May 1, 2025 • 45 mins
Pelvic floor physical therapy (PFPT) is a crucial yet often overlooked component of gut health that can dramatically improve quality of life for people suffering from bowel issues, bladder problems, or pelvic pain. Dr. Alicia Jeffrey-Thomas joins us to demystify and normalize this specialized therapy and explain how proper pelvic floor function impacts everything from constipation to sexual health.
• Understand that daily bowel movements don't necessarily mean you're not constipated
• What happens during a PFPT session and how therapists create a safe + comfortable environment
• The importance of proper pooping position
• Why breathing techniques and sounds (like mooing!) can help relax your pelvic floor during bowel movements
• Demystifying tools like pelvic wands and dilators for at-home maintenance
• How dyssynergic defecation affects approximately 50% of people with constipation and how pelvic floor PT can help
• Why all women can benefit from pelvic floor PT after childbirth (and even during pregnancy)
• Men face pelvic health issues too, like post-prostate surgery incontinence
• The downside of "peeing just in case" and how it trains your bladder to signal fullness prematurely
If you've experienced pelvic floor issues, don't accept them as normal - seek help from a pelvic floor physical therapist who can address these problems and improve your overall quality of life.
References and Resources:
Where to find a pelvic floor PT:
Alicia Jeffrey-Thomas' book, Power to the Pelvis.
Got constipation? Check out Kate's constipation guide.
Learn more about Kate and Dr. Riehl:
Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast
Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.
The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making cha
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Kate Scarlata, MPH, RD (00:17):
This episode has been sponsored by
Ardelyx.
Maintaining a healthy gut iskey for overall physical and
mental wellbeing.
Whether you're a healthconscious advocate an individual
navigating the complexities ofliving with GI issues or a
health care provider you are inthe right place.
The Gut Health Podcast willempower you with a fascinating
scientific connection betweenyour brain, food and the gut.
Come join us.
We welcome you.
(00:37):
Hello friends, and welcome toThe Gut Health Podcast .
where we talk about all thingsrelated to your gut and
well-being.
We are your JeffreyKate Scarlata, a GI dietitian.
Dr. Megan Riehl (00:47):
And I'm Dr Megan Riehl, a GI psychologist.
Kate Scarlata, MPH, RD (00:50):
You know , when we think about the dream
team for achieving your best guthealth, there's a crucial piece
we're spotlighting today, andthat's pelvic floor physical
therapy.
We are joined by Dr AliciaJeffrey-Thomas, a pelvic floor
physical therapist.
If you've ever struggled withbowel or bladder issues yes, I'm
talking to you, friends.
(01:11):
If you are afraid to sneeze andpee or dread those jumping
jacks in exercise class, maybeyou've had a baby or experienced
pain with sex or dealt with anycondition affecting the pelvic
floor, this episode is for you.
And men don't skip this episodetoo, because constipation and
(01:32):
prostate issues can benefit frompelvic floor physical therapy
too.
We're going to enlighten youtoday on how pelvic floor
physical therapy might be justthe missing link in your health
journey.
Dr. Megan Riehl (01:44):
So welcome Dr Jeffrey- Thomas.
Dr. Alicia Jeffrey-Thomas (01:47):
Hi, thank you so much for having me.
Dr. Megan Riehl (01:49):
Let me share a little bit more about you.
You have a really impressivehistory and we are just so
thrilled to have you today.
You have been a pelvic floorphysical therapist since 2016
and treat people of all gendersin the greater Boston area, and
you aren't one to shy away fromthe taboo topics, so from
bladder problems to bowelmovements to sex, Alicia is
(02:12):
always game to talk through thedirty details of helping her
patients figure out what isgoing on, quote unquote, down
there.
You're also the creator behind@AtT he Pelvic Dance Floor, a
social media presence with overa million followers across
Instagram and TikTok, and I'vebeen watching.
You use a lot of humor andshare evidence-based pelvic
(02:34):
health information in a veryrelatable way, and also you just
published your first book,Power to the Pelvis, which aims
to further the mission andempower people to take charge of
their pelvic floor health.
We are so, so excited to talkwith you today.
Dr. Alicia Jeffrey-Thomas (02:51):
Thank you.
Dr. Megan Riehl (02:52):
Also, we like to kick off every episode with a
myth buster.
So what in the kind of thepelvic floor health space or
overall health and well-being?
What myth would you like tobust for us today?
Dr. Alicia Jeffrey-Thomas (03:08):
So if we're trying to kind of combine
gut health and pelvic floorhealth, I think the thing that I
hear most commonly from peopleis well, I poop every day.
There's no way that I can beconstipated.
And that's just really not true, right?
Because if we have kind of thatincomplete evacuation, where
your pelvic floor muscles maybearen't getting out of the way to
(03:29):
allow for that full emptying,you can kind of have this
buildup and backup of stool sothat you're still constipated,
even if just a little bit'scoming out every day.
Dr. Megan Riehl (03:37):
The constipation I mean we've had
this conversation so many timesthat like at the root for so
many people, especially thosethat are having diarrhea, we're
always like we got to check.
We got to check to see ifactually constipation is really
at the root of things.
So that is a perfect myth tokind of kick us off.
Thank you for sharing that.
Kate Scarlata, MPH, RD (03:56):
Yeah, absolutely.
I would say too, in my practicethat has been a huge problem
and I always recommend a pelvicfloor evaluation and a referral.
And I would say, you know, I'vebeen seeing thousands and
thousands of patients over thelast 30 years and pelvic floor
physical therapy has beenprobably one of the most
(04:16):
top-tier treatments that havereally altered my patient's
quality of life.
And it's just to that pointthey weren't eliminating that
stool and you have that extrastool in your colon that's
really slugs down your smallintestine motility, so that
bloating and that distension canreally be a problem and
patients hate that.
(04:37):
So when you work with patients,is there more common conditions
that you see in your practice?
Can you please just talk aboutwhat a pelvic floor physical
therapist does on a day-to-dayoperation and then what you see
more commonly in your practice?
Dr. Alicia Jeffrey-Thomas (04:53):
So, as a pelvic floor therapist, I
tend to kind of lump mycategories of things that I
treat into three.
So you have your urinary issues, which most commonly people
will think of stressincontinence so leaking urine
when you cough or laugh orsneeze or jump or run or urgency
related issues so not making itto the bathroom in time or
feeling like you constantly haveto go.
(05:15):
And then you can also kind ofget into the bowel side of
things, where the most commonthing that I treat within that
category is going to beconstipation, whether that's
working on motility through thesystem or that sphincteric piece
of making sure that the doorsare able to open and everything
is able to make its way out.
And then there's also fecalincontinence.
That falls under that umbrellaas well.
(05:36):
And then your third umbrella isgoing to be pelvic pain, and
that could be anything relatedto pain related to either
urinary or bowel function.
It could be pain related tothings like endometriosis or
interstitial cystitis.
It could be pain with sex.
It could be this kind oftension in the pelvic floor
that's maybe contributing to hippain or back pain.
(05:58):
So it's all-encompassing.
It's not just that hammock ofmuscles at the bottom, it's how
it affects everything around itas well.
Kate Scarlata, MPH, RD (06:06):
Can you just talk a little bit about
tension in the pelvic floor?
And I think when people thinkof tense they think like their
muscles are tight, obviously,but are they also weak sometimes
, Like is tension sometimespresent with weak muscles or is
tension typically with they'restrong?
What are you working against,say, in someone with
(06:28):
constipation typically?
Dr. Alicia Jeffrey-Thomas (06:30):
It can go either way.
You can have tension in thepelvic floor, where the muscles
just don't have the room to move, and so that could mean that
the muscles are weak.
And once we get the pelvicfloor to relax it's like oh,
this muscle doesn't know how tocoordinate at all, it can't
contract on its own because it'sbeen stuck in this tense,
contracted state for so long.
(06:51):
Or you can have people wheretheir pelvic floor is tense but
they do have that ability tokind of tension further.
That tends to happen a littlebit less often.
I generally tend to find thatthere's this dis-synergy, this
discoordination, where themuscles have been stuck in one
position for so long that theykind of lose the plot and don't
(07:12):
know how to do their jobsappropriately once we get that
range of motion back.
Dr. Megan Riehl (07:16):
Awesome.
And one of the things I want tojust kind of think about here
is, a lot of times, our patientsthat we're seeing from a gut
health perspective or just ingeneral, I say comfortable being
uncomfortable.
So this idea that, like, I gaveup running because I pee a
little bit every time I run,like and that's just the way
it's supposed to be because I'vehad three babies, and that's
(07:39):
not the right mindset, rightLike, and women that are in
their seventies or eighties thatthey get up to pee or something
just dribbles out, these arenot common things, that or I
guess they are common things butthey're not things that we have
to live with.
Is that right?
Dr. Alicia Jeffrey-Tho (07:54):
thinking that's totally correct.
I mean, I think that pelvicfloor dysfunction tends to
slowly rob you of these littlejoys and you make these
adaptations in your life towhere you're not exercising the
way that you want to becauseyou're afraid to run or to jump
on a trampoline because youdon't want to pee and be
embarrassed by that, or you stophaving sex because it's painful
and you're like oh well, maybethis is just how it is as I get
(08:17):
older and so over time we'rekind of missing out on these
integral pieces of life.
And then also, I mean, there'sjust the ways that it just
affects you on a day-to-day.
I mean, if you have a lot ofurinary urgency, you may not
want to travel because you'reafraid of not being able to find
a bathroom in time.
So there's just little waysthat it starts to impact you.
Dr. Megan Riehl (08:36):
Yeah, so walk us through that introductory
consultation with a patient,because I think people are just
very curious and anxious aboutwhat that might look like to
work in kind of the pelvic floorarea.
So what is a typicalconsultation for constipation or
diarrhea or even some of thoseurinary issues?
Dr. Alicia Jeffrey-Thomas (08:55):
So I'm looking at all of these
things simultaneously.
If somebody comes in sayingthat they have a constipation
issue, I'm already thinking, hmm, I need to make sure I ask
about pain.
I need to make sure I ask aboutbladder issues, because I kind
of call it the theory of stuff.
There's only so much room foreverything to coexist within the
pelvis.
And so I'm going to start outasking a bunch of personal
(09:15):
questions, depending on whatyou're comfortable with from an
exam standpoint.
That doesn't happen until waylater.
I want to get a good idea ofwhat's going on.
So I'm taking a really thoroughhistory.
I'm asking about all of thosedifferent kind of umbrella areas
and then, depending on whatyou're telling me, I'm also
asking about back pain.
I'm also asking about whetheryou've had other abdominal
surgeries before, things thatmight be impacting what's going
(09:36):
on, and then my exam tends toflow from that into looking like
a more orthopedic exam first.
So if you've ever been tophysical therapy for your back
or for your shoulder, we'relooking at range of motion in
your hips and in your back andwe're making sure that there
aren't any limitations therethat might be telling me that
something else is going on.
We're looking at strength.
We're looking at all of theseother different pieces that when
(09:59):
we get to the pelvic floor,that's going to tell me, oh okay
, we tend to have a little bitmore weakness on the left side.
How does that then translate towhat's happening at the pelvic
floor?
And the pelvic floor exam isnever mandatory, right?
I'm never going to forceanybody to do anything.
It's another piece of theinformation that we're trying to
gather to figure out what'sgoing on with you.
So that doesn't have to happenat the first visit, it doesn't
(10:19):
have to happen at the secondvisit, it doesn't have to happen
at all if you're really nevercomfortable with it.
I've had people where I'vewalked them through how to do
this assessment on their own ifthey're more comfortable with
doing that and giving me someinformation.
It's just we're more limited inhow we can interpret that
information when it's not medoing the exam.
So that exam for somebody witha vagina is going to be a
single-digit vaginal exam or asingle-digit rectal exam,
(10:40):
depending on what's going on.
And what we're doing there is.
We're assessing what'shappening with the muscles, so
the range of motion, the sameway we would assess in the hips
or the back the strength, sowhether that muscle is able to
contract and relax fully.
We look at whether you're ableto bear down appropriately
what's happening with themuscles when that's occurring,
so we're able to put all ofthose pieces together.
(11:03):
Is there pain, is theresomething else going on, so that
we can form this full pictureand say, okay.
I think that the reason thatyou're having constipation isn't
because you're not movingthings through the system
appropriately.
It's that that exit is blockedand it's not wanting to relax
and get out of the way, andmaybe that's also driving why
you're having some urinaryurgency, because there's just
(11:24):
more pressure built up in thatsystem and it's maybe putting a
little bit of pressure onto thebladder and causing some of the
bladder spasms there.
Dr. Megan Riehl (11:31):
So I always say that therapist is incorporated
in your name because this is avery sensitive type of
collaborative workingrelationship right working
relationship right and so peoplethat have a history of trauma.
It's important to advocate, aswell as I'm sure on your
consultative side you're askingabout that.
And again, like you're saying,a digital exam doesn't have to
(11:55):
be incorporated into thetreatment plan right away or
ever so your comfortability.
We know there is a highprevalence of individuals with
pelvic issues that may have ahistory of trauma and we don't
want to avoid this aspect of thetreatment plan because of that,
and we can help you to feelvery safe and comfortable.
Dr. Alicia Jeffrey-Thom (12:14):
Exactly , and I honestly I tend to
assume, based on the statisticsright, I tend to assume that
there is something there in mostpeople that come into my office
and I'd much rather approach itfrom that really
trauma-informed lens of what areyou not telling me, because
you're already coming into thisoffice really anxious about just
talking about the bowel andbladder issues that you may not
even think to bring this up, andthat's honestly what will
(12:35):
happen a lot of times issomebody will disclose a
previous assault or abusehistory on that second visit
once they're starting to getmore comfortable with me, and so
I always want to make sure thatI'm leaving space for that and
making somebody feel comfortablewith disclosing that to me so
that we can form a bettertherapeutic relationship and
make sure that I'm not doinganything that's going to trigger
them in session.
Kate Scarlata, MPH, RD (12:56):
Yeah, that rapport is so huge.
I think in my practice as well,you know when patients will say
I'm so sorry, I'm talking aboutmy poop and it's like that's my
business.
Yep, exactly that's why you'rehere.
That's why you're here, we'regood with that.
So I'm going to shift thingshere a little bit.
You know, I see a lot.
I've heard a lot about pelvicwands Very intriguing.
(13:20):
Do you have one?
Of course I do.
Of course you do.
Look at that.
I mean, I don't know if it'slike intriguing or scary or, you
know, just provocative.
But let's talk about pelvicwands and when you might use
them in your field.
Dr. Alicia Jeffrey-Thomas (13:36):
So yeah, so a pelvic wand is
another tool in the toolbox.
Again, it's not something thateverybody's going to have to use
.
I usually use it related moreto pelvic floor tension and it's
a way that you can recreatesome of the manual therapy
techniques that I would do inthe clinic on your own at home.
So it can be really good formanaging in-between visits or
(13:56):
even long-term once you'vegraduated from physical therapy.
Now, just looking at this wandright, there's this big long
thing here and everybody getsreally intimidated by this.
The amount that's going in.
It's trying to mimic what'shappening when my finger is
inside, so that much at most isgoing inside Finger length If
you're looking at.
So this is the Intimate Rosebrand one.
(14:18):
There's actually a littleflower right there and that's
usually where I tell people.
That's the limit of where youwant to try to go usually and it
has this curve to it becauseit's trying to be able to kind
of get down onto the bowl of themuscles in the pelvic floor.
It's not just a straight canal.
You want to kind of be able tolike gently angle down onto the
muscles.
It's really similar to like aTheracane that you would use to
get knots out of your shoulder,so it kind of has to have that
(14:40):
little bit of an arc to it to beable to kind of get into that
muscle to do a gentleself-release.
And then the other end of it istypically designed if you're
using it in the back passage.
So if you're using itinorectally, then you're able to
better get onto the musclesthere.
It's a little bit more of atapered end and so people are a
little less intimidated by that.
Dr. Megan Riehl (14:59):
Wowza, I love it.
So you would be teachingsomebody how to use something
like this in your sessions andagain their comfortability level
, like going home and tryingthis on your own might take some
time and practice and you mightengage in the exercise for 60
seconds and call it good.
I've worked with a lot ofpatients where sometimes they
(15:20):
feel overwhelmed at theexercises that they're supposed
to do in between their sessionsand then they just don't do them
.
And so on the GI psychologyside, I kind of talk about well,
number one, talk about thiswith your pelvic floor physical
therapist and then also havesome flexibility with yourself
and also you probably need to bepretty relaxed to be doing this
(15:41):
type of homework andnormalizing that.
Dr. Alicia Jeffrey-Thomas (15:45):
Yeah, absolutely.
I mean, you don't want to haveyour nervous system be super
upregulated at the thought ofusing the pelvic wand, because
then we're just kind of fightingthis uphill battle and
nothing's really going to relax,right.
And so I want to make sure thatyou're comfortable at least
attempting to use the wand andagain, even if it's like I'm
just going to, like, place ithere at the entrance and see how
(16:05):
that feels and come back to itlater, that's good, right.
Like we're resolving some ofthat fear, that nervous system
upregulation, before we get intodoing, you know, maybe more of
like a full session of musclereleases, and I'm guiding people
in the clinic.
They're going home tryingsomething, they're coming back,
we're doing something in theclinic and it's that back and
forth of making sure thatthey're getting the right
feedback there.
(16:26):
That's right.
Kate Scarlata, MPH, RD (16:27):
So just with these wands, you're really
is it almost like identifying aknot.
Is that what we're like?
Targeting to help relax, likeyou would have a massage break
up a knot in your back.
Dr. Alicia Jeffrey-Thomas (16:39):
Is it similar?
Similar, yeah, and everybody'sgoing to be a little bit
different in terms of what we'respecifically targeting.
There are also versions ofthese wands that have vibratory
functions or have temperaturefunctions, and so if somebody is
not really thinking that theywant to be applying a lot of
pressure to that muscle which Idon't really recommend anyway
but with, like, the vibratingones, you can apply even gentler
pressure and use that low levelvibration to help to facilitate
(17:02):
that relaxation as well.
So it's maybe more of ageneralized relaxation as
opposed to specifically findinga spot in those cases, excellent
.
Dr. Megan Riehl (17:13):
All right.
So something that definitelyapplies to all of us is proper
pooping.
Can you explain to us how youdescribe proper pooping position
and do you have any personaltips and tricks that help your
patients poop like a champion?
Dr. Alicia Jeffrey-Thomas (17:30):
Oh, of course.
So my number one recommendationis to get some kind of toilet
step stool.
We'll call it I'm not going tonecessarily call out a specific
brand but you want to have yourknees in a position where
they're a little bit higher thanyour hips, because that's going
to help to facilitate morerelaxation of the pelvic floor.
Typically, when your feet arejust flat on the floor, your
(17:53):
pelvic floor is kind of kinkingaround your large intestine, so
everything has to make an extraturn before it comes out.
If you get your knees higherthan your hips, that relaxes
that pelvic floor muscle, soyour colon straightens out and
then everything has an easierpath to the exit.
Now where I see this gettingmessed up for people sometimes
is when there's a flexibilitydeficit.
So they get their knees up, butthen they're kind of hunched
(18:14):
over because they don't have theability to kind of hold
themselves upright in thatposition.
So I'll tell people, okay, likemaybe we bring the height of the
step stool down a little bitand you work on trying to get
that like upright posture aswell, so that you know your
tailbone isn't then getting inthe way of everything making its
way to the exit.
And then in terms of actuallymaking things happen right,
(18:37):
further relaxing the sphinctericmuscles and allowing things to
empty.
I like to incorporate a lot ofbreath work and a lot of sound
use, so I'll teach people how todo diaphragmatic breathing,
specific types of exhales, sopretending like you're blowing
on a pinwheel or blowing bubblesthrough a bubble wand.
That kind of slow, pursed lipexhale helps to kind of keep the
pelvic floor muscles in arelaxed position so you're not
(18:58):
straining, you're not holdingyour breath.
If somebody needs a little bitmore help and a little bit more
oomph, sometimes I'll teach themto do like a shh as they're
doing that exhale, or evenmaking low pitch sounds like a
moo or a humming sound to try tofacilitate that as well.
Dr. Megan Riehl (19:13):
I was going to say can you give us some sound
examples?
So a moo is one of them and youcan feel that lower in the
pelvic floor, in the belly, whenyou make those lower sounds.
So it's a really good tip andvery helpful.
Dr. Alicia Jeffrey-Thomas (19:27):
And it's definitely one that you
want to practice in the comfortof your own home.
That might not be a publicbathroom, first attempt.
Kate Scarlata, MPH, RD (19:34):
I was just thinking that too.
Dr. Megan Riehl (19:37):
But you know what, once you do get good at
this, listen, go for it Ifthat's going to help.
You have a more complete bowelmovement and you're traveling or
you're out and about.
I've heard the tip of likethrow in some headphones, go
into the public bathroom.
That way you're not worriedabout what everybody else is
doing, but you're able to dowhat you need to do and you know
before you're done or I guessbefore you know it you're done
(20:00):
and onward with the rest of yourday, exactly.
Kate Scarlata, MPH, RD (20:03):
You broached this topic before, but
I'd like to really do a littlemore of a deep dive into
dysnergic defecation.
It's about 50% of people withconstipation have dysnergia and
I'd like to really break thisdown for our listeners because I
think it's probably could bepart of their picture.
Dr. Alicia Jeffrey-Thomas (20:23):
Yeah, so basically dyssynergic
defecation is thatdiscoordination or so that
misalignment between what'shappening in the rectum and
what's happening at the pelvicfloor and the anal sphincter.
So a lot of times when I'm doingjust a visual exam of the
pelvic floor, I'll see this.
I'll say, okay, try to bear downlike you're pooping, and
they'll start to have a littlebit of movement downward with
(20:46):
their pelvic floor, but then thesphincter will just clench up
and close up and pull inwardinstead of that kind of like
dropping and lengthening.
And so if that's happening everytime you go to try to poop,
then a lot of times people willdescribe having very skinny
bowel movements or feeling likethere's a blockage, that
something won't come out, and sothen we're really focused on
(21:08):
okay, how do we link things backup?
And maybe that's working withsome of the breath and sound
strategies that I was justtalking about.
Maybe that's doing some manualrelease work to the pelvic floor
muscles to kind of get thatrange of motion back so that
it's accessible.
When you are trying those otherstrategies.
I'll teach different stretchesand breath work in different
positions to again kind ofaccess that range of motion and
(21:31):
be able to tap into it when thetime comes, and sometimes we're
even doing work with rectaldilators where they can almost
kind of have that poopingpractice outside of the
stressful situation of trying tomake a bowel movement happen.
Kate Scarlata, MPH, RD (21:44):
Perfect.
(21:49):
When it comes to irritable bowel syndrome with constipation
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(22:11):
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(22:31):
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Dr. Megan Riehl (22:52):
So the next topic again, I think, is one
that some people may just beliving with and or avoiding, and
that's painful sex, and so howcommon is it?
And let's normalize this forpeople and what might pelvic
floor PT kind of look like inorder to address that issue?
Dr. Alicia Jeffrey-Thomas (23:11):
Yeah, I mean, the vast majority of
people will have a painfulsexual experience at some point
in their lives.
It's whether it becomessomething that is more chronic
and continuous, and that's wherewe want to make sure that we're
diving in and figuring out whythat's happening.
So, because that could happenfor muscular reasons, it could
be because the muscles are tootense and so we're kind of
(23:33):
having that painful response assomething tries to kind of go
past them.
It could be a hormonal issue,so there could be dryness, there
could be a decrease in estrogen.
That could be driving some ofthat.
There could be kind of thatnervous system upregulation
where we're anticipating thatsomething is going to hurt and
so we're involuntarily kind ofclenching those muscles.
So pelvic floor physical therapyin that instance is really
(23:56):
trying to find the driver.
Is this a hormonal issue?
Is this a muscular issue?
Is there something elsehappening further up and down
the chain?
And then maybe we're doingmanual release work, we're
practicing breath work to beable to relax the pelvic floor
in that moment.
Sometimes we're working withvaginal dilators, which are
progressively sized cylindricaldevices Hold on, I have one
(24:17):
right here so they'reprogressively-.
Kate Scarlata, MPH, RD (24:18):
Of course you do.
Dr. Alicia Jeffrey-Thomas (24:19):
Of course I do.
I tried to set aside a bunch ofthings.
I'm like maybe I can reach forthis.
Dr. Megan Riehl (24:27):
I love this.
We're going to include somepictures with this episode today
, so you'll have to check outthe Instagram page for us,
because we will help youunderstand what we're talking
about.
Dr. Alicia Jeffrey-Thom (24:33):
Perfect and so progressively sized
cylindrical devices.
They start as small as yourpinky, if not smaller in some
brands, and it progresses allthe way up through the size of
most partners, and so you'reable to kind of work through
being able to relax the pelvicfloor around these devices so
that you're not anticipatingpain and you're able to maybe
(24:54):
even stretch into certaindirections where, if you say, oh
I tend to have more tightnesson the left, let me pull down
and stretch.
That way it becomes a way thatyou can be doing things on your
own in addition to just cominginto therapy.
Dr. Megan Riehl (25:06):
Some of these topics that are taboo.
They don't need to be.
They don't need to bestigmatized.
We want to have conversationsabout this.
We want women and men to beable to communicate to each
other what they're experiencing,and it also makes me think
about women that have hadvaginal deliveries.
Do you think that most womenthat have had a baby would
(25:27):
benefit from a consult with apelvic floor physical therapist?
Dr. Alicia Jeffrey-Thomas (25:30):
I honestly think that, regardless
of how you delivered, you shouldhave a consult with a pelvic
floor therapist afterwards,because even if you have a
C-section, that's still a majorabdominal surgery that is
affecting how your abdominalmuscles are able to function.
And also, you just went througha pregnancy where for nine
months, there was pressuresitting on top of your pelvic
floor.
So I would love it, in theideal world, if everybody at
(25:52):
least came in and had thingsscreened, because I'm also maybe
going to be the only personthat's going to ask you these
more in-depth questions.
Your six-week follow-up withyour gynecologist or your OB
isn't going to necessarily getinto the dirty details of are
you having fecal incontinence?
Are you having urinaryincontinence?
Does it hurt when you have sex?
That would lead us to maybeneeding to do some therapy to
(26:16):
help to alleviate that.
Dr. Megan Riehl (26:17):
And is there any timeframe?
So if you are somebody that hasa three-year-old and you're
like, well, I didn't go do that,should I maybe go back?
What are your thoughts on thetimeline there?
Dr. Alicia Jeffrey-T (26:27):
Absolutely .
It's never too late to see apelvic floor therapist.
I have people that come sixweeks right after they deliver
and we start working right away.
But I have people that come 20years afterwards and they're
saying, oh, I've kind of beensitting on this because I was
raising children and busy andnobody told me that this was a
thing.
And suddenly, you know, theyhad a friend that mentioned it
(26:49):
and now they're taking time forthemselves and coming in and we
still see them getting better.
We still see them havingimprovements.
So, yes, earlier is going to beideal because then you're not
going to have those years lostwhere you're peeing your pants
or having all of this pain.
But it's never too late.
If you want to come in, ifyou're having issues, please
seek care from a pelvic floortherapist.
Kate Scarlata, MPH, RD (27:09):
I'm glad it's getting its day.
I know you probably feel likeyou're seeing it and you're
making a big difference by beingout there and letting people
know about pelvic floor physicaltherapy, because it's sad to me
that people are peeing theirpants and thinking it's okay or
normal after having a baby orhaving fecal incontinence and
(27:31):
being embarrassed and notthinking that there's help out
there.
Dr. Alicia Jeffrey-Thomas (27:35):
It's super valid because there's the
embarrassment factor where yousay, ooh, am I the only person
dealing with this?
Or if you do start to bring itup, a lot of times, that
conversation gets shut down withoh, that's just normal, that's
just how it is.
And because of thatembarrassment factor you never
ask a second time, and whereasmaybe asking a second provider,
you would get a completelydifferent answer.
(27:56):
So it's really good to see thatmore people are realizing that
they can seek care for this.
I mean, in the nine years thatI've been doing this, it used to
be that when people came in,their doctors referred them.
They had no idea why they wereshowing up to pelvic floor
therapy, and so it was a lotmore education on my end to try
to get them on board with whatwas happening.
And now I'm seeing people thatare self-referring, that
(28:18):
recognize that they're havingthese issues and don't want to
just have this be their normal.
Dr. Megan Riehl (28:23):
And I think maybe to your point, Kate, that,
like people are sufferingunnecessarily and maybe some of
it is an access issue, that youjust haven't heard about it or
you don't know where to turn,and that was part of the reason
we wrote our book was toincrease access, and I'm sure
part of your motivation too towrite yours that you know we've
got to put this out there andlet people know of the variety
(28:47):
of different ways in which wecan address these health issues,
absolutely.
Kate Scarlata, MPH, RD (28:52):
So can we talk a little bit more about
fecal incontinence?
Because certainly I've workedwith a number of patients and
interestingly, you know, earlyin my practice it wasn't a
question I really asked and thenI developed an online
questionnaire that patients didprior to their visit and I added
it and I was really surprisedto see the numbers of patients
(29:14):
coming back where it was aproblem, especially the older
woman that came to see me.
So what are some of the toolsand tricks that you do for this
condition?
Dr. Alicia Jeffrey-Thomas (29:24):
Yeah, and fecal incontinence for sure
is one of those hidden ones.
People don't think to bring itup, but I saw a statistic
somewhere that said it's ascommon as asthma.
So we really want to make surethat we're screening for this,
because this is something thatis really going to keep people
home if they're thinking thatthey're going to have an
accident in public or somethinglike that.
So, similar to anything else, Iwant to figure out why this
(29:47):
fecal incontinence is happening.
Is what's happening more solidstool, more liquid stool?
Is there an underlyingconstipation within kind of an
overflow that's happening?
So it maybe isn't necessarily.
Oh, I need to be doing a bunchof Kegel strengthening exercises
.
Yes, that does come into playfor a lot of people with fecal
incontinence, but sometimes weare defaulting back to oh, it's
(30:08):
actually because you're notemptying, and so we want to make
sure that we're having thisfull, comprehensive thing going
on.
And even if we're getting intothe strengthening of the pelvic
floor, it's not just going to bethat in isolation.
If we're looking at fecalurgency, I'll teach them
different strategies andtechniques to manage that urge
(30:28):
when it happens, so that theycan be able to comfortably make
their way to the bathroomwithout having an accident
before they get there, and wereally just wanna make sure that
we're looking at thiscomprehensively and not cutting
any corners and makingassumptions when it comes to
fecal incontinence.
Dr. Megan Riehl (30:42):
Do you have a tip or trick on how to
get there, how to hold it.
That might be a very generalkind of tip for urgency.
Dr. Alicia Jeffrey-Thomas (30:51):
So I base it off of the technique
that I use for urinary urgency.
So I usually give people a fewdifferent strategies of like,
okay, don't try to do this asyou're running to the bathroom,
right, you want to freeze inplace, you want to try to take a
few deep breaths to regulatethe nervous system.
But where I would cue somebodyto do quicker pelvic floor
contractions when it's urinaryurgency, I'll get them to do a
(31:14):
longer pelvic floor contractionif it's for bowel urgency,
because we're trying to kind ofreset that rectoanal inhibitory
reflex where basically it's likeif we're able to kind of like
pull things up and hold thingsup out of that chamber for long
enough, it hits a little bit ofa reset button to allow people
to get where they're going.
Kate Scarlata, MPH, RD (31:32):
Got it.
Interesting.
So I know diaphragmaticbreathing can really get that
kind of high anxiety down.
Is that kind of what you'retalking about, those deep belly
breathing?
Dr. Alicia Jeffrey-Thom (31:42):
Exactly , Exactly.
Dr. Megan Riehl (31:44):
So I forgot to ask, and I'm also thinking that
this might be beneficial whatabout seeing you while you're
pregnant?
I'm thinking that, of course,after you have a baby and you're
saying, pretty much every womanthat has ever had a baby could
benefit from this but what aboutduring your pregnancy?
Dr. Alicia Jeffrey-T (32:06):
Absolutely so.
During pregnancy is usually thefirst time that a lot of people
start to see pelvic floorissues manifesting.
So maybe that's an increase infrequency of urination, or maybe
that's they're starting tonotice some urinary incontinence
because of that growingpressure and heaviness.
You don't have to wait untilyou deliver to start addressing
that.
So I'll see people duringpregnancy to work on
strengthening not only theirpelvic floor but their deep core
(32:27):
and everything that's helpingto support that whole system.
But then I'll also help peopleto manage any pelvic pain.
So if they're having pubicsymphysis pain, back pain, hip
pain during pregnancy, you don'tjust have to exist with that.
Nine months is a long time tobe in pain and I don't want
people to think that that's justhow it is.
There's a lot of things that wecan do from a muscular
standpoint.
(32:47):
We can talk about differentsupports, that you can be
wearing a whole bunch ofdifferent things there, and then
, as we get into that thirdtrimester, we're also talking
about birth prep.
So, instead of then focusingmore on strengthening, how do we
get the pelvic floor to be ableto get out of the way so that
the uterus can push the baby out.
So we're talking about pelvicfloor relaxation.
We're also talking aboutoptimal labor positioning, ways
(33:08):
that you can kind of open upsome hip mobility to allow for
that positioning to be possiblein the moment.
So there's a lot, a lot that wecan do there.
And then also you'veestablished care with a pelvic
floor therapist so that you canget right back in after you hit
that six-week clearance withyour OB.
Dr. Megan Riehl (33:26):
Exactly.
It can be so hard to thinkabout taking care of yourself
when, all of a sudden, you havethis new baby that is 100%
reliant on you, and so this maybe.
People are always saying, likewhat could I get the mom?
Partners, spouses, best friends, girlfriends remind your
(33:50):
pregnant friends or loved onesthat this could be a beautiful
gift, a good referral, and pairyou with a good postpartum
massage or a prenatal massage,and that sounds like a
picture-perfect day for me.
Dr. Alicia Jeffrey-Thom (34:02):
Exactly .
Kate Scarlata, MPH, RD (34:03):
Lots of self-care.
I like it.
So, while we're talking aboutpregnancy a little bit, I hope I
don't butcher this termdiastasis recti yeah, is that
right, you did it.
So it's a separation of theabdominal muscles and it can be
seen in postpartum women.
Can you talk about how pelvicfloor physical therapy might
(34:24):
help with this?
Dr. Alicia Jeffrey-Thomas (34:26):
Now just to clarify the term itself.
It's not a separation of themuscles themselves.
It's a separation of the fasciabetween the two sides of your
six-pack muscles.
So, the muscle itself isn'ttearing, it's basically a
thinning and a stretching ofthat line in the middle.
And so we start to notice maybethat widening which can result
(34:46):
in coning or doming when you'redoing different abdominal
exercises or even when you justgo to sit up in bed, and that
can contribute potentially to aninability of that whole core
system that exists between yourpelvic floor, your core, your
diaphragm, to be able to managepressure.
So that could mean that you'redealing with back pain or
(35:07):
abdominal pain or evencontributing to some of those
pelvic floor symptoms Inpregnancy.
It's pretty common, it's goingto happen to most people.
So it's no failure of your ownactivity levels or something
that you did that you end upwith a diastasis.
There are certainly things thatyou can be doing in terms of
strengthening the deeper coremuscles.
(35:29):
You can be more mindful ofbreathing out when you're doing
exertional movements.
That can keep it from maybeprogressing or getting worse.
But there's definitely going tobe some amount of separation in
most people.
And then postpartum, we'rethinking about re-engaging that
whole system, so the deep core,the pelvic floor, your breath,
(35:51):
and being able to create supportthrough the spinal column so
that we're not ending up withback pain and more pelvic floor
issues.
I'm not so concerned withclosing the width of the gap.
A lot of that is going tohappen kind of on its own, but
I'm really also thinking aboutbeing able to generate tension
and support across thatseparation.
So the muscle that's below thator deeper to that is called the
(36:15):
transverse abdominus.
I wanna make sure that that isable to be doing its job,
because it's acting more as kindof like a corset to help to
support everything, and sothat's going to be the more
functional piece versus focusingon the aesthetics of closing
the width of the gap?
Dr. Megan Riehl (36:30):
Stress which symptoms might drive somebody to
this.
Dr. Alicia Jeffrey-T (36:33):
Definitely .
Back pain, urinary incontinence,abdominal pain those are going
to be the main things thatyou're going to see with a
diastasis.
Dr. Megan Riehl (36:50):
Okay, what, on average, might somebody expect
in terms of like how longthey're working with somebody
like you?
Just to kind of set the stageof expectation.
Dr. Alicia Jeffrey-Thomas (36:55):
So I'm going to use a really common
physical therapy phrase and sayit depends.
Okay, that's fair.
Everybody is going to be alittle bit different.
Everybody's level of bodyawareness is completely
different.
There are some people that comein and they get what I'm trying
to tell them immediately and wecan kind of move through a
progression at a much fasterpace.
And so those people, maybe I'mseeing them for I don't know,
(37:17):
six visits or so.
But then I certainly have peoplewho have more complex things
going on.
Maybe they have chronic pelvicpain or they've had constipation
for 10, 20 years before they'vethought to come and get it
addressed, and so we'reunwinding more and more pieces,
and so those are people thatI'll see much longer term.
I mean, I have people that I'veseen for over a year at this
point and they're certainlydoing so much better than where
(37:39):
we started from.
But we're trying to really getback to that optimal function
than where we started from.
But we're trying to, like,really get back to that optimal
function.
And you're not necessarilygoing to have this straight,
linear path of everything isgetting better all the time.
You're going to have dips,you're going to have regressions
, and so you want to kind of begentle with yourself and know
that your body is moving at thepace that it's meant to move at,
based on a lot of differentfactors.
Kate Scarlata, MPH, RD (37:59):
I often think and see in my patients,
you know, a refresher, likenutrition, like a psychology
refresher.
I send patients back after theyhaven't been for a couple of
years.
It's like you know what, maybeyou just need a little refresher
here, a little tune up, exactly, exactly.
So I'm constantly re-referringafter a few years and it
(38:20):
definitely makes a difference.
So you know, we all needrefreshers.
Dr. Alicia Jeffrey-Thomas (38:25):
No, exactly.
I think I heard somebody usethe example of you go to the
dentist twice a year but youstill brush your teeth in
between, and so you know we'restill doing all this maintenance
stuff, but you do still need tosee the dentist.
Dr. Megan Riehl (38:39):
So thank you to all the men that are still
listening.
We have a very importantquestion for you now, because
pelvic floor PT is not just forthe ladies, so can you talk to
us a little bit about how thisPT could be helpful after a
prostate surgery or when men aredribbling and having urinary
leaks, or even for erectiledysfunction?
(39:00):
Tell us a little bit about whatthey could expect in terms of
treatment.
Dr. Alicia Jeffrey-Thomas (39:05):
Yeah, absolutely.
I mean, you start to see iteven in much younger men who
have had a diagnosis ofprostatitis, which is an
inflammation or an infection ofthe prostate, and they're given
antibiotics and they're thinkingthat this is going to make them
better and it doesn't quiteresolve all of their symptoms in
a lot of cases and that'sbecause it's actually more of a
pelvic floor issue in this case.
So if you look at kind of across-section side view of a
(39:28):
male pelvis, you can see thatthe prostate sits right next to
the pelvic floor muscles and sooftentimes people will think, oh
, there's pain in my prostatearea, but it's really that those
pelvic floor muscles are inspasm and so that can be
contributing to pelvic painsymptoms.
That can be genital pain, thatcan be pain through the perineum
(39:57):
, pain in the groin, it can alsohave urinary and bowel
implications, so they may notfeel like they're emptying
completely pelvic floor, keepingthat tension from building back
up.
And then kind of, as youprogress through things, let's
say that you have to havesurgery for prostate cancer.
The prostate is aspace-occupying thing and so it
helps to support the neck of thebladder and when you take that
(40:18):
out a lot of times thatinstability can result in
urinary incontinence, and sowe're training the pelvic floor
to essentially make up for thatlost function, so that people
don't leak when they're doingactivity and then you can also
have dribbling after you go tothe bathroom.
That could be a weakness issue,but it could also be a tension
(40:39):
issue.
So we're kind of thinking aboutwhy is that happening?
Do we need to make sure thatyou're not power peeing and
trying to force every last dropout?
We're actually focusing on okay, let's relax the pelvic floor,
and a lot of times guys don'teven realize that they have a
pelvic floor.
So there's this wholerebuilding of bodily awareness
that's going on.
Kate Scarlata, MPH, RD (40:58):
Can you talk about power peeing in women
too?
Because I think some people arepushing it out real quick and
trying to move on with their day.
But that's probably not a goodidea?
Dr. Alicia Jeffrey-Thomas (41:08):
It's really not a good idea.
When we're pushing.
It's putting a lot of pressuredown onto the pelvic floor,
which can weaken it over time.
So even if there is a kidscreaming in another room or
you're trying to get onto ameeting in the next five minutes
, you really want to giveyourself that time to relax,
take a deep breath while you'regoing so that we're not messing
(41:29):
with our pelvic floor musclefunction over time.
It should not sound like you'refrying chicken in the toilet
bowl.
I know there's people that wantto have a strong stream, but
that's a little too far.
Kate Scarlata, MPH, RD (41:42):
Yes, that's so funny.
One more question.
Peeing, just in case?
I have to hop on a call.
I'm running out to the grocerystore.
There's some negative effectsto that?
Or tell us about peeing, justin case.
Totally.
Dr. Alicia Jeffrey-Thomas (42:00):
In most cases you shouldn't be
peeing just in case.
Your bladder needs to be ableto fill up appropriately in
order to be able to contractempty appropriately.
And so if we're repeatedlygoing in and kind of cutting it
short, we're losing some of thatcontractility of the bladder
and it's also going to affectwhen your bladder senses that
it's full.
If it's only filling up to 50%,most of the time it's going to
(42:21):
start to tell you oh hey, youneed to be going to the bathroom
when you're only about 50% full, even if the capacity of the
bladder is much larger.
And so then that can result inmore urgency and more kind of
compounded frequency, becausethen you're trying to jump the
line and get in front of whenyou're going to get that signal.
So normal time between trips tothe bathroom is anywhere between
two to four hours.
So I usually use the examplesof.
(42:45):
You know, if you're just makinga quick trip to CVS and it's
only been an hour since you lastwent to the bathroom, like
don't go, just in case beforeyou do that, like you can get in
, get out, get home, it's goingto take maybe more time to work
up to doing a Costco run withoutdoing a just in case pee.
But you can get there.
You absolutely can get there.
It takes a little bit of thatbladder retraining knowing what
your limits are, knowing what'shappening with your pelvic floor
(43:05):
and how to manage an urgencysituation when it occurs.
Kate Scarlata, MPH, RD (43:08):
That's good advice yes, so this has
been incredible and just so muchvaluable information for all of
our listeners, all sexes, allages, all stage of life.
So, as we wrap up, we'd love tohear what you do for your own
gut health and well-being.
Dr. Alicia Jeffrey-Thomas (43:27):
So I was a really constipated kid and
so I have my routines that I'vekind of fallen into right.
So I make sure that I have mysmoothie every morning.
I use my coffee to get thingsgoing.
Obviously I make sure thatthere's a squatty potty pretty
much wherever I go, so we putthem in the office at work I
have them in all of ourbathrooms.
(43:48):
At home I have a travel squattypotty that I take with me.
I never want to be caught in aposition where I'm trying to be
up on my tiptoes or makingsomething up to try to get by
there and then also just stayingon routines in terms of
physical exercise and movement,also just staying on routines in
terms of physical exercise andmovement.
If you're active, you knowmovement is good for bowel
(44:10):
movements, and that is one ofthe things that I like to impart
the most to my patients.
And I try to be that example forthem as well.
Kate Scarlata, MPH, RD (44:14):
I love that.
Dr. Megan Riehl (44:14):
Yeah, you know.
I hope that everyone will pickup power to the pelvis because,
as we've learned, we all canbenefit from it, and you'll have
some fun following you onsocial media at the pelvic dance
floor.
So, Dr.
Jeffrey- Thomas, thank you sovery much for joining us today
and, to all of our listeners, wehope that you will subscribe,
(44:38):
follow and like The Gut HealthPodcast.
Your support means the world tous, our friends.
Thank you for joining us as wegrow this gut health community.
We hope you enjoyed thisepisode and don't forget to
subscribe, rate and leave us acomment.
You can also follow us onsocial media at The Gut Health
Podcast, where we'd love for youto share your thoughts,
(45:00):
questions and experiences.
Thanks for tuning in, friends.
This episode has been sponsored by
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We welcome you.
(00:37):
Hello friends, and welcome toThe Gut Health Podcast .
where we talk about all thingsrelated to your gut and
well-being.
We are your JeffreyKate Scarlata, a GI dietitian.
Dr. Megan Riehl (00:47):
And I'm Dr Megan Riehl, a GI psychologist.
Kate Scarlata, MPH, RD (00:50):
You know , when we think about the dream
team for achieving your best guthealth, there's a crucial piece
we're spotlighting today, andthat's pelvic floor physical
therapy.
We are joined by Dr AliciaJeffrey-Thomas, a pelvic floor
physical therapist.
If you've ever struggled withbowel or bladder issues yes, I'm
talking to you, friends.
(01:11):
If you are afraid to sneeze andpee or dread those jumping
jacks in exercise class, maybeyou've had a baby or experienced
pain with sex or dealt with anycondition affecting the pelvic
floor, this episode is for you.
And men don't skip this episodetoo, because constipation and
(01:32):
prostate issues can benefit frompelvic floor physical therapy
too.
We're going to enlighten youtoday on how pelvic floor
physical therapy might be justthe missing link in your health
journey.
Dr. Megan Riehl (01:44):
So welcome Dr Jeffrey- Thomas.
Dr. Alicia Jeffrey-Thomas (01:47):
Hi, thank you so much for having me.
Dr. Megan Riehl (01:49):
Let me share a little bit more about you.
You have a really impressivehistory and we are just so
thrilled to have you today.
You have been a pelvic floorphysical therapist since 2016
and treat people of all gendersin the greater Boston area, and
you aren't one to shy away fromthe taboo topics, so from
bladder problems to bowelmovements to sex, Alicia is
(02:12):
always game to talk through thedirty details of helping her
patients figure out what isgoing on, quote unquote, down
there.
You're also the creator behind@AtT he Pelvic Dance Floor, a
social media presence with overa million followers across
Instagram and TikTok, and I'vebeen watching.
You use a lot of humor andshare evidence-based pelvic
(02:34):
health information in a veryrelatable way, and also you just
published your first book,Power to the Pelvis, which aims
to further the mission andempower people to take charge of
their pelvic floor health.
We are so, so excited to talkwith you today.
Dr. Alicia Jeffrey-Thomas (02:51):
Thank you.
Dr. Megan Riehl (02:52):
Also, we like to kick off every episode with a
myth buster.
So what in the kind of thepelvic floor health space or
overall health and well-being?
What myth would you like tobust for us today?
Dr. Alicia Jeffrey-Thomas (03:08):
So if we're trying to kind of combine
gut health and pelvic floorhealth, I think the thing that I
hear most commonly from peopleis well, I poop every day.
There's no way that I can beconstipated.
And that's just really not true, right?
Because if we have kind of thatincomplete evacuation, where
your pelvic floor muscles maybearen't getting out of the way to
(03:29):
allow for that full emptying,you can kind of have this
buildup and backup of stool sothat you're still constipated,
even if just a little bit'scoming out every day.
Dr. Megan Riehl (03:37):
The constipation I mean we've had
this conversation so many timesthat like at the root for so
many people, especially thosethat are having diarrhea, we're
always like we got to check.
We got to check to see ifactually constipation is really
at the root of things.
So that is a perfect myth tokind of kick us off.
Thank you for sharing that.
Kate Scarlata, MPH, RD (03:56):
Yeah, absolutely.
I would say too, in my practicethat has been a huge problem
and I always recommend a pelvicfloor evaluation and a referral.
And I would say, you know, I'vebeen seeing thousands and
thousands of patients over thelast 30 years and pelvic floor
physical therapy has beenprobably one of the most
(04:16):
top-tier treatments that havereally altered my patient's
quality of life.
And it's just to that pointthey weren't eliminating that
stool and you have that extrastool in your colon that's
really slugs down your smallintestine motility, so that
bloating and that distension canreally be a problem and
patients hate that.
(04:37):
So when you work with patients,is there more common conditions
that you see in your practice?
Can you please just talk aboutwhat a pelvic floor physical
therapist does on a day-to-dayoperation and then what you see
more commonly in your practice?
Dr. Alicia Jeffrey-Thomas (04:53):
So, as a pelvic floor therapist, I
tend to kind of lump mycategories of things that I
treat into three.
So you have your urinary issues, which most commonly people
will think of stressincontinence so leaking urine
when you cough or laugh orsneeze or jump or run or urgency
related issues so not making itto the bathroom in time or
feeling like you constantly haveto go.
(05:15):
And then you can also kind ofget into the bowel side of
things, where the most commonthing that I treat within that
category is going to beconstipation, whether that's
working on motility through thesystem or that sphincteric piece
of making sure that the doorsare able to open and everything
is able to make its way out.
And then there's also fecalincontinence.
That falls under that umbrellaas well.
(05:36):
And then your third umbrella isgoing to be pelvic pain, and
that could be anything relatedto pain related to either
urinary or bowel function.
It could be pain related tothings like endometriosis or
interstitial cystitis.
It could be pain with sex.
It could be this kind oftension in the pelvic floor
that's maybe contributing to hippain or back pain.
(05:58):
So it's all-encompassing.
It's not just that hammock ofmuscles at the bottom, it's how
it affects everything around itas well.
Kate Scarlata, MPH, RD (06:06):
Can you just talk a little bit about
tension in the pelvic floor?
And I think when people thinkof tense they think like their
muscles are tight, obviously,but are they also weak sometimes
, Like is tension sometimespresent with weak muscles or is
tension typically with they'restrong?
What are you working against,say, in someone with
(06:28):
constipation typically?
Dr. Alicia Jeffrey-Thomas (06:30):
It can go either way.
You can have tension in thepelvic floor, where the muscles
just don't have the room to move, and so that could mean that
the muscles are weak.
And once we get the pelvicfloor to relax it's like oh,
this muscle doesn't know how tocoordinate at all, it can't
contract on its own because it'sbeen stuck in this tense,
contracted state for so long.
(06:51):
Or you can have people wheretheir pelvic floor is tense but
they do have that ability tokind of tension further.
That tends to happen a littlebit less often.
I generally tend to find thatthere's this dis-synergy, this
discoordination, where themuscles have been stuck in one
position for so long that theykind of lose the plot and don't
(07:12):
know how to do their jobsappropriately once we get that
range of motion back.
Dr. Megan Riehl (07:16):
Awesome.
And one of the things I want tojust kind of think about here
is, a lot of times, our patientsthat we're seeing from a gut
health perspective or just ingeneral, I say comfortable being
uncomfortable.
So this idea that, like, I gaveup running because I pee a
little bit every time I run,like and that's just the way
it's supposed to be because I'vehad three babies, and that's
(07:39):
not the right mindset, rightLike, and women that are in
their seventies or eighties thatthey get up to pee or something
just dribbles out, these arenot common things, that or I
guess they are common things butthey're not things that we have
to live with.
Is that right?
Dr. Alicia Jeffrey-Tho (07:54):
thinking that's totally correct.
I mean, I think that pelvicfloor dysfunction tends to
slowly rob you of these littlejoys and you make these
adaptations in your life towhere you're not exercising the
way that you want to becauseyou're afraid to run or to jump
on a trampoline because youdon't want to pee and be
embarrassed by that, or you stophaving sex because it's painful
and you're like oh well, maybethis is just how it is as I get
(08:17):
older and so over time we'rekind of missing out on these
integral pieces of life.
And then also, I mean, there'sjust the ways that it just
affects you on a day-to-day.
I mean, if you have a lot ofurinary urgency, you may not
want to travel because you'reafraid of not being able to find
a bathroom in time.
So there's just little waysthat it starts to impact you.
Dr. Megan Riehl (08:36):
Yeah, so walk us through that introductory
consultation with a patient,because I think people are just
very curious and anxious aboutwhat that might look like to
work in kind of the pelvic floorarea.
So what is a typicalconsultation for constipation or
diarrhea or even some of thoseurinary issues?
Dr. Alicia Jeffrey-Thomas (08:55):
So I'm looking at all of these
things simultaneously.
If somebody comes in sayingthat they have a constipation
issue, I'm already thinking, hmm, I need to make sure I ask
about pain.
I need to make sure I ask aboutbladder issues, because I kind
of call it the theory of stuff.
There's only so much room foreverything to coexist within the
pelvis.
And so I'm going to start outasking a bunch of personal
(09:15):
questions, depending on whatyou're comfortable with from an
exam standpoint.
That doesn't happen until waylater.
I want to get a good idea ofwhat's going on.
So I'm taking a really thoroughhistory.
I'm asking about all of thosedifferent kind of umbrella areas
and then, depending on whatyou're telling me, I'm also
asking about back pain.
I'm also asking about whetheryou've had other abdominal
surgeries before, things thatmight be impacting what's going
(09:36):
on, and then my exam tends toflow from that into looking like
a more orthopedic exam first.
So if you've ever been tophysical therapy for your back
or for your shoulder, we'relooking at range of motion in
your hips and in your back andwe're making sure that there
aren't any limitations therethat might be telling me that
something else is going on.
We're looking at strength.
We're looking at all of theseother different pieces that when
(09:59):
we get to the pelvic floor,that's going to tell me, oh okay
, we tend to have a little bitmore weakness on the left side.
How does that then translate towhat's happening at the pelvic
floor?
And the pelvic floor exam isnever mandatory, right?
I'm never going to forceanybody to do anything.
It's another piece of theinformation that we're trying to
gather to figure out what'sgoing on with you.
So that doesn't have to happenat the first visit, it doesn't
(10:19):
have to happen at the secondvisit, it doesn't have to happen
at all if you're really nevercomfortable with it.
I've had people where I'vewalked them through how to do
this assessment on their own ifthey're more comfortable with
doing that and giving me someinformation.
It's just we're more limited inhow we can interpret that
information when it's not medoing the exam.
So that exam for somebody witha vagina is going to be a
single-digit vaginal exam or asingle-digit rectal exam,
(10:40):
depending on what's going on.
And what we're doing there is.
We're assessing what'shappening with the muscles, so
the range of motion, the sameway we would assess in the hips
or the back the strength, sowhether that muscle is able to
contract and relax fully.
We look at whether you're ableto bear down appropriately
what's happening with themuscles when that's occurring,
so we're able to put all ofthose pieces together.
(11:03):
Is there pain, is theresomething else going on, so that
we can form this full pictureand say, okay.
I think that the reason thatyou're having constipation isn't
because you're not movingthings through the system
appropriately.
It's that that exit is blockedand it's not wanting to relax
and get out of the way, andmaybe that's also driving why
you're having some urinaryurgency, because there's just
(11:24):
more pressure built up in thatsystem and it's maybe putting a
little bit of pressure onto thebladder and causing some of the
bladder spasms there.
Dr. Megan Riehl (11:31):
So I always say that therapist is incorporated
in your name because this is avery sensitive type of
collaborative workingrelationship right working
relationship right and so peoplethat have a history of trauma.
It's important to advocate, aswell as I'm sure on your
consultative side you're askingabout that.
And again, like you're saying,a digital exam doesn't have to
(11:55):
be incorporated into thetreatment plan right away or
ever so your comfortability.
We know there is a highprevalence of individuals with
pelvic issues that may have ahistory of trauma and we don't
want to avoid this aspect of thetreatment plan because of that,
and we can help you to feelvery safe and comfortable.
Dr. Alicia Jeffrey-Thom (12:14):
Exactly , and I honestly I tend to
assume, based on the statisticsright, I tend to assume that
there is something there in mostpeople that come into my office
and I'd much rather approach itfrom that really
trauma-informed lens of what areyou not telling me, because
you're already coming into thisoffice really anxious about just
talking about the bowel andbladder issues that you may not
even think to bring this up, andthat's honestly what will
(12:35):
happen a lot of times issomebody will disclose a
previous assault or abusehistory on that second visit
once they're starting to getmore comfortable with me, and so
I always want to make sure thatI'm leaving space for that and
making somebody feel comfortablewith disclosing that to me so
that we can form a bettertherapeutic relationship and
make sure that I'm not doinganything that's going to trigger
them in session.
Kate Scarlata, MPH, RD (12:56):
Yeah, that rapport is so huge.
I think in my practice as well,you know when patients will say
I'm so sorry, I'm talking aboutmy poop and it's like that's my
business.
Yep, exactly that's why you'rehere.
That's why you're here, we'regood with that.
So I'm going to shift thingshere a little bit.
You know, I see a lot.
I've heard a lot about pelvicwands Very intriguing.
(13:20):
Do you have one?
Of course I do.
Of course you do.
Look at that.
I mean, I don't know if it'slike intriguing or scary or, you
know, just provocative.
But let's talk about pelvicwands and when you might use
them in your field.
Dr. Alicia Jeffrey-Thomas (13:36):
So yeah, so a pelvic wand is
another tool in the toolbox.
Again, it's not something thateverybody's going to have to use
.
I usually use it related moreto pelvic floor tension and it's
a way that you can recreatesome of the manual therapy
techniques that I would do inthe clinic on your own at home.
So it can be really good formanaging in-between visits or
(13:56):
even long-term once you'vegraduated from physical therapy.
Now, just looking at this wandright, there's this big long
thing here and everybody getsreally intimidated by this.
The amount that's going in.
It's trying to mimic what'shappening when my finger is
inside, so that much at most isgoing inside Finger length If
you're looking at.
So this is the Intimate Rosebrand one.
(14:18):
There's actually a littleflower right there and that's
usually where I tell people.
That's the limit of where youwant to try to go usually and it
has this curve to it becauseit's trying to be able to kind
of get down onto the bowl of themuscles in the pelvic floor.
It's not just a straight canal.
You want to kind of be able tolike gently angle down onto the
muscles.
It's really similar to like aTheracane that you would use to
get knots out of your shoulder,so it kind of has to have that
(14:40):
little bit of an arc to it to beable to kind of get into that
muscle to do a gentleself-release.
And then the other end of it istypically designed if you're
using it in the back passage.
So if you're using itinorectally, then you're able to
better get onto the musclesthere.
It's a little bit more of atapered end and so people are a
little less intimidated by that.
Dr. Megan Riehl (14:59):
Wowza, I love it.
So you would be teachingsomebody how to use something
like this in your sessions andagain their comfortability level
, like going home and tryingthis on your own might take some
time and practice and you mightengage in the exercise for 60
seconds and call it good.
I've worked with a lot ofpatients where sometimes they
(15:20):
feel overwhelmed at theexercises that they're supposed
to do in between their sessionsand then they just don't do them
.
And so on the GI psychologyside, I kind of talk about well,
number one, talk about thiswith your pelvic floor physical
therapist and then also havesome flexibility with yourself
and also you probably need to bepretty relaxed to be doing this
(15:41):
type of homework andnormalizing that.
Dr. Alicia Jeffrey-Thomas (15:45):
Yeah, absolutely.
I mean, you don't want to haveyour nervous system be super
upregulated at the thought ofusing the pelvic wand, because
then we're just kind of fightingthis uphill battle and
nothing's really going to relax,right.
And so I want to make sure thatyou're comfortable at least
attempting to use the wand andagain, even if it's like I'm
just going to, like, place ithere at the entrance and see how
(16:05):
that feels and come back to itlater, that's good, right.
Like we're resolving some ofthat fear, that nervous system
upregulation, before we get intodoing, you know, maybe more of
like a full session of musclereleases, and I'm guiding people
in the clinic.
They're going home tryingsomething, they're coming back,
we're doing something in theclinic and it's that back and
forth of making sure thatthey're getting the right
feedback there.
(16:26):
That's right.
Kate Scarlata, MPH, RD (16:27):
So just with these wands, you're really
is it almost like identifying aknot.
Is that what we're like?
Targeting to help relax, likeyou would have a massage break
up a knot in your back.
Dr. Alicia Jeffrey-Thomas (16:39):
Is it similar?
Similar, yeah, and everybody'sgoing to be a little bit
different in terms of what we'respecifically targeting.
There are also versions ofthese wands that have vibratory
functions or have temperaturefunctions, and so if somebody is
not really thinking that theywant to be applying a lot of
pressure to that muscle which Idon't really recommend anyway
but with, like, the vibratingones, you can apply even gentler
pressure and use that low levelvibration to help to facilitate
(17:02):
that relaxation as well.
So it's maybe more of ageneralized relaxation as
opposed to specifically findinga spot in those cases, excellent
.
Dr. Megan Riehl (17:13):
All right.
So something that definitelyapplies to all of us is proper
pooping.
Can you explain to us how youdescribe proper pooping position
and do you have any personaltips and tricks that help your
patients poop like a champion?
Dr. Alicia Jeffrey-Thomas (17:30):
Oh, of course.
So my number one recommendationis to get some kind of toilet
step stool.
We'll call it I'm not going tonecessarily call out a specific
brand but you want to have yourknees in a position where
they're a little bit higher thanyour hips, because that's going
to help to facilitate morerelaxation of the pelvic floor.
Typically, when your feet arejust flat on the floor, your
(17:53):
pelvic floor is kind of kinkingaround your large intestine, so
everything has to make an extraturn before it comes out.
If you get your knees higherthan your hips, that relaxes
that pelvic floor muscle, soyour colon straightens out and
then everything has an easierpath to the exit.
Now where I see this gettingmessed up for people sometimes
is when there's a flexibilitydeficit.
So they get their knees up, butthen they're kind of hunched
(18:14):
over because they don't have theability to kind of hold
themselves upright in thatposition.
So I'll tell people, okay, likemaybe we bring the height of the
step stool down a little bitand you work on trying to get
that like upright posture aswell, so that you know your
tailbone isn't then getting inthe way of everything making its
way to the exit.
And then in terms of actuallymaking things happen right,
(18:37):
further relaxing the sphinctericmuscles and allowing things to
empty.
I like to incorporate a lot ofbreath work and a lot of sound
use, so I'll teach people how todo diaphragmatic breathing,
specific types of exhales, sopretending like you're blowing
on a pinwheel or blowing bubblesthrough a bubble wand.
That kind of slow, pursed lipexhale helps to kind of keep the
pelvic floor muscles in arelaxed position so you're not
(18:58):
straining, you're not holdingyour breath.
If somebody needs a little bitmore help and a little bit more
oomph, sometimes I'll teach themto do like a shh as they're
doing that exhale, or evenmaking low pitch sounds like a
moo or a humming sound to try tofacilitate that as well.
Dr. Megan Riehl (19:13):
I was going to say can you give us some sound
examples?
So a moo is one of them and youcan feel that lower in the
pelvic floor, in the belly, whenyou make those lower sounds.
So it's a really good tip andvery helpful.
Dr. Alicia Jeffrey-Thomas (19:27):
And it's definitely one that you
want to practice in the comfortof your own home.
That might not be a publicbathroom, first attempt.
Kate Scarlata, MPH, RD (19:34):
I was just thinking that too.
Dr. Megan Riehl (19:37):
But you know what, once you do get good at
this, listen, go for it Ifthat's going to help.
You have a more complete bowelmovement and you're traveling or
you're out and about.
I've heard the tip of likethrow in some headphones, go
into the public bathroom.
That way you're not worriedabout what everybody else is
doing, but you're able to dowhat you need to do and you know
before you're done or I guessbefore you know it you're done
(20:00):
and onward with the rest of yourday, exactly.
Kate Scarlata, MPH, RD (20:03):
You broached this topic before, but
I'd like to really do a littlemore of a deep dive into
dysnergic defecation.
It's about 50% of people withconstipation have dysnergia and
I'd like to really break thisdown for our listeners because I
think it's probably could bepart of their picture.
Dr. Alicia Jeffrey-Thomas (20:23):
Yeah, so basically dyssynergic
defecation is thatdiscoordination or so that
misalignment between what'shappening in the rectum and
what's happening at the pelvicfloor and the anal sphincter.
So a lot of times when I'm doingjust a visual exam of the
pelvic floor, I'll see this.
I'll say, okay, try to bear downlike you're pooping, and
they'll start to have a littlebit of movement downward with
(20:46):
their pelvic floor, but then thesphincter will just clench up
and close up and pull inwardinstead of that kind of like
dropping and lengthening.
And so if that's happening everytime you go to try to poop,
then a lot of times people willdescribe having very skinny
bowel movements or feeling likethere's a blockage, that
something won't come out, and sothen we're really focused on
(21:08):
okay, how do we link things backup?
And maybe that's working withsome of the breath and sound
strategies that I was justtalking about.
Maybe that's doing some manualrelease work to the pelvic floor
muscles to kind of get thatrange of motion back so that
it's accessible.
When you are trying those otherstrategies.
I'll teach different stretchesand breath work in different
positions to again kind ofaccess that range of motion and
(21:31):
be able to tap into it when thetime comes, and sometimes we're
even doing work with rectaldilators where they can almost
kind of have that poopingpractice outside of the
stressful situation of trying tomake a bowel movement happen.
Kate Scarlata, MPH, RD (21:44):
Perfect.
(21:49):
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(22:11):
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(22:31):
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Dr. Megan Riehl (22:52):
So the next topic again, I think, is one
that some people may just beliving with and or avoiding, and
that's painful sex, and so howcommon is it?
And let's normalize this forpeople and what might pelvic
floor PT kind of look like inorder to address that issue?
Dr. Alicia Jeffrey-Thomas (23:11):
Yeah, I mean, the vast majority of
people will have a painfulsexual experience at some point
in their lives.
It's whether it becomessomething that is more chronic
and continuous, and that's wherewe want to make sure that we're
diving in and figuring out whythat's happening.
So, because that could happenfor muscular reasons, it could
be because the muscles are tootense and so we're kind of
(23:33):
having that painful response assomething tries to kind of go
past them.
It could be a hormonal issue,so there could be dryness, there
could be a decrease in estrogen.
That could be driving some ofthat.
There could be kind of thatnervous system upregulation
where we're anticipating thatsomething is going to hurt and
so we're involuntarily kind ofclenching those muscles.
So pelvic floor physical therapyin that instance is really
(23:56):
trying to find the driver.
Is this a hormonal issue?
Is this a muscular issue?
Is there something elsehappening further up and down
the chain?
And then maybe we're doingmanual release work, we're
practicing breath work to beable to relax the pelvic floor
in that moment.
Sometimes we're working withvaginal dilators, which are
progressively sized cylindricaldevices Hold on, I have one
(24:17):
right here so they'reprogressively-.
Kate Scarlata, MPH, RD (24:18):
Of course you do.
Dr. Alicia Jeffrey-Thomas (24:19):
Of course I do.
I tried to set aside a bunch ofthings.
I'm like maybe I can reach forthis.
Dr. Megan Riehl (24:27):
I love this.
We're going to include somepictures with this episode today
, so you'll have to check outthe Instagram page for us,
because we will help youunderstand what we're talking
about.
Dr. Alicia Jeffrey-Thom (24:33):
Perfect and so progressively sized
cylindrical devices.
They start as small as yourpinky, if not smaller in some
brands, and it progresses allthe way up through the size of
most partners, and so you'reable to kind of work through
being able to relax the pelvicfloor around these devices so
that you're not anticipatingpain and you're able to maybe
(24:54):
even stretch into certaindirections where, if you say, oh
I tend to have more tightnesson the left, let me pull down
and stretch.
That way it becomes a way thatyou can be doing things on your
own in addition to just cominginto therapy.
Dr. Megan Riehl (25:06):
Some of these topics that are taboo.
They don't need to be.
They don't need to bestigmatized.
We want to have conversationsabout this.
We want women and men to beable to communicate to each
other what they're experiencing,and it also makes me think
about women that have hadvaginal deliveries.
Do you think that most womenthat have had a baby would
(25:27):
benefit from a consult with apelvic floor physical therapist?
Dr. Alicia Jeffrey-Thomas (25:30):
I honestly think that, regardless
of how you delivered, you shouldhave a consult with a pelvic
floor therapist afterwards,because even if you have a
C-section, that's still a majorabdominal surgery that is
affecting how your abdominalmuscles are able to function.
And also, you just went througha pregnancy where for nine
months, there was pressuresitting on top of your pelvic
floor.
So I would love it, in theideal world, if everybody at
(25:52):
least came in and had thingsscreened, because I'm also maybe
going to be the only personthat's going to ask you these
more in-depth questions.
Your six-week follow-up withyour gynecologist or your OB
isn't going to necessarily getinto the dirty details of are
you having fecal incontinence?
Are you having urinaryincontinence?
Does it hurt when you have sex?
That would lead us to maybeneeding to do some therapy to
(26:16):
help to alleviate that.
Dr. Megan Riehl (26:17):
And is there any timeframe?
So if you are somebody that hasa three-year-old and you're
like, well, I didn't go do that,should I maybe go back?
What are your thoughts on thetimeline there?
Dr. Alicia Jeffrey-T (26:27):
Absolutely .
It's never too late to see apelvic floor therapist.
I have people that come sixweeks right after they deliver
and we start working right away.
But I have people that come 20years afterwards and they're
saying, oh, I've kind of beensitting on this because I was
raising children and busy andnobody told me that this was a
thing.
And suddenly, you know, theyhad a friend that mentioned it
(26:49):
and now they're taking time forthemselves and coming in and we
still see them getting better.
We still see them havingimprovements.
So, yes, earlier is going to beideal because then you're not
going to have those years lostwhere you're peeing your pants
or having all of this pain.
But it's never too late.
If you want to come in, ifyou're having issues, please
seek care from a pelvic floortherapist.
Kate Scarlata, MPH, RD (27:09):
I'm glad it's getting its day.
I know you probably feel likeyou're seeing it and you're
making a big difference by beingout there and letting people
know about pelvic floor physicaltherapy, because it's sad to me
that people are peeing theirpants and thinking it's okay or
normal after having a baby orhaving fecal incontinence and
(27:31):
being embarrassed and notthinking that there's help out
there.
Dr. Alicia Jeffrey-Thomas (27:35):
It's super valid because there's the
embarrassment factor where yousay, ooh, am I the only person
dealing with this?
Or if you do start to bring itup, a lot of times, that
conversation gets shut down withoh, that's just normal, that's
just how it is.
And because of thatembarrassment factor you never
ask a second time, and whereasmaybe asking a second provider,
you would get a completelydifferent answer.
(27:56):
So it's really good to see thatmore people are realizing that
they can seek care for this.
I mean, in the nine years thatI've been doing this, it used to
be that when people came in,their doctors referred them.
They had no idea why they wereshowing up to pelvic floor
therapy, and so it was a lotmore education on my end to try
to get them on board with whatwas happening.
And now I'm seeing people thatare self-referring, that
(28:18):
recognize that they're havingthese issues and don't want to
just have this be their normal.
Dr. Megan Riehl (28:23):
And I think maybe to your point, Kate, that,
like people are sufferingunnecessarily and maybe some of
it is an access issue, that youjust haven't heard about it or
you don't know where to turn,and that was part of the reason
we wrote our book was toincrease access, and I'm sure
part of your motivation too towrite yours that you know we've
got to put this out there andlet people know of the variety
(28:47):
of different ways in which wecan address these health issues,
absolutely.
Kate Scarlata, MPH, RD (28:52):
So can we talk a little bit more about
fecal incontinence?
Because certainly I've workedwith a number of patients and
interestingly, you know, earlyin my practice it wasn't a
question I really asked and thenI developed an online
questionnaire that patients didprior to their visit and I added
it and I was really surprisedto see the numbers of patients
(29:14):
coming back where it was aproblem, especially the older
woman that came to see me.
So what are some of the toolsand tricks that you do for this
condition?
Dr. Alicia Jeffrey-Thomas (29:24):
Yeah, and fecal incontinence for sure
is one of those hidden ones.
People don't think to bring itup, but I saw a statistic
somewhere that said it's ascommon as asthma.
So we really want to make surethat we're screening for this,
because this is something thatis really going to keep people
home if they're thinking thatthey're going to have an
accident in public or somethinglike that.
So, similar to anything else, Iwant to figure out why this
(29:47):
fecal incontinence is happening.
Is what's happening more solidstool, more liquid stool?
Is there an underlyingconstipation within kind of an
overflow that's happening?
So it maybe isn't necessarily.
Oh, I need to be doing a bunchof Kegel strengthening exercises
.
Yes, that does come into playfor a lot of people with fecal
incontinence, but sometimes weare defaulting back to oh, it's
(30:08):
actually because you're notemptying, and so we want to make
sure that we're having thisfull, comprehensive thing going
on.
And even if we're getting intothe strengthening of the pelvic
floor, it's not just going to bethat in isolation.
If we're looking at fecalurgency, I'll teach them
different strategies andtechniques to manage that urge
(30:28):
when it happens, so that theycan be able to comfortably make
their way to the bathroomwithout having an accident
before they get there, and wereally just wanna make sure that
we're looking at thiscomprehensively and not cutting
any corners and makingassumptions when it comes to
fecal incontinence.
Dr. Megan Riehl (30:42):
Do you have a tip or trick on how to
get there, how to hold it.
That might be a very generalkind of tip for urgency.
Dr. Alicia Jeffrey-Thomas (30:51):
So I base it off of the technique
that I use for urinary urgency.
So I usually give people a fewdifferent strategies of like,
okay, don't try to do this asyou're running to the bathroom,
right, you want to freeze inplace, you want to try to take a
few deep breaths to regulatethe nervous system.
But where I would cue somebodyto do quicker pelvic floor
contractions when it's urinaryurgency, I'll get them to do a
(31:14):
longer pelvic floor contractionif it's for bowel urgency,
because we're trying to kind ofreset that rectoanal inhibitory
reflex where basically it's likeif we're able to kind of like
pull things up and hold thingsup out of that chamber for long
enough, it hits a little bit ofa reset button to allow people
to get where they're going.
Kate Scarlata, MPH, RD (31:32):
Got it.
Interesting.
So I know diaphragmaticbreathing can really get that
kind of high anxiety down.
Is that kind of what you'retalking about, those deep belly
breathing?
Dr. Alicia Jeffrey-Thom (31:42):
Exactly , Exactly.
Dr. Megan Riehl (31:44):
So I forgot to ask, and I'm also thinking that
this might be beneficial whatabout seeing you while you're
pregnant?
I'm thinking that, of course,after you have a baby and you're
saying, pretty much every womanthat has ever had a baby could
benefit from this but what aboutduring your pregnancy?
Dr. Alicia Jeffrey-T (32:06):
Absolutely so.
During pregnancy is usually thefirst time that a lot of people
start to see pelvic floorissues manifesting.
So maybe that's an increase infrequency of urination, or maybe
that's they're starting tonotice some urinary incontinence
because of that growingpressure and heaviness.
You don't have to wait untilyou deliver to start addressing
that.
So I'll see people duringpregnancy to work on
strengthening not only theirpelvic floor but their deep core
(32:27):
and everything that's helpingto support that whole system.
But then I'll also help peopleto manage any pelvic pain.
So if they're having pubicsymphysis pain, back pain, hip
pain during pregnancy, you don'tjust have to exist with that.
Nine months is a long time tobe in pain and I don't want
people to think that that's justhow it is.
There's a lot of things that wecan do from a muscular
standpoint.
(32:47):
We can talk about differentsupports, that you can be
wearing a whole bunch ofdifferent things there, and then
, as we get into that thirdtrimester, we're also talking
about birth prep.
So, instead of then focusingmore on strengthening, how do we
get the pelvic floor to be ableto get out of the way so that
the uterus can push the baby out.
So we're talking about pelvicfloor relaxation.
We're also talking aboutoptimal labor positioning, ways
(33:08):
that you can kind of open upsome hip mobility to allow for
that positioning to be possiblein the moment.
So there's a lot, a lot that wecan do there.
And then also you'veestablished care with a pelvic
floor therapist so that you canget right back in after you hit
that six-week clearance withyour OB.
Dr. Megan Riehl (33:26):
Exactly.
It can be so hard to thinkabout taking care of yourself
when, all of a sudden, you havethis new baby that is 100%
reliant on you, and so this maybe.
People are always saying, likewhat could I get the mom?
Partners, spouses, best friends, girlfriends remind your
(33:50):
pregnant friends or loved onesthat this could be a beautiful
gift, a good referral, and pairyou with a good postpartum
massage or a prenatal massage,and that sounds like a
picture-perfect day for me.
Dr. Alicia Jeffrey-Thom (34:02):
Exactly .
Kate Scarlata, MPH, RD (34:03):
Lots of self-care.
I like it.
So, while we're talking aboutpregnancy a little bit, I hope I
don't butcher this termdiastasis recti yeah, is that
right, you did it.
So it's a separation of theabdominal muscles and it can be
seen in postpartum women.
Can you talk about how pelvicfloor physical therapy might
(34:24):
help with this?
Dr. Alicia Jeffrey-Thomas (34:26):
Now just to clarify the term itself.
It's not a separation of themuscles themselves.
It's a separation of the fasciabetween the two sides of your
six-pack muscles.
So, the muscle itself isn'ttearing, it's basically a
thinning and a stretching ofthat line in the middle.
And so we start to notice maybethat widening which can result
(34:46):
in coning or doming when you'redoing different abdominal
exercises or even when you justgo to sit up in bed, and that
can contribute potentially to aninability of that whole core
system that exists between yourpelvic floor, your core, your
diaphragm, to be able to managepressure.
So that could mean that you'redealing with back pain or
(35:07):
abdominal pain or evencontributing to some of those
pelvic floor symptoms Inpregnancy.
It's pretty common, it's goingto happen to most people.
So it's no failure of your ownactivity levels or something
that you did that you end upwith a diastasis.
There are certainly things thatyou can be doing in terms of
strengthening the deeper coremuscles.
(35:29):
You can be more mindful ofbreathing out when you're doing
exertional movements.
That can keep it from maybeprogressing or getting worse.
But there's definitely going tobe some amount of separation in
most people.
And then postpartum, we'rethinking about re-engaging that
whole system, so the deep core,the pelvic floor, your breath,
(35:51):
and being able to create supportthrough the spinal column so
that we're not ending up withback pain and more pelvic floor
issues.
I'm not so concerned withclosing the width of the gap.
A lot of that is going tohappen kind of on its own, but
I'm really also thinking aboutbeing able to generate tension
and support across thatseparation.
So the muscle that's below thator deeper to that is called the
(36:15):
transverse abdominus.
I wanna make sure that that isable to be doing its job,
because it's acting more as kindof like a corset to help to
support everything, and sothat's going to be the more
functional piece versus focusingon the aesthetics of closing
the width of the gap?
Dr. Megan Riehl (36:30):
Stress which symptoms might drive somebody to
this.
Dr. Alicia Jeffrey-T (36:33):
Definitely .
Back pain, urinary incontinence,abdominal pain those are going
to be the main things thatyou're going to see with a
diastasis.
Dr. Megan Riehl (36:50):
Okay, what, on average, might somebody expect
in terms of like how longthey're working with somebody
like you?
Just to kind of set the stageof expectation.
Dr. Alicia Jeffrey-Thomas (36:55):
So I'm going to use a really common
physical therapy phrase and sayit depends.
Okay, that's fair.
Everybody is going to be alittle bit different.
Everybody's level of bodyawareness is completely
different.
There are some people that comein and they get what I'm trying
to tell them immediately and wecan kind of move through a
progression at a much fasterpace.
And so those people, maybe I'mseeing them for I don't know,
(37:17):
six visits or so.
But then I certainly have peoplewho have more complex things
going on.
Maybe they have chronic pelvicpain or they've had constipation
for 10, 20 years before they'vethought to come and get it
addressed, and so we'reunwinding more and more pieces,
and so those are people thatI'll see much longer term.
I mean, I have people that I'veseen for over a year at this
point and they're certainlydoing so much better than where
(37:39):
we started from.
But we're trying to really getback to that optimal function
than where we started from.
But we're trying to, like,really get back to that optimal
function.
And you're not necessarilygoing to have this straight,
linear path of everything isgetting better all the time.
You're going to have dips,you're going to have regressions
, and so you want to kind of begentle with yourself and know
that your body is moving at thepace that it's meant to move at,
based on a lot of differentfactors.
Kate Scarlata, MPH, RD (37:59):
I often think and see in my patients,
you know, a refresher, likenutrition, like a psychology
refresher.
I send patients back after theyhaven't been for a couple of
years.
It's like you know what, maybeyou just need a little refresher
here, a little tune up, exactly, exactly.
So I'm constantly re-referringafter a few years and it
(38:20):
definitely makes a difference.
So you know, we all needrefreshers.
Dr. Alicia Jeffrey-Thomas (38:25):
No, exactly.
I think I heard somebody usethe example of you go to the
dentist twice a year but youstill brush your teeth in
between, and so you know we'restill doing all this maintenance
stuff, but you do still need tosee the dentist.
Dr. Megan Riehl (38:39):
So thank you to all the men that are still
listening.
We have a very importantquestion for you now, because
pelvic floor PT is not just forthe ladies, so can you talk to
us a little bit about how thisPT could be helpful after a
prostate surgery or when men aredribbling and having urinary
leaks, or even for erectiledysfunction?
(39:00):
Tell us a little bit about whatthey could expect in terms of
treatment.
Dr. Alicia Jeffrey-Thomas (39:05):
Yeah, absolutely.
I mean, you start to see iteven in much younger men who
have had a diagnosis ofprostatitis, which is an
inflammation or an infection ofthe prostate, and they're given
antibiotics and they're thinkingthat this is going to make them
better and it doesn't quiteresolve all of their symptoms in
a lot of cases and that'sbecause it's actually more of a
pelvic floor issue in this case.
So if you look at kind of across-section side view of a
(39:28):
male pelvis, you can see thatthe prostate sits right next to
the pelvic floor muscles and sooftentimes people will think, oh
, there's pain in my prostatearea, but it's really that those
pelvic floor muscles are inspasm and so that can be
contributing to pelvic painsymptoms.
That can be genital pain, thatcan be pain through the perineum
(39:57):
, pain in the groin, it can alsohave urinary and bowel
implications, so they may notfeel like they're emptying
completely pelvic floor, keepingthat tension from building back
up.
And then kind of, as youprogress through things, let's
say that you have to havesurgery for prostate cancer.
The prostate is aspace-occupying thing and so it
helps to support the neck of thebladder and when you take that
(40:18):
out a lot of times thatinstability can result in
urinary incontinence, and sowe're training the pelvic floor
to essentially make up for thatlost function, so that people
don't leak when they're doingactivity and then you can also
have dribbling after you go tothe bathroom.
That could be a weakness issue,but it could also be a tension
(40:39):
issue.
So we're kind of thinking aboutwhy is that happening?
Do we need to make sure thatyou're not power peeing and
trying to force every last dropout?
We're actually focusing on okay, let's relax the pelvic floor,
and a lot of times guys don'teven realize that they have a
pelvic floor.
So there's this wholerebuilding of bodily awareness
that's going on.
Kate Scarlata, MPH, RD (40:58):
Can you talk about power peeing in women
too?
Because I think some people arepushing it out real quick and
trying to move on with their day.
But that's probably not a goodidea?
Dr. Alicia Jeffrey-Thomas (41:08):
It's really not a good idea.
When we're pushing.
It's putting a lot of pressuredown onto the pelvic floor,
which can weaken it over time.
So even if there is a kidscreaming in another room or
you're trying to get onto ameeting in the next five minutes
, you really want to giveyourself that time to relax,
take a deep breath while you'regoing so that we're not messing
(41:29):
with our pelvic floor musclefunction over time.
It should not sound like you'refrying chicken in the toilet
bowl.
I know there's people that wantto have a strong stream, but
that's a little too far.
Kate Scarlata, MPH, RD (41:42):
Yes, that's so funny.
One more question.
Peeing, just in case?
I have to hop on a call.
I'm running out to the grocerystore.
There's some negative effectsto that?
Or tell us about peeing, justin case.
Totally.
Dr. Alicia Jeffrey-Thomas (42:00):
In most cases you shouldn't be
peeing just in case.
Your bladder needs to be ableto fill up appropriately in
order to be able to contractempty appropriately.
And so if we're repeatedlygoing in and kind of cutting it
short, we're losing some of thatcontractility of the bladder
and it's also going to affectwhen your bladder senses that
it's full.
If it's only filling up to 50%,most of the time it's going to
(42:21):
start to tell you oh hey, youneed to be going to the bathroom
when you're only about 50% full, even if the capacity of the
bladder is much larger.
And so then that can result inmore urgency and more kind of
compounded frequency, becausethen you're trying to jump the
line and get in front of whenyou're going to get that signal.
So normal time between trips tothe bathroom is anywhere between
two to four hours.
So I usually use the examplesof.
(42:45):
You know, if you're just makinga quick trip to CVS and it's
only been an hour since you lastwent to the bathroom, like
don't go, just in case beforeyou do that, like you can get in
, get out, get home, it's goingto take maybe more time to work
up to doing a Costco run withoutdoing a just in case pee.
But you can get there.
You absolutely can get there.
It takes a little bit of thatbladder retraining knowing what
your limits are, knowing what'shappening with your pelvic floor
(43:05):
and how to manage an urgencysituation when it occurs.
Kate Scarlata, MPH, RD (43:08):
That's good advice yes, so this has
been incredible and just so muchvaluable information for all of
our listeners, all sexes, allages, all stage of life.
So, as we wrap up, we'd love tohear what you do for your own
gut health and well-being.
Dr. Alicia Jeffrey-Thomas (43:27):
So I was a really constipated kid and
so I have my routines that I'vekind of fallen into right.
So I make sure that I have mysmoothie every morning.
I use my coffee to get thingsgoing.
Obviously I make sure thatthere's a squatty potty pretty
much wherever I go, so we putthem in the office at work I
have them in all of ourbathrooms.
(43:48):
At home I have a travel squattypotty that I take with me.
I never want to be caught in aposition where I'm trying to be
up on my tiptoes or makingsomething up to try to get by
there and then also just stayingon routines in terms of
physical exercise and movement,also just staying on routines in
terms of physical exercise andmovement.
If you're active, you knowmovement is good for bowel
(44:10):
movements, and that is one ofthe things that I like to impart
the most to my patients.
And I try to be that example forthem as well.
Kate Scarlata, MPH, RD (44:14):
I love that.
Dr. Megan Riehl (44:14):
Yeah, you know.
I hope that everyone will pickup power to the pelvis because,
as we've learned, we all canbenefit from it, and you'll have
some fun following you onsocial media at the pelvic dance
floor.
So, Dr.
Jeffrey- Thomas, thank you sovery much for joining us today
and, to all of our listeners, wehope that you will subscribe,
(44:38):
follow and like The Gut HealthPodcast.
Your support means the world tous, our friends.
Thank you for joining us as wegrow this gut health community.
We hope you enjoyed thisepisode and don't forget to
subscribe, rate and leave us acomment.
You can also follow us onsocial media at The Gut Health
Podcast, where we'd love for youto share your thoughts,
(45:00):
questions and experiences.
Thanks for tuning in, friends.
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