? And people ask, well, I mean, why is water so important? Like Shana, why do you always talk about water? It's so crazy, right? Well, our body's made up of a very large amount of water, right? Water helps to lubricate our joints. Also, when we don't drink enough water, and again, this is where patients say, well, I'm not going to drink any because then I won't have to pee, and then I won't have to, I won't have any urgency, and I won't leak. When we don't drink enough water, our urine is more concentrated. So it's more acidic. So it ends up being more irritating. So we drink less, and our bladder feels worse, right? So it's just, it's more concentrated internally, so it's just more irritating to the system, right? Why else do we need water? Well, we need water for our bowels to be able to easily empty, right? If we don't have enough water, our body is not going to donate any to the bowels because, you know, they're leaving the body. So the body says, nope, I'm going to hold on to all of it for myself, right? Water is really helpful for our concentration and our focus for our brain. Again, made up of a lot of water, right? So many reasons to drink our water. So what I recommend on my end is, let's say you want to increase your water intake, go slow, okay? So add a glass, give your body a couple days to adjust, all right? And a lot of patients say, like, well, I don't really like water, so how do I, how do I drink that? Okay, well, could you throw in some frozen berries, and then as they unsal, you get a little bit of flavor, right? Or maybe some essential oils, you know, that are safe to ingest, right? Different things that you can kind of put in your water if you just want a little bit of a flavor. Now, another question I had was, who knows what are the four most common bladder irritants? Caffeine is one, yep. Alcohol, cocktails, carbonation. One more. It's not sugar. It's, yeah, it's citrus. So we call it the four C's, right? So caffeine, carbonation, cocktails, and citrus, right? But here's the thing, ladies, right? You'll, you will notice, but someone called me out on it this morning. Wait, there's coffee back there. How could you provide us coffee, right? This is caffeine. Okay, it's, it's all right. It's all in moderation. Thank you, right? It's okay to indulge, but again, if you're consuming multiple cups of coffee in the morning and you're not having any water, and then you're coming in saying, man, I've got all this urgency and I'm rushing to the bathroom. Okay, well, that's going to be really related to our habits and what we're consuming, okay? So I don't take away people's coffee and I don't say, don't indulge and enjoy yourself, you know, with a beverage in the evening, whatever it is that you choose to take in. But let's really look at what we're consuming and then let's look at our symptoms, right? So sometimes we'll have people kind of map it out so we can really see what's going on throughout the day, okay? Does that make sense? Yeah, okay. Yeah, so lemon water, lemon juice. I do lemon water every morning and my doctor wanted me to do it and I read there's so many benefits, so many different things. I said, well, why do you want me to do this? He said, because I want to get your urine in better shape. And then I learned, though, lemons, lemon juice, it's the one thing that when you ingest it, it turns alkaline. Hmm. I know, it's like weird, but... Very interesting. Yeah, but the other sisters know and I remember I asked Dr. Sears, well, what about limes? He said, they're about half as effective, better than nothing, but there's something about the lemons, it turns alkaline. Very interesting. I know. Yeah, right. So again, all in moderation, but again, I like to just educate, wanted to educate you guys and have you just start to understand a little bit more about maybe some of the things that you're struggling with. Then as you hear these things, you start to like connect the dots and you say, oh, okay, maybe I could change this or, oh, maybe this is having an effect on my symptoms, right? We just realized tomatoes are probably not good. Tomatoes, I mean, again, it's not like you can't ever have spaghetti, right? But maybe not all the meals of the day with the tomatoes. I know. Yeah. So I want you guys to know that if you're struggling with pain with intimacy, this is something that we see a lot and there's a lot of things that we can do to help. There's a lot of different things we can teach you. We can, there's different things we can incorporate in your treatment. So there are exercises and ways you can help your body even when you're not in therapy. You know, when you're dealing with these pelvic floor symptoms, no one really knows what you're going through, right? You don't have like a cast on your leg or you don't have crutches, right? No one has any idea, but you know, this really affects our quality of life. It affects our relationships. And again, it's just something that you don't have to live with for the rest of your life, okay? Now, the postpartum population is very near and dear to my heart with as many children as I have. And I just, I love working with moms. I love working with our pregnant patients and just really helping them postpartum. There are so many things that our body goes through during a pregnancy and with having our children. And that goes for a vaginal birth and a C-section, right? There's pros and cons to both, right? So again, I really, really recommend that people come in and they get help. So did you know, and this is in my book, that in France, every woman that has a baby is sent for pelvic PT. Wow. Right? Again, one of my overall missions really is to just spread awareness. So educating you guys this morning, then whatever you choose to do after this, you can go on and you can teach someone else. Again, whether it's your kids, whether it's your grandkids, whether it's a friend. That's why I asked you guys to bring friends because I said, I bet there are people in your life that are going through some of these things and maybe they just don't want to talk about it because it's pretty personal, right? And again, we hear these things, these stories every day, but I want you to know that you can, you can get help. And again, with, with a pregnancy, it's not, it takes nine months to be ready. So why do we expect that? Oh, at the six week appointment, Oh, everything looks great. See you later. I'll see you in a year. That's terrible care, right? That's not looking at the mom. The whole attention of the pregnancy, everything's focused on the mom. Then we have the baby. Oh, all right. All about the little person. What about us? Right? How about we get the support and how about we make sure that we know how to use all these muscles and then we get put on a really good program, right? So that I don't see in 20 years, right? Okay. Questions so far? Okay. So I want to teach you guys an exercise. You mentioned I might go through an exercise. I want to go through diaphragmatic breathing. Okay. And this is just because it's so important, right? Of all the things that we teach. Diaphragmatic breathing is a way for our system to really use our breath. And so our diaphragm is a really big muscle that goes around our body. So when I tell people to take a deep breath, this is what I get, right? I'm like, I love the proud penguin that you are. But our diaphragm's down here, right? So when we take a deep breath, when we take a breath and it goes up into our lungs, it actually ends up being a really shallow breath. We're using a lot of accessory muscles. So when we breathe down into our diaphragm, so I want everyone to put your beverages down for a minute. Put one hand on your stomach. Okay. Take that other hand and wrap it around your back to your sides. And I want you to inhale. And what I want you to focus on is feeling the air fill into your hands. So if you watch me, I'm going to breathe in. You guys feel it happening? These are some of the things that we work on with our patients, right? This is a really hard one, right? Yes, because like for me, because it's such a habit and because I've practiced it again and again and again, right? So even let's say in workouts, right? I do like to exercise, like to be strong and be able to keep up with my kids. So when I'm working out, I'm very intentional about utilizing my breath properly, right? Because I know if I take a diaphragmatic breath, as my whole diaphragm fills with air, we get that 360 degrees of filling. What happens to our pelvic floor on the bottom is it lengthens a bit. Okay. So then when we exhale, all the air comes out of our body. So we get a very subtle contraction of those muscles. Again, very subtle. We wouldn't really have any awareness that this is going on. I would say as pelvic floor PTs, we've become hyper aware of all these things, right? And you don't need to necessarily be aware of it. But when we're looking at how do we support our body the best? How do we, okay, if we want to lift weights, how about like power lifters? How do we lift, but not leak? Or how do we lift and not push our organs out of our body? Well, we use our breath. We use our pelvic floor. We use our abs to work with us, right? So we exhale on the exertion. So on the hard part of the lift, right? Let's say you've got a heavy bag of groceries and you're like, all right, I gotta, I gotta pick this up. Okay. All right. I'm down here. Oh, what do I do? Right? We want to breathe in. We want to engage our muscles. Exhale as we stand up, right? That's something that sometimes we have to reprogram our body. Like we have to teach it time and time again so that it's automatic. So that our body can really support us and support our back, right? Poor back pain is the most common thing that we see as CTs, right? But who wants to live with back pain every day? Sounds awful, right? Sounds distracting. Does not sound fun, right? So questions? Yeah? I did a pelvic floor class online. Um, you know, it was all about educating about pelvic floor and also strengthening it. So I brought it with me. I thought you'd be curious if you were familiar with it. And it's pelvic floor pro and it's this contraption that you strap between your legs. Okay. But it's from a PT person online that I highly, highly, highly, um, you know, recommend. Yeah. Yeah. Okay. Okay. She does all sorts of educational stuff online. So it looks weird, but actually, it's supposed to be really, really helpful. So what, um, what's the purpose of it? In the pelvic floor. Okay. And she doesn't advocate Kegels or she said sometimes they can do more harm than good. Right. Well, again, that's where, you know, we can put out, you know, and, um, give the public like a general program. But if we don't know all of the underlying things that are going on with your body, it's difficult to say. So I agree that Kegels are not for everyone and that you really need to know when to use that part of your body and when not. And we always have to have an imbalance. Right. Absolutely. Yeah. Oh, thanks for bringing that one up, Sheila. That's a good one. Right. So that's such a like pet peeve of mine. So yeah. Okay. All right, ladies, let me teach you something. Okay. Think about, I'll tell you, I'll tell you why you shouldn't do that. Okay. Let's all imagine that we have a super full bladder. Okay. And we're like, oh man, really got to go, really got to go. And then just imagine we sit down on that toilet. Do you know that feeling that like, ah, right? Most of us do, right? Ideally all of us. Okay. Let's go back to our anatomy. What's happening with our body? These pelvic floor muscles that are on the bottom of our pelvis, they're relaxing in that ah moment in time. That allows the muscle that's around the bladder to contract. Okay. So the pelvic floor muscles and the bladder muscle, they work opposite. So what happens if you're emptying your bladder and then you say, Oh, let me do a Kegel. Oh, let me tighten these up. Well, one, you're stopping your flow, right? Which then, but also you're sending a message to the bladder that you're done. So if you do this on a repetitive basis, your body gets a bit confused. I was like, well, I don't really know what you want me to do. So then we start to get the wrong information. And then we say, Oh, I'm like, I'm having some urgency, but I don't really have to go. My bladder's not quite full. I don't really know what's going on. Right? So I highly, highly do not recommend that you practice Kegels. If Kegels are for you and your body needs that to heal, do not do them when you're on the toilet, please, please. Right. If anything, you walk away of this with. So other questions. Every person is unique, but with me is the scar tissue from having the kid. And I was in labor for over three hours and that's what created all. And it's a force that deliberates. Yeah. So I'm like, I didn't realize that's trauma. Yeah. Right. That's a lot. Now, 40 years later, all this comes to pass. Yeah. Definitely. I had to find out for myself because nobody I looked you guys up and in Google, you know, or looking for, okay, public floor. And that's how I found you guys. Yeah. So again, that's part of why we're here today is if we can, if you guys can take just even a piece or a fraction of what you learned, and if you can share it with someone else, it just means that they can also get help or that they can know that they don't have to suffer. Right. But it's a choice. Yeah, I had twins 39 years ago. A lot of muscle separation. Yep. Gap is still there. 39 years later. And also I'm going to milk over here, which has been there all this, all this time. And my primary has never made a big deal about it. But you know, I went to a new primary recently and he's like, you really should get to fit because the intestines will help you. And I just take them back. I just push them back. So this is 39 years. That's a long time. So I don't know. Do you also, I'm looking at going for a spinal fusion and you know, I'm thinking about the abdominals and the core and that spine. So would this be something to think about doing before? Yes. So I would say even just from the perspective of just understanding how to connect with these muscles, because you're going to need to be working on them afterwards. Right. So for you to know where really are your deep abdominals, right? Not like the rectus muscles, but where are low abdominals that really help to support that pelvic floor and the abdominals that help to close or lessen that gap. I would say that it would be really beneficial for you to spend a little time and work on this area, right? So that you know exactly what's going on. And then you have a baseline. Right. But it's not going to repair without surgery. I mean, it's just to that degree. Right. So sometimes that, you know, that's the case. All situations are going to be a little bit different, right? It's not to say, again, when I was talking about medications, it's the same thing. There's sometimes like our body needs to go that surgical route. Absolutely. I'm here to try to prevent that for, you know, any of, and all of you, but sometimes there are exceptions to that rule. Right. So that's okay. And again, we can talk a little more later about kind of what you need, but I would say, if anything, you're walking away from today with, if you have all these surgeries and you have these repairs, you really need the support afterwards. Right. And the support before is going to help you be more successful afterwards. Yeah. Yeah. Coming to a pelvic floor PT. Yeah. Again, learning about what muscles to work, how to use your body properly. Right. So speaking of pelvic floor physical therapists, we are lucky to have one of my team and I would love to introduce her. Kayla, come on up. So Kayla is a part of my pelvic floor team. She's phenomenal. Right. She's also a mom and just does an amazing job. A lot of our patients see both of us and just really, really proud to have her on our team. Yeah. Thank you. I really like enjoying, I love working with this population. Like she said, I'm a mom, I'm a new mom. So I have an almost two-year-old and a four-month-old. So I really got into pelvic floor after having all those experiences. And I even had my own experience where postpartum, I went to the doctor, I was like having some pain. I knew there was more to it than that. And they're like, oh, you had a C-section. There's nothing wrong with your pelvic floor. You can go home. I knew better. But a lot of our patients, and that's why education is so important. We know better, but our patients don't. And if your doctor tells you that, you feel really helpless afterwards. So I'm glad she was doing this and we can get the word out to other moms too. So there's a lot more out there and a lot more help. Thank you. All right. And I have another guest I'd love to bring up, Ian, who's hiding in the back. Ian is our amazing tech guy, right? He's doing all the cameras and the microphones. You can come closer. It's okay. I don't bite. Yay, Ian. So I wanted to introduce Ian as well. He's now a certified stretch therapist. So in being able to really help our patients from a more holistic approach, this is something that we've recently brought on and he's had some raving reviews from patients that have gotten, we have some free 15 minute stretch sessions for you guys to have a little taster. Our stretch therapy room is actually in the corner back there. But my goal is to just have you guys just get that tension off of your body. Just be more aware of your body, head to toe, and just enjoy. Because I feel like a lot of times as mothers, we have stress, we have tension everywhere. And one thing to relieve that is to stretch. And that's something that I educate people as well. Yeah, I'm excited. Yeah. All right. Thank you, Ian. So you've never heard of it. Oh, well, I guess we have to get you signed up. I said, I guess we have to get you signed up. Right. Here we go. All right. Um, so also, Gail, who's walking away.