When Your Pelvic Floor Needs Help (Part 2)

Episode summary

In this episode, pelvic health physiotherapist Elzke shares expert insights on pelvic floor dysfunction, signs, causes, assessment, and treatment options, empowering women to take control of their pelvic health.

Key topics

- Signs of pelvic floor issues
 -Causes of pelvic prolapse
- Pelvic floor assessment process
- Non-surgical treatment options
- Myths and misconceptions about pelvic health

Takeaways

- Pelvic floor dysfunction can present as urinary, bowel, or sexual issues.
- Pelvic organ prolapse symptoms include pressure, heaviness, and bulging sensations.
- Lifestyle modifications and targeted exercises can often improve pelvic health without surgery.
- Kegels are not a one-size-fits-all solution; assessment is crucial.
- Understanding the load and strain on pelvic tissues helps prevent and manage prolapse.

Chapters

00:00 Introduction to Pelvic Health
01:21 Understanding Pelvic Floor Dysfunction
04:11 Common Signs of Pelvic Floor Issues
07:22 Pelvic Organ Prolapse Explained
12:05 When to Seek Professional Help
14:30 Identifying Red Flags in Pelvic Health
16:00 Stress Incontinence and Its Implications
19:21 The Impact of Coughing on Pelvic Health
23:14 Common Causes of Pelvic Organ Prolapse
29:07 The Role of Kegels and Multidisciplinary Care
30:43 What to Expect During a Pelvic Floor Assessment
32:32 Understanding the Pelvic Floor Examination
35:10 When to See a Pelvic Health Physiotherapist
36:37 Non-Surgical Treatments for Pelvic Floor Dysfunction
38:53 Impact of Pelvic Floor Dysfunction on Quality of Life
41:16 Lifestyle Changes for Pelvic Health
44:03 Conservative vs. Surgical Options for Pelvic Floor Issues
48:04 Recovery and Rehabilitation Post-Surgery
52:48 Common Misconceptions About Pelvic Floor Health
56:05 The Role of Technology in Pelvic Health

Resources

Elevation Health and Physiotherapy - https://elevation.ky

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 Elzke on IG (@elevation.ky) 

• Follow us on Instagram and Facebook (@breastintentionspodcast ) 

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

Transcript

0:00

If we can use myself in this example again, like some pelvic floor muscle issues due to sporting in my 20s, then uh two babies later. It's like adding stripes to a tiger a little bit. And then I was sick for the last month. So that coughing probably wouldn't have been so detrimental to me, but because of the previous sort of strains and things that happened, perhaps to my tissues, it's now not as strong to take that load. Welcome to Breast Intentions, the podcast where we take off the braff expectations and dive into honest, empowering conversations. We're your hosts, Nadine and Cynthia, two Canadian girls who swap 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 Elska for part two of our pelvic health series, diving into what happens when pelvic prolapse becomes a reality, from symptoms and treatment options to recovery, support, and getting your confidence back. This episode is an empowering conversation every woman needs to hear. So in today's episode, we have Elska, who is a pelvic health physiotherapist. Welcome to the show. Oh well, thanks for coming on. Um, now, if anyone has watched, or if anyone is going to be watching this episode, what they may want to know as well is that we have done a part one um with another pelvic floor um physiotherapist. And so this whole podcast is and this whole episode is really about I now have pelvic floor issues. How do I deal with them? Who should I talk to? What should I ask for? Um so we're really glad that you're on the podcast and we get to chat with you a little bit more. But um, for any of our listeners who may not be familiar with you, can you give us a little bit of a background on how you ended up on the island, how you ended up as a physiotherapist? Yes, absolutely. Well, in my uh youth, I was an avid athlete and sports enthusiast, and um, I have a passion for medicine and for helping people, and that made physiotherapy quite a no-brainer and an easy fit for me. And while I was living my best life, and as you do in your twenties, we decided to travel the world and came and kind of just was the place that draw drew us. And and we've been I've been here 10 years now and we've been enjoying the island, and I've been privileged to to help many people here with my skills and so forth. But uh as I was participating mostly in sports and orthopedics, physiotherapy, naturally, um, I uh was exercising and doing, again, living my best life. And sadly, kind of in my late 20s, I developed pelvic floor dysfunction. And that kind of took me by surprise as you know, these symptoms of pelvic floor dysfunction just occur and you kind of feel, oh, what what now? And I realized that I needed pelvic floor physiotherapy as a result, and back then that wasn't so easy to come by. And so I very quickly enrolled in my postgraduate specification in pelvic health physiotherapy, and and that really helped and changed my personal life as well as um my the way I practice every day. And um, as very much as a patient, you can often feel alone. And I don't know if you guys have done a mental health podcast about pelvic health, but often you that affects your mental health as well. So yeah, we did kind of talk to you. Yeah, yeah. Yeah. So uh I'm great, like luckily positioned in a place where um I can contribute to these people's quality of life and help them from my own experience as well as expertise. Good for you. You're doing some great work down here. Um, what are actually I'm just gonna get straight into the question. So, what are the most common signs that something is wrong with the pelvic floor? Like even for you, like you were saying in your late 20s, what were some of the signs that you noticed? Yeah, so I I am well personally uh I developed as an athlete a lot of pelvic pain um at the time, but it was associated with some urinary dysfunction, sexual dysfunction, bowel dysfunction, a whole triade of things. And often these um symptoms can be complex. It's not just one area like bladder or well that are affected. But I think if I could take a little detour, um, it often really helps to understand the function of the pelvic floor before we look at problems such as in dysfunction, right? So the the pelvic floor is a little hammock-shaped muscle at the base of our pelvis, and it governs sort of your urethra for urinary function, vagina for sexual function, um, rectum for bowel function. And then it has a um a great function in organ support, like holding the bladder and the uterus and the bowels up. And um, and so that it does a lot for a group of muscles that we do not think about until something goes wrong. Yeah, yeah, you know, um, like myself. And um, so dysfunction often looks like things that interrupt those systems. So um unable to hold your urine in, unable to pass urine smoothly and normally, so urinary retention, pain with intercourse, pain with um sexual, any sexual function, really, um, bowel issues such as continence, keeping stool in, constipation, straining, pain with defecation. And then often when it comes to the organ support part, patients would report things like feeling pressure, dragging, discomfort in their pelvic area. So, like I said, pelvic floor is the unsung hero. It does heavy lifting, and we we don't think about it until it really fails us. So those would be the things that would show up. Okay, so this part of the symptoms. Yes. Yeah, and I'm sure we'll probably get into more. We'll get into it. Yes, for sure. Okay, so when we're talking about pelvic floor, what does pelvic organ prolapse feel like and how do women typically describe it? Yes, okay. So I I see patients like that every day in my office, and they often complain of uh a feeling of pressure and discomfort. Sometimes it starts like over their lower abdomen, other times it's in the perennial area or in the sort of vaginal area, and they will report um symptoms, sometimes like feeling that something is there, like a little ball or like a tampon is inside of them and partly coming out, right? And um can be painful. They'll often say that, oh, I feel something there. There is a little ball-shaped thing that wasn't there before, or I took a mirror and I looked and I see something there and um it wasn't there before. And these symptoms can often be reported as aggravated with longstanding, uh long like after a long day when gravity has really done its work a little bit. And after exercise or heavy lifting, uh, that might be aggravating factors for these symptoms. So you might wake up feeling pretty good, but by the end of the day, you're just like, why is this so heavy and uncomfortable? And what's happening to my pelvic floor? Oh, okay. So this is more um did you mean like they can feel a ball? So so yes, sometimes they don't, depending on the stages of prolapse. Right. But but very often, if you at the entrance of the vagina, there might be a little bulge. A little like it's almost like a cyst-like feeling or a little ball feeling. Oh, okay. But maybe not if it's still early. If it's still early days, they might not feel that at all. So I kind of grouped all of these together of how they can present. But depending on on where they're at, they might not feel anything palpable or see anything. But they still might feel they still might feel off and pressure and that sort of heaviness is the right word. I almost feel like carrying on. Um that like you guys is that also like a feeling of like just heavy cramps for a woman? I personally haven't had these symptoms. So I I think it could be a similar type feeling. I I actually had a patient this week and again who it started out more abdominally, which uh we don't always think uh pelvic organ prolapse when we when it starts out abdominally, right? So it actually she it was delayed in diagnosing it because she did um go and seek some assistance and it wasn't diagnosed because it that was kind of not so typical. But yes, I think it can present itself like um some cramping. And and just I think sometimes women are very intuitive and speaking to her that something's off. You you know when when something is off. Right. So it's it's usually not an acute pain and sort of you know what I mean? It's it's quite a nagging, dragging discomfort rather than sharp and acute. Okay. And then will it start to just like uh become worse and worse in the pain area, a pain level, or I think it's just to backtrack a little bit, sorry, it's important to note it could also be associated with changes in bladder function, um, depending on what organs are kind of losing their support. Okay. And also changes in bowel function. And that might be the only symptoms that you see. So just to point that out as well. Um so it's not necessarily that it's gonna get uh quickly exponentially worse, but it is definitely something that I would say needs attention because it points that the support system of the pelvis is now not doing its job like it should. And if we continue just down the same road and do the same things of our daily life that we did, that kind of brought this about, it could potentially get worse. And kind of pausing and assessing and finding the right uh assistance might change the course of how it can develop. Right. Let me ask you another question as well. Um, do a lot of your clients come to you because they have noticed something or have they seen their like gynecologist and then it's been referraled over to you. Yeah, so that's a great question. It's a mix. Is it? So some some patients and in today's world, we thankfully have so much information at our fingertips, right? You put your symptoms in, something spits out an answer. Right. So there's some answers that you also have. Yeah, exactly. Right. So but it but it helps direct at least who you need to call in the morning. Right. So it tells you it helps tell you who to call. So so I definitely see as a first-line practitioner, patients in my office where they haven't seen a specialist and um and vice versa. Sometimes somebody would not feel very comfortable with these changes in their body, and rightfully so. And they would call their general practitioner or their gynecologist. And it can really go either way. And we work hand in hand. If I see a patient and I really think they need to be seen by their general practitioner or gynecologist to make sure that there's nothing sinister going on, or that there isn't something more to this, and it really is just what it is and can be dealt with in my office, I will refer them immediately. And if they get seen, vice versa, by their gynecologist or their GP, and pelvic fluorotherapy forms a part of their rehabilitation, they would get referred. Okay. Now, with this being kind of the second part series, and we're talking more about we now have an issue. Um, what are some of the red flags that really do uh mean that like you need to see someone, whether it's a gynecologist or or you? Where are some of those red flags? Yeah. So again, just to highlight, like any changes, I think women put up with so much that we want to wait for red flags before we get help. Yeah. And and really in this stage of life that that women are going into, we don't have to accept that as normal. So they don't have to be a red flag to kind of get early assessment, early intervention, and better outcomes. When it comes to red flags in medicine, those are things that we kind of are more serious. Now we need to like escalate this a little bit and maybe see a professional. Luckily, in the on the topic of pelvic organ prolapse and pelvic floor dysfunction, like urinary dysfunction and so forth, there are very seldomly emergencies where things are sort of okay, now we're we're going. Okay. But um, I I would want to encourage anyone listening to this that if they have symptoms like we've discussed about prolapse or or any of these dysfunctional symptoms associated with um bleeding, like urine, like you in their blood in their urine, or bleeding that isn't normally related to their period, or blood in their feces, or if they have fever associated with these symptoms, or if they have a sudden loss of bladder or bowel control, right? So, oh, I've lost complete control of my bladder and this has never happened before. Or that they cannot empty their bladder, so urinary retention, those would be definite. Call your doctor and and go and see them. Okay. Now, going along the lines of the urinary side of things, so that like sneeze where you kind of pee, or the um you know, quickly running, or you're skipping or something, and there's like a little bit of peeing happening kind of thing. Um is that like a sign right at that time to be like, I need to go and talk to someone? Or is that more of like, I'll just give it a little bit and maybe I'll do some key goals and then you know, see if it continues to still happen. So you mentioned symptoms of stress incontinence, super common in the world of pelvic health. And um, I think of women, especially if they have children, right? And again, uh, how many patients come and say, you know, I've had leaking with coughing and running and jumping since I had my first baby 25 years ago. Right, right, you know, and um we women again, women are resilient and they put up with a lot, and we often label things as normal after childbirth or normal during menopause or just you know, getting on, just trotting along and focusing so much on our families and and on our careers and life and kind of shifting that a little bit to the back of our of our minds. But I would definitely say yes to your questions that that should be a sign that uh your pelvic floor support system isn't able to take the loads and the pressures that we're you're applying to it day to day, um, and it is failing a little bit. Now, you mentioned kegels, so very often, very often um we think that, oh, I have urinary leaking and my pelvic floor is weak, and therefore I need to do a thousand kegels. Yeah, and and that is not the case, right? So it's important to understand that pelvic floor and urinary dysfunction issues can develop um not just from a weak um pelvic floor, but also from a tight pelvic floor who's struggling, right? Um a pelvic floor that isn't working at the right timing, so timing becomes important. Um, a pelvic floor that that just has been under excessive load, like a chronic cough, like I've had for the last two months. My pelvic floor suffered significantly. Right. So, um, and sometimes you do not need to do kegels, you need to make some lifestyle adjustments, or you might need to do a different set of exercises as opposed to kegels. And that's why early assessment and individual care is super important rather than this is a cookie cutter, I leak, I do kegels. I wish it was that simple. Right. But it but it isn't. And and sort of having somebody help you and guide you through what exactly you need to do to resolve those symptoms, I think, are super important. So then going along the lines of what you're saying about the coughing, um, and you know, the little bit of the struggle as well, um do you just leave that until you start to feel better? Like, is there anything that you can do when a person has a cough? And why would a cough put strain on our pelvic floor? I think you two can hear now. I always take a back road, so let's pedal back and explain and then and then see how we got here. So the the the pelvic floor basically not just the pelvic floor, I hate just if we look at the pelvic floor in isolation, we're definitely missing some things. But we want to look at the pelvic floor as a and the pelvic support system, right? That consists of ligaments, tendons of other muscles, the pelvic floor muscles, um the um pelvic fascia, right, which are like very strong connective tissue fascia that help support the the vaginal walls and the organs and so forth. They they're like a dynamic scaffolding holding all of this together, right? And it takes load constantly. Like every time you run up the stairs, every time you cough, every time you move, this whole thing is kind of moving as well and under strain. If you go to German, do your little weight training, if you're pregnant, my goodness, right? So um the scaffolding is doing a serious job, right? So if you have something like a chronic cough, the load and the impact that's going through the scaffolding sometimes is just a bit too much, right? And it fatigues and tires and gets strained, right? Imagine carrying a heavy load on your back. You're straining, you're training, you're tensing using all those muscles. So those muscles fatigue or they become really tight because incontinence is embarrassing. So they're like, whoop, we're not gonna let this happen. So they they clench for dear life, and and that's dysfunctional. So then they can't hold the urine in because they're trying too hard almost in a way. So um, so that's why things like a chronic cough, it just excessively loads the system and the demand becomes more than the capacity for load. And that's where we see dysfunction. That's where any dysfunction is gonna kind of start developing. So, like, yeah, what do we do about that? We need to cough. Yeah. So, so one look one normal cough, coughing is part of normal life, right? We're never gonna not cough. Um, I think it's important to also say with dysfunction like this, it's often not one thing. It's often not your cold and the coughing associated with that that's causing pelvic floor. If we can use myself in this example again, like some like pelvic floor muscle issues due to sporting in my 20s, then uh two babies later. And um, so that it's like adding stripes to a tiger a little bit. And then I was sick for the last month. So that coughing probably wouldn't have been so detrimental to me, but because of the previous sort of strains and things that happened perhaps to my tissues, it's now not as strong to take that load. Right. So, what can we do? Like obviously, we do need to cough sometimes. It's good to learn techniques to cough if you have a chronic cough. It's good to see somebody like myself to understand um what is your pelvic floor doing and how can you optimize its function so that when that happens, right, you can handle it, you can actually you have the capacity to meet the demand, right? That's what you want to work on. And then a multidisciplinary approach is always important. If you have a chronic cough, you need to go to your GP and talk to them and sort out your allergies and figure out how do you decrease the load on the system. You don't just hack away because eventually that load will become too much. Right. That makes sense. It's really just getting to the root of the cough, right? The root of the understanding, yeah. Yeah. Okay. So then looking at pelvic floor dysfunction or prolapse, what are the most common causes? Now, the one of the things That I was gonna say about this too is um someone I know. Someone I know. Can we name them? Is it Cynthia? No. Friend of a friend. Actually, it's it's my mom. Um and she'll probably be fine with me saying this. But um she has the um bladder prolapse and um in Canada and basically was given a video to watch when she was diagnosed with it by the doctor. And my mom was saying, in this video, you are actually the person that is blamed for why you have the why you have the issue. Well, that's just very, very disheartening. That must be terrifying as well. Like, yeah, I mean, I don't think an individual can ever be blamed, right? Because also tissue, we just talked about the scaffolding, tissue integrity can be genetic, right? These things can often be genetic. So uh some tissues are more lax and more easy to like susceptible to stretching and being floppier, other tissues are more susceptible to be rigid. How are you supp like if your mom was pregnant with you? How was she gonna be in control of of how how that baby grew and and what happened to her pelvis and birth? So I think that's actually very sad. And again, it leaves patients with mental health. The mental health components of this can can often be debilitating because they feel alone and isolated and and well, some mostly just because of their symptoms, because it's changing their quality of life. And you don't want to go out and dance your heart out with your friends if you're weeing your pants. Right. Or laugh. But in your mom's case, that video also just made her feel sort of yeah, disheartened. Yeah. Which which is not what healthcare should be today. So genetics is one of the causes. Sorry, back to your question. I got carried away by by the sad, right? It horrifies me. Um so you're at your just repeat your question, sorry, Nadine. What are the common causes of prolapse? Yeah. Right. So back to my scaffolding theory. Anything that really affects these struts can be can cause prolapse. And it's very seldomly one individual thing. Occasionally someone will have childbirth and that will cause prolapse. But but it's often like I said, stripes on a tiger, it's the cumulative load over time. So hypothetically, um, a runner who's jogging a lot and doing lots of weight training. So impact, things that have impact, but that doesn't mean we shouldn't run, right? Or shouldn't lift weights. I'm not saying that. I'm just saying sometimes we do we lift too much weight that's appropriate for us, or we we don't necessarily do them correctly, right? And over time the load accumulates. Pregnancy and childbirth are major contributors to this. Things um, like I said, mentioned before, chronic coughs um and and other um conditions can sometimes contribute to this. And then I think menopause is a is a big contributor. Now, menopause doesn't necessarily directly add to the top-down load, like you can see, running, weightlifting, and all those things kind of have a structural loading. Um what menopause does, and as estrogen lowers in our body, estrogen can be seen like this uh tissue maintenance hormone for the pelvis, right? And it helps to keep the tissues kind of thick and flexible and supple and strong, right? And gradually, as that decreases, the tissues become a little more fragile. So the dynamic struts, the ligaments and things are a bit more brittle, a little drier, a little thinner, right? So less load is required for the system to collapse essentially, right? Makes sense. So menopause definitely is a major contributor. And you often see these patients kind of like myself, pelvic floor dysfunction, younger perhaps, pregnancy, childbirth, and then estrogen disappears, and we don't necessarily do HRT or help the tissues in that way, and then the pelvic organ prolapse shows up. I think we may have talked about it with um uh in a different podcast, but is it HRT or can it also be the vaginal um estrogen? You can use that, right, to help. Absolutely, yes. And seven great for a lot of women who are, because I think we talked about this with Heidi. Um, for women who may be like post-menopausal who are now having the incontinence and and that kind of thing. That's why Heidi was saying that she's like all day, every day, she'll prescribe that for a lot of the women because of what I've just kind of explained, what happens to the tissue. So I mean, I am not an expert on prescription and and advising on vaginal estrogen and HRT and all of that, Heidi and uh other women's health doctors are fantastic at that. And that brings me back to my point multidisciplinary team. You can do all the key, you can do your thousand kegels. Yeah. But if your tissues that don't kegel, the ligaments don't kegel, are are brittle and weak and and not necessarily thriving, you're still gonna have a hard time um managing that load distribution. So, so yes, I would say definitely if this is something that somebody is like thinking about right now as they might be listening to this, they should talk to their physician and get somebody in their corner to help them through this. And I think one of the things that we've realized now with this being the second podcast is um kegels are not it's not the answer. It can help, it's not it's not always the end of the answer either. Like it's definitely not gonna solve all your problems. No, which is women, I think would that's that's the go-to. Like, oh yeah. But but in in in every in in all of your defenses, pelvic health um, physiotherapy specifically, has come a long way in the last decade, right? So um they used to prescribe these Kegels to women, left, right, and center. And and we're so grateful. I'm so grateful to let we live in an era with with just better ways to do research, better ways to get these answers, and and that we can sort of move, admit that maybe we weren't correct and move along swiftly. Okay, so now we've realized that maybe something's wrong and we need to see a pelvic health physiotherapist. What happens during a pelvic floor assessment? Excellent question. Yes. I love how it's it demystify. Let's demystify the process, yes. It depends how much NCIS you've watched. I'm kidding, in the sense that it's a very detective process. Oh, like we we always look for culprits, what's causing this and and and so forth. Um I'm joking. Anyways, uh, to be more serious, a patient would come and see a public therapist, and it would definitely be a very sort of private private conversation and exam in a comfortable setting, right? So, first and foremost, uh um is sort of a subjective examination. So talking to your therapist and getting a very good understanding of what exactly are your symptoms. Because as you could see, pelvic floral dysfunction is so broad, yeah, it can cover so many parts as we've now discussed. And um, you also really want to dig deep into how we kind of got there. What is someone's history? What kind of led to this point? And and also maybe their family history. We just talk a little bit about genetics and so forth. So I always say that like that that's sort of where the gold is in a in a pelvic floor assessment is really getting an understanding of that person as a whole. Do they have sinusitis? What does that have to do with pelvic floor? They think I'm nuts. Why are you asking about my sinus, but until they learn how this really affects them? Yeah. So just like the coughing and the sneezing and all of that loads the pelvic floor. The post nasal drip. Yeah. So so we want to be able to refer and kind of we want to work on decreasing that load, right? And managing that. So that'll be the first part of the exam. The second part would be more what we call an objective exam. And that's kind of looking, um, feeling, and moving, right? And everybody thinks we're just going to dive right to the pelvic floor. But it's important to note that the pelvic floor works as a in a system in the body, right? So how we're breathing has an effect on the pelvic floor. So we would look at how somebody is breathing, how you're doing your squat and your lunge and at the gym might be affecting your pelvic floor. So we would do a movement examination. Your lower back pain and hip dysfunction might be affecting your pelvic floor. So we're going to look at how's your lower back and hip mobility, strength, and so forth, which are all non-related to the pelvic floor. So a lot of the exam is not very much focused on the pelvic floor, but acknowledging that the pelvic floor is a part of this more holistic system. And then lastly, well not lastly, but but um we get to the part where we occasionally have to do an internal pelvic floor exam. Now, that doesn't have to be done. If a patient doesn't want to do that, we can gain a lot of information from the things that I've just said, and we can still attempt to help. Sometimes it is necessary to assess the pelvic floor muscles, and that would be an internal vaginal exam. And if you think of any muscle assessment, if you've ever been to physio, it's kind of feeling what do these muscles feel like? Are they tight? Are they floppy? Um, what's happening to them? And then also kind of seeing how are they moving. So, what is your kegel doing? Essentially, can we rate it? No, I'm kidding. Um, how are these muscles working? And then how are they responding under strain like a cough? And can they relax and and how are they functioning? And then that all together kind of makes this picture of support structure, capacity compared to load, and then we can see where we need to start working. Is there an easy way to let people know when is a good time to go see a physiotherapist, pelvic health physiotherapist, versus like say a gynecological gynecologist or or yeah, I guess a physician? Yeah. So it's tough, it's a tough, it's a tougher question. Sorry. It's not clear-cut. Like X symptoms equals pelvic fluorophysia, Y symptoms equals visit to gynecologists, and these things are quite overlapping. Right. I guess, as I previously mentioned, if the symptoms are new and you're you feel very uncomfortable and unsure about what's happening to your body, and they might be persistent or more leaning towards the red flags we've discussed, definitely visit your gynecologist first. If you are familiar with your symptoms and you kind of intuitively know you should be seeing a pelvic floor physiotherapist, and you can um say my symptoms have clear aggravating factors. They're definitely worse when I run, or they're definitely worse with intercourse. That might point more towards perhaps starting with a pelvic flow therapist and then maybe getting referred to your gynecologist or GP, etc., if we think a more multidisciplinary approach like v um vaginal estrogen or so forth might be necessary. Um so we've talked a little about Kegels. Are there other effective non-surgical treatments to pelvic floor? To pelvic floor. Yeah. Again, it's very broad when we say just pelvic floor dysfunction, right? So sometimes if they'd say just in some patients, their dysfunction can easily be managed just by some lifestyle changes. They didn't even realize they were doing these things, bothering their pelvic floor, and just stopping that can sometimes already be a winner, right? Um, other times, like in pelvic organ prolaps, uh there is more work to be done, right? So it can vary on a range of of what needs to be done, but things like lifestyle modifications and changes, focusing on bladder and bowel habits and how we're going with that, and just being educated on that topic can be very useful. Then again, looking at movement as a whole and not just kegels. So exercising appropriately, breathing appropriately can be very helpful tools. Things like uh pezaries can really be helpful in pelvic organ prolapse as a non-surgical uh tool, very, very helpful improving women's quality of life and working that with pelvic physiotherapy can often provide great results. Right. Well, we had um Robin on the podcast, and she had it, was it called triple organ prolapse? Um and it happened after giving birth to her twins, and it was do you have twins? No. Oh I was like no, thank you. So she sorry for my shock. I still have young babies and twins scare that scare me. You just scare me. And she used a pessary, which yeah, she said she didn't feel like it was fitted properly, yeah, so it did she didn't find it helpful, and then just didn't bother telling, like didn't go back to sort of let them know it wasn't so she just stopped using it. And she had surgery in the end. She did. We actually um did the podcast with her seven weeks after um the triple organ surgery. Okay, yeah, but um very much changed the quality of her life, like where she was saying that it um her husband bought her a bike to ride with her kids, and she's like, I can't sit on the bike. And you make a very valid point, like pelvic floor dysfunction has a direct impact on women's quality of life. 100%. And and we again, I I I always wonder how they've been putting up with it sometimes for so long. Yeah. Um well, because I we talked about this on the part one of the episode with Danielle, where it's these taboo kind of topics, like women don't want to talk about if they're peeing in their pants or if they're pooing when they're not supposed to be. Now better, and you two are trailblazing this for them. Good. Um doing this part. Women should be talking about this, but but it is kind of taboo topics. I think 10 years ago no one mentioned this, but but we're slowly coming through that, and and more women are talking about it. Definitely, and I'm so just happy because someone's listening to this that once needs to hear this, and oh, for sure. Yeah. Well, and I think I maybe said it on one of the last podcasts, but um I know of a woman who had three babies back to back, and um even like laughing, running, she couldn't do any of that and ended up having the surgery, very successful. And the comment was made to her after the surgery by one of her kids that they had never seen her laugh because she couldn't, and so like thinking about how much that affects the quality of your life, or not being able like Robin, not being able to do certain things with her kids because you can't run, you can't ride a bike. But doesn't just that also just point to like she probably didn't even notice her kids never seen her laugh, then how good we are at compensating and buffering for that. She never even she probably got on with her life and just didn't laugh and didn't make anything of it. Yeah, agree. And um, so we're very women are resilient and just compensate for it left, right, and center. Yeah, definitely. Yeah. If we I just want to go back for a quick second. The lifestyle changes. Oh, yeah. Yeah. What are the what are some of those? So I mean, again, wide, broad topics, but let's let's touch, we can touch on a few for sure. Let's say you have chronic constipation, right? And you are straining every couple of days to have a bowel movement, you might want to look at your nutrition and your diet. And again, that multidisciplinary team uh approach comes into hand and to improve your soul consistency so that there's less strain on your pelvic uh support system, right? That that could be one of them uh silly things. Sometimes patients complain of frequent waking to urinate at night, and uh again, uh sometimes we're so busy in our day with kids and school drop-offs and well, or work or whatever we're doing that that we don't hydrate well in the early parts of the day. So something as simple as just hydrating well in the early parts of the day and not towards the end of your day when you're feeling really thirsty or maybe exercising can already improve your frequent night urination waking. So, so just uh critically looking at what you're doing. Yeah, can we talk a little bit about make changes in the last one too about some bad habits that yeah? I for sure have. I for sure have. And I didn't before talking to Danielle in episode one, um, I would I wouldn't I didn't realize these were bad habits, like where I'm in a hurry and just doing like the power pee and keeping pee as quickly as I can was one of them. But yeah, I don't think we realize that these are bad habits or that they could over time accumulate accumulate and have an effect because I feel fine now. So yes, so so like I said, sometimes you need more extensive rehabilitation and multi-tenant multidisciplinary approach, but other times a few simple things can really have a big impact. I think as well, some of the work that you're doing, uh I don't even know if I realized how much it's not just the physiotherapy side of things, it's the conversation where you're gonna meet with someone for 45 minutes or however long. And in that amount of time is an opportunity for a woman to talk about herself, right? Where we don't really get to very often. That is so what I'm there for. I love that. That is literally the part of my job that I love. Like they can just be seen once for every little part. And back to the little mental health part that I keep bringing up a little bit, because I just I think I just see so many women in my office, and it's not not even just related to their pelvic floor dysfunction, but somebody under a lot of stress. Stress, again, we're not gonna we don't have to unpack that in in the session, but it can be such a big contributing factor to pelvic floor dysfunction. And and um yeah, just like getting it all out sometimes is very helpful and a good starting point and for someone just to be seen. Right. If we think I might think about it in a range from like these pelvic floor dysfunction to prolapse being a bit more serious, can we actually can these things actually be reversed, or is surgery kind of the only option? That's a very good question. It also has many parts, as you can see with all these questions. Yeah. But I think as previously mentioned, very very few times in pelvic sort of dysfunction, as we've been talking about it, is there sort of emergencies, right? So surgery doesn't have to be right now. So often what ha what we what we do, what we would recommend or or so forth is that conservative therapies be attempted and give it a good go. And so if your conservative therapies and your changes that you've now made is still haven't re improved your quality of life and given you your confidence and your comfort back, then perhaps surgery might be the next option, similar to Robin, right? Maybe Pesari wasn't quite working out, she tried the conservative way, and it it just didn't cut it, right? So then surgery can be on the table. Now pointing to can conservative therapies actually reverse the dysfunction, we're gonna break it into two parts. Sometimes when it's just not pelvic organ prolapse, or this basket of dysfunctions that we sometimes point towards, yes, we can um significantly. Improve the symptoms that somebody is experiencing and improve their quality of life, and we would consider that a success. But when it comes to pelvic organ prolapse again, it's a little bit more complicated than that. And patients ask me this very, very often. So small prolapses, right? Yes, we again improve improving the things we've spoken about without repeating myself, can improve that. If you start with in Robin's case, you have three different kinds of prolapses. The support structures of the scaffolding have now failed a little bit. You've maybe torn a ligament, the pelvic fascia has strained and weakened significantly that the organs are no longer supported. But pelvic flora or conservative therapies can, in those cases, still improve somebody's um function and quality of life, but they cannot restore the anatomy to where it needs to be. Right. And and on the same topic is that tissue damage doesn't always directly isn't always directly proportional to dysfunction and symptoms. You sometimes see patients with severe prolapse that have minimal symptoms. And other times you see patients with small prolapses that are very symptomatic. So so, in terms of, you know, so yeah, I hope that that answers your question somewhat, but but it's very much a symptom quality of life thing that we want to ask ourselves. Can you live your life and enjoy it in the way that you would like? And most people are coming to you because it's affecting their quality of life. Yeah, 100%. Yeah. Okay. Makes sense. So when surgery is necessary, is there anything that women should know before considering that? Yes. Yes, I I think so. I think, well, knowing that consider there are conservative therapies out there. Yeah. Right. Okay. So if they want to try them, some patients are not eager to just go for the surgery, right? So knowing your options, I think is always a good, a good thing. And and then if you want to try some conservative therapies before having surgery, so that's always very good. And then also if you decide to have the surgery, I think it's important to speak to your surgeon, uh gynecologist, urogynecologist, etc. And understand the risks of the surgery and just also the success rates of the surgery. Some uh uh surgeries have a higher success rate than others, depending on the anatomy involved. And sometimes revision surgeries are needed. Okay. And so I think just like everything in this field, but specifically surgery, should always be discussed on a case-by-case basis. What's your tissue looking like? What's your life looking like? What are you gonna do after this surgery? Are you gonna, you know, be the next trampoline gymnast? Like, what are you gonna do once you've had the surgery? Yeah, yeah. And then I think my last important thing for for surgery is what are you gonna do after the surgery in terms of rehabilitation? Because just gonna ask you that's our next question. Sorry, guys. Oh, that's okay. Exactly. Let us right into it. What does recovery look like? How long does it typically take to see movements? I'm gonna get back to you on that in a second. But it's important to note that the surgery is going to help strengthen some of those connective tissues, repair some of the ligaments, get your scaffolding back. But if you're still overloading the tissue, right, and you haven't kind of helped the support structures through the pelvic floor, which we have more control over, your surgery is not going to be necessarily has the longevity that you would like it to have. So sometimes we think, oh yeah, stitch it up, put it back together, and off we go. Right. But but then we haven't looked at the lifestyle factors and the the load on the system. And that should be very much looked at sometimes prior to surgery and after surgery. Yeah. And that's where we kind of play a role as well. Well, or even for instance, like chronic constipation. Yes. Right? If you haven't solved that after you had your surgery, it's detriment. It's actually it's sad, and and that's not good. Like you wanna, if you are going to have the surgery, you kind of want to make sure you've ticked all your boxes so that that you can get the best quality of life out of that surgery. And again, uh that should all be assessed on a case-by-case basis because no two women are gonna be the same in any of these situations. Sorry, that I missed something. Recovery. Like what does it look like? How long does it take? Like, what does the recovery look like and how long does it take to see an improvement after surgery? So after after surgery, I mean, surgery is is very often very good at correcting the anatomy, as we've discussed. So very quick after surgery, women can see improvement, right? Especially if we're talking about post-op recovery. Right. Because the the bladder is sitting where it should sit, the rectum's gone back, the uterus is maybe removed, so no longer part of the problem. So so patients often feel feel much better. I think the recovery comes more into the the long-term factors, right? And and again, sometimes that can be resolved pretty quickly. Other times somebody needs more extensive rehab and an extra return to exercise. And that's also gonna depend on the patient's goals. What what do what load do they want to run? A marathon. Okay. Well, we're gonna have to do a lot more work to be able to tolerate that load than somebody who just wants to enjoy their life and trot along. Yeah, yeah. What's the biggest misconception women have about pelvic floor issues that you wish you could change? I think we've covered at least one of my is that obviously Hegel's does not fix this problem. Right, yeah. And um, I guess just if you have a pelvic floor problem and you want to address it, get some professional advice and get it addressed properly and get an individualized approach for you. You're probably gonna get the most out of it. So skip the giggles, get down there, figure out if you should be doing them or not. Right. Right. And then I guess the other misconception is that, and I and I'm sure you that's why you guys are talking about this, is that this is not normal. Pelvic flora dysfunction shouldn't be accepted as part of aging, as part of postpartum recovery, as as normal. And we can be informed, and there's and like I say, there's not even just one professional that can help you. There are many professionals who can point you at least in the right direction to getting help and improving your quality of life. Right. Yeah. Anything else that you think that do we miss anything we want to you want to discuss? Uh what's your thoughts on the high femme chair? Oh, Aimsla. Um come on. It that's an easy question. We've answered it repeatedly. How are 25,000 Kegels gonna solve any of these problems? Right. We've answered that question, I think, enough here. And I and again, like I think back to misconceptions. I think occasionally a lot of women come to my office, they've already concluded that Kegels might not be the answer. They already know they have a problem, so they're already there, so we've and they already want to empower themselves. So we've ticked those boxes. But um, they often think that you know, the pelvic, I'm gonna just examine their pelvic floor. And when we think about those high-femme chairs, it's just addressing the pelvic floor. It's not looking at the patient as a whole. And it's also not looking at the patient and how the patient engages in their environment. And environmental factors here play a huge role. So I think we're missing so much of the puzzle, and and that's just one piece of it. Do I say that someone cannot benefit from that? Absolutely not. But you need to know if that's right for you. Right. Is there anything else out there that you've like seen people come in and tell you about and sort of technology-wise? Or even just like old wives' tales or anything like that? Oh my yeah. Oh really? Yeah, yeah. Well, uh you you guys must be familiar with this, but uh a lot of misconceptions back in the day, along with the Kegel misconception, was that you should stop the flow of urine midway. Yes. Oh, yes, you're right. My goodness. And I mean, my heart stops kind of in my chest every time somebody says that, yes, I stopped my flow of urine midway every time I wee, and I'm like, ah, partly while you're here. And so that is such a such a that's doing more damage. That's doing so much more harm than good. Right? We need to get that like out of the books, rewrite those books. But no way of it. Because yeah, it's trying to- Because we think, or we we could potentially think that it's helping to strengthen it. Yes, and it's actually making it weaker by it's not making it weaker per se, but like the brain and the pelvic floor work together, right? So the pelvic floor is super complex as well, and in the whole body, like your brain works with everything. So you're basically training your brain that you should tighten your pelvic floor muscles when you're urinating, which you should not. You should relax your pelvic floor muscles when you're urinating, so you can empty your bladder completely. And then patients end up with things like not fully emptying their bladder, road tract infections, overactive bladder syndrome. So we just we're really messing with the the new the communication between the brain and the bladder there. Yeah. And so we need to get an end to that. I don't even know where we would have learned that from. I do remember hearing. I know, me too. Yeah, I do. There was also something else that you had brought up about um like the really heavy lifting. And I know you're saying like you're not trying to tell people to not lift heavy, but I'm assuming it's more in terms of like how you brace yourself. Yes, and how you breathe. I there's a couple of factors I think that implicate heavy lifting. And I'm actually just thinking about a patient I saw recently. I mean, when we're going post-40, right, we are being bombarded with eating protein and weightlifting to counteract the changes of bone health and muscle health, right? And and that is rightfully so. But sometimes some of some women just they haven't exercised in the last decade. Oh. And now they want to make up for it a little bit. So they're perhaps starting too eagerly. Yeah. And they are sort of imminently overloading tissues that haven't been stressed and loaded for a decade, right? Right. So the tissues are not kind of resilient and ready to take on that load. So very quickly, that can result in an overload, right? So, and I and I I can see that even for myself, you know, you kind of have two children, you never have time to exercise ever again because you're just trying to survive. And then you can see when they kind of sleep through the night, oh, here we go, we're gonna hit the gym, right? So it's a very common, I think, pattern. And um, so that could be part of it. And then there is the element of not breathing properly, not bracing, or using your whole body properly to do the technique, and obviously repeatedly doing that overloads the system. Again, another reason for why when you're doing your assessments, that one big part that you were talking about is like understanding how a person's body moves. Because if this person every single time does something, I'm not really sure, but like holds their breath, yeah, and they can learn how to not do that. And that can make such a big change, right? Just take like basically unloading the repetitive strain that we do to the pelvic floor. Right. Yeah. Sometimes we most of the time, uh in your like your mom, like no one's harming their pelvic floor consciously. No. You know? No. It's it's it's that we're not realizing that some women might even not be aware that they're holding their breath if they're doing an exercise. It's an unawareness thing. Yeah, yeah. Well, this is great. This is great. Yeah. It was it was. Thank you for coming on. You guys are so welcome. Thank you so much for having me and keep doing what you're doing. Yeah, thank you. Um, for anyone who does want to come and talk to you, have a chat with you, book an appointment with you, how do they get in touch? They will see. It will be a very long talk as established. Anyways, so yes, they can find me at Elevation Health and Physiotherapy, and they can just um look up elevation.ky and my details will come. And they don't need a referral. Uh this is an insurance-based question. So, depending on their health insurance, they might need a referral. I see. But they could come and see me and we can establish the um administrative details from there. Got it. Okay. Thank you guys. Thank you. Thank you. Thanks for joining us on Best 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 cable 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!