The Barbell Mamas Podcast | Pregnancy, Postpartum, Pelvic Health

Beyond the Uniform: Why Pelvic Floor Function Matters for Service Women

• Christina Prevett

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Christina Prevett shares powerful insights about pelvic floor issues in the military and advocates for better awareness and support for female service members. She connects her personal experience using exercise as a coping mechanism during difficult times to the importance of movement for pregnant and postpartum women's mental health.

• One in three female service members experience pelvic floor or genitourinary complaints
• Military physical testing and duties place significant demands on the pelvic floor
• Six key gaps exist in military support: lack of education, stigma, toilet access during deployment, urge suppression, menstrual cycle management, and pregnancy/postpartum fitness
• Research shows high-strain activities like paratrooper training can change vaginal wall mobility even in women who haven't given birth
• Pelvic floor issues can be categorized as "not strong enough," "not coordinated enough," or "too tight" syndromes
• Sexual trauma in military settings may contribute to pelvic floor dysfunction
• Building resilience through proper mechanics and individualized rehabilitation is key for returning to duty after pregnancy
• These principles apply broadly to women in physically demanding occupations beyond the military

I hope you found that interesting. If you have any other questions or comments, let me know. Otherwise, have an incredible week and I will talk to you all next time.


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Speaker 1:

Hello everyone and welcome to the Barbell Mamas podcast. My name is Christina Previtt. I'm a pelvic floor physical therapist, researcher in exercise and pregnancy, and a mom of two who has competed in CrossFit, powerlifting or weightlifting, pregnant, postpartum or both. In this podcast, we want to talk about the realities of being a mom who loves to exercise, whether you're a recreational exerciser or an athlete. We want to talk about all of the things that we go through as females, going into this motherhood journey. We're going to talk about fertility, pregnancy and postpartum topics that are relevant to the active individual. While I am a pelvic floor physical therapist, I am not your pelvic floor physical therapist and know that this podcast does not substitute medical advice. All right, come along for this journey with us while we navigate motherhood together, and I can't wait to get started. Hello everybody and welcome back to the Barbell Mamas podcast. Christina Previtt here.

Speaker 1:

I hope that you all are having a really wonderful week. I am totally in the trenches right now in a very tough part of my life. I know that I've kind of been keeping you all abreast of stuff going on with me and I really appreciate everybody sending me messages. I told you all about my mom that you know, she was diagnosed with lung cancer and we found out last week that it is stage four small cell carcinoma, which is not good news. It is incurable and it seems like it's months. So we've been struggling over here and it really. You know there's going to be a random soapbox before we go into the content for today, but it makes me think so much about having really tough periods of time in your life and how we lean on different strategies to try and get out of that stress or to try and cope when it feels like you're having a hard time coping. In the last year I've lost my godmother, who I was really close to. I've had a miscarriage and I found out that my mom has a terminal cancer diagnosis and I've also had some stressors with work and things like that. That ebb and flow, some things worse than others. And I look back on the last 12 months and I just think, oh my gosh, like you know, there's always like that you don't want to say anything like it couldn't possibly get worse because it keeps getting worse. And I'm just thinking, you know I'm going to watch my mom steadily decline over the next hopefully a long time, but we find out in the next couple of days, what, what that really truly looks like.

Speaker 1:

But when you have those tough seasons you're always looking for stress management strategies and you know we can kind of put those into positive and negative buckets and you know those negative ones are, you know, binge eating, gambling, maybe like overly spending alcohol Don't get me wrong, I have retail therapy. It's not that it's more like you cannot possibly you put yourself into debt is kind of where we go into those like negative stress coping mechanisms. And then the positive ones are like leaning into friends and family, that you're really close to showing that vulnerability with your small circle exercise, making sure that you're nourishing your body well, to be resilient, trying to get sleep Though sleep for me has been difficult because my mind is whirling about my mom but it's been one of those things where not only am I kind of reflecting on my own experience as somebody who wants to get pregnant again and I'm postpartum, even though it's been, you know, several years at this point and exercises truly saved me um from, I think, spiraling into a really negative mental health space. I wouldn't say like I'm thriving right now, but thankfully I don't think that I have depression or anxiety at the moment and I truly do believe that I have leaned on exercise and having a positive relationship with exercise as a way to cope I talked a lot about when I was in my miscarriage my dog and I going out and running was something that truly did save me and now has made me be a little bit codependent with my lab Tucker.

Speaker 1:

But, um, I I kind of if I can extrapolate that into the pregnant and postpartum spaces when you're like just acutely in it, you know, when you are pregnant or when you are very early postpartum and your world is flipping and you're recovering and all that kind of thing. It makes me reflect on this time in my life and perinatal mood disorders like depression and anxiety, psychosis and OCD and it really invigorates me to think truly about the harms of restricting our movement when we have individuals who are having a hard time and they're in a really hard part of their life and they need something to allow them to cope right. And you know my positive coping strategies have been running with my dog. I've also been doing a lot of reading. It's a little bit more like escapism and trying to lean on my husband and my friends for support and reaching out, even when I think that I'm. You know, you can sometimes feel like, oh, they've already heard from me about this, they don't want to hear from me again, and it's easy for us to get into those spirals. But it just it mimics so much of what we're trying to advocate for in the pregnant and postpartum spaces through my research, but also you know, this podcast and online, and, yeah, it makes me think a lot about it and so it makes me really feel like I want to double down almost on that type of space until proven otherwise. But our systematic reviews from the exercise guideline that I talked about a couple episodes ago, it really does kind of reinforce that message that getting some early movement maybe not at like the intensity or to the same level that people were doing pre-pregnancy year before or even during their pregnancy in that early postpartum period, but definitely trying to encourage early movement for all of its health benefits and its stress management benefits.

Speaker 1:

The postpartum period in particular is such a beautiful time, but it's also a really scary time. It's also a very vulnerable time. You love this little baby and you're, but you're also a really scary time. It's also a very vulnerable time. You love this little baby and you're, but you're also trying to figure it out. I know my love of motherhood has grown and expanded. I like inherently knew that I loved Maya, but I didn't know how to love Maya because I'd never been a parent before. And you know, everybody talks about how you just get so obsessed right away, and for me it just has grown over time, like that love was always there but it's taken root and those roots have gotten deeper. And then I added Quinn and so those roots branched off and now you know, I really do hold onto motherhood as a big part of my identity. But I think that early movement was something that really helped me to feel good within my own body and then that allowed me to have space to be able to bond and be the mom that I wanted to be to my kiddos, and so a little bit of a soapbox, but definitely something that I've been reflecting on as part of my own journey right now and how that relates to my area of practice and what I'm thinking about with respect to the messaging that we have around pregnancy and postpartum health the messaging that we have around pregnancy and postpartum health Today.

Speaker 1:

What I wanted to talk about from a content perspective is pelvic floor issues in the military. If you all follow me online, I've had a couple of really cool experiences. To take some of my research around pelvic floor dysfunction in high strain jobs or high strain exercise and translate it into a group of individuals who have a high strain jobs or high strain exercise and translate it into a group of individuals who have a high strain job. I have done multiple talks in my local community. So I'm in Kingston, ontario, so I was at the Canadian Armed Forces base that is there and they invited me to come back. They were talking about inviting me to come back again, which is really great around pelvic floor dysfunction in the military as a way to advocate for female. It was particularly around the female pelvis, female service members.

Speaker 1:

I have also done private pelvic health courses for US military organizations to help them also advocate for their female service individuals and this has been really cool to see this grow in awareness and in just the openness of conversations. Part of it is because, from a business perspective in the military, they are trying to recruit female officers and military members and they want to retain these female members, particularly around the pregnancy and postpartum space, and that's where I've kind of come in at first talking about exercise and return to military service, postpartum, kind of as an application of some of my research and some of my teaching, and it's been really neat to connect and to see what we can do within this space as a drop in the bucket. And so today I thought I would talk a little bit about some of the incidents and awareness of military pelvic floor dysfunction and then talk a little bit about some of the incidents and awareness of military pelvic floor dysfunction and then talk a little bit about some of the things that I discussed in my presentation with the Canadian Armed Forces. When we are thinking about the incidence of pelvic floor issues in the military, they US data from 2016 says that about one in three service women have some sort of pelvic floor or genital urinary complaint, so they are peeing when they don't want to be, they have heaviness in their vagina, they have rectal or constipation related issues, um, they have pelvic pain or potentially there is some things to be said around menstrual dysfunction and being able to engage in their occupation when they're having issues like really significant PMS or premenstrual dysphoric disorder. When we are thinking about the demands on the pelvic floor for individuals in the military and obviously this is going to have there's a wide range of demands on the pelvic floor for individuals in the military and obviously this is going to have there's a wide range of demands on the pelvic floor depending on your area or where you are being trained that that amount of loading on the pelvic floor can be very high or relatively low.

Speaker 1:

You have to think that there is a test to get into the military and basic training. In Canada it is the force test that is completed annually by armed forces members. That includes four tasks. They have a 20-meter fast sprint, kind of like a beep test. They have a sandbag lift which is 20 kilos or 44 pounds. They have to use that sandbag for intermittent loaded shuttles. So you have to load up the sandbag, move it across, unload it and then go back and forth between a loaded and unloaded shuttle run, load it and then go back and forth between a loaded and unloaded shuttle run. And then they also have to be able to drag that same 45-pound sandbag over 20 meters without stopping.

Speaker 1:

In the US, in other areas in Europe. Their military tests are probably going to be some variation of those physical capacity tests but there's probably going to be some sort of loaded lift or moving of a load over an obstacle, over a wall, over something that is, for many, a very strenuous task. So, going into the military, there's going to be a occupation-based test that has a physicality element to it. Then in the military, when you're in basic training, there's a large physicality load to that as well, where you are doing a lot of rock walking, you are carrying weapons and equipment, you are being expected to pass a variety of tests and challenges. That is another element. And then in the job itself, there's a lot of PT time or gym time that is required while maintaining your status as an active member.

Speaker 1:

And then there's pregnancy and postpartum. What that means is there is a lot going on. So there is the entry into the test, there is maintaining your physical status and retesting, there is the high demands on the pelvis, and when I was doing some of the US private training, we were working with groups that were discussing exercise needs and demands for individuals who are paratroopers, for example, who are jumping out of airplanes. Then we have the fact that service and motherhood transition overlap and it is acknowledged that, as individuals are pregnant, postpartum, that it can be a barrier for them getting back into active duty. And now the physicality and returning to the fitness side of it is one question, but obviously there's a lot of reasons why when individuals have children, they may step away from active duty, going to acknowledge that there.

Speaker 1:

What we see a lot, too, is that there is a lot of conversations in the postpartum period about basically occupation hardening. When we are thinking about workplace injuries right, and we can definitely think about birth as an injury either to the pelvic floor or to the belly, depending if we're having a belly birth or a vaginal birth. Pelvic floor to the belly, depending if we're having a belly birth or a vaginal birth. That return to occupation is also something that we want to be considering in order to optimize chance of success for entering back into the workforce and therefore the questions that I was having in the US-based context is what should the expectation be for women who have had children about getting back up to the standards from a physicality perspective in that postpartum period? What should the window be? In Canada we have 12 to 18 months of paid maternity leave and therefore that's kind of the accepted window about reentry, but still there's a lot of questions about what that looks like about reentry, but still there's a lot of questions about what that looks like when we are thinking about pelvic floor issues, because it is such a huge like 33% right, one in three of female service members are having issues. This has to be a bigger conversation, similar to ankle and knee injuries. That can happen often when individuals are in you know those military boots and doing a lot of wrecking.

Speaker 1:

Lower extremity injuries is definitely something that we see a lot, and there's been more and more conversations about how to allow or what we need to do from a training perspective to try and mitigate that chance of injury. And the argument that I'm trying to make is that the pelvis is not different. Right, our pelvic floor is a group of muscles, which means that it has to be strong enough to handle what we're asking it to do. It needs to be able to relax to its full capacity so it doesn't get overused and it has to be contracting at the right time in order to meet the demand of the pelvic floor in the task that we're asking it to do when talking to female military members about what they think we can do as a military community or as somebody who wants to advocate for pelvic health in the community. They brought up six main points that they felt were still gaps that were needed within the military in order for them to feel more supported.

Speaker 1:

When the first two are kind of close together and they are one that there's a lack of education regarding pelvic health complaints, particularly in females, but I would also argue that this has a lot of carryover to the male population as well, in combination with the stigma and culture. This has been a very big conversation around the even talking about pregnancy, postpartum pelvic health because of military structure and expectations in military and just the interplay of leadership, et cetera. I am not going to pretend like I have an in-depth understanding of what that means as a civilian who has never been in military service, but I can help on the lack of education piece regarding pelvic floor complaints and that's why I've been to our, to our Canadian armed forces multiple times talking about my context around uh pelvic health, pelvic floor and uh types of pelvic floor dysfunction. So those are kind of two, but there's definitely a lot of dismantling around the stigma that is going to be required and that is going to take some time to really be conceptualizing and moving this conversation forward in a culture that may not be very welcoming to it.

Speaker 1:

The second two kind of also go together and it has more to do with deployment and thinking about hydration and toilet access right With males having a larger appendage that they can just whip out on the side of a road if they're deployed and go pee. That isn't the case with women, who may have, you know, weapons, belts and things on that make it a little bit more challenging for them to just go to the bathroom on the side of the road. And I don't know about you, but I'm not very good at it. To begin with, I just pee on my shoes, and but it is something that is a uniquely female problem. And the secondary piece that came into this was urge suppression. And so can you hold it when you need to, and if you cannot, what can you do about it?

Speaker 1:

When you're in deployment-based situations where access to toilets or access to sanitary products and things like that can be a little bit more difficult. This kind of goes into number five, which is menstrual cycle management. This can be difficult when deployed Individuals who also have symptoms around their cycle, like they have really bad PMS, or if their PMS is so significant. It's also affecting mood, mental health, and then they can have that diagnosis of premenstrual dysphoric disorder. That is very disruptive to a person's quality of life and their ability to engage in their job, especially when that job is very physical. And so that menstruation management in deployment situations and at home based situations when out on the field, on a training, exercise or what have you where there may not be access to a toilet or the opportunity to have breaks if you have a heavy flow, for example are things that are really difficult and are uniquely female situation where you may not want to go to your commanding officer and tell them that you have to change your tampon, to go to your commanding officer and tell them that you have to change your tampon. And then the last one is around pregnant postpartum fitness and having the military understand and support pelvic floor considerations in that return to active duty and the military fitness exams that are required of active duty members.

Speaker 1:

And so I thought this was such a great breakdown of some of these key, pivotal moving parts that we can't just think about treating the pelvic floor. It requires so many more conversations around helping with pelvic floor issues, yes, but also considering the system at which that pelvic floor is interacting, and that's where I am just so thankful that I was given the opportunity to be talking about some of these issues. From there, what we have started to see over the last five to six years is that we are getting more and more research that is military specific, and actually the Canadian Armed Forces and the Department of Defense put out a variety I think it was two different grant calls to investigate some of this work. Unfortunately, I was not one of those grant was not given grant funding, but I was very excited to see that that grant funding has become available and as we continue to have that research funding, we are going to have a lot more insight into the lived experiences of individuals who are experiencing pelvic floor issues male and female and what we can do about it.

Speaker 1:

We've had a variety of very cool studies that have come out around unique pelvic floor considerations for military members. For example, they did a study on college-aged girls, women who had never given birth before and went through paratrooper training. So they were jumping out of airplanes right, pretty high stress, pretty high strain activity and what they saw was a change in their vaginal range of motion. Similar in sorry, in the way that we assess pelvic organ prolapse. This wasn't symptoms, so they weren't necessarily feeling subjective complaints, but what they saw was that during paratrooper training there was an increase in range of motion of the vaginal walls. That may be something that we want to think about. And now, as a clinician, who's thinking about that? Right, if that because that's a very, very high stress task, right jumping out of an airplane, I think you know from a pelvic floor perspective, as a researcher and as a clinician, when we know, hey, it can change the range of motion of the vaginal walls, just like you know, doing some of that might impact the structures in the knee, how can we? We're not the knee jerk reaction, isn't that? Women therefore shouldn't be paratroopers, it's one. We need to give them access to resources if that range of motion change does become something associated with other symptoms, like feelings of heaviness or something taking up space within the opening of the vagina like an Impreza system, that would maybe prevent that range of motion change, because we know that range of motion change is more prevalent in individuals in higher straining tasks in the military, and so the response of this is kind of that two-prong, which I think is going to be really cool to see where this research goes.

Speaker 1:

So, talking about some of those unique complaints, we know that incontinence, pelvic organ prolapse or heaviness and pelvic pain are three of the biggest complaints of female military members. And when I was discussing this I kind of put it into three buckets because most of the people that I was talking to were not the healthcare providers in there. I had talked to some of their healthcare providers, but it was a lot of um active duty members who were in leadership positions, and so I broke it down into pelvic floor not strong enough syndrome, pelvic floor not coordinated enough syndrome and pelvic floor too tight syndrome. With our pelvic floor not strong enough syndrome, pelvic floor not coordinated enough syndrome and pelvic floor too tight syndrome. With our pelvic floor not strong enough syndrome, we're thinking about our muscular strengthening with pelvic floor muscle training and then also glute, hip and lower body strengthening. With our not coordinated enough syndrome, we're thinking about bracing mechanics and making sure that we're not putting extra stress and strain on the pelvis because of the way that we are completing a task. And then something kind of unique that we need to be thinking about in the pelvic floor too tight syndrome is that we can have this hypertonicity because they're trying, or this too tight syndrome where they're trying to hold on really tightly because they're having issues. Their pelvic floor is holding on really tight because of their weapons, belts and their rucksacks, et cetera, and we may need to do some down regulation.

Speaker 1:

But also kind of unique in military situations is two things. One is similar to other first responders. They are potentially going into really stressful situations where they are in a area for months or years that is not safe for whatever reason or a variety of reasons, and that accumulative stress on the body can lead to expressions of pain that can be rooted in the pelvis, where individuals with complex traumas like PTSD can have issues with their nervous system that makes them hold on really tightly and that can. The way that that can present is with pelvic pain syndromes and I talked about how, whenever I'm working with military members this is kind of true for anybody that I'm working with I'm always kind of going in with the assumption of a trauma informed lens.

Speaker 1:

And then the other part that we talked about, which was the elephant in the room, is that there is also a an awareness that is coming to light of the incidence of sexual trauma and sexual assault in military areas, and there is fairly strong reporting in the Canadian context. I'm not sure what this looks like in other countries, but in 2022, almost 2, military members have had come forward in that year saying that there had been some sort of sexual misconduct, and there is also an acknowledgement that almost two thirds of victims did not report that incident to a commanding officer. So there is a lot of individuals who may be experiencing sexual trauma, and also there may be a lot of individuals who have experienced sexual trauma who haven't said anything, and from that perspective, it can lead to pelvic floor too tight syndromes. It can also be a precipitating factor to how individuals feel within their body and then interacting with medical providers around the pelvis and the pelvic floor, and I've treated a lot of military vets who have told me their own stories and so, unfortunately, it's more common than we want it to be and something that we need to be thinking about when having these discussions around pelvic floor issues in the military. And as much as I'm talking about the female pelvis, this is not just a uniquely female problem, though it is obviously more common or more prevalent with female officers, but this can also be true of men as well. And so from there, where we went with this conversation was talking about how to promote resiliency in the background of pelvic floor dysfunction, and with that, where we often go is talking about before our knee jerk reaction is to take anything away. We have to clean up a person's mechanics and that might be at the level of the pelvic floor right. That's one layer and if you're seeing a pelvic floor physiotherapist they'll probably do that evaluation and work on that with you. But then also, in the broader lens of whatever you're experiencing issues with, can we coach some of your positions or work on strengthening of different parts of your body to help create a more resilient system in general, that system being your body to withstand the demands on your body in the military and you know we talk about that in a lot of different ways and then when you transition from that into being an active duty or taking time off for having kiddos, then where my research really comes in and is very relevant to military service is strength training in pregnancy to prevent as much deconditioning as is possible given the unique circumstances of you and your pregnancy. But then also in that return postpartum, how do we come alongside service member, women who are trying to get back into active duty, and the research that I've been talking about over the last couple of episodes around not requiring medical clearance. Having this individualized, personalized, symptom-dependent reconditioning in the postpartum period again becomes unbelievably relevant to our military members who are returning to very active jobs, and so, overall, the podcast, overall the presentation was very, very well received and I think you know they're.

Speaker 1:

The military is unique in and of itself because there's a lot of moving pieces. There's a lot of different sections and units of the military that are going to have their own needs and expectations from a physicality perspective of their active officers, but I think that there's a lot of carryover that this can have for a variety of different occupations. I think about nurses, who we're seeing doing heavier and heavier transfers and having low back pain or pelvic floor issues from moving patients. You know thinking about individuals who are working in blue collar jobs, our tradeswomen, like all of these individuals who are coming back to really physically active job. Landscaping A lot of the things that I was talking about through the lens of military service is also going to be really relevant for individuals who have jobs that require a lot of physicality, and so it is very cool.

Speaker 1:

I always think about my role in life.

Speaker 1:

Apparently.

Speaker 1:

I'm doing a lot of reflecting on life, as I have existential crises and sick family members have existential crises and sick family members, but I always want to try and reach out and be a light for to my community.

Speaker 1:

Right.

Speaker 1:

It's very cool.

Speaker 1:

Like you know, I travel around the US talking about geriatric practice and pelvic health a lot, but, which is fantastic, and I just love seeing the ripples that happen from some of our education, how it changes, how our PTs and OTs and other exercise professionals, how it changes how they interact with their people.

Speaker 1:

But there's also something that sparks a lot of joy in me about changing or helping to advocate for the people that are in my immediate sphere, like my community members, my neighbors, and so I always try and do a couple of different presentations throughout the year, and so I got to do a geriatric one for our therapists in our Eastern Ontario region.

Speaker 1:

I got to do an obstetrical grand rounds to talk about my research for all of our OBGYNs who are in my local city, and then I've been able to do a couple for the Canadian Armed Forces and I just they fill me with so much joy. And then it's really fun to kind of come on here and talk about some of the things that I'm talking about and hopefully you all can, you know, go forth in your own communities and talk a little bit about this with individuals maybe in your spheres who may be experiencing some of the same things. All right, with that, I'm going to sign off. I hope you all found that interesting. If you have any other questions or comments, let me know. Otherwise, have an incredible week and I will talk to you all next time.

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Christina Prevett

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