January 30, 2025 • 44 mins
For many of us, our first exposure to our pelvic floors is through the Kegel exercises we learned about in Cosmo, promising us great sex. The reality of our pelvic floors comes roaring back in pregnancy, when they are are more taxed than they've ever been. The pelvic floor turns out to have a hand in many things, including peeing, pooping, sex, pregnancy, labor, birth, postpartum, and menopause. And like with all muscles, the more we take care of them, they better they can take care of us.
Today on ParentData, we welcome the Vagina Whisperer herself, Dr. Sara Reardon. Sara's new book, Floored: A Woman’s Guide to Pelvic Floor Health at Every Age and Stage, which will be released in June, explores the seasons of life with a pelvic floor, from puberty to menopause. In this conversation, we talk about the optimal ways to pee and poop. We discuss what actually happens when you go to pelvic floor therapy. We discuss Kegels and why they are often good but also not a panacea. More than anything, Sara takes something that we all experience privately, and encourages us to shine a light on it, take the stigma away, and tighten up with confidence.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
This is parent data. I'm Emily Oster. Look at this,
the kegel Master. What's a kegel muscle? It helps you
stay tight down there?
Speaker 2 (00:11):
And I have one. If you have to ask, you
haven't been doing your exercises. What exercises?
Speaker 1 (00:17):
All you have to do to stay tight is to
tighten and release it for ten minutes a day, cagel exercises.
I'm doing mine right now.
Speaker 3 (00:27):
Man, She's good. My first exposure to the kegel exercise,
like many women of my age, was in Cosmopolitan magazine,
where I was promised that.
Speaker 1 (00:43):
Doing keegels religiously was the key.
Speaker 2 (00:46):
To great sex.
Speaker 3 (00:48):
At the time, I was a decidedly not sex having
high school student, so I promptly forgot about them. Keegels
then came roaring back during pregnancy, where they promised to
preserve my pelvis floor for a great sex later, along
with improving my birth experience. Interestingly, in all this discussion
of this exercise, no one ever told me about what
(01:11):
these exercises were doing or connected.
Speaker 1 (01:13):
Them to my pelvic floor.
Speaker 3 (01:16):
I'm not sure I was entirely clear on what a
pelvic floor even was, which is why I am delighted
that Instagram introduced me to a woman dancing in a
volva costume. The vagina whisper Doctor Sarah Reardon. Sarah is
an expert in the pelvic floor, and it's safe to
say her knowledge goes way beyond Keegel's. The pelvic floor
(01:38):
turns out to have a hand in many things, peeing, pooping, sex, pregnancy, labor, birth, postpartum, menopause, etc.
Sarah explains all of this online and now in her
new book Floored, A Woman's Guide to Pelvic Floor Health
at Every Agent Stage, which will be released in June.
Speaker 1 (01:57):
There's a pre order link in the show.
Speaker 3 (01:58):
Notes, and seriously, people, this one you have to buy.
Today we talk about the book and about the seasons
of life with the pelvic floor, from puberty to menopause.
We spend quite a lot of time on the optimal
ways to pee and poop, and discuss what actually happens
when you go to pelvic floor therapy. We discuss keegels
(02:18):
and why they are often good but also not a
panacea for me. Sarah is special because she does an
amazing job shining a light on something which affects everyone
and something we ignore because we just don't see it.
Speaker 1 (02:36):
So here we go.
Speaker 3 (02:38):
Sit back, relax, do a few keegels if you wish,
and let's go.
Speaker 1 (02:44):
After the break.
Speaker 3 (02:45):
Doctor Sarah Reardon, Sarah, thank you so much for joining me.
Hey a link, great to be here. So we're going
to talk all about the pelvic floor today, and I
would encourage people to stick around till the end where
(03:06):
we're going to talk about why I think about you
every time I pee.
Speaker 1 (03:09):
I don't want to spoil that for people, but it
will come up.
Speaker 3 (03:12):
But before we get into any of that, could you
start by just telling us who you are, where you're
coming from, a little.
Speaker 1 (03:19):
Bit, what you do.
Speaker 2 (03:20):
Absolutely.
Speaker 4 (03:21):
So, I'm doctor Sarah Ordon. I'm a board certified pelvic
floor physical therapist. I live in New Orleans and I've
been practicing as a pelvic health PTE for seventeen years.
I have a social media presence as the Vagina Whisper,
where you'll occasionally see me again showing folks how to
pee and educating you while I'm in a Volva costume.
And I'm the recent author of a new book, Floored,
(03:42):
a Woman's Guide to Pelvic Floor Health at Every agent stage.
Speaker 1 (03:46):
Which is fantastic.
Speaker 3 (03:48):
Okay, So I want to start with why you love
the pelvic floor so much, and why you chose this
part of the body. Where does your passion for the
vulva and pelvic floor come from?
Speaker 4 (04:02):
So I started in this field immediately after grad school
in two thousand and seven. I went through regular pelvic
floor physical therapy school and thought I was going to
be like a trainer for the New Orleans Saints football team,
and just was really into sports and activity. And during
my grad school education, we had a professor who taught
us about the pelvic floor. It's like a two week stint,
(04:23):
and I was like, Huh, this is really interesting to
learn about this part of my body that I never
knew that I had. That everyone has all genders, males, females, everyone,
and it's super important, like every time you pee, your
pelvic floor is activating, every time you have to pass gas,
it's relaxing when you birth, when you run, And I
really just loved learning about my own body as a
(04:44):
woman and thought everybody needs to know this information. It
seems pretty important. And right when I started my career,
I jumped right into it in my first job in Austin, Texas,
and since then have just I've worked with tens of
thousands of patients, I would say, and it's just an
incredibly rewarding feel to educate folks about their body and
help them prevent issues which are super common yet so
(05:06):
rarely talked about.
Speaker 3 (05:08):
It seems like one of the things I get out
of your book is this feeling of some of the
time when you tell people things, it seems like magic,
like they didn't know a whole area was unknown, and
then you can explain something which somebody was struggling with
or was painful, or just you illuminate in a way
that I'm not sure we get, you know, with dentistry
(05:31):
or something, since we all know we have teeth and
right things like that.
Speaker 2 (05:34):
Well, I think that's one of it.
Speaker 4 (05:35):
You can't see the pelvic floor, so it's hard to
even see, like or imagine what is it, what is
it doing? It feels very mystical, yet it's super important. Again,
it plays this role in peeing, pooping, sexual health, reproductive health, pregnancy, birth, menopause.
So there are so many seasons and stages of life
where this, you know, this group of muscles is you know,
(05:58):
very much impacted, sometimes transformed, and you know one in
two women will have a pelvic floor dysfunction later in
the later years of life. I'm like, why aren't we
talking about this more and giving people tips to prevent
these issues.
Speaker 2 (06:11):
Down the line.
Speaker 3 (06:13):
So for those people who are listening now and thinking, wait,
I also don't know where my pelvic floor is, let's
do like a very quick one oh one, Like when
you talk about the public floor, what is the muscle
group you're talking about?
Speaker 1 (06:24):
And how would I know that I had one?
Speaker 3 (06:27):
So?
Speaker 2 (06:27):
Well, everybody has one, so we'll start the back. You
have one, okay, Beck, you have one.
Speaker 4 (06:33):
So I would say, if you're sitting right now, I
want you to or standing. I want you to put
your hands on your hips and you can feel those
little hip bones that we often feel and we're used
to seeing on.
Speaker 3 (06:41):
Like a I want the listeners to know that both
Tomorrow and I are doing this right now, right right,
go ahead.
Speaker 4 (06:47):
And you're used to seeing on like your skeleton. Jammi's
for your kiddos, and that's your pelvis. So your pelvis
is a ring of bones that you know attaches in
the front at the pubic bone, in the back, at
the sacred table at the very bottom of that. Imagine
this hammock of muscles. So I want you to think
about what you would do if you had to stop
your urine stream. You tighten a little muscle down there,
(07:08):
like you're trying to kink off your urine stream, or
if you have to pass gas and you're in an
elevator and you're like, oh, squeeze it right. Also, my
favorite way to cue people to do this is to
take a big, deep breath and then on the Xdale,
think about sipping up a smoothie with your vagina. So
I'm like, who does that? Every patient of mine imagines it.
(07:28):
But when you think about that sipping up maneuver, it
activates those pelvic floor muscles. And again, Emily and Tomorrow
are both doing this as we're talking, and you get
that like, oh, there's something happening down there, and that's
your pelvic floor muscles. So it's a way to kind
of just start connecting with them. But everybody has them,
and again, there are different seasons of life they're affected,
(07:51):
and there's just day to day stuff that they do
to help us function.
Speaker 3 (07:56):
So let's talk about a little bit of that day
to day stuff before we get into these seasons of life.
Speaker 1 (08:00):
So the pelvic floor when one is peeing.
Speaker 2 (08:03):
What is it doing.
Speaker 4 (08:05):
It's holding p in your bladder so that you don't
leak ideally, and then when you sit down to pee
again I encourage sitting, not hovering over a toilet, unless
it's like super growth. But when you sit down to pee,
it relaxes, so the muscle relaxes, and then your bladder
pushes the p out for you. So it's helping. You say,
what we call continent, which is the ability to hold
(08:25):
in urine, and the same thing for pooping. It holds
in poop as your rectum fills and your colon fills
with waste. And then when you sit down ultimately ideally
with a squatty potty or a little poop stool under
your feet, you can relax your pelvic floor muscles aka
your buttthole, and then you can empty the tank.
Speaker 1 (08:43):
Okay, so let's talk about pooping.
Speaker 3 (08:47):
You are online, you show us the use of a
squatty potty very frequently.
Speaker 1 (08:53):
I have a squatty potty. Can you explain why this is,
what that is and why people should have one?
Speaker 4 (09:00):
So, a squatty patty is the designer name for these
poop stools, and it's really just a stool you put
under your feet. You can use a toddler stool, you
can use yoga bot blocks, you can use an old
Amazon box.
Speaker 2 (09:11):
I don't care what you use.
Speaker 4 (09:12):
But the goal is to get your knees above your
hip level. So when you're sitting on a regular toilet,
your knees are kind of in line with your hips.
If you elevate your feet, then your knees go up
and it helps your pelvic floor muffles relax. So squatting
is the best position to relax your pelvic flore muscles
for pooping. So think about if you're in the woods,
or if you're on a runway out in the forest,
(09:34):
or you're camping, you squat over the ground, or other
Eastern countries you squat over the ground to poop. It's
the physiological way to have a bomb movement that's best.
What's happened in the Western world is we have these
porcelain thrones that are indoors and they're comfortable, and we've
got heated bathrooms, and so we've kind of moved away
from the physiological way to poop, and now we have
(09:57):
to recreate that with a pooping stool under your feet.
Speaker 3 (10:01):
Is it a good idea to pee with a squatty
potty or is that not as important.
Speaker 4 (10:07):
It's not a bad idea, but it's not a must.
So it's really just the butthhole muscles that relax best
with squatting. You can use a squatty potty when you pee,
but you can also just like sit with your feet flat.
That's a great question.
Speaker 3 (10:20):
I think we should get into a little more about
peeing also because I feel like this is the segment
of the podcast where people, I.
Speaker 1 (10:26):
Guess you get a lot of takeaways.
Speaker 3 (10:28):
Uh okay, So every time I sit down to peanout,
I think to myself, don't push the pee out?
Speaker 2 (10:34):
Because this is a big.
Speaker 3 (10:35):
Thing in your book, can you please tell people why
they should not be first of all, what does that mean?
Speaker 2 (10:40):
And why should they not be doing that?
Speaker 4 (10:42):
You know, this is music to my ears because that's
a big takeaway from the book is don't push when
you pee.
Speaker 2 (10:48):
I call it power peeing.
Speaker 4 (10:49):
And we are as busy women, as moms, as parents,
as working women, we are notorious for power peeing.
Speaker 2 (10:58):
The reason you can God so fast?
Speaker 1 (11:01):
Okay, anyway, go ahead, It's.
Speaker 4 (11:03):
True, right, we like are trying to rush through everything,
including peeing. So when you pee, you really just need
to sit and chill because your bladder is the muscle
that's pushing the pe out. If you push and like
power pee, you are putting extra strain on your pelvic
flore muscles, which can weaken them over time, and this
can lead to urinary leakage or what we you know,
(11:24):
pelvic organ prolapse, which is a scary thing when it's
like your organs are falling into your vagina. So it
can weaken your muscles over time and lead to other
pelvic flore conditions which we want to try to prevent.
So don't push when you pee. You just need to
sit and chill and breathe, and your bladder actually pushes
the p out for you.
Speaker 3 (11:43):
What if I'm in a hurry, though, is there a
situation in which I should be power peeing?
Speaker 2 (11:48):
Never?
Speaker 4 (11:49):
Okay, I don't care if there's like little you know,
if there's something really no, never, never, Just sit and
chill and breathe and it'll it will actually come out
faster and better and you'll empty better. If you push,
you actually don't even empty your bladder as well, and
so then you're gonna have to go back thirty minutes
(12:09):
sixty minutes later and pee again. So just really from
an efficiency standpoint, Emily, I just recommend chilling. Is it
okay to p in the shower? One hundred percent? Totally
fine and quite good for the environment.
Speaker 1 (12:24):
Great?
Speaker 3 (12:24):
All right, So what I think is a good place
to start because peeing and pooping are things that happen
for everybody, and it is important to note that the
pelvic floor, therefore is important at all ages. The time
people most frequently hear about the pelvic floor is during pregnancy.
Is there a time before pregnancy where you would say,
(12:46):
you know, here's another time of life that you really
should be thinking about your pelvic floor a little more,
where it's doing other things for you other than peeing
and pooping.
Speaker 2 (12:56):
Yeah.
Speaker 4 (12:56):
So it's it's interesting because I think as parents we
think about what do I need to do for my
public floor?
Speaker 2 (13:01):
But I even think we need to have these tips
and tools to.
Speaker 4 (13:03):
Educate our kids, right Like we're body training them, we're
teaching them how to you know, poop in toilets or
kids struggle with constipation. So if you're a parent, some
of the things that you're going to learn and for
you need to be implementing and teaching for your kids,
because again, if they don't learn it young, when.
Speaker 2 (13:18):
Are they going to learn it.
Speaker 3 (13:20):
So when we think about kids, is bed wetting something
that's associated with the public floor or.
Speaker 2 (13:26):
Is this a totally different issue.
Speaker 4 (13:29):
It can be and so, but I would say bed
wedding and kids is typically multifactorial.
Speaker 2 (13:34):
Right.
Speaker 4 (13:34):
It's not just like, hey, they're holding it too long
and then they have to pee at night. There's typically
some neurodaverdens that can be evolved, some behavioral issues. I
will tell you one of the biggest contributing factors to
nighttime bed wetting is constipation, which is the most common
gi complaining kids. So if you're constipated, and this kind
of goes for adults too, you know, think of that
(13:55):
basket of muscles holding you know, it only has so
much space in it, and if.
Speaker 2 (13:59):
It's full of poop, that's going to push on your bladder.
Speaker 4 (14:02):
So some people find like they have more urgency to
pee when they're constipated, and that's that's true. The same
thing for kids when their bed wetting. One of the
first things I do is I actually talk to their
parents about curing their constipation and then getting them on
an avoiding schedule of going every couple hours during the
day and then setting alarms at night. But there's also
(14:23):
some kind of behavioral things that can and neurological things
that need to be addressed as well. That's outside of
PELBLC floor therapy, but some of these tips do help
when it comes to addressing pooping and peeing habits.
Speaker 3 (14:33):
I should say that that until the age of about seven,
it is actually pretty typical for kids to just not
wake up to pee and to need a pull up.
So when we talk about sort of bed wedding you
would want to see somebody about it's really if they
are still not dry at night after six or seven.
Speaker 4 (14:51):
Yeah, and that's you know, my son was he'll probably
not love me sharing. This was five or six, and
he was still in night time both.
Speaker 2 (14:56):
Completely trying it.
Speaker 4 (14:57):
During the day, he just was lazy and he didn't
want to pay all day, so we'd hold it till
the nighttime. And I'm like, dude, I get that. I mean,
how many times are we like cold in bed and
don't want to get up the key? But then he
just grew out of it, and I was like, Okay,
if he's nine or ten and we have this issue,
we'll get some help.
Speaker 2 (15:14):
But otherwise they typically do grow out of it.
Speaker 4 (15:17):
I think the other incremental time when we're thinking about
how early is it appropriate to start really learning about this,
it's really puberty. When you have a young woman who
was going through menstruation, their body is going through significant
hormonal changes, and hormones affect our public floor function and
our vagina in volva. But also this is their first
(15:38):
exploration into their genitalia, into their body, and if we
don't talk about it, it can often feel embarrassing or
you know, shrouded in shame. But it's also they are
learning how to use menstrual hygiene products. They are learning
how to find their vaginal opening, perhaps to insert a
tampon or a menstrual disc or cup. They're learning about
(15:59):
like what is the significance of a painful period? Does
that mean something else could be going on, like an
endometriosis or something. So really teaching them about their bodies
young is where it needs to start because it opens
the doors for greater and bigger conversations and curiosity later
versus not talking about it at all. So that's just
another major time, and I would say after that, it's
(16:21):
also when someone becomes sexually active.
Speaker 2 (16:23):
So the vagina is part of the pelvic.
Speaker 4 (16:25):
Floor, and one in four women will experience pelvic pain
and painful sex at some point in their life and
they don't even think of the pelvic floor muscles as
a source.
Speaker 2 (16:33):
Of that pain.
Speaker 3 (16:35):
Going back quickly to puberty, I think one of the
pieces it's very helpful for me in thinking about the
book is like, this is a this is a scientific
way to approach a topic that with an adolescent is
often very uncomfortable to just be like, hey, there are
muscles in the pelvic floor, Like let's talk about like
inserting a tampon. But rather than talking about it like
(16:57):
in an uncomfortable way, at least there's a little bit
of a way to come into it with like, you know,
here's some interesting cool facts about muscles and the muscles
you have and all the cool stuff they can do.
And by the way, also, this is where your vagina
is in case you want to use a tampon.
Speaker 2 (17:12):
Right, I mean, And it's so much more.
Speaker 4 (17:14):
It's kind of like we and that's in a very
practical sense of how do we approach pelvic floor health.
But I think it has even greater implications about how
do we feel comfortable talking about our bodies as women
in the greater scheme, like where do we start going
to for help? Where do we get education about our bodies?
And then when we become sexually active, or we struggle
(17:35):
with infertility, or we're pregnant and postpartum, we kind of
start keeping all of these things in because we've never
talked about them. So I think it just there's so
much more we can achieve by having these conversations early
that the ripples of that go really far, way far
into the later stages of being a woman.
Speaker 3 (17:51):
So let's talk about sex, either becoming sexually active or
just in general problems with sex.
Speaker 1 (17:56):
Can you be a little bit of a sense.
Speaker 3 (17:58):
Of what what is the pelvic floor doing during sex
that it might fail at.
Speaker 2 (18:07):
Let's talk about potential fairs but also achieve achievements. Okay, So.
Speaker 4 (18:13):
I would say, so the vaginal opening is in through
is through the pelvic floor muscle. So in order to
have anything insert into the vagina, whether it's a penis,
a dildo, a finger, ultimately a speculum for pelvic exams
or you know again we mentioned tampons.
Speaker 2 (18:31):
The pelvic floor muscles have.
Speaker 4 (18:32):
To relax for anything to enter into the vagina, so
if those muscles are tight or tense, it can often
obstruct insertion. And this is when people complain of something like, oh,
it feels like my partner's hitting a wall, or when
I put the tamp on, it just feels like I
can't go any further. That can often literally just be
muscle spasm, and so we really need those muscles to
(18:53):
be able to relax at the opening and then even
at the deeper level. If someone experiences pain with deeper
insertion or certain position, or it feels like they're partner's
poking them, or there's a bruise, that can literally just
be muscle tension. So as physical therapists, we work with
muscles to help relax them, teach you how to breathe
different positions and stretches to relieve tension and pain. Also,
(19:16):
the outer layer of the pelvic floor muscles, there's two layers.
The outer layers are the ones that contract and relax
during an orgasm, so we go through stages of arousal
which hopefully ultimately lead in the climax, which is an orgasm,
and those muscle contractions are what happening during an orgasm.
So if you have pain with orgasms or difficulty having
(19:37):
an orgasm, or leakage with orgasms, your pelvic floor muscles
are also involved.
Speaker 3 (19:42):
And then if the sex is successful in a different
way than the orgasm and you get pregnant, this is
the time I think people almost always hear about, or
at least well, this is the time people should always
hear about the pelvic floor, whether they do or not.
So during pregnancy, your public floor is doing a tremendous
(20:03):
amount of additional work, correct, right, because it is holding
up I'm gonna see if I get it right, having
done my little now that you've taught me about the
smoothie thing is it's holding the public floor. Muscles are
holding up the baby, which is getting larger and larger
and larger. And there's a lot of water in there also,
and it's a lot of work. Am I roughly correct? Right?
Speaker 2 (20:22):
You are spot on bad only And so.
Speaker 4 (20:26):
You know, we're so used to getting these text messages
or emails about the size of the baby. It's the
size of a blueberry, then it's the size of an avocado,
and then it's the size.
Speaker 2 (20:34):
Of a watermelon.
Speaker 4 (20:35):
Well, your pelvic floor muscles are ultimately the hammock that's
holding up that blueberry, avocado, or watermelon. And so if
you can imagine a hammock holding an avocado, it's not
going to sink down or stretch that much. But if
it's holding a watermelon, it's going to sink lower, it's
going to be really stretched out. It's not going to
be able to support you as well. So regardless of
what type of birth you have, because it's a misconception
(20:58):
that you know, only vaginal birth moms need pelvic floor PTE,
your pelvic floor change is just through pregnancy itself. And
this is when we start to see things like urinary leakage, hemorrhoids,
prolapse like all this, you know, vagina stuff starts to
pop up that we're like, oh, this is just pregnancy. However,
there is research to support that getting pelvic therapy interventions
(21:20):
soon or during pregnancy give you better postpartum outcomes. So yeah,
your vagina's changing, your pelvic color is changing. You got
to get pelviclore therapy during pregnancy.
Speaker 3 (21:30):
I want to talk about what that looks like, But
then I want to, But at first, I want to
tell you the most embarrassing story that I have from
either of my pregnancies, which is during my second pregnancy,
I was in New York and I wanted to get home,
and I was a little bit late for the train,
and there was a lot of traffic, so I decided
to run, and I did have to pee a bit,
and so I ran like like a lot of blocks,
(21:51):
and I was maybe five months pregnant, and I just
the entire time was being on myself as I was running.
Speaker 1 (21:57):
Through the streets of New York.
Speaker 3 (21:58):
And thank god I had another pair of pants with
me when I got on the train, which I totally made.
Speaker 2 (22:03):
But it is it is a very.
Speaker 3 (22:06):
Salient memory of Yeah, and if you think about it,
if by pelic floor failed me.
Speaker 2 (22:12):
You're not alone.
Speaker 4 (22:14):
Well, you were pregnant, and that's a lot of pressure,
and running is extra pressure on your pelvic floor. So again,
it's one of these things where I'm like, we have
to train these muscles like we do any other muscles
in our body. If we're going to ask it to
support a five month old baby running through the streets
of New York, we have to train it for that.
(22:36):
Just like you would run a marathon, you Emily, and
you train for months and months and months. Pregnancy is
no different, Like we're the demands on our body are different,
so we need to train our public floor to meet
those demands. And yet we just haven't incorporated this into
prenatal care.
Speaker 3 (22:50):
So in your ideal incorporation of this into prenatal care,
when would it start and what happens beyond? I think
keeg are the thing people have most frequently heard of, right,
the sort of scope of this is much larger than that.
So if you weres like like I'm telling someone who
is just just found out they're pregnant, like or before,
(23:11):
what is the advice about how long and what would
that even look like for them?
Speaker 2 (23:16):
I mean I would start week one.
Speaker 4 (23:18):
I mean, if you're pregnant week four, like, start getting
some education about you know, of course I have all
these videos about this, but you know your pelvic floor
is going to go through changes even in that first trimester.
You're going to have constipation from surging progesterone, You're going
to have urinary frequency, you may have some you know,
leakage even start right away. So but I would say
(23:38):
at the latest you need to really be checking in
with a pelvic floor therapist or starting some pelvic floor
training at the very beginning of your second trimester, because
this is when our body starts to really transform with
respect to ligaments, get more soft and lax, and we
get some instability in our pelvis. We start getting more
stretching up the core muscles, the abdomen and pelvic floor.
(24:00):
Trying to stay active but not sure how to modify
what workouts we're doing, and aches and pain start to
pop up, you know, hit pain, back pain, things like that.
So all of those things can be addressed proactively. And
if you get pelvic foe muscle training and address issues
during pregnancy, it's gonna want optimize your birth. You can
(24:20):
get a lot of education on how to prep for birth.
Pushing cesarean you know, birth preparation and then postpartum recovery.
So I would say as early as your second trimester,
check in with a pelvic floor therapist in person or
start doing some training to really get your body ready
for that long marathon of the next several months.
Speaker 1 (24:40):
What is ikegel.
Speaker 2 (24:43):
It's a pelvic clere contraction.
Speaker 4 (24:44):
Well, first of all, it's an exercise named after a man,
which like I'm going to start a revolution to rename it, right,
I mean, we just don't. We don't need any more
body parts or anything to do with the female genitalia
named after a dude. Second, and it's a pelvic floor contraction.
So that sipping up the smoothie that we all practiced earlier, that's.
Speaker 2 (25:05):
A kegel contraction.
Speaker 4 (25:06):
So it's a closing of the sphincters. It's a lifting
of those pelvic organs. And again it's like it's like
a bicep curl, it's like a crunch. It's like one
exercise you can do for a group of muscles. However,
it's the most popular one that we hear about. It's
kind of the foundation of pelvic floor training for strengthening. However,
(25:27):
you can't just sit in the carpool line and do kegels.
You need to do quicker contractions. You need to do
longer hold ten second contractions. You need to you know,
work this muscle in standing. If you're a runner, kegels
in the carpoo lane, it's not going to help you out.
You need to do squats and lunges and kind of
higher impact stuff while training your pelvic floor. The flip
(25:48):
side of this, I'll say is a lot of people
actually have tight pelvic floors and we think like, oh,
tight vagina, that sounds awesome, But you know, tension can
also impair functions, so you can't relax your muscles, well, pee, poop,
have sex, or even contract. So you know, I caution
people to just start doing other kegels because a lot
of people have tension just normal. In today's world, we
(26:10):
have tension in our bodies, and you want to address
that first before doing strengthening.
Speaker 3 (26:14):
I think there's a there's a core insight in the
book which I found very illuminating, which was, you know,
I've gone to physical therapy for other things, and generally
when you go to physical therapy, they look at what
the issues are that you are personally struggling with, and
they give you a set of exercises to deal with
those issues. And this is the same thing. It's just
(26:37):
not a muscle that you see, uh correct, And to
therefore the same logic applies. You figure out what's trying,
what's going on, and you develop a set of exercises
that are going to train that problem away, which may
involve kegels. Just like fits, which like sometimes there are
squats or bicep curls or crunches or your regular physically,
(26:58):
I think.
Speaker 2 (26:59):
We want to think about that.
Speaker 4 (27:00):
And I think that one, I mean, we are kind
of illuminating so much more about the pelvic flour now
that like, hey, it doesn't need to just tighten, it
also needs to relax. But I also think that there
is no one size fits all protocol. I always say
it's like if you have back pain and your therapist
is like, hey, just go do a bunch of crunches,
or that's what your physician tells you, You're like, well,
(27:20):
that doesn't sound like the right prescription, right. We need
to look at how you move and breathe and what's
tight and what's weak. And I go through in the
book kind of a checklist of if you're doing this
at home and not seeing a pelvic four therapist in person,
like which kind of pathway do you fall? And how
do you know if you have tension? How do you
know if you have weakness and need kegels or tension
(27:41):
and need relaxation. And I even give you tips on
how to explore your pelvic flour, like how do I
know if I'm doing a kegel properly, and you know,
to give people really to demystify this a little bit,
and to also just give them some simple practical tools
at home to start addressing these issues.
Speaker 3 (28:01):
More parent data, including the pelvic floor after menopause, what
the pelvic floor is like in men and a lightning
round of your most pressing pelvic floor questions. After the break,
(28:22):
I want to talk about a third part of life,
which is the kind of perimenopause menopause piece, because this
is another time in which even people who have not
had problems brier with their pelvic floor can develop almost unexpectedly.
So things like prolapse can come up in perimenopause or
(28:45):
menopause even if it didn't come up before. So can
you give us a sense of is this just my
pelvic floor is aging and starting to droop like all
my other muscles?
Speaker 1 (28:55):
Is that basically what's happening?
Speaker 3 (28:57):
As I turned to ash protein, is it something about proteins?
Speaker 4 (29:03):
So I was thinking about that, it's always about protein.
So yeah, I mean yes and no. So muscles weaken
over time, they atrophy over time when we don't address them,
and when you go through transitions like pregnancy and postpartum,
where those are risk factors for developing pelvic four dysfunction
because again, you are going through physical changes, hormonal changes,
(29:25):
lifestyle changes, and if those don't get addressed at those
early stages, then when you hit perimenopause and you don't
have your hormonal system to prop you up anymore, things
start to take a nose dive. So during perimenopause, you
start having less estrogen in your body, and estrogen is
the hormone that really plumps up the vagina. It keeps
you well lubricated in the evolve in vagina, and it
(29:47):
gives you more tone and thickness to your pelvic floor muscles.
You also lose testosterone during perimenopause, so you know, you
have less muscle strength, the different things like that, more
visceral fat, and then you lose colligen so you know,
I like put collagen in my coffee and I rub
it all over my face. I'm like our vaginas and
volvers are also losing collagen. So all of those things
(30:08):
do lead to more pelvic floor weakness, less tone in
the muscles, which can lead to prolapse and leakage, and
vaginal dryness. So One of the biggest things people experience
is more vaginal dryness and painful sex and perimenopause and
definitely into menopause because you don't have the natural lubrication
of estrogen to help, you know, provide moisture down there.
(30:31):
So I'm a huge fan of obviously doing exercise, but
then and proactively strengthening your pelvic floor. Looking at perimenopause
like a runway, like, hey, there's a red flag down there,
and you need to kind of like start working to
get yourself ready to address that. Like you we have
this runway where it feels like things are going bananas,
(30:52):
but it's also a warning sign of like your body's
changing and you need to make it kind of stay
healthy so that when you get there, you're in your
tip top pelvic floor shape. The other thing is I
do encourage folks to have a volva care routine, just
like we have a skincare routine, and not using harsh products,
(31:13):
but also thinking about using a you know, all natural
moisturizer for their volvet in vagina, using good lubric.
Speaker 1 (31:19):
Sorry, what can we back up?
Speaker 3 (31:21):
I like, like, what can you say more about the
Please say more?
Speaker 4 (31:30):
So there are moisturizers that you can use for your
volven vagina. And some people use these postpartum when they
are lactating and have low estrogen levels, but then also
in perimenopause and menopause, and so there are there's a
brand called Medicine Mama that has a volva bomb. It's
olive oil based, its organic ingredients. Some people just use
(31:51):
coconut oil. There's another brand called Kindra. So there's a
bunch of these bombs or lotions that are specifically made
for the volven vagina that aren't going to alter your
pH and put you at risk for infection, but they're
going to keep it lubricated. So it's just like we
do for our face. And you'll notice, like going through
perimenopause and definitely menopause, like it's dry down there, it's itchy,
(32:13):
it's uncomfortable, it can even close up. So I'm a
big fan of that. And then some people do use
a topical estrogen cream as well to help plump.
Speaker 2 (32:22):
Up the tissues.
Speaker 1 (32:24):
So much to look forward to.
Speaker 3 (32:27):
So much more to add to our daily routine, because yes,
I'm barely making it as it is with just putting
a small metamisturizer and washing my face.
Speaker 1 (32:34):
So TBD on that. Do men have a pelvic floor?
Speaker 3 (32:42):
And what is important for I feel we should We've
left them out, so I'd like to have this brief
discussion of men pull them in.
Speaker 4 (32:50):
So men absolutely have a pelvic floor. The differences are
they have two openings. So when female pelvic floors, we
have an opening for urine, the urethra, we have an
open for the vagina, and then we have an opening
for the anis where poop and gas exit. Male bodies
have two openings, one for the urethra, which goes through
the penis and exits through the opening of the penis,
and then one for the anus, so they have two openings.
(33:13):
They obviously don't have a vagina, but the pelvic floor
also closes the sphincters. It maintains an erect penis, so
blood stains in the penis when those muscles are tighter, tense,
and they also contract and relax during climax and orgasm.
They support your pelvic organs. They assist with breathing, just
like they do in the female body. More often though,
(33:34):
men have tension versus weakness, so many more women experience
weakness because of the hormonal fluctuations and because of events
like pregnancy and birth and menopause. But male bodies typically
what I see is much more tension in the area
and that needs to focus more in relaxation unless they
have like a prostate surgery, which could lead to weakness
issues as well. So you know, they have problems just
(33:57):
like female bodies do.
Speaker 3 (33:59):
They also have urinary leakage problems. Is that like an
issue for men?
Speaker 4 (34:04):
I can especially if they have a prostate procedure because
the prostate kind of surrounds the urethra. So if they
have a procedure to the prostate or a surgery to
remove it because of prostate cancer, then it affects the
urethra and they can leak urine. They can have a
rectile dysfunction because the nerves are impaired, they get a pain.
Speaker 2 (34:22):
So it is a it is a common issue.
Speaker 4 (34:25):
It's interesting because as little as we talk about the
female pelvic floor, we talk about the male pueblic floor
actually a lot less. And I've seen men in my
practice my entire career. We have you know, wives coming
in like I think my husband needs this too, you know,
And so we do see a lot of males as well,
and it's a it's an up and coming, you know,
sector of pelvic floor therapy.
Speaker 3 (34:46):
They definitely need more attention in general. Okay, so I
want to end with a few rapid fire questions. My
favorite Okay, what is your favorite of the pelvic floor muscles,
the puba rectalis, which relaxes for pooping.
Speaker 1 (35:10):
What should I do if the porta potty is really dirty?
Speaker 4 (35:14):
Hover, lean forward, rest your elbows on your knees, and
take some big, deep breath to empty.
Speaker 3 (35:20):
Is it bad if I hold in my poop for
a long time while I'm running asking for a friend hashtag.
Speaker 4 (35:30):
It's not a deal. If you're running, you have two options.
You hold it or you squat on the side of
the road. If you are ambitious and courageous enough to squat,
go for it. If not, hold it. But when I
get back from running, I would drink some hot water.
I would maybe eat a little something, and that can
stimulate the urge for the poop to go. But it's
not ideal to hold it unless you have to.
Speaker 3 (35:51):
Is it important to pee after sex to prevent you
to Yes, it is important to pee after sex.
Speaker 4 (35:57):
I'm not a fan of what I call just in case,
which is like every time you get to target, and
then you get home from Target, and then you go
pick the kids up from school, and every time you
pass a bathroom. However, times that are okay to pee
just in case are before sex, after sex, before pelvic
floor therapy, after pelvic floor therapy, or if you like
(36:20):
know you're not going to be have access to a
bathroom for many many hours. Typically you want to pee
every two to four hours, but after sex is an
important time to go.
Speaker 3 (36:30):
An issue that many people have raised to me is
as they are getting ready for bed, they feel they
need to pee many times, and sometimes it's just in
case peing, or it's just this feeling of like I
just maybe I have to do like a little bit,
a little bit is that?
Speaker 1 (36:44):
Why is that happening? And should I do? Should I
give into it?
Speaker 4 (36:50):
So, No, it's a miscommunication between your bladder and your
pelvic floor. So typically you are supposed to pee every
two to four hours, right if you have a drink,
So if you have like wine or a cocktail or
spicy food that could irritate your bladder, that might make
you more susceptible to pee more often. If you don't
(37:13):
front load your fluids and you drink everything in the
evening after getting home, that can make you have to
pe more often, or you have a little bit of
overactive bladder, and overactive bladder is like your bladder saying
I gotta go, I gotta go when it's not really
that full. So there's two things that I tell people
to do. It's like front your load your fluids earlier
in the day, cut off your fluids two hours before
you go to bed pe. And then if you go
(37:35):
to the bathroom and pee and you still have the urge,
I want you to take like five big deep breaths
and then five kegel contractions, suck up that smoothie five times,
because tightening your pelvic floor tells your bladder to chill out.
And so if you do that on repeat, and you
can buy yourself fifteen minutes, thirty minutes, and then you're like, shit,
I gotta go again, go again, that's fine. But eventually
(37:57):
you'll push that urge often enough where you don't have
to go every five minutes and keep going because you
keep it's a false urge. There's nothing in there.
Speaker 3 (38:04):
When you have to go again, so can you say
a little bit more about when you do physical therapy
what what does it involve. Somebody mentioned some kind of
zapping of the vagina, and I'm just curious if that's
like a core element or just a sometimes extra.
Speaker 4 (38:25):
You know that vaginal zapping is not standard in pelvic
floor therapy, so it's think of traditional physical therapy where
you get an assessment. However, the assessment is an internal
examination of the pelvic floor, which is either through the
vagina or through the anus, and this is obviously with consent.
And once we evaluate those muscles, if they're tense, we
may work on strengthening exercises, which again can include pelvic
(38:49):
floor contractions or key goals. We do use some machines
which are called biofeedback, which kind of are like like
an EKG for the heart, but it goes around your
buttthole or in your vagina and it shows you on
a green how your muscles are performing. But then we
do squats and lunges and hip strengthening and all kinds
of stuff. If it's a weakness issue, I mean, if
(39:09):
it's a tension issue, we may do more relaxation like
internal vaginal massage to the pelvic floor using trigger point
winds or dilators to relax the muscles. There is something
called electrical stimulation which can like activate the muscles kind
of like I don't know if you remember, like the
old Bruce Lee Daisy used to put this thing on
his stomach and it would like fire up his six pack.
(39:30):
It's that for your vagina. However, the research is really
mixed in how effective that is long term. Ultimately, we
want you doing these exercises on your own and with
different activities during the day. So these vibrating chairs and
vagina zappers and lasers are very minimally effective and can
be quite expensive, and ultimately you still have to just
(39:54):
keep up with these home exercises to give yourself long
term relief.
Speaker 3 (39:58):
But I think it is good for people to know
that you go for pelvic floor physical therapy, you are
going to there is a physical component of this, an
internal exam physical component of this.
Speaker 2 (40:10):
Yeah, there should be.
Speaker 4 (40:11):
And the only time we don't do what is maybe
during the first trimester with a higher risk pregnancy, or
in the first six weeks postpartum, or if somebody you
know does not want it obviously, but yeah, there is
a the way that we assess the pelvic floor is
through the vagina or anus. And it's funny. I mean,
I've had people like show up in their workout clothes
and they're like I'm ready, and I'm like, you can
(40:31):
take those off. You're going to be laying on a
bed and we're doing an exam, Like, don't even more
about what you're wearing.
Speaker 2 (40:37):
You don't need a Lila lemon for that.
Speaker 1 (40:39):
Okay, now we're back to our lightning run. Do pelvic
floor problems get worse with each pregnancy if I have
multiple pregnancies.
Speaker 4 (40:47):
If they go unaddressed, Yes, So the research is clear
that the majority of dysfunction can happen typically with a
first berth. But this is why it's so important to
make sure that you are rehabbing your body afterwards, like
you have just gone through a huge transformation. So that
postpartum period in the first year again, when we're exhausted
(41:09):
and sleep deprived and you know, physically just drained, that's.
Speaker 2 (41:13):
The time to do the public floor pt But yes,
it can.
Speaker 4 (41:17):
Obviously get worse three or more berths, three or more
vaginal births are definitely a higher risk factor for peblic
floor dysfunction, which is why you want to be proactive
about that pelic floor care. But even if you haven't
started it, it is never too late, ever, ever, Ever,
Like you could be in your third trimester, you could
be in your fifty sixty seventies, It's never too late.
Speaker 2 (41:39):
To start pelblic floor rehab.
Speaker 3 (41:46):
Sarah, I really think the work you're doing is incredibly important,
and I am very grateful for you being here. But
I'm very grateful for the book, and I just I
think you are going to change the lives of a
lot of people, and that's a really special thing. So
thank you for sharing with us today and for changing
how we pee, and it's wonderful.
Speaker 4 (42:11):
Thanks Emily, thanks for having me. I'm super grateful for
your support. But also I also hope that this changes
the lives and vaginas of many many people, because we
need it and we deserve it, So I hope that
that is what happens as well.
Speaker 1 (42:25):
No power peeing, Thank you for listening.
Speaker 3 (42:55):
Parent Data is produced by Tamar Avishai with support from
the Parent Data team and pr. If you have thoughts
on this episode, please join the conversation on my Instagram
at Prof Emily oster, and if you want to support
the show, become a subscriber to the parent Data newsletter
at parentdata dot org, where I write weekly posts on
everything to do with parents and data to help you
(43:17):
make better, more informed parenting decisions. For example, last year,
Sarah wrote a great article for us about painful postpartum sex,
the different reasons for it, and some tips to get
past it. Read all about it at our new and improved.
Speaker 1 (43:31):
Website, parentdata dot org.
Speaker 3 (43:35):
There are a lot of ways you can help people
find out about us. Leave a rating or review on
Apple podcasts, Text your friend about something you learned from
this episode. Debate your mother in law about the merits
of something parents do now.
Speaker 2 (43:47):
That is totally different from what she did.
Speaker 3 (43:50):
Post a story to your Instagram debunking a panic headline
of your own. Just remember to mention the podcast too.
Write Penelope right, mam, We'll see you next time. It
is simple that though a ball
This is parent data. I'm Emily Oster. Look at this,
the kegel Master. What's a kegel muscle? It helps you
stay tight down there?
Speaker 2 (00:11):
And I have one. If you have to ask, you
haven't been doing your exercises. What exercises?
Speaker 1 (00:17):
All you have to do to stay tight is to
tighten and release it for ten minutes a day, cagel exercises.
I'm doing mine right now.
Speaker 3 (00:27):
Man, She's good. My first exposure to the kegel exercise,
like many women of my age, was in Cosmopolitan magazine,
where I was promised that.
Speaker 1 (00:43):
Doing keegels religiously was the key.
Speaker 2 (00:46):
To great sex.
Speaker 3 (00:48):
At the time, I was a decidedly not sex having
high school student, so I promptly forgot about them. Keegels
then came roaring back during pregnancy, where they promised to
preserve my pelvis floor for a great sex later, along
with improving my birth experience. Interestingly, in all this discussion
of this exercise, no one ever told me about what
(01:11):
these exercises were doing or connected.
Speaker 1 (01:13):
Them to my pelvic floor.
Speaker 3 (01:16):
I'm not sure I was entirely clear on what a
pelvic floor even was, which is why I am delighted
that Instagram introduced me to a woman dancing in a
volva costume. The vagina whisper Doctor Sarah Reardon. Sarah is
an expert in the pelvic floor, and it's safe to
say her knowledge goes way beyond Keegel's. The pelvic floor
(01:38):
turns out to have a hand in many things, peeing, pooping, sex, pregnancy, labor, birth, postpartum, menopause, etc.
Sarah explains all of this online and now in her
new book Floored, A Woman's Guide to Pelvic Floor Health
at Every Agent Stage, which will be released in June.
Speaker 1 (01:57):
There's a pre order link in the show.
Speaker 3 (01:58):
Notes, and seriously, people, this one you have to buy.
Today we talk about the book and about the seasons
of life with the pelvic floor, from puberty to menopause.
We spend quite a lot of time on the optimal
ways to pee and poop, and discuss what actually happens
when you go to pelvic floor therapy. We discuss keegels
(02:18):
and why they are often good but also not a
panacea for me. Sarah is special because she does an
amazing job shining a light on something which affects everyone
and something we ignore because we just don't see it.
Speaker 1 (02:36):
So here we go.
Speaker 3 (02:38):
Sit back, relax, do a few keegels if you wish,
and let's go.
Speaker 1 (02:44):
After the break.
Speaker 3 (02:45):
Doctor Sarah Reardon, Sarah, thank you so much for joining me.
Hey a link, great to be here. So we're going
to talk all about the pelvic floor today, and I
would encourage people to stick around till the end where
(03:06):
we're going to talk about why I think about you
every time I pee.
Speaker 1 (03:09):
I don't want to spoil that for people, but it
will come up.
Speaker 3 (03:12):
But before we get into any of that, could you
start by just telling us who you are, where you're
coming from, a little.
Speaker 1 (03:19):
Bit, what you do.
Speaker 2 (03:20):
Absolutely.
Speaker 4 (03:21):
So, I'm doctor Sarah Ordon. I'm a board certified pelvic
floor physical therapist. I live in New Orleans and I've
been practicing as a pelvic health PTE for seventeen years.
I have a social media presence as the Vagina Whisper,
where you'll occasionally see me again showing folks how to
pee and educating you while I'm in a Volva costume.
And I'm the recent author of a new book, Floored,
(03:42):
a Woman's Guide to Pelvic Floor Health at Every agent stage.
Speaker 1 (03:46):
Which is fantastic.
Speaker 3 (03:48):
Okay, So I want to start with why you love
the pelvic floor so much, and why you chose this
part of the body. Where does your passion for the
vulva and pelvic floor come from?
Speaker 4 (04:02):
So I started in this field immediately after grad school
in two thousand and seven. I went through regular pelvic
floor physical therapy school and thought I was going to
be like a trainer for the New Orleans Saints football team,
and just was really into sports and activity. And during
my grad school education, we had a professor who taught
us about the pelvic floor. It's like a two week stint,
(04:23):
and I was like, Huh, this is really interesting to
learn about this part of my body that I never
knew that I had. That everyone has all genders, males, females, everyone,
and it's super important, like every time you pee, your
pelvic floor is activating, every time you have to pass gas,
it's relaxing when you birth, when you run, And I
really just loved learning about my own body as a
(04:44):
woman and thought everybody needs to know this information. It
seems pretty important. And right when I started my career,
I jumped right into it in my first job in Austin, Texas,
and since then have just I've worked with tens of
thousands of patients, I would say, and it's just an
incredibly rewarding feel to educate folks about their body and
help them prevent issues which are super common yet so
(05:06):
rarely talked about.
Speaker 3 (05:08):
It seems like one of the things I get out
of your book is this feeling of some of the
time when you tell people things, it seems like magic,
like they didn't know a whole area was unknown, and
then you can explain something which somebody was struggling with
or was painful, or just you illuminate in a way
that I'm not sure we get, you know, with dentistry
(05:31):
or something, since we all know we have teeth and
right things like that.
Speaker 2 (05:34):
Well, I think that's one of it.
Speaker 4 (05:35):
You can't see the pelvic floor, so it's hard to
even see, like or imagine what is it, what is
it doing? It feels very mystical, yet it's super important. Again,
it plays this role in peeing, pooping, sexual health, reproductive health, pregnancy, birth, menopause.
So there are so many seasons and stages of life
where this, you know, this group of muscles is you know,
(05:58):
very much impacted, sometimes transformed, and you know one in
two women will have a pelvic floor dysfunction later in
the later years of life. I'm like, why aren't we
talking about this more and giving people tips to prevent
these issues.
Speaker 2 (06:11):
Down the line.
Speaker 3 (06:13):
So for those people who are listening now and thinking, wait,
I also don't know where my pelvic floor is, let's
do like a very quick one oh one, Like when
you talk about the public floor, what is the muscle
group you're talking about?
Speaker 1 (06:24):
And how would I know that I had one?
Speaker 3 (06:27):
So?
Speaker 2 (06:27):
Well, everybody has one, so we'll start the back. You
have one, okay, Beck, you have one.
Speaker 4 (06:33):
So I would say, if you're sitting right now, I
want you to or standing. I want you to put
your hands on your hips and you can feel those
little hip bones that we often feel and we're used
to seeing on.
Speaker 3 (06:41):
Like a I want the listeners to know that both
Tomorrow and I are doing this right now, right right,
go ahead.
Speaker 4 (06:47):
And you're used to seeing on like your skeleton. Jammi's
for your kiddos, and that's your pelvis. So your pelvis
is a ring of bones that you know attaches in
the front at the pubic bone, in the back, at
the sacred table at the very bottom of that. Imagine
this hammock of muscles. So I want you to think
about what you would do if you had to stop
your urine stream. You tighten a little muscle down there,
(07:08):
like you're trying to kink off your urine stream, or
if you have to pass gas and you're in an
elevator and you're like, oh, squeeze it right. Also, my
favorite way to cue people to do this is to
take a big, deep breath and then on the Xdale,
think about sipping up a smoothie with your vagina. So
I'm like, who does that? Every patient of mine imagines it.
(07:28):
But when you think about that sipping up maneuver, it
activates those pelvic floor muscles. And again, Emily and Tomorrow
are both doing this as we're talking, and you get
that like, oh, there's something happening down there, and that's
your pelvic floor muscles. So it's a way to kind
of just start connecting with them. But everybody has them,
and again, there are different seasons of life they're affected,
(07:51):
and there's just day to day stuff that they do
to help us function.
Speaker 3 (07:56):
So let's talk about a little bit of that day
to day stuff before we get into these seasons of life.
Speaker 1 (08:00):
So the pelvic floor when one is peeing.
Speaker 2 (08:03):
What is it doing.
Speaker 4 (08:05):
It's holding p in your bladder so that you don't
leak ideally, and then when you sit down to pee
again I encourage sitting, not hovering over a toilet, unless
it's like super growth. But when you sit down to pee,
it relaxes, so the muscle relaxes, and then your bladder
pushes the p out for you. So it's helping. You say,
what we call continent, which is the ability to hold
(08:25):
in urine, and the same thing for pooping. It holds
in poop as your rectum fills and your colon fills
with waste. And then when you sit down ultimately ideally
with a squatty potty or a little poop stool under
your feet, you can relax your pelvic floor muscles aka
your buttthole, and then you can empty the tank.
Speaker 1 (08:43):
Okay, so let's talk about pooping.
Speaker 3 (08:47):
You are online, you show us the use of a
squatty potty very frequently.
Speaker 1 (08:53):
I have a squatty potty. Can you explain why this is,
what that is and why people should have one?
Speaker 4 (09:00):
So, a squatty patty is the designer name for these
poop stools, and it's really just a stool you put
under your feet. You can use a toddler stool, you
can use yoga bot blocks, you can use an old
Amazon box.
Speaker 2 (09:11):
I don't care what you use.
Speaker 4 (09:12):
But the goal is to get your knees above your
hip level. So when you're sitting on a regular toilet,
your knees are kind of in line with your hips.
If you elevate your feet, then your knees go up
and it helps your pelvic floor muffles relax. So squatting
is the best position to relax your pelvic flore muscles
for pooping. So think about if you're in the woods,
or if you're on a runway out in the forest,
(09:34):
or you're camping, you squat over the ground, or other
Eastern countries you squat over the ground to poop. It's
the physiological way to have a bomb movement that's best.
What's happened in the Western world is we have these
porcelain thrones that are indoors and they're comfortable, and we've
got heated bathrooms, and so we've kind of moved away
from the physiological way to poop, and now we have
(09:57):
to recreate that with a pooping stool under your feet.
Speaker 3 (10:01):
Is it a good idea to pee with a squatty
potty or is that not as important.
Speaker 4 (10:07):
It's not a bad idea, but it's not a must.
So it's really just the butthhole muscles that relax best
with squatting. You can use a squatty potty when you pee,
but you can also just like sit with your feet flat.
That's a great question.
Speaker 3 (10:20):
I think we should get into a little more about
peeing also because I feel like this is the segment
of the podcast where people, I.
Speaker 1 (10:26):
Guess you get a lot of takeaways.
Speaker 3 (10:28):
Uh okay, So every time I sit down to peanout,
I think to myself, don't push the pee out?
Speaker 2 (10:34):
Because this is a big.
Speaker 3 (10:35):
Thing in your book, can you please tell people why
they should not be first of all, what does that mean?
Speaker 2 (10:40):
And why should they not be doing that?
Speaker 4 (10:42):
You know, this is music to my ears because that's
a big takeaway from the book is don't push when
you pee.
Speaker 2 (10:48):
I call it power peeing.
Speaker 4 (10:49):
And we are as busy women, as moms, as parents,
as working women, we are notorious for power peeing.
Speaker 2 (10:58):
The reason you can God so fast?
Speaker 1 (11:01):
Okay, anyway, go ahead, It's.
Speaker 4 (11:03):
True, right, we like are trying to rush through everything,
including peeing. So when you pee, you really just need
to sit and chill because your bladder is the muscle
that's pushing the pe out. If you push and like
power pee, you are putting extra strain on your pelvic
flore muscles, which can weaken them over time, and this
can lead to urinary leakage or what we you know,
(11:24):
pelvic organ prolapse, which is a scary thing when it's
like your organs are falling into your vagina. So it
can weaken your muscles over time and lead to other
pelvic flore conditions which we want to try to prevent.
So don't push when you pee. You just need to
sit and chill and breathe, and your bladder actually pushes
the p out for you.
Speaker 3 (11:43):
What if I'm in a hurry, though, is there a
situation in which I should be power peeing?
Speaker 2 (11:48):
Never?
Speaker 4 (11:49):
Okay, I don't care if there's like little you know,
if there's something really no, never, never, Just sit and
chill and breathe and it'll it will actually come out
faster and better and you'll empty better. If you push,
you actually don't even empty your bladder as well, and
so then you're gonna have to go back thirty minutes
(12:09):
sixty minutes later and pee again. So just really from
an efficiency standpoint, Emily, I just recommend chilling. Is it
okay to p in the shower? One hundred percent? Totally
fine and quite good for the environment.
Speaker 1 (12:24):
Great?
Speaker 3 (12:24):
All right, So what I think is a good place
to start because peeing and pooping are things that happen
for everybody, and it is important to note that the
pelvic floor, therefore is important at all ages. The time
people most frequently hear about the pelvic floor is during pregnancy.
Is there a time before pregnancy where you would say,
(12:46):
you know, here's another time of life that you really
should be thinking about your pelvic floor a little more,
where it's doing other things for you other than peeing
and pooping.
Speaker 2 (12:56):
Yeah.
Speaker 4 (12:56):
So it's it's interesting because I think as parents we
think about what do I need to do for my
public floor?
Speaker 2 (13:01):
But I even think we need to have these tips
and tools to.
Speaker 4 (13:03):
Educate our kids, right Like we're body training them, we're
teaching them how to you know, poop in toilets or
kids struggle with constipation. So if you're a parent, some
of the things that you're going to learn and for
you need to be implementing and teaching for your kids,
because again, if they don't learn it young, when.
Speaker 2 (13:18):
Are they going to learn it.
Speaker 3 (13:20):
So when we think about kids, is bed wetting something
that's associated with the public floor or.
Speaker 2 (13:26):
Is this a totally different issue.
Speaker 4 (13:29):
It can be and so, but I would say bed
wedding and kids is typically multifactorial.
Speaker 2 (13:34):
Right.
Speaker 4 (13:34):
It's not just like, hey, they're holding it too long
and then they have to pee at night. There's typically
some neurodaverdens that can be evolved, some behavioral issues. I
will tell you one of the biggest contributing factors to
nighttime bed wetting is constipation, which is the most common
gi complaining kids. So if you're constipated, and this kind
of goes for adults too, you know, think of that
(13:55):
basket of muscles holding you know, it only has so
much space in it, and if.
Speaker 2 (13:59):
It's full of poop, that's going to push on your bladder.
Speaker 4 (14:02):
So some people find like they have more urgency to
pee when they're constipated, and that's that's true. The same
thing for kids when their bed wetting. One of the
first things I do is I actually talk to their
parents about curing their constipation and then getting them on
an avoiding schedule of going every couple hours during the
day and then setting alarms at night. But there's also
(14:23):
some kind of behavioral things that can and neurological things
that need to be addressed as well. That's outside of
PELBLC floor therapy, but some of these tips do help
when it comes to addressing pooping and peeing habits.
Speaker 3 (14:33):
I should say that that until the age of about seven,
it is actually pretty typical for kids to just not
wake up to pee and to need a pull up.
So when we talk about sort of bed wedding you
would want to see somebody about it's really if they
are still not dry at night after six or seven.
Speaker 4 (14:51):
Yeah, and that's you know, my son was he'll probably
not love me sharing. This was five or six, and
he was still in night time both.
Speaker 2 (14:56):
Completely trying it.
Speaker 4 (14:57):
During the day, he just was lazy and he didn't
want to pay all day, so we'd hold it till
the nighttime. And I'm like, dude, I get that. I mean,
how many times are we like cold in bed and
don't want to get up the key? But then he
just grew out of it, and I was like, Okay,
if he's nine or ten and we have this issue,
we'll get some help.
Speaker 2 (15:14):
But otherwise they typically do grow out of it.
Speaker 4 (15:17):
I think the other incremental time when we're thinking about
how early is it appropriate to start really learning about this,
it's really puberty. When you have a young woman who
was going through menstruation, their body is going through significant
hormonal changes, and hormones affect our public floor function and
our vagina in volva. But also this is their first
(15:38):
exploration into their genitalia, into their body, and if we
don't talk about it, it can often feel embarrassing or
you know, shrouded in shame. But it's also they are
learning how to use menstrual hygiene products. They are learning
how to find their vaginal opening, perhaps to insert a
tampon or a menstrual disc or cup. They're learning about
(15:59):
like what is the significance of a painful period? Does
that mean something else could be going on, like an
endometriosis or something. So really teaching them about their bodies
young is where it needs to start because it opens
the doors for greater and bigger conversations and curiosity later
versus not talking about it at all. So that's just
another major time, and I would say after that, it's
(16:21):
also when someone becomes sexually active.
Speaker 2 (16:23):
So the vagina is part of the pelvic.
Speaker 4 (16:25):
Floor, and one in four women will experience pelvic pain
and painful sex at some point in their life and
they don't even think of the pelvic floor muscles as
a source.
Speaker 2 (16:33):
Of that pain.
Speaker 3 (16:35):
Going back quickly to puberty, I think one of the
pieces it's very helpful for me in thinking about the
book is like, this is a this is a scientific
way to approach a topic that with an adolescent is
often very uncomfortable to just be like, hey, there are
muscles in the pelvic floor, Like let's talk about like
inserting a tampon. But rather than talking about it like
(16:57):
in an uncomfortable way, at least there's a little bit
of a way to come into it with like, you know,
here's some interesting cool facts about muscles and the muscles
you have and all the cool stuff they can do.
And by the way, also, this is where your vagina
is in case you want to use a tampon.
Speaker 2 (17:12):
Right, I mean, And it's so much more.
Speaker 4 (17:14):
It's kind of like we and that's in a very
practical sense of how do we approach pelvic floor health.
But I think it has even greater implications about how
do we feel comfortable talking about our bodies as women
in the greater scheme, like where do we start going
to for help? Where do we get education about our bodies?
And then when we become sexually active, or we struggle
(17:35):
with infertility, or we're pregnant and postpartum, we kind of
start keeping all of these things in because we've never
talked about them. So I think it just there's so
much more we can achieve by having these conversations early
that the ripples of that go really far, way far
into the later stages of being a woman.
Speaker 3 (17:51):
So let's talk about sex, either becoming sexually active or
just in general problems with sex.
Speaker 1 (17:56):
Can you be a little bit of a sense.
Speaker 3 (17:58):
Of what what is the pelvic floor doing during sex
that it might fail at.
Speaker 2 (18:07):
Let's talk about potential fairs but also achieve achievements. Okay, So.
Speaker 4 (18:13):
I would say, so the vaginal opening is in through
is through the pelvic floor muscle. So in order to
have anything insert into the vagina, whether it's a penis,
a dildo, a finger, ultimately a speculum for pelvic exams
or you know again we mentioned tampons.
Speaker 2 (18:31):
The pelvic floor muscles have.
Speaker 4 (18:32):
To relax for anything to enter into the vagina, so
if those muscles are tight or tense, it can often
obstruct insertion. And this is when people complain of something like, oh,
it feels like my partner's hitting a wall, or when
I put the tamp on, it just feels like I
can't go any further. That can often literally just be
muscle spasm, and so we really need those muscles to
(18:53):
be able to relax at the opening and then even
at the deeper level. If someone experiences pain with deeper
insertion or certain position, or it feels like they're partner's
poking them, or there's a bruise, that can literally just
be muscle tension. So as physical therapists, we work with
muscles to help relax them, teach you how to breathe
different positions and stretches to relieve tension and pain. Also,
(19:16):
the outer layer of the pelvic floor muscles, there's two layers.
The outer layers are the ones that contract and relax
during an orgasm, so we go through stages of arousal
which hopefully ultimately lead in the climax, which is an orgasm,
and those muscle contractions are what happening during an orgasm.
So if you have pain with orgasms or difficulty having
(19:37):
an orgasm, or leakage with orgasms, your pelvic floor muscles
are also involved.
Speaker 3 (19:42):
And then if the sex is successful in a different
way than the orgasm and you get pregnant, this is
the time I think people almost always hear about, or
at least well, this is the time people should always
hear about the pelvic floor, whether they do or not.
So during pregnancy, your public floor is doing a tremendous
(20:03):
amount of additional work, correct, right, because it is holding
up I'm gonna see if I get it right, having
done my little now that you've taught me about the
smoothie thing is it's holding the public floor. Muscles are
holding up the baby, which is getting larger and larger
and larger. And there's a lot of water in there also,
and it's a lot of work. Am I roughly correct? Right?
Speaker 2 (20:22):
You are spot on bad only And so.
Speaker 4 (20:26):
You know, we're so used to getting these text messages
or emails about the size of the baby. It's the
size of a blueberry, then it's the size of an avocado,
and then it's the size.
Speaker 2 (20:34):
Of a watermelon.
Speaker 4 (20:35):
Well, your pelvic floor muscles are ultimately the hammock that's
holding up that blueberry, avocado, or watermelon. And so if
you can imagine a hammock holding an avocado, it's not
going to sink down or stretch that much. But if
it's holding a watermelon, it's going to sink lower, it's
going to be really stretched out. It's not going to
be able to support you as well. So regardless of
what type of birth you have, because it's a misconception
(20:58):
that you know, only vaginal birth moms need pelvic floor PTE,
your pelvic floor change is just through pregnancy itself. And
this is when we start to see things like urinary leakage, hemorrhoids,
prolapse like all this, you know, vagina stuff starts to
pop up that we're like, oh, this is just pregnancy. However,
there is research to support that getting pelvic therapy interventions
(21:20):
soon or during pregnancy give you better postpartum outcomes. So yeah,
your vagina's changing, your pelvic color is changing. You got
to get pelviclore therapy during pregnancy.
Speaker 3 (21:30):
I want to talk about what that looks like, But
then I want to, But at first, I want to
tell you the most embarrassing story that I have from
either of my pregnancies, which is during my second pregnancy,
I was in New York and I wanted to get home,
and I was a little bit late for the train,
and there was a lot of traffic, so I decided
to run, and I did have to pee a bit,
and so I ran like like a lot of blocks,
(21:51):
and I was maybe five months pregnant, and I just
the entire time was being on myself as I was running.
Speaker 1 (21:57):
Through the streets of New York.
Speaker 3 (21:58):
And thank god I had another pair of pants with
me when I got on the train, which I totally made.
Speaker 2 (22:03):
But it is it is a very.
Speaker 3 (22:06):
Salient memory of Yeah, and if you think about it,
if by pelic floor failed me.
Speaker 2 (22:12):
You're not alone.
Speaker 4 (22:14):
Well, you were pregnant, and that's a lot of pressure,
and running is extra pressure on your pelvic floor. So again,
it's one of these things where I'm like, we have
to train these muscles like we do any other muscles
in our body. If we're going to ask it to
support a five month old baby running through the streets
of New York, we have to train it for that.
(22:36):
Just like you would run a marathon, you Emily, and
you train for months and months and months. Pregnancy is
no different, Like we're the demands on our body are different,
so we need to train our public floor to meet
those demands. And yet we just haven't incorporated this into
prenatal care.
Speaker 3 (22:50):
So in your ideal incorporation of this into prenatal care,
when would it start and what happens beyond? I think
keeg are the thing people have most frequently heard of, right,
the sort of scope of this is much larger than that.
So if you weres like like I'm telling someone who
is just just found out they're pregnant, like or before,
(23:11):
what is the advice about how long and what would
that even look like for them?
Speaker 2 (23:16):
I mean I would start week one.
Speaker 4 (23:18):
I mean, if you're pregnant week four, like, start getting
some education about you know, of course I have all
these videos about this, but you know your pelvic floor
is going to go through changes even in that first trimester.
You're going to have constipation from surging progesterone, You're going
to have urinary frequency, you may have some you know,
leakage even start right away. So but I would say
(23:38):
at the latest you need to really be checking in
with a pelvic floor therapist or starting some pelvic floor
training at the very beginning of your second trimester, because
this is when our body starts to really transform with
respect to ligaments, get more soft and lax, and we
get some instability in our pelvis. We start getting more
stretching up the core muscles, the abdomen and pelvic floor.
(24:00):
Trying to stay active but not sure how to modify
what workouts we're doing, and aches and pain start to
pop up, you know, hit pain, back pain, things like that.
So all of those things can be addressed proactively. And
if you get pelvic foe muscle training and address issues
during pregnancy, it's gonna want optimize your birth. You can
(24:20):
get a lot of education on how to prep for birth.
Pushing cesarean you know, birth preparation and then postpartum recovery.
So I would say as early as your second trimester,
check in with a pelvic floor therapist in person or
start doing some training to really get your body ready
for that long marathon of the next several months.
Speaker 1 (24:40):
What is ikegel.
Speaker 2 (24:43):
It's a pelvic clere contraction.
Speaker 4 (24:44):
Well, first of all, it's an exercise named after a man,
which like I'm going to start a revolution to rename it, right,
I mean, we just don't. We don't need any more
body parts or anything to do with the female genitalia
named after a dude. Second, and it's a pelvic floor contraction.
So that sipping up the smoothie that we all practiced earlier, that's.
Speaker 2 (25:05):
A kegel contraction.
Speaker 4 (25:06):
So it's a closing of the sphincters. It's a lifting
of those pelvic organs. And again it's like it's like
a bicep curl, it's like a crunch. It's like one
exercise you can do for a group of muscles. However,
it's the most popular one that we hear about. It's
kind of the foundation of pelvic floor training for strengthening. However,
(25:27):
you can't just sit in the carpool line and do kegels.
You need to do quicker contractions. You need to do
longer hold ten second contractions. You need to you know,
work this muscle in standing. If you're a runner, kegels
in the carpoo lane, it's not going to help you out.
You need to do squats and lunges and kind of
higher impact stuff while training your pelvic floor. The flip
(25:48):
side of this, I'll say is a lot of people
actually have tight pelvic floors and we think like, oh,
tight vagina, that sounds awesome, But you know, tension can
also impair functions, so you can't relax your muscles, well, pee, poop,
have sex, or even contract. So you know, I caution
people to just start doing other kegels because a lot
of people have tension just normal. In today's world, we
(26:10):
have tension in our bodies, and you want to address
that first before doing strengthening.
Speaker 3 (26:14):
I think there's a there's a core insight in the
book which I found very illuminating, which was, you know,
I've gone to physical therapy for other things, and generally
when you go to physical therapy, they look at what
the issues are that you are personally struggling with, and
they give you a set of exercises to deal with
those issues. And this is the same thing. It's just
(26:37):
not a muscle that you see, uh correct, And to
therefore the same logic applies. You figure out what's trying,
what's going on, and you develop a set of exercises
that are going to train that problem away, which may
involve kegels. Just like fits, which like sometimes there are
squats or bicep curls or crunches or your regular physically,
(26:58):
I think.
Speaker 2 (26:59):
We want to think about that.
Speaker 4 (27:00):
And I think that one, I mean, we are kind
of illuminating so much more about the pelvic flour now
that like, hey, it doesn't need to just tighten, it
also needs to relax. But I also think that there
is no one size fits all protocol. I always say
it's like if you have back pain and your therapist
is like, hey, just go do a bunch of crunches,
or that's what your physician tells you, You're like, well,
(27:20):
that doesn't sound like the right prescription, right. We need
to look at how you move and breathe and what's
tight and what's weak. And I go through in the
book kind of a checklist of if you're doing this
at home and not seeing a pelvic four therapist in person,
like which kind of pathway do you fall? And how
do you know if you have tension? How do you
know if you have weakness and need kegels or tension
(27:41):
and need relaxation. And I even give you tips on
how to explore your pelvic flour, like how do I
know if I'm doing a kegel properly, and you know,
to give people really to demystify this a little bit,
and to also just give them some simple practical tools
at home to start addressing these issues.
Speaker 3 (28:01):
More parent data, including the pelvic floor after menopause, what
the pelvic floor is like in men and a lightning
round of your most pressing pelvic floor questions. After the break,
(28:22):
I want to talk about a third part of life,
which is the kind of perimenopause menopause piece, because this
is another time in which even people who have not
had problems brier with their pelvic floor can develop almost unexpectedly.
So things like prolapse can come up in perimenopause or
(28:45):
menopause even if it didn't come up before. So can
you give us a sense of is this just my
pelvic floor is aging and starting to droop like all
my other muscles?
Speaker 1 (28:55):
Is that basically what's happening?
Speaker 3 (28:57):
As I turned to ash protein, is it something about proteins?
Speaker 4 (29:03):
So I was thinking about that, it's always about protein.
So yeah, I mean yes and no. So muscles weaken
over time, they atrophy over time when we don't address them,
and when you go through transitions like pregnancy and postpartum,
where those are risk factors for developing pelvic four dysfunction
because again, you are going through physical changes, hormonal changes,
(29:25):
lifestyle changes, and if those don't get addressed at those
early stages, then when you hit perimenopause and you don't
have your hormonal system to prop you up anymore, things
start to take a nose dive. So during perimenopause, you
start having less estrogen in your body, and estrogen is
the hormone that really plumps up the vagina. It keeps
you well lubricated in the evolve in vagina, and it
(29:47):
gives you more tone and thickness to your pelvic floor muscles.
You also lose testosterone during perimenopause, so you know, you
have less muscle strength, the different things like that, more
visceral fat, and then you lose colligen so you know,
I like put collagen in my coffee and I rub
it all over my face. I'm like our vaginas and
volvers are also losing collagen. So all of those things
(30:08):
do lead to more pelvic floor weakness, less tone in
the muscles, which can lead to prolapse and leakage, and
vaginal dryness. So One of the biggest things people experience
is more vaginal dryness and painful sex and perimenopause and
definitely into menopause because you don't have the natural lubrication
of estrogen to help, you know, provide moisture down there.
(30:31):
So I'm a huge fan of obviously doing exercise, but
then and proactively strengthening your pelvic floor. Looking at perimenopause
like a runway, like, hey, there's a red flag down there,
and you need to kind of like start working to
get yourself ready to address that. Like you we have
this runway where it feels like things are going bananas,
(30:52):
but it's also a warning sign of like your body's
changing and you need to make it kind of stay
healthy so that when you get there, you're in your
tip top pelvic floor shape. The other thing is I
do encourage folks to have a volva care routine, just
like we have a skincare routine, and not using harsh products,
(31:13):
but also thinking about using a you know, all natural
moisturizer for their volvet in vagina, using good lubric.
Speaker 1 (31:19):
Sorry, what can we back up?
Speaker 3 (31:21):
I like, like, what can you say more about the
Please say more?
Speaker 4 (31:30):
So there are moisturizers that you can use for your
volven vagina. And some people use these postpartum when they
are lactating and have low estrogen levels, but then also
in perimenopause and menopause, and so there are there's a
brand called Medicine Mama that has a volva bomb. It's
olive oil based, its organic ingredients. Some people just use
(31:51):
coconut oil. There's another brand called Kindra. So there's a
bunch of these bombs or lotions that are specifically made
for the volven vagina that aren't going to alter your
pH and put you at risk for infection, but they're
going to keep it lubricated. So it's just like we
do for our face. And you'll notice, like going through
perimenopause and definitely menopause, like it's dry down there, it's itchy,
(32:13):
it's uncomfortable, it can even close up. So I'm a
big fan of that. And then some people do use
a topical estrogen cream as well to help plump.
Speaker 2 (32:22):
Up the tissues.
Speaker 1 (32:24):
So much to look forward to.
Speaker 3 (32:27):
So much more to add to our daily routine, because yes,
I'm barely making it as it is with just putting
a small metamisturizer and washing my face.
Speaker 1 (32:34):
So TBD on that. Do men have a pelvic floor?
Speaker 3 (32:42):
And what is important for I feel we should We've
left them out, so I'd like to have this brief
discussion of men pull them in.
Speaker 4 (32:50):
So men absolutely have a pelvic floor. The differences are
they have two openings. So when female pelvic floors, we
have an opening for urine, the urethra, we have an
open for the vagina, and then we have an opening
for the anis where poop and gas exit. Male bodies
have two openings, one for the urethra, which goes through
the penis and exits through the opening of the penis,
and then one for the anus, so they have two openings.
(33:13):
They obviously don't have a vagina, but the pelvic floor
also closes the sphincters. It maintains an erect penis, so
blood stains in the penis when those muscles are tighter, tense,
and they also contract and relax during climax and orgasm.
They support your pelvic organs. They assist with breathing, just
like they do in the female body. More often though,
(33:34):
men have tension versus weakness, so many more women experience
weakness because of the hormonal fluctuations and because of events
like pregnancy and birth and menopause. But male bodies typically
what I see is much more tension in the area
and that needs to focus more in relaxation unless they
have like a prostate surgery, which could lead to weakness
issues as well. So you know, they have problems just
(33:57):
like female bodies do.
Speaker 3 (33:59):
They also have urinary leakage problems. Is that like an
issue for men?
Speaker 4 (34:04):
I can especially if they have a prostate procedure because
the prostate kind of surrounds the urethra. So if they
have a procedure to the prostate or a surgery to
remove it because of prostate cancer, then it affects the
urethra and they can leak urine. They can have a
rectile dysfunction because the nerves are impaired, they get a pain.
Speaker 2 (34:22):
So it is a it is a common issue.
Speaker 4 (34:25):
It's interesting because as little as we talk about the
female pelvic floor, we talk about the male pueblic floor
actually a lot less. And I've seen men in my
practice my entire career. We have you know, wives coming
in like I think my husband needs this too, you know,
And so we do see a lot of males as well,
and it's a it's an up and coming, you know,
sector of pelvic floor therapy.
Speaker 3 (34:46):
They definitely need more attention in general. Okay, so I
want to end with a few rapid fire questions. My
favorite Okay, what is your favorite of the pelvic floor muscles,
the puba rectalis, which relaxes for pooping.
Speaker 1 (35:10):
What should I do if the porta potty is really dirty?
Speaker 4 (35:14):
Hover, lean forward, rest your elbows on your knees, and
take some big, deep breath to empty.
Speaker 3 (35:20):
Is it bad if I hold in my poop for
a long time while I'm running asking for a friend hashtag.
Speaker 4 (35:30):
It's not a deal. If you're running, you have two options.
You hold it or you squat on the side of
the road. If you are ambitious and courageous enough to squat,
go for it. If not, hold it. But when I
get back from running, I would drink some hot water.
I would maybe eat a little something, and that can
stimulate the urge for the poop to go. But it's
not ideal to hold it unless you have to.
Speaker 3 (35:51):
Is it important to pee after sex to prevent you
to Yes, it is important to pee after sex.
Speaker 4 (35:57):
I'm not a fan of what I call just in case,
which is like every time you get to target, and
then you get home from Target, and then you go
pick the kids up from school, and every time you
pass a bathroom. However, times that are okay to pee
just in case are before sex, after sex, before pelvic
floor therapy, after pelvic floor therapy, or if you like
(36:20):
know you're not going to be have access to a
bathroom for many many hours. Typically you want to pee
every two to four hours, but after sex is an
important time to go.
Speaker 3 (36:30):
An issue that many people have raised to me is
as they are getting ready for bed, they feel they
need to pee many times, and sometimes it's just in
case peing, or it's just this feeling of like I
just maybe I have to do like a little bit,
a little bit is that?
Speaker 1 (36:44):
Why is that happening? And should I do? Should I
give into it?
Speaker 4 (36:50):
So, No, it's a miscommunication between your bladder and your
pelvic floor. So typically you are supposed to pee every
two to four hours, right if you have a drink,
So if you have like wine or a cocktail or
spicy food that could irritate your bladder, that might make
you more susceptible to pee more often. If you don't
(37:13):
front load your fluids and you drink everything in the
evening after getting home, that can make you have to
pe more often, or you have a little bit of
overactive bladder, and overactive bladder is like your bladder saying
I gotta go, I gotta go when it's not really
that full. So there's two things that I tell people
to do. It's like front your load your fluids earlier
in the day, cut off your fluids two hours before
you go to bed pe. And then if you go
(37:35):
to the bathroom and pee and you still have the urge,
I want you to take like five big deep breaths
and then five kegel contractions, suck up that smoothie five times,
because tightening your pelvic floor tells your bladder to chill out.
And so if you do that on repeat, and you
can buy yourself fifteen minutes, thirty minutes, and then you're like, shit,
I gotta go again, go again, that's fine. But eventually
(37:57):
you'll push that urge often enough where you don't have
to go every five minutes and keep going because you
keep it's a false urge. There's nothing in there.
Speaker 3 (38:04):
When you have to go again, so can you say
a little bit more about when you do physical therapy
what what does it involve. Somebody mentioned some kind of
zapping of the vagina, and I'm just curious if that's
like a core element or just a sometimes extra.
Speaker 4 (38:25):
You know that vaginal zapping is not standard in pelvic
floor therapy, so it's think of traditional physical therapy where
you get an assessment. However, the assessment is an internal
examination of the pelvic floor, which is either through the
vagina or through the anus, and this is obviously with consent.
And once we evaluate those muscles, if they're tense, we
may work on strengthening exercises, which again can include pelvic
(38:49):
floor contractions or key goals. We do use some machines
which are called biofeedback, which kind of are like like
an EKG for the heart, but it goes around your
buttthole or in your vagina and it shows you on
a green how your muscles are performing. But then we
do squats and lunges and hip strengthening and all kinds
of stuff. If it's a weakness issue, I mean, if
(39:09):
it's a tension issue, we may do more relaxation like
internal vaginal massage to the pelvic floor using trigger point
winds or dilators to relax the muscles. There is something
called electrical stimulation which can like activate the muscles kind
of like I don't know if you remember, like the
old Bruce Lee Daisy used to put this thing on
his stomach and it would like fire up his six pack.
(39:30):
It's that for your vagina. However, the research is really
mixed in how effective that is long term. Ultimately, we
want you doing these exercises on your own and with
different activities during the day. So these vibrating chairs and
vagina zappers and lasers are very minimally effective and can
be quite expensive, and ultimately you still have to just
(39:54):
keep up with these home exercises to give yourself long
term relief.
Speaker 3 (39:58):
But I think it is good for people to know
that you go for pelvic floor physical therapy, you are
going to there is a physical component of this, an
internal exam physical component of this.
Speaker 2 (40:10):
Yeah, there should be.
Speaker 4 (40:11):
And the only time we don't do what is maybe
during the first trimester with a higher risk pregnancy, or
in the first six weeks postpartum, or if somebody you
know does not want it obviously, but yeah, there is
a the way that we assess the pelvic floor is
through the vagina or anus. And it's funny. I mean,
I've had people like show up in their workout clothes
and they're like I'm ready, and I'm like, you can
(40:31):
take those off. You're going to be laying on a
bed and we're doing an exam, Like, don't even more
about what you're wearing.
Speaker 2 (40:37):
You don't need a Lila lemon for that.
Speaker 1 (40:39):
Okay, now we're back to our lightning run. Do pelvic
floor problems get worse with each pregnancy if I have
multiple pregnancies.
Speaker 4 (40:47):
If they go unaddressed, Yes, So the research is clear
that the majority of dysfunction can happen typically with a
first berth. But this is why it's so important to
make sure that you are rehabbing your body afterwards, like
you have just gone through a huge transformation. So that
postpartum period in the first year again, when we're exhausted
(41:09):
and sleep deprived and you know, physically just drained, that's.
Speaker 2 (41:13):
The time to do the public floor pt But yes,
it can.
Speaker 4 (41:17):
Obviously get worse three or more berths, three or more
vaginal births are definitely a higher risk factor for peblic
floor dysfunction, which is why you want to be proactive
about that pelic floor care. But even if you haven't
started it, it is never too late, ever, ever, Ever,
Like you could be in your third trimester, you could
be in your fifty sixty seventies, It's never too late.
Speaker 2 (41:39):
To start pelblic floor rehab.
Speaker 3 (41:46):
Sarah, I really think the work you're doing is incredibly important,
and I am very grateful for you being here. But
I'm very grateful for the book, and I just I
think you are going to change the lives of a
lot of people, and that's a really special thing. So
thank you for sharing with us today and for changing
how we pee, and it's wonderful.
Speaker 4 (42:11):
Thanks Emily, thanks for having me. I'm super grateful for
your support. But also I also hope that this changes
the lives and vaginas of many many people, because we
need it and we deserve it, So I hope that
that is what happens as well.
Speaker 1 (42:25):
No power peeing, Thank you for listening.
Speaker 3 (42:55):
Parent Data is produced by Tamar Avishai with support from
the Parent Data team and pr. If you have thoughts
on this episode, please join the conversation on my Instagram
at Prof Emily oster, and if you want to support
the show, become a subscriber to the parent Data newsletter
at parentdata dot org, where I write weekly posts on
everything to do with parents and data to help you
(43:17):
make better, more informed parenting decisions. For example, last year,
Sarah wrote a great article for us about painful postpartum sex,
the different reasons for it, and some tips to get
past it. Read all about it at our new and improved.
Speaker 1 (43:31):
Website, parentdata dot org.
Speaker 3 (43:35):
There are a lot of ways you can help people
find out about us. Leave a rating or review on
Apple podcasts, Text your friend about something you learned from
this episode. Debate your mother in law about the merits
of something parents do now.
Speaker 2 (43:47):
That is totally different from what she did.
Speaker 3 (43:50):
Post a story to your Instagram debunking a panic headline
of your own. Just remember to mention the podcast too.
Write Penelope right, mam, We'll see you next time. It
is simple that though a ball
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