Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org.
Welcome back to another episode of Life Without Leaks. I'm your host, Bruce Kassover, and we're joined today by Steve Gregg, the Executive Director for the National Association for Continence. Welcome, Steve.
Steve Gregg: Thanks, Bruce. Great to be here. Really looking forward to talking to Dr. Bri.
Bruce Kassover: Yes. Today we're being joined by Brianne Grogan, though you may know her better as Dr. Bri, because her YouTube channel, Dr. Bri's Vibrant Pelvic Health, has more than 300,000 subscribers, which certainly qualifies her as one of the country's most well-known experts on pelvic health and related conditions. Welcome, Dr. Bri!
Dr. Brianne Grogan: Oh, thank you so much for having me. I'm excited to be here.
Bruce Kassover: And we're excited to have you. Now, I understand that one of your real areas of interest is pelvic organ prolapse, and part of that is because you have a personal story that got you interested in that. Can you tell us a little bit about it?
Dr. Brianne Grogan: Yeah, absolutely. So prolapse is a really, really common condition, and it's something that is not really discussed still to this day.
A lot of people who develop the condition are completely shocked because they didn't even know it was a thing, you know? And so I did know it was a thing because I had recently gone through my training to specialize in the field of, specifically, the field of pelvic floor physical therapy when I was pregnant and had my son and developed my own prolapse.
So, luckily, I wasn't completely sidelined because I do, I did know, you know, what it was. However, when it happened, I was absolutely just like, what is like, I can't believe this. I was so disappointed. I was so scared. I was like, “oh, no, I can't believe, you know, I can't believe this happened to me.” I knew better.
I shouldn't have done what I did, which was to go running at about, oh, about three weeks postpartum. I was very early postpartum, and I went for a run. I was completely exhausted. I was addled, a new mother, and I just wanted to get back to my regular life. And so I went for a run and less than a mile into the run, I felt a shift.
I felt a drop. I felt a. A change in my pelvic area. And again, I knew, I, I thought, oh, I know what this is. So I went home and I gave myself an examination and I confirmed. You know, insert, insert curse word here. And I went to my midwife and she basically… I felt blown off. She basically told me, “I don't see anything wrong. Don't worry about it. It's nothing. It's not a big deal.”
And so that really gave me such a good starting place to really, really, understand what my clients are going through and to understand the journey of healing because I did resolve my issues. And a lot of that was the natural course of postpartum recovery.
You know, a lot does change naturally as you go through that recovery process. But I also was able to use my own tricks and tools and techniques that I was using with my clients and that I'd recently learned in my advanced training for pelvic floor physical therapy, I used those tools on myself to resolve my own issues.
And it was really from that, that I was able to, you know, A) have the foundation of empathy and understanding what other people are going through, and B)you know, learn how what works, what works, and what people really need to understand when they're learning how to manage or even relieve their prolapse.
Bruce Kassover: So I would imagine that, if somebody with your training and your background feels sort of blindsided by this condition, that women who have no understanding of what prolapse is and no expectations that this is something that can happen to them have to be really surprised when they start experiencing symptoms.
What are some of the things that somebody might be looking out for that, that tell them, “Hey, this, this might be prolapse”?
Dr. Brianne Grogan: Right. Great question. And it's true that a lot of people just think that these feelings are they, they may not even think about them. They may not even realize that there is a difference, that something has changed.
And so I'll share what some of the symptoms are, but often when people do realize something doesn't feel right, and they go to their provider and their provider says, “Oh, you have prolapse.” That often causes a real shockwave of grief, honestly of grief when people realize, oh my goodness. And they do some Googling and they see things that are a bit gloom and doom online.
And it can really, really scare them. So that's what I often see as people, again, don't even know it's a thing. And then when it does occur, they do some research and they get really scared. And so I want to, I definitely think we'll probably touch on that and the fact that there's a lot that you can do.
There's so much you can do to help with this issue, but what people, to answer your question, what people might notice is a feeling of heaviness in the pelvis, a feeling of dragging, kind of a dragging sensation in the pelvic floor area. In the vaginal area. They might feel a bulge like there's a golf ball in the vagina or like a tampon kind of stuck in the vagina.
They may feel symptoms of urinary urgency or frequency or have some bladder leakage that can occur. They may have some issues with bowel movements, might have some troubles feeling like they're able to fully go to the, you know, go to the bathroom, have a bowel movement. They may feel a bulging, depending, especially on the type of prolapse, they may feel a strange bulging sensation as they are having a bowel movement.
They may feel that their symptoms are worse toward the end of the day or after, you know, being on their feet for long periods of time or lifting things. Those are some general things that people may experience, but it's often that feeling of dragging in heaviness and it can often manifest as well with some low back pain.
Bruce Kassover: Okay, so now you, you're experiencing some of these symptoms and either you go to a physician who tells you that, “Yes, this is prolapse,” or you, you, you go to Dr. Google and you, you say, “Hey, wow, I think I have prolapse.” You said that a lot of people's first reaction is doom and gloom. So maybe you want to give us an idea of what, what the truth really is about prolapse.What does it truly mean if you find that this is something that you're experiencing?
Dr. Brianne Grogan: Yes. Oh, so, well, there are different levels. It's usually prolapse is graded in different stages or levels of prolapse. And depending on the stage of prolapse you have, there's differences in the ability of your body to respond to different types of treatment.
So if the prolapse is quite extreme and if you are actually seeing your, for example, your uterus can prolapse where your uterus actually can protrude outside of the vaginal opening, it can actually protrude outside of the vagina. The bladder can prolapse so that it's pressing into the front, the anterior vaginal wall. So the bladder is kind of falling into the vaginal wall and it can create a bit of a bulge. The rectum can press into the posterior vaginal wall and can create also a bulge. So depending on how much this, how big this bulge is and how advanced the prolapse is, in some cases it really is very important to, you know, look into different options.
And a lot of times surgery is posed as the only option, but what I always want to really, really tell people is if the prolapse is, you know, there, if there is, if there is a bulge, if there is some of those feelings that I described earlier, but if it's more mild to moderate, then there's so much you can do conservatively.
So changing your lifestyle, certain lifestyle practices and also certain exercises that can help reduce the symptoms, certainly, and even make the prolapse less pronounced. I've had many, many people come to my work and do some of the practices that I teach, and their level of prolapse has actually reduced from, for example, a Grade 2 to nothing that their physician or their midwife or their gynecologist can see.
There's, they're like, “I, I don't see prolapse anymore.” So what I want, what I would want people to know is that it's really important to get an examination, but if you hear that, “You have prolapse, your only option is surgery,” then to look a little bit further, because it really depends on the level of prolapse that you have.
And some people just don't know. Some providers just don't know that there are options out there that can help if the prolapse is more mild to moderate without surgery being required.
Bruce Kassover: So if somebody goes to a physician and surgery is really the, the primary approach that the physician is recommending, and they're not comfortable that, you know, that they, that's what they should immediately be going for. what do you recommend a patient does?
Dr. Brianne Grogan: Well, I really have to advocate for my career, my profession, which is pelvic floor physical therapy. I truly believe that this is such a wonderful a wonderful specialty of the world of physical therapy and pelvic floor.
Physical therapists are often someone you can go, in some states in the United States, you can go direct access directly to a pelvic floor physical therapist without a referral, but that's different in different states. And of course, your insurance repayment depends… you know, they may not accept direct access to a PT, but often you can get a referral to a pelvic floor physical therapist.
So if there is that specialty available to somebody in, you know, in your area, I highly recommend going to a pelvic floor PT because they can do a really thorough assessment. That's really what we focus on, is the conservative management of issues such as prolapse, bladder leakage, pelvic pain, et cetera.
So we really know how to work with. All levels of prolapse and we can also give a, a reasonable evaluation ourselves as, yeah, this is to the point that I think, uh, surgery is your best option. However, we can also say, you know, let's try this first, or at the very, you know, in the scenario that surgery truly is the best option, going to a pelvic floor physical therapist who has the time and specialty and skills to really understand what lifestyle practices you need to strengthen you and best prepare you for surgery is wonderful to have almost like a pre-hab, like a pre-surgery. You know, process of, of strengthening, of learning how to live, what I call a “lifted lifestyle,” where you're learning how to manage your pressure, because prolapse is largely an issue of pressure management.
So you're learning how to, you know, various lifestyle techniques that are going to help you manage the pressure in your pelvic area so there's not a constant bearing down and a straining, which so many people are unconsciously doing. Because the problem is if you do go through surgery but you have not learned these particular lifestyle tips and how to keep your body strong and use your core muscles effectively, including your pelvic floor, then you know what? What you don't fix before surgery is going to follow you after surgery, and you won't have necessarily the best surgical outcomes because you're still going to have those issues that may have contributed to your prolapse in the first place. So I truly believe that for anybody going to pelvic floor physical therapy is a really wonderful step, whether or not surgery is indicated for you in the future/
Steve Gregg: You are talking specifically about prolapse following childbirth postpartum. But we have been to meetings and we have had discussions with people where prolapse doesn't occur, doesn't appear to occur until later in life. Can you address that a little bit more, because those folks are really now confused as to what this is and or what the treatment options would be.
Dr. Brianne Grogan: Right. Yeah. So prolapse is often thought of as something that is just for, you know, women who've, who've been pregnant. And granted it is very common. In fact, one study that I was reading 46% of women who'd never been pregnant at their 36 week appointment before giving birth actually had some degree of prolapse.
So it does often develop during pregnancy. And then of course after delivery, there's some prolapse. You know, about 50% of women who've given birth have some degree of prolapse, and it does increase, the risk does increase with each subsequent birth, and so it is often very associated with pregnancy and postpartum.
But even women who've never been pregnant. never given birth, never delivered a baby can develop prolapse and it really depends on the job they have, maybe the activities they do, and again, how they manage that intraabdominal pressure through their life.
Maybe they have a history of their whole life. Perhaps they're 65 years old and have never been pregnant, but they have lived a lifestyle where they do a lot of gardening and heavy lifting, and maybe they're chronically constipated. So there's been a lot of straining to bear down and have a bowel movement over the years. And basically what happens is over time all of this adds up, these repetitive issues that just happen over and over again, and then, especially as we get older, because prolapse does increase as women get older. and so one thing that does occur is our hormones change, that changes our tissues and the integrity of our tissues and the strength of our tissues and the support tissues that hold all of your organs in place. In addition to, of course, the muscular changes that can occur as we get older.
So it's like this cumulative effect that can happen for women of honestly, of any age, but especially as we get older, we see it more and more. So even if you've never been pregnant, it can absolutely occur.
Bruce Kassover: So it sounds to me like even though people may first hear about this condition and start to think, “Oh, gloom and doom,” that that really, the prognosis is not nearly as dire and dark as they might think when they first hear it.
Dr. Brianne Grogan: Right. Exactly. And so while this is a really common issue, I think, you know, it's statistically, it's actually more common than incontinence, bladder leakage but it's rarely talked about. And so I think that can add to the fear and the gloom and doom, and also just that awareness of, “Oh my gosh, this happens to so many people and maybe it's happening to me.”
But yes, there's a lot you can do to feel better absolutely, naturally. And there's hope and there's help.
Bruce Kassover: Well that's encouraging. And I want to thank you for sharing all of these insights. We really appreciate it. So thank you for being a part of this podcast, Dr. Bri.
Dr. Brianne Grogan: Thanks again for having me.
Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin McLeod and can be found online at incompetech.com.