Why "Just Live With It" Is the Worst Advice for Your Pelvic Floor with Dr. April Ritz

This episode is for the mom who's been told that leaking, discomfort, or just feeling off in her body after babies is normal — but deep down knows it doesn't have to be.

MaKenzie sits down with Dr. April Ritz, a pelvic and obstetric physical therapist and the founder of Effingham Pelvic Health and Wellness. April helps women, men, and children with bladder, bowel, and pelvic health, as well as pregnancy, postpartum recovery, and birth preparation — and she brings such a real, compassionate approach to work that most women were never taught about.

Together they get into what's actually happening in your body after babies, why so many symptoms get brushed off as "normal," and how pelvic health, the nervous system, and gut health are all deeply connected. April breaks down the kegel myth, the link between stress and pelvic floor tension, why breathwork heals your core, and the gut and hormone connection no one is talking about.

If you've ever been told to just relax, drink some wine, or wait it out, this conversation will change the way you see your body.

What We Cover

When to stop accepting leaking, pain, and discomfort as "normal" — and the mental health piece that often comes first. Why your why has to be strong enough before rehab can work. The kegel myth — why tightening an already tight muscle makes pelvic pain worse. The connection between your nervous system and your pelvic floor (and the study that shows the pelvic floor tightens first under stress). Why 360 diaphragmatic breathing — not sit-ups — heals your core and diastasis recti. Why pain with sex after babies is common but treatable. What hands-on pelvic floor therapy actually looks like (and how consent and comfort come first). The gut connection — constipation, IBS, SIBO, and how your bowel health impacts your hormones, serotonin, and brain. Why individualized care matters and why no two bodies are the same.

Connect with Dr. April Ritz

Website: effinghampelvichealth.com

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Transcript

SPEAKER_01 0:01

All right. Welcome back to regulating and raising podcasts. Today's conversation is for the mom who's been told that leaking, discomfort, or just feeling off in her body after babies is normal. But deep down knows it doesn't have to be that way. So I am joined by Dr. April Ritz, a pelvic and obstetric physical therapist and the founder of Effingham Pelvic Health and Wellness. She specializes in helping women, men, children with bladder, bowel, and pelvic health, as well as pregnancy, postpartum recovery, and birth preparation. So as a mama for herself, April brings such a real life, like compassionate approach to this work, helping families really just understand what's actually going on in their bodies instead of just like brushing symptoms off. So this is going to be really eye-opening conversation around pelvic health, gut health, and what it actually looks like to support your body in this season. So, April, welcome to the podcast. I'm so, so happy you're here.

SPEAKER_00 1:06

Thanks, Mackenzie, for having me. I'm really excited to share this information with moms.

SPEAKER_01 1:11

I love it. All right, to start off with, I love for my audience just to get to know you on a more personal level. So tell us a little bit about like how you got to where you are today, because I feel like pelvic health isn't something that's super talked about. Um, and then also tell us about you on a more like personal level, where you're from, kids, all of that good stuff.

SPEAKER_00 1:30

Yes. So I am a physical therapist. I have my doctorate in physical therapy, and I honestly didn't even know about pelvic and obstetric rehab until I was in grad school. Didn't even know it was a specialty. I was an athlete throughout junior high, high school, and I was like, I am gonna work with athletes. That's that's my passion for physical therapy. And then I went to a conference and was exposed to pelvic rehab and learned. Well, I actually heard a lot of women in the bathroom talking about how much it helped them too personally. And I was like, okay, I want baby someday, like personally, kind of selfishly, like I'm gonna need this myself. And I knew in Effingham at that point there was only one other public floor rehab therapist. And so I was like, I'm gonna bring this back. I wanted to start a program at a hospital, which I did. Um, and then I just opened my own clinic. Five, it's been five years. This fall will be. Um, and so now I have a team of providers and we treat um primarily women, but we also do treat men with prostate issues and children with constipation, bed wetting, things like that. Um, but we have a membership at our clinic for pregnancy and postpartum moms because all moms need rehab. Even if they think they're doing well, their rib cages off, their core is off, their pelvic floor has been affected, especially postpartum. You either had your body went through trauma, whether it was a C-section or a vaginal delivery, both of those really affect our muscles. Um, so yes, I'm super passionate about pelvic health and pregnancy and postpartum. And I love actually one of my favorite populations outside of like chronic pelvic pain and really complex patients is pregnancy and postpartum worlds. And then personal, personal level, um I am married to my high school sweetheart. We've been married, it'll be 10 years. Um we have four kids. My first one was an unplanned C section. I was not obstetric trained at that point. So looking back, there was a lot of things I learned. And I say it was a God thing that he gave me an unplanned C section. And then I had a hospital V back, and I had two home births that were like physiologic births that were beautiful. Um, so we work with moms throughout the span, whether they're wanting the repeat section or whether they're wanting that physiologic home birth. We love working with all moms, no matter what they choose. Um and then, yes, so my kids now are seven, five, three, and I have almost one year old. Um, and I personally have experienced public rehab myself. Um, I've needed it with all my kids.

SPEAKER_01 4:01

So I love that you've, you know, had your own life experiences as well. I'm so excited to dive in. So my first question that um I want to talk about is I think so many moms have been told that things like the leaking, the pain, or even like constipation after having kids is just normal. And obviously we know that that is not the truth. So, at what point should a woman actually like stop accepting that and start like seeing it as a sign that her body needs support?

SPEAKER_00 4:33

Honestly, before we even get to that point, ideally. Um, so if it's a postpartum mom, we want them to come in in at two weeks. Um, and at that point, you are still gonna likely have some urinary incontinence issues going on after having a baby. Um, but we think all women need to be seen postpartum to work on so many aspects of care, even if they feel great. But if a mom is having symptoms and you're realizing this is affecting your quality of life, it's time to do rehab. With that being said, though, the mom has to be in the right mental state and have the support at home. Cause um, a mom, I actually was doing life coaching this morning in a session. A mom came in and was like, April, I know I need to be doing this stuff, but I go home and I can't bring myself to do any of it. And um, I was like, okay, you're penny to come in here. You know you need to be in here, but maybe your why isn't strong enough. Um, because moms were always like, we got to get the next things done, we got to get the kitchen clean, we gotta do the laundry, we gotta do the shopping. Um, and moms often put everybody else in before themselves. And that's what she's exactly what she was doing. And I said, I can't want this for you more than you want it. But then I also had the conversation. Sometimes we're seeing in moms and they're not aware of it. Is there any postpartum anxiety or depression that has popped up after having babies that we need to address? Because that can be a huge culprit of why we're not doing anything. Like we feel like we feel it. I had a patient a couple of weeks ago. World feels like it's crumbling down on top of me. I just can't manage doing exercises. And it's okay, this is not for you right now. We've got to get your mental health taken care of. Um, so I'm like, let's talk to your provider um and see what we can do for that. And then once you're feeling feeling better and you don't feel like you're crumbling and like there's not an elephant sitting on your chest, then we can come back. I'll I'll call you and let's see where we're at if you're ready to do some rehab. So I always tell moms, if you're having symptoms, the time is now to address it. But you have to be ready to physical therapy and pelvic rehab is not a pill. Um, we're not about a quick fix. Um, this is takes commitment. We need consistency. And if we don't have that, it's gonna take a lot longer to make the progress that moms need.

SPEAKER_01 6:55

So what's the average um that you see patients who are like postpartum?

SPEAKER_00 7:01

Uh like length of care. Yeah. It depends. So we have, like I said, we like to get most moms in at two weeks. Those moms aren't coming into us at two weeks, though, typically, unless they were a patient of ours during pregnancy and they realize the importance of that. Most moms, if they haven't even heard of pelvic rehab, they're not coming to us typically until four, six months later, sometimes even a year, because often they're told it's normal, it'll get better, just give it some more time until it doesn't get better and then it's gone on. Um, so we always, like in my postpartum class, I tell women, if you're still experiencing urinary leakage at three months, I think it's like 90 to 95% likely you're gonna have that at a year. So I tell moms at six to eight week period, if you're having urinary leakage issues, you need to call and get in right away. Um and then we see some moms, I see a lot of perimenopause, menopause women, and this really wasn't offered um 20, 30 years ago. Um, so we have some moms, 40s, 50s coming in, and they're like, I've been having low back pain, hip pain, um, pain with sex or urinary leakage or even bowel smearing now. Um, and some of these issues started after having kids and they haven't addressed it in 20 to 30 years. And I always say, it's never too late. It's not too late, but it is easier to address the symptoms right away than waiting that long. So, like my mom this morning who told me, she's like, I don't, I just don't know why I can't do this. I said, listen, based on your labor and delivery experience, you are gonna be the mom that's gonna be likely when you go into menopause and lose that estrogen, you're gonna be one of the moms that I come that come in and I see I'm starting to see more fecal leakage and smearing. Um, I've had a lot of moms with third and fourth degree tears that were like, I was fine in my 20s and 30s. I wasn't having bowel leakage, but then they hit menopause and they lose that estrogen and then the muscles get weaker too, and it's a combination of everything, and now they're having the bowel smearing. So if we can address that, rehab the muscles right away, it's gonna be better than waiting.

SPEAKER_01 8:54

Yeah, I mean, it's just building up. And the more that you wait, the harder, longer it's going to take to heal.

SPEAKER_00 9:04

Yeah. And we haven't even talked about like hip strength. With pregnancy, our hips often get really weak, especially our rotators and our SI joint, which is in our C. Um, there's often shifts that happen there in the pelvis, and we check that on all of our women. And if we can get you adjusted postpartum and then get you stronger to keep everything in balance, that's great. Um, some of the women I'm seeing, you know, like I said, in the 40s and 50s, like, I've had this pain. Um, I check their pelvic alignment. I'm like, you've probably been off alignment for 20 to 30 years since having those babies because it's very common with our ligaments and everything relaxing in our pelvis to allow things to expand for baby. It's very common to get some instability there.

SPEAKER_01 9:42

Is there any way for the mom who's pregnant right now to like build up the strength of those limit, those ligaments um so that it's not so hard to, you know, once the baby comes?

SPEAKER_00 9:54

So, not the ligaments in particular. The ligaments are going to stretch. We can't do anything about that.

SPEAKER_02 10:00

Okay.

SPEAKER_00 10:00

The muscles, though, the muscles give us the support. So often if we're getting um low back pain or hip pain, it's normally a muscular issue. There's a weakness somewhere that's not stabilizing. So a lot of these women I'm seeing left versus right, one side's weaker than the other. Um, so we're focusing more on hip strengthening in specific directions. I have women that say, Um, well, I go to the gym. Okay, great. I'm glad you go to the gym. That's really important. We need to be doing exercise, even pre-conception. But if you're just going to the gym and always doing squats or always walking or doing hamstring curls, whatever, you don't actually, unless you've been assessed by a physical therapist, you don't know where your differences are of left versus right and what muscle groups you really need to be targeting. Um, so yesterday, um, a postpartum mom who's actually a physical therapist came in. She's like, I'm doing great. And I was like, Let me check your hips again. And she was still off. And I'm like, Have you been doing your hip rotating exercises? And she's like, No. And I'm like, You've been going to the gym. I'm like, have you only been doing your squats and like heavy lifting and all that? And she's like, Yeah. And like, you can't forget about the small hip rotators. We have to get some hip rotation. Um, so even when people think they're doing great, even physical therapists, yeah, it's like, we got it, you need an individualized assessment. You need to be targeting the specific muscles that your body needs. You really need individualized the care. And then once you're like approved and you're doing great, and I say, like, okay, yes, you're up to this level of core exercise, then you can transition to some of those at-home programs. Um, but a lot of core exercises for women postpartum are too high level and can actually make things worse, like diastis rectus, umbilical hernias, pelvic organ prolapse, low back pain. So that's where like the individualized care, yeah, really comes in.

SPEAKER_01 11:44

I feel like the individualized care and just in general is becoming like more prominent. Like people are like starting to realize like you can't just like put a lump sum of people into these, you know, care plans any longer. And I hope like, you know, that's what my hope with this podcast is, you know, bringing awareness that like we are not all built the same way. We do not have the same bodies, we have not been through the same, you know, um, upbringings, um, you know, all of the assortment. So that is why like I love your work because it is so like individualized. And like you don't just go in and say, like, these are all of the, you know, um the movements that you should be doing. Like you, you're like before I remember like whenever we first met, you're like, I have like an hour-long, you know, consultation with my patients just to understand like their lifestyle, their history. And then I bring to the table, you know, a care plan that I think would match best with them.

SPEAKER_00 12:44

Yeah. So we do all of our treatments are one hour in length. And our initial evaluation for patients is two hours because we want to get to the full history. Like I always tell women, your low back pain, your thoracic tension, your upper trap, your TMJ pain. So TMJ and pelvic floor is connected. Um, all of that is connected. Your nervous system's connected, your diet, your stress, your, your how your like stress is how your marriage is, all of that plays a huge role. And we want to get into all of that and really see how you're functioning. Um, yeah, it's yeah, so intertwined. And that's how I'm like when I open my own practice, I'm like, we're doing two hour e-bows because patients need this. Women need this, they need individualized care, they need to be listened to, they need to be told what they're experiencing is not normal and just to brush it off and live with it. Um, one of my pet peeves is um I've had women told just for pain with sex, just drink a little bit wine, use some lubrication, just relax. And I'm like, okay, let's actually acknowledge that pain with sex exists and it can be like a musculoskeletal issue that can be helped and not just dismiss women.

SPEAKER_01 13:57

Why is it so like common that because I feel like um a lot of like people in my network have experienced like sexual pain after having kids? Like what exactly like happened and why is that?

SPEAKER_00 14:12

Yeah, so um vassal delivery or C-section, it really doesn't matter. You can still get pelvic floor dysfunction with both. Because if you think about it, you have all that extra weight pushing down on the pelvic floor muscles for nine to ten months, and your body, depending on how strong it is, how the hips, the core, the back, it braces, and that pelvic floor muscle sometimes tenses to try to withhold um that pressure coming down. And the more babies we have, some of my patients get more pelvic heaviness with each child where they get more of an achiness sensation. Um, so during pregnancy, sometimes the muscles themselves want to brace and tense up and hold. And then if you have um any degree of pushing, or if you have that vaginal delivery, if you have a vaginal delivery, the pelvic floor muscles I say stretch about 200%. No other muscle in our body is stretching 200%. And then if we take into consideration if there's any degree of tearing, that's second, third, or fourth degree, that's into muscle. And then we have the scar tissue that comes from that, or any stitches. Was there a forceps delivery? Was it vacuum assisted? All of those things play a huge role. Um, and this afternoon I had a patient and she's doing pretty good. Um, but her complaint at this time is like they've returned to sex and it was it was not comfortable. I said, okay, let's talk about it. Um, and so yes, lubrication is very important, especially if you're breastfeeding. We just have more vaginal dryness. Um, so it's called the genito-urinary symptoms of lactation. So just like menopause, there's a GSM or genito-urinary symptoms of menopause. There is now with the within the past year or two, they came out with this term, um, where there's a change in the hormones from breastfeeding. And so we recommend vaginal estrogen cream too. So we need to do pelvic floor rehab to work on scar tissue, pelvic floor tension. And this is where a pet peeve of mine is birth prep classes telling all women to be doing kagels or kegels. Not all women need to be strengthening their pelvic floor. A lot of women do not need to be doing that. They can actually increase tailbone pain, pain with sex, um, pelvic discomfort. So kagles are because if we're tightening a ready tight muscle, it's not gonna get any stronger when making a muscle more tense. So causing more pain.

unknown 16:39

Interesting.

SPEAKER_00 16:40

Okay. So um in our clinic, honestly, I don't know. I might have had one patient today that I was doing like pelvic floor strengthening specific with, but a lot of my patients are um breathing and uh coordinating with their pelvic floor to get it to open up and let go of tension so we're not holding tight. I mean, yeah, I think it's like your if it's like your bicep here and your biceps tight, we don't want to just do bicep curls here. We want to fully lengthen it and then like it full range. Same thing with the pelvic floor. We need it to be able to fully relax and then strengthen and lift up all the way through that full range of motion. So yeah, tigles are not for everybody. So if you guys have one takeaway and you're having pelvic pain or like endometriosis, PCOS, interstitial cystitis, pain with sex, tailbone pain, those are all things I would say immediately stop doing ciggles if you're doing them and find a pelvic for physical therapist in your area that knows what they're doing.

SPEAKER_01 17:35

So can you, I feel like we need to like take a like couple steps back. Um, because you know, after you and I met, like I honestly didn't even really know what pelvic health was um and like what it all encompasses. And now I just like love it and I want to tell the world about it, um, especially because um she is doing a training this fall on what you do you want to talk about that, like what that really entails about your the fertility training.

SPEAKER_00 18:09

Okay, yes. Um, like I'm doing a couple things this fall. So yes, um this fall, um, I think I'll be like the, I think it's the second, maybe, maybe the first. I don't remember. Um, pelvic floor physical therapist in Illinois, like certified infertility care. So I currently teach a menstrual cycle, our fifth vital sign class for um moms and daughters, as well as every once in a while, I'll offer it for adults because most women just don't know their body very well. And a lot of symptoms women are experiencing, whether it's like dysmenorrhea or pain with periods, abdominal pain, low back pain, pelvic pain, pelvic floor physical therapy is like first-linked treatment for that and not birth control. Okay. And birth control actually can cause pelvic pain to be worse. Um, there's fertility issues that can come with being on birth control. So um, I just feel like women need to be completely informed before they make the decision to go on birth control. Um, but the training this fall is working with women that are dealing with fertility issues and period issues. Um, so I am really excited about that. I'm already doing a little bit of the work for that in the clinic, but I'll be able to like come back with so much more information on how to um help women that are dealing with infertility, um, women who are not ovulating, PCOS, endo, all those types of things, as well as women that are in perimenopause, menopause, um, and considering like hysterectomies and these big like life-changing decisions and helping kind of guide them through of like what are your options if you don't want to jump straight into. I feel like a lot of women are just told, yeah, do a hysterectomy. And it's like, that's a big decision. Um, we fully discuss that and decide if that's what's best for you. Um, and have you tried all the things that you want to you want to try before going into a surgery?

SPEAKER_01 19:53

Love, love, love that, obviously, because my background's in fertility as well. Like whenever April told me that, I was like, this is amazing. Um, so I can't wait to hear how that goes.

SPEAKER_00 20:03

I do wish there's one more thing, McKinsey, on that too. Because when we talked, I just thought about is like most women, if they knew their periods better and knew what was going on, they wouldn't have to be like they they're just like the um unexplained infertility, you know. Um I just wish more women knew that there was other options before going to like IVF. Um, so we treat we um teach like cycle tracking in the clinic and like creatine model, cervical mucus. Um, I will sometimes hook a woman up with an actual instructor in our area who does creighton. But then there's providers to like creatine model is like a form of natural family planning. So it is based all off of cervical mucus observation. And then there's some that are like more basal body temperature, things like that. Okay. Um, and then there's doctors. We have some great ones in St. Louis who do it's called Naprotechnology, natural procreative technology. And I've actually worked with one of them, but their success rates, I have a handout on it, are so much better than IBF, and it's natural. Um, and and with IBF, there's so many risks associated with that. The pregnancy is more like, yeah, we could talk a whole podcast on that. Yes, we can but um yeah, so yeah, be on the lookout. If you're having fertility issues, feel free to reach out to our clinic. Um, I'll start taking a lot more clients for that later this year. Um, but I'm I am really excited to help women with this because women are spending so much money. And I'm like, oh, you guys, if we just could yeah, not have to do that.

SPEAKER_01 21:37

Yeah, at least like, you know, I I yeah, yeah, let's just not do that. Okay. So um you said like birth control can actually um you know, irritate the the pelvic floor. Tell me a little bit about like why that is.

SPEAKER_00 21:55

Yeah, that is a great question. So it's not all of them. Um, so if we're like if we're gonna get into specifics, um what IUDs, I don't even know if there's actually research on this, but I have seen it so many times in the clinic where woman was fine, pain-free sex, had an IUD, and then all of a sudden they're having pelvic pain and tension. The only thing I can really think of with that is there's this foreign object being inserted. Um, and our pelvic floor muscles are like, I don't like this in here. And then so our muscles tense up and guard around it. And I've had women that have got them removed and the pain goes away. So I'm always asking, like, do you have an IUD? Did was that inserted? Because I don't want to like jump straight visit first visit and be like, hey, I think it's your IUD, you know, because it might not be. It could be pelvic floor tension, there could be a lot of other factors. Um, but I have had a few women that have gotten those removed and they're like, oh, that is so much better. And now I'm like, okay, now let's work on releasing those muscles a little bit more since they were holding tense because of that pain from the IUD, then we now have to work on the muscles. So I say if there's like any trauma in any body part, our muscles around it guard and protect it. And so then we need to release those. And then um, some birth controls, um, research has shown this, can cause issues such as like um vulvo dinia. Uh, dinia is pain, vulva is like the vulvar region. So we can sometimes get condition a condition called um vulvo dynia or vestibulodinia, where the vulva and the vestibular vestibular tissue, which is like right inside the labia, um get really irritated and painful. And then that makes um sex painful. Sometimes even tight clothing can become painful too. Um, so yeah, that is a side effect of some birth controls.

SPEAKER_01 23:41

Okay, so so, so interesting. Okay, so can you just give, because like I said, like I had not really heard of pelvic health until I met you, like your quick spiel of like what pelvic health is and like where can it assist like women. Um, you you kind of mentioned men and kids, but like just kind of give like a quick synopsis of that.

SPEAKER_00 24:06

Yes. So pelvic floor physical therapy is physical therapy. It is hands-on musculoskeletal treatment um based off exercises, breath work, um, calming and nervous system, and we help for urinary issues, um, bowel issues, abdominal pain, back pain, hip pain, pelvic pain. Um, you come into the clinic, it is not a is not a quick fix. It is a two-hour initial evaluation, weekly, one hour follow-ups. And we um see people, we write out their plan of care for a full year. We're not seeing them weekly for a full year, um, but we're doing hands-on exercises based on what we find at that first couple visits of what we need to be working on. A lot of it can be education around bladder bowel habits. People don't even know what's normal. Um, some of our patients are just coming in for paint with sex. And then we're discussing pelvic floor tension. We're talking about like what are good, good brands of lubrication, because some ingredients we should not be putting down there. Um, we talk about positioning. There's our pelvic inlet and our pelvic outlet. So our pelvis has two holes to open. And so certain positions are better for some people. Um yeah, so that's and then pregnancy postpartum. We do birth prep, we work on sciatic pain, we work on any like any dysfunction, really, like neck to pelvis. We address because if we're holding stress up in our upper traps, our pelvic floor is probably holding stress too. Um, but yeah, I could keep talking. That's a I'll leave it at that.

SPEAKER_01 25:28

Hard question for you. You know, pelvic health. Um, it can be very intimate for, you know, women. Um, like I feel like that is probably a reasoning why women probably aren't coming in your door because they think that you you just said like hands on. Like you're not like physically putting like hands, like I guess kind of like tell us like what that looks like.

SPEAKER_00 25:51

Yes. So um we are we always get patient consent. So the first visit with it being two hours, if you are coming in for um pelvic floor specific issues, we do typically want to do a pelvic exam. If you're okay with it, we have some patients who have a history of pelvic trauma. Um, and so we don't do that the first visit. And sometimes it takes us a month or two to get there, and that is fine. Um, some people can't even tolerate their abdomen being touched. So um yeah, depending on like what level of trauma we're dealing with. So we start with where we can. Um, if a patient is cuffed comfortable and they're an adults, we do not do this with pediatrics. Um, if they're comfortable, we will do an internal vaginal exam. We don't use a speculum, your legs aren't pulled up and out. We keep it like our clinic is very homey. We want like you actually get like true real sheets. You're not on any pig plastic or like crumbly paper, you know, that's gonna stick to your butt. Yeah, but we will do an internal vaginal exam. It's one digit insertion. We are looking at first the outside muscles. There's two layers of pelvic floor muscle. So we're palpating and pushing on those muscles and seeing if there's any areas are like, oh, that's kind of tender. It should not be tender at all. And then we're doing the internal exam. And with that, we're looking at coronation. Can they squeeze? Can they relax? Can they do anything? Or is it just all tight and painful? Does it cause urinary urgency symptoms? Sometimes a pain can refer to the tailbone or to a deep butt pain or to a hip pain. It's all connected. And then based off that, we put together our program for the public floor. But we're also looking at breathing. How do your ribs open? Because a lot of people don't breathe properly. That's the whole session in itself. Um, we're looking at the core. Can the core fire? Can you engage your deep core? Are you just holding your breath and bearing down? Um, there's a lot to it.

SPEAKER_01 27:43

Wow. Um, so how does that, because obviously, like I'm a you know, nervous system lover over here. Um, how does this all relate to like why are you tapping into the nervous system in relation to the pelvic health?

SPEAKER_00 27:57

Yeah. So there's been um some studies done that show the relationship between the nervous system and the pelvic floor. So there was a study done that hooked up women to electrodes all throughout their body. And then they showed these women like core images and like videos. And the first muscles to tighten up and contract on most women were their pelvic floor muscles. And then the, I think second was their upper trap. But you know, we all know people like at work or in our lives that are like, oh yeah, I'm in my neck, I can't turn it, you know. And so a lot of people do get tension up through here. But even more women, when living in stress, pelvic floor is naturally gonna tighten and tense and pull up to protect us. Um, and then especially if we add on any history of sexual trauma, that makes and and sometimes women after that, their muscles just and they don't want to let go. Um, so yes, nervous system is huge. So for those patients, we don't even start at the pelvic floor, we start with breathing. 360 diaphragmatic breathing. Um, our ribs should be able to open out to the side, back and forward. It's not all upper chest breathing, it's not all belly breathing. We're getting our ribs to fully expand because that's our diaphragm. And our breathing diaphragm works with our pelvic floor diaphragm. So when we inhale, they both like lower together. When we exhale, they both lift up. And if they're we sometimes like this is so stuck on the pelvic floor and the diaphragm is just shallow. So if we can get to fully open and drop down, then the pelvic floor can start to drop. So yes, um, some of my patients I'm doing vagus nerve work on. Um, we have to calm down the nervous system. And again, like I said, if the nervous system is upregulated, they're not gonna go home and do their exercises. So we gotta get get that calmed down first.

SPEAKER_01 29:47

Yeah, I love it. Um, I remember like after my third kid um that like in the shower, like after I had um just labored him, like I would continuously do that because my uterus was so, you know, stretched out and I could see it on the sides. And like that helped me tremendously. What what's it called where your muscles are separated in the uh DRA or diastasis rectus abdominis. That helped me tremendously heal that area.

SPEAKER_00 30:17

Yes, that is our deep. So I normally don't give like general exercise recommendations, right? But deep breathing is one thing all women should be doing during pregnancy and postpartum. Yep. And then with DRA, learning how to engage the core with that too. So Yep.

SPEAKER_01 30:34

I was like, you know, I don't, I haven't done an like a sit-up, I haven't done and like I will say like I do have abs and like it's because of like breath work, like what you can do with it. Like it's a game changer. Um, so I agree, like starting there and your just postpartum journey is like crucial. Um, I want to talk about um constipation, IBS. Like, I feel like those like uh is such a common thing that like I hear time and time again from like my own family, let alone like my girlfriends. Like, you know, what is normal like pooping schedule in your eyes?

SPEAKER_00 31:11

I would love daily, daily uh daily once or twice. I don't really like once we're getting up to like three. If we're more than that, that's not normal. And I also don't like going every three days. Okay. So research really says normal can be every, it can say three times a day to three times a week. Okay. If you're going three times a week, you're kind of you're constipated. Okay. So like a daily bow movement. I love when people tell me, like, oh yeah, schedule. Like every day, nine o'clock. Perfect, good. Um, I do have a poop chart. Um, I think it's at my desk. Yeah, I don't have it here. Um, it's called the Bristol Stool chart. And it's type one to type seven, and type one is like little rabbit turds, type seven is like liquid diarrhea. And then like there's a normal on that range. So I'm always asking my patients where are you where are you at on the scale? If we have like little rabbit turds and you never feel fully empty, or if you're having a strain, if you have abdominal bloating, that is none of that is normal. You should be off the toilet within five to ten minutes of having a bowel movement. You shouldn't be sitting there forever.

SPEAKER_01 32:11

Don't bring your phone.

SPEAKER_00 32:12

Don't don't bring your phone. Bad habit. Yep. And that's hard for moms. Oh, yeah. It's like they're time to get away and it's like, I'm gonna scroll. And then I'm like, oh, your legs went numb. Yeah, you are sitting too long. Like it puts pressure on those nerves. Um, but yeah, so daily, I ideally a ty a good type like three, four, or five. I like type four. I say it's like this is kind of summer's coming up, but like soft serve ice cream comes out easy, soft, um, not like many cracks in it. Um, there should be absolutely no pain. But then on the other side of that, we shouldn't have diarrhea either. If you're having chronic diarrhea all the time, that's not normal either.

SPEAKER_01 32:50

So, what exactly is going on in the body for like ladder of both of those?

SPEAKER_00 32:56

Okay. Could be multiple things. There's multiple different types of constipation. Um, so it could be functional constipation, it could be like slow transit where your gut is literally slowed down. Um, so we do specific testing in the clinic to figure out what type of constipation they have. If they're if they're not responding to the typical normal stuff that we give, we will dive in into it more. Um, I had a patient that came in about a month ago with um severe constipation, would maybe poop once a week, maybe, maybe twice. Um, I think she it was all type number ones, a lot of abdominal pain, bloating, burping, and gas. Red flag went off immediately. And I was like, ooh, sounds like SIBO to me, small intestinal bacterial overgrowth. Um I cannot test that in the clinic, but she with that is typically always some pelvic floor dysfunction and abdominal dysfunction because our body has been dealing with that pain where everything starts to tense up. So I worked with a functional medicine provider and um she just got, she just came back positive for SIBO yesterday. So um working with other providers, and then when it comes to like irritable bowel syndrome, technically what that is, if I remember right, diagnostic criteria is I think it has to go on for six months, but abdominal pain associated with changes in bowel, so either constipation or diarrhea or both. And um typically with bowel movement, the pain is relieved. Um, but yeah, bloating abdominal pain, and then you're never like a good consistent number for. Um, so I do see that a lot in the clinic, and then we treat that. And I like to work um with a local um dietitian who is specialized in like low FODMAP and IBS. And so we like to partner together.

SPEAKER_01 34:36

Love that. And like just for the women who are listening, they're like, okay, I'm dealing with constipation or, you know, IBS. Like, you know, what is like what exactly is happening? Like constipation, like your poop is seriously just like staying in your intestine. And what it's doing is like leaking out of your gut, getting in your bloodstream. Like it is leaky gut and like contaminating your bloodstream. Like, and that is, I mean, can you do you agree with that?

SPEAKER_00 35:03

Yeah, yes. So um, I always say if we're not pooping every day, that stool is sitting in your rectum or somewhere, and the water is being absorbed from it, and so it's getting even more dry. And then our gut process helps process and metabolize our hormones too. Yes. So if we are constipated, our hormones and like estrogen are not being um like emptied out of our body like they should every day. So then we have more hormone issues as well. So yeah, it's our gut is so important, and there's a lot more coming out on gut health. Oh, but yes, our gut is so important. And if we're not having regular bowel movements, that can that can impact our hormone synthesis, like so so many things.

SPEAKER_01 35:43

Yeah, I mean your gut is your second brain as well. Like, I mean, it's gonna mess up like you brain fog, anxiety, depression. Like, if you don't get this situated, like it starts to shut down everything else. So that's why like I'm such a big proponent. As far as like IBS, like it's the opposite, like you're just like depleting all your minerals that you have. Like, so like that is just as important to get it figured out by a professional and to get the support that you need. I know my network, like everybody is dealing with this. And like, I'm like, I just want to cure everybody.

unknown 36:17

Yeah.

SPEAKER_00 36:17

And that's the thing too, that people have to be ready to get the help. Um, but normally people get to a point and they're like, I can't deal with this anymore. But the big thing is people realizing it is not normal. Uh like just because you were constipated as a kid and you're still constipated as an adult doesn't make it normal for you. It's still not normal. It can still be better.

SPEAKER_01 36:35

It should be painful, it should be easy. It should actually, I love pooping. It's it's like the highlight of my day. Like, I think it feels good. Like, you know what I mean? Like, that's the experience that I want everybody to have. So I appreciate you so much, April. Like I said, like I could pick your brain for days. You are so knowledgeable and she's put the work in and she's so passionate. And like, I just love everything that she she talks about. So if anyone listening wants your assistance, like how do they find you? What resources do you have available? Share with us.

SPEAKER_00 37:10

Yes, great question. So we are not your typical um hospital-based program. We are an outpatient clinic. You do not need a referral to see us. Um, so you don't have to mess with going to your PCP or your GI doctor to get in to see us. Just give us a call and we will get you scheduled. Um, it may not be with me, but we have a team of providers here and they're all great. I would not have hired them if I didn't believe so. Um, but yes, two-hour email, one hour follow-ups, just give us a call, follow us if you're like, I'm not sure about this. Follow us on social media. We're on Facebook and Instagram at Effinghampelvic PT. We also have a YouTube channel, same thing, Effinghampelvic PT. Um, check out our website, effinghampelvichealth.com. And then yeah, just call our office and we can always explain more information if you have any questions.

SPEAKER_01 37:58

She's so good about also like wrapping her arms around the community and giving free uh services and you know, education sermons. Um, so definitely follow their Facebook page so that you can track her down and pick her brain. So I appreciate you so much, April, and we will talk to you soon. Thanks, Mackenzie.