Protect Your Pelvic Floor (Part 1)

Episode Summary

In this episode, physiotherapist Danielle Trader discusses the importance of pelvic floor health, early signs of issues, and strategies for prevention and treatment. Gain insights into how pelvic health impacts overall well-being and what women can do to maintain it.

Key  topics

- Understanding the pelvic floor and its functions
- Early signs of pelvic floor weakness and issues
- Strategies for prevention and maintaining pelvic health
- Impact of aging, childbirth, and lifestyle on pelvic health

Chapters

00:00 Introduction to Pelvic Floor Health
04:47 Understanding the Pelvic Floor
08:15 Signs of Pelvic Floor Weakness
11:22 The Importance of Early Intervention
15:39 Factors Affecting Pelvic Floor Health
21:27 Chronic Constipation and Its Impact
25:45 Exercise and Pelvic Floor Health
29:11 Kegels: Are They Enough?
31:13 The Role of Breathing in Pelvic Health
31:43 Understanding the Inner Core Unit
33:07 The Impact of Estrogen Loss on Pelvic Health
35:25 Recognizing and Addressing Pelvic Floor Issues
37:23 Preventative Measures for Women in Their 30s and 40s
39:17 Long-term Effects of Childbirth on Pelvic Floor
40:47 Common Pelvic Floor Issues Post-Pregnancy
43:06 Everyday Habits Affecting Pelvic Floor Health
46:37 The Role of Technology in Pelvic Health
51:22 Examining Pelvic Floor Health
52:45 Defining a Healthy Pelvic Floor
54:14 Protecting the Pelvic Floor During Physical Activity
56:47 Non-Negotiable Habits for Lifelong Pelvic Health
58:31 Postpartum Care and Pelvic Health Awareness
01:01:19 Addressing Pelvic Health in Older Women
01:02:54 The Importance of Preventative Care

Resources

- Pelvic Floor Physiotherapy at Synergy Cayman - https://synergycayman.com
- Pelvic Floor Physiotherapy Resources - https://www.womenshealth.gov/health-topics/pelvic-floor-health
- Hyaluronic Acid for Vaginal Health - https://www.vaginalmoisturizer.com

Disclaimer

Breast Intentions is intended for informational and entertainment purposes only. The content shared on this podcast is not a substitute for professional medical advice, diagnosis, or treatment. Any views or opinions expressed by the hosts and guests are their own and do not necessarily reflect the views of any affiliated organizations. Always consult with a qualified healthcare provider for medical advice or concerns.

Resources & Mentions:

• Find Danielle on IG and book (@danielle.waite.37 @Synergychriophysiocayman) 

• Follow us on Instagram and Facebook (@breastintentionspodcast ) 

Connect With Us: Have a topic or guest suggestion? Email us at breastintentionspodcast@gmail.com 

Transcript

SPEAKER_03 0:00

A lot of important functions and then therefore can really impact our quality of life. So when things start to impact our bowels, bladder, sexual function, ability to your delivery and labor and childbirth and that sort of thing, they can really impact somebody's quality of life. If we think of kind of Maslow's hierarchy of needs, we have some of these basic needs that when those are not met, it's hard for some of the rest of the things in our life to kind of go well.

SPEAKER_00 0:28

Welcome to Best Intentions, the podcast where we take off the bra of expectations and dive into honest, empowering conversations. We're your hosts, Nadine and Cynthia, two Canadian girls who swapped snow boots for flip-flops in the Cayman Islands. This is your space to feel seen, supported, and a little less alone. So grab a cup of coffee or a glass of champagne and get ready for your weekly handful of truth, wellness, and empowerment. Welcome back to Breast Intentions. Today we're joined by pelvic health physiotherapist Danielle Trader to uncover what every woman in midlife needs to know about her pelvic floor. From bladder leaks and prolapse to core strength, hormones, and prevention. This episode dives into the symptoms women are often told to just live with and what you can start doing now to protect your body long term.

SPEAKER_02 1:19

So on today's episode, we have physiotherapist Danielle Trader. Welcome to the show.

SPEAKER_03 1:24

Thank you so much for having me.

SPEAKER_02 1:26

Well, thanks for coming on and um speaking to us today about everything pelvic floor, um, particularly before anything happens with the pelvic floor, and something um it's also something that I'm actually not very familiar with. Yeah, me either. Um I don't really know a whole lot about it, even with like having a child and stuff like that. So um maybe if you can give our listeners a bit of um the background on yourself and then why you chose to um have a special interest in pelvic floor.

SPEAKER_03 1:58

Sure. Again, thank you for having me talking about this very important topic that I'm very passionate about. Um, I guess this all started in physiotherapy school. Um there was a couple little specialization, like little courses that we could do on the side. Um, so I chose to take the women's health course, thought it was very interesting. Um, one of my friends started into the pelvic health courses and um practice very early on, and she was saying how amazing it was, how beneficial it was for women that she was getting really great results. So it again, as an early physio, it really kind of boosts your ego to see and just again how much it can impact the quality of life on women. So when I started taking the courses, again, I started learning so much about myself and my own health that I was just very passionate about sharing that information with others. Right.

SPEAKER_02 2:54

I think as well with uh pelvic floor, it's maybe from our era um or our parents, our mom's era, it wasn't anything that was talked about. I don't really know how much it's talked about now. We'll get into that a little bit more, but um, it's not something that is talked about. Like another taboo type topic. Yeah. We don't talk about those things. Yeah. So maybe if you can give our listeners a little bit of um a background on like what pelvic floor actually is and why should women care about it before symptoms actually start to show up.

SPEAKER_03 3:30

So the pelvic floor um itself is a set of muscles at the base of the pelvis. Um, there's different layers of the muscles, um, and they have a lot of different functions in that really impact our quality of life. Um, so in the pelvic floor, um, in that whole area, it's important to remember it's not just muscles that are in there as well. We have um our urinary organs like our bladder, urethra, we have our um reproductive organs, we have our bowels, there's fascia and tissue, connective tissue, um, we have nerves in this area, we have joints of the pelvis and lower back. It's really a complex area, um, and it's not just the pelvic floor. So I guess if we start with that, then all of the information kind of from this leads to it's never just the pelvic floor. Um, but the pelvic floor, the muscles really where they are situated at the base of the pelvis, um, if they weren't there, there would just be a hole kind of going through. So these muscles literally form the base of our torso and they hold everything in. So they hold in those organs and hold everything up. The muscles work to um function to hold our hold things in and then to release things and allow things to come up. So they have to contract and hold our urine, they hold our bowels in until we're ready to go. And when we are ready to have a bowel movement or release our bladder, these muscles have to relax. They're involved with um childbirth. Um, the muscles again have to relax and stretch and open for muscles to come in. But even I guess before childbirth, they're involved in sexual function. So the muscles again have to relax and contract as part of allowing intercourse to happen. They're involved with as well as arousal. So there are also our sexual organs like the clitoris in this area that's important for sexual arousal, and the muscles play a role in that as well. These muscles are also part of our core, so they help to stabilize and transfer forces from our lower body to our upper body. Also, the the position where they are in the base of the pelvis, they're involved in circulation and blood flow transfer from our lower body into our upper body. So, again, a lot of important functions, and then therefore can really impact our quality of life. So when things start to impact our bowels, bladder, sexual function, um, ability to um your delivery and um labor and childbirth and that sort of thing, they can really impact somebody's quality of life. If we think of kind of Maslow's hierarchy of needs, we have some of these basic needs that when those are not met, it's hard for some of the rest of the things in our life to kind of go well. A lot of these time, a lot of times these issues are um private and again this this taboo topic, so people don't really know that it's going on and that it is an issue, but can really affect people um mentally, socially, in our relationships.

SPEAKER_02 6:31

Oh, confidence would probably 100% completely go.

SPEAKER_03 6:36

So it has a huge impact. So really important to kind of talk about and um get some information.

SPEAKER_02 6:42

Yeah. Well, I'm glad you're here then. So, what are some early subtle signs that your pelvic floor is starting to starting to weaken? I'm gonna guess like some of the the top ones are like the um where you like kind of pee yourself if you like sneeze. Like going to triple. Yeah, yeah, yeah.

SPEAKER_03 6:59

Skip, you know. Yeah. So some of the problems with those subtle signs too, people just, yeah, well, kind of laugh them off. Or um, oh, it's just, you know, normal. It's just this, it's just that. Um, or they think, oh, it's just so small, it's you know, there's so many other things that are more important to deal with, or oh, maybe this is just something small that is just gonna go away. Um, so I think a lot of those subtle signs, um, yeah, again, there's some taboo or or issues around kind of noticing those and knowing that they aren't kind of normal. So, what are some other ones then? So, with um urinary symptoms, um, again, just that sudden little um release of urine if you're gonna like run really quick or yell at your kids possibly, or um, so that little kind of squirt of urine, or along with the urinary issues, it could be um some urgency or frequency, like you get home from grocery shopping and you notice you have to really like rush to the bathroom and you can't kind of hold, or there's a little bit of leakage with that. Um, so you can start to notice some of these little subtle signs that maybe some things are changing. So, we can also have some bowel signs as well. Um maybe you're having trouble holding in gas, maybe you accidentally releasing gas passing wind when you don't really want to. Um it could be again bowel urgency, like, oh, you have to rush, you can't, you don't have any kind of time to spare before you go to the bathroom. Um, so there's yeah, a lot of these subtle signs that people kind of put off that um can actually be a problem.

SPEAKER_02 8:39

Oh wow. And it's just not anything that people are really talking about or who it's also like who do you talk to about?

SPEAKER_00 8:48

So you're not gonna tell your friends like, oh, I really make it to the bathroom again today.

SPEAKER_02 8:53

Yeah, just let's shit my pants.

SPEAKER_00 8:56

Right. Came out of nowhere.

SPEAKER_03 8:59

Yeah. I can't for some people, it's yeah, people don't want to.

SPEAKER_00 9:10

I know. I was joking about it, but it was serious. And imagine like, but yeah, I would be embarrassed because I wouldn't be like, oh gosh, Vic, and guess what? Or like you I would I probably would tell myself it's it's nothing, it'll get better. That's right. And so I probably wouldn't even go to the doctor until it got to a point where I was it was just not controlled, yeah.

SPEAKER_03 9:32

Yeah. Becomes harder to sometimes deal with later on as well.

SPEAKER_00 9:37

Yeah.

SPEAKER_03 9:37

As things progress. And yeah, so really knowing what are some of these early signs and yeah, doing something about them.

SPEAKER_02 9:44

So then is it safe to say that something like that won't get any better if you don't treat it? Or will it ever go back if you don't treat it?

SPEAKER_03 9:58

Sometimes it can just be like a one-off. Like maybe it's a perfect storm of a whole bunch of things. And that's what we often find in the pelvic floor as well, too, is that maybe on that day other things were going on, and maybe that time when you're coming back from grocery shopping and you're really stressed and you have somewhere else to rush to. So sometimes the stress and tension and things can kind of um make that situation just kind of the perfect storm where it is sometimes a one-off. Um, so a lot of the times when we start to notice these issues too, it's our capacity of our pelvic floor and our and our body is um outweighed by kind of the load or demands and things that we're kind of placing on it. I guess going back as well to to talk about the function of the pelvic floor again, why it is so interesting and different that yes, these are muscles that we can control. So we do have some um control where we can turn the muscles on. But these muscles. That's right, yeah, where you can kind of feel the muscle squeezing. But these muscles do have an automatic, an autonomic component as well, too. So there are some nerves that go to this muscle, or these this group of muscles that are part of our autonomic system. So these muscles can turn on anticipatory, or again, if something is going on upstream in our nervous system, that it can kind of turn these muscles on or off or impact how the muscles are functioning from that um kind of difference perspective.

SPEAKER_02 11:31

Oh.

SPEAKER_03 11:31

So sometimes it's not just a problem with the pelvic floor and the muscles, but it can actually be a problem with um how the nervous system is firing, and um these muscles can tense up and they can work kind of proactively. So they will, they're anticipatory in nature, they can kind of turn on when they think they need to turn on, um, but sometimes it's not appropriate. Or sometimes they're turning on and they're holding because um these muscles are really important as part of our kind of protection for our internal organs. Um, so in response to fear and protection of the rest of our body, so we have that fight or flight system, um, the nervous system can kind of turn those muscles on, and that can create issues from that kind of upstream part as well.

SPEAKER_02 12:20

Now, let me ask you a question. Um, and I don't know if it's actually related or not, but um, like if you see younger kids that might pee their pants um where all of a sudden they like something um some kind of fear or something like that. Is that the same thing is it the nervous system? That's right. Okay. I didn't know that. That makes sense though.

unknown 12:45

Okay.

SPEAKER_03 12:52

It's good to understand and know that um there are other impacts other than just our own evolitional control of these muscles. Um, that again it can be a lot more complicated.

SPEAKER_02 13:04

And I think another myth that you know I obviously had kind of always assumed as well is that it only happened to people who had children or who had babies. But it can happen to any woman as well, right?

SPEAKER_03 13:19

And men. So men have pelvic floors and pelvic floor issues as well. They obviously haven't given birth. So um again, it's not only just about giving birth, and not all women that have birth or that give birth have any issues with their pelvic floor, too. Some people's bodies are again that resiliency, um, it can kind of come back and other people it doesn't, and they're a little bit more at risk of some different issues.

SPEAKER_02 13:45

Right. And even some people who have had children, the pelvic floor issues for them may not show up until much later on in life. I guess okay.

SPEAKER_03 13:56

Again, with that, is it just the length of time? Is it that other issues have been going on in the meantime, or is it the chain the hormonal changes? Maybe they were okay after childbirth, but it's just other things in life or the changes in hormones eventually that can kind of catch up to them that can and then that's where they're seeing those changes, but maybe it maybe it wasn't the childbirth.

SPEAKER_02 14:20

Right. So then with saying that it's not always childbirth, what are the other areas that can cause this? I'm assuming chronic constipation is another one, a big one.

SPEAKER_03 14:33

I guess I'll just start with a little summary again. What are some other risk factors for pelvic floor um issues? So genetics um can be a huge um risk factor. So if you're um mother, sister, aunt, um, even on both sides of the family, because it can be passed on through um like your father's side as well, too. As in like a weak pelvic floor, um, or changes in um collagen and elastin within your body and how that's processed. So some people kind of naturally have a little bit more elastin, they're more elastic in their tissues. Um and then naturally they're maybe not gonna have as much support through that fascial connection. Um some people naturally just have a bit more collagen and kind of support in their tissues. Maybe some people are a bit stiffer generally, kind of in their body. Um, so maybe they have a bit more stiffness and neither one like are good or bad. Are good or bad. Yeah, there can be pros and cons of each depending on what it's giving you a risk factor for. Okay. Um there can be issues, um different trauma, so falls or injuries in your pelvic area, um, physical injuries, but also those emotional um injuries as well, too. So um sexual trauma and stuff can really lead to pelvic floor issues from that kind of nervous system kind of side of things. Yeah, it becomes very protective and tense and tight. Um falls, same thing. You can either have weakness from lack of movement injuries, um, or it can be direct trauma to the area, or you can be left with kind of some tension issues. Maybe they weren't able to move for a long time due to the injury, and then they become like stiff and tight in those areas as well, too. Um, any kind of abdominal or pelvic um surgeries. So, again, those surgeries can impact how the pelvic floor is working. Again, that chronic coughing and straining. Um, let's see, there's all sorts of different things that um impact activity can be a risk factor sometimes. Um again, but there's kind of a a gray area with that. Do you mean like exercise? That's right, like high impact, um intense skip impact, high intense, yeah, skipping, jumping, those types of things.

SPEAKER_00 17:02

I don't know if this was relevant. I went to I went to Iceland a year and a half ago and went on a tour. And it was at nighttime, it was freezing cold, and we were on a bus and out in the middle of nowhere. I really had to go to the bathroom. There was nowhere to go. Like they were like, just go anywhere. I'm like, hey, it's freezing. Like I will I will be freezing. Um where I don't want to be freezing. And also we were on a giant bus with giant windows, and people were inside the bus. So you couldn't go behind the bus because people were inside trying to get warm. Makes sense. So I had to hold my pee for a very, very long time, like hours. I was in so much pain near the at the like near the end of it, at the end of it. Like I ran to my hotel when I got off the bus, and like, but I did not feel good even after. So I was like, did I just mess up myself? Yeah. Did I sometimes those real damage there?

SPEAKER_03 18:03

Those one-offs, again, symptoms versus damage. We have to kind of be careful with that language, but um oftentimes some of these one-offs aren't a problem. It's one that is like like, for example, there are certain um careers that I see that a lot more often where they don't have the opportunity to go to the bathroom, and so they are chronically holding their bladder for long periods of time. Right. And again, you see some of these pelvic floor dysfunctions come out of that. Um, but yeah, in that moment again, there's you're holding, there's a lot of tension in these muscles. Oh, I can feel it. In your abdominal muscles, and everywhere, like it's quite painful. And then it becomes very psychologically distressing. Right. So you add that kind of fear, worry into the mix, and it becomes, yeah, a very complex um kind of system. But hopefully you're able to release your bladder and relax and kind of again do that all the time. Exactly.

SPEAKER_00 19:06

I was like, whenever I have to go to the bathroom, I'm going right away from now on. Yeah. Because it was so scary.

SPEAKER_03 19:21

So again, looking at some of these patterns and habits, um, and how, yeah, over time they can kind of add up to some of these issues. Um, but these one-offs or yeah, those types of things, most often we're gonna be okay from those.

SPEAKER_00 19:36

Right.

SPEAKER_02 19:37

Yeah. So then from the chronic constipation side, that is a big contributor as well. Um, I'm guessing that maybe not like a one-time kind of constipation. Yeah, like what you were saying. Right. Right. But chronic.

SPEAKER_03 19:50

Over time. Yeah. So again, I like to go back with people oftentimes because people say that they're constipated, but everyone kind of kind of has a different definition of what is constipation. Um, so there are um kind of more rules and guidelines around what is constipation. So what is it? Yes, normal bowel movements you can have up to three times a day to three times a week. So it's not always just how often are we going to the bathroom and releasing our bowels. It's more when we do go to the bathroom, how easy or difficult is it to come out? There's also a little chart on kind of our stool shape. So we're looking for that on that Bristol stool scale, um, that uh four. So it's that it's nice, smooth, soft, kind of snake-like, easy to evacuate. You're not sitting on the toilet for long periods of time, it's easy to wipe after, and um, and how do you feel as well, too, like with going that often? Like, is that you feel okay with that, or if you're not feeling good, then maybe there are some things that you can change. So when it comes to constipation, it can be its own issue from a gut uh motility kind of side, or it can actually be caused from pelvic floor issues themselves. So it's kind of chicken or the egg, is it um the gut and motility kind of issues, or is there issues with your pelvic floor where you don't have good coordination with these muscles? Sometimes people think they're releasing, but they're actually squeezing in their pelvic floor. It's gonna be very hard to release your bowels if you don't know how to properly kind of relax them. So yeah, when people get into these chronic states, these long periods of time where they're not going frequently, it's hard, difficult. You're straining, you're on the toilet for long periods of time. You can really get kind of straining to the muscles and the fascia, the connective tissue. Um, there's nerves in this area too that you can be straining and kind of injuring. You can so you can end up with pain, um, weakness, and all sorts of different issues from straining for long periods of time.

SPEAKER_02 22:07

Do they actually harm the pelvic floor if done incorrectly? Or do all high impact work?

SPEAKER_03 22:16

I think again, I like to kind of go backwards like that and I like to watch my words and what I think I think words are powerful in terms of harm and I think there's enough barriers to kind of exercise and kind of doing things for for people as well um already. So I don't like to create more barriers and fear and um things like that. So um I'm very careful with like the word again, harming and danger and that sort of thing. Um but yeah, potentially for some people, if they are if their pelvic floor is not responsive enough, not strong enough, there are some people aware over time that you can see more of those issues. Is it because they were already weak to begin with, um, and then they're doing that, or is it that as they're doing it that they become more weak? I'm not really sure. I think there's a lot more research into women and exercise and especially women um post-birth that's coming up. Um again, research in general for women is well behind men, so I think there's a lot more research to come on that to understand kind of the impact a little bit more. We definitely know there are certain people that are maybe more at risk. Um so yeah, potentially having a baby is one of those things. And again, after having a baby, one of those risk factors, specifically for prolapse, for example, is the space of the um the hiatus. So there is a little gap in between your pelvic muscles where your bladder um and your uterus or and the vagina kind of come out, so that space can become like greater after childbirth, and sometimes um you can have an abultion where like a muscle can get pulled off of the pelvis to again create that space even wider. So, again, in some of those women they are maybe a little bit more at risk of doing that exercise. So I mean there are risk factors, but I think um oftentimes when it comes to loading and impact and and symptoms, again, it comes down to that capacity. And is your body um you know able to tolerate those loads? Um, so I like to look at how can we keep people doing those types of things and looking at rest days and making sure because if you're already tired, like your pelvic floor is going to be a bit more tired that day as well, too. So I think especially as we age, um our our demands and what we can take, our resiliency kind of changes a little bit. So I think kind of meeting your body where it's at and getting those rest days, um loading um or sorry, um food. So making sure that you have the right proper energy in your body asleep again builds that resiliency. Um so I think I like to again instead of just saying people are at risk or they can't do that, what are the things that we can do to build that most um capacity and resiliency in our pelvic floor so that you can keep um doing those things and your body can kind of meet that need.

SPEAKER_02 25:27

Are they enough or are they outdated or an incomplete approach? What's your belief on that?

SPEAKER_03 25:36

Yeah, I would firstly say like enough for what? So I'm always um again, I'm very I like to be very clear on like language, especially when talking with um patients and clients and making sure like well, what are your goals? What do you want to do? And making sure that it's meeting that. So for some people, maybe all they need to do are some keegals. Like if you have um that stress urinary incontinence, maybe you just need a little bit more of that um interior sphincter, like around that urethra and just get a little bit more strength um and support there. Maybe that is enough for them. Um, some people who are maybe more in that pain spectrum where they have a bit more tension their floor, maybe they don't need to do any kegels at all.

SPEAKER_02 26:18

Oh, so it's not the um cure for everything? Yeah, yeah. Yeah, because I think that that's kind of how I've always associated it is keegels are what is going to keep everything up. Right. Um and if you have an issue, you just do your kegels and then you'll be okay. Kind of thing.

SPEAKER_03 26:37

Yeah, and it's not um yeah, that easy, unfortunately. And again, um I again very much like to take that holistic approach. Your pelvic floor is only kind of one piece of the puzzle. Um, so as a physiotherapist, I like to make sure that I am assessing and looking at other parts of the body, making sure that you're moving well in your hips and in your low back, um, that you're strong in other places. You can only be kind of as strong as our weakest link as well, too. So you can try and do a lot of pelvic floor strengthening exercises in isolation, um, but it's only going to get you kind of so far. So I think being strong again in the rest of your body is really important. As we spoke before, taking care of those bowels, making sure that your bowels are moving well, that you're sleeping well. So it is very much a holistic approach and again, very individualized. So depending on the person in front, kind of what combination of things do they need to keep their pelvic health um working well and um that capacity up and that resiliency.

SPEAKER_02 27:40

So then I would say that um you would say breathing is one of the important things when it comes to pelvic health. And I I would probably even notice it um myself, like even from a nervous system side, right? Where if you are um in fight or flight or if you are really stressed or anything like that, you hold you hold your breath, you hold your um like everything very, very tight, and you're not probably able to release. That's probably why there's like yoga and Pilates and stuff like that. That's so important, right? To teach people how to breathe and um relax that nervous system.

SPEAKER_03 28:15

Okay. Going back to I think the initial kind of anatomy as well, too, like understanding that that inner core unit is it's like a canister. So there's a top, a bottom, and a front and a back. Your pelvic floor is the bottom of that canister, your diaphragm is that top part of the canister. And then in the front, you have your deep abdominal, your transversus abdominis muscle, and then you have some deep low back muscles that form this inner core unit. So they work together to control pressure for that stability. And um it's a really nice way, and I I am usually always start with breathing in my sessions, whether somebody needs to release their pelvic floor because they have a lot of that tension or nervous system up regulation. We can start with breathing to help relax into that pelvic floor. It can be a really good tool and feedback for people. So these muscles, because they are your pelvic floor specifically, because they are inside, you don't get a lot of feedback about what's happening with them. It's not like your bicep where you can see it bending and straightening. So to kind of coordinate that with the breath and some visualization, it can really be helpful to kind of get more of that sense of how does the pelvic floor move naturally. And then it gives people more control then over how to actually contract and release it properly.

SPEAKER_02 29:37

One of the ones that I don't think we've talked about yet is um the loss of estrogen. So I know that like constipation and um stress and and everything like that, but with the loss of estrogen can also come pelvic floor issues as well, right?

SPEAKER_03 29:54

Definitely. Yeah. Okay. So as we know, as we start to age, um these estrogen levels and other hormones as well can change, specifically estrogen as it starts to decline. We have estrogen receptors all throughout our body. Um, I know you've had people on here speaking of that before, like in our brain, bones, all sorts of different um places, but we also have a lot of estrogen receptors in our pelvic floor. So when we don't have that on board and these receptors are used to getting this estrogen, they become very cranky and not very happy without having that estrogen. So we get what are these symptoms called the genitourinary symptoms of menopause. Um this can happen and start in perimenopause as well. You can start to notice some of these changes. So we can have changes in our urination, um, again, frequency, urgency, some of that stress incontinence. You have changes in our muscle activation and strength, and even that fascial connection, which can again lead to pelvic organ prolapse and things like that because we don't have as much support from below. We can also have changes in our vaginal kind of cells and things, so they become thinner, we lose muscle, so we get that atrophy in our vaginal canal. It can lead to pain with intercourse, we lose some of that lubrication, um, bleeding sometimes, um, and we're actually at risk of more infections in the pelvic area due to the lack of estrogen as well, too. So you might see more urinary tract infections or even um vaginal and other kinds of infections in this area as well, too. So they we they can have this very broad kind of spectrum of different symptoms from this lack of estrogen.

SPEAKER_01 31:47

Right.

SPEAKER_02 31:49

Oh.

SPEAKER_03 31:49

That's a lot.

SPEAKER_02 31:50

Yeah, it is, but it's very interesting too.

SPEAKER_03 31:53

Um But there's so many things that you can do about it as well. Yeah. And that's where understanding what some of these symptoms are and how they are kind of natural and a normal part of the aging process when we don't have estrogen. So I think if you can start to recognize when some of these symptoms are coming on and know, oh, that's maybe there's some changes here happening. Um, okay, so what can I do about it? Um, again, a little selfless plug. You can go see a pelvic flower physio, kind of identify what some of these issues are, how you can keep things feeling good. Um, going to see your doctor, hormonal um replacement therapy is one option. There's lots of other things that you can do vaginally using vaginal moisturizers like hyaluronic acid, things like that that can help things stay moisturized and lubricated. Um, vaginal um uh oh my gosh, vibrators. So vibrators can be a very good part of um not only for sexual health, but also our pelvic health and maintenance of our pelvic health. So it's really good for increasing blood flow and circulation and can really minimize some of these issues that we see um during menopause. And um, again, that that blood flow and stuff is what we're kind of looking for, can also help with muscle strengthening as well, too. So lots of things that you can do about it. It doesn't have to be scary, but I think firstly just recognizing what are these things and knowing who you can reach out to. Right. Such a big topic.

SPEAKER_02 33:30

I'm glad we're doing a two-part series here because there's a lot to unravel.

SPEAKER_00 33:34

Yeah. So for women in their say 30s and 40s, is there are there things that they could do now or should be doing now to prepare for those hormonal shifts?

SPEAKER_03 33:45

Yeah, 100%. Um, it's always easier to prevent things from coming on um or to kind of nip them right away before they become something bigger. I always say to people, it's never too late though to um to do things, to make those changes. Our bodies are so resilient if we're giving them the right like tools and opportunities to get stronger or just healthier, fitter, more resilient. Um so yeah, starting by getting information, understanding again, what are those symptoms, what should I be looking for, and knowing that it can be a normal part of aging, but that it's not something that we just have to like live with and um that there are things that you can do to change those symptoms and reverse them before they become too too like out of control or start to impact that quality of life a lot more. Um, you've probably heard this on some of your other interviews as well. Um, strengthening just as we like age and and start to lose um estrogen, sarcopenia. So we the natural part of aging, we just lose muscle strength. So I think just generally keeping strong, not only just in the pelvic floor, but I think generally doing that resistance training um can really have a protective um effect in our whole body for as our body starts to go into some of those changes. Um, there's so many other benefits of um being active and healthy as well that we can get. I think knowing your pelvic floor, not only just can you kind of contract those muscles, but can you release those muscles? So knowing what it feels like in your body and in your own body, knowing what are some of these things that um are impacting you right now and what can I tweak? Oh, I know, like, yeah, my bowels have never been good. Okay, now is the time to kind of start to make some of those changes um before again down the road things can be different.

SPEAKER_00 35:46

If a woman had a child, say years ago, but she feels fine, could there still be underlying issues?

SPEAKER_03 35:53

Yeah. Yeah. Um so I'm biased in my field because I see all mostly women that have the issues. Um, but yes, oftentimes women can come out of childbirth, not again promoting this bounce back, but our bodies are resilient and they can kind of come back from some of these things. Um, especially when I see women after childbirth that are making sure that they throughout that fourth trimester and beyond that they are being very intentional in their movements, kind of building that core strength and kind of doing that nice progressive strengthening and loading over time, taking care of some of those issues that they might not have any problems kind of at all and be perfectly fine. Um, and again, maybe somebody feels fine, but maybe there are some of those little things. There's always little things that you can kind of tweak and improve. Um, and again, I think we kind of talked about earlier that as you age, is it because of that childbirth that was the problem? Or is it some of these other issues that are now just becoming more apparent as you continue to like the above? Right, yes. Yeah. Yeah. Yeah.

unknown 37:08

Okay.

SPEAKER_00 37:08

What are the most common long-term pelvic floor issues you see from pregnancy and childbirth?

SPEAKER_03 37:14

Probably the most common would be um that stress urinary incontinence. There are other forms of incontinence as well, like that urge incontinence, that rushing to kind of get to the bathroom, you don't quite make it, but that stress incontinence where you're leaking with um that extra pressure in that canister from coughing, sneezing, laughing, running, jumping, yelling, any of those quick or sudden movements. Um, so that's probably number one. It is a very common um kind of symptom that women across the world um are struggling with that. And then from childbirth, um, it's probably the pelvic organ prolapse is kind of the second more common kind of thing. Right. Um, especially from vaginal births, um people who have a C-section birth, they can also have other issues related to pelvic floor symptoms that people don't really think that their pelvic floors are going to be impacted from a C-section birth, but your pelvic floor unfortunately isn't spared. Um sorry to tell you. So, especially if a woman maybe they started by pushing and um so they are gonna have some of those that strain and issues on the pelvic floor, and their labor stalled, something happened, they had to get baby out, and then they had to do a C-section. Um, so they might have double, they might have some of those um vaginal issues from that strain, um, and then other issues from the C-section as well, too. So, from typically, if someone even just has a planned C-section, um again, you can get a lot of core in that deep kind of core weakness. They're not cutting through the muscles, but it's gonna impact this whole area. Um, so again, rebuilding that core strength from that inside out is really important. And oftentimes after a C-section as well, too, because there's, you know, this big incision that's like 11 layers deep or something like this that they have to heal from. There's a lot of tension. A lot of women are kind of hunched over the first little bit because there's a lot of pressure, so you can end up with a lot of pain or tension or a lot of protection in this area from again that nervous system where um that those are some different issues that those women might um have versus someone who's had um a vaginal delivery. Okay.

SPEAKER_00 39:32

Are there everyday habits or things that we're doing, like sitting, standing, going to the bathroom that quietly damage the pelvic floor?

SPEAKER_03 39:40

Yeah, good question. Um again, yes, these things over time um can have a very, very gradual impact for sure on our pelvic floor. It's not an immediate, it's not something that again, we should maybe worry about right away. Again, creating that fear like, oh, I'm not sitting properly. There's no perfect sitting posture, no perfect standing posture. Really, we shouldn't maybe be sitting for that long in general. So the length of time, yes, that people are sitting for is not ideal, not just for the pelvic floor, but for our overall health. We're getting stiffness in our hips, weakness in our hips, and that has a direct impact really on our pelvic floor. Um, some other day-to-day things, um, especially with some toileting habits. So again, maybe a lot of women or just men, kids in general, will go to the bathroom just in case. Like, oh, just before I'm leaving someplace.

SPEAKER_00 40:34

I do it all the time. I go before every podcast because you know, that hour might have to go.

SPEAKER_03 40:41

But it's over time. Your your bladder, you can sometimes be training it to go when it maybe doesn't need to go, or some of that hypervigilance or that nervous system kind of um impact on your pelvic floor that it really does impact it over time. Um, that power peeing. Some people oh gosh, I do that too.

SPEAKER_00 41:03

Like if you're in a hurry, go as fast as you can push.

SPEAKER_03 41:06

Yeah, pushing and straining because their lives are so busy that this is a lot of people are having it.

SPEAKER_00 41:13

I have an appointment. I have to complete this. Oh, yeah, somebody's waiting for me.

SPEAKER_03 41:16

And yeah, so some of these things, again, gradually over time it can add up to issues. So um just kind of recognizing like what are we doing? Why are we doing this? I like to um get people that, you know, normally if we go pee, say five to eight times a day, if you take that time, actually just sit down, just relax, take a couple of deep breaths, allow your pelvic floor to relax, allow your bladder to empty. Um, it can really I don't have time for that, Dania.

SPEAKER_00 41:48

Okay, but no, I'm going okay. That's my homework.

SPEAKER_02 41:51

Well, I I get how it's it's connected to the nervous system because the power P is like the high stress and the nervous system being kind of amped up there and um yeah, they're all kind of interconnected.

SPEAKER_03 42:05

Yes. Yeah, okay. Yeah. Things like too for women for wearing like really tight fitting clothes or you're holding kind of things in over time that can put a lot of like pressure and tension in this area, which can really impact the pelvic floor. We need that space for breathing and movement. So really kind of holding everything in. Um, I know I sometimes will kind of feel like that tension and pain at kind of at the end of the day, and I'm like, oh, I just need to get you know these pants up. Like we're not meant to wear that tight fitting of clothing. So there's yeah, there's a lot of these daily habits and and postures and things that um yeah, it's not necessarily a problem one time, right? Over time. Okay.

SPEAKER_02 42:51

So then what's your thought on those people that wear those like girdle things, those waist trainers, the waist trainers, those really tight ones. It's obviously squishing a lot of stuff in there. Yeah.

SPEAKER_03 43:03

Um listen, sometimes technology um bracing things like that. I think it does have um a role. And I think depending on what your goals are and why you're wearing that, it can be helpful. Um but hopefully you've had some very specific information about how to use that, why you're using that, um making sure if it is for strength that you're not you're okay, you're using that for support, but that we're still working on strength at the same time. Um so yeah, I think there's there's space for those types of things along with the proper education and use.

SPEAKER_02 43:43

What now I'm gonna ask you a bunch of and I don't I don't know what your thoughts are gonna be on this. And um, you know, if if you need to, then just say no. Um But what are those little s ball things that women inside? Oh, yeah, yeah, yeah. Like the vaginal weights, yeah, cones, those types of things.

SPEAKER_03 44:00

Yeah. Yeah. It's um just another way of training these pelvic floor muscles.

SPEAKER_00 44:04

Like you're it's like a fancy.

SPEAKER_03 44:06

Yeah, you're purposely putting a load and trying to hold against that load. Yeah, it can be very good for some people, especially for that feedback. Um because if it comes out, you know. Yeah, yeah. Um yeah, it can be really helpful. There's all sorts of different tools that people can use for strengthening and um a lot of it comes from at feedback as well, too. And um makes sense. Yeah, getting people to understand again what they're using it for and why we shouldn't be holding that in necessarily all day long and walking around with it, but again, short periods of time with a specific goal in mind, it can be helpful.

SPEAKER_02 44:47

Okay. Um, and then I do also want to ask your uh opinion of the high foam chair.

SPEAKER_03 44:54

That yeah, yeah, I think there it's really um sophisticated um you know technology that can really help individuals.

SPEAKER_02 45:04

Um should someone come and talk to you first before they go and hop on one of those chairs?

SPEAKER_03 45:09

As a physiotherapist, we screened people before they went onto the chair. Because um, again, looking at um the research, looking at the benefits and risks, and making sure that people are appropriate to go on there and and we would flag people to know that maybe they wouldn't do so well. Um so I think the screening is really important to make sure who you're putting on. Um I do think again, and I'm definitely like a holistic, I think that's maybe a piece of the puzzle. Um, but again, if somebody is going away and and are doing some of these other habits, or yeah, their bowels aren't moving well, or they're pushing B2P, um, or um again their estrogen levels are changing. I think there's a lot of other things other than just the chair, it should be like a piece of the treatment and very much like a holistic approach to using that, um, especially if we're looking at those long-term gains and maintenance and maintenance and stuff. Um that yes, but it can be amazing for some people that they can get a lot of benefits. Um again, as a public health physio, I don't pretend to sit here thinking that I can fix everyone and help everyone, um, but that I think there's a lot of other things out there um that women can do to help, that it's not just a public floor of physiotherapy. So I think it's it can be a really great option for some people.

SPEAKER_02 46:34

I I do want to ask you another question because I'm not familiar with it and you know this podcast is more about like pre like what may happen before. Right. But how do you examine a person? How do you work with a person? Is it all internal?

SPEAKER_03 46:49

Like it yes, it can be really it's the gold standard up to this point to really know what's happening in someone's pelvic floor. We can guess, um, but sometimes we don't know exactly. So they've done studies to actually try to see if we can predict um what someone's pelvic floor would be, yeah, um, just based on symptoms. Um and it's not always predictable what someone's pelvic floor is actually doing. Um so yeah, I'll leave it kind of at that. That it's there are other devices like um external ultrasound and stuff that can give you some feedback again of what's going on, specifically with like contraction and and relaxation. Um sometimes that specific feedback can be really helpful. Some people don't want the the internal exams, and obviously I'm always going to um respect that. And there's lots of other things that we can do externally and that we can try. Um but again, the more specific I can be with kind of knowing what the driver is, knowing what's actually going on, then the more direct the treatment you know can be for that specific um issue.

SPEAKER_02 48:04

Yeah, makes sense.

unknown 48:05

Okay.

SPEAKER_00 48:06

So what does a healthy pelvic floor actually feel like?

SPEAKER_03 48:10

Mm-hmm. Good question. Obviously, we've talked up to this point about some of these dysfunctions and things. So I think it would be absent of any of those dysfunctions. So no issues with the bladder, any of these leakages, um, not rushing to the bathroom, that sort of thing where you have good control, where you can hold your pee in when you need to or near poo, and when you're ready to go to the bathroom, you release that. No pains um or issues with um like intercourse, so no pain there, um, where you feel like supported. Um, I also think that the pelvic floor and our pelvic health, it shouldn't take up too much of our headspace. Like if we're constantly kind of thinking about it and checking in, um, but that's not necessarily either it's not an issue with the pelvic floor, but again, that nervous system and that connection to the pelvic floor. So I think if you can kind of check in with your pelvic floor here and there and do, you know, make some of these adjustments as you need to, but otherwise it shouldn't be something that's necessarily on your on your mind or a concern. Um, so I think that would be that healthy, resilient pelvic floor that you can do all the things that you need to do in your day-to-day, that the strength and the capacity of your pelvic floor is meeting those demands of your of your daily life.

SPEAKER_00 49:28

Yeah. So if somebody does want to stay active, like running, jumping, lifting, heavyweights, what should they be doing now to protect their pelvic floor long term?

SPEAKER_03 49:39

I think it goes back to that um building that resiliency in your pelvic floor right now. So kind of knowing where your weak points are where you struggle, what you need kind of help with. So again, maybe you see a pelvic floor physio and kind of get those things identified if you're not sure on your own, working on some of these little things right now. As we spoke about before, strength training, um, not only just for your pelvic floor, but again for that whole body, kind of in preparation for those changes during estrogen. Um I think not only again knowing how to contract, but also that relax your pelvic floor as well, too, and understanding how that nervous system kind of plays a role in how your pelvic floor is kind of working.

SPEAKER_00 50:26

I think for me overall, I'm just gonna pay more attention, like be more present. That's it. When going to the bathroom instead of trying to rush it or or going like I don't know, I don't really think I just it's a chore that I do. I just go and do it. Yeah, yeah. But it's not time where I sit and try to relax or breathe or whatever.

SPEAKER_02 50:49

I don't see I really don't breathe. Right.

SPEAKER_00 50:52

Trying to get I just get through it and go. Yeah, yeah. Um, but for me at least, that's that's what I'm gonna try to focus on.

SPEAKER_03 50:59

Yeah, slowing down, being mindful, um, and understanding that it is one of those kind of that base of the the foundation of what we need to do in our daily lives. And when it's working well, it's great. And I really want you to feel good about it.

SPEAKER_00 51:15

Which is probably why I have been able to kind of go to the bathroom the way I have been, because it's working well and it's fine. It's not something that I'm concerned about yet.

SPEAKER_03 51:24

And then right, then when it changes, then that's when it can become extremely distressing, distressing for people who like fearful and um can cause a lot of issues.

SPEAKER_00 51:38

So well, because it is also a big part of our day, like it's not just oh, that happens one time a day. Like if you could give women one non-negotiable habit for lifelong pelvic health, what would it be?

SPEAKER_03 51:54

Uh, I just have to pick one. No? Okay.

SPEAKER_00 51:57

You can give us a couple.

SPEAKER_03 51:58

Uh, there's so many things. I think um bowels is a big one that I like to focus on a lot. Again, it's one of those things that it's just part of our daily, you know, kind of things that we do, or maybe not daily, up to, you know, three times a week can be normal. But again, our our bowel health, there's been a lot more issues um with like colon cancers and the rates and stuff going up. And um, it literally are it's toxins that we shouldn't be having in our body, and it can really have a big impact and can have all this crosstalk between all the other organs in our area. And in terms of that gut health, um, and there's such a large portion of our immune system is in our gut health, and people are now saying that our gut rules our brain and versus the other kind of way around. So I think if we can have regular bowel movements and kind of take care of that gut health, it's gonna take care of our pelvic floor and so many other things in the health and wellness of our body as well too.

SPEAKER_02 53:02

Completely agree, completely agree.

SPEAKER_03 53:04

So bowels is a big one. I think, like you said, just being aware and knowing what your pelvic floor does, knowing well, what what it used to be like, what it is like now. Yeah, no knowing those changes, kind of being in tune with it, um, knowing how to contract but also relax. Um, a lot of people, again, like we talked about before, just think keegels for the pelvic floor. So I think knowing that flip side and how to um have that full resiliency in your pelvic floor, I think is important.

SPEAKER_02 53:33

Would you also say to any woman that um has had a child, like that you would want to see them quite soon after they've had a child, no matter what they've been through? Like, is it something that you would probably tell most women that if they are pregnant to come and see me after?

SPEAKER_03 53:53

Yeah, I I do think it's obviously I'm biased as a pelvic um health physio, but oftentimes, yeah, if you can catch some of these little things, even if it's things like little issues that they had before, little some of those habits and things, um, that that is a good because it is such a turning point in in someone's life where there are a lot of changes that I think um it's a really good time to maybe have that check-in where you can yeah, catch some of these things, make some of these tweaks before it can it does become an issue. I'm seeing a lot more of that actually.

SPEAKER_02 54:25

Um I think there's just more especially down here, there's so much conversation around it. And um you know, now they're talking about this whole fourth trimester, um, which that wasn't really something in my wheelhouse when I was pregnant 14 years ago. I never heard any about this fourth trimester and um it even post baby. There was never ever a conversation about physio.

SPEAKER_00 54:49

Yeah, right.

SPEAKER_02 54:50

Yeah, I think maybe I missed the class, I don't know. But yeah, yeah, it just wasn't talked about. I think maybe the only time that you would go and see a physio for pelvic health is if something was really wrong. Yeah, yeah. And not try to get ahead of it.

SPEAKER_03 55:11

Yeah, yeah. Yeah, I think a lot more people, yeah, that knowledge is power. Um and there's a lot more um ways that people can get that information um nowadays as well. Too. People are starting to be a lot more open about talking some of the about some of these issues that yeah, like you said in the past, people didn't as much. So I think it's it's definitely coming around. And again, that assessment might just be a one-off. Like I don't want to, you know, make someone keep coming back. And sometimes it is just like a look, your body's doing great, you're doing amazing, keep going, like um, and just again building that confidence with them too at that checkpoint, especially when there's so many different changes and they're learning to become a mom. And am I doing okay with that? And so I think even from that pelvic health perspective, like building that, like, yeah, your pelvic floor is really strong, like you're doing great. Um that it helps to kind of build some of their confidence at that point of in time to um know how to pursue and how to progress moving forward for them as well.

SPEAKER_02 56:17

Well, and then there's this this other group, I would say, of women, um, and this conversation came up when I was home at Easter, is the women that are in their late 60s that are now starting to have the um the pelvic prolapse or the uh bladder prolapse. Oh really? Yeah. Yeah. And I think maybe one of it, and this is just my personal opinion, is they were all also the women that missed out on HRT. So there's a big loss of estrogen at that time as well. And the no pelvic help at that, you know, when they're that young. And um, so now they're kind of moving into, I just find that it's a lot of um surgeries. And so kind of, you know, now they're at the spot where it's like, well, we need to now do something about this, and it's surgeries.

SPEAKER_01 57:09

Yeah.

SPEAKER_02 57:10

Yeah.

SPEAKER_03 57:11

Yep. The options change and over time. And as we spoke about kind of building that strength and stuff now, it's some of that is that natural aging. We just lose strength, elasticity, right? Yes. Or that there's more elasticity and stuff in our body that there's sometimes it's harder to make gains with just say pelvic health at that point in time. So other options become, you know, more the number one kind of line versus just kind of strengthening at that point in time. Yeah. Yeah, doing stuff now, always that preventative stuff is always easier. I mean, it's hard work, it's not easy sometimes to kind of find all that time to exercise and do all your kind of normal things. Um, but I think really prioritizing that and again, this that strength training just three times a week doesn't have to be a long period of time. Um, but I think really making it a priority earlier on in life is really important. Right. Yeah.

SPEAKER_02 58:18

Oh, is that it? That's it. Oh. Well, this is great. Thank you. Thank you guys.

SPEAKER_00 58:24

Thank you for joining us today.

SPEAKER_02 58:26

Um, how can people find you if they need to get a hold of you and want to come and see you?

SPEAKER_03 58:30

Sure. Um, I right now I'm working at Synergy Chiropractic and Physiotherapy. So in Grand Cayman, we're in the Marquee Plaza by um Simboco and Cafe Delsol. Um, so we have online booking um through Jane. We also you can call in. Um most people don't need a referral for to come into physio. I can just see you without that referral. Um, certain insurance companies do need a doctor's note for for coverage for that. So I always just tell people maybe look into your insurance and see if you need that just as that first step. Um, which again sometimes can be that barrier to getting people in. So maybe that will change one day where people are just able to come in without having that extra kind of step in between.

SPEAKER_01 59:19

Right.

SPEAKER_02 59:19

And even just to to encourage people that if like kind of feeling a little bit different to just come in and have a conversation with you. That's right. Right. How long do you usually spend?

SPEAKER_03 59:29

So I'm very lucky at this clinic. I get a full hour for initial assessments. That's good. Um, yeah, there's so much um that needs to go into the conversation. So um, and then our follow-ups are 40 minutes, um, but they can be extended um based on the individual's kind of needs and complexity and things like that as well, too. So I get lots of time. Um, that's what I love about my job. Oh, that's awesome.

SPEAKER_00 59:55

Thank you. Thank you so much. Thank you guys. Thanks for joining us on Breast Intentions. We hope you felt seen, supported, and maybe had a few laughs along the way. Don't forget to share, subscribe, rate, and review us. Your support keeps the conversation alive. Follow us on social media for more insights, behind the scenes fun, and updates on future episodes. Got a topic you want us to dive into? We'd love to hear from you. Remember, life's too short for bad bras, toxic relationships, and kale you don't actually like. So until next time, stay bold and keep your best intentions exactly where they belong. Front and center. Now go crush midlife, or at least today's to do list. Cheers.