Dr. Susan Clinton: Understanding Incontinence, Pelvic Floor & Treatment Options

Incontinence is a part of health, wellness and performance that is often kept hush-hush, but influences a very large number of people worldwide. Many individuals suffer in silence, not realizing there are options beyond such suffering or surgery.

This week we welcome women's health expert, nationally board certified health & wellness coach and physical therapist Dr. Susan Clinton. She takes us through some of the causes, what can be done and how to find the help you're seeking (both women and men).

For health & wellness coaches, physical therapist or other health care provider, you will find this episode to be extremely valuable. For everyone else, we expect this episode to be among our most-shared episodes of all time due to the positive influence it can have on the lives of so many. 

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Transcript

Dr. Cooper: 0:00

Welcome to the Catalyst Health, Wellness, and Performance Coaching podcast. I'm your host, Dr. Bradford Cooper of the Catalyst Coaching Institute. And today we're going to venture into a very personal yet extremely important aspect of health, wellness, and performance, incontinence. This is a topic that often flies under the radar with many people who struggle with this issue, assuming they're alone, you're not, they're not. And as you'll learn today, you have options when it comes to treatment. We were so very fortunate to have as our guests, Susan Clinton, an award winning physical therapist, nationally board certified health and wellness coach, and a specialist in women's health. She has more credentials after her name than zebras have stripes. And she is the cofounder of the global women's health initiative. Men, before you click this off, we'll get to us to, as this is not simply an issue that affects women. And for everyone, obviously, please share this episode as you see appropriate. For those planning to become nationally board certified health and wellness coach, we've been saying the last chance to qualify you for the requirements would be July. However, the NBHWC just extended one of their deadlines. So that means the August program will now give you plenty of time to qualify. So if you have questions, or you thought you were out of luck, contact us anytime Results@CatalystCoachingInstitute.com. And you can certainly look into the details on the website CatalystCoachingInstitute.com. Just a heads up, our last three programs have filled up very early. So if this is a priority for you, please don't wait too long. Now let's listen in as Susan Clinton provides some potentially life changing insights for so many on this episode of the Catalyst Health, Wellness, and Performance Coaching podcast. Susan Clinton, it is a privilege to have you join us here on the Health and Wellness Coaching podcast. I appreciate you being here.

Susan Clinton: 1:49

Thank you. It's my honor to be here and to discuss some very important issues with you.

Dr. Cooper: 1:55

Really important. And, and I think maybe we could start off by setting the stage for today's discussion about incontinence. Why is this such a timely discussion in the context of our topic today, of health, wellness, and performance?

Susan Clinton: 2:09

It is one of the, factors that I think is often missed. That is probably one of the number one things that is keeping females from being as active as they want to be. You know, we're so used to looking at health markers, blood pressure, heart rate, respiratory rate, pulse ox, you know, any of the, you know, what's your blood sugars, what's your A1C, all of those kinds of things as motivators. But we forget to look at the things that are demotivating, particularly to females. And that's the, it's the issue of urinary incontinence. It's one of, yeah, it's one of the number one, so to kind of give you an idea of the incidents and prevalence, and these are numbers that are, that are clear across the world. It's not just in the United States or Canada. But it's estimated that one in three females are suffering from urinary incontinence in their lifetime.

Dr. Cooper: 3:07

Is that right? Wow. And is it a brief period of time, like after having a baby for six months or is this something that can be a lifetime or does it just depend?

Susan Clinton: 3:18

That's a great question because I think what happens in our, in our culture, in our societies, especially across the world is that we normalize it. We've kind of passed down through tradition in generations like, Oh honey, I had a baby too. And that's just what happens. Right? And, so we've normalized something, it is common, but it certainly is not normal and it is not ever normal for a female to have to have incontinence with running, jumping, laughing, coughing, sneezing, climbing trees. They just shouldn't, you know, they should be able to be dry and it's also, you know, although having a child is a risk factor for pelvic floor dysfunction and I will get to that. We'll talk about that a little bit down the road, but it's definitely a risk factor for developing urinary incontinence. It's not the only people who have it, there's plenty. And so you talked about performance, which is very key here, and it's starting to come out. I think the movement started about six or seven years ago when they were at a CrossFit games and people were talking about leaking with double unders and a certain, you know, clean lifts and poles and some different lifting techniques they were doing. And, it came out that a gynecologist on there said, Hey ladies, it's okay to leak when you lift. And the physical therapy world went ballistic because it was like, no, it's not, okay. This can be treated. We can get this so much better. And, so there's a lot of, of athletes and, performance people, whether they want to classify themselves as athletes or not, they just want to walk, that, you know, have never had a baby and are leaking, so it can happen, you know, to anybody. And it's just, you know, certainly something that is a little bit more prevalent in countries and cultures that sit rather than squat, but in those countries that are considered more third world or, you know, countries without chairs, you know, they have other incidents and risk factors such as fistulas from having babies way too young, the tearing in the pelvic floor, you know, and things like that. So there's all kinds of different things that can lead to it. But certainly, in the cultures we're talking about, about health and wellness coaches, that your audience is participating within their clients. One of the little secrets that may be holding them back and a barrier that you keep running into with your clients is, well, you're ready to go. Your nutrition's better. You're feeling better. You're getting some more sleep. Why aren't you out there like banging it, you know? And they're kind of coming up with all the other excuses of, you know, I just don't like the gym. I can't really, I don't like the way I'm looking at an exercise class. So I don't go, is that really the reason? It could be one of them. What they did was they did a study, about 10 years ago, it was a qualitative study that they did, they did surveys across, so that they would be held anonymous at gyms across the country. And they asked people, what was the number one thing that kept them from progressing or would make them stop coming to the gym and hands down they answered leaking.

Dr. Cooper: 6:30

Is that right? Wow.

Susan Clinton: 6:32

So, you know, that's terrifying to be a female and you're sitting on a bench and you're doing, you know, press ups, military press ups with weights and you stand up and there's this big wet spot sitting on the bench, you know? So, you know, it's just you're terrified of like doing, you know, doing a deep squat or a deadlift and feeling the urine running down their legs. And, you know, in some instances, and in some areas of weightlifting, it's become kind of like a badge of honor. I can, I'm so strong. I can lift until I pee. And it's like, I don't know if that's really the badge of honor we want to be carrying, especially when a lot of people are avoiding activity because it makes their leaking worse.

Dr. Cooper: 7:16

Well, and when I was treating patients 15 years ago, as a physical therapist, I worked with a PT who was fantastic in this area and she built a wonderful reputation, but it seemed to me, and maybe this has changed over 15 years. It seemed to me that many of the women that were referred to her by a physician, they didn't even know this was an option. They didn't know there was an answer to this outside of, you know, medications or surgery or those kinds of things. What, what is that like now? Is it getting out there? Is it more, do women know this is there is an option and it's available through physical therapy?

Susan Clinton: 7:52

That's an excellent question. And I love that. I love that historical perspective. I got into working in pelvic health, 20 something years ago, when we didn't have all the courses. And we did, you know, there was a listserv that we all got on and talked about, you know, things on a forum back in the nineties. And the only people that were talking about urinary incontinence were urogynecologists. And because they were the only ones doing, sling surgeries and things to help, you know, I think people, your audience probably knows it as, you know, the bladder lift surgery or the surgery that's going to prevent incontinence from happening that, you know, things have fallen a little bit. So they sling it up and shore up the anatomy a little bit. But they also were kind of on the forefront of working with physical therapists on there's more to it than just kinking the hose, we want to get the natural muscle system working too. And as a physical therapist, Brad coming from where you came from, you know, that you really didn't just look at somebody who came in with back pain as their back was the issue. You look at them from the feet, all the way up to their head. You know, what's happening, how are they coping with load? What are the big problems that they're, that are incurring that in their system? And one of the biggest ones that people with back pain have is incontinence. It's, it's a huge correlative factor. It may not be causative, but it definitely is correlative. And so the push now in the world of physical therapy is to get our, and I'm an orthopedic therapist as well as a pelvic health specialist, and a coach too. And the push is to get our orthopedic counterparts to start screening for this because women aren't talking about it still. However, they are becoming more aware because we've all gotten, you know, with the use of social media in the last, especially in the last 10 years and certainly in the last six or seven years, pelvic health therapists have come out from everywhere and are really doing a lot of education out there and talking to people, you know, in social media clips and, you know, Facebook posts and forums and everything, so that people are starting to get the idea that this is not something that they need to live with. And it is certainly, certainly not something to be dismissed. The issue has been over the last 15 years is that it's still very poorly researched as is most issues for women.

Dr. Cooper: 10:14

Well, and that's why I wanted to have you on. I mean, that's why we were like, Susan, we've got to do this. This would be great for our audience cause this isn't talked about enough.

Susan Clinton: 10:22

Right. But when we start thinking about the problem with urinary incontinence over the lifespan, I'll just consider the females first. I'm happy to answer a few questions about men, although they're not my primary audience that I work with. I certainly do have some answers and things for people to be aware of for men too. But with urinary incontinence, a lot of women will just say, this is what I hear a lot. I'm only leaking with some occasional sneeze if my bladder is full or if I have to do a sudden jump or a move, if my bladder is full. Or if I yell at my kids and you know, it's like, but they, you know, they, they qualify it all the time. But only when my bladder is full. It's like, well, you should be able to hold your urine if your bladder is full. We have the capacity and the mechanics and the neurology and the physiology for that to not be an issue. So it starts that way. And they just put up with it and they think, well, I'm just wearing a pad every once in a while, because right before my period, I tend to be more vulnerable and I leak a little bit more or, you know, so the story goes on. And then you start really digging in and asking some questions, like, what did you do before all of this started, Oh, I was running marathons. It's like, what, what are you doing now? Well, I don't run anymore because I leak when I run. It's like really? Wow. Yeah. You know, sometimes it may be mile five. Sometimes, maybe mile 8 for some people, it may be mile one, for some people it's the minute they start to put their feet on the ground and start to run and jump. And so that's a failure of the system not only to remain continent, but it's also that system is, is not coping real well with load transfer. And you know, so that could be muscle strength, muscle coordination, endurance factors, a lot of breath holding. There's a lot of different things that can be unpacked around that. But the issue is, is that once you start down the road of incontinence, as we age, we have great data on this. It only gets worse. It doesn't get better.

Dr. Cooper: 12:20

But bottom line, bottom line, it's not normal. You don't have to put up with this. This does not have to be part of your life. Whether you just had a baby, whether you are getting older, this is not, don't, don't accept this. Is that our bottom line here?

Susan Clinton: 12:35

That's our bottom line there. And I'm one to believe that all of the urinary incontinence products should come with a warning label that consistent use of this product without medical intervention will only cause your incontinence to worsen over time.

Dr. Cooper: 12:52

Oh, great idea.

Susan Clinton: 12:53

They'll never do that, because they've got commercials on TV saying that I can run five miles now, cause I have my young adult pretty leak-proof underwear. Right. And it's a great thing to use while you're going through training and getting your pelvic floor stronger and getting your system organized better, but it's not the answer. You know, it should be a stop gap measure for just the stress urinary incontinence or the urinary urge that, you know, they talk about on TV that gotta go, gotta go, gotta go, go, go. That's kind of a sign of worsening incontinence. And that usually you see that much more as we get women into the perimenopausal age, which is what, 35 to 55. Now it's a huge age range and this is time critical for females where they stop moving.

Dr. Cooper: 13:45

At the time when they need it the most.

Susan Clinton: 13:47

When it's absolutely essential to lay down that structure and those habits and maintain that bone bank and keep their blood sugars under control and all of those things, and it becomes a time in their life where they've got aging parents and either young or teenage children, pressures from the workplace. There's a lot. And as coaches, we all know that there's a lot of things that women have to deal with during that age group. And of course, changing hormones and, you know, things begin to start to happen all at once. But one of the questions that really never seems to get asked or really investigated with these women is how much is urinary incontinence affecting your life and how much has it caused you to stop doing things? And when they really have the opportunity to stop and reflect on that, they're actually pretty surprised at how much it's actually been in the back of their head, controlling the idea that I just don't want to deal with it. And so they normalize it and they talk around it and they make stories up about it. Like I said, only if my bladder is full or just, you know, if I go out and have a couple of drinks, or you know, those types of things. And so I think it's incumbent upon the health coach to really be able to get comfortable with asking questions about it.

Dr. Cooper: 15:03

Okay. So we'll come back to the coaching piece here in a second. Men, before all the men flip off to a different podcast, is this something that only affects women?

Susan Clinton: 15:14

No, it definitely affects our men. The numbers for men being affected by this rises much more rapidly in the older age group or the group around where we have, prostate enlargement, which is kind of a little bit of a normal aging process that goes on. But also those that are undergoing prostatectomies. I think it's about one in four with prostatectomies that can have, you know, uncontrollable urinary incontinence and younger men can also run into this. There are younger men who have what we call and women too, we have kind of not really have the weakness of their pelvic floor muscles, but they have muscles that are being over recruited for whatever reason. And I see this in a lot of guys with pelvic pain as well. They'll come to me because they're having pain in their pelvis and in their perinatal area or pain in their penis, but oftentimes they're having associated incontinence with it. And, men are much more, they tend to seek treatment a lot quicker than women and they tend to be a bit more vocal about it. Of course, there's always a subset that won't be, but for the most part, men are outraged when anything's going wrong with their plumbing.

Dr. Cooper: 16:33

Right. Okay. Okay. So let's come back to what you're talking about, coaches. So what might a coach pick up on men or women that might indicate that this is maybe a potential issue that they're dealing with because no, one's going to come out men or women and say, here's my issue coach. So if a coach is listening to this right now, and I know we have a broad audience and not everyone's a coach, but for the coaches listening, is there some clue that they can pick up on some hint or, or things that come along with it? And you mentioned a couple of them, but can you broaden that out for us a little bit more?

Susan Clinton: 17:05

Sure. I'm happy to. And I think it's really kind of important to come at it as a coach. Like we do for a lot of things from kind of a point of curiosity and wonder what else is going on with them, you know, besides the barriers are throwing up here about, well, you know, I don't have time to exercise, right. I don't like going to the gym. I don't like, you know, I hate to run. Um, and it could be that they really hate to run, Oh wait, nobody yet. They really could be that. But to really just not accept things at face value as much, you know? Cause I think what's very cool about, um, health coaching and life coaching is not just going with the status quo, but digging deeper and, and getting their clients to deeper into what are the real barriers? What are the, what are you really worried about here with going to a gym? Like when you say you don't want to go to a gym, what really bothers you about it? What is a concern for you? Is there anything else besides just being at the gym or like, you know, looking in the mirror is anything else happening when you exercise? You know, and just seeing if they'll kind of like uncover it that way before you kind of like ask the specific questions, those can be good ones. When people talk about, you know, Oh, jumping rope, jumping on the trampoline with my kids now, you know, ask questions. Like, do you exercise with your kids? Oh no, no. Why not? Well, I have this kind of, I kind of like leak a little bit when I get on the trampoline, you know, they'll kind of start sheepishly coming in forward with things. Um, when you start asking some more of those investigative kind of things, like when you do exercise, what happens that makes you stop? Is it just to see what they say? Sometimes they'll say pain is joint pain. Oh, my back starts hurting or I run out of gas. I run out of air or then they can, you can say, is there anything else going on too, that makes you say, Oh, I don't think I should be going any further or, you know, I really should stop because, and let them fill in the blank. If they're postpartum. Definitely. You want to investigate that because oftentimes they may be a little more vocal about saying, well, I've been reluctant to get into exercise because I hear so much about, you know, they're big things. Postpartum ladies is going to be about their bellies and about their bottoms. You know, I don't want anything to blow out. So they'll talk more about prolapse or pelvic organ for those of you out there listening. That just means the pelvic organs tend in some cases can descend. So we can have the uterus kind of creeping down into the vaginal canal or the bladder dropping down into the vaginal canal. And people are very freaked out about that. So they'll talk about that. Like pretty quick, like, Oh, I don't want to live because I don't want to prolapse, you know, but they won't talk about the leaking part.

Dr. Cooper: 19:49

Okay. So take us down this, the definition of pelvic floor dysfunction, not necessarily your definition, but just walk us through what, what exactly is pelvic floor dysfunction in the first place?

Susan Clinton: 19:59

Right. So pelvic floor dysfunction is one of those terms that has come up now as a buzz word, much like low back pain. Um, anything to do with the pelvic region, people are kind of lumping it into, Oh, they have pelvic floor dysfunction. Their pelvic floor is out of order and needs to be, uh, fixed and rarely it's a problem of just the pelvic floor. But basically what they're talking about is that you either have a pelvic floor muscle, and we're talking about muscles that either have a force activation problem. In other words, it's weak. So we have weak pelvic floor muscles. Maybe they've been overstretched. Maybe they've been overloaded from lifting and blowing out, you know, uh, you know, just some strange mechanics, things like that. And for whatever reason, the muscles have become weak or they become inhibited because of pain. So when we have pain in areas of our body, particularly the low back, we can have muscles that tend to switch on and work too hard, such as our back muscles. You know, people with back pain can feel back there and build those back muscles kind of bulge out. You know, they're just overworking all the time and they have other muscles that just turn off and that's just kind of the way it works with pain in our body. So that can lead to incontinence and some other issues there. Or we can have muscles in the pelvic floor that switch on and stay over recruited. In other words, they become kind of tight and painful because it's like holding your bicep at 90 degrees with the weight in your hand and leaving it there for like an hour. That would be like the pelvic floor over recruiting all day long. So you can imagine how tender and sore it would get. And then it doesn't have the ability to lift and descend and do the movements up and down in the pelvis that it needs to do to help us with continents. And this is treatable, very treatable, very treatable. These are things that I think as a health coach can really kind of, if they start hearing some of these stories and, and get people to talk about it, there's lovely recommendations they can make, and they can actually assist their clients into figuring out which direction to the health system. They want to go. In many States, they can go directly to a physical therapist that specializes in, um, incontinence or pelvic pain, or they can go,

Dr. Cooper: 22:12

How would they find the right person,

Susan Clinton: 22:15

The right person? So the best way to find a person who really deals with pelvic health is probably through the Academy of pelvic health physical therapy, which is part of the American physical therapy association. And there's a men and women and all the humans that are identifying with different genders. Okay.

Dr. Cooper: 22:38

And it was again, the Academy of pelvic health,

Susan Clinton: 22:40

The Academy of pelvic health physical therapy at the American physical therapy association has find a, find a practitioner list

Dr. Cooper: 22:48

And physicians, any suggestions on the physician side.

Susan Clinton: 22:50

So physicians the best entree, I feel for physicians, for people who are really worried about things. Like if they're just thinking pelvic floor dysfunction, if we're just going to think that term, cause that may be what the public is really using now is to find a Euro gynecologist. If you're a female and go to them, a lot of people will start off at the OB GYN office, which is a great place to start, but generally they're going to refer the mantra to a Euro gynecologist so they can, they can see if their insurance, most insurances allow us to use specialties right away. They can just make an appointment there and go get checked out. And there's all uro gynecologists partner with physical therapists all the time. It's a great relationship that they have together to allow the, you know, and as a coach, it's really kind of nice because you can set up different kinds of avenues and that the client can self select which direction they want to go.

Dr. Cooper: 23:43

It sounds like by this route, with the Academy of pelvic health PT, with a PTA, that's going to really center their search. So there, they can pretty much trust that that person really knows their stuff. The Euro gynecologists, are there some that are specialized in this and others that aren't, are there certain questions the patient should be asking before they choose that doctor or choose that PT?

Susan Clinton: 24:06

Um, I think that everybody should be kind of asking questions that concern themselves in their own health is surgery. The only answer for the physicians, do you consider other forms of interventions or treatments besides surgery, you know, and we have the chance to talk about all of those and from a physical therapist, point of view, do you just look at the pelvic floor or do you look at the entire body and consider how the whole system is working together?

Dr. Cooper: 24:40

Okay, good. Well, let's talk constipation. How does that affect the bladder and pelvic floor function?

Susan Clinton: 24:47

I'm so glad you asked that because behind every bladder problem there lurks a GI problem, really that I find to be the biggest driver of all and constipation is the number one culprit. Interesting. I know, right? It's like, but you know what? You have to think when you're constipated. And this goes for men too, this is really a huge driver for men as well as women. And I see this a lot, even in the post prostatectomy clients, it's like, they're very constipated on top of having, you know, their plumbing issues that have been affected from removing a prostate and shortening their urethra. Um, you know, but constipation is really is, uh, a big driver, number one, there's a lot of straining that's involved and going to the bathroom. So that is over time is not good for the tissues. Of course, that makes the restraint against. Yeah, it does make perfect sense, but people don't think about that. You know, and again, constipation is one of these things that everybody normalizes until they get older and then they talk about it all the time. When they're, you know, they'll say to me, I've been constipated my whole life. It's like, really tell me more about that, you know, and you can kind of dive in and get to it and they don't realize that it can change, but constipation is that carrying a, you know, if you'll forgive the words of poop baby, around inside you all the time. So because you're not clearing the decks and, and that can become a bit inflammatory to the GI system. We have an inflammatory GI system. Um, we're not absorbing our food well, and we're not doing other things well, and we're not getting energy to the cells that need to get it. And you know, so that whole cascade of events can occur and constipation can be one of those big, huge things lurking in the background that if you can solve the constipation problem, you're probably going to go a long way to starting to solve some of their urinary incontinence problems as well, because you don't have that constant pressure on top of the bladder and you can, you can make a huge difference and how the muscles function and how the system organizes itself and works.

Dr. Cooper: 26:52

So in terms of foundational pieces, what, what are some of the foundational pieces that are, are lacking or missing with people that might have this pelvic floor dysfunction going on?

Susan Clinton: 27:03

So some of the big foundational pieces that are missing is adequate hydration. And when I say adequate, I don't mean overloading and drinking two or three liters of water a day. I don't know where all of that came from, but they glasses a day, you know, uh, came from, there's no evidence behind it, zero. And I think what you have to do is kind of look at the person and help them get into a rhythm of what good hydration is going to feel like for them. If they're going to the bathroom, every 30 minutes, they're over hydrating. If they're, unless they have some sort of medical condition that, you know, that is most of our, most of our clients that we're going to run into and health and wellness coaches are going to either be over hydrating or under hydrating, which means they're either over hydrating and peeing a lot like every hour or so, which is too much. And, or they're under hydrating, which means the restricting fluids because they don't want to leak. And when we think about, if they've got a backup situation of constipation by restricting fluids, that's going to be very unhelpful. Then they drink all the water written at four o'clock or five o'clock and then they're up half the night going to the bathroom. So now we're losing what sleep. One of the most important foundational pieces that we need to work with with our clients is helping them get to sleep.

Dr. Cooper: 28:21

We've had multiple incredible guests talking on that exact subject. That's such an important one. Absolutely. Let's swing back to the men just briefly for one more question for, for men, may maybe dealing with a, some version of incontinence or are there some initial, is there any initial advice that you can give them for best steps besides seeking out a trained physical therapist or a physician?

Susan Clinton: 28:44

Is there a need for the men? Yeah. The physician to go to for them, it's going to be a urologist. Okay. They just understand men a lot better. So that would be, you know, for the physician side of it, that would be the best place to go for men. Probably the best thing is the, you know, to take a look at what it is that they are eating and drinking and, you know, the, the other issue we didn't talk about, and this can go for women too, but I see it a lot with men with this issue is the overuse of caffeine. And that's tied to this. Absolutely because caffeine, caffeine is a bladder irritant, you know, and a stimulant, so it can make, you know, it can really, it really can. Um, and it also dries out the stool. So it's not good for people with constipation, but, um, you know, really being able to back down on the coffee, get more water in and get moving more through their day, especially, you know, a lot of the guys that I see with this are guys that are sitting a lot, you know, they're for whatever reason, chained to the desk, you know, and they're really, um, they're just sitting a lot. Their job requires a great amount of sitting and they tend to run into more issues because they're just not moving as much. I mean, you know, think about your life and when you were a PT, uh, when did you sit? Never know. And one of the challenges for health coaches is they're sitting a lot more talking to clients rather than standing and moving. So, but, you know, I think probably the number one thing is getting up and moving and kind of not blowing past what your body signals are, but paying attention to them. So like, I really need to go to the bathroom, but if we sit all day long, we don't get the signal that we need to go, and then they get up a, or could be, you know, leaking on the way to the bathroom or not emptying completely because their pelvic floor muscles are either weak or they're overworking. So for a lot of guys, w what they'll have going on is what we call post-void dribble. And it's just there. They're just not getting the great, you know, the great release of, of all their urine. And so the rest of it kind of trickles out at the end, or maybe even, you know, 15 minutes later, you know, that's a huge issue for them, but that's just a sign that the muscles aren't opening and closing. Right. And it could be either because they're weak or because they're overworking or reactive.

Dr. Cooper: 31:15

So for the guys hearing this and saying, Oh, I didn't think about this, but I think that's me. Do they Google some term, obviously CPT would be the best advice, but initially is there a, an exercise term that they could Google to see some things that they could start off doing on their own and then seek a PT?

Susan Clinton: 31:34

So I think probably the big term that everybody's still Googles a lot is cables. Okay. And that's certainly, yeah. For men or women, um, exercises to improve by Pell to improve incontinence is also a great Google term. Um, you're going to see all, you know, Google is always interesting because it depends on who is like, uh, bumping up their, uh, um, optimization, you know, on the engine to get in there. But, um, you know, what you really want to pay attention to is that if something, you know, what are the biggest things that's going to work is to like, balance out your hydration, stop the constipation and get moving. All of those things are going to be so healthy and so helpful. And let's see what happens to the incontinence as we do that, because the very thing that drives people from exercising is the thing that they need to do to get better. So it's kind of like maybe wear a pad for a bit. Let's get you moving. And if things don't start improving, let's get you over to, you know, a pelvic health expert, you know, a PT, a doctor, um, you know, somebody now you're talking to Lynn

Dr. Cooper: 32:40

Elmo, this is across the board, the hydration and the activity level, everything is men and women. Okay. Anything that would be female specific in terms of some of this advice like you, you gave us for the men, or it kind of sounds like the things you mentioned for the men would apply to the women as much, is that true?

Susan Clinton: 32:58

Exactly, exactly. Through the, you know, and for both people, you know, as well is, um, don't be afraid to talk about it. So for the women's specifically, if you can just get a little more curious as a health coach and really kind of see if you can uncover that barrier for them, because then the possibilities of, you know, we don't recommend like, Oh, well you need to do Cagle exercises and, you know, do this and do that and do that as a health coach. It's like, no, but it is incumbent upon us to help them find the resources that they need, um, to actually improve that. And if that's an issue it's holding them back from exercise, you know, having them consider the various options that they can pursue and allowing them to begin to navigate that scaffolding and just supporting them as they do. That is really a very powerful tool to helping our clients understand that this isn't normal. And it's only gonna get worse. Let's take care of it now that we're talking about it.

Dr. Cooper: 33:56

This is great. Great, great stuff, Susan, last question. Any just final words of wisdom on this topic that maybe we haven't chatted about, or I haven't brought up through some specific question.

Susan Clinton: 34:09

Ah, the final thing.

Dr. Cooper: 34:11

So I'll do the background music BOM bomb,

Susan Clinton: 34:15

Because it's always like what's going to be the thing everybody's going to walk away with. I would say, stay with the term incontinence. You know, let's go with the systems that are, you know, the symptoms that are driving the behaviors rather than the, you know, uh, big terms like pelvic floor dysfunction or back pain, you know, let's go with, you know, it's kind of like when you're doing something with somebody, with neck pain, you're working with them on ways to actually make reading improved, optimizing reading with, with their neck pain, you know, that incontinence, you know, use that word. It's okay. Talk about it, use it, talk about pelvic pain if you want to, but let's use the symptoms because that's really what the patients pay attention to our clients pay attention to his symptoms. They don't, they're not going to, we don't want to give them more labels and syndromes to have to carry around. And I think, you know, incontinence to me means solvable, you know, pelvic floor dysfunction means what is that, right? That means I'm broken in some way, or I have a dysfunction, right? Like I'm, I'm not whole, and we want to stick with things that are solvable as coaches, you know, like, okay, so you have it. And then it's kind of, you know, unpack it. When does it happen? Under what circumstances, how much have you ever tracked it? Just like they're tracking their food or their sleep or their activity level tracking this part too. Let's get a feel for how often this actually is occurring. And then we can talk about maybe what you want to do about it,

Dr. Cooper: 35:44

Susan, this has been so good. It's such a sensitive subject for both men and women, but you've, you've really done a great job. If people want to reach out to you, if they want to contact your, or follow some of your work, what are some of the best ways to do that?

Susan Clinton: 35:58

So, um, you can follow me on Instagram and Facebook and my, and Twitter. My handle is S Clinton Petey. Um, I'm Susan Coel Clinton on Facebook and my clinic name is embody[inaudible] dot com. We have a website and we have a Facebook page and an Instagram page as well. And you can find me through all of those little areas and see what I'm up to and what we're doing and what's happening. Um, if any of you want to hear from a practitioner standpoint, how PTs kind of work this together or how I work it together with other, other things. Um, I also have a podcast with another PT, Erica mellow, it's called, uh, tough to treat and it's the physio's guide to treating, uh, complex patients. But we talk about these issues, GI issues and urinary issues with our patients, with chronic pain and, and other issues as well.

Dr. Cooper: 37:02

Excellent. Excellent. Well, thank you again. This has been fantastic.

Susan Clinton: 37:07

Perfect. Thank you so much for having me. I am honored to share this information and if anybody wants to, you know, I think you have my email that you're going to share too. If anybody has any specific questions or anything, feel free to email me as well. Perfect. Perfect. Well, thank you, Susan. Thank you.

Dr. Cooper: 37:24

Quite the insights worthy a big thank you to our gracious guest, Susan Clinton for joining us today. I hope you found this to be helpful as it's a topic we had not yet covered in our first three years as a podcast, but clearly one of great importance for so many thank you for tuning into the number one podcast for health and wellness coaching. Next week's episode features dr. Jeremy Harper dog, who will provide us with basically some superpowers about how we can see through all the artificial claims that we're seeing out there in the news and social media about health and wellness, and frankly, other things as well for the current and future coaches, our YouTube coaching channel is now up over 50 videos. They're, they're free, they're complimentary. They're there to help you enhance your coaching seals, build your coaching business, or maybe even be some resources you can share with your clients to kind of build your own toolbox. You can find them all at youtube.com/coaching Chen. This is dr. Bradford Cooper of the catalyst coaching Institute signing up, make it a great rest of your week. And I'll speak with you soon on the next episode of the catalyst, health, wellness, and performance coaching podcast, or maybe over on the YouTube coach gel.