February 4, 2025 • 53 mins
Dr. Kelly Sadauckas brings her pelvic floor wisdom to the world as we explore the crucial link between pelvic health and your overall well-being in this first episode of our February series, Heart Surgery to Happy Pelvis. Dr. Kelly, with her 25 years of experience, busts the myths surrounding pelvic health issues—whether it's pee, poop, or the delicate topic of intimacy. You’ll discover why your recovery journey must go beyond just focusing on your heart, touching on why "normal" pelvic functions might be more elusive than you think, and why being pain-free isn’t just wishful thinking. Prepare to learn what your pee and poop habits say about you—in ways you never expected. With a success rate of 80% in pelvic health recovery, Dr. Kelly unveils practical tips on achieving a healthier, happier you post-surgery. This is more than just a podcast episode; it's a guide to breaking taboos and taking control of your body’s quirkiest functions. Listen in and enlighten yourself on the secret to whole-body healing.
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Time Stamps
00:00 "Heart Surgery & Pelvic Health"
04:22 Pelvic Health Awareness Journey
06:56 Pelvic Health Assessment Guide
12:34 Daily Water Intake Guidelines
14:55 Pregnancy and Poop Health Tips
18:39 Periods Should Be Pain-Free
21:09 Bladder and Pelvic Floor Explained
24:45 Rethinking Pelvic Health: Beyond Kegels
28:21 Pelvic Floor Overactivity Issues
33:01 Pelvic Floor and Bowel Mechanics
33:54 Stress-Induced Constipation Explained
40:15 Pelvic Floor Recovery Tips
42:00 Pelvic PTs Expanding Healthcare Presence
45:50 Sigmoid Colon Massage Technique
48:57 Poop Management in Healthcare
51:52 Course Discounts & Health Insights
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
A poop problem. Right. If the doctor knows about pelvic
PT, which again, there's. Our success rate is 80%.
So we can help four out of five people that come into our door with
pee problems, prolapse problems, sexy time problems, poop problems we can
help without medication and without any nasty side effects of surgery
or medication. The one out of five that we can't help,
(00:25):
we educate the shit out of you so you now understand
your pelvis and you are essentially prehabbed for
success. Welcome to Open Heart
Surgery with Boots, where this February we're going
below the belt. That's right, we're diving
into the surprisingly connected world of heart surgery
(00:47):
and pelvic floor health in this five part series
series. Join me and our special guest expert, Dr.
Kelly Sudakis as we talk about everything you're too
embarrassed to ask your cardiologist. From what makes a
happy pelvis to getting your groove back after
surgery, to yes, even the great post
(01:09):
op poop debate. With candid
conversations, practical advice and plenty of laughs,
we're exploring the ups and downs of recovery.
Because let's face it, healing happens from top
to bottom. So buckle up for some real talk about the
parsif recovery nobody warned you about.
(01:30):
Hello, welcome to Heart Month on Open
Heart Surgery with Boots. I am your host, Boots Knighton.
Please give a gigantic welcome to
Dr. Kelly Sudakis who is coming at you
today from Drake's Idaho. I am down in Victor,
Idaho and Kelly and I have
(01:52):
known each other for quite some time and both of our
lives have taken all kinds of interesting and winding paths.
And here we are today and for the month of February
to bring you a whole series on the
pelvis and
and I cannot be more excited. And this is coming
(02:15):
on the heels of my four year anniversary of
open heart surgery. Oh my gosh, I can't believe that
Boots. And I
am just astonished that just now
at four years, I am finally learning about
what it means to have a pelvis, to take care of the
(02:37):
pelvis, what is a healthy pelvis? Because
lo and behold, thanks to you, I just recently
learned that open heart surgery affects the
pelvis and pelvic health. I wanted to bring you
on for the whole month of February for Love month
and Heart Month. Love Month. What is
(03:00):
more love than the heart and the pelvis, right?
Like the two primary pieces in Love month. So
thank you so much for having me boot. So a little more
about me, guys. I am a pelvic health physical
therapist. I have been in pelvic health my entire
Career, which is about 25 years now.
(03:23):
And I feel so blessed.
And in this calling, I really do consider it a calling to
reach people and helping people understand their
pelvis and their pelvic health, and helping them pee better and
poop better and have more fun in the bedroom. When you
can help someone with those things, you help them on a such a
(03:45):
deeper, more holistic level than just helping them with their shoulder
pain. So it's been such a personally fulfilling
journey. As with many other pelvic health
pts. Probably about 10 years into my career,
I was feeling a little overwhelmed and burned out
with patient load and having a huge wait
(04:06):
list and dealing with the insurance game. And so many people needed my
help. And I often had a wait list of two to
three months for people to come in to get help from me. And we'd
often help them in just one or two visits. So I began to think,
how. What can I do to reach more people? And
through a circuitous, amazing
(04:28):
journey. In 2020, I launched
Pelvic Floor with the vision to change the
world one pelvis at a time, starting with you
and how we're going to do that. The mission is to reduce
geographic financial psychosocial
barriers to accessing this information about pelvic
(04:49):
health. And boots, four years into your journey, you're
just learning about this. I meet physicians that are
50 years into their successful medical practices that have never
understood the relationship of pelvic health to
the whole body, you know, and so you are actually ahead of the
game for most. And I am so grateful that your listeners here are going to
(05:12):
get to learn about the pelvic floor and the heart
here in February, heart month. Oh,
today, though, like, before we get into all those deets, this is like, you
know, pelvic floor 101. Like, what the heck is a
pelvic floor? Right, right, right. Yeah. What
is it? And so, listeners, I've asked
(05:34):
Kelly to just treat us like we are
starting from scratch and treating me like I
have just shown up in her office for the first time and we're going
to take it from there. So this is like, we're not skipping over
anything. I have not seen Kelly for my pelvic floor, although
I do need to. And call me. I'm just going to be
(05:55):
overt about that. And that is okay. Like, this is going to be a
series of it's okay to talk about weird and
awkward things. It doesn't have to be weird and awkward, but
if we're thinking about one of the impetus of me starting this
podcast was. I didn't learn. I didn't get
instructions on how to heal completely from open heart
(06:18):
surgery. It was only focused on the heart and the
chest. And it didn't include the emotional, spiritual aspects. And it
definitely didn't include the pelvic floor. It didn't include
nutrition, which is why I had the whole series in October of
2024 with Michelle. And so the whole point
of this podcast is to help you find healing mind,
(06:40):
body, spirit, head to toe, front to back.
Amen, sister. So we're starting from scratch.
I'm starting with you listeners, so. All right, Kelly, I just
love it. Your office. I love it. Okay, let's dive
in. So if you were seeing me or another pelvic health physio
(07:02):
in person, we would do a detailed medical history about
everything that's gone through, everything you've gone through in your life, right? What
surgeries have you had, et cetera. We would
dive into, if you have a vagina, into your menstrual history
as well. When did your periods start? How regular were they? Were
they painful? We then are going to ask
(07:24):
questions about pee, poop, and intimate
functions, regardless of what type of pelvis you have.
And based upon those
answers, then that guides the
rest of the visit. So, Boots, you and your listeners, we're going to
just go through, number one, what's normal, and then we're going to
(07:47):
talk about the anatomy and, like, how of the bones
and the muscles and how they work to provide
that quote unquote normal function. And then
we'll get to the nitty gritty of what's not normal.
And, you know, what's not normal might be ludicrously common
in this world of pelvic health, but that doesn't mean
(08:09):
that we have to deal with it. Right? The, the incidence of pelvic problems.
So pelvic pain, problems with peeing and pooing, it is the same
incidence as back pain in the world. Eight out of 10 people
will suffer from some type of pelvic problem in their
lifetime. But here's the thing. When you have back
pain, the average time that it takes you to get care
(08:32):
is two to three weeks if it doesn't resolve. If you have a
pelvic problem, pain, pee, urgency, pee
leaks, poop problems of constipation or loose poops, sexual
problems. Your average time before you seek
care is five to seven years. And I would
honestly argue that that's five to seven years for someone with a
(08:53):
vagina. And someone with a penis might even go longer than
that for a multitude of reason. Reasons. And it's because
we think it's a normal consequence of aging. It's because we're ashamed and we
feel alone. And then worst of all, if we go to ask
for help and we're told by a medical provider that it is normal
and it just stops our ability to progress, which is so sad. So I'm
(09:16):
so grateful to be here to talk to you about these things. To number one,
improve awareness. Number two, encourage you to get your cute butts in
for help. And then, number three, we might even save some
lives by learning about a few pelvic changes that are shown
to pre. I exist before
heart issues. Oh, my gosh. Are we
(09:38):
ready? I am so excited. I feel like I
need to get, like, school supplies ready. And like.
Yeah, and we're going to be saying
penis and vagina and sex, like all the.
I mean, it's all the words that go with the pelvis. And I hope
you are listening to this and you're already, like, feeling
(10:00):
squeamish. I invite you to sit with the discomfort
because what I really want for you is complete and total
health. And that includes your pelvis, and it includes your
vagina and your penis. Can I say that? Yes. Yes, girl. And we.
We should do a whole nother talk about, I think the Latin origin of
the perineum is like that. That shall not be named
(10:22):
or something. Oh, my gosh. So then there's a whole nother talk about, like, purity,
culture and stuff. But we'll. That. That's for later. So first and foremost,
folks, what is normal in the pelvic floor? Because
to understand what's not normal, we need to start with the basic ground rules of
what is normal. Regardless of your age,
regardless of what parts you have in your pelvis,
(10:45):
we ought to pee on average once every
three to four hours while awake. And when we
pee, it should be preceded by a
gradual urge to pee, never a freight train.
Hey, get your butt to the bathroom right now. No, no, no. It should
start as a whisper that gradually builds up that we
(11:06):
eventually listen to on our own terms when we
start the stream, it should be very easy to start the stream.
To maintain the stream of pee, that stream should last
at least 10 to 15 seconds of a nice healthy stream. Per
pee following the stream, we should either give it a
wiggle or a single wipe and be able
(11:28):
to stand up if we're already standing, tuck things in, have
no post void dribbles, and then the cycle
resets. There should never be any Pee
leaks. There should never be any leaks associated with
urgency. Jumping, laughing, coughing, sneezing. That
should really never happen. Hmm. When we
(11:49):
finish peeing, we should feel satisfied. We should not feel like it burns
when we pee or that it burns afterwards.
In general, we should actually sleep through the night without awaking,
awakening to pee. And this is something that is considered
normal as we age, or doctors will even say it's normal during pregnancy to get
up at night to pee. And I would beg to differ. Like maybe we'll give
(12:11):
you one pee a night by like your third
trimester because then baby actually is settling down,
possibly in the first trimester because of the increased blood
flow. But in general, I want you sleeping. The
importance of sleep for overall holistic health cannot be
overestimated. And I want you to sleep whilst still
(12:33):
being hydrated. So yes, there are a few caveats within
this and I don't want you to dehydrate yourself
at all because hydration is important. So if I go through my whole day and
I haven't drunk enough water and I drink 32 ounces right before bed,
bed, in that particular case, I might need to pee at
night and it's better to be hydrated and wake up once and pee.
(12:55):
But if I'm only drinking 30 ounces during a
whole day, like that is woefully inadequate. I should not,
and I should not be waking up to pee that night. But I might be
because I might be dehydrating my bladder, but I'm getting ahead of myself a
little bit. And so all of that P function
should occur with us drinking this normal
(13:17):
amount of water which we take our body weight in pounds and we
divide it by two. So I weigh 160 pounds, so
I should be drinking at a base level 80 fluid ounces
every single day. 75% of that should be non
caffeinated, non alcoholic. Really. Alcohol
is just a chemical shitstorm. Like we should all be avoiding it at all
(13:39):
costs. And then if I am living in a high,
dry mountain climate, if I'm exercising, that base amount
needs to go up a little bit. So am I
having all those normal P functions while being adequately, hi
adequately hydrated? That's a really important thing to
check. Poop. The same muscles that
(14:01):
control the P function also control poop function. So what's normal for
poop? Poop has a little bit wider range. We
should poop anywhere from three times a week
to three times a day. And it needs to
be soft formed and non emergent.
As long as it's soft Formed and non emergent. We
(14:24):
sit down, we hopefully elevate our feet
up on a little stool, we relax our pelvic floor and
our colon pushes the poop, poop out. In
heart health, specifically Boots, this is a big deal.
If we strain to push poop out, we could
bring on a cardiac event. Not okay.
(14:48):
But in general health, it's just your bladder pushes your
pee out, your colon pushes your poop out. And if you have a
uterus and you're pregnant, your uterus pushes your vagina out or your vagina.
Oops. That was an oopsie. Your uterus pushes your baby out. And
if we're straining, then we actually can push other
stuff out that's not meant to come out like a hemorrhoid. We could cause a
(15:11):
bladder prolapse, we could cause some pee incontinence if
we're always constipated and pushing poop out. So that's
important. When you poop, are you able to sit down
and relax and have that poop happen? Like I'm in under one minute,
honestly, in general, and then it's
one or two wipes and we should be gone. We should be done. Like it
(15:33):
should not take half the roll of toilet paper to clean
up. And if it does, that's something that's called smearing and that's again
abnormal, something we can work on. And I have to
object that I do know someone know
of someone who died of a cardiac event on the
toilet at work. It was so sad.
(15:54):
Right, right. And we'll talk about that like, and like, yeah, if
we don't talk about it today, we're going to talk about it in one of
these segments. But like it's a big deal and it's something that we need to
talk about first and foremost from a primary health perspective. But
secondly, your listeners, this is open heart surgery with Boots.
So people that are here, we have a vested interest in managing this
(16:15):
arterial pressure. So if you've been a terrible pooper your whole
life, guess what, it's time to change. And it can get better.
And especially in the post surgical phases with
the medicines. Oh my gosh. Like, we really need
to understand what goes into poop. The whole
poop section. Again, there's so much we can do
(16:37):
nutritionally and hydrationally and musculoskeletally
to set you up for poop success. And the
greatest thing about all this is it's going to be overwhelming for some of you
listeners and just please don't be overwhelmed. You have access to this you can watch
this a zillion times. Take notes. You'll absorb what
you're ready to absorb. The same
(16:59):
specific and simple things that will help improve the pee
function, will improve the poop function, will improve the bedroom
function. So please just be kind and curious and not
overwhelmed with all this, because this is a lot of stuff that we're going to
cover in 30 minutes. Okay?
Sexy time. The bedroom is for two things.
(17:19):
Sleep and something else, my friends. And
something else. The intimacy. It should be pain
free, unless you want it to hurt,
but that's a whole different talk. But
intimacy should be pain free at the start.
You should be able to experience a pleasurable
(17:41):
rise to a climax, which should also be enjoyable and
pain free. And we should have no pain
afterwards. There should be no leaking of pee
or poop during intimate functions. And we
should not regularly have urinary tract
infections following. You know, there are some basic
(18:02):
things that, you know, with hygiene are good to follow.
But if you're always getting a UTI every time after you're intimate,
there's probably something else going on. And we're going to talk about
that in a moment. Oh, and you know, if you
are still menstruating, if you have a vagina and you're menstruating,
this is going to blow your mind. Period should be pain free.
(18:25):
What? Complete. Yeah, the.
Yeah, think. I'm just thinking about how
it is just. I'm just thinking about all my years. Like
I've been. Hold on, I just need a second. I know, right? I
know. Me too. I. So I am a double board certified doctor of
physical therapy, one of like 100 doctors of physical therapy in the world,
(18:47):
double board certified in pelvic health and orthopedics. I just
learned this less than 10 years ago, that periods are supposed to be
pain free. And I didn't even believe it when I think maybe even five
years ago, because my boobs have hurt my whole life
until I learned this. My labias, that's like the part you can see on
the side of the vag. Like, those would always be very sore. The second day
(19:09):
of my cycle made a few specific changes.
And pain free. It's insane. And we
don't know this. We normalize pain for women and it's not
okay. And when we can do things to control the
pain, which again, are a lot of the same things that I'm gonna talk to
you about, we can make your periods pain free. And if we
(19:31):
can't, and especially if they're debilitating, that can Be a
sign of a condition called endometriosis, which is something totally
separate. And you need to get your cute butt in for appropriate
treatment. There's a study of women, younger
girls, who ever missed school or work due to
period pain. Almost 100% of them have this condition called
(19:52):
endometriosis, which, which is super debilitating. And we are like, oh,
it's just period pain. And we, we just shove them. Oh, just take this
medicine. It's like, no, listen to them. This is a huge deal.
Well, and I was thinking about all the marketing from like the
ibuprofen, Aleve, Motrin, and.
And it just seems like it's just accepted. And that's just how it is. And
(20:16):
so you just have to take this and then that will make your periods better,
you know, and just how. I think I've had my period for maybe 30
years now. And I just assumed that that was just part of
being a woman. That's so infuriating. I know, right? Isn't it?
Isn't it? So we can. We'll talk about the things that we can do to
change that. So that is the basics of, like, what's normal.
(20:38):
Now, if you were coming to see me one on one, we would touch very
lightly on each of those. I would have on your intake,
though, your chief complaint, your reason for seeing me. So I might spend a
little bit more time on one of those items than the
other. We would then go into educating to the muscles
of the pelvis and the core and explaining how those
(21:00):
things happen. So we would begin with the bladder because
pee urges and pee leaks are one of the primary reasons that someone might come
to a pelvic floor. Physical therapist and your bladder. And
for those of you who can see this on video, we have your cute
little bladder here that kind of rests upon
a shelf that is the pelvic floor.
(21:23):
And that shelf, I'm going to hold up Patty, the pelvis here,
who is an anatomical model of the pelvis.
And essentially, white parts are bones, red parts in
general are muscles. And we have the bony
pelvis is like the structure of the house, the
drywall. You've got your low back in the very back,
(21:46):
and then you have a ring of pelvic bones that are made
of your two hip bones and your sacrum behind that
kind of form, this circle, right? That's base of your core.
You have tummy muscles that help dynamically
support this pelvis in the front and kind of connect the two
pelvic bones. You have butt muscles that go from the back
(22:09):
of your hip bones to your leg bones and back.
And, and from my humble perspective, most
importantly, you have this incredible hammock of
pelvic floor muscles that form the bottom of this
bowl. And those of you that can see, I know, right,
they go from the front of your sacrum all the
(22:30):
way to the back of your pubic bone. That is
quite right. And get this girl and
boys, everyone who's looking and watching, it's not just one
muscle on the bottom, it's a whole
group. And I highly recommend if you can check out the video
to do so at this exact minute, it's more than
(22:52):
13 muscles on the right and the left. Just like
you have right legs and left legs and this one here is a
vad. You can see the two holes, but penises are not that different
really. It's just this top hole is kind of closed. But they're mostly all the
same muscles internally, they all have different
roles. Constricting the urethra, the P
(23:13):
zone, elevating the middle of the perineum, which is that
muscular middle support controlling the rectum and back, helping you keep your
balance, right? And like what, it's
amazing that they ever work in the first place. And
truly. So you've got this cute little bladder resting
on that hammock and, and in real life,
(23:36):
this is the. And already right now, you listeners, you
boots know more about your pelvic floor muscular
anatomy than probably most primary care
providers. Just from this last three minutes, just. From that
last three minutes. Because most primary care providers in medical school
got one lesson on the pelvic floor that was taught by possibly a
(23:57):
pelvic floor physio, possibly just a physiological. And
then they went on to, quote, unquote, more important things,
right? They went on to medicines to help save lives, to
surgeries to help save lives. So this is not to minimize or say that they're
missing something, but they just had to go down a different road and they
never got this education. And now you
(24:19):
are though, and so you can be your own advocate. All
right, so we've got this cute little bladder resting
upon that hammock of pelvic muscles.
And the pelvic muscles are like an elevator in
a four story building. And they're
meant when they're super happy and healthy to rest on the ground
(24:42):
floor of this four story building. And then
with day to day life, the brain should automatically
decide how much muscles to use when you stand
and walk and run and pick up your groceries. And it should decide to
bring the Muscles up to that second, third, fourth floor and
back down again. When we sit down to pee or
(25:04):
poo, it should know how to relax them into the sub
basement and then come back to that ground
floor again. They're kind of like always on standby.
Pelvic problems, including leakage,
they primarily occur not because the pelvic floor is
sloppy and loose and open,
(25:26):
but because, for a variety of reasons, it starts to
rest too tight.
There's your second big mind blowing thing of the
day. Because for most humans, when you start to have
any type of pelvic problem, we are going to
do Kegels, and that's totally the wrong thing to do. Kegels
(25:49):
are the least important part of the pelvic perspective, and they will
typically make PE leaks, make pain, make sex
worse. Whoa. When I hear
that, that's like the main treatment for everything. And
who told you that? Yeah, I mean,
I. You just. You just know. Yeah, you
(26:11):
just. Isn't that funny? You just know. But here's the dirty
truth about Kegels. People were just told to do
Kegels because, oh, if you're leaking, yes, clearly the
pelvic floor must be weak. So you should tighten them in the 80s.
So this is the 80s. There's not even cell phones yet. All phones are still
connected to the walls. Right. There was a landmark study by
(26:33):
Bump et al that told people
to do Kegels. Then they followed up and they found
that just telling someone to do Kegels, if you had 100
people, by sheer luck, 1/4,
25 of those people would get better. However,
the same amount, 25%, would actually get worse and
(26:56):
half of the people would not see any change. And
that's because there was no actual education
connection to the muscles. So let's bring it back
to our elevator analogy, right? The
way the body reacts to pain,
dysfunction, and stress. And boots
(27:19):
your comment in the opener. In your open
heart surgery journey, you were not treated holistically. You did not
receive this education into what happened. Beyond the physical
heart. The pelvic floor has a direct connection
to your amygdala, which is your emotional center of
your brain. If we show a college age woman with
(27:41):
no history of abuse or stress.
Stress beyond life. A picture of a dark
parking lot. Her pelvic floor will clench because it senses the
potential for danger. Whoa. This is a survivalistic
standpoint. If we are physically stressed, emotionally
stressed, the amygdala tightens. The pelvic floor brings
(28:03):
this elevator up to the second or the third floor as a
sympathetic fight or flight response to help us get ready to run away from this
tiger. Right? And now like, what is.
And heart surgery is stressful, My Lantai. It's
stressful, right? Life is stressful.
That's going to start to bring this up to the second floor. And it's something
(28:24):
that happens that we're not cognizantly aware of. Right? So, so we
don't. If I say, relax your pelvic floor, you think it's already relaxed.
So now I'm resting on the second floor here. My pelvic floor is doing too
much work all the time. That's going to irritate my
urethra, that's going to maybe annoy my bladder, so it
starts to send a more urgent signal. And depending on
(28:46):
everything else that's happening upstream, that
now that these muscles are doing too much work all the time, they might not
have energy to hold my pee in when I need to
and I might start to pee my pants. And now we
have this like net downward spiral. Now that's stressful.
I might, because I quote unquote know that I'm supposed
(29:08):
to do Kegels, I might try to tighten up more. And now,
now I'm resting on the fourth floor and lo and behold, my urges and my
pee leaks get worse because the problem's not that my muscles are
so loosey goosey that I'm. I've been in a wall sit for
18 years and now I'm asking myself to go run a
marathon. Like, it's so sad.
(29:29):
Well, and I hate wall sits.
And I have. And I have really silly Instagrams. I'll get you the links
that we could put under about how these tight muscles can cause
leaks, but they also cause pelvic pain
with intimacy because they close the door. Essentially, they cause
us be to be unable to climax because the muscles that are
(29:51):
associated with climax are high performance muscles. So if they're
not healthy, we're not going to be able to build into a climax. We're not
going to have one. If we have a penis, we might not be able to
have an erection. And that's a huge deal that we're going to talk about in
the next segment. It's an independent risk factor for major
adverse cardiac event, period wise. Guess what? Are you
(30:12):
ready for your third mind blowing topic? Okay.
It's been mind blowing for 30 minutes already. Like, oh no, it's already 30 minutes.
What? We might have to divide it into two. Not just saying all of this
has been mind blowing. So. But we need this Is why we need to talk
about it, because there's so much. Right. So here's these sweet pelvic muscles
again. For those of you that can see, I just showing the. The. The in.
(30:34):
I'm inside the belly, looking down. There's all these different pelvic muscles. Here's a
vag. Guess where these muscles. I'm pointing to the muscles kind
of on. I. Oops. That was the rectum. I'm. Trust me, I'm a doctor. Here's
the vag. These little muscles on either
side of the pelvic floor. You know,
if you have a heart attack, where do you feel the
(30:55):
pain? By common knowledge, boots, Is it in your heart or
is it. Could it be elsewhere? Well, the two I've had,
yes. My left arm, the first one. My left arm, my
chest. But the second one here was. Here's the crazy
part. The second one, I had no pain, but I had
stopped peeing. No. Oh, my gosh. Okay. That's wild. I
(31:18):
can't wait to dive in. So first one, had we worked on your
arm, it not only would not have helped, but you might have
died. Right? Like. Like not understanding where the pain was
coming from. These pelvic floor muscles that live on
either side of the vagina and then even further back towards the rectum, their
referred pain pattern, they don't tip it. They could hurt in the vulva.
(31:41):
Sometimes they could hurt in the pelvic floor. They're more common.
Referred pain pattern is the lower abdomen.
So that's where your period cramps can come from.
In the absence of endometriosis, the pelvic floor resting too tight.
During the period process, there's increased inflammatory chemicals.
Everything's resting just below the pain threshold. Here comes the period. Here comes the
(32:04):
chemicals. Boom. We cross the pain threshold, and we can put a hot
pack on our lower bellies as much as we want. And it might help a
touch, but we actually need to do is relax. The pelvic floor,
dude. Wild, right? I know, I know. And then the third
hole moving backwards, you know, is the rectum back there. So we have
that sweet rectum. Where. Where's my rectum gone
(32:27):
to? There it is. Found
it. Does it have a name? Because we've got Patty Pelvis.
Patty the rectum does. I have Patty the pelvis. And it. It
alternates between Peter the pelvis and Philip the pelvis. The rectum
doesn't have a name, though. I should name it Randy. Randy the
rectum. I.
(32:49):
All my friends named Randy out there. Just going to Tell them that I just
named my rectum Randy. Yeah, yeah, you heard it. You heard it here
first, people on open heart surgery. Boots. Yes,
Randy. Yes. Ran random Randy. The rectum has been named
and I like it. We're keeping it. So you got the rectum back
here. And remember that hammock of pelvic muscles, right?
(33:11):
Same thing happens back here. It's meant to rest on that
ground floor, come up to support our pelvic pressure during
life, relax to give the on switch
to the colon to push the poop out when
that pelvic floor starts to elevate in response to
life stresses, in response to physical pain, in response to,
(33:34):
oh, gosh, I'm having pee problems.
Now we not only have the problem that it's much
harder to relax and open the door to give the on switch for the
colon to push the poop out, we're also engaging a
backwards reflex called the rectal anal inhibitory reflex.
We'll talk about this in the poop one. But we're engaging a reflex
(33:56):
that the brain thinks we're running away from a tiger and we don't have time
to stop and poop. So the brain's going to push the poop back up the
tube to give us a little bit of time to escape the tiger.
But that's meant to be like a very short term solution. So
what if we're resting up on that second or that third floor for days, weeks,
months, years on end, our poop is always getting this
(34:17):
negative signal. And so that's going to elicit,
typically more of a constipated trend. So the
poop's going to be harder to come through. It's going to be harder for us
to relax and give the signal for the colon to push out.
And then if we're straining to force the poop
out now there's all the other problems, the collateral damage, so
(34:39):
to speak, for the heart system and for the pee and the vag, if
we have one. Right. So the key in all of
this is to, number one, understand that because before
these last 30 minutes boots, have you known any of
this? None. And you
are a very educated woman and you are in
(35:01):
this heart surgery world and you're an active human. And
like you, you've had a period your whole life. So isn't it just mind blowing
that we don't know this? Well, I mean, I think how
unfair it is. It just leads to so many
unnecessary mind, body, spirit
issues that could be so
(35:23):
avoided. And, you know, just, just to like, talk about how I'm
educated. My undergraduate degree is in biology.
My graduate degree is in education. I
taught high school science, so it's not.
And I also taught at the collegiate level. I'm naturally
curious. I'm almost 47 years old and I
(35:44):
am just now learning this. So I just want to lay
the groundwork of really, what the
fuck? Exactly, exactly. And you
think about what happens. So we look at all these studies about
that gap in care that like, for most people, they're going to wait at
least five to seven years before they talk to a physician about their
(36:07):
pee problems specifically. And then depending on that
physician's education, like, what are they going to do?
Like now, if that person isn't watching this podcast, if they're not
following me on social media, what if that physician's like, oh,
here's a pill that's going to like, let's
say it's pee urgency, that's going to calm down your bladder. Does that
(36:29):
fix any of this musculoskeletal stuff? It doesn't.
And it's not without risk. There is the same things that that pill
works on to relax your bladder. It interferes with your cognitive
function. And people don't know that. There's not like, informed consent. A
poop problem, Right. If the doctor knows about pelvic
PT, which again, there's. Our success rate is 80%.
(36:51):
So we can help four out of five people that come into our door with
pee problems, prolapse problems, sexy time problems, poop problems. We can
help without medication and without any nasty side effects of surgery
or medication. The one out of five that we can't help, we
educate the shit out of you so you now understand your
pelvis and you are essentially prehabbed for
(37:13):
success for whatever that next step might be. And we can help
guide you to, hey, based on our experience, this should be
the next step because surgeries are not always bad. Open heart surgery
saved your life, prolapse surgery, bladder surgery, sometimes you need a
colon surgery. They're all amazing in the right place. But
just like you would never have a knee surgery like
(37:35):
an acl and then be like, oh, well, just rest six months, you'll
be fine. Like, you'd maybe survive, but you would not
thrive. You should never have a pelvic procedure.
Ideally, we'd always have prehab. But you should never have a pelvic procedure
without post operative pelvic floor physical
therapy. And that includes appendectomies,
(37:56):
gallbladder surgeries. That includes open heart surgery. I know it's not a
pelvic surgery, but it's a whole body surgery, and so that
should be a part. And it's not yet a standard of care. But
we just talked about what happens to the pelvic floor in response to
stress. Right. There's not much more stressful than open heart
surgery. I just wanted to interject in that because. And I'm going
(38:19):
to get real personal here for a second. Yeah, yeah.
I'm thinking post op for me. And if you, if you're
just now finding this podcast, first of all, I'm tickled you're here. You're here.
Thank you so much. And I hope that you will
subscribe and you'll visit our Patreon and you'll go back and
listen, because I've been building a whole network of
(38:41):
resources for you heart patients and
caregivers for, for thriving post surgery.
But I, I bring that up because I want you to go back and listen
to my story in episodes one and two. And I
definitely talk about the first few days of just
how my body needed to purge. And one thing I wanted to bring up,
(39:02):
you know, I. I threw up 25 times post
sternotomy, which was just hell on earth. But
then I obviously couldn't poop. And one
question I have for you, Kelly, is, you know, you hear about
post surgery, you can't poop. And granted, I had the
P tube in for a few days getting the fluid out of me, and that
(39:23):
was fine once it came out, but I couldn't poop and
I needed to poop. I knew I needed to poop. And so then I drank
a diuretic. But then I made it.
I. Then I couldn't control it. And so I just like to
say I took advantage of all the CNAS on the floor.
(39:43):
That's why they're there.
Exactly. But it was like such an
intense experience. And if we, you know, in these last few
minutes of this first installment talk about that,
because, yes, it is so important to poop post
surgery because I. I have two
(40:05):
pages, single spaced, font size
10 list of all the medications that were put into my body
during open heart surgery that needed to come out.
Right, Exactly. No, this is such an important part of
the discussion Boots. And we should do, you know, we'll do like a whole thing
just about pooping, but in general, the key things that
(40:26):
you can do, there is a very simple,
easy belly massage that we could start. And we
honestly should start these things that I'm about to say we should start them
pre open heart surgery as well, because they are all going to be things to
help connect to this pelvic floor and calm it back
down. The one additional part that also contributes to that tight
(40:47):
pelvic floor, beyond the physical stress and the emotional stress of the
surgery. Breathing, Right. How after a
sternotomy, how was it to breathe?
Suzanne, you had respiratory therapy, right? Like so.
Yeah. Breathing's hard and we're not going to get into too
much except to blow your mind. A fourth, possibly final time of
(41:09):
this talk. The pelvic floor muscles are an accessory
muscle of breathing, which means that in their. Yes,
that in their perfect state, when we are relaxed and those cute
little pelvic floor muscles are down here, I got Randy the rectum. When they're
down here on the ground floor, we're totally relaxed. You breathe
into your belly and your belly gets bigger and you exhale and
(41:32):
your belly gets smaller. Diaphragmatic breathing core of every
post open heart surgery, do they ever once say,
hey, tune into your pelvic floor as you inhale
and your belly gets bigger. Your sweet little pelvic floor is up here on the
third floor. Can we inhale? Belly gets bigger. Pelvic
floor drops towards the ground floor. Can you exhale?
(41:54):
Belly gets smaller. Pelvic floor stays
relaxed. That was never mentioned.
Of course it was never mentioned. And we are, pelvic pts are making great
strides in OB floors, finally coming in to
see women post baby, post cesarean. Hugely important. It
is just as important for us to start to have a presence on open heart
(42:15):
surgery floors and in the ICU or even collaborating with your
respiratory therapist. But that singular piece of
belly breathing, step one, again, pre heart surgery, we
are super stressed, right? If we are able to, if it's
not this emergency thing, we know this is coming. We're very stressed. Our pelvic floor
is going to be up here. So we owe it to ourself to do some
(42:36):
of that diaphragmatic breathing to stimulate your
parasympathetic nervous system, the calm the rest and digest
system to bring the pelvic floor specifically down
to not irritate the bladder or Randy the rectum
here. Now, so that's one thing is this belly breathing we can do and
we can start that as soon as we are out of
(42:58):
surgery. The second thing is a very simple belly
massage. And what will physically happen is at first you're going to
say, well, I can feel that belly moving, but I
can't feel anything back here. And that's just curious. We're
not angry that we can't Feel that. But we're simply curious. And that's going to
give our brain permission to try to find those nerves, because I guarantee they're
(43:20):
there for you. Um, in a future one, we'll go over the exercises, but just
being aware of that and possibly even sitting on a little rolled
towel vertically. So a little pressure on the vag or the
part behind the scrotum, a little pressure on the rectum. Inhaling, try
to encourage those pelvic muscles to come down. Is huge.
Secondarily, belly massage. Um, those of you that can see
(43:42):
me, I'm going to stand up here. Here's my belly. You would have a
big old incision here. We would be laying down. And this is my
belly button. This is clockwise. I never
know what direction my video shows up. But we
would be laying down. Relax. And we would do gentle pressure,
gentle circles in a clockwise direction. This
(44:05):
is called sunflower massage and old
school, I love you massage.
Fine. It's better than nothing, but I'm going to give you something better. Old school
I love you massage is you would do an I coming up from
the right hip here, and then an L up and
over and then a U and. And that's
(44:27):
fine. And the theory is that you're helping to move the
poop through the tubes. I want to be very honest that
in real life, you're simply mobilizing the nerves and the blood vessels. But it has
an exquisite benefit. Okay, so you would
spend three to five minutes of this sunflower massage just
feeling your tummy. And it should feel like soft
(44:49):
bread dough. And you might get to a spot like right
here. Mine's not moving the greatest. Right there. That's
interesting. So if I was having any poop
issues, that would be good for me to just gently work on. We would never
poke into a spot that was sharp pain. If for any
reason you had any insertion, like, you know, any
(45:10):
ports in here during your surgery, then we wouldn't want to be doing this.
But in open heart surgery, we normally don't. But we would
do this three to five minutes of this belly massage while belly
breathing. Okay. Then we would follow it
with the PT version of digestive massage,
which is actually going to start at the outhole. So,
(45:32):
Randy, the rectum here. I didn't talk about this at first.
We just talked about where he was in relation to the pelvic muscles. He's
actually turned 90 degrees. So your
poop at the end of its journey through the tube has to make two turns,
90 degree turns, and that's kind of unfair. That's called your
sigmoid colon. But to clear that, you're going to
(45:55):
go find your left hip bone, you're going to come to the inside of
it. You're going to push in and then pull towards a
line between your belly button and your
pubic bone. So you're going to push in, pull here, and then release and
you're essentially clearing the sigmoid colon.
We might be pulling poop into the final holding
(46:16):
stage. In reality, you're massaging all the nerves that are going
to that colon and helping it move more freely. And
you're going to do that three to five times while belly breathing and trying to
relax your pelvic floor. And now we've
opened the door a little bit of the pelvic floor. We've softened
it to take the brakes off the colon. We started to move
(46:39):
here. Now we can push here. And this is something that if your arms are
tired, if this amount of pressure is sore from the sternotomy,
your A partner can help with this. You can use a silicone massage
cup three to five times, pushing downwards to
help the poop down the descending colon. And again,
in reality, just mobilizing all the nerves that are going to the descending
(47:01):
colon. We would then do transverse colon. And this
depends on how low our incision is. Right. So we're always going to be healthily
below the incision. And we could even have a second hand on the bottom of
it to make sure we're not disrupting that. And we would go three to five
times across. And it doesn't matter that my actual colon is like up here
and way back there. This is the nerves that are going to the
(47:22):
colon that we're working on, people. Then second to last is
ascending colon. I start at the lower right and I pull up
and the whole time I'm just any place where I've just created space. Now I'm
encouraging poop to move towards or I'm encouraging the
nerves to be healthier. Final one is your cecum, where
your small intestine meets your large intestine. And it's the mirror
(47:45):
of our first one. We push to the right and pull over
three to five times, Doing that
relaxed breath frequently throughout the
day. Doing that colon massage two or three times a
day. And then when you move, exhale
with exertion. Exhale as you log roll to the side.
(48:08):
Exhale as you push up to the edge of the bed.
Exhale as you stand up. That's going to help the deep
tummy muscles. Do the work so that the pelvic floor can
stay a little bit more relaxed. And then when you
do exhale, when you sit down on the toilet, you might have an
elevated toilet seat, which is kind for your, for the core
(48:29):
muscles, but when the hips are kind of
lower than so. So the ideal poop position
is that my knee would actually be like higher than my
hip. So if we're on an elevated toilet seat, we might ask a
caregiver or a nurse to bring in a stool to rest our
feet on. So we have more of like a 90 degree angle. And
(48:50):
then we could put, typically we say pillows, but
honestly that they're not, they're a little soft. So if the nurse could
bring in like an extra set of sheets that have like a little bit more
firmness to them and I'm sorry I don't have one with me right now because
I didn't think we were going to talk about poop so much. Woo hoo. But
we would sit on the toilet, elevate my knees up a bit. Those of you
(49:11):
that are here watching, I'm giving a great visual demonstration.
And then we would push the towel, the, the folded
sheets kind of against the low belly while we just tried to breathe and
relax the pelvic floor and, and that's setting
up the system as much as possible
to push that poop out. And essentially we never want to
(49:33):
strain ourselves. And the medicines that you need
to clear, you will need the stool
softener in general to have that happen. So if you do have
then the poop emergencies and the poop accidents,
if we needed that drug to get the poop out, it is a
common thing that might happen in the ICU or in, you know, the
(49:55):
transitional. And just know that the nursing staff is there to help
you. Don't be embarrassed. And then
the next poop, as we wean off of those, we can do all of those
good things that we just talked about. And pooping your pants, vomiting, it's all
super stressful. So again, just coming back to can I just belly
breathe? Can I tell my body this is super fricking hard and this
(50:17):
sucks, but thank God I'm alive. And can I
experience all of these feelings while relaxing my pelvic
floor? While understanding that that collateral damage of the pelvic
floor tightening is going to happen in response to all of this.
So let's soften it. Oh my gosh. Game is everything.
Wow, that was Quite the initial
(50:39):
101. Yay.
You guys are so welcome. And I know it's a lot, but we're going to
do a lot more segments together for this February Heart and Pelvis Month. Pelvic
Floor.com is the website where we have lots of blogs that
are getting repopulated. There's going to be more and more dropping each
day. Instagram
(51:01):
therealpelvic Floored I take my job
seriously and not myself, so I have a bunch of
silly videos about all things pelvis.
I have a small newsletter that's getting a big revamp in
2025. Please access all of that
information. We're going to do a lot more talks, but whatever
(51:22):
questions you have for Boots and I please submit them because you are not
alone. You are not the only person with this question so you asking that question
is going to help so many others. You can work with me in
person or online or I have a great blog about how to find a pelvic
physio near you. That's amazing. If you have questions
again, send us a message. Here's where you live, here's what you're wanting help with.
(51:44):
I'm happy to physically help you connect with a pelvic PT in person near
you. And then lastly, I do have online
resources. There are some courses that you'll see as well as a newfound
Treasure Channel chest that has a little bit more in depth information
and exercises than the Insta and Boots and I as
gratitude for you guys being here, you can use the coupon
(52:06):
OHS2025 for
25% off any of those online programs. And if you
did do the Treasure Chest that would give you 25% off the first
three months. So I sincerely hope that's helpful to
to you Boots. Thank you from the bottom of my heart for having me here.
This is so fun. I cannot wait to talk about poop
(52:29):
more. I love talking about poop and to talk about
erectile dysfunction as a primary risk
factor for major cardiac event and. So much more
and so much more. So if you are in hysterics
now, just wait for the rest of the month. We can
Talking about poop and sex and the vag and
(52:51):
penises can be fun. It can be. It doesn't have to be shameful.
So be sure to come back next week. I'm so excited
and I love you. You matter and
your pelvic floor is your best friend along with your heart. Come
back next week.
A poop problem. Right. If the doctor knows about pelvic
PT, which again, there's. Our success rate is 80%.
So we can help four out of five people that come into our door with
pee problems, prolapse problems, sexy time problems, poop problems we can
help without medication and without any nasty side effects of surgery
or medication. The one out of five that we can't help,
(00:25):
we educate the shit out of you so you now understand
your pelvis and you are essentially prehabbed for
success. Welcome to Open Heart
Surgery with Boots, where this February we're going
below the belt. That's right, we're diving
into the surprisingly connected world of heart surgery
(00:47):
and pelvic floor health in this five part series
series. Join me and our special guest expert, Dr.
Kelly Sudakis as we talk about everything you're too
embarrassed to ask your cardiologist. From what makes a
happy pelvis to getting your groove back after
surgery, to yes, even the great post
(01:09):
op poop debate. With candid
conversations, practical advice and plenty of laughs,
we're exploring the ups and downs of recovery.
Because let's face it, healing happens from top
to bottom. So buckle up for some real talk about the
parsif recovery nobody warned you about.
(01:30):
Hello, welcome to Heart Month on Open
Heart Surgery with Boots. I am your host, Boots Knighton.
Please give a gigantic welcome to
Dr. Kelly Sudakis who is coming at you
today from Drake's Idaho. I am down in Victor,
Idaho and Kelly and I have
(01:52):
known each other for quite some time and both of our
lives have taken all kinds of interesting and winding paths.
And here we are today and for the month of February
to bring you a whole series on the
pelvis and
and I cannot be more excited. And this is coming
(02:15):
on the heels of my four year anniversary of
open heart surgery. Oh my gosh, I can't believe that
Boots. And I
am just astonished that just now
at four years, I am finally learning about
what it means to have a pelvis, to take care of the
(02:37):
pelvis, what is a healthy pelvis? Because
lo and behold, thanks to you, I just recently
learned that open heart surgery affects the
pelvis and pelvic health. I wanted to bring you
on for the whole month of February for Love month
and Heart Month. Love Month. What is
(03:00):
more love than the heart and the pelvis, right?
Like the two primary pieces in Love month. So
thank you so much for having me boot. So a little more
about me, guys. I am a pelvic health physical
therapist. I have been in pelvic health my entire
Career, which is about 25 years now.
(03:23):
And I feel so blessed.
And in this calling, I really do consider it a calling to
reach people and helping people understand their
pelvis and their pelvic health, and helping them pee better and
poop better and have more fun in the bedroom. When you
can help someone with those things, you help them on a such a
(03:45):
deeper, more holistic level than just helping them with their shoulder
pain. So it's been such a personally fulfilling
journey. As with many other pelvic health
pts. Probably about 10 years into my career,
I was feeling a little overwhelmed and burned out
with patient load and having a huge wait
(04:06):
list and dealing with the insurance game. And so many people needed my
help. And I often had a wait list of two to
three months for people to come in to get help from me. And we'd
often help them in just one or two visits. So I began to think,
how. What can I do to reach more people? And
through a circuitous, amazing
(04:28):
journey. In 2020, I launched
Pelvic Floor with the vision to change the
world one pelvis at a time, starting with you
and how we're going to do that. The mission is to reduce
geographic financial psychosocial
barriers to accessing this information about pelvic
(04:49):
health. And boots, four years into your journey, you're
just learning about this. I meet physicians that are
50 years into their successful medical practices that have never
understood the relationship of pelvic health to
the whole body, you know, and so you are actually ahead of the
game for most. And I am so grateful that your listeners here are going to
(05:12):
get to learn about the pelvic floor and the heart
here in February, heart month. Oh,
today, though, like, before we get into all those deets, this is like, you
know, pelvic floor 101. Like, what the heck is a
pelvic floor? Right, right, right. Yeah. What
is it? And so, listeners, I've asked
(05:34):
Kelly to just treat us like we are
starting from scratch and treating me like I
have just shown up in her office for the first time and we're going
to take it from there. So this is like, we're not skipping over
anything. I have not seen Kelly for my pelvic floor, although
I do need to. And call me. I'm just going to be
(05:55):
overt about that. And that is okay. Like, this is going to be a
series of it's okay to talk about weird and
awkward things. It doesn't have to be weird and awkward, but
if we're thinking about one of the impetus of me starting this
podcast was. I didn't learn. I didn't get
instructions on how to heal completely from open heart
(06:18):
surgery. It was only focused on the heart and the
chest. And it didn't include the emotional, spiritual aspects. And it
definitely didn't include the pelvic floor. It didn't include
nutrition, which is why I had the whole series in October of
2024 with Michelle. And so the whole point
of this podcast is to help you find healing mind,
(06:40):
body, spirit, head to toe, front to back.
Amen, sister. So we're starting from scratch.
I'm starting with you listeners, so. All right, Kelly, I just
love it. Your office. I love it. Okay, let's dive
in. So if you were seeing me or another pelvic health physio
(07:02):
in person, we would do a detailed medical history about
everything that's gone through, everything you've gone through in your life, right? What
surgeries have you had, et cetera. We would
dive into, if you have a vagina, into your menstrual history
as well. When did your periods start? How regular were they? Were
they painful? We then are going to ask
(07:24):
questions about pee, poop, and intimate
functions, regardless of what type of pelvis you have.
And based upon those
answers, then that guides the
rest of the visit. So, Boots, you and your listeners, we're going to
just go through, number one, what's normal, and then we're going to
(07:47):
talk about the anatomy and, like, how of the bones
and the muscles and how they work to provide
that quote unquote normal function. And then
we'll get to the nitty gritty of what's not normal.
And, you know, what's not normal might be ludicrously common
in this world of pelvic health, but that doesn't mean
(08:09):
that we have to deal with it. Right? The, the incidence of pelvic problems.
So pelvic pain, problems with peeing and pooing, it is the same
incidence as back pain in the world. Eight out of 10 people
will suffer from some type of pelvic problem in their
lifetime. But here's the thing. When you have back
pain, the average time that it takes you to get care
(08:32):
is two to three weeks if it doesn't resolve. If you have a
pelvic problem, pain, pee, urgency, pee
leaks, poop problems of constipation or loose poops, sexual
problems. Your average time before you seek
care is five to seven years. And I would
honestly argue that that's five to seven years for someone with a
(08:53):
vagina. And someone with a penis might even go longer than
that for a multitude of reason. Reasons. And it's because
we think it's a normal consequence of aging. It's because we're ashamed and we
feel alone. And then worst of all, if we go to ask
for help and we're told by a medical provider that it is normal
and it just stops our ability to progress, which is so sad. So I'm
(09:16):
so grateful to be here to talk to you about these things. To number one,
improve awareness. Number two, encourage you to get your cute butts in
for help. And then, number three, we might even save some
lives by learning about a few pelvic changes that are shown
to pre. I exist before
heart issues. Oh, my gosh. Are we
(09:38):
ready? I am so excited. I feel like I
need to get, like, school supplies ready. And like.
Yeah, and we're going to be saying
penis and vagina and sex, like all the.
I mean, it's all the words that go with the pelvis. And I hope
you are listening to this and you're already, like, feeling
(10:00):
squeamish. I invite you to sit with the discomfort
because what I really want for you is complete and total
health. And that includes your pelvis, and it includes your
vagina and your penis. Can I say that? Yes. Yes, girl. And we.
We should do a whole nother talk about, I think the Latin origin of
the perineum is like that. That shall not be named
(10:22):
or something. Oh, my gosh. So then there's a whole nother talk about, like, purity,
culture and stuff. But we'll. That. That's for later. So first and foremost,
folks, what is normal in the pelvic floor? Because
to understand what's not normal, we need to start with the basic ground rules of
what is normal. Regardless of your age,
regardless of what parts you have in your pelvis,
(10:45):
we ought to pee on average once every
three to four hours while awake. And when we
pee, it should be preceded by a
gradual urge to pee, never a freight train.
Hey, get your butt to the bathroom right now. No, no, no. It should
start as a whisper that gradually builds up that we
(11:06):
eventually listen to on our own terms when we
start the stream, it should be very easy to start the stream.
To maintain the stream of pee, that stream should last
at least 10 to 15 seconds of a nice healthy stream. Per
pee following the stream, we should either give it a
wiggle or a single wipe and be able
(11:28):
to stand up if we're already standing, tuck things in, have
no post void dribbles, and then the cycle
resets. There should never be any Pee
leaks. There should never be any leaks associated with
urgency. Jumping, laughing, coughing, sneezing. That
should really never happen. Hmm. When we
(11:49):
finish peeing, we should feel satisfied. We should not feel like it burns
when we pee or that it burns afterwards.
In general, we should actually sleep through the night without awaking,
awakening to pee. And this is something that is considered
normal as we age, or doctors will even say it's normal during pregnancy to get
up at night to pee. And I would beg to differ. Like maybe we'll give
(12:11):
you one pee a night by like your third
trimester because then baby actually is settling down,
possibly in the first trimester because of the increased blood
flow. But in general, I want you sleeping. The
importance of sleep for overall holistic health cannot be
overestimated. And I want you to sleep whilst still
(12:33):
being hydrated. So yes, there are a few caveats within
this and I don't want you to dehydrate yourself
at all because hydration is important. So if I go through my whole day and
I haven't drunk enough water and I drink 32 ounces right before bed,
bed, in that particular case, I might need to pee at
night and it's better to be hydrated and wake up once and pee.
(12:55):
But if I'm only drinking 30 ounces during a
whole day, like that is woefully inadequate. I should not,
and I should not be waking up to pee that night. But I might be
because I might be dehydrating my bladder, but I'm getting ahead of myself a
little bit. And so all of that P function
should occur with us drinking this normal
(13:17):
amount of water which we take our body weight in pounds and we
divide it by two. So I weigh 160 pounds, so
I should be drinking at a base level 80 fluid ounces
every single day. 75% of that should be non
caffeinated, non alcoholic. Really. Alcohol
is just a chemical shitstorm. Like we should all be avoiding it at all
(13:39):
costs. And then if I am living in a high,
dry mountain climate, if I'm exercising, that base amount
needs to go up a little bit. So am I
having all those normal P functions while being adequately, hi
adequately hydrated? That's a really important thing to
check. Poop. The same muscles that
(14:01):
control the P function also control poop function. So what's normal for
poop? Poop has a little bit wider range. We
should poop anywhere from three times a week
to three times a day. And it needs to
be soft formed and non emergent.
As long as it's soft Formed and non emergent. We
(14:24):
sit down, we hopefully elevate our feet
up on a little stool, we relax our pelvic floor and
our colon pushes the poop, poop out. In
heart health, specifically Boots, this is a big deal.
If we strain to push poop out, we could
bring on a cardiac event. Not okay.
(14:48):
But in general health, it's just your bladder pushes your
pee out, your colon pushes your poop out. And if you have a
uterus and you're pregnant, your uterus pushes your vagina out or your vagina.
Oops. That was an oopsie. Your uterus pushes your baby out. And
if we're straining, then we actually can push other
stuff out that's not meant to come out like a hemorrhoid. We could cause a
(15:11):
bladder prolapse, we could cause some pee incontinence if
we're always constipated and pushing poop out. So that's
important. When you poop, are you able to sit down
and relax and have that poop happen? Like I'm in under one minute,
honestly, in general, and then it's
one or two wipes and we should be gone. We should be done. Like it
(15:33):
should not take half the roll of toilet paper to clean
up. And if it does, that's something that's called smearing and that's again
abnormal, something we can work on. And I have to
object that I do know someone know
of someone who died of a cardiac event on the
toilet at work. It was so sad.
(15:54):
Right, right. And we'll talk about that like, and like, yeah, if
we don't talk about it today, we're going to talk about it in one of
these segments. But like it's a big deal and it's something that we need to
talk about first and foremost from a primary health perspective. But
secondly, your listeners, this is open heart surgery with Boots.
So people that are here, we have a vested interest in managing this
(16:15):
arterial pressure. So if you've been a terrible pooper your whole
life, guess what, it's time to change. And it can get better.
And especially in the post surgical phases with
the medicines. Oh my gosh. Like, we really need
to understand what goes into poop. The whole
poop section. Again, there's so much we can do
(16:37):
nutritionally and hydrationally and musculoskeletally
to set you up for poop success. And the
greatest thing about all this is it's going to be overwhelming for some of you
listeners and just please don't be overwhelmed. You have access to this you can watch
this a zillion times. Take notes. You'll absorb what
you're ready to absorb. The same
(16:59):
specific and simple things that will help improve the pee
function, will improve the poop function, will improve the bedroom
function. So please just be kind and curious and not
overwhelmed with all this, because this is a lot of stuff that we're going to
cover in 30 minutes. Okay?
Sexy time. The bedroom is for two things.
(17:19):
Sleep and something else, my friends. And
something else. The intimacy. It should be pain
free, unless you want it to hurt,
but that's a whole different talk. But
intimacy should be pain free at the start.
You should be able to experience a pleasurable
(17:41):
rise to a climax, which should also be enjoyable and
pain free. And we should have no pain
afterwards. There should be no leaking of pee
or poop during intimate functions. And we
should not regularly have urinary tract
infections following. You know, there are some basic
(18:02):
things that, you know, with hygiene are good to follow.
But if you're always getting a UTI every time after you're intimate,
there's probably something else going on. And we're going to talk about
that in a moment. Oh, and you know, if you
are still menstruating, if you have a vagina and you're menstruating,
this is going to blow your mind. Period should be pain free.
(18:25):
What? Complete. Yeah, the.
Yeah, think. I'm just thinking about how
it is just. I'm just thinking about all my years. Like
I've been. Hold on, I just need a second. I know, right? I
know. Me too. I. So I am a double board certified doctor of
physical therapy, one of like 100 doctors of physical therapy in the world,
(18:47):
double board certified in pelvic health and orthopedics. I just
learned this less than 10 years ago, that periods are supposed to be
pain free. And I didn't even believe it when I think maybe even five
years ago, because my boobs have hurt my whole life
until I learned this. My labias, that's like the part you can see on
the side of the vag. Like, those would always be very sore. The second day
(19:09):
of my cycle made a few specific changes.
And pain free. It's insane. And we
don't know this. We normalize pain for women and it's not
okay. And when we can do things to control the
pain, which again, are a lot of the same things that I'm gonna talk to
you about, we can make your periods pain free. And if we
(19:31):
can't, and especially if they're debilitating, that can Be a
sign of a condition called endometriosis, which is something totally
separate. And you need to get your cute butt in for appropriate
treatment. There's a study of women, younger
girls, who ever missed school or work due to
period pain. Almost 100% of them have this condition called
(19:52):
endometriosis, which, which is super debilitating. And we are like, oh,
it's just period pain. And we, we just shove them. Oh, just take this
medicine. It's like, no, listen to them. This is a huge deal.
Well, and I was thinking about all the marketing from like the
ibuprofen, Aleve, Motrin, and.
And it just seems like it's just accepted. And that's just how it is. And
(20:16):
so you just have to take this and then that will make your periods better,
you know, and just how. I think I've had my period for maybe 30
years now. And I just assumed that that was just part of
being a woman. That's so infuriating. I know, right? Isn't it?
Isn't it? So we can. We'll talk about the things that we can do to
change that. So that is the basics of, like, what's normal.
(20:38):
Now, if you were coming to see me one on one, we would touch very
lightly on each of those. I would have on your intake,
though, your chief complaint, your reason for seeing me. So I might spend a
little bit more time on one of those items than the
other. We would then go into educating to the muscles
of the pelvis and the core and explaining how those
(21:00):
things happen. So we would begin with the bladder because
pee urges and pee leaks are one of the primary reasons that someone might come
to a pelvic floor. Physical therapist and your bladder. And
for those of you who can see this on video, we have your cute
little bladder here that kind of rests upon
a shelf that is the pelvic floor.
(21:23):
And that shelf, I'm going to hold up Patty, the pelvis here,
who is an anatomical model of the pelvis.
And essentially, white parts are bones, red parts in
general are muscles. And we have the bony
pelvis is like the structure of the house, the
drywall. You've got your low back in the very back,
(21:46):
and then you have a ring of pelvic bones that are made
of your two hip bones and your sacrum behind that
kind of form, this circle, right? That's base of your core.
You have tummy muscles that help dynamically
support this pelvis in the front and kind of connect the two
pelvic bones. You have butt muscles that go from the back
(22:09):
of your hip bones to your leg bones and back.
And, and from my humble perspective, most
importantly, you have this incredible hammock of
pelvic floor muscles that form the bottom of this
bowl. And those of you that can see, I know, right,
they go from the front of your sacrum all the
(22:30):
way to the back of your pubic bone. That is
quite right. And get this girl and
boys, everyone who's looking and watching, it's not just one
muscle on the bottom, it's a whole
group. And I highly recommend if you can check out the video
to do so at this exact minute, it's more than
(22:52):
13 muscles on the right and the left. Just like
you have right legs and left legs and this one here is a
vad. You can see the two holes, but penises are not that different
really. It's just this top hole is kind of closed. But they're mostly all the
same muscles internally, they all have different
roles. Constricting the urethra, the P
(23:13):
zone, elevating the middle of the perineum, which is that
muscular middle support controlling the rectum and back, helping you keep your
balance, right? And like what, it's
amazing that they ever work in the first place. And
truly. So you've got this cute little bladder resting
on that hammock and, and in real life,
(23:36):
this is the. And already right now, you listeners, you
boots know more about your pelvic floor muscular
anatomy than probably most primary care
providers. Just from this last three minutes, just. From that
last three minutes. Because most primary care providers in medical school
got one lesson on the pelvic floor that was taught by possibly a
(23:57):
pelvic floor physio, possibly just a physiological. And
then they went on to, quote, unquote, more important things,
right? They went on to medicines to help save lives, to
surgeries to help save lives. So this is not to minimize or say that they're
missing something, but they just had to go down a different road and they
never got this education. And now you
(24:19):
are though, and so you can be your own advocate. All
right, so we've got this cute little bladder resting
upon that hammock of pelvic muscles.
And the pelvic muscles are like an elevator in
a four story building. And they're
meant when they're super happy and healthy to rest on the ground
(24:42):
floor of this four story building. And then
with day to day life, the brain should automatically
decide how much muscles to use when you stand
and walk and run and pick up your groceries. And it should decide to
bring the Muscles up to that second, third, fourth floor and
back down again. When we sit down to pee or
(25:04):
poo, it should know how to relax them into the sub
basement and then come back to that ground
floor again. They're kind of like always on standby.
Pelvic problems, including leakage,
they primarily occur not because the pelvic floor is
sloppy and loose and open,
(25:26):
but because, for a variety of reasons, it starts to
rest too tight.
There's your second big mind blowing thing of the
day. Because for most humans, when you start to have
any type of pelvic problem, we are going to
do Kegels, and that's totally the wrong thing to do. Kegels
(25:49):
are the least important part of the pelvic perspective, and they will
typically make PE leaks, make pain, make sex
worse. Whoa. When I hear
that, that's like the main treatment for everything. And
who told you that? Yeah, I mean,
I. You just. You just know. Yeah, you
(26:11):
just. Isn't that funny? You just know. But here's the dirty
truth about Kegels. People were just told to do
Kegels because, oh, if you're leaking, yes, clearly the
pelvic floor must be weak. So you should tighten them in the 80s.
So this is the 80s. There's not even cell phones yet. All phones are still
connected to the walls. Right. There was a landmark study by
(26:33):
Bump et al that told people
to do Kegels. Then they followed up and they found
that just telling someone to do Kegels, if you had 100
people, by sheer luck, 1/4,
25 of those people would get better. However,
the same amount, 25%, would actually get worse and
(26:56):
half of the people would not see any change. And
that's because there was no actual education
connection to the muscles. So let's bring it back
to our elevator analogy, right? The
way the body reacts to pain,
dysfunction, and stress. And boots
(27:19):
your comment in the opener. In your open
heart surgery journey, you were not treated holistically. You did not
receive this education into what happened. Beyond the physical
heart. The pelvic floor has a direct connection
to your amygdala, which is your emotional center of
your brain. If we show a college age woman with
(27:41):
no history of abuse or stress.
Stress beyond life. A picture of a dark
parking lot. Her pelvic floor will clench because it senses the
potential for danger. Whoa. This is a survivalistic
standpoint. If we are physically stressed, emotionally
stressed, the amygdala tightens. The pelvic floor brings
(28:03):
this elevator up to the second or the third floor as a
sympathetic fight or flight response to help us get ready to run away from this
tiger. Right? And now like, what is.
And heart surgery is stressful, My Lantai. It's
stressful, right? Life is stressful.
That's going to start to bring this up to the second floor. And it's something
(28:24):
that happens that we're not cognizantly aware of. Right? So, so we
don't. If I say, relax your pelvic floor, you think it's already relaxed.
So now I'm resting on the second floor here. My pelvic floor is doing too
much work all the time. That's going to irritate my
urethra, that's going to maybe annoy my bladder, so it
starts to send a more urgent signal. And depending on
(28:46):
everything else that's happening upstream, that
now that these muscles are doing too much work all the time, they might not
have energy to hold my pee in when I need to
and I might start to pee my pants. And now we
have this like net downward spiral. Now that's stressful.
I might, because I quote unquote know that I'm supposed
(29:08):
to do Kegels, I might try to tighten up more. And now,
now I'm resting on the fourth floor and lo and behold, my urges and my
pee leaks get worse because the problem's not that my muscles are
so loosey goosey that I'm. I've been in a wall sit for
18 years and now I'm asking myself to go run a
marathon. Like, it's so sad.
(29:29):
Well, and I hate wall sits.
And I have. And I have really silly Instagrams. I'll get you the links
that we could put under about how these tight muscles can cause
leaks, but they also cause pelvic pain
with intimacy because they close the door. Essentially, they cause
us be to be unable to climax because the muscles that are
(29:51):
associated with climax are high performance muscles. So if they're
not healthy, we're not going to be able to build into a climax. We're not
going to have one. If we have a penis, we might not be able to
have an erection. And that's a huge deal that we're going to talk about in
the next segment. It's an independent risk factor for major
adverse cardiac event, period wise. Guess what? Are you
(30:12):
ready for your third mind blowing topic? Okay.
It's been mind blowing for 30 minutes already. Like, oh no, it's already 30 minutes.
What? We might have to divide it into two. Not just saying all of this
has been mind blowing. So. But we need this Is why we need to talk
about it, because there's so much. Right. So here's these sweet pelvic muscles
again. For those of you that can see, I just showing the. The. The in.
(30:34):
I'm inside the belly, looking down. There's all these different pelvic muscles. Here's a
vag. Guess where these muscles. I'm pointing to the muscles kind
of on. I. Oops. That was the rectum. I'm. Trust me, I'm a doctor. Here's
the vag. These little muscles on either
side of the pelvic floor. You know,
if you have a heart attack, where do you feel the
(30:55):
pain? By common knowledge, boots, Is it in your heart or
is it. Could it be elsewhere? Well, the two I've had,
yes. My left arm, the first one. My left arm, my
chest. But the second one here was. Here's the crazy
part. The second one, I had no pain, but I had
stopped peeing. No. Oh, my gosh. Okay. That's wild. I
(31:18):
can't wait to dive in. So first one, had we worked on your
arm, it not only would not have helped, but you might have
died. Right? Like. Like not understanding where the pain was
coming from. These pelvic floor muscles that live on
either side of the vagina and then even further back towards the rectum, their
referred pain pattern, they don't tip it. They could hurt in the vulva.
(31:41):
Sometimes they could hurt in the pelvic floor. They're more common.
Referred pain pattern is the lower abdomen.
So that's where your period cramps can come from.
In the absence of endometriosis, the pelvic floor resting too tight.
During the period process, there's increased inflammatory chemicals.
Everything's resting just below the pain threshold. Here comes the period. Here comes the
(32:04):
chemicals. Boom. We cross the pain threshold, and we can put a hot
pack on our lower bellies as much as we want. And it might help a
touch, but we actually need to do is relax. The pelvic floor,
dude. Wild, right? I know, I know. And then the third
hole moving backwards, you know, is the rectum back there. So we have
that sweet rectum. Where. Where's my rectum gone
(32:27):
to? There it is. Found
it. Does it have a name? Because we've got Patty Pelvis.
Patty the rectum does. I have Patty the pelvis. And it. It
alternates between Peter the pelvis and Philip the pelvis. The rectum
doesn't have a name, though. I should name it Randy. Randy the
rectum. I.
(32:49):
All my friends named Randy out there. Just going to Tell them that I just
named my rectum Randy. Yeah, yeah, you heard it. You heard it here
first, people on open heart surgery. Boots. Yes,
Randy. Yes. Ran random Randy. The rectum has been named
and I like it. We're keeping it. So you got the rectum back
here. And remember that hammock of pelvic muscles, right?
(33:11):
Same thing happens back here. It's meant to rest on that
ground floor, come up to support our pelvic pressure during
life, relax to give the on switch
to the colon to push the poop out when
that pelvic floor starts to elevate in response to
life stresses, in response to physical pain, in response to,
(33:34):
oh, gosh, I'm having pee problems.
Now we not only have the problem that it's much
harder to relax and open the door to give the on switch for the
colon to push the poop out, we're also engaging a
backwards reflex called the rectal anal inhibitory reflex.
We'll talk about this in the poop one. But we're engaging a reflex
(33:56):
that the brain thinks we're running away from a tiger and we don't have time
to stop and poop. So the brain's going to push the poop back up the
tube to give us a little bit of time to escape the tiger.
But that's meant to be like a very short term solution. So
what if we're resting up on that second or that third floor for days, weeks,
months, years on end, our poop is always getting this
(34:17):
negative signal. And so that's going to elicit,
typically more of a constipated trend. So the
poop's going to be harder to come through. It's going to be harder for us
to relax and give the signal for the colon to push out.
And then if we're straining to force the poop
out now there's all the other problems, the collateral damage, so
(34:39):
to speak, for the heart system and for the pee and the vag, if
we have one. Right. So the key in all of
this is to, number one, understand that because before
these last 30 minutes boots, have you known any of
this? None. And you
are a very educated woman and you are in
(35:01):
this heart surgery world and you're an active human. And
like you, you've had a period your whole life. So isn't it just mind blowing
that we don't know this? Well, I mean, I think how
unfair it is. It just leads to so many
unnecessary mind, body, spirit
issues that could be so
(35:23):
avoided. And, you know, just, just to like, talk about how I'm
educated. My undergraduate degree is in biology.
My graduate degree is in education. I
taught high school science, so it's not.
And I also taught at the collegiate level. I'm naturally
curious. I'm almost 47 years old and I
(35:44):
am just now learning this. So I just want to lay
the groundwork of really, what the
fuck? Exactly, exactly. And you
think about what happens. So we look at all these studies about
that gap in care that like, for most people, they're going to wait at
least five to seven years before they talk to a physician about their
(36:07):
pee problems specifically. And then depending on that
physician's education, like, what are they going to do?
Like now, if that person isn't watching this podcast, if they're not
following me on social media, what if that physician's like, oh,
here's a pill that's going to like, let's
say it's pee urgency, that's going to calm down your bladder. Does that
(36:29):
fix any of this musculoskeletal stuff? It doesn't.
And it's not without risk. There is the same things that that pill
works on to relax your bladder. It interferes with your cognitive
function. And people don't know that. There's not like, informed consent. A
poop problem, Right. If the doctor knows about pelvic
PT, which again, there's. Our success rate is 80%.
(36:51):
So we can help four out of five people that come into our door with
pee problems, prolapse problems, sexy time problems, poop problems. We can
help without medication and without any nasty side effects of surgery
or medication. The one out of five that we can't help, we
educate the shit out of you so you now understand your
pelvis and you are essentially prehabbed for
(37:13):
success for whatever that next step might be. And we can help
guide you to, hey, based on our experience, this should be
the next step because surgeries are not always bad. Open heart surgery
saved your life, prolapse surgery, bladder surgery, sometimes you need a
colon surgery. They're all amazing in the right place. But
just like you would never have a knee surgery like
(37:35):
an acl and then be like, oh, well, just rest six months, you'll
be fine. Like, you'd maybe survive, but you would not
thrive. You should never have a pelvic procedure.
Ideally, we'd always have prehab. But you should never have a pelvic procedure
without post operative pelvic floor physical
therapy. And that includes appendectomies,
(37:56):
gallbladder surgeries. That includes open heart surgery. I know it's not a
pelvic surgery, but it's a whole body surgery, and so that
should be a part. And it's not yet a standard of care. But
we just talked about what happens to the pelvic floor in response to
stress. Right. There's not much more stressful than open heart
surgery. I just wanted to interject in that because. And I'm going
(38:19):
to get real personal here for a second. Yeah, yeah.
I'm thinking post op for me. And if you, if you're
just now finding this podcast, first of all, I'm tickled you're here. You're here.
Thank you so much. And I hope that you will
subscribe and you'll visit our Patreon and you'll go back and
listen, because I've been building a whole network of
(38:41):
resources for you heart patients and
caregivers for, for thriving post surgery.
But I, I bring that up because I want you to go back and listen
to my story in episodes one and two. And I
definitely talk about the first few days of just
how my body needed to purge. And one thing I wanted to bring up,
(39:02):
you know, I. I threw up 25 times post
sternotomy, which was just hell on earth. But
then I obviously couldn't poop. And one
question I have for you, Kelly, is, you know, you hear about
post surgery, you can't poop. And granted, I had the
P tube in for a few days getting the fluid out of me, and that
(39:23):
was fine once it came out, but I couldn't poop and
I needed to poop. I knew I needed to poop. And so then I drank
a diuretic. But then I made it.
I. Then I couldn't control it. And so I just like to
say I took advantage of all the CNAS on the floor.
(39:43):
That's why they're there.
Exactly. But it was like such an
intense experience. And if we, you know, in these last few
minutes of this first installment talk about that,
because, yes, it is so important to poop post
surgery because I. I have two
(40:05):
pages, single spaced, font size
10 list of all the medications that were put into my body
during open heart surgery that needed to come out.
Right, Exactly. No, this is such an important part of
the discussion Boots. And we should do, you know, we'll do like a whole thing
just about pooping, but in general, the key things that
(40:26):
you can do, there is a very simple,
easy belly massage that we could start. And we
honestly should start these things that I'm about to say we should start them
pre open heart surgery as well, because they are all going to be things to
help connect to this pelvic floor and calm it back
down. The one additional part that also contributes to that tight
(40:47):
pelvic floor, beyond the physical stress and the emotional stress of the
surgery. Breathing, Right. How after a
sternotomy, how was it to breathe?
Suzanne, you had respiratory therapy, right? Like so.
Yeah. Breathing's hard and we're not going to get into too
much except to blow your mind. A fourth, possibly final time of
(41:09):
this talk. The pelvic floor muscles are an accessory
muscle of breathing, which means that in their. Yes,
that in their perfect state, when we are relaxed and those cute
little pelvic floor muscles are down here, I got Randy the rectum. When they're
down here on the ground floor, we're totally relaxed. You breathe
into your belly and your belly gets bigger and you exhale and
(41:32):
your belly gets smaller. Diaphragmatic breathing core of every
post open heart surgery, do they ever once say,
hey, tune into your pelvic floor as you inhale
and your belly gets bigger. Your sweet little pelvic floor is up here on the
third floor. Can we inhale? Belly gets bigger. Pelvic
floor drops towards the ground floor. Can you exhale?
(41:54):
Belly gets smaller. Pelvic floor stays
relaxed. That was never mentioned.
Of course it was never mentioned. And we are, pelvic pts are making great
strides in OB floors, finally coming in to
see women post baby, post cesarean. Hugely important. It
is just as important for us to start to have a presence on open heart
(42:15):
surgery floors and in the ICU or even collaborating with your
respiratory therapist. But that singular piece of
belly breathing, step one, again, pre heart surgery, we
are super stressed, right? If we are able to, if it's
not this emergency thing, we know this is coming. We're very stressed. Our pelvic floor
is going to be up here. So we owe it to ourself to do some
(42:36):
of that diaphragmatic breathing to stimulate your
parasympathetic nervous system, the calm the rest and digest
system to bring the pelvic floor specifically down
to not irritate the bladder or Randy the rectum
here. Now, so that's one thing is this belly breathing we can do and
we can start that as soon as we are out of
(42:58):
surgery. The second thing is a very simple belly
massage. And what will physically happen is at first you're going to
say, well, I can feel that belly moving, but I
can't feel anything back here. And that's just curious. We're
not angry that we can't Feel that. But we're simply curious. And that's going to
give our brain permission to try to find those nerves, because I guarantee they're
(43:20):
there for you. Um, in a future one, we'll go over the exercises, but just
being aware of that and possibly even sitting on a little rolled
towel vertically. So a little pressure on the vag or the
part behind the scrotum, a little pressure on the rectum. Inhaling, try
to encourage those pelvic muscles to come down. Is huge.
Secondarily, belly massage. Um, those of you that can see
(43:42):
me, I'm going to stand up here. Here's my belly. You would have a
big old incision here. We would be laying down. And this is my
belly button. This is clockwise. I never
know what direction my video shows up. But we
would be laying down. Relax. And we would do gentle pressure,
gentle circles in a clockwise direction. This
(44:05):
is called sunflower massage and old
school, I love you massage.
Fine. It's better than nothing, but I'm going to give you something better. Old school
I love you massage is you would do an I coming up from
the right hip here, and then an L up and
over and then a U and. And that's
(44:27):
fine. And the theory is that you're helping to move the
poop through the tubes. I want to be very honest that
in real life, you're simply mobilizing the nerves and the blood vessels. But it has
an exquisite benefit. Okay, so you would
spend three to five minutes of this sunflower massage just
feeling your tummy. And it should feel like soft
(44:49):
bread dough. And you might get to a spot like right
here. Mine's not moving the greatest. Right there. That's
interesting. So if I was having any poop
issues, that would be good for me to just gently work on. We would never
poke into a spot that was sharp pain. If for any
reason you had any insertion, like, you know, any
(45:10):
ports in here during your surgery, then we wouldn't want to be doing this.
But in open heart surgery, we normally don't. But we would
do this three to five minutes of this belly massage while belly
breathing. Okay. Then we would follow it
with the PT version of digestive massage,
which is actually going to start at the outhole. So,
(45:32):
Randy, the rectum here. I didn't talk about this at first.
We just talked about where he was in relation to the pelvic muscles. He's
actually turned 90 degrees. So your
poop at the end of its journey through the tube has to make two turns,
90 degree turns, and that's kind of unfair. That's called your
sigmoid colon. But to clear that, you're going to
(45:55):
go find your left hip bone, you're going to come to the inside of
it. You're going to push in and then pull towards a
line between your belly button and your
pubic bone. So you're going to push in, pull here, and then release and
you're essentially clearing the sigmoid colon.
We might be pulling poop into the final holding
(46:16):
stage. In reality, you're massaging all the nerves that are going
to that colon and helping it move more freely. And
you're going to do that three to five times while belly breathing and trying to
relax your pelvic floor. And now we've
opened the door a little bit of the pelvic floor. We've softened
it to take the brakes off the colon. We started to move
(46:39):
here. Now we can push here. And this is something that if your arms are
tired, if this amount of pressure is sore from the sternotomy,
your A partner can help with this. You can use a silicone massage
cup three to five times, pushing downwards to
help the poop down the descending colon. And again,
in reality, just mobilizing all the nerves that are going to the descending
(47:01):
colon. We would then do transverse colon. And this
depends on how low our incision is. Right. So we're always going to be healthily
below the incision. And we could even have a second hand on the bottom of
it to make sure we're not disrupting that. And we would go three to five
times across. And it doesn't matter that my actual colon is like up here
and way back there. This is the nerves that are going to the
(47:22):
colon that we're working on, people. Then second to last is
ascending colon. I start at the lower right and I pull up
and the whole time I'm just any place where I've just created space. Now I'm
encouraging poop to move towards or I'm encouraging the
nerves to be healthier. Final one is your cecum, where
your small intestine meets your large intestine. And it's the mirror
(47:45):
of our first one. We push to the right and pull over
three to five times, Doing that
relaxed breath frequently throughout the
day. Doing that colon massage two or three times a
day. And then when you move, exhale
with exertion. Exhale as you log roll to the side.
(48:08):
Exhale as you push up to the edge of the bed.
Exhale as you stand up. That's going to help the deep
tummy muscles. Do the work so that the pelvic floor can
stay a little bit more relaxed. And then when you
do exhale, when you sit down on the toilet, you might have an
elevated toilet seat, which is kind for your, for the core
(48:29):
muscles, but when the hips are kind of
lower than so. So the ideal poop position
is that my knee would actually be like higher than my
hip. So if we're on an elevated toilet seat, we might ask a
caregiver or a nurse to bring in a stool to rest our
feet on. So we have more of like a 90 degree angle. And
(48:50):
then we could put, typically we say pillows, but
honestly that they're not, they're a little soft. So if the nurse could
bring in like an extra set of sheets that have like a little bit more
firmness to them and I'm sorry I don't have one with me right now because
I didn't think we were going to talk about poop so much. Woo hoo. But
we would sit on the toilet, elevate my knees up a bit. Those of you
(49:11):
that are here watching, I'm giving a great visual demonstration.
And then we would push the towel, the, the folded
sheets kind of against the low belly while we just tried to breathe and
relax the pelvic floor and, and that's setting
up the system as much as possible
to push that poop out. And essentially we never want to
(49:33):
strain ourselves. And the medicines that you need
to clear, you will need the stool
softener in general to have that happen. So if you do have
then the poop emergencies and the poop accidents,
if we needed that drug to get the poop out, it is a
common thing that might happen in the ICU or in, you know, the
(49:55):
transitional. And just know that the nursing staff is there to help
you. Don't be embarrassed. And then
the next poop, as we wean off of those, we can do all of those
good things that we just talked about. And pooping your pants, vomiting, it's all
super stressful. So again, just coming back to can I just belly
breathe? Can I tell my body this is super fricking hard and this
(50:17):
sucks, but thank God I'm alive. And can I
experience all of these feelings while relaxing my pelvic
floor? While understanding that that collateral damage of the pelvic
floor tightening is going to happen in response to all of this.
So let's soften it. Oh my gosh. Game is everything.
Wow, that was Quite the initial
(50:39):
101. Yay.
You guys are so welcome. And I know it's a lot, but we're going to
do a lot more segments together for this February Heart and Pelvis Month. Pelvic
Floor.com is the website where we have lots of blogs that
are getting repopulated. There's going to be more and more dropping each
day. Instagram
(51:01):
therealpelvic Floored I take my job
seriously and not myself, so I have a bunch of
silly videos about all things pelvis.
I have a small newsletter that's getting a big revamp in
2025. Please access all of that
information. We're going to do a lot more talks, but whatever
(51:22):
questions you have for Boots and I please submit them because you are not
alone. You are not the only person with this question so you asking that question
is going to help so many others. You can work with me in
person or online or I have a great blog about how to find a pelvic
physio near you. That's amazing. If you have questions
again, send us a message. Here's where you live, here's what you're wanting help with.
(51:44):
I'm happy to physically help you connect with a pelvic PT in person near
you. And then lastly, I do have online
resources. There are some courses that you'll see as well as a newfound
Treasure Channel chest that has a little bit more in depth information
and exercises than the Insta and Boots and I as
gratitude for you guys being here, you can use the coupon
(52:06):
OHS2025 for
25% off any of those online programs. And if you
did do the Treasure Chest that would give you 25% off the first
three months. So I sincerely hope that's helpful to
to you Boots. Thank you from the bottom of my heart for having me here.
This is so fun. I cannot wait to talk about poop
(52:29):
more. I love talking about poop and to talk about
erectile dysfunction as a primary risk
factor for major cardiac event and. So much more
and so much more. So if you are in hysterics
now, just wait for the rest of the month. We can
Talking about poop and sex and the vag and
(52:51):
penises can be fun. It can be. It doesn't have to be shameful.
So be sure to come back next week. I'm so excited
and I love you. You matter and
your pelvic floor is your best friend along with your heart. Come
back next week.
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