Better Me with BodyByBree
Better Me with BodyByBree
Healing Your Pelvic Floor with Pauli Hannan
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It's not normal to pee your pants! This week, Bree is talking with Pauline Hannan, a pelvic floor expert, all about strengthening, healing, and protecting your pelvic floor.
You can find her at www.beyondthevwomenshealth.com and on Instagram @byondthev.bypauli
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Are you looking for a space where you will learn to improve your mental strength, emotional health, and heal your insecurities from the inside out? Take the first step to living a more meaningful life with the Better Me with Body by Free podcast. I'm your host, Bree. I'm a certified personal trainer, entrepreneur, and mother of three. I've helped empower thousands of women to take action through fitness, nutrition, meditation, personal development, and aligning thoughts with action. This podcast is for those who are ready to feel inspired and motivated to live a more purposeful life. Let's grow together. Did you know that peeing your pants when you run or jump after you have kids is not normal? There are so many things women just deal with because they're told that that's what happens when they have a baby. But that's simply not true. There are things you can do to strengthen your pelvic floor and protect your core after you have a baby. And I brought Pauline, a pelvic floor specialist, to chat about ways that we can strengthen and protect our pelvic floor. We also talk about common misconceptions, things we all do that make our pelvic floor weaker, and signs to look out for if you do have a weak pelvic floor. Pauline has been practicing as a pelvic floor physical therapist for over 12 years. She specializes in simplifying incontinence, pain with sex, core and pelvic floor strengthening, and other pregnancy and postpartum related issues, as well as exercising programming that target and focus on the female pelvis and its relationship to the rest of the body. She has a clinic in Utah County Beyond the V physical therapy, online pelvic floor workout program, and no cagles university. She also has a YouTube channel devoted to discussing all things related to pain with sex. She is the mom of two, married to the man of her dreams, enjoys her chicken and dogs, and riding horses. Her mission is to help women overcome their postpartum issues, no matter how long ago it was, and to empower and educate women on how to solve these issues because there are answers and it's a whole lot more than cagles. Let's get started. Hi, Pauline.
SPEAKER_01Welcome to the podcast. How are you? I'm great. Thanks so much for having me. I'm really excited to do this.
SPEAKER_00Well, I'm excited to have you on the podcast because you know how passionate I am about pelvic floor health and core. And I feel like so many women just live with these issues that they think are normal and they are not normal at all. So I'm excited to talk about it. And we actually had a phone call a few days ago, and I was like, I'm gonna title this, It's not normal to pee your pants. Because so many people think it's normal, right?
SPEAKER_01Right. You're so you're so right on this. And I'm so thankful that you talk about it so much because I I feel like women in your industry, if they could do more talking about this and provide more guidance and referrals, I feel like it would make a much bigger impact because I I think women are more likely to trust people like you that are authentic and genuine and providing women with real and lasting results in their life.
SPEAKER_00Oh, thank you. That means a lot. Um so I actually am kind of upset that they don't give more care for your pelvic floor and your core after you have a baby. Like at your six-week checkup, they're like, okay, your stitches look good, you're good to go. And that's it. Like they do no rehab, no education. And these poor women just go out and have no idea what they're doing, and then a lot of times end up hurting themselves. And the reason why I'm so passionate about it is because I don't know if you know my story, but and I've said this in one of my podcasts a long time ago. But um, after I had my first daughter, Olivia, before I got certified in pre and postnatal fitness, um, I was just so eager to feel like myself again after I had my baby that I was in the gym two weeks after I had my baby. Like, I'm pretty sure I still have stitches. And I wow, I was like lifting weights and I'm like, I just want to feel like myself again. And I actually ended up having a prolapse uterus because I was putting too much strain on my pelvic floor and it wasn't healed yet. And so I'm like, oh my gosh, I and then I learned all about pelvic floor. I went to a specialist, and that's when I'm like, I need to get certified in this so that I can help other women after they have a baby, not do what I just did. So now I'm very passionate about spreading the word, and you are an expert, and I'm really excited. So, what made you so passionate about women's health and pelvic floor?
SPEAKER_01Um, well, it was actually an accident. I had done some observation work at a uh women's health clinic, and they did a lot of postmastectomy care. So after you have part of your breast or most of your breast removed after a cancer diagnosis. And so I started a rotation thinking that it was going to be all post-mastectomy care, and it was no post-mastectomy care. It was all pelvic floor, and I was honestly mortified. I felt sick to my stomach that first day, but I started hearing all of these heart-wrenching stories, you know. Um, I I tell them a lot. So if you've heard me say this before, I'm sorry for saying the same stories, but there was a gr a grandma who wanted to watch her son graduate from Tulane medical school. This was down in Louisiana, and she she couldn't because I think she was, I mean, I can't remember, it was so long ago, like 13 years ago. She was going through like four pads within an hour or two. So there's no way she could go watch her grandson graduate from medical school. And there was another like blood or pea? Like what do you mean? Of pea, of urine.
SPEAKER_00Oh, so that told me, like she couldn't, she couldn't hold, she had incontinence.
SPEAKER_01Yes, yeah. So she was going through that many, that many pads because she couldn't control her bladder because her pelvic floor was weak, and it was it really hurt my feelings that cause because I knew there was answers. I didn't know, you know, really the full extent how to help her at that time because I was still a student, but it it really hurt me because my grandma could go wherever she wanted, and I thought she should be able to go wherever she wanted. And there was another lady, and this story kills me every time I tell it, but she told her husband that he could just go be intimate with whomever he wanted because it hurt her too much to be intimate.
SPEAKER_00Oh, sad.
SPEAKER_01Yeah, it it really was, and and that's not the first time I've heard that story. And so there was enough stories like that. Um, those are some of the bigger heavy hitters that I remember that I just kind of realized, you know, this is not about me. And if there's answers, and I forget who says the quote, but I don't know, maybe Eleanor Roosevelt or something, I'm not that well read, but where they talk about, you know, if you can if you can get women, you know, to change the world, you know, a whole lot there's going to be a lot bigger impact. And so I just really think that if we can I mean, from your end and from my end, if we can offload some of the burden of these women so that they can go, you know, be better mothers without this burden, or go live their dreams, or start their businesses, or, you know, be a better wife or start the hobby they've always wanted, but you know, and they now can go do these things because they have answers, I just think this work is really important.
SPEAKER_00I love that. So, what are some of the signs that a woman might have a weak pelvic floor? Like, why should we even care? A lot of women don't even know what a pelvic floor is. So, what what would some of the like side effects be or signs of a weak pelvic floor?
SPEAKER_01Sure. So I think the first and foremost is if you've had an epesiotomy or you tore with birth, uh another sign would be incontinence, whether that's uh your bowel or bladder or your pooper pee, that you don't have control of either of those. If you I'm not kidding.
SPEAKER_00I I just have to tell you, I'm not kidding when I say every single time I sneeze, I have to cross my legs or I will pee. Oh I will like like my my kids even make fun of me because if I forget to cross my legs, I'm like, well, crap, I just peed my pants. Oh no. Oh no.
SPEAKER_01Okay, well, let's let's we can fix this. We can totally fix this.
SPEAKER_00Yeah, so I have to work on that even too. And I thought I was good, but when I was talking to you, and you're like, no, that's not normal to pee your pants when you sneeze, I'm like, okay, well, it can get stronger then. So okay, so keep going.
SPEAKER_01Um, so urgency. So if you have a really strong urge to get to the bathroom and and you can't get there on time, meaning you leak on the way there, or you really feel like you don't have a say over at what point you're using the restroom, that would be a sign of a weak pelvic floor. Having pain with intercourse, and that's a that's a deeper topic, I'll just kind of say that. Um, any pelvic pain that you have, you know, whether that's um pain with your menstrual cycle or with ovulation, abdominal pain is another one where the pelvic floor can play a role. Hip pain or back pain can be an indicator of a weak pelvic floor, and even constipation.
SPEAKER_00Okay, so there's a lot. So what you so what are some things that cause a weak pelvic floor? So that's like let's say that you have some of those things. Is childbirth childbirth is one of them?
SPEAKER_01Yes, of course. Yeah, childbirth is one of them. Um when we when we have babies vaginally and we tear or have an epesiotomy, when we have scar tissue that gets laid down, while scar tissue is a really wonderful thing because it lets that wound heal and it doesn't allow us to have that gaping wound anymore. That scar tissue can act a lot like super glue in the sense that it can inhibit those muscles from either contracting or relaxing or lengthening. And so that can kind of pause that muscle or freeze it where it's at and doesn't allow it to move. So that's a that's a really big cause of weak pelvic floor that I see a lot in my clinic and a lot um in my DMs too, as I'm talking to women about this. Um another, you you hinted at it earlier with your story when you said that you returned back to exercise too quick. And I think that there's there's a couple of components that go with that. One is understanding that after we have a baby, our our hormones, even though we don't have that placenta anymore producing all those, you know, hormones that make all of our ligaments very loosey-goosey, it still has an effect, especially if we're nursing. And so I tell my patients pretty conservatively, I I wouldn't get into too much impact until about two to three months after you get done nursing, which this is not my passive-aggressive way of, you know, giving up nursing. I often joke in my clinic, um, you nurse that baby till they're 18 years old, I'll support you however I can. But I think understanding that after you had that baby, not only are those hormones affecting how your ligaments are supporting your pelvis and other parts of your body, which can change how you manage your pressure in that pelvic floor with your organs, your or your pelvic organs and your abdominal organs, they're also not sitting in the same place that they used to. So I don't know if you've ever seen those, if you've been hit with those Facebook ads, I think Baby Center does them, where you can watch, it's like a cartoon, a side view, you can watch that baby develop, and you can kind of see those, it's like an uh they like speed it up, and you can see the organs and it's like shifting your organs.
SPEAKER_00Yes.
unknownYeah.
SPEAKER_01So I mean your organs aren't sitting very well, and then you have the ligaments that aren't doing their job to help hold those organs in place, and then those ligaments aren't helping that uh pelvis, you the bony structure, your bones to stay in place. It's not helping that pelvic floor either, and that's just talking about your abdomen and your pelvis. It's not talking about what's happening, you know, other joints as well.
SPEAKER_00So I even like your lower back, your knees, like everything. I'm like, act as if it's like an overused rubber band that like can't snap all the way back. Like you can pull muscles so easily, but I never thought like, oh, your pelvic floor, you can pull like you like in your even in your pelvic floor, you know. I'm thinking of more your joint, so that's super interesting. I love that.
SPEAKER_01Yeah, it's yeah, there's a there's a lot to happen. And and even on the flip side, I've had patients where you know, I've kind of put them through rigorous testing because they want to get back to working out so much, that very similar to you. And for some of them, their body's held up pretty good through the through the testing, but your hormones can fluctuate from day to day. So I think it's it's it's kind of tough to juggle. Um, but I I think there's a lot of uh safeguards that you can put into play as you're returning to exercise in your postpartum period.
SPEAKER_00Definitely. So, what are some things that we do that maybe are like common mistakes that could be making the pelvic floor weaker?
SPEAKER_01Sure. So I I hinted at this a little bit earlier when I said that you weren't managing your pressure very well. So I'll quickly explain this. I don't want this to feel like a big old long lecture that you know we're back in college or anything. But when there's they'll reference it as intra-abdominal pressure, but really if you can think about you know your abdomen, it's almost like a big balloon. And as we inhale and exhale our belly like a balloon, it's expanding, um, it's deflating, and there's there's always pressure happening in there. And as our body changes, as we become more pregnant, which is a lovely thing because that means babies growing and developing, as we do that, our the way we manage our pressure, we we kind of start to hold our breath. And what this really hit home for me when I was pregnant with my second, every time I would bend over, I would go up a stair or off a curb, I would grunt. And my little girl, who is always with me, because this was during COVID, she started doing that. I mean, she's not even too grunting every time. And it it really took me aback that, man, I even know better, but my body is trying to help me, right? To to survive this pregnancy, you know, to to hold my breath and help me, and I'm using air quotes, like to accidentally cheat, to help me manage my muscles, to help provide this quote unquote stability, but really it was interfering because I wasn't managing my pressure well. So, what I mean by that is I would hold my breath, and as I did that, more pressure built up inside inside, and so it is almost like creating this false sense of stability from the inside out rather than my muscles doing their job and creating that stability from the outside in as those muscles should have been contracting. But they had a harder time, right? Because I was pregnant. So that's kind of what I mean. I hope this makes sense in terms of managing your pressure. It really comes down to your breath. Like I'll see people reference this. Oh, you need to work on your breath. And and I think a lot of people just ignore it because it seems too easy. But truly, if you can manage your breath and make sure that you're breathing well through exercises and doing laundry and going up and downstairs and picking up your kids and something as simple as bending over and shaving your legs while you're pregnant, you can still make a big impact by by working on your breath. So you're not creating that increased pressure as you're accidentally holding your breath to create that stability. Does that hopefully that makes sense?
SPEAKER_00My question is Um, I do know, like as being being a trainer, um, if you can learn how to do that breathing, and um, I almost call it like the zipper where you're kind of like zipping up your core and your pelvic floor, and you're kind of like not arching your back, you're you're kind of tucking a little bit when you're doing certain lifts, you can help take some of that pressure off of your pelvic floor when you're lifting. And so I try to help my clients with that as well. But I tell my clients, you tell me what you tell your clients, but I tell them um not to run while they are in their third trimester because it's too heavy for their pelvic floor and that constant pounding. Um, what do you advise your clients? Like, do you think it's okay to run or what how do you feel?
SPEAKER_01That's a really good and a loaded question. But I I think generally speaking, I typically ask, like, I'll go back and say, okay, well, what's your reason for wanting to run? Is it to stay in shape and like to feel fit? You you can accomplish that by lots of other things.
SPEAKER_00So I think some of the things lower impact um cardio.
SPEAKER_01Yeah. And I I think I think it's a a good question to ask, you know, like, you know, can you run in the third trimester? But I I never like to say that there's a good exercise or a bad exercise. It's just your reasoning behind it. So I like I've had patients that are like, well, I just I want to get back to working out so I can lose weight. Okay, well, I think you can accomplish that by, you know, not going to, I'm gonna pick on CrossFit for a second, not that I dislike it greatly, but I've had patients that are back at CrossFit at four weeks and it's it's too much. And so kind of going over and I I know this is one of the things that I do love about you is that you incorporate so much mindset into what you're teaching and educating your clients about, but kind of really understanding their reason why. So a lot of times when I pull that out of them, it's not really because they love running, it they're pretty miserable while they're doing it. And that by in itself answers the question, you know, if if you're if you're not enjoying it, but you're doing it for a totally different reason, that that's the cool thing, and I'm sure you can attest to this as well, that you can change one exercise 500 different ways times 300 different ways to to make it fit that you know client a little bit better, to help them achieve their goals, or maybe they have knee pain or or what have you. And so I I think to go back and answer that question, I I'm kind of not answering that question, but just to kind of figure out why. But but generally I would say no, I don't really encourage them to run because a lot of them, I think a lot of women get so sick their first trimester, that's three months-ish of them not being very active, and then to jump right back into working out with a body that is not the same as what they left off working out at, right? Because of all the changes that are still occurring. I think it just makes it really tricky. And that's where I go back to asking them that question well, what's the real reason you're wanting to do it? And then yeah. And and maybe sometimes running is what they want to do, but a lot of times there's other avenues of exercise and fitness that they can pursue without doing the one thing that they were doing.
SPEAKER_00That's what, yeah, that's what I try to show my clients is there's so many other ways to get in shape and like feel really good without putting so much pressure on your pelvic floor with like a bowling ball just bouncing up and down on your pelvic floor. Just it's just a lot. And I also try to tell them like, let's figure out other ways besides running right after you have the baby. Let's let that pelvic floor heal, your back heal, your knees heal before we start doing the pounding, you know, the heavy pounding. So, um, what are some ways that we can strengthen our pelvic floor? I know that we talked a little bit about the breathing. Uh, what else do you have?
SPEAKER_01So, one of the um methods that I use, and it it's I I use it when I start teaching my patients the principles of how I like to strengthen the pelvic floor. And it's, I'll be honest, it's kind of different. And and I think probably some of your listeners' brains might be like, what? What? We're not talking about kegels. Um The reason I don't necessarily love kegels and I don't think that they're enough, is one you for example, if you started giving out advice that, hey ladies, all you need to do is just lay there, squeeze all your muscles, and then relax, and squeeze all your muscles and relax. That's that's all you need to do to you know have strong muscles and to you have a great physique and to lose weight. I am quite certain that your following would be like, I don't know what happened to you. This is terrible advice. And that's how I feel about the about doing kegles. To be able to achieve a strong pelvic floor in order for that, for those muscles to do the job that they were designed to do. So, really quick, like when you go to bend over to pick something up, your pelvic floor contracts to support those organs. It contracts against your urethra so that that pressure, how we kind of talked about our belly acting like a balloon, so that it's not like someone's like stepping on our bladder. That pelvic floor supports that. When you jump off a step, or if you run, or um if you go to pick up a laundry basket, or you go to pick up a case of something at Costco, that pelvic floor is having to do a whole lot more than what the strength or tension is generated by you doing an isometric contraction or just squeezing the muscle on its own. So I kind of feel like it's not giving that pelvic floor the recognition and the care that it deserves. So the way I like to teach my patients these principles, anyways, is I call it VAB 3 or VAB3. And what that stands for is vertical, above, below, and then three planes. So vertical meaning that if we're strengthening the pelvic floor, we're doing vertical motion. So whether that's squats or squat jumps, anytime we land a jump, our pelvic floor contracts against that urethra to support our organs and to squeeze against that urethra so we're not leaking. I like to reference above the A in that VAB3 is we're strengthening the muscles above the pelvic floor. So that is the abdominals, the back muscles, making sure your thoracic spine is moving, making sure your diaphragm is moving well. Those all play a role when I referenced pressure before into that pelvic floor having the appropriate input to do the job that it was designed to do. And then B is for below your hip, your knee, and your ankle and your foot, making sure that those muscles are strong as well. And three, meaning that we're moving in all three planes. So to kind of bring that all together, the vertical is kind of on its own in how that pelvic floor works. But our pelvic floor, and I know this is a podcast I can't show you, but if you were to look up where all the hip muscle attachments are on the pelvis, there's a ton. The hip muscles and the pelvic floor, they share a lot of the same origins and attachments, and a lot of times they're right, they're next door neighbors. And research has shown time and time again that whatever the hip does or doesn't do, the pelvic floor does or doesn't do. So getting that hip moving in all three planes can really impact that pelvic floor. And that's that's a lot of how my programming goes is to is to address all those uh four principles in VAB three.
SPEAKER_00I love that. I love how you have it so concise. Thanks. Yeah, I love it. That's that's great. So um I have a question too. Are there things that we can do as we're pregnant to protect our pelvic floor? Obviously, I mean I'm pregnant right now, so I'm 16 weeks, so I'm really trying to make sure that I'm doing everything I can to not, you know, really damage that pelvic floor.
SPEAKER_01Of course. Um, so there's a couple things. The first thing I would say is get really good at breathing and breathing in a way that your belly expands. I'm gonna go back to that balloon reference again. So as you inhale, that belly should blow up like a balloon. So the front should move, the sides should move, and while your back isn't gonna move, you you should feel some pressure back there. And I'll warn you it'll get harder as um you and the baby grow. But if you get if you get well practiced with it early on, and and that's not to say that you know, if you're listening to this and you're 36 weeks pregnant, uh, you you can still make a big difference. So the pelvic floor should descend or drop when we inhale. And so that will kind of keep your body honest in the sense of like you're not going to be holding your breath and tightening your pelvic floor with everything. The second thing that I would say to do, and I'll I didn't tag this phrase. Um, a PT by the name of Julie Weeby did. Um, she calls it blow before you go, and she presents a lot on how the pelvic floor and core work, and how a lot of us, and this is how I learned it coming out of PT school, and I always kind of struggled with it, that they would say, okay, you know, like squeeze your pelvic floor and your core and then do blank activity. But if you look at a lot of the research that's coming out, it's showing that sometimes our pelvic floor actually might be the third to contract in a certain activity, and sometimes our abdominal muscles might be first or third or fifth, and sometimes not even functioning with that pelvic floor. So this is some newer stuff, and I I have a lot of patients that sometimes struggle with this because it's not how they've been taught to do it. And so by utilizing this blow before you go technique, just to kind of I mean that that was the background on it, but using the blow before you go in uh neurological PT, we I I mean I haven't done this for a very, very long time, but they use this technique, it's called a quick stretch, on these patients that have had traumatic brain injuries and spinal cord injuries, and it allows those muscles, essentially what's happening is as you stretch the fibers of the muscles, it allows them to activate and respond like they used to, like they were designed to. So when we blow before you go, so what I mean by that is like if you went to bend over to pick up the laundry basket, if you're standing there, I would blow and then bend over and pick up the laundry basket. By you blowing like that, one, it's helping you manage that pressure, like I have referenced before, but it also is giving your pelvic floor and your belly that quick stretch of those muscle fibers so they can better respond like they're supposed to. So that's one of the things it's it's newer, and I think it is harder for some people to digest. But if what I always say is, well, go home and try it. Like try picking up that laundry basket like the way you used to, and then try doing it with the blow before you go. So you'll blow first, then bend over and and pick it up.
SPEAKER_00And so just whenever like before you go where?
SPEAKER_01Like what what exercise or what movement anything, um, anything that would be taxing. So like I referenced the laundry basket just because I mean I try to cram as much stuff into that laundry basket so I'm not having to take so many trips up and down the stairs. But like if you bent over to get something at Costco, if you decided that you felt really good and you wanted to do some heavy lifting, and you're like, man, I don't, I don't know if I'm quite ready to do this, you can do the it, you can do that blow right before each rep or right before every third or fourth rep. Not that you'll have to do it the entire time, but it just helps keep your body honest. So, really any activity that that you might question yourself if you should do it or not, but also you can utilize it as a way to keep yourself honest, especially if you aren't necessarily sure should I be doing this? Am I doing this the right way? Or the last time I did this activity, I didn't feel strong. I didn't feel like I was capable of doing it well.
SPEAKER_00Okay.
SPEAKER_01So yeah, the go part is just the activity. It's just that it just rhymes. That's not true.
SPEAKER_00I'm like, where are we going? What are we doing here?
SPEAKER_01The activity, yeah. Well starting.
SPEAKER_00Not it.
SPEAKER_01It's probably just not it.
SPEAKER_00No, no, it's good. It's good. For some reason in my mind, I was thinking like go to the bathroom, you know, because you think before you go. But no, I go I like that um analogy, and I like that it's something simple that we can incorporate every day, you know, and that we can do while we're already doing simple things around the house that we're already doing. That's something we can just add to it. So I love that. Thank you. Okay, so last question what is one message you'd like to leave with our audience?
SPEAKER_01The one um you're doing better than you think you are, and you're not wrecking your pelvic floor as much as the media says or your sister says, or wherever you read it, your your pelvic floor is a lot stronger and more resilient than you think it is.
SPEAKER_00That's awesome. I love that. A lot of times uh people, trainers even will use fear base, you know, to be like, you have to buy this program because if you don't know what you're doing, you're gonna ruin, you know. Like, so I love that you give people peace of mind. That was really great. So if people want to find you, if they want more information, where can they find you?
SPEAKER_01Sure. So I'm on Instagram at Beyond the V by Pauly, P-A-U-L-I. Um, I have a YouTube channel, Beyond the V Women's Health. And I have an email as well, but you can you're welcome to message me on Instagram.
SPEAKER_00Perfect. And I will link those in the show notes as well so that people can find you if they want more information. Great. So thank you so much, Pauline. I am so grateful that you're here to share your knowledge with everyone. Um, and if you guys have any questions, make sure to put them in the show notes and we will make sure to send them to Pauline. All right. I'll talk to you later, Pauline. Thank you. You're welcome. It was good to talk to you. Bye. Thank you for joining us in today's episode. If you liked the content and want to hear more, remember to hit that subscribe button and write a review. As a small business owner, I appreciate it more than you know. If you are looking for a program to help with self-confidence, to lose weight, get in shape, and work on your mental, physical, and emotional health. Check out my training programs on www.bodyby.com. My team and I help to hold you accountable through the Body Bybree app, where you log in to see all your workouts, custom meal plan made specifically for you and your needs, and communication through the messenger. You are never alone when you're on the Body by Bree training program. Click the link in the show notes to get more information on how to transform your life from the inside out.
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