Mama You Belong
Welcome to 'Mama You Belong' - a podcast for moms in the thick of it. We delve into the need for belonging and connection that mothers often face alone and help you feel seen. We acknowledge the dissonance between societal expectations of motherhood and the realities of managing our mental and physical load, with science and trauma-informed support. Co-hosts of 'Mama You Belong' are Kirsten Desmarais, PT, DPT, OCS, CD(DONA) a physical therapist, birth doula, and mother of three, and Molly Hilgenberg, MSW, LICSW, a psychotherapist, singer/songwriter, and new mom.
Kirsten and Molly were both kids who collected rocks, hugged trees and grew up in different towns in Minnesota. They met only a few years ago when Kirsten became Molly's PT and then her birth doula. They bonded when they both realized they could pretty much share anything without judgment and text each other about the moon.
Through shared stories and expert insights, 'Mama You Belong' seeks to empower mothers by creating a supportive space for connection and understanding in their unique journeys. Each episode aims to provide validation, education, and some laughs. By sharing our stories and inviting expert guests in future episodes, we aspire to create a nurturing and inclusive environment for moms.
Mama You Belong
Your Pelvic Floor Matters More Than You Think (Motherhood, Recovery, and Women’s Health)
Why don’t we talk more about the pelvic floor? From postpartum recovery to long-term health, moms are often left in the dark about this essential part of their bodies. In this episode, we break the silence and explore what every mother should know about pelvic floor health.
Pelvic health specialist and physical therapist Kirsten Desmarais, PT, DPT, OCS, shares her journey into pelvic health and explains the interconnectedness of our body systems to the pelvic floor. She details common reasons people seek pelvic floor therapy while debunking myths about what's normal versus common.
• Kirsten's path to specializing in pelvic health began through working with perinatal patients
• The pelvic floor connects to multiple body systems including hips, spine, and visceral organs
• Common reasons for seeking pelvic health care include urinary leaking, pain, pressure sensations, and painful periods
• Pain with intimacy is an undertreated issue that many people suffer with silently due to shame
• The pelvic floor muscles provide stability, control openings, and play a role in intimacy and pleasure
• Postpartum incontinence is commonly accepted as normal when it's actually treatable
• Barriers to seeking care include resources, time, transportation, and insurance limitations
• Pelvic floor function often happens unconsciously, making it easy to disconnect from this area until problems occur
You can find Kirsten through her clinical practice online at empowerorthoandpelvichealth.com or on Instagram at @kirstendesmaraisdpt
Kirsten's Physical Therapy website
Hey, mama, you belong. We are so glad you're here. We are your hosts.
Speaker 2:Molly mental health therapist, singer and songwriter, tree hugger and a new mom like many of you and Kirsten, physical therapist, birth doula, deep feeler, lover of trees and fellow mama. We hope you feel seen through these episodes and truly believe that you belong.
Speaker 1:Hey, kirsten, hi, molly, Hi, how's it going over there?
Speaker 3:Pretty good, I feel like I have a flow going. Yeah, you're like jumping in my flow. It's going to be just get ready along for the ride. Ooh, just like jumping on the raft on the river. A hundred percent Cause it's either that or it's like a dead hold stop. So this is good, let's keep flowing. I know my brain's in a good place, okay.
Speaker 1:Well, today we're going to talk about your expertise as a pelvic health physical therapist.
Speaker 2:Yeah, and.
Speaker 1:I'm really excited to learn from you. I know we're going to kind of narrow in on learn from you. I know we're going to kind of narrow in on some aspects of it, but I guess I don't even know the answer to this question. What got you interested in becoming a specialist in pelvic health?
Speaker 3:Yeah, it was just kind of like a slow roll over time. I had worked at a hospital system in more of a neighborhood clinic setting, so I saw really just people from the community and it was everybody with everything. It was super great, especially as a new grad, to just get comfortable with a lot of stuff In. For sure, one of the practices that I one of the clinics I was at, there were some primary care providers who still did OB work and when they had their primary care patients who were pregnant they would go to the hospital and be there for their birth. And so I saw, you know, these clients were following up with their family practice providers postpartum and they started sending people with like back pain, you know, and would kind of ask like, do you do pelvic health? And at the time I didn't. And so I started just seeing more people specific to the perinatal season and it slowly bubbled further.
Speaker 3:When I moved to one of those primary practices I was split between two neighborhood clinics at the time so I just got to know the providers better. I got to know the patients there better. It was a smaller practice, it was me and one other physical therapist who was a mentor of mine and he was more of a manual therapist so I really improved a lot of my orthopedic and hands-on skills during that time. But anytime he had someone in this perinatal season on his schedule, he's like, why are they on my schedule? They should be seeing you. They're going to be more comfortable with you. You know, he's like you can be doing this, not even from the public health perspective, but just that like there's a level of comfort with he's like I don't even know if they're going to be telling me everything that's going on and just like a level of safety.
Speaker 1:Yeah like I think his awareness is okay I'm not know.
Speaker 3:There are some people who it's just like if they went to PT and their PT was just kind of a guy and didn't have any experience with this, it's like, how are they going to help me? Like. I would probably feel that way too.
Speaker 1:I personally would yes.
Speaker 3:Yeah, super skilled so. So anyway, I was just seeing more people in this season, saw there was a huge need and then the longer I did, it had this realization everybody's birth story comes out in their PT. It doesn't matter if they could be in really yep, they could mid back stuff, just kind of like core. Their birth story comes out and I just realized, you know, people are still processing specifically around birth, like what happened with their birth, and it's sort of almost this like integration with like birth and their body and and so. So that kept going and I did more training specific to pelvic floor stuff, more pelvic floor with fitness specific considerations. Then I did doula training, more pelvic health stuff, and so over time it became what it is.
Speaker 3:I definitely didn't set out being like I'm going to do this, I'm going to niche down and I still. I mean I have, but I absolutely still do orthopedic stuff all the time and have a board certification in orthopedics and more specialized in orthopedics than I am in pelvic health from a credential perspective. But also these systems are different but they're all in our body. So being trained in pelvic health and being trained in orthopedics allows me to really treat the entire. You, sometimes the ratio might be more orthopedic than pelvic health. Right, might just be some education, might just be like hey, watch out for these things. Let me know if you experience this stuff. Sometimes it's more pelvic health specific and there's less orthopedic kind of musculoskeletal stuff going on. But I don't think it has to be one and I think part of why I get to do what I do is because I have a lens for both.
Speaker 1:Yeah, I just really never thought about how much overlap there is. We think about the pelvis.
Speaker 3:We think about the hips, we think about the lumbar spine, the mid-back, the rib cage, that alone they all communicate, connect, interact with your pelvic floor, your visceral organs, pressure management, and and then you can still move on from there. How you manage limb, you know femur, foot rotation, control. There's a level of responsiveness that goes all the way up the chain. And people could argue that anything could be connected to the pelvic floor. I wouldn't say necessarily go that far, but I'm absolutely one to say like anything can cause anything. I guess, like if we want to look into it, we absolutely can.
Speaker 1:Yeah Well, even just like in my experience working with you, I was coming in with that chronic hip pain that flares up every now and again, without even really thinking about how it was tied to pelvic health, and then you know, it came tumbling out as we're getting to know each other and I'm your patient and going, I'm struggling so much with infertility. I've had a pregnancy loss Like this has been so hard. And you just asked such a gentle question around like how it might be related. I don't even remember how you asked it, but it was the first time somebody validated for me, like what I kind of intuitively felt, but that like there's so much connected to the pelvic health area and fertility and anyway it just it was nice to feel so validated and seen in that way.
Speaker 1:I think you felt that, yeah. So I mean for me, it took me forever to finally seek care and I wasn't having like a pelvic floor issue. But I am really curious floor issue. But I am really curious like what are, what are some of the reasons people come seek you out for pelvic floor issues or pelvic health issues, and what do you wish more people would reach out for help for instead of suffering with just you. You know, without knowing what to do.
Speaker 3:Yeah, so people seek me out for common things are going to be like urinary leaking, incontinence. Sometimes it has to do with really strong or sudden urge to urinate and sometimes it has to do with more stressful activities like running, jumping, sneezing, laughing, bigger movements like getting up from the floor. Those are really common things, sometimes more of those stressful movements that happens during exercise. So it's really specific to certain kind of movement like jump rope or running or a certain lift like push press or strict press, bench press, where it's like I'm fine until I'm not fine. Then there are other things people will come in with that are a little more specific. So people will have more persistent pelvic pain pressure, heaviness, changes in sensation, reports of like tension.
Speaker 3:There are so many different ways people will describe this, but it's persistent Years and years and years and they've kind of bounced around with in-network care and just feel like they want something different. Maybe they want someone to take into account that they're a whole person. They feel like they've been kind of had every test done, you know, and so I have more of the persistent pain. Sometimes endometriosis can fall under that category too, but not everybody with endo would categorize themselves in that persistent pelvic pain category. So understand that people can seek care for endo. Another reason would be just really painful periods or painful ovulation. So we'll work on that, but that's a reason why someone comes in. I have really painful periods. I'm going to public health PT.
Speaker 1:How many of your patients are working with you and do experience kind of what I'm talking about? Do experience kind of what I'm talking about, but maybe even more on a level of like they've been talking to a provider for a long time trying to understand what's going on and then they see you and they get answers finally, like does that happen?
Speaker 3:Yes, because sometimes providers their job's to rule out the really scary things. Most of the time these symptoms are not that, but sometimes if we have some pelvic pain, lower abdominal quadrant pain, maybe we need imaging, maybe they need to do something like that to rule out the major stuff before they're comfortable saying, okay, it's probably this. But I have the privilege of spending more time with people and asking some pretty thorough subjective questions to understand the behavior of what they're experiencing is that can help a lot and that we can pull some threads from their story about, like, what do they think is involved? What do they think is going on? That reveals a lot and sometimes people don't necessarily connect the dots and that's where my questioning and curiosities can help us. But oftentimes people have a pretty good idea of what's happening in their body and if they've had some ominous stuff ruled out already, that gives us the green light to really kind of pursue some things.
Speaker 3:So when that validation happens is sometimes when I can recreate their symptoms that they're experiencing or they experience something that they're not like. So I'll say like maybe I'll notice something. Or like if we're doing some kind of an assessment and I identify something and they're like yeah, it's that thing. When I do this, this happens. You notice that and I'm like, sure, right. And then when it's like they get they feel seen, they're finally someone, whether it's like I can actually feel their symptoms. Maybe it's like they get they feel seen. They're like finally someone, whether it's like I can actually feel their symptoms. Maybe it's that pressure heaviness and we realize it's a pressure issue and they, how they pressurize their abdomen, abdomen or manage that pressure is creating some of that. And for me to be like, oh, right, there during that movement when you did your your thing with your breath, then they're like, yeah, that's so helpful to have someone be like that's. I see that like that's the thing. Providers, the kind of testing that they do sometimes, that just doesn't allow for that.
Speaker 3:It doesn't make them know that this might be the cause, might be, but they don't have the luxury of doing the kind of assessments and the prolonged subjective conversation to be able to have that occur there. It's just not designed for that and there's lots of reasons for that. But coming to my office when we have an hour, we do get to have a longer conversation. I can look at some things and take a little bit of time and honestly I go over pretty much every time I have a new client. You do so if you're listening and you haven't seen me plan for an hour and a half. I'm working on it, but there's too much stuff to figure out.
Speaker 1:It's like I'll never forget that feeling because I was like watching the clock, like, wow, it has to go so fast, just like every medical appointment and this is going to be, you know, in and out, but you take so much time. And I'm sure there are other specialists out there who have their own clinics who can have that luxury of time. But it's just not like that in a larger place where you have to go in for a quick appointment in and out, and that level of deep care and questioning is such a different experience. It like bended my mind.
Speaker 3:It was so cool. I'm glad you felt that way, because that's why it's designed that way.
Speaker 1:So what do you wish more people would come in for help with.
Speaker 3:I think pain with intimacy is probably a really big one that more people experience. They've either been told certain things about that from their provider, if they bring it up with their provider, but I think there are a lot of people out there who don't bring it up. They may not even bring it up to any partner and they deal with it. Maybe they self-medicate alcohol, something to literally like change how their body responds. But there's so much around intimacy with societal pressures and expectations if you add any cultural or religious beliefs or expectations, but then you also have, like another person or people involved in this and their feelings and expectations and it can get really complex, like pretty quickly. But there are so many different ways to address painful intimacy. It isn't, it isn't just a stretch or the use of some kind of tool or internal pelvic floor treatment. There are so many different ways to assess it and some of it or sorry, to treat it, some of it really depends on what someone's ready for, what they think is a good place to start.
Speaker 3:You know what is really going on. Is their nervous system really ramped up? Is this more of like a partner to partner thing? Is this a education thing? Is this a pelvic floor thing, and oftentimes there's a huge combination of those things. But I think there's a lot of people who don't seek care, who experience symptoms and it's impacting their relationship with themselves, their relationship with any partner, and they a lot of people internalize it like they are the problem and then they experience so much shame because of different parts of this that then the idea of seeking care is like it gone, like can't even do it. But what if it wasn't super challenging to learn some things, to change this experience and you know if they're ready to work through some of these more more challenging aspects of it? But I would say I think there's a lot more people who are experiencing that, who could be seeking care and who aren't.
Speaker 1:It seems like the way you're assessing and understanding the complexity is such a trauma-informed approach. I'm curious did you just sort of find that along the way, or did you actually seek out trauma-informed training Like, how did you get to this?
Speaker 3:point and educational opportunities that I've participated in that are definitely a little bit more intentional about discussing these things the idea that it's quite common to have a client in your office that has experienced some form of abuse or trauma is quite high, One in three right.
Speaker 3:Yeah, that idea is quite high. One in three, right, yeah. Yeah, that idea is not new. But that doesn't mean that people, that every training includes a practical application of what we do with that information. It doesn't mean that I am afraid of triggering somebody. I can't tiptoe around some things that are kind of integral to the reason why they're there.
Speaker 3:Yes, and I need to be able to trust my clients, but how we work through that is together and a lot of what I do is really just informed consent for a lot of things and every time and in that, when we're talking about, like maybe pain with intimacy, some of it is clarifying language and being sure that, like we're talking about the same things, people don't always use the correct anatomy language and maybe it's because they don't know, maybe they're uncomfortable saying certain words.
Speaker 3:So some of it is like clarifying and being really clear about what someone's experiencing and giving them an opportunity to help me understand. Giving them an opportunity to help me understand, but also educating them about what the process can be like with me and that they have a choice in how a session goes, in what we talk about, if certain aspects of assessment or treatment are off the table and if that's off the table forever, if that's off the table today, right, but that there are many different ways to understand what's going on and to treat what's going on, and that they can decide what's okay for them in that moment, and they can always change their mind. And here's what that could look like.
Speaker 1:Yeah, I really appreciate what you're saying about how you're not going to tiptoe around clients and hold your breath that you're going to trigger somebody because, that's not fair to best for them, especially in a world where there is just like it's not just possibly sexual trauma, it's medical trauma, it's like so many layers of what someone's experience could be. So just treating them as the consenting adult that they are and giving them that information and trusting and building that rapport where there's safety and they can say what they consent to, exactly, that's yeah, I love that A lot of people come in just expecting if they come in with a pelvic floor issue.
Speaker 3:If they come in with a pelvic floor issue, they're expecting an internal pelvic floor exam assessment and oftentimes they have had pelvic floor PT in the past and they weren't really offered a different opportunity for any kind of assessment, or that it didn't all have to be done on that day, or maybe actually, I want to be sure. So what I usually say is you know, I understand a lot of people are expecting this assessment. That can be a part of this. Here's the other things that I think would be helpful for me to see. I you know, and based on their story and the symptoms that they're having, here's definitely the top priorities. Here's what an internal assessment, that information could give us. Here's how that might look. There's different ways for an internal assessment. If you know, I want to be sure that you leave here with what you wanted to leave here with in terms of information, homework, knowledge, right, and if that specifically included an internal assessment, regardless of why they're there, 100% will do it. I'm also not going to do an internal assessment on every single client I see that has pelvic floor symptoms if I have a ton of other stuff to do that day, or especially if they're hesitant in any way, because I would prefer to build safety in a relationship, because I'm going to gain information, we're going to get homework going, we're going to get treatment going. But if we had a plan for the next treatment, the session, to include an internal assessment, here's how that would go, here's what we're going to look at, here's how that's going to change what we're doing or not. That gives people a little bit of time to wrap their head around it and I've had both scenarios. I've had people where they're like, if it's not going to give you, if it's not going to change what we're going to do today in terms of the other assessment and treatment, because they also had co-occurring musculoskeletal issues at the pelvis or low back.
Speaker 3:I like to tackle those first, because sometimes the pelvic floor just like jumps in and wants to just either help out or do what everyone else is doing, and I like to downregulate or support what the pelvis and that lumbopelvic region needs musculoskeletally first. And I'm sure there's pelvic floor PTs out there who would do the exact opposite and that's fine. But anyway, if it doesn't change what we're going to do that day. They're like I'm fine waiting, like I don't, I'm not dead set on having this assessment today. And there are other people who are. They're like I would feel better if I had this assessment and you told me what was happening, because I don't know what's going on.
Speaker 3:I'm afraid about it. They have their reasons why they're like this would actually be helpful, just the fact that we did this assessment. And then it's like okay, well, let's do that first, let's get, let's get that going first. But if I didn't give people choices, you know a group of people could be leaving and they're like oh, I didn't know we were going to do that. I guess it's fine, they would have gotten information, maybe it wouldn't have even changed the outcome, but it was like ooh, abrupt. I didn't feel like I could have, with them, created a level of safety in a relationship that I could have if we started somewhere else first and then the opposite. Right, so choices yeah, choices.
Speaker 1:As you were talking, I feel like we need a side note. Can we break down what the pelvic floor is, and you've told it to me before, but I forgot. Yeah, maybe someone else out there doesn't quite understand what this whole pelvic floor thing is so your pelvic floor is a group of muscles that sits in your pelvis.
Speaker 3:If you are sitting right now or you can be in your body enough to think about your butt bones that you sit on and then kind of towards the front, where your pubic bone is, there's a triangle that you just created between your two butt bones and your pubic bone. That triangle is essentially where that pelvic floor lives in, between kind of that triangle.
Speaker 1:And it's made of like muscles and it's muscles.
Speaker 3:Okay, and they have a handful of important functions. Some of the main functions are they do give the pelvis stability. They control the openings, so they keep the openings closed when they need to be closed and then they allow the openings to open on purpose. Okay, they're also a part of intimacy and pleasure. They're also a part of intimacy and pleasure and they're important because some of their function, especially with some things like it, it isn't always conscious or voluntary.
Speaker 3:Let's take the pelvic stability, for example. If you're going to quick stand on one leg or go like jump up the stairs, you're not going to think about what your pelvic floor is doing to help support the stability of your pelvis. When you needed to do something single leg like that, it just happens. When you're going to cough or laugh really hard, like, let's say, you like almost aspirated something and you're like really coughing, every single time you cough you are not consciously having to turn your pelvic floor on. It really functions with a lot of other systems and really without a lot of thought. So it's not uncommon for people to not really be connected with their pelvic floor because for the most part it sort of functions on autopilot for a lot of people.
Speaker 1:It's interesting because it's like kind of like the way the breath works right, like I'm always coaching people in therapy on like deeper breathing, but we're always breathing. You're not thinking all the time about breathing to survive, but sometimes we're not breathing in a way that could benefit our whole being right, everything involved. So, yeah, just knowing that there's just so many other things like involved with moving, laughing, cut, like all of these movements, and that when something doesn't feel right, if something feels off, like I guess where I'm going with this is, I hear so many times people mostly women joke about like oh honey, you've had a baby, you're just going to pee a little for the rest of your life. When you do blank right, when you cough, when you laugh, I would really like to understand from your perspective, why does that become normalized? I know that there's other countries, like France for example, where pelvic health rehabilitation is built into your postnatal care. But what? Yeah, I want to hear your perspective on that.
Speaker 3:Yeah, I think it's normalized for a lot of reasons because it is quite common, right? Okay, I think some people interchange the word common with normal, and that's where I'm like. Just because it is really common among people who have given birth, it can also happen without ever giving birth. People can have pelvic floor dysfunction and symptoms. It just is quite common for people, especially if they've had a vaginal birth. But I think they don't know that it can get better. They're maybe truly naive about that, that this isn't normal, or it's easier to laugh at it than it is to address it.
Speaker 3:Or it's easier to laugh at it than it is to address it Mm-hmm. And that goes to maybe a little bit of the shame or maybe even guilt that they have, like maybe it was their fault, maybe part of their birth or how they did or didn't exercise or other things that they are attributing to their symptoms, and it's easier to laugh at it, mm-hmm, to their symptoms, and it's easier to laugh at it and make it a joke than it is to actually say like, oh, this is something that I should seek care for because it doesn't have to be this way.
Speaker 1:And I would add on, just from my social work, brain resources, right, like that might be another reason. Just resources, time, transportation, money, all of the things to get, oh yeah, a specialist for that.
Speaker 3:Barriers are absolutely there. And then when you look at, yeah, even the financial aspect, insurance companies aren't forking over more money Each year, it's less. They're not. They pay for less. They scrutinize the claims. They, you know, change what they're going to pay for how long, how many visits someone has. Those cost containment, cost management strategies from insurance companies only increase in intensity.
Speaker 1:Yeah, With time. Well, that's a good segue into just acknowledging that you don't bill insurance Correct and there's a reason why you don't do that Kind of like what we were talking about earlier, right, Like a whole hour for an appointment for an assessment A whole hour.
Speaker 3:That's tough to find in an insurance model at this point in time and that's just because it truly is not sustainable from a financial perspective for the clinics to allow a therapist to spend one-on-one an hour with you for one session, let alone more. Yeah, if you are using insurance and there are other stipulations of how many units PTs can bill, and certain insurances are a little bit different. They pay different money for different billed codes. It's a whole thing. Then you look at your deductible. You know, is the clinic in network or out of network? Are you close to meeting your deductible? Do you have what you know?
Speaker 3:And all of that is pretty overwhelming. And if you don't really have that much hope that it can be different, or maybe you've already tried once and it didn't really change and your experience was kind of subpar maybe your therapist was nice but you didn't really connect and you didn't really feel much difference. Maybe they didn't understand the kind of things that you like to do or the way that you need to exercise or care for yourself, and so they couldn't really match treatment with that. It's like there are more barriers than positives. So I understand why people don't seek care.
Speaker 1:Yeah, yeah, same goes for me with therapy. Like it's just, I totally understand.
Speaker 3:I get it. I just had someone see me recently and they were like why didn't I come in sooner? And I was like because you couldn't. Yeah, you couldn't, but you're here, now and that's great. Yeah, so if there's people listening who have pelvic floor dysfunction or or other orthopedic things going on and you are like yeah, yeah, right, like whether it's financial barriers or, you know, resource specific barriers that cause you to feel like you can't get there, just know that maybe you can't right now, not in the way that you think you should.
Speaker 1:Yeah Well, thank you for sharing some of your wealth of knowledge with us. I hope we can continue to do some more episodes on pelvic health, because there's so many deep dives we could do, we could talk about. Yes. Any last final thoughts before we close our episode?
Speaker 3:I don't think so. I think it's felt good to get out there.
Speaker 1:Yeah, empower ortho and pelvic health with.
Speaker 3:Dr Kirsten Demere, that's right, thank you. Okay, yep.
Speaker 1:Thank you.
Speaker 2:Thanks for listening. We hope you feel seen. If you enjoyed this episode, please share it with other mamas, subscribe to our podcast and leave us a review, if that's your thing. You can find me on Instagram, kirsten Demaree DPT, or through my clinical practice online at empowerorthoandpelvichealthcom.
Speaker 1:And you can find me, molly, through my music at Sister Viri on IG or streaming on most music platforms like Spotify, or you can find me through my clinical practice at Insight Counseling in Duluth, minnesota. You can follow us, too, or send us a DM on Instagram at MamaYouBelong, and we will see you next time. Please remember that when you're feeling alone, you still belong.