May 14, 2025 • 31 mins
Ever sneezed and leaked a little? Felt an urgent need to use the bathroom the moment your key touches your front door? You're not alone—and contrary to what many believe, these symptoms aren't just normal parts of aging or motherhood that you have to accept.
In this conversation with Dr. Bijal Toprani, physical therapist specializing in pelvic floor health, we unpack the hidden world of pelvic floor function and dysfunction that affects up to one-third of women. Dr. Toprani demystifies what exactly the pelvic floor is (those muscles extending from pubic bone to tailbone), the common issues that arise (from various types of urinary incontinence to pelvic pain), and why waiting an average of six years to seek help is unnecessarily prolonging your discomfort.
We challenge widespread misconceptions, including the belief that Kegels are the universal solution (they can actually worsen certain conditions!) and explore the fascinating connection between stress, trauma, and pelvic tension. Most importantly, Dr. Toprani emphasizes that these conditions are highly treatable, with many patients seeing a 50% reduction in symptoms within just three months of consistent therapy.
For Health Select of Texas and Consumer-Directed Health Select participants, there's now a convenient virtual option through Hinge Health that eliminates the typical three-month wait to see a specialist. Whether you're experiencing issues during pregnancy, postpartum, perimenopause, or any stage of life, this episode delivers practical insights that can transform your relationship with your pelvic floor and overall quality of life.
Take the first step toward addressing what's been normalized but shouldn't be. Your pelvic floor deserves attention, and relief is more accessible than you might think. Listen, learn, and reclaim control of this crucial but often overlooked aspect of your wellbeing.
Learn more about Hing Health's Pelvic Floor program and see if you may be eligible through the HealthSelect website.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Toprani (00:01):
I think that there needs to be a rebrand for pelvic
health.
You know that it's not a niceto have, it's a need to have.
It is a very small region ofthe body but it has all the
muscles, the ligaments and thefascia that are really essential
for everyday functions thingswe do all the time.
Lacy Wolff (00:23):
Welcome back to the Buena Vida podcast, where we
explore practical ways tosupport your well-being body,
mind and everything in between.
I'm your host, lacey Wolfe.
In our episode today, I'mjoined by Dr Bijal Toprani, who
is a physical therapist withHinge Health.
We talked about something thatI think doesn't get talked about
quite often enough, and that ispelvic floor health.
(00:44):
The truth is, pelvic floordysfunction is incredibly common
, but many people suffer insilence, unsure of where to go
or what's normal.
We're going to change some ofthat today.
In our conversation.
We discuss the pelvic floor,what it is and why it matters,
common dysfunctions and symptomsto look out for what assessment
(01:04):
and treatment actually involve,and our new pelvic floor
program from Hinge Health,available since January for
eligible Health Select of Texasand consumer-directed Health
Select participants.
Whether you're eligible for thisprogram or not, this episode is
packed with valuableinformation and insights that
can be foundational but oftenoverlooked and helpful in your
(01:28):
own personal life.
So I hope you enjoy ourconversation.
Let's get started.
So, dr Toprani, thank you somuch for being with us on the
Buena Vida podcast.
I'm looking forward to talkingwith you about all things pelvic
floor and Hinge Health.
Thanks for having me.
Yeah, we are going to.
I want to dig into the newoffering that is available for
(01:52):
our health plan participants andthat is the pelvic floor
program, and you are a doctor ofphysical therapy and specialize
in pelvic floor.
Can you talk to our listenersjust a little bit about why did
you get into this pelvic floorin the first place?
Where did that come from?
Dr. Toprani (02:12):
Sure.
So when I went to physicaltherapy school, you know our
curriculum pretty much startsout where you're dealing with
orthopedic conditions, so thingsthat people know a lot about
sprains, orthopedic conditions,so things that people know a lot
about sprains, strains, lowback pain, shoulder pain, and
(02:33):
then it kind of transitions toteaching you about neurological
conditions.
So if, god forbid, anyone has afamily member that's ever had a
stroke or a spinal cord injury,they might have seen a PT work
with somebody in that world, andthen there's also pediatrics in
that world, and then there'salso pediatrics, but pelvic
floor care, even within physicaltherapy school, it's not really
talked about that much.
In other words, it's like veryniche.
And so I got really interestedin it because I was intrigued by
(02:58):
learning more.
You know why isn't there somuch more awareness about it?
How does what I already knowabout the human body and anatomy
translate to treating pelvicfloor care?
So that's really what kind ofgot me interested and started.
And then I always my mom alwayscalls me a rebel without a
(03:18):
cause, but I think I have acause but I always like try to
look for patient populationsthat are more underserved, and
so pelvic floor and like women'shealth, is definitely one of
those areas, and so that made mekind of think like what can I
do to improve care for that typeof population?
Lacy Wolff (03:37):
And that's why I decided to go into it.
That's amazing, wow.
And can you explain to ourlisteners, who may not have a
really extensive background inexercise physiology or human
anatomy, what is the pelvicfloor, what specific muscles
kind of make up the pelvic floorand what does it do for us?
Dr. Toprani (03:54):
Yeah, so the pelvic floor is the muscles that go
from your pubic bone in thefront to your tailbone in the
back.
So it is a very small region ofthe body but it has all the
muscles, the ligaments and thefascia that are really essential
for everyday functions thingswe do all the time like going to
(04:16):
the bathroom so all your boweland bladder function, sexual
health, of course.
If you ever have a baby, thisis the region that you know that
the vaginal delivery occursfrom, and so very small, like I
said, that region, but it'sreally those muscles that make
up the bottom of your bowlshaped pelvis are very important
(04:46):
, obviously for the reasons thatyou said, and there are a lot
of pelvic floor challenges thatpeople face.
Lacy Wolff (04:49):
It sounds like there's a lot of disorders
around the pelvic floor and Ibelieve from your website it's
one in four women struggle witha pelvic floor dysfunction.
Is that true?
Dr. Toprani (04:59):
Yeah, About 25 to 33% of the female population.
Lacy Wolff (05:03):
Wow, yeah, and so many people are not reaching out
for support, right?
So could you talk about maybesome of the more common
dysfunctions that you see inyour practice, and what kinds of
conditions?
Dr. Toprani (05:18):
Sure, the most common ones I see are urinary
incontinence, so that's leakageof urine that can happen during
certain activities.
So we kind of, as pelvic healththerapists, split up urinary
incontinence or leakage intothree categories.
The first is what we callstress incontinence, so that's
(05:39):
when you're leaking urine whenyou cough or you sneeze, when
there's like an increase inpressure urine when you cough or
you sneeze, when there's likean increase in pressure and
leaking urine with exercise alsokind of falls into that
category.
Jump rope, jump rope trampolinethere was like a viral
trampoline video about you knowwomen that were, you know,
dealing with that during thattype of activity.
(06:01):
And then there's urgeincontinence, and that's where
your muscles aren't necessarilyweak but your brain keeps
telling your bladder it's timeto empty.
So this can happen sometimeswhen someone's like opening
their front door of their house.
The second they put the key inthe door, they start to feel
like this urgency that they haveto go right away, and sometimes
(06:23):
people in that situation can'thold it and so that's another
type of leakage.
And then there's also the mixedversion, which is kind of a
combination of the two.
So that's the most commoncondition that I see in my
practice.
Lacy Wolff (06:37):
What are some signs?
I mean, you've given some signsalready.
You know around leakage, butwhat are some things that people
should be looking out for, likewhen is it time to get help for
pelvic floor?
Dr. Toprani (06:49):
There's actually a criteria that was built by a
really well-known pelvic floorPT and it kind of goes through a
list of different things youcan look out for.
So some of the things on thatlist are urine leakage, Like I
mentioned.
If you're getting up in themiddle of the night to go to the
bathroom more than two times anight, that could be a sign that
(07:10):
you have some sort of pelvicfloor dysfunction or urgency.
If you've ever fallen on yourbutt or your tailbone or your
back, like even when you were alittle kid sometimes, if you did
gymnastics and you, like fell alot, that can lead to toxics or
tailbone pain later, which isalso related to pelvic floor.
(07:31):
If you have pain withintercourse so pelvic pain, pain
in the lower abdominal regionthose are all signs that you
could definitely benefit frompelvic floor physical therapy.
And then also things related toconstipation, so if you're
chronically unable to have abowel movement easily, that's
(07:53):
also a sign of pelvic floordysfunction.
Lacy Wolff (07:55):
Okay, men can also have pelvic floor challenges,
correct they?
Dr. Toprani (07:59):
can yeah?
Lacy Wolff (08:00):
But our program right now is for women, so we're
kind of focusing on that today.
But during pregnancy or thereare certain stages in a woman's
life that maybe there's morestrain on the pelvic floor.
Can you talk a little bit aboutthat?
Dr. Toprani (08:13):
Absolutely so.
Pelvic floor conditions canreally pop up at any time, but
there's definitely an uptick oran increase in them around
pregnancy, during the postpartumphase, okay, and then around
perimenopause and menopause andthose kind of get used, you know
, interchangeably butessentially, if you're having a
(08:35):
decrease in estrogen, so aroundperimenopause maybe your
menstrual cycle is getting alittle bit more irregular, that
can also lead to pelvic floorissues.
So those are the three mostcommon life stages.
Lacy Wolff (08:47):
And can you explain what's happening there with the
estrogen decrease and theperimenopause?
Dr. Toprani (08:53):
Yeah, so estrogen receptors?
They live on a lot of differentparts of our bodies and
specifically they help yourvaginal tissue stay really
elastic and really lubricated.
Okay, so when your estrogendeclines it can cause the
muscles to become a little lessflexible, a little less elastic,
(09:16):
interesting and they can getlike dry and a little painful
with intercourse and then, also,because they're less elastic,
sometimes they don't contract orrelax the way that they're
supposed to to like keep you dry, or you know, in other words,
you might not be able to do aKegel contraction properly if
you have a decrease in estrogen.
Lacy Wolff (09:38):
Okay, so you said Kegel, yep, and that's kind of a
good transition, because I wantto talk next about what pelvic
floor therapy looks like.
What would someone expectduring a session?
And I would love to have youkind of walk our listeners
through a kegel exercise.
I think that would be really,really nice because we can do it
anywhere you can you can.
Dr. Toprani (09:59):
So with the Hinge Health Program, what you can
kind of expect is we want tofirst understand your symptoms.
So we want to know whetheryou're dealing with leakage,
because leakage is going to be awhole different set of
exercises than if you're dealingwith pelvic pain.
So we're going to start withasking you questions regarding
that and then, when you meetwith the pelvic floor PT, we
(10:22):
want to again maybe talk youthrough a Kegel exercise.
So, for example, if we were allgoing to do one now while we're
on this podcast, kegelcontraction is essentially
trying to bring your pelvicfloor up and in towards the
center of your body, and thatincludes also squeezing the
(10:42):
muscles around your anus, andsometimes we use imagery to help
people so you can kind of relaxagain and then imagine trying
to like, pick up a blueberrywith your pelvic floor muscles
and kind of closing the pelvicfloor around that blueberry and
then relaxing back down, and sothat is maybe the set of
(11:05):
exercises that you would do ifyou had weakness of the pelvic
floor and we had to kind ofassess whether you could
contract or relax.
So for some people on the linemaybe I was saying this and you
weren't really feeling theability to do that down there.
Maybe for other people theywere like oh, I totally get it.
So we assess that while you'remeeting with the pelvic health
(11:28):
PT and we'll ask questions oh,are you getting that sensation?
Do you feel like you're able tocontract?
You know, do you feel likeyou're contracting more on the
backside of your body or thefront side, and kind of tease
out whether you can reallycontract your pelvic floor.
And then, once we get thatbaseline, we know where to go
from there.
Lacy Wolff (11:48):
Okay, and can someone have too much tension
and you wouldn't recommend alsomaybe doing a Kegel?
Yes, okay.
Dr. Toprani (11:57):
So I think that Kegels have gotten a lot of PR
out in the world right, Likeevery woman knows about Kegel
exercises, and that can actuallybe dangerous not to be dramatic
, but it can be so.
If you're someone that haspelvic pain whether that means
that you have a diagnosis likeendometriosis and you're getting
(12:21):
a lot of pain in your pelvicfloor just at rest, or you have
pelvic pain when you haveintercourse with your partner,
that is a sign that you havetension in your pelvic floor,
that those muscles are reallytight and maybe they're always
in that Kegel contraction andthey actually need to relax to
(12:43):
make your symptoms better.
So Kegels are not always whatshould be prescribed to
everybody with the pelvic floordysfunction.
It really matters what type ofpelvic floor issue you have to
then decide whether Kegels arebeneficial or not.
Lacy Wolff (12:58):
Okay, that makes so much sense.
So if you were out there doingthe Kegel, maybe you should not
have been necessarily doing it,but for most people would you
say that the issue is theweakness and not the overstraint
, or is it a?
Dr. Toprani (13:15):
You know, I don't know the stats off the top of my
head, but I feel like most ofthe time, folks that have gone
through pregnancy and are in thepostpartum stage and are more
in that life stage or are inperimenopause, they tend to have
(13:35):
more weakness of the pelvicfloor, which they would benefit
from Kegels for Sometimes.
Younger patients, like those intheir early adulthood who
haven't gone through that buthave pelvic floor dysfunction,
tend to have more tightness ofthe pelvic floor.
Lacy Wolff (13:52):
Okay.
Dr. Toprani (13:52):
So those are broad generalizations, but if you are
having urine leakage and youdon't have any type of pain of
the pelvic floor, it's a prettygood sign that it's due to
weakness and that Kegels wouldhelp Okay.
Lacy Wolff (14:06):
Yeah, that's so helpful.
We know that there's aconnection between the brain and
the body and I think stresssort of impacts everything in
our body.
Would you say it affects pelvicfloor.
Dr. Toprani (14:21):
Absolutely it does.
You know, a lot of patientsthat I've worked with the ones
that have pain in the pelvicfloor sometimes have had a
history of some sort of sexualabuse.
Or maybe there's been some sortof history where there's a fear
of a vaginal exam at like yourdoctor's office and that can
(14:44):
kind of cause you to feel a lotof tension which translates into
the muscles actually tighteningup.
So fear and history that allstarts in from a mental health
perspective can cause you tothen tighten up or tense up,
which can cause you to feel morepain sometimes in the pelvic
(15:04):
floor region.
Lacy Wolff (15:05):
Wow, that makes so much sense.
Are there any misconceptionsaround pelvic floor therapy that
you would like to clear up forour listeners?
Dr. Toprani (15:16):
I think that pelvic floor therapy I kind of started
off talking about all thedifferent types of PT that
exists in the world, you know,and I think people think, oh, I
sprained my ankle, I need to goto physical therapy.
Or, you know, I have frozenshoulder, I need to go to
physical therapy.
But pelvic health isn't reallysomething people automatically
(15:37):
think oh, there's PT for that,right.
And so I think themisconception is more around
like awareness in and of itselfthat this is an actual expertise
that exists, that there arepelvic health PTs like me who
have gone through training, thatare, that are specifically
trained to treat this region.
And the other misconception Iwould say is that I think folks
(16:00):
think that even when they arebought in to going to pelvic
health PT, that it might not bethat effective or like is it
really going to get better?
And I think the reason why isbecause a lot of women have kind
of just dealt with thesesymptoms for a long time.
Like we see in the literaturethat it takes about six and a
half years for a woman to talkto a provider about pelvic
(16:25):
health symptoms, and I thinkthat really speaks to the fact
that women are just kind of likeoh well, you know, I had a
couple of children or I'm aging,that's just kind of a part of
life.
And I know a lot of my patientswill talk about their mothers
and grandmothers who just wore,you know, depends or wore adult
diapers for years and years andyears because they had kind of
(16:48):
resigned to the fact that thiswas just a normal part of life,
and so that's really a bigmisconception that I see that I
want people to realize that,like common doesn't mean normal
and common doesn't mean thatit's not treatable.
It's an incredibly treatablecondition and we have people in
(17:08):
our program that have reducedtheir urinary incontinence
symptoms by half.
So if they're leaking fivetimes a week, they're only
leaking like two to three afterlike three months of being
really committed to theirexercises.
Lacy Wolff (17:22):
So very treatable and yeah, that's amazing and I
just from my own personalexperience, I've been going
through the pelvic floor program.
I am 46.
I've had two kids and I'm oneof those people that kind of
resigned to this.
This is normal and it's notterrible.
It's just here and there, but Ilike to go through anything
that we're recommending for ourhealth plan participants and
(17:45):
it's been a game changer.
So I am grateful we can haveyou on and hopefully get this
information out to everybody,because it does.
It has hugely impacted mepersonally as well.
You have worked from patients,according to your bio, from ages
two to 102, which is amazing.
How can the pelvic floor healthchange during different life
(18:07):
stages?
You talked a little bit aboutwomen and aging, but just
generally, what can peopleexpect?
Dr. Toprani (18:12):
Yeah, so my expertise is definitely with the
populations that I've alreadytalked about.
You know the pregnancy,postpartum, menopause and then
early adulthood, but there arepediatric use cases for pelvic
health PT.
That's another like niche of aniche specialty.
But if there are issues aroundbedwetting, around potty
(18:33):
training in general, chronicconstipation, which is really
common in young children, thatis something that Pelvic Health
PT can help with.
Of course this program is for18 and over, but that's just for
a knowledge check there.
And then, like I mentioned,early adulthood is where you're
kind of seeing some of the moretightness-related issues,
(18:55):
whereas weakness-related issuestend to happen around pregnancy,
postpartum.
There's also pelvic organprolapse, which can feel like a
heaviness of your pelvic floor,like your pelvic organs are kind
of slipping out of their normalposition, which sounds scary,
but it's again very treatable.
That's another thing that wesee.
(19:16):
If you've had multiple birthsand maybe you've had labors in
which you've had to push formany hours, that can kind of
cause extra strain on yourpelvic floor which causes some
prolapse related issues.
(21:08):
Yeah, you should definitelystart, which, by the way, you're
such a good patient, so thatmakes me happy but you should
start to see improvements withinthat three-month period.
Like I said, we're kind ofseeing 50% improvements at three
months and then more of like aresolution of much, much better
within, you know, three monthsafter that.
So like a six-month period.
(21:28):
It depends how severe yoursymptoms are.
How severe your symptoms are,but especially with urinary
incontinence, there arelifestyle things that you can
start to implement kind ofimmediately that will give you
relief pretty soon.
So like, for example, not goingto the bathroom just in case we
call that gig.
(21:48):
Um, and so you know, we kind ofall grew up like oh, we're going
on a road trip Like Go to thebathroom, just in case, even if
you don't have to, we call itpreventive pee, there we go.
Preventive pee, and sopreventive peeing actually
tricks your bladder intothinking that it has to empty,
even when your bladder is notfull.
Oh, so you really shouldn'teven be going to the bathroom
(22:11):
until your bladder is full.
And how do you know yourbladder is full If you sit down
on the toilet and you start topee, you should be able to count
to 12 to 15 Mississippis.
What, yeah, like oneMississippi, two Mississippi,
three Mississippi, and that is asign that your pelvic, that
(22:32):
your bladder, was actually fulland needed to be emptied.
Wow, if you're countingMississippis and it's like four,
you might've done a preventiveP or a JIC.
Lacy Wolff (22:39):
A JIC.
Yeah, okay, that is sointeresting.
I love it.
I'm going to start working onthat.
So what advice do you have?
I know we talked a little bitabout the fact that everyone has
a pelvic floor, men and women.
What advice do you have for menthat may, and what kinds of
challenges do men have withpelvic floor?
What advice do you have for menthat may, and what kinds of
challenges do men have with?
Dr. Toprani (23:00):
pelvic floor With pelvic floor conditions, if you
are someone who gets diagnosedwith prostate cancer and then
goes through the treatment forprostate cancer.
Oftentimes after that you canhave urinary incontinence and
sometimes there's even erectiledysfunction that can occur from
that.
We also have men that havechronic, like hamstring and
(23:21):
groin related pain, which iscommon in like athletes that do
a lot of kicking, like soccerplayers or hockey players, where
their groin is like an areathat is used a lot with a lot of
skating that they do A lot oftimes.
When your pelvic floor is weak,it can cause issues in other
(23:42):
surrounding muscles, like yourhips and your hamstrings.
So those are types of thingsthat men may experience related
to the pelvic floor, okay, andso my advice for them would be
you know, if you're already inthe Hinge Health program and
you're in for another body part,you can message your pelvic.
You can message your PT, excuseme, and just say, hey, I'm
(24:05):
having these issues and thereare some resources within the
program that are for men that wecan send over to you, okay.
Or you can always find a pelvichealth PT to work with in
person if you go topelvicrehabcom.
But yeah, men have pelvic floorissues too and they definitely
deserve care for that.
Lacy Wolff (24:27):
Let's talk a little bit about what someone might do
if they are interested ingetting support with pelvic
health issues.
What's the first step thatsomeone might take?
Dr. Toprani (24:37):
Yeah, the first step is you should might take.
Yeah, for the first step is youshould definitely look into the
Hinge Health program.
So if you go to hingehealth,slash health select, you can
learn about the program and thenalso fill out an application on
there.
That is the first step and thenfrom there you're kind of off
to the races, because we'll setyou up with the exercises that
(24:59):
you need.
We'll have you download theHinge Health app, lacey you
mentioned a moment ago.
We make it so that theexercises are really
approachable.
That's by design.
So the first step is reallygetting enrolled in the program
at that website and then fillingout an application.
Lacy Wolff (25:17):
And it's all virtual .
So just for our listeners thatmay not be as familiar with
Hinge Health, yet it is allvirtual, but you can, there are.
I mean, we want to make surepeople know that you can also go
through your healthcareprovider, your PCP, and get
referred for pelvic floortherapy.
(25:37):
But from what I understand andhaving friends who have had to
go, who have needed that support, it can take a long time to get
into a pelvic floor therapistright.
There aren't enough of you,there aren't enough of us.
Dr. Toprani (25:49):
No, it can take a really long time.
It can take like three monthsin most metros.
So, like San Francisco, austin,new York, it can take like 93
days, to be exact, to get in tosee a provider, a pelvic health
PT.
So that's actually why I likethis program so much is because
(26:10):
I know that when there's monthsof time between me doing the
thing that I need to do, it'sgoing to fall off my list.
So with this it's really nicebecause you can get started
right away and you don't have toleave the house and I know for
some of my patients it's kind ofan uncomfortable topic too for
some folks, and so it's reallynice to have that privacy Right.
(26:33):
But yeah, we can get youstarted right away, which is
really nice, amazing.
Lacy Wolff (26:37):
And I know for me personally.
You said I'm a really goodpatient, but actually I was a
really good patient for a whileand then I got sick.
I had this terrible cold and itwas 10 days and I was coughing
so much that all my symptomscame back and I felt like, oh
man, I did all that work andthen it's just for nothing.
And then I was discouraged andI started back and within a
(27:01):
couple more weeks I was back towhere I was.
So it's amazing how quickly youcan make progress with the
program.
I really love the consistencyand the tracking and you know,
it's just gamifying healthybehaviors is what I love about
your program.
Dr. Toprani (27:17):
Absolutely, and I know you're an enthusiast on
like habit formation and all ofthat and I've read the book
Atomic Habits and it's reallyall about that fitting in.
You know, 10 minutes, 15minutes.
If you can only do it twice aweek, great.
If you progress to three days aweek, awesome, Like.
We're here to really applaudand support people, regardless
(27:39):
of what their starting point is.
So if you do have anyapprehension, any listeners that
are like I don't know if I cancommit to this, it's better to
just take the first step and youknow we'll definitely meet you
where you are.
Lacy Wolff (27:52):
So in your coaches so gently nudge.
Dr. Toprani (27:55):
Yes, I call it gentle nudges too.
Yeah, we have amazing, amazinghealth coaches who are their
entire goal and ethos is reallyto be your support system.
So they want to reach out toyou and say, hey, lacey, haven't
seen you in the app in a while.
Uh, how can I help you?
What's going on?
You know, they're not here tojudge, they just really want to
(28:18):
support you.
And if your answer to them is,hey, life is lifing right now.
I need a little bit of a break,like, that's okay too, and
they'll touch back with you in afew weeks, yeah, and they're
not.
Lacy Wolff (28:28):
They're not on you every day, but I really
appreciate that support throughthe program.
All right, so what?
I have just a couple morequestions here for you, and I
know we're at time, but I couldtalk about this all day.
What is one takeaway you would?
Dr. Toprani (28:47):
like for our listeners to take away around
pelvic floor health.
I think the common is notnormal thing.
I think that there needs to bea rebrand for pelvic health.
You know that it's not a niceto have, it's a need to have.
Based on my research on thestandard of care in other
countries, for example, inFrance, if you have a baby, the
(29:10):
standard of care is that you goto six pelvic health PT visits.
Okay, that's just the standard,wow, and I think that says a lot
, because normally here apostpartum visit is six weeks
post-op, I mean post-delivery,like okay, are you good, you
know you don't have an infection.
Okay, great.
Like good luck with the rest ofyour life.
(29:33):
And it's really unfortunate.
And so you know, I think mybiggest takeaway is that, like,
you deserve to get care for this, and just because the standard
is not you know what it is thesix visits like let's remake
that standard for ourselves andreally get the support that we
(29:54):
deserve, right?
Lacy Wolff (29:55):
So, yeah, especially important for postpartum, and
anyone can join the join theprogram.
So, all right, uh, very lastquestion, and then we'll talk
about where people can go formore information.
This podcast in our wellbeingprogram is called Buena Vida,
which means the good life, andwe're really trying to emphasize
that a good life can meandifferent things for different
(30:15):
people.
What is a good life?
And we're really trying toemphasize that a good life can
mean different things fordifferent people.
What is a good life for you?
Dr. Toprani (30:24):
A good life for me is having a really good mental
health perspective on things.
You know, I've worked a lot inthe last couple of years like
going to therapy and figuringout how to grow and how to be
more confident and how to takecare of my mental health, and I
(30:45):
think that that has trickleddown into everything that I do
my work, my relationships and soI think living a good life is
having the time to pour intoyourself and your mental health
and your mental well-being asmuch as you possibly can.
Lacy Wolff (31:02):
That's great.
I love that.
All right.
Well, I know that you have theeligibility requirements for
Hinge Health, so do you mindtelling people the requirements
for the program?
If anybody's interested in, Iwill also put all of this in our
show notes as well.
So if you're wanting to getinvolved in the pelvic floor or
hinge health in general, you canlook at the show notes.
Dr. Toprani (31:23):
Yes, absolutely so for ERS participants.
Those that are on the HealthSelect of Texas medical plan,
including those that areenrolled in the consumer
directed Health Select and areover the age of 18, consumer
directed Health Select and areover the age of 18 living in the
US are eligible to enroll inHinge Health.
(31:44):
So if you do want to learn more, you can go to hingehealth
slash health select where youcan sign up for the program.
Lacy Wolff (31:50):
Awesome, you are amazing.
Thank you so much, really,really grateful for your time,
your energy and all you're doingto help support our health plan
participants.
Thanks for having me.
Thank you All right.
That wraps up our episode fortoday.
Thank you so much for listeningto this important conversation.
Pelvic floor health impactsmore people than we realize, and
(32:11):
the more we talk about it, theeasier it becomes to find the
help and the support we need.
If you think someone in yourlife could benefit from this
information, please considersharing this episode with them,
and if you're interested inlearning more about the Hinge
Health Pelvic Floor Program, ifyou are a Health Select of Texas
or Consumer Directed HealthSelect participant, please check
(32:32):
out our show notes, where youwill find the link to the
registration process.
Until next time, take care ofyourself and your pelvic floor.
Have a great day.
I think that there needs to be a rebrand for pelvic
health.
You know that it's not a niceto have, it's a need to have.
It is a very small region ofthe body but it has all the
muscles, the ligaments and thefascia that are really essential
for everyday functions thingswe do all the time.
Lacy Wolff (00:23):
Welcome back to the Buena Vida podcast, where we
explore practical ways tosupport your well-being body,
mind and everything in between.
I'm your host, lacey Wolfe.
In our episode today, I'mjoined by Dr Bijal Toprani, who
is a physical therapist withHinge Health.
We talked about something thatI think doesn't get talked about
quite often enough, and that ispelvic floor health.
(00:44):
The truth is, pelvic floordysfunction is incredibly common
, but many people suffer insilence, unsure of where to go
or what's normal.
We're going to change some ofthat today.
In our conversation.
We discuss the pelvic floor,what it is and why it matters,
common dysfunctions and symptomsto look out for what assessment
(01:04):
and treatment actually involve,and our new pelvic floor
program from Hinge Health,available since January for
eligible Health Select of Texasand consumer-directed Health
Select participants.
Whether you're eligible for thisprogram or not, this episode is
packed with valuableinformation and insights that
can be foundational but oftenoverlooked and helpful in your
(01:28):
own personal life.
So I hope you enjoy ourconversation.
Let's get started.
So, dr Toprani, thank you somuch for being with us on the
Buena Vida podcast.
I'm looking forward to talkingwith you about all things pelvic
floor and Hinge Health.
Thanks for having me.
Yeah, we are going to.
I want to dig into the newoffering that is available for
(01:52):
our health plan participants andthat is the pelvic floor
program, and you are a doctor ofphysical therapy and specialize
in pelvic floor.
Can you talk to our listenersjust a little bit about why did
you get into this pelvic floorin the first place?
Where did that come from?
Dr. Toprani (02:12):
Sure.
So when I went to physicaltherapy school, you know our
curriculum pretty much startsout where you're dealing with
orthopedic conditions, so thingsthat people know a lot about
sprains, orthopedic conditions,so things that people know a lot
about sprains, strains, lowback pain, shoulder pain, and
(02:33):
then it kind of transitions toteaching you about neurological
conditions.
So if, god forbid, anyone has afamily member that's ever had a
stroke or a spinal cord injury,they might have seen a PT work
with somebody in that world, andthen there's also pediatrics in
that world, and then there'salso pediatrics, but pelvic
floor care, even within physicaltherapy school, it's not really
talked about that much.
In other words, it's like veryniche.
And so I got really interestedin it because I was intrigued by
(02:58):
learning more.
You know why isn't there somuch more awareness about it?
How does what I already knowabout the human body and anatomy
translate to treating pelvicfloor care?
So that's really what kind ofgot me interested and started.
And then I always my mom alwayscalls me a rebel without a
(03:18):
cause, but I think I have acause but I always like try to
look for patient populationsthat are more underserved, and
so pelvic floor and like women'shealth, is definitely one of
those areas, and so that made mekind of think like what can I
do to improve care for that typeof population?
Lacy Wolff (03:37):
And that's why I decided to go into it.
That's amazing, wow.
And can you explain to ourlisteners, who may not have a
really extensive background inexercise physiology or human
anatomy, what is the pelvicfloor, what specific muscles
kind of make up the pelvic floorand what does it do for us?
Dr. Toprani (03:54):
Yeah, so the pelvic floor is the muscles that go
from your pubic bone in thefront to your tailbone in the
back.
So it is a very small region ofthe body but it has all the
muscles, the ligaments and thefascia that are really essential
for everyday functions thingswe do all the time like going to
(04:16):
the bathroom so all your boweland bladder function, sexual
health, of course.
If you ever have a baby, thisis the region that you know that
the vaginal delivery occursfrom, and so very small, like I
said, that region, but it'sreally those muscles that make
up the bottom of your bowlshaped pelvis are very important
(04:46):
, obviously for the reasons thatyou said, and there are a lot
of pelvic floor challenges thatpeople face.
Lacy Wolff (04:49):
It sounds like there's a lot of disorders
around the pelvic floor and Ibelieve from your website it's
one in four women struggle witha pelvic floor dysfunction.
Is that true?
Dr. Toprani (04:59):
Yeah, About 25 to 33% of the female population.
Lacy Wolff (05:03):
Wow, yeah, and so many people are not reaching out
for support, right?
So could you talk about maybesome of the more common
dysfunctions that you see inyour practice, and what kinds of
conditions?
Dr. Toprani (05:18):
Sure, the most common ones I see are urinary
incontinence, so that's leakageof urine that can happen during
certain activities.
So we kind of, as pelvic healththerapists, split up urinary
incontinence or leakage intothree categories.
The first is what we callstress incontinence, so that's
(05:39):
when you're leaking urine whenyou cough or you sneeze, when
there's like an increase inpressure urine when you cough or
you sneeze, when there's likean increase in pressure and
leaking urine with exercise alsokind of falls into that
category.
Jump rope, jump rope trampolinethere was like a viral
trampoline video about you knowwomen that were, you know,
dealing with that during thattype of activity.
(06:01):
And then there's urgeincontinence, and that's where
your muscles aren't necessarilyweak but your brain keeps
telling your bladder it's timeto empty.
So this can happen sometimeswhen someone's like opening
their front door of their house.
The second they put the key inthe door, they start to feel
like this urgency that they haveto go right away, and sometimes
(06:23):
people in that situation can'thold it and so that's another
type of leakage.
And then there's also the mixedversion, which is kind of a
combination of the two.
So that's the most commoncondition that I see in my
practice.
Lacy Wolff (06:37):
What are some signs?
I mean, you've given some signsalready.
You know around leakage, butwhat are some things that people
should be looking out for, likewhen is it time to get help for
pelvic floor?
Dr. Toprani (06:49):
There's actually a criteria that was built by a
really well-known pelvic floorPT and it kind of goes through a
list of different things youcan look out for.
So some of the things on thatlist are urine leakage, Like I
mentioned.
If you're getting up in themiddle of the night to go to the
bathroom more than two times anight, that could be a sign that
(07:10):
you have some sort of pelvicfloor dysfunction or urgency.
If you've ever fallen on yourbutt or your tailbone or your
back, like even when you were alittle kid sometimes, if you did
gymnastics and you, like fell alot, that can lead to toxics or
tailbone pain later, which isalso related to pelvic floor.
(07:31):
If you have pain withintercourse so pelvic pain, pain
in the lower abdominal regionthose are all signs that you
could definitely benefit frompelvic floor physical therapy.
And then also things related toconstipation, so if you're
chronically unable to have abowel movement easily, that's
(07:53):
also a sign of pelvic floordysfunction.
Lacy Wolff (07:55):
Okay, men can also have pelvic floor challenges,
correct they?
Dr. Toprani (07:59):
can yeah?
Lacy Wolff (08:00):
But our program right now is for women, so we're
kind of focusing on that today.
But during pregnancy or thereare certain stages in a woman's
life that maybe there's morestrain on the pelvic floor.
Can you talk a little bit aboutthat?
Dr. Toprani (08:13):
Absolutely so.
Pelvic floor conditions canreally pop up at any time, but
there's definitely an uptick oran increase in them around
pregnancy, during the postpartumphase, okay, and then around
perimenopause and menopause andthose kind of get used, you know
, interchangeably butessentially, if you're having a
(08:35):
decrease in estrogen, so aroundperimenopause maybe your
menstrual cycle is getting alittle bit more irregular, that
can also lead to pelvic floorissues.
So those are the three mostcommon life stages.
Lacy Wolff (08:47):
And can you explain what's happening there with the
estrogen decrease and theperimenopause?
Dr. Toprani (08:53):
Yeah, so estrogen receptors?
They live on a lot of differentparts of our bodies and
specifically they help yourvaginal tissue stay really
elastic and really lubricated.
Okay, so when your estrogendeclines it can cause the
muscles to become a little lessflexible, a little less elastic,
(09:16):
interesting and they can getlike dry and a little painful
with intercourse and then, also,because they're less elastic,
sometimes they don't contract orrelax the way that they're
supposed to to like keep you dry, or you know, in other words,
you might not be able to do aKegel contraction properly if
you have a decrease in estrogen.
Lacy Wolff (09:38):
Okay, so you said Kegel, yep, and that's kind of a
good transition, because I wantto talk next about what pelvic
floor therapy looks like.
What would someone expectduring a session?
And I would love to have youkind of walk our listeners
through a kegel exercise.
I think that would be really,really nice because we can do it
anywhere you can you can.
Dr. Toprani (09:59):
So with the Hinge Health Program, what you can
kind of expect is we want tofirst understand your symptoms.
So we want to know whetheryou're dealing with leakage,
because leakage is going to be awhole different set of
exercises than if you're dealingwith pelvic pain.
So we're going to start withasking you questions regarding
that and then, when you meetwith the pelvic floor PT, we
(10:22):
want to again maybe talk youthrough a Kegel exercise.
So, for example, if we were allgoing to do one now while we're
on this podcast, kegelcontraction is essentially
trying to bring your pelvicfloor up and in towards the
center of your body, and thatincludes also squeezing the
(10:42):
muscles around your anus, andsometimes we use imagery to help
people so you can kind of relaxagain and then imagine trying
to like, pick up a blueberrywith your pelvic floor muscles
and kind of closing the pelvicfloor around that blueberry and
then relaxing back down, and sothat is maybe the set of
(11:05):
exercises that you would do ifyou had weakness of the pelvic
floor and we had to kind ofassess whether you could
contract or relax.
So for some people on the linemaybe I was saying this and you
weren't really feeling theability to do that down there.
Maybe for other people theywere like oh, I totally get it.
So we assess that while you'remeeting with the pelvic health
(11:28):
PT and we'll ask questions oh,are you getting that sensation?
Do you feel like you're able tocontract?
You know, do you feel likeyou're contracting more on the
backside of your body or thefront side, and kind of tease
out whether you can reallycontract your pelvic floor.
And then, once we get thatbaseline, we know where to go
from there.
Lacy Wolff (11:48):
Okay, and can someone have too much tension
and you wouldn't recommend alsomaybe doing a Kegel?
Yes, okay.
Dr. Toprani (11:57):
So I think that Kegels have gotten a lot of PR
out in the world right, Likeevery woman knows about Kegel
exercises, and that can actuallybe dangerous not to be dramatic
, but it can be so.
If you're someone that haspelvic pain whether that means
that you have a diagnosis likeendometriosis and you're getting
(12:21):
a lot of pain in your pelvicfloor just at rest, or you have
pelvic pain when you haveintercourse with your partner,
that is a sign that you havetension in your pelvic floor,
that those muscles are reallytight and maybe they're always
in that Kegel contraction andthey actually need to relax to
(12:43):
make your symptoms better.
So Kegels are not always whatshould be prescribed to
everybody with the pelvic floordysfunction.
It really matters what type ofpelvic floor issue you have to
then decide whether Kegels arebeneficial or not.
Lacy Wolff (12:58):
Okay, that makes so much sense.
So if you were out there doingthe Kegel, maybe you should not
have been necessarily doing it,but for most people would you
say that the issue is theweakness and not the overstraint
, or is it a?
Dr. Toprani (13:15):
You know, I don't know the stats off the top of my
head, but I feel like most ofthe time, folks that have gone
through pregnancy and are in thepostpartum stage and are more
in that life stage or are inperimenopause, they tend to have
(13:35):
more weakness of the pelvicfloor, which they would benefit
from Kegels for Sometimes.
Younger patients, like those intheir early adulthood who
haven't gone through that buthave pelvic floor dysfunction,
tend to have more tightness ofthe pelvic floor.
Lacy Wolff (13:52):
Okay.
Dr. Toprani (13:52):
So those are broad generalizations, but if you are
having urine leakage and youdon't have any type of pain of
the pelvic floor, it's a prettygood sign that it's due to
weakness and that Kegels wouldhelp Okay.
Lacy Wolff (14:06):
Yeah, that's so helpful.
We know that there's aconnection between the brain and
the body and I think stresssort of impacts everything in
our body.
Would you say it affects pelvicfloor.
Dr. Toprani (14:21):
Absolutely it does.
You know, a lot of patientsthat I've worked with the ones
that have pain in the pelvicfloor sometimes have had a
history of some sort of sexualabuse.
Or maybe there's been some sortof history where there's a fear
of a vaginal exam at like yourdoctor's office and that can
(14:44):
kind of cause you to feel a lotof tension which translates into
the muscles actually tighteningup.
So fear and history that allstarts in from a mental health
perspective can cause you tothen tighten up or tense up,
which can cause you to feel morepain sometimes in the pelvic
(15:04):
floor region.
Lacy Wolff (15:05):
Wow, that makes so much sense.
Are there any misconceptionsaround pelvic floor therapy that
you would like to clear up forour listeners?
Dr. Toprani (15:16):
I think that pelvic floor therapy I kind of started
off talking about all thedifferent types of PT that
exists in the world, you know,and I think people think, oh, I
sprained my ankle, I need to goto physical therapy.
Or, you know, I have frozenshoulder, I need to go to
physical therapy.
But pelvic health isn't reallysomething people automatically
(15:37):
think oh, there's PT for that,right.
And so I think themisconception is more around
like awareness in and of itselfthat this is an actual expertise
that exists, that there arepelvic health PTs like me who
have gone through training, thatare, that are specifically
trained to treat this region.
And the other misconception Iwould say is that I think folks
(16:00):
think that even when they arebought in to going to pelvic
health PT, that it might not bethat effective or like is it
really going to get better?
And I think the reason why isbecause a lot of women have kind
of just dealt with thesesymptoms for a long time.
Like we see in the literaturethat it takes about six and a
half years for a woman to talkto a provider about pelvic
(16:25):
health symptoms, and I thinkthat really speaks to the fact
that women are just kind of likeoh well, you know, I had a
couple of children or I'm aging,that's just kind of a part of
life.
And I know a lot of my patientswill talk about their mothers
and grandmothers who just wore,you know, depends or wore adult
diapers for years and years andyears because they had kind of
(16:48):
resigned to the fact that thiswas just a normal part of life,
and so that's really a bigmisconception that I see that I
want people to realize that,like common doesn't mean normal
and common doesn't mean thatit's not treatable.
It's an incredibly treatablecondition and we have people in
(17:08):
our program that have reducedtheir urinary incontinence
symptoms by half.
So if they're leaking fivetimes a week, they're only
leaking like two to three afterlike three months of being
really committed to theirexercises.
Lacy Wolff (17:22):
So very treatable and yeah, that's amazing and I
just from my own personalexperience, I've been going
through the pelvic floor program.
I am 46.
I've had two kids and I'm oneof those people that kind of
resigned to this.
This is normal and it's notterrible.
It's just here and there, but Ilike to go through anything
that we're recommending for ourhealth plan participants and
(17:45):
it's been a game changer.
So I am grateful we can haveyou on and hopefully get this
information out to everybody,because it does.
It has hugely impacted mepersonally as well.
You have worked from patients,according to your bio, from ages
two to 102, which is amazing.
How can the pelvic floor healthchange during different life
(18:07):
stages?
You talked a little bit aboutwomen and aging, but just
generally, what can peopleexpect?
Dr. Toprani (18:12):
Yeah, so my expertise is definitely with the
populations that I've alreadytalked about.
You know the pregnancy,postpartum, menopause and then
early adulthood, but there arepediatric use cases for pelvic
health PT.
That's another like niche of aniche specialty.
But if there are issues aroundbedwetting, around potty
(18:33):
training in general, chronicconstipation, which is really
common in young children, thatis something that Pelvic Health
PT can help with.
Of course this program is for18 and over, but that's just for
a knowledge check there.
And then, like I mentioned,early adulthood is where you're
kind of seeing some of the moretightness-related issues,
(18:55):
whereas weakness-related issuestend to happen around pregnancy,
postpartum.
There's also pelvic organprolapse, which can feel like a
heaviness of your pelvic floor,like your pelvic organs are kind
of slipping out of their normalposition, which sounds scary,
but it's again very treatable.
That's another thing that wesee.
(19:16):
If you've had multiple birthsand maybe you've had labors in
which you've had to push formany hours, that can kind of
cause extra strain on yourpelvic floor which causes some
prolapse related issues.
(21:08):
Yeah, you should definitelystart, which, by the way, you're
such a good patient, so thatmakes me happy but you should
start to see improvements withinthat three-month period.
Like I said, we're kind ofseeing 50% improvements at three
months and then more of like aresolution of much, much better
within, you know, three monthsafter that.
So like a six-month period.
(21:28):
It depends how severe yoursymptoms are.
How severe your symptoms are,but especially with urinary
incontinence, there arelifestyle things that you can
start to implement kind ofimmediately that will give you
relief pretty soon.
So like, for example, not goingto the bathroom just in case we
call that gig.
(21:48):
Um, and so you know, we kind ofall grew up like oh, we're going
on a road trip Like Go to thebathroom, just in case, even if
you don't have to, we call itpreventive pee, there we go.
Preventive pee, and sopreventive peeing actually
tricks your bladder intothinking that it has to empty,
even when your bladder is notfull.
Oh, so you really shouldn'teven be going to the bathroom
(22:11):
until your bladder is full.
And how do you know yourbladder is full If you sit down
on the toilet and you start topee, you should be able to count
to 12 to 15 Mississippis.
What, yeah, like oneMississippi, two Mississippi,
three Mississippi, and that is asign that your pelvic, that
(22:32):
your bladder, was actually fulland needed to be emptied.
Wow, if you're countingMississippis and it's like four,
you might've done a preventiveP or a JIC.
Lacy Wolff (22:39):
A JIC.
Yeah, okay, that is sointeresting.
I love it.
I'm going to start working onthat.
So what advice do you have?
I know we talked a little bitabout the fact that everyone has
a pelvic floor, men and women.
What advice do you have for menthat may, and what kinds of
challenges do men have withpelvic floor?
What advice do you have for menthat may, and what kinds of
challenges do men have with?
Dr. Toprani (23:00):
pelvic floor With pelvic floor conditions, if you
are someone who gets diagnosedwith prostate cancer and then
goes through the treatment forprostate cancer.
Oftentimes after that you canhave urinary incontinence and
sometimes there's even erectiledysfunction that can occur from
that.
We also have men that havechronic, like hamstring and
(23:21):
groin related pain, which iscommon in like athletes that do
a lot of kicking, like soccerplayers or hockey players, where
their groin is like an areathat is used a lot with a lot of
skating that they do A lot oftimes.
When your pelvic floor is weak,it can cause issues in other
(23:42):
surrounding muscles, like yourhips and your hamstrings.
So those are types of thingsthat men may experience related
to the pelvic floor, okay, andso my advice for them would be
you know, if you're already inthe Hinge Health program and
you're in for another body part,you can message your pelvic.
You can message your PT, excuseme, and just say, hey, I'm
(24:05):
having these issues and thereare some resources within the
program that are for men that wecan send over to you, okay.
Or you can always find a pelvichealth PT to work with in
person if you go topelvicrehabcom.
But yeah, men have pelvic floorissues too and they definitely
deserve care for that.
Lacy Wolff (24:27):
Let's talk a little bit about what someone might do
if they are interested ingetting support with pelvic
health issues.
What's the first step thatsomeone might take?
Dr. Toprani (24:37):
Yeah, the first step is you should might take.
Yeah, for the first step is youshould definitely look into the
Hinge Health program.
So if you go to hingehealth,slash health select, you can
learn about the program and thenalso fill out an application on
there.
That is the first step and thenfrom there you're kind of off
to the races, because we'll setyou up with the exercises that
(24:59):
you need.
We'll have you download theHinge Health app, lacey you
mentioned a moment ago.
We make it so that theexercises are really
approachable.
That's by design.
So the first step is reallygetting enrolled in the program
at that website and then fillingout an application.
Lacy Wolff (25:17):
And it's all virtual .
So just for our listeners thatmay not be as familiar with
Hinge Health, yet it is allvirtual, but you can, there are.
I mean, we want to make surepeople know that you can also go
through your healthcareprovider, your PCP, and get
referred for pelvic floortherapy.
(25:37):
But from what I understand andhaving friends who have had to
go, who have needed that support, it can take a long time to get
into a pelvic floor therapistright.
There aren't enough of you,there aren't enough of us.
Dr. Toprani (25:49):
No, it can take a really long time.
It can take like three monthsin most metros.
So, like San Francisco, austin,new York, it can take like 93
days, to be exact, to get in tosee a provider, a pelvic health
PT.
So that's actually why I likethis program so much is because
(26:10):
I know that when there's monthsof time between me doing the
thing that I need to do, it'sgoing to fall off my list.
So with this it's really nicebecause you can get started
right away and you don't have toleave the house and I know for
some of my patients it's kind ofan uncomfortable topic too for
some folks, and so it's reallynice to have that privacy Right.
(26:33):
But yeah, we can get youstarted right away, which is
really nice, amazing.
Lacy Wolff (26:37):
And I know for me personally.
You said I'm a really goodpatient, but actually I was a
really good patient for a whileand then I got sick.
I had this terrible cold and itwas 10 days and I was coughing
so much that all my symptomscame back and I felt like, oh
man, I did all that work andthen it's just for nothing.
And then I was discouraged andI started back and within a
(27:01):
couple more weeks I was back towhere I was.
So it's amazing how quickly youcan make progress with the
program.
I really love the consistencyand the tracking and you know,
it's just gamifying healthybehaviors is what I love about
your program.
Dr. Toprani (27:17):
Absolutely, and I know you're an enthusiast on
like habit formation and all ofthat and I've read the book
Atomic Habits and it's reallyall about that fitting in.
You know, 10 minutes, 15minutes.
If you can only do it twice aweek, great.
If you progress to three days aweek, awesome, Like.
We're here to really applaudand support people, regardless
(27:39):
of what their starting point is.
So if you do have anyapprehension, any listeners that
are like I don't know if I cancommit to this, it's better to
just take the first step and youknow we'll definitely meet you
where you are.
Lacy Wolff (27:52):
So in your coaches so gently nudge.
Dr. Toprani (27:55):
Yes, I call it gentle nudges too.
Yeah, we have amazing, amazinghealth coaches who are their
entire goal and ethos is reallyto be your support system.
So they want to reach out toyou and say, hey, lacey, haven't
seen you in the app in a while.
Uh, how can I help you?
What's going on?
You know, they're not here tojudge, they just really want to
(28:18):
support you.
And if your answer to them is,hey, life is lifing right now.
I need a little bit of a break,like, that's okay too, and
they'll touch back with you in afew weeks, yeah, and they're
not.
Lacy Wolff (28:28):
They're not on you every day, but I really
appreciate that support throughthe program.
All right, so what?
I have just a couple morequestions here for you, and I
know we're at time, but I couldtalk about this all day.
What is one takeaway you would?
Dr. Toprani (28:47):
like for our listeners to take away around
pelvic floor health.
I think the common is notnormal thing.
I think that there needs to bea rebrand for pelvic health.
You know that it's not a niceto have, it's a need to have.
Based on my research on thestandard of care in other
countries, for example, inFrance, if you have a baby, the
(29:10):
standard of care is that you goto six pelvic health PT visits.
Okay, that's just the standard,wow, and I think that says a lot
, because normally here apostpartum visit is six weeks
post-op, I mean post-delivery,like okay, are you good, you
know you don't have an infection.
Okay, great.
Like good luck with the rest ofyour life.
(29:33):
And it's really unfortunate.
And so you know, I think mybiggest takeaway is that, like,
you deserve to get care for this, and just because the standard
is not you know what it is thesix visits like let's remake
that standard for ourselves andreally get the support that we
(29:54):
deserve, right?
Lacy Wolff (29:55):
So, yeah, especially important for postpartum, and
anyone can join the join theprogram.
So, all right, uh, very lastquestion, and then we'll talk
about where people can go formore information.
This podcast in our wellbeingprogram is called Buena Vida,
which means the good life, andwe're really trying to emphasize
that a good life can meandifferent things for different
(30:15):
people.
What is a good life?
And we're really trying toemphasize that a good life can
mean different things fordifferent people.
What is a good life for you?
Dr. Toprani (30:24):
A good life for me is having a really good mental
health perspective on things.
You know, I've worked a lot inthe last couple of years like
going to therapy and figuringout how to grow and how to be
more confident and how to takecare of my mental health, and I
(30:45):
think that that has trickleddown into everything that I do
my work, my relationships and soI think living a good life is
having the time to pour intoyourself and your mental health
and your mental well-being asmuch as you possibly can.
Lacy Wolff (31:02):
That's great.
I love that.
All right.
Well, I know that you have theeligibility requirements for
Hinge Health, so do you mindtelling people the requirements
for the program?
If anybody's interested in, Iwill also put all of this in our
show notes as well.
So if you're wanting to getinvolved in the pelvic floor or
hinge health in general, you canlook at the show notes.
Dr. Toprani (31:23):
Yes, absolutely so for ERS participants.
Those that are on the HealthSelect of Texas medical plan,
including those that areenrolled in the consumer
directed Health Select and areover the age of 18, consumer
directed Health Select and areover the age of 18 living in the
US are eligible to enroll inHinge Health.
(31:44):
So if you do want to learn more, you can go to hingehealth
slash health select where youcan sign up for the program.
Lacy Wolff (31:50):
Awesome, you are amazing.
Thank you so much, really,really grateful for your time,
your energy and all you're doingto help support our health plan
participants.
Thanks for having me.
Thank you All right.
That wraps up our episode fortoday.
Thank you so much for listeningto this important conversation.
Pelvic floor health impactsmore people than we realize, and
(32:11):
the more we talk about it, theeasier it becomes to find the
help and the support we need.
If you think someone in yourlife could benefit from this
information, please considersharing this episode with them,
and if you're interested inlearning more about the Hinge
Health Pelvic Floor Program, ifyou are a Health Select of Texas
or Consumer Directed HealthSelect participant, please check
(32:32):
out our show notes, where youwill find the link to the
registration process.
Until next time, take care ofyourself and your pelvic floor.
Have a great day.
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