14. Pelvic Pain, Leaking, Urgency? Creating a Therapeutic Exercise Plan With Pelvic Floor Dysfunction

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Tight pelvic floor doesn't always mean it is actually
strong and it can be tight and weak at the same time.
I kind of think of things more like being really loose and then
being really tight. So loose.
A loose pelvic floor think aboutlike floppy and like not really
hasn't got very much integrity or in it.

(00:20):
Like for me that would be like someone with a prolapse that
like it's got a lot of downward pressure.
It's been a bit stretched or post Natal or something like
that. Those people are tend going to
tend to have a lot more loss of things accidentally have a
really hard time holding anything in.
Welcome to the Gut Fit NutritionPodcast, the show where we dive
deep into the world of gut health, nutrition and fitness to
help you unlock your best self from the inside out.

(00:42):
I'm your host, Lee Morato, a registered dietitian, gut health
expert, long distance runner, and movement enthusiast on a
mission to empower you with science backed whole body
strategies to fuel your body, heal your gut, and thrive in
your active life. Whether you're here to finally
break free from IBS and digestive symptoms, optimize
your fitness performance, or learn how to support your gut

(01:03):
health with natural strategies, you're in the right place.
Each week we'll explore topics like conquering digestive
symptoms, building a gut friendly lifestyle, enhancing
endurance and strength performance, and more.
So grab a cup of your favorite gut friendly tea and settle in
because we're about to get gut fit together.
If you've ever felt like exercise makes your symptoms

(01:25):
worse or you've been told to just do gentle yoga and hope for
the best, this episode is going to change the game for you.
In today's conversation, we explore what the pelvic floor is
and how dysfunction can show up alongside digestive symptoms
like bloating, Constipation, urgency, and diarrhea.
How to know if your pelvic flooris tight versus weak and why
that matters. The role of nervous system

(01:46):
regulation in gut and pelvic floor function.
How exercise, when done right, can help reduce pain, support
digestion and improve overall pelvic health.
Plus, a fun segment where we rate tools like standing desks,
biofeedback devices, squatty potties and more.
Joining me all the way from Australia is Courtney Pollack,
accredited Exercise Physiologistand founder of Her Exercise

(02:10):
Physiology, a virtual clinic providing accessible, evidence
based care for women special focus on pelvic health across
the lifespan. Courtney has extensive
experience in helping women navigate endometriosis, chronic
pelvic pain, postpartum recoveryand more.
And she's here to share her expertise on how to build an
intentional, supportive exerciseplan that works with your body,

(02:33):
not against it. If you've been feeling
frustrated, limited, or even afraid to move because of IBS or
pelvic floor symptoms, you're not alone.
This episode will give you hope,validation, and the tools to
start rebuilding trust in your body.
Let's dive in. Hey.
Hello, Courtney. Welcome to the show.
Hello, thanks for having me. How are you?

(02:54):
Yeah, I'm super excited that we could connect to despite our
time zone different. Yeah, it's always a challenge,
isn't it? Yeah, it's it's morning for you
and it's evening for me. But yeah, so I think just to get
into the the episode, if you want to explain a bit more about
who you are and and who you helpand, and then we'll get into

(03:18):
today's topic. Sure, I'd love to.
So I am an accredited exercise physiologist, which if you have
no idea what that means, it means we basically use an
exercise or movement based approach to help people that
live with any chronic or complexhealth conditions.
So we can use exercise or movement in a prescriptive way,

(03:39):
which helps change the Physiology of the body.
So I fall into that category. However, a lot of us would niche
down into particular fields of interest.
So mine is in Women's Health andmore specifically in pelvic
health. So I use, I see a lot of clients
that have pelvic, anything pelvic health related.
So I think pelvic full dysfunction, it might be pelvic

(04:03):
pain, endometriosis, it could beprolapse issues, it could be
like post Natal recovery, pelvicgirdle pain during pregnancy, it
could be menopause changes that we're trying to deal with a lot
of health issues. So kind of like anything that
umbrellas into that. My clinic is 100% virtual, so I

(04:23):
see clients from all over the place, which is really exciting,
connecting with people who are all over the world, actually,
which is always really cool. Yeah.
So the time zone thing's always an issue for me too.
Yeah, which is really cool. But yeah, so that's pretty much,
I guess what I do in a nutshell.Yeah.
OK, cool. My question was gonna be what an

(04:45):
exercise physiologist does, but I think you answered that that
pretty well, I guess. How would you say that they're
sort of different from just likea personal trainer?
I know here in Canada we don't really have like a regulatory
body. There's different ways you can
get certified as like a personaltrainer, but how is an exercise
physiologist maybe different? Like a step above or a few steps

(05:07):
above that? So here in Australia, and I
would, and I think it's mostly in most other countries too, any
exercise physiologist is a degree qualified professional.
So we fall into allied health over here, which is like at the
same level as like your chiropractor, your
physiotherapist, your dietitian.So we're, we've done four years
usually of university study, which I guess is very different

(05:31):
to a personal trainer. And we learn about like the
cellular changes within the body.
So think about like how a chronic illness changes how your
body would actually work. So then we then use exercise as
interventions to either reverse some of those in the case of
something like maybe type 2 diabetes, or where it's like we
can actually change how the bodyis turning up.

(05:53):
Or it might be to manage symptompresentation.
So let's say for example, with chronic pain or chronic pelvic
pain in particular, which I feellike maybe some of your
followers will resonate with this, which is why I pick this
one. The way that it's impacted, say
the nervous system, muscle tissue, other organs, we can use
certain types of movement and exercise programmed throughout

(06:15):
the week to actually help address that.
So then quality of life and how you manage symptoms is improved.
So if you were to go to a personal trainer, their
knowledge is definitely not thatdeep in the sense of how this
condition is affecting the body and the choice of exercise.
The volume that you do, how many, how much weights, reps and
sets that you might do is going to be very differently

(06:37):
programmed because they don't understand how that works.
So a lot of the times when I have clients that have come from
personal trainers, the particular types of exercise
might be exacerbating their symptoms rather than supporting
them. So we would then be able to
address sort of like we need to change this.
This is actually not helpful foryou.
Some types of exercise are not helpful for people with problems

(06:59):
or health conditions and they don't actually know that because
I think the everything you run exercises is like do more, go
hard, work hard and feel like a boss.
And like sometimes that is actually not helpful for people,
which we will dive more into today, I think because it that
definitely is something that is a problem with pelvic floor
health and pelvic health in general.
So yeah, I guess I hope that's kind of given you a little bit

(07:22):
more insight into the difference.
It's extremely. No, it does make sense.
I think about it even comparing like nutrition coaches or
nutritionists to dietitians cause.
Yeah. Yeah.
Like nutrition is not a regulated term here in Canada.
Anyone can call themselves that.But to be a dietitian, same as a
exercise physiologist, you have to do that additional post

(07:46):
secondary study. And then is it also with the EP
that you have to be regulated with the college?
Yeah. So we have like a governing body
that regulates us, Yeah. And we have to be accredited
through them. So we can then take rebates
through health, health funding for us or we have like a system
here like Medicare, which is I guess reduced rebates for

(08:08):
healthcare. So personal trainers don't get
that whereas we actually so it is quite simple to how you would
associate with a nutritionist I guess.
Yeah, yeah. And even with like you may see a
nutritionist or a nutrition coach just for like healthy
behavior change and like helpingwith maybe more basic healthy

(08:28):
eating, but like seeing a registered dietitian maybe more
for medical nutrition therapy where using nutrition clinical
interventions to treat a diseaselike diabetes or heart disease.
Yes, 100%, yeah. Gut Gut issues very much the
same. Yeah.
So I guess, yeah, using more evidence based research to sort

(08:50):
of address more more complex andmore clinical conditions and and
treatment. Yeah, cool.
I guess what what got you into this area of of work?
Yeah, I actually got into health, shall we say.
I grew up. I grew up as like an overweight

(09:11):
kid. Like people like, oh, I'm like
overweight and I need to go loseweight.
And I think I just started training in the gym and I did
some personal training. I, I landed up in, in CrossFit
for a while there and I was like, oh, this is really cool.
I should like learn about the body.
So I went to university and I started off with exercise sport

(09:33):
science. And then I realised that the job
potential from exercise sport science wasn't as good as
exercise Physiology. So you can't do chronic health
conditions with exercise sport science, I guess that would be a
little bit more like strength and conditioning type stuff.
So I probably should just go anddo exercise fields so that I can

(09:53):
like get out of uni and probablyget some better jobs in doing
that. I also studied personal training
at the same time so that I couldstart working with clients and
like develop my skills in that and in, in that.
So from my own experience with like really struggling with
weight loss, I just didn't really know how to get there.

(10:14):
I never really got results. So studying that myself and then
seeing that a lot of other clients that I had had similar
issues, I really wanted to like help them.
But then a lot of the barriers for them to do exercise were
actually other complex issues. So I initially started out, I
seemed to attract a lot of like post Natal clients where there
were, you know, I would really like to go back to running and

(10:37):
training, but like I've got abdominal separation and I've
got prolapse. So we can't actually get these
like heavier lifting exercises or running.
And it was always something was the barrier to achieving your
fitness goals. And that was what I really
resonated with. It was like, I really understand
this because like you really want to get to all these other
things that you can't. So I kind of just navigated down

(10:58):
into Women's Health and eventually had, I used to have
like my own issues with CrossFitwith leaking, with double unders
and skipping from like, I don't have any kids either, which, you
know, I always thought bladder issues and like pelvic floor
problems were only four women who had children.
I was like, man, there's way more to this than just like

(11:19):
having a kid. So I was like, I'm going to dive
into this. And so as I did that, then I
realized how many people in lifego through pelvic health
problems and pelvic floor issuesthat don't have children that
feel a little bit left out because they're like, Oh, I
don't like, I don't want to tellanybody this.
Like I shouldn't have these problems.
Because I don't. Have so I actually don't really

(11:41):
see a lot of pregnant and post Natal women because a lot of my
content is really around other issues that are like, Oh yeah, I
can get help for this. It's not it is actually very
common for other people to have,you know, these these symptoms.
So yeah, I got into it like through that, I guess, and then

(12:02):
I just didn't really care about any other like really clinical
stuff. So a lot of other exercise
physiologists will see like Parkinson's disease or like
stroke rehab. And I was like, I don't really
resonate with any of that. And I love the health and I love
this. So I just went like full in down
that way. A lot of EPS is short for
exercise Physiology. EPS will normally see like a lot

(12:22):
of different types of people. They're very generalist or
they'll see, you know, heaps of variety in their day, whereas I
don't do that. And it's quite rare to see an EP
that only does one thing. So if anyone here is listening,
going, I've seen EPS and they doall this other stuff, that's
it's probably why. Right.
Yeah, you're really specialized in the Women's Health space.

(12:44):
And yeah. And just from working with
people finding that that was like AI guess, Yeah, like you
said, a barrier for more women being more active and feeling
like they couldn't do harder exercise or get into more
strength training and maybe working with just like a general
personal trainer who wasn't really helping them sort of
like. Yeah, 100% and.

(13:05):
Pass those barriers. There's so many other health
conditions later on in life thatbecome a problem for women when
we go through menopause that youhave to set up all those
foundations earlier, which lookslike bone density, heart health,
which looks like, you know, muscle tone.
And if you are training well during the earlier years because
you have these barriers and you're like, oh, whatever, I

(13:26):
don't really care. Your future self will care when
you get to that point. And you're like, Oh my gosh, I
should have been doing this, youknow, a lot longer.
And I think women get to that age of about probably 30 ish
where exercise actually becomes a lot more than just what you
look like. And it's more about like
function and how do I feel better?
So I feel like if you can deal with the barriers earlier, then

(13:49):
you're probably more inclined toactually want to do things for
health and fitness. And you're setting up your long
health to be way more successful.
So I think, you know, if you don't know that it's not, it's
too late. It's like you know you're
dealing it with it now when it'sat the very depths of the
problem. I guess we're in a time now
where it's becoming a lot more talked about even in the last
like maybe 2-3 years to talk around like menopause and

(14:12):
setting yourself up for perimenopause in a menopause
transition has gotten like. Yeah, I feel like that's a new
hot topic. It is, it is and strength
training I saw, I think it was in like the Fit Insider
newsletter. It's a good like just update of
all the fitness health trends. But there's something around
like I should have checked the statistic, but I think in gyms

(14:32):
in North America, like the number of like, I guess female
and women clients and especiallyin the strength training section
has gone up like 150% or something.
I'll double. Check that but.
Yeah, way more, way more interest like specifically from
women in regards to like strength training in the last

(14:52):
five years or so, which is a good, yeah, good move in the
right direction. But to your point, maybe like
there are women who want to get into that but are still dealing
with these sort of pelvic healthissues that are holding them and
back from that. I did want to ask, before we get
into that, I wanted to ask, are you still into CrossFit or how

(15:14):
do you feel about it now? OK, no, it's actually so funny
because when I was at CrossFit, the coach that I actually had, I
thought had so much knowledge and I was like, man, this guy is
so good. And as I started training, I
would be like, hey, what do you think about this?
And he had no idea. And I was like, oh, that's so
funny. Like yeah, actually I really

(15:34):
know a lot. And I think the type of training
is it's not very well balanced from like a my, in my opinion in
it, unless you have like a really, really, really good
coach. So it can vary so much.
I just got a bit like, I don't do CrossFit anymore.
I just trained in the gym, weightlifting and I think

(15:54):
programming my own stuff becauseI know what I need.
And that's what another thing I think it's really important,
which we might talk about today is like each person actually
does need something different most of the time.
And those types of like group scenarios are great, but
sometimes I don't meet the needsof what the person actually
needs. That's true.
Yeah. Actually that's a good point.
So even just yeah, leaning into the next part of the discussion,

(16:16):
can you explain a bit more aboutwhat, what is the pelvic floor
and what does it do? One thing I think is really
important to clear up and I'm not sure do you have a lot of
like is yours just do you see mostly women or are you?
Mixed. I see.
Mixed. Yeah, yeah.
OK, so there's maybe even some men listening who also have

(16:38):
pelvic flaws, which I think is the first barrier, is that it is
literally a muscle inside your body that everybody has.
And I kind of think about it like it's dysfunction, unlike
something maybe in the shoulder,which is like, you know, you
would get pain doing shoulder movements.
The pelvic force function is to hold things in, keep you
continent and create stability within the pelvis.

(17:00):
So it's dysfunction looks like loss of those functions, which
is loss of control with pelvis, pelvic floor, sorry, urinary or
bowel. So those two issues, it's
instead of pain, you get leakingor maybe it doesn't come out
very well. Even pelvic instability can be
part of what that pelvic floor dysfunction looks like, which
would look like maybe hip pain or back pain where the pelvis

(17:24):
isn't stable very properly. So something else kicks in and
we get dysfunction around those joints.
It's also really important for sexual function as well.
So if you have any issues with that pain, lack of any
sensation, all of those are related to pelvic floor function
as well. So it's basically underneath
your organs like a big hammock holding everything in from the

(17:49):
tailbone to the front of your your pubic bone and then out to
the sides. It's very big and there's a lot
of different muscles in that. It's not just one.
And it's connected to every other part of your body
basically through fascial integration.
Like it kind of, you know, feedsaround and holds everything in.
So it's a really, really important muscle for anyone for

(18:09):
creating a lot of central stability, so trunk stability so
that you can move arms and limbsoff.
So the work that I do is very much like for anyone who has
basically hip problems, back problems, knee issues, even some
shoulder issues, because it would stem from lack of central
control, thinking prolapse. Like you can see how it's very

(18:30):
very important for a lot of functions.
Yeah. Is it 11 muscle or is it a group
of muscles? It's groups, it's a group, so
it's a lot of different muscles that will feed into each other.
Right. Very well connected so.
Yeah, OK. I don't know, I've even heard to

(18:50):
even just like a tight jaw, likeclenching in your jaw, I guess
from stress can also contribute to a tight pelvic floor.
Yeah, you can Fact Check that. But OK, you're great.
Yeah, it's it's actually a really interesting research
paper out that I think is so cool about doing a lot of manual
release work through the jaw hasseen significant improvements in

(19:13):
hip mobility, but that is where part of pelvic floor actually
joins into the side of the hip or into the hip pocket.
So it can affect that, but it's also mostly like there's a lot
of fascial integration like downthrough your throat and into the
rest of your body, but it's alsojust stress response thing.
So pelvic floor tends to be recruited during stressful times

(19:40):
because of like, it's like a little bit of a protective
response. So see like tension in your jaw
means probably tension in the rest of your body if you're like
jaw clenching and stress, right?So it's a really integrated
system. Everything is connected so.
Yeah, it is, yeah. Something you do talk a lot
about just with the IDs and gut issues is that like things in

(20:02):
your body don't exist in isolation.
Like they're all. Connected and your body is such
a like complex system that we can't just look at like one part
of it or one thing that's going on is probably related to
multiple different things and systems in your body.
It's the same with the the pelvic floor.
Like, it's not just isolated to your pelvis, it's probably
connected to what's going on in your brain and your body And

(20:25):
yeah, all of those things. Too right?
What would you say are sort of like like maybe red flags or
common symptoms that someone is having issues with their their
public floor, public floor dysfunction that could sort of
come up? I guess the main ones and the
obvious ones are leaking. That's what everyone thinks

(20:47):
pelvic floor dysfunction is. They'll be involuntary loss of
urine or maybe even bowel like fecal incontinence is also quite
common that I think isn't getting any highlight at all,
but it is very important. So those two are your obvious
ones because they're not supposed to be coming out
involuntary riots. So people like, oh, I've got

(21:07):
pelvic floor issues, but the other issue is actually not
being able to get any get anything out.
So things tend based issues. So difficulties fully emptying
your bladder or your bowel, having to like strain and push,
which I'm sure is a big topic ofconversation for maybe some of
your listeners. But even things, even things

(21:30):
like not associated directly with pelvic floor that are
almost secondary or like referral based issues.
So we've got hip pain, hip hip dysfunction.
So think about like that unresolved hip problem that
you've just been seeing so many people to get help with, but no
one's actually asked about your pelvic floor because the muscle
tissue feeds into the hip socket.

(21:52):
So if it's not working well, then it will affect the hip,
even back pain. So the back of the pelvic floor
attaches to the tailbone, which is the bottom of your spine.
So it's going to pull on the spine and create changes up the
chain. So we're going to get back pain
issues. So there's a lot of other

(22:13):
symptoms that are generally not pelvic floor related that you
would be like, I don't know why I'm getting this problem.
And if someone that you see doesn't have pelvic floor
knowledge, they are not going toask about pelvic floor symptoms.
But in when I find when I've, I do like quite a bit of mentoring
for other clinicians who are learning and a lot of their

(22:34):
patients themselves will come inand they'll say, oh, do you
like, have you got pelvic floor issues or like other symptoms
related to maybe leaking or anything like that when maybe
seeing them for back pain. And they'll be like, yeah, I
actually do have all of these issues and no one's ever asked
me about them. And they've been the primary
problem is actually the pelvic floor.

(22:55):
Right. Yeah, yeah.
So I mean, it can come up and itcan show up in a lot of
different ways. And I think the the theme here
is that it is more common than we think.
And probably part of that, too is because a lot of people
aren't talking about it, or maybe they feel embarrassed to
share about it or they aren't asked about it.
As well. Yeah, I think it's, well, I

(23:16):
mean, it is a pretty personal, like those things that you that
are problematic are personal. You don't just talk to them, you
know, unless someone's really open and holds a nice space for
you to talk about this like a clinician, you're probably not
just, oh, by the way, I have, I accidentally pee myself all the
time. If you're seeing someone for
back problems, you know, like they'd probably be like, oh,
wait. If the you know, if the

(23:36):
clinician doesn't think to ask, then there's an awkward.
It's awkward. Yeah, exactly.
And the thing too is that it can, like, it can get worse over
time. Like, I find with a lot of
clients who've been dealing withConstipation for years, like
decades, they tend to be the ones that have more of that,
like pelvic floor dysfunction. And then it makes it harder to

(23:57):
treat the Constipation. It's like fiber and water and
movement won't work alone. Like there needs to be sort of
that additional pelvic floor support sometimes like
biofeedback or other things thatyeah, public floor is.
Actually, there it's so important, especially in
Constipation, because there's a mechanical component to going to
the toilet too. It's not just about how well

(24:19):
your bowels function. If your pelvic floor doesn't
relax properly, its job is to hold everything in and stay
closed until you need to go. So if it doesn't have the
flexibility in there and can't open, then the mechanical side
of your pelvic floor or your Constipation could actually be
the problem. And I see that a lot.
There is actually quite a lot ofdiagnosed IBS for people who

(24:41):
actually have pelvic floor problems and that issue is not
being able to get it out properly.
And so they're having, you know,it's staying in the bowel and
you're getting chronic Constipation or even then bouts
of diarrhoea, like trying to come out around that.
So when we think about like there's two things.
So for me, I almost am like, oh,I think you actually need gut
help issues in some of my clients and like from a diet,

(25:04):
from a diet perspective. But then there's other people
that are like actually need perfect floor support to help
with this because your pelvic floor is designed to hold things
into your bowels and into your bladder.
Like that's his point. So, you know, having any issues
with both of those outside of, you know, anything else is going
to affect the other part of thatsystem.
Definitely, yeah. I find with Constipation it's

(25:26):
usually one or both of two things going on.
Like 1 is slow colonic or like your large bowel movement,
something is causing the large bowel to not move like it
should, and it could be bacterial or it could be thyroid
malnutrition, etcetera. And then the other piece of the
puzzle is pelvic floor dysfunction.
Yeah, there's something going onwith that.

(25:47):
And sometimes they're together, or sometimes it's just one
existing button. Yeah, definitely.
So that that can contribution oflike if you've had bowel issues
for a while, then it can then lead to pelvic floor problems
and then make that worse over time as well, like straining.
I mean, we can probably dive into that a bit more if you want

(26:07):
to. But it's, you know, they're kind
of like, then you got to figure out like chicken or the egg,
which is the problem. Yes, exactly.
I guess what would you say are sort of common, common causes
then of to the pelvic floor dysfunction or or issues?
So many because it's such a it'sgot so many different like it

(26:29):
feeds into so many other systems.
So like postural issues can cause pelvic floor problems.
So that could be constant sitting.
It could be being on your feet too much.
It could be even I see a lot of issues with people who have had
a history of trying to hold in urine or, you know, feces too

(26:51):
long. So going going too often just in
case poor bout like poor habits,toileting habits.
It could be pregnancy history that's manifested into something
later. It could be a chronic, another
chronic health condition that isaround cyclic pain.
It could be history of physical trauma, mental like any sort of

(27:11):
trauma history will feed into pelvic floor function.
It could be even hormonal. So a lot of hormonal issues
become a really big problem because its impact on tissue
function. And then that can also feed into
things like eating disorders. So if you've had like lack of
like you've, you know, you've lost your period from a history
of eating disorders, then that change of estrogen from a

(27:35):
woman's perspective will affect muscle tissue same way as what
happens when you go through menopause, same issues with
hormonal changes during pregnancy.
So like there's a huge, you know, fluctuation of things that
could be contributing. Then we've got issues with like
hip injuries that have led into other dysfunction around the hip

(27:58):
and then into the pelvic floor. So like I see a lot of that
people have like fallen off horses or they've had a car
accident or, and they've now gota hip issue that's now creating
muscle dysfunction around the joint.
And one of those muscles is the pelvic floor.
So there's actually so many chronic straining that could be
from Constipation, it could be from chronic coughing.

(28:21):
That's a lot of a big one too. You'll notice lots of people
have pelvic floor problems afterhaving chronic coughs, heavy
lifting, power lifters, like ongoing, basically anything
that's straining through your trunk.
A lot of dysfunction too. So a lot more than just
pregnancy and post Natal which Ifeel like got the highlight for
so long. Yeah, Yeah, that's quite a long

(28:43):
list. Yeah.
Yeah, even the hormonal one too,I believe.
Yeah, I was aware of that. Like low, is it low estrogen
levels can impact the pelvic floor function.
So even for like clients, I havefemale clients who are really
active but are maybe under eating.
There's like sort of like energydeficiency, which then can lead

(29:04):
to, you know, less production ofestrogen and loss of period can
contribute to public floor issues and then potentially
Constipation as well, which is, yeah, it is like a common one.
But as you said, it doesn't justexist like in in female clients.
I do have male clients to have, you know, IBS, but also there's

(29:27):
an aspect of the public floor, Ithink dysenergic defecation,
that's a common one. Yeah.
So that's like kind of like doing the opposite to what it
should. So contracting rather than
relaxing when going to the bathroom.
I think males tend to have more back pelvic floor issues because
the front for them is so different.
They've got a really long urethra.

(29:48):
So for them, like incontinence, urinary incontinence is not as
common as what it is sort of women.
But I hear a lot more like tailbone pain, back pass like
back pain, posterior hip, like back of the hip socket pain,
issues getting bowel movements going.
I mean, they will have erectile dysfunction if there's pelvic
floor issues as well, which I think is also a big red flag for

(30:11):
some men. But it's exactly like it's the
same thing. It's designed to hold everything
in, keep it up. So similar symptoms, men poor.
They don't even, I mean, this isone thing they don't get the
highlight about. It's like pelvic health men is
actually also a problem as well so.
Yeah, yeah, I'm just gonna plug in my computer.

(30:32):
You know why the battery's goingto die, why it is plugged in.
But it it's not like. Turned on.
Yeah, like it's not saying that it's plugged in.
Why today all the tech issues, Idon't know.

(30:56):
So frustrating. Lucky, you can just like chop
and edit this. I will.
Yeah. See.
Now I lost my camera. OK.
Now it says it's like to specific camera.
OK, OK. I think it's I think it's
plugged in. You can still hear me.

(31:19):
You see me. OK.
We're still good. OK I will edit out that section.
Where was I in the chat? So I just want to ask how what
what's the difference between having a weak pelvic floor and a
tight pelvic floor? And are they the same thing or

(31:39):
do they exist separately? This is a good question because
a tight pelvic floor doesn't always mean it is actually
strong and it can be tight and weak at the same time.
I kind of think of things more like being really loose and then
being really tight. So loose a loose pelvic floor.
Think about like floppy and likenot really hasn't got very much

(32:03):
integrity or in it. Like for me that would be like
someone with a prolapse that like it's got a lot of downward
pressure. It's been a bit stretched or
post Natal or something like that.
Those people are tend going to tend to have a lot more loss of
things accidentally have a really hard time holding
anything in. So that would look like maybe
people who rely on like incontinence pads all the time.

(32:24):
That is just always coming out potentially and maybe a lot of
like heaviness feelings or dragging pressure, bulging type
feelings. Not always the case, but
generally is like that. And then we have tension based
issues, which is more like problems getting anything in or
getting anything out like as in it's kind of like congested and

(32:44):
tight and pain, very much pain associated.
So when it's weak though, that just means it's not very strong
in a sense of its function. So when a pelvic floor is
actually tight, it will have, italso isn't strong because it's
stuck in this tightened positionall the time that when you're
trying to use it, it doesn't have strength because it doesn't
get its full range of motion allthe time.

(33:06):
It's just kind of like any othermuscle in the body.
So that might look like having troubles holding in when you
really need to go because it's not strong enough for you to
like keep holding on. It's like fatigues quite easily.
There might be a limit, a ceiling limit of strength.
So maybe if you've got tension, this is very common in tension,

(33:26):
you'll have tension issues and you might not have leaking at
all until you do heavy lifting and then it's not strong enough
at those heavier loads. It's got no given flexibility in
it. So everything just kind of like
rushes out. So those people are like, I
better do more pelvic floor exercises and squeeze and lift.
But in reality, it's really going to help them because they
need to achieve full range of motion, which means properly
relaxing and properly contracting to get the

(33:49):
functional strength that they actually need.
So it's a little bit harder to kind of blanket rule like what
these look like without really seeing the individual and it's
kind of hard to tell what you have.
I think more like if you're having anything, any issues
getting anything out or getting anything in.
So that might look like intimacytampons, menstrual cups, those
types of things, as well as actually having a full bladder

(34:12):
release or full bowel release. That is tension based issues to
me. Whereas like if you can't keep
anything in or out at all and that might, you know, even
tampons falling out, menstrual cups falling out, those types of
things to me is like weak but loose, more like loose and like
isn't like contracting enough, if that makes sense.
OK. But in both instances, you tend

(34:34):
to see it's more weak, essentially, yeah.
The overarching issue is just that it's not strong.
It's not doing what it needs to be doing in.
The muscles, it's just not doingits job.
Yeah, right. And some, I mean, there is some
scenarios where there is a lot of strength in a muscle, but
it's not functional. So think of someone who has
like, this is really common in endometriosis or pelvic pain

(34:59):
where there's a lot of accidental contraction and
gripping of the muscle tissue because of like trying to like
guard. They're in a lot of guarding.
So this could be appropriate forany bowel issues as well, where
that muscle tissue is getting thicker because they're
constantly contracting it, but it doesn't actually function
very well. So it's still not holding things
in very well. It's still causing a lot of

(35:19):
pain. But once you start to get full
range of motion, the strength isprobably OK.
So these are people that have maybe had internal checks and
the physiotherapist or the physical therapist, I think you
call them over there. Physiotherapist, yeah.
They might say, oh, you've got areally strong pelvic floor, but
it's very tight. So it's kind of confusing.

(35:39):
It's like, well, why is it a problem?
It's because it's not functioning properly.
We do need a level of like flexibility in the muscle.
Like something that's stuck in achronic tight position anywhere
in the body is never going to behelpful because if you pull on
everything and be like angry andtight and stuck and it's, it
needs to be functional, I think is a much better word.

(36:01):
It needs to do it's job properlyrather than be too tight or too
weak, right? Like I say, even think about
like, like bodybuilders, they work so hard to like build up
the muscle and they may be really strong, but a lot of them
like lack really the mobility toeven just do like, you know,
raise their arm over their shoulder or yeah, kind of like

(36:21):
to, you know, or hold their armsout.
So there's sort of like, I guesslacking that like full range of
motion that that the muscles should be able to do.
So you're saying it could be thesame thing with the pelvic floor
where it could be, yeah, it could be strong, but it's still
not able to like function in allthe ways that it should be.

(36:42):
Yeah, I feel like a healthy of healthy pelvic floor shouldn't
have any problems with it. Like you shouldn't experience
anything wrong. So if it's having problems with
something there is it's idle, weak or strong, weak or tight or
not fully getting its best rangeof motion, if that makes sense.
Yeah, yeah, no, that, that helpsto put it in that perspective.

(37:04):
I guess what's Yeah, I just wantto ask just around like the
nervous system part of it. And I did see in a lot of your
content too, you talk about likenervous system regulation.
Yeah. That's actually a theme that's
come up in like multiple in interviews when we talk about
different areas of health and disease.
Like it always comes back to nervous system.
But what would you say is sort of the connection between our

(37:27):
pelvic floor and nervous system and what does it mean to
regulate your nervous system to support pelvic floor health?
Yeah. So a lot of my content you'll
see is actually around pelvic pain and endometriosis.
That's a really big population Isee.
And they have a lot of nervous system dysfunction from chronic
pain. So they have to actually address
that because the driving problemwith a lot of their muscle

(37:50):
dysfunction is coming from an very overactive nervous system.
So when we think about what the nervous system is, it's like our
signalling system based on how we feel.
So if someone is constantly feeling in this fight, I think
about it like energy mobilisation rather than fight
or flight because sometimes it'sactually good.
Our sympathetic nervous system where we're doing exercise like

(38:12):
that is a good thing, but it's also a heightening exercise
rather than like a relaxing exercise.
So, you know, if you're in that state all the time, then you're
going to be like on muscles are ready to go to like push you
forward in energy mobilisation. So there's a lot of muscle
dysfunction that comes about from that from like a overactive
point of view. So we need to actually address

(38:35):
that for the relaxation side. So this is a lot more about
pelvic floor tension. We can't relax the pelvic floor
if the body is in an on state all the time.
It's a little bit more difficult.
There is actually a really cool research paper about women who
were shown threatening images inlike physically threatening,

(38:56):
emotionally threatening. And then I think there was also
like a sexual threatening and they were measuring muscle
tissue activity and the pelvic floor was heightened in all of
them with visual like threatening scenarios.
So we know that at a time when awoman feels threatened, whatever
that might look like in every situation, they'd go and they'd
be like, get this like holding, like guarding sensation.

(39:18):
So we think about life and we think about, I don't know if
you, I don't have children, but I hear it's pretty much like
you're a bit stressed 24/7 work or maybe there's, you know, life
issues where you're feeling likethat all the time, then you're
going to have this ongoing contraction of the pelvic floor.
So when we, when we think about the nervous system side where

(39:38):
that's designed to like calm us down a little bit and bring us
down into this more like recovery restful state, which is
super important for bathrooming.So like if you're trying to go
to the bathroom or you know, you're trying to have a bowel
movement or go to the toilet, you're in rewires.
If your system is so like on andyou can't relax through your
pelvic floor, nothing's going tocome out.
So we have to teach you, OK, it's safe to go into these like

(39:59):
relaxing states. It's that's going to help your
muscle actually relax. So this is where like I think
release. There's a lot of information
about internal release of the pelvic floor, really helpful at
some point. However, it doesn't teach the
body how to actually take control of that release
yourself. So a lot of the work I do, it's
all virtual. I don't do any internal work.

(40:20):
I'm not even actually qualified to do an internal examination.
We don't do that as exercise physiologist.
So I have to teach people to check in with their nervous
system, relax, get them in a down regulated state so that we
can then actually get the pelvicfloor to relax properly and then
understand what that feels like.So that when you need to go to

(40:41):
the bathroom or even after exercise, if you're having
pelvic floor problems or tensionafter exercise, which is super
common, you can go, OK, bring that back down, let's relax
that. Now, intimate times, pain with
penetration, if you're having a lot of that, you need to be able
to control that and relax through your pelvic floor, which
requires you to check in with your body, relax everything, go

(41:02):
into a more sympathetic, A parasympathetic state.
So that's why a lot of the initial stuff for me is actually
nervous system work because I can't deal with anything if you
can't get relaxed. Exactly.
So we have to take, yeah, we have to take like a bit of like
an approach to that in this, in the scenario of like a lot of
weakness, I'm thinking someone who has maybe prolapse or

(41:23):
something like that, sometimes that's definitely not a problem.
It's not the nervous system isn't driving a prolapse, right?
That's actually damage, physicaldamage to the tissues.
And I think that's important to talk about because chronic
straining can lead to prolapse, which is, I think, something
that would maybe resonate a lot with the listeners here.
If they've got gut health issuesand they're constantly trying to
push anything out on the bathroom that over time can

(41:46):
strain the tissues and cause a prolapse.
And that would be more about I don't need to do as much nervous
system work there. Sometimes we do it depending on
the person, but it's not drivingproblems with the appellate
floor in that in that scenario. Yeah, Yeah, that makes sense.
I guess even the nervous system connection, like think about it
and the aspect of like travelling, like I know I have a

(42:08):
lot of like more IBSC or Constipation clients who when
they travel more likely to, you know, skip a bowel movement.
And part of that is just becauselike you're out of your regular
routine. It's part of its time zone
change. So there's the impact on like
circadian rhythms. But I think the biggest thing is
just like stress and being in a different environment and your

(42:32):
nervous system just being a little bit more on high alert
and like you said, not in that like the rest in digest state or
the parasympathetic state where it's able to sort of relax.
So that's one thing that might like resonate with the people
listening, but just to that point, like even trying to, to
help yourself relax and putting like, you know, bowel routine

(42:54):
steps in place in the morning where you give yourself some
time to just like take it easy. Like allow yourself some time to
to give your body, like let yourbody relax and, and feel like
it's comfortable to use the washer versus what a lot of
people tend to do is like wake up, we look at our phones, check
social media, e-mail, constant onboarding of of stress right

(43:16):
away and maybe rush to start theday and see how that may, you
know, contribute to the public floor feeling tight and then not
wanting to eliminate the bottom sort of impact that too.
Yeah. Yeah.
I also think our nervous system is a way for us, like we have
these responses from a previous experience that might have been
a little bit, I want to say traumatic in.

(43:39):
So like if you're someone who really struggles with the
bathroom, say and you've got a lot of pain going to the toilet,
even your body is going to go tothe you're going to sit on the
toilet and you're going to have this nervous system response
where your body goes. I know this isn't comfortable.
I'm really nervous. It's going to be painful and
everything goes into this like protect me, which is gripping
tension. So like if you can then
understand how that is affectinghow you have a bowel movement,

(44:02):
like then we know it's actually the power of like retraining
what that association actually is.
So there's like, how do we shiftnervous systems in that
scenario? Understanding what's actually
happening on a physiologically physiological level so that you
can then repair like, oh, maybe I can have a better bowel
movement and then restart believing, oh, going to the
toilet isn't that bad. So there's like so much involved

(44:25):
in the nervous system. It's like a signalling system of
our body to keep us safe, right?So, so many.
It'll just automatically do things and we're like, you try
and not let it happen and it's like, no, what's happening?
Right. And just saying like rewiring
those connections or the previous conditioning.
That sort of lets you 100% and that can just like, I don't know

(44:46):
whether this is actually relevant or not for any of your
listeners and whether this is a good tip, but I actually had a
client who had IBS but more Constipation based type and
going to the bathroom. She had that like dysenergic
contractions, but if she actually did like a poo outside
in the Bush like when she was out and about, no problems

(45:07):
whatsoever. So like environment was a such a
big change because the toilet environment was the stress for
her and that reaction of the nervous system going like I know
this is going to be painful. Positional wise, it was
definitely different outside than sitting on a toilet.
But she was like, never have this problem outside.
And I was like, whoa, this is actually crazy because you're
more relaxed in that environmentbecause you've always had a good

(45:29):
bowel movement there. So your body isn't going, Oh my
God, this is the problem. Like this is a nervous system
response. This is affecting how you're
going to the toilet. This is affecting your pelvic
floor. So like if that's you, maybe I
was like, maybe you can just poop outside.
Yeah. But we like tried to like change
the environment of her toilet. Like how do we make this feel
more like outside? Right.
Right. Which is like, so crazy, right?

(45:52):
Yeah, to get some like nature sounds going and.
Yeah, we put like more plants inher bathroom.
I think we thought like, I triedto get her to visualize that
outside. And I think it actually
eventually worked because she was like, wow, I actually don't
have this problem normally. Like I just need to try and
bring that feeling into the toilet.
I was like, no, this is actuallypretty cool.
Yeah, no, that is a good tip. I'm sure some people ask me.

(46:14):
You're like. Yeah, they're like, Oh my God,
the same. Yeah.
But no one tells you unless you ask, right?
Like you wouldn't say, oh, have you ever pooped outside?
And does it feel better? Well, a lot of people haven't.
I mean, yeah, unless you've gonecamping or yeah, I'm a runner
and sometimes, you know, there'snot a lot.
Yeah. See.
Everybody has, though. Everybody has Eating outside is

(46:38):
actually a nervous system regulator, like being in green
spaces helps your nervous systemcalm down.
So I sometimes I wonder if that's actually for me.
Yeah, yeah, could just be that fresh air and green and yeah,
that's true, I guess. Yeah.
Just if you want to maybe walk us through a bit more about what
like if you were to work with someone who does have IBS or gut

(46:58):
issues dealing with pelvic floorconsiderations, let's say.
Maybe if it's loose and they're having trouble like holding
stuff in, what might sort of that like, I guess exercise plan
look like for them? Let's say we've you've got the
like nervous system stuff sort of under control.
What what would be sort of the the prescription or what make

(47:20):
that look like? Yeah.
So I think it's important to realize that an exercise
physiologist might not just go, here's a gym program, go and do
it in the gym, right? We have like, I want you to
think about bridging this gap between maybe what a
physiotherapist would do where you're just working on like one
muscle rehab exercise and then into a program all the way to

(47:41):
that that gap. So for us, I would your program
would look a lot like a rehab based initial program where
we're like, OK, we're training all the muscles around your
pelvis to function better where working through pelvic floor,
where retraining how you use your core where training all the
muscles around your pelvis. So the pelvic stability
component is really healthy as well.

(48:01):
There's a lot of things feeding into pelvic floor function that
could actually be, you know, contributing to the problem.
So we start to build those really foundational stability
based muscles and retraining. And then that would look like,
OK, now that we we want to strengthen that system so that
we can increase the strength of your pelvic floor.
So now we've got to make sure you do that well in other
movements. So that might look like how well

(48:22):
do you brace your pelvic floor in your core in squatting, in
lunging exercises. Then it might look like now
we're going to add some weights to that and strengthen
everything. So as you hold something, your
external weight is now heavier, you've got a grip, grip engage
through pelvic floor, probably abetter word.
So now you've got, you're basically like holding more
weight at the same time you're turning your pellet floor on.

(48:44):
So it's getting stronger. And then over time we load and
load and load. So it's its function is better,
its strength is better and its endurance is better.
Then it might look like how do we integrate this into jumping
and impact exercises? So they're the hardest ones
because there's a lot more ground reaction forces and
things that have to work for us to work against.
So that's kind of like the hardest 1.

(49:04):
So if you're currently dealing with that symptom, there's a big
process to get to that. You can't just like improve it
straight away into that. So it looks like rehab and then
it's like half rehab, half exercise where it's like body
weight movements and retraining.And then it looks like, OK, now
we go and do strength training and now we're in this like block
of strengthening over 8 weeks doing, you know, functional

(49:26):
exercises with proper awareness around your telefluorin core.
Yeah. OK.
And you sort of progress your clients through those stages
just depending on how they're, Yeah, I guess how they're
they're improving and sort of like building on their on their
plan sort of as you go. Yeah.
It's very much independent on the person because some people

(49:48):
might not need to go all the wayback to the beginning because
they've done a little bit of pelvic floor work before, or
they might have really good awareness.
So once you teach them that, you're like, oh, you understand
what you're doing. Let's go into this stage.
But the idea is to like increaseits capacity.
So that would look like, how do I get this?
Doing more, more regularly, heavier weights, longer, just

(50:10):
like any other. I kind of think about it like
running. Like when you first start
running, you probably can only do a minute and then you're like
dying, right? But then over time you just do a
little bit more and then you geta little bit faster and then
maybe you're going up hills and mountains and that's harder
again. So it's kind of the same thing.
It's just a muscle that we can'tsee.
Yeah, yeah. And we can't, can't just like

(50:32):
strengthen it in a day, like it takes no weeks, months.
No, and it's not ever in isolation, right, like it's not
gonna you don't just do pelvic floor squeezes and that's it.
It has to be added into everything else, which is also
the issue. It's like I do kegels, pelvic
floor squeezes is great, but like, you know, to increase your

(50:53):
push ups, you don't just do one exercise and hope that the rest
of the push up is easy, right? Like you need good core
strength, bicep strength, you need shoulder stability, you
need core strength. So you know, it's, it's the
same. We need to like integrate it
into everything else because it has to turn on when you're
squatting, not just when you do a pelvic floor lift.
Right, Exactly. Yeah, that's a good way of

(51:15):
explaining it too. Would you say that there's any,
like if you're the group exercises, are there exercises
that are more beneficial for thepelvic floor and some that are
not? Or would you say it just depends
on the person and where they're at and what they're dealing
with? It definitely depends on the
person, but the it's all about how you use it.

(51:38):
So it's a stability based musclereally at the end of the day.
So if you're not using it well in your other exercises then
it's not contributing to stability or you might actually
weaken it over time. It's a little bit like the
rotator cuff kind of it's not really like any muscle really,
but you know, shoulder issues like you might be super strong
in your shoulder. If anyone's had a shoulder
injury, I feel like this resonates well.

(52:00):
They'll get you to like, oh, you've got this rotator cuff
issue. You've got to like do your
external rotations. But the problem is actually in
overhead pressing something likethat.
So when we think about improvingthat, like if you're not using
it well in the other exercises, that's where the problems
actually are. So there's there's nothing
that's like bad for the pelvic floor unless you're not using it

(52:22):
well in that exercise. I think.
Person or you have or you're doing exercises that are adding
to the problem. So there's a lot of issues with
pelvic floor tightness and doinga lot of external hip rotation,
which looks like, you know, clamps, sideline clamps where
you would open up your leg and push out or even abduct the
machine where you sit on the machine and you push your legs

(52:43):
out Like so they were the very, very deep hip back of the hip
muscles, which feed into the back of the pelvic floor.
So if there's tension in the back of the pelvic floor and
those muscles already have tension in them, then you're
going to be adding more tension by doing those exercises.
This is where I see a lot of issues coming from personal
trainers where they don't understand they're actually
tightening an already tight muscle that make it worse.

(53:04):
So sometimes you might be doing a bad exercise because it's not
supportive to your particular issue.
Whereas like some people actually need that external
rotation strength and that's causing a lot of weakness into
the pelvic floor. So we need to actually do that.
So there's never going to be a bad exercise that's worse for
your pelvic floor. It's actually more about are you

(53:25):
doing this exercise that is helpful or is it unhelpful for
you? Right.
Or sort of are you, Are you ready to engage in that exercise
at your point in your journey like and not get symptoms?
So maybe you're not ready to runyet without, you know,
experiencing bladder or bowel cause leakage.
Running is actually like quite alot of load down on the pelvic

(53:45):
floor and if it's weird you probably problems, but it's also
a really great way to continue strength strengthening the
pelvic floor in its function. If you're ready and you can
handle a bit of running, we're always going to be working at
this level. That's like improving its
function where that where you are in that journey is
important. Yeah, yeah.
But even with running too, it's so much bouncing, getting kind

(54:07):
of that like jostling of the pelvic floor.
So I do, we see a lot of runnerswith IBS and gut issues and they
deal with a lot of like urgency and, you know, needing to use
the washer very frequently online.
And part of that is like, there's diet components that we
adjust and making sure they're feeling properly hydration.

(54:27):
But sometimes too, it can be an aspect of like public floor
issues too. And yeah, exacerbate it, right?
Yeah. And the issue with a lot of that
stuff, especially with gut problems is the bloating is a
lot of a lot of load on the pelvic floor.
So we look at load on a muscle tissue as either positive or

(54:47):
negative. Too much load can cause weakness
and like stretching, say, which would look like floating down
out towards the front of your abs, but also down onto your
pelvic floor, like lots of pressure downwards.
They would come from coating. But then you know, if you have
enough load, which would be likesqueezing and lifting, that's a
load and then weighting something that's a load as well.

(55:10):
That's a positive load that's contributing to strength.
So like the, the running the runner issue is that they've,
they've probably already had a lot of downward load that's
unhelpful for pelvic floor. And then they're adding in
strength like running and it's too flexible and it's like going
like this all the time, when in reality they actually need a
little bit more strengthening init.

(55:32):
But you know, once they get thatand they're starting to run
again, if it's working really, really well, then it might
actually help to strengthen a long time.
Right, Yeah, OK, that makes sense if you put it that way
too. I did want to ask.
I compiled like a small list of so the pelvic floor tools and
hacks. I was going to ask you to rate
them. Rate them on a scale of 1 to 10.

(55:57):
One being like ditch it, not helpful at all. 10 being like
yes you need to to do this so feel free to bad at writing.
Any of these like 1 to 10 ratingscales I'm always really bad at.
OK. I will say like.
Yeah, it's OK. You can always.
I'll be like fast can iPhone a friend.

(56:19):
Yeah, I'll allow it. You get one of each.
The first one is standing desks.This is more around like not
sitting all day, but if someone has the opportunity to invest in
a standing desk, what are your thoughts?
Do I have to give it a number orcan I just explain my thoughts?
On it, Sure. Explain your thoughts.

(56:40):
Because the body hates being in the same position for too long.
It doesn't matter what that is, right?
So if you're like people who stand all day in one spot
stationary are almost just as bad as standing, sitting all day
in one spot. Like we need to be moving around
and changing our positions. Muscles will change to whatever
position you put them in for toolong.
So I love a standing desk idea. If it's like used up and down

(57:02):
and you see it and then you stand and then you move around
and you go get a water and you come back and you stand back up.
Really important. But people who stand desks for
too long, that's a lot of pressure on your pelvic floor if
it's already weak. So if you have weakness in your
pelvic floor, you'll find at theend of the day you're getting
heaviness feelings if you're on your feet for too long because
it's not strong enough to hold you there.
So like super important, needs to be well used and everyone

(57:26):
always. Like when was the last time you
stood at a desk and actually stood there properly without
like shifting your weight to oneside?
Yeah, I do that. I lean on one hip, then I yeah.
You lean on one hip. So like, you know, I think that
I think the idea is actually change your position as
regularly as you can in any different position.
So like I sit on the floor, I kneel, I stand, I go and sit at

(57:49):
a different desk. Do you know what I mean?
Yes, yeah, no, I know what you mean.
It's going to lead into my next fuck.
Did you want to give this standing desk a number?
Throw it up. I don't.
I'm like, I think maybe like A7.OK, I was in the guest so not
like 10. But it's.
Only perfect, but it's not like bad.
And the next one were the the medicine bowl chairs.

(58:11):
So these it's just an idea of like, it's not a typical chair.
So you're sitting in a differentway.
I don't know if you're familiar with them, but they're like.
I have only really seen them a couple of times.
Like I've used a medicine bowl to sit on, which I found helpful
because I, I moved around quite a lot when I did that.
I I also found that my knees were too high to my hips and I
got a lot of hip tightness in the front of my hips and because

(58:34):
I was bouncing all the time, like he's like just like
contracting. I was like, oh, I actually don't
know if I love this. So I mean, maybe you could have
the medicine board chair with standing desk and then you could
just like wean everything. Yeah.
But I mean, I, I, I am, I think maybe 55.
OK. I'm like, there's way too much

(58:55):
pressure on this. It's OK.
Like I should have. I should be like, don't ask me
this. Don't ask me to write things.
The other one, the next one is like sitting in a in a deep
squat position for at least likea couple minutes a day.
I've heard that as another tip. I reckon that's a, that's a good
one for tension. So 10 for tension unless you

(59:18):
have hip problems and you can't actually do it.
But for weakness, super vulnerable people with prolapse
will feel like, Oh my gosh, thisis way too vulnerable and
everything's going to fall out because it's stretching the
pelvic floor quite a lot. So I wouldn't put anyone who has
a lot of laxity and looseness ina deep squat straight away.

(59:39):
So. 0 for them. OK.
Relative to the the person, I'm like, I'm just imagining someone
with prolabs going oh 10 out of 10, I gotta do that and then
making their prolabs worth listening.
To. I think that was a good.
I'm covering all grounds. The next one are pelvic floor
trainers. So I think this encompasses like
different devices but. Yeah.

(01:00:03):
Thoughts on this? I don't love devices at all, but
I'm a big believer in integration of the pelvic floor
with everything else. So the trainer doesn't do that,
right? Like you just squeeze your
pelvic floor and that's it. It's kind of like just doing
pelvic floor only isolated stuff.
But there is a very good place for them for people who cannot

(01:00:27):
connect with their pelvic floor straight away.
So if you can't actually turn onyour pelvic floor and feel it
and know if you're doing it correctly, then you need some
help with that. And that's where the devices, I
think have a really good place. Or there's so much weakness that
that you can't get strength by just doing a pelvic floor lift.
You have to start there. You have to really start with
training the pelvic floor. And if you can't do that, you

(01:00:49):
need someone to help you. So I think a trainer would be
good, but I feel like you need to get help understanding that a
little bit more with someone whomaybe knows what they're talking
about. I actually have never had a go
at one of these, I'm not going to lie.
But I've also seen a lot of problems come about from them
because people that have tightness in their pelvic floor
use a trainer and increase the tightness.

(01:01:10):
So if you don't really know if it's suitable for you, then it
could be a wrong choice. So yeah, I kind like, I don't
really love trainers. I'm going to say like 2.
Oh, OK, yeah. But that's my personal opinion
as a practitioner who doesn't dointernal work.
You'll find a very different Other practitioners will love
them, yeah. Depending.

(01:01:31):
On who they see so. OK.
And it can kind of vary I think from like those wearables to
like little weight sets and someof them are connected to apps
that give you like feedback. So it's some kind of range, but
yeah, overall and you're like. Yeah, yeah.
Like just get some help from someone, do a proper like

(01:01:52):
retrain the muscles and learn how to strengthen it through the
exercise. I think that I think that works
well, but I'm biased because that's what I do.
Yeah. Oh, that's OK.
So I should buy one and have a go and see what it's like, but I
don't really need it so I feel like it'd be pointless.
Yeah, yeah, you can always maybereach out.
I'm going to send you one and doa do a review.

(01:02:13):
Yeah, I'll do a. Review.
Unbiased review next one are. Kegels, Kegels, like I said
before, you have to start with learning to contract your pelvic
floor, but you have to learn howto contract and relax your
pelvic floor. Most people do kegels from the
squeeze and they're just liftingand squeezing and squeezing, and

(01:02:33):
that's a tension issue over time.
Ask like you're asking for too much tightness eventually, but
that's the that's level 1, right?
I teach that in my very first consult with people and by the
end of I usually do about on average maybe 6 consults with
people over like a 12 week block.
And we just retrain into gym programs.
So like that's like exercise number one.

(01:02:54):
And then we go, how do we do that in with your abdominals?
And now how do we do that in core work?
And then how do we do that in squats?
So if you don't move beyond that, you're never going to get
anywhere. So.
Kegels themselves, I would. I don't call them kegels because
I just call them like you're just retraining in pelvic floor
by doing pelvic floor exercises like relaxing and attracting.

(01:03:14):
But that's a tough 1/3. Three, OK.
Yeah, important, but like it's not going to solve your problem,
so right you. Have to do that.
So then you said it's like foundation, like you would start
there, but you don't want to just stay there, you need to?
Yeah, because you'll just be doing kegels everyday for the

(01:03:34):
rest of your life. Like that's not you want to be
able to go. I've retrained and I've got
strength and now I just go to the gym and my problems are
fixed, right? It's like you don't want to do,
you know, if you've got a shoulder injury and you have to
do rotator cuff with external rotations every single day for
the rest of your life. But that's not fixing your
problem. Yeah, and most people won't
stick to that either. You don't stick to it anyway.

(01:03:56):
And then you. Yeah.
So I like them at the beginning and then done throw them in the
bin after that. Like keep going to the next
level progress, you know? OK, noted.
Sorry. Two more I have these these ads.
You don't look like you're expecting these responses from.
Me. No, no, they're good.
No, no. I'm I'm very much appreciating.

(01:04:17):
I think they were in alignment with with what I thought.
So it's OK, OK, good. Two more.
Next one is diaphragmatic breathing, or we'll just say
breath work. 10 out of 10 Hands down most important part of
pelvic floor work because they. Have a nervous system
regulation. Yeah, nervous system, but the

(01:04:37):
pelvic floor and the diaphragm have a relationship where they
work In Sync together and that'show you manage press pressure.
So I don't know if you'll ever do a video of this, but if
you're watching me, as you take your inhale breath, your pelvic
floor drops. So your diaphragm inhale pelvic
floor and as you exhale does this all day, every single time.
It's supposed to do that. It's a pressure management

(01:04:57):
issue. So you keep pressure in tight
inside your trunk and it has to change based on what you're
doing to, you know, not extreme pressure and you explode.
But so the diaphragm, if it doesn't move well at all, that
doesn't happen at all. So you have to actually address
breathing as step one before youeven do kegels.

(01:05:20):
And people don't breathe very well, especially if you're
stressed because you don't have,you usually like upper chest
breathe. So then you don't get a high
from diaphragm movement. So and then we use the breath to
then integrate that into everything else.
So when you exercise, if you breathe well, then.
You get a. Really good response through
your pelvic floor, so you shouldn't have to then think
about your pelvic floor every single time you do exercise.

(01:05:40):
You just breathe well. Yeah, OK.
Yeah, it is a tool like I have clients do even just if they can
do it before meals just to get into that rest and digest.
But it's also shown to be helpful, like even with reflux
flare ups, bloating with pain, like more in a flare up state.
But also like I definitely referout if if someone has like

(01:06:03):
pelvic floor concerns, but just as sort of like a foundational
approach when they're having a bowel movement.
And if they're used to straininginstead of straining, like get
them like using a stool, but breathing into their fists and
sort of like breathing into their diaphragm.
And that kind of I think puts some little bit of like just
gentle nudge pressure on the pelvic floor to help with the

(01:06:26):
release versus them like tightening and pushing.
Yeah. And when we think about the
inhale breath is coupled with pelvic floor length.
So if you. Inhale.
Breathe. Your pelvic floor will lengthen
at that point in time, so inhalebreath on the toilet.
Pelvic floor length. OK, that's a good addition.
Add that one in. Yes, OK.

(01:06:49):
And then the last one there are squatty potties. 10 out of 10.
OK yeah, it changes the positionof your hips so your pelvic
floor can open and lengthen properly.
This is why pooping outside in asquat position.
Is always better. Yeah, I love them.
Too get a get a squatty potty oreven just like a stool like a

(01:07:10):
kids stool. I just have one of those.
I don't even have a squatty potty.
I just put my feet up on something.
Yeah, as long as your hips are or your knees are elevated above
your hips. Hips.
Yeah, yeah. Yeah, I get, I get some, some
clients at first that are like, well, I'm not not constipated
and everything just comes out. I don't have issues.
But then they tell me that they're straining and I'm like

(01:07:33):
that Squatty Potty is just a, a good foundation thing to have.
Cause all of our toilets are so high that like it just, it
doesn't happen, right? Unless you're, you're pooping
outside or you're using a reallylow toilet.
But yeah, I give them a 10 out of 10, maybe 12 out of 10.
Yeah, I was going to say, can weride Hile Bichromatic breathing,

(01:07:55):
Squatty Potty 15 out of 10? So just to wrap things up, I
guess if you were to give went through that that list and we
know what your favourites are. But just to wrap things up,
would you give like listeners maybe one or two things that
they could try or consider todayto help better support their

(01:08:15):
public floor health? What would you what would you
say? I know, I think.
Question, but I think understanding pelvic floor
relaxation and the breath work is the biggest change that I
hear in many of my clients, which I think is something easy
to implement. So like really working on
slowing down your breath, reallygood inhales, really good

(01:08:37):
exhales slow. The slower you do that and the
longer you can do them, it meansyou're in more of a restful
state. So if you're doing like that's
really fast, that's more like you're having troubles relaxing.
If you can do like a 45 second inhale and the same exhale,
you're going to start relaxing alot better.
And that's going to affect all systems of the body.

(01:08:59):
We know how good that is. So gut health, general
inflammation, resting nervous system, all that stuff, muscle
tissue relaxation. So breathe better #1 tip #1 And
then I think the second one is probably trying to what can they
do today? Blanket ruling everything.

(01:09:21):
Honestly, I would just like try and get someone to help you with
what's your actual issue. Like if you don't know, stop
wasting time like trying to figure it out yourself just like
booking and see someone. And sometimes it's not as easy.
I understand there are many other barriers, but if it's
really something that bothers you, you can actually do so much
to fix this and live such a better life.

(01:09:42):
So like I just look at investingin your health as like something
that isn't non negotiable for mereally.
I'll take things, you know, I'llsacrifice other things to like
go get some help because you're just wasting so much time trying
to navigate it yourself. Like a year, like most of my
clients will come from years andyears and years of trying to do
it online and whatever. And within 3 or 4 weeks we've

(01:10:03):
like solved, you know, 50% of their problems.
And it's like, wow, imagine how good your life would be if you
could fix it pretty quickly. So if you have a capacity to,
just go get some help. Yeah.
And like you said too, they might be doing things that sorry
are making things worse that they may think is helping about
the core, but it could actually be working against them just

(01:10:24):
depending with what they're they're dealing.
With, and there's just so much information online, it's really
hard to navigate who actually knows what they're talking about
#1 and that it's actually relevant for you.
Like what we've talked about this whole time.
There is such a big difference with tension, weakness or
laxity. And if you don't actually know

(01:10:45):
that that's what they're talkingabout and that's what you have,
then you might be doing it and making things worse.
So you'll know that because yoursymptoms won't improve and
they'll probably get worse anyway.
But I think like, don't stop. Just don't DIY it.
Like there's a reason why you'renot a qualified health
professional, like, you know, doing that, like.

(01:11:05):
So if it's something that reallybothers you, my piece of advice
is just go get some help and someone who cares will give you
some hot tips. Even if it's just one session,
go away, implement them, see if it works for you.
And then, yeah, be convinced it's actually the right thing.
So. Very true.
I think there's even just that aspect of kind of added stress
when you feel like you're navigating it alone and then

(01:11:27):
you're like seeing all these things online, you're feeling
overwhelmed with what to try andyou're like piercing it
together. And even just that adds more
stress to your life, which then,like you said, can make the
pelvic floor tighter. So even just see someone who can
help you in knowing that you have a plan and someone to like
check in with that can even justgive yourself like help you, you
know, take a a sigh of relief and relax a little bit too.

(01:11:51):
Just know. And like, there's something
about trusting the process when a professional tells you, then
even if you did the same thing by yourself, there's still this
level of doubt. Like, is this actually gonna
work? That your mind and your body is
connected? That is the stress and anxiety
in itself. You're not going to stick to it
for as long. You're not going to be as
diligent by yourself. We all know that, Like, no one's

(01:12:11):
accountable, like 100%. And if someone who knows what
they're talking about actually tells you what to do, you're
probably going to follow it, stick to it and you'll get
results. So like, it's just so different.
Yeah, very true. So I guess that that leads me
into my last question. But how can people get in in
touch with you? And yeah, for people that want
to work with you, what is that? What does that look like?

(01:12:35):
Yeah, I'm on mostly on Instagram, so my handle is at
her dot exercise dot Physiology.So you're more than welcome to
reach out that way. That way you can check out my
website, which is www.herexercisephysiology.com
dot AUI have like you can submitinquiries.
There's an inquiry form I alwayslike to jump on like a clarity

(01:12:57):
call with everybody before we get started.
And that's just for me to learn a little bit more about people's
what's the problem and whether or not I can actually help and
what kind of commitment or service would be more beneficial
for them. Because I find everyone needs
something a little bit different.
So that's always something really good to do because you
can sort of ask questions then and not feel like, oh, I have to
book something in. And hopefully this is the thing

(01:13:20):
because sometimes there's like actual functional problems,
right? Like if the bladder is got a
problem with it, I'm not going to be able to fix your bladder.
I just weed to pelvic floor work.
So there's a component. It's not always the answer.
So it's nice to have that. So if you're thinking about it,
I'm happy to chat beforehand anyway.
But those two are the probably the main places you will find me

(01:13:40):
if you're interested. Yeah, it's probably good.
Yeah, I will. I'll link your Instagram in your
website in the in the show notestoo.
Yeah, yeah. All right.
Well, thanks, Courtney. This was awesome discussion.
I think a lot of people listening will be like, yeah,
that sounds like me. And now I feel like, oh, I

(01:14:01):
actually can do something about it.
So I think it was an awesome chat and I, yeah, I love, I love
exercise and it makes me sad when people feel like they can't
engage in the types of exercise that they want to do because of
IBS got issues popped before. But I think for those of you
listening like they're there areways that you can do get back to

(01:14:21):
doing like the activities that you love is just finding out
what's going on and where the problem is.
And then, you know, getting clarity and having a, a plan to
help work through that and get back to the activities.
So, yeah, yeah. Well, thank you for this chat
today. You're welcome.
Thanks so much for having me. Yeah.
That's a wrap for today's episode.

(01:14:42):
Thank you so much for listening and being a part of our
community here. If the Gut Fit Nutrition podcast
is giving you value, helped yourdigestion and fitness, made you
rethink how you approach your gut health, consider leaving a
review on Apple, Spotify, or wherever you're getting your
podcasts. If you have questions for my
listener Q&A episodes, you can submit them as a comment on this

(01:15:03):
episode or send me an e-mail at lee@leemorado.com.
For more digestible IBS gut health and fitness tips, be sure
to follow me on Instagram at LeeMorado under score Rd.
And to apply for coaching, shop the resource suite or grab a
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Thanks for tuning in. We'll be in touch.
Soon.

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