Ep. 464 Pelvic Floor 101: From Pregnancy to Menopause with Sara Reardon
- Team Cynthia
- May 10
- 45 min read
Updated: May 15
I am honored to connect with Dr. Sarah Reardon today. She assists women in caring for their pelvic floors as a doctor of physical therapy, a board-certified pelvic floor physical therapist, and a Women's Health Clinical specialist. She is also the Founder and Chief Vagina Officer of the Vagina Whisperer, an online, on-demand pelvic floor workout platform women at all stages of life.
In our discussion today, we explore the many contributors to the silent suffering of women, exploring advocacy and screening, pregnancy, the postpartum period, and the transitions of perimenopause and menopause. Dr. Reardon brings clarity to the often-misunderstood pelvic floor, shedding light on everything from vaginal and C-section deliveries and painful sex, to proper pooping and the impact of bladder irritants and incontinence.
Dr. Sara Reardon shares many practical and empowering insights today, and her book Floored, A Woman's Guide to Pelvic Floor Health at Every Age and Stage, is a must-read for every woman.
IN THIS EPISODE YOU WILL LEARN:
Why does much shame and secrecy exist around women’s pelvic health?
Why pelvic floor therapy should be a first-line treatment for women
How pregnancy and childbirth affect the pelvic floor
The link between pelvic floor muscles, constipation, bladder issues, and painful sex
How fatigued pelvic floor muscles can lead to bladder leakage
Common signs of pelvic floor dysfunction
Helpful strategies for healthy bowel movements
How birth and emotional trauma can affect pelvic health
Red flags that indicate the need for medical evaluation beyond pelvic floor therapy
Top tips for pelvic floor health
“We need to rehab moms during their postpartum period just like we rehab someone after surgery."
-Sara Reardon
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Sara Reardon
On her website
Directories: PelvicRehab.com, Academy of Pelvic Health
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness podcast. I'm your host Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today I had the honor of connecting with Dr. Sara Reardon. She's been caring for people's pelvic floors as a Doctor of Physical Therapy, Board Certified Pelvic Floor Physical Therapist, and Women's Health Clinical Specialist. She's also the Founder and Chief Vagina Officer of The Vagina Whisper, an online on demand pelvic floor workout platform for all stages of women's lives.
[00:00:53] Today, we spoke about what has contributed to women suffering in silence, the role of advocacy and screening, the impact of pregnancy, the postpartum period, perimenopause and beyond, as well as vaginal and C-section deliveries helping us define what exactly is our pelvic floor, the impact of bladder irritants as well as common symptoms of under and overactivity of the pelvic floor, the impact of incontinence, why pooping properly is so important, why painful sex does not need to be our destiny, how tissue scar restrictions can impact movement as well as blood flow of the skin and last but not least, her top tips for supporting our pelvic floor health. This has been a truly invaluable and insightful conversation and Dr. Reardon's book, Floored should be part of every woman's library.
[00:01:47] Dr. Sara, welcome to the podcast. I've been so looking forward to this conversation and for any listeners that are not aware of your work, you are helping to destigmatize conversations and work around pelvic floor health, which is so important. There's not anyone listening to this podcast, irrespective of age, that cannot benefit from this information. This is a vital conversation.
Dr. Sara Reardon: [00:02:10] Thanks so much for having me, Cynthia.
Cynthia Thurlow: [00:02:11] Absolutely. What do you think has contributed to women's suffering in silence? And I don't say that lightly. I really think on many levels, not just young women, middle-aged women, older women, there's so much shame and secrecy around our bodies, especially the pelvic floor. And talking about issues around urination, defecation, menstruation, I mean, literally every function that makes us unique as women, there's so much shame and secrecy about this.
Dr. Sara Reardon: [00:02:39] Right. So, we're never educated about our pelvic floor. And I think when we're younger, maybe we get a book about periods or even depending where you live or if you're lucky enough, you get some sex education which is like sperm meets egg. [Cynthia laughs] It's not really even about sexual health. But nobody educates you about your pelvic floor health. And often we don't realize that we have a pelvic floor issue or even that we have a pelvic floor at all until we have a problem. And some of the three biggest risk factors for developing pelvic floor dysfunction, you can get it at any age and stage in life, but it's pregnancy, giving birth, and then menopause. And so, 100% of women will go through menopause and are at a high risk of developing a pelvic floor issue. But we don't know that there are muscles, tissues that are responsible for some of the pelvic floor issues we experience later in life.
Cynthia Thurlow: [00:03:28] Well, and it's interesting, in the book you talk about one in three women suffer from pelvic floor disorders, whether it's painful sex, lack of orgasms, back pain, constipation. And I think to myself, that applies to everyone. I mean, when I think about it, there is no one that is untouched by these issues. And my hope and my intent, as I know the focus of your work is getting women talking about this so they can get the help and support that they need. I think that, now that I'm in a stage of life, I'm now in menopause. My conversations with my girlfriends are both hilarious and also troublesome in many instances, because they're comfortable maybe mentioning to me that they're having a problem, but they're uncomfortable mentioning or having the conversation with their provider to get referrals to experts like yourself?
[00:04:11] And, so when you're speaking to women, what are some of the ways that you encourage women to have conversations so that they get the referrals to the experts like you that can help them better understand their bodies and what they need to be doing to get back to a path of, I don't want to say the word wellness that sounds very trite, but get back to being able to have an orgasm, not become worsening in their incontinence where they can't hold their urine or chronic constipation? How many women think that is totally normal and they don't realize that if their pelvic floor health is not optimal, that it can make it much easier for them to suffer from an inability to empty their bowels?
Dr. Sara Reardon: [00:04:50] Yes, you're exactly right. And if medical providers don't ask women about these issues. They're less likely to tell them. The research is very clear. So, from a medical provider perspective, it's really important that we screen our patients for urinary leakage, hip pain, back pain, painful intercourse, difficulty with orgasms, constipation. Like they need to be screening for this. And then referring out to pelvic floor therapy, I think that often pelvic floor therapy is an option of last resort. So, let's try a medication, let's do a procedure, let's do Botox to your pelvic floor, let's do injections. And then it's like, “Okay, nothing else has worked, go to therapy.” But in every other aspect of our bodies, therapy is a first line treatment.
[00:05:29] So, if you have back pain, if you have a knee injury, if you have shoulder pain, you go to physical therapy. But we're not thinking about that for the pelvic area of a woman's body. And I think that because we're not educated on this pelvic health arena, we don't know who to go to talk about it. And then again, because medical providers aren't trained in it, they don't know where to send you. So, it's cycle of lack of education, awareness, and lack of treatment. When it comes to advocating to your medical providers, I think it's one. It takes a lot of courage to go to someone and say, “Hey, sex is really painful for me. What are my options?”
[00:06:07] If you have any issues in a lot of the areas you just described, whether it's bowel movements, bladder health, frequent urination, urinary tract infections, pelvic organ prolapse, sexual health, your pelvic floor is likely involved. And whether it's the chicken or the egg, your pelvic floor really needs to be assessed for you to get full comprehensive health care and make progress. And in every state in the United States, you can go see a pelvic floor therapist without a referral from a physician. So, you can walk into their office like you would, a chiropractor, an acupuncturist and say, “Hey, I want to get an evaluation.” And then we can also communicate with the doctor and say, “Hey, we saw this patient, they're one of your patients, we found these issues, we are requesting more pelvic floor coverage.”
[00:06:50] So, sometimes we can help be the advocate for you. Or I think a lot of doctors just don't know. And when you ask them, they're happy to send you out but again, talk to your girlfriends, talk to other mom friends, talk to your medical providers and you will be able to find some resources. And this is part of why I wrote the book is I don't want you to have to doom scroll on Instagram to learn about your body. I love that I can do that for you. But I think we all need a resourcing guide because your pelvic floor demands something different, a different level of care for every life stage.
[00:07:20] And so whether it's your first period or you've got kids who are having their first period, whether they're becoming sexually active, whether you're pregnant, postpartum or you are menopausal, you need different ways to care for your pelvic floor. And that's really what I provide in the book.
Cynthia Thurlow: [00:07:36] Yeah, I think it's so important because many providers, they're so well intentioned, they're so uncomfortable addressing these issues. They are happy to refer you out. I have a wonderful internist and last year for full disclosure, I started pelvic floor therapy because of painful sex. And I remember initiating the conversation with a male provider who is wonderful and he could not have been happier to refer me out. He was like, “This is who you need to see.” And I found it to be really interesting I think because I'm physically active and I lift weights, I do all these things. I mean, how can my pelvic floor be weak? And what I found from my conversations with my physical therapist was, “Yes, I've had two breech kids, yes, I've had two C-sections.” She was saying you had two large kids.
[00:08:19] You know what I found interesting was she was talking about and you mentioned this in the book almost 50% of women go through some degree of birth trauma. And obviously vaginal deliveries can be really challenging if someone has a fast delivery or they're pushing for a long period of time. Many of my friends ended up with C-sections, ended up having very long labors and then getting a C-section. I was one of those people, they figured out pretty quickly my baby was a cannonball breach. So, it means that he was tucked up with his butt at the base of my cervix. So, there's no other way that he was coming out at that point.
[00:08:52] But I was surprised to know that even with a C-section, you can have significant weakening of the pelvic floor and then you add into it this loss of estrogen as we are navigating perimenopause and menopause, and it creates this perfect storm. So, talk to me about women post birth, whether they've had a vaginal or C-section. What are some of the big concepts you work on with your patients to help inform them about changes that have gone on during their pregnancy that can contribute to worsening of symptoms as they get older? Because I think for a lot of people it seems so intangible, or they assume my sex isn't painful because I'm on vaginal estrogen, or I'm not yet at the point where it's painful, or I'm not having incontinence with any frequency. So, I don't see it being a problem. But navigating the trajectory of our child birth years, navigating into reverse puberty is effectively what's happening.
Dr. Sara Reardon: [00:09:47] Right. And we're having babies later in life. More women are having babies in their 40s than they are in their teens. So, we go from this transition from pregnancy and postpartum right into perimenopause. And it's one blurry season where we're like, “Okay, I don't know what my hormones are doing and I don't know if this is post birth issues or perimenopausal issues.” So, postpartum, again, as you mentioned, your pelvic floor changes. It typically weakens and lengthens just by being pregnant. I always say, “Imagine, we get these text messages about your baby's holding an avocado or your baby's the size of an avocado, then it's the size of a papaya, then it's the size of a watermelon, where your pelvic floor muscles sit like a hammock at the base of your pelvis and they're supporting that growing baby.”
[00:10:28] So, if you have an avocado or a papaya, that hammock's not going to stretch or sink down that much. But if you put a watermelon in a hammock, it's going to stretch, it's going to sink lower and that's exactly what pregnancy does to your pelvic floor. If you have again, a vaginal birth, you have a likelihood of some perineal tearing which can go into the muscles at the vaginal opening. You can have some weakness from pushing, but a C-section, you go through seven layers of muscle, skin and tissue. And then so your core is significantly affected, it can be weaker, you have decreased sensation. And that scar tissue doesn't move the way that your pre-surgery tissue does, so it can often get stuck and that can lead to pain and tension in the abs and pelvic floor.
[00:11:07] So, women who have a C-section have a higher likelihood of experiencing painful periods, painful bowel movements, incomplete bladder emptying and painful sex. Whereas a vaginal birth, you're more likely to have urinary leakage and pelvic organ prolapse. So, unfortunately, birthing moms don't get spared in their vaginas [laughs] anyway-- [crosstalk]
[laughter]
[00:11:26] But just we rehab someone after surgery for a knee replacement or a shoulder injury, we need to be doing that for moms during their postpartum period. And I really recommend all postpartum moms, if you haven't yet given birth and you're listening to this to check in with a pelvic floor therapist at six weeks, because your pelvic floor muscles are functioning at less than 50% strength at six weeks. And that's when we get the thumbs up to go back to exercise, to go back to sex. But our bodies have not returned to their pre-pregnancy state of strength and function.
[00:12:00] So, that's really a great time to start addressing strengthening or if you have tension, relaxation, to talk about different lubricants, vaginal moisturizers, exercises to get you back to peeing, pooping, sex exercise, caring for yourself, going to work with less dysfunction because it unfortunately doesn't get better on its own all the time. Like if you're still experiencing leakage or pain at three months postpartum, you have a high likelihood of experiencing it at one year. And so that goes to show us that it's not just time that will help. And I also say even if your months or years postpartum, it's never too late. We see so many moms well past their birthing years that can really reap the benefits of pelvic floor therapy.
Cynthia Thurlow: [00:12:43] I think it's a really important message because I know my oldest will be 20 in August. Twenty years ago, we were not talking about these things. I know that I breastfed him for a year and I had significant like pain and just discomfort. And my GYN, who was very well meaning, and I'm not blaming him because this was just standard of care, they just kept giving me steroids. They were like, “Oh, once you stop breastfeeding, this will get better.” And I remember, like now I recognize it is my estrogen was so low because I had been breastfeeding for so long and I'm like, “What I needed was vaginal estrogen and back then, that just wasn't the standard of care.
[00:13:21] And my hope and my intent is by sharing my experiences, it destigmatizes the conversation because, no, this isn't like what I want to be putting out on a placard. But if we don't talk about it as women, we don't allow other women to understand, what they're experiencing as normal. And there are ways to address it proactively without embarrassment. It should be no different than going in because you have ankle pain or you have shoulder pain or any other complaint that we can address with our providers. So, when we're talking about what the pelvic floor is, let's give listeners some perspective. You mentioned the hammock, which I love analogies, but let's talk a little bit about pelvic floor muscles and ligaments and how all these things work together to support these organs. And because I think for a lot of people, they don't understand that because they're not clinicians, and that's okay. But between the bladder, the uterus, the rectum, all of these organs are supported and held up by this very intricate network of ligaments, muscles, etc.
Dr. Sara Reardon: [00:14:24] So, we call it the pelvic floor because it sits at the base of your pelvis. So, you've got those bony muscles, that ring of bones that we all see on skeleton pajamas or in the models at the doctor's offices. And there's an opening at the bottom. But in reality, that opening is closed by this hammock of muscles. And those muscles support your pelvic organs, your uterus, your ovaries, your bladder, and bowels in the female body, all genders have a pelvic floor. Males do as well. So, they sit in there like a basket. But in the female body, you also have three openings in the pelvic floor muscles. One is for the urethra, where urine exits, one's for the anal opening, and then one's for the vagina for vaginal intercourse, menstruation, vaginal birth.
[00:15:05] So, if anything is awry in any of those areas, whether it's sexual health, painful sex, and orgasms, whether it's constipation or fecal staining in the underwear, whether it's urinary leakage or difficulty emptying your bladder, your muscles are likely involved. And yet in our medical system, we, like, see a bladder doctor, we see a vagina doctor, we see a colon doctor. But nobody's really assessing the muscles, which are a component to all of these dysfunctions. And your muscles are working for you all throughout the day. They're keeping in urine and stool, and then you can relax them to have a bowel movement or urination. They're supporting your pelvic organs. So, they're really important, and we use them and just don't even realize that they're working for us.
Dr. Sara Reardon: [00:15:48] And I think the challenge in pelvic healthcare, which is what I really hope to your point about normalizing these conversations and also increasing the literacy of our bodies. I mean, we're not taught about what these muscles do, how to pee, how to poop, how should sex feel? What should we do proactively with menopause approaching? How do we care for these body parts? Because otherwise we're just waiting for problems to happen, and then we're trying to treat them. And you talked a little bit about strengthening. I'm 42, I'm perimenopausal and a year ago, I started strength training, and I do my pelvic floor exercises while I'm strength training, I contract and relax my pelvic floor.
[00:16:25] And I'm thinking we're doing this proactively to help our bone density, to help stay strong, but we need to be doing the same thing for our pelvic floors. Like, perimenopause is a runway into when we-- our hormones, like, kind of drastically change at menopause. And so instead of waiting for that to happen, we need to be proactive, just like we are with diabetes and high blood pressure and osteoporosis. We need to be addressing our pelvic floor health, in advance to prevent issues.
Cynthia Thurlow: [00:16:53] Well, and I think it's important. I always think about my grandmother who had five children vaginally. She was tiny, 5 foot 2. And at the end of her life, she was a retired nurse. She started talking to me about she had both a bladder prolapse and a rectal prolapse. And for anyone listening, this is when and obviously you can do greater justice to the explanation than I can. There's a weakening in the pelvic floor and these organs have dropped down. And so going to urinate or defecate became quite an interesting conversation with my grandmother. She was explaining to me what she had to do, and I said, “Well, Grandma, you could have had surgery.” And she said, “But we just didn't do that in my day.”
[00:17:32] And so women of that generation in many ways, accepted these prolapsed organs, and they would wear pads. I mean, you mentioned in the book the impact of incontinence. $20 billion with a B is spent yearly on treating leakage in the United States alone, not to mention internationally. And so, these are why these conversations are so important. Because, I think it was Lisa Rinna, who's one of the housewives in Beverly Hills, and she was marketing like a Depends undergarment. And I thought to myself, this is not what we want to be marketing. We want to actually offer women, real solutions. I mean, obviously, if someone's in a nursing home, they're not in a position to be able to do physical therapy, or maybe they're not even cognizant of what's happening. That is very different. But we don't want to normalize things that we have gotten to a point where, we don't understand that there are options beyond just a personal care product.
[00:18:22] And maybe that's something you do on occasion. But my grandmother explained that was just what she and her entire generation, her sisters, they all accepted that was part of the aging process. They would have prolapsed organs, they would have incontinence, and that they would have trouble going to the bathroom, and that was just normal for them.
Dr. Sara Reardon: [00:18:39] Yeah, I mean, you're so right. And I do think, those products are necessary, but when you go to the grocery store and there's an entire aisle of incontinence products, it gives some exposure to how common these issues are. 50% of women over the age of 65 leak urine. So, what may start off as, like, a little leak with a cough or a sneeze or a jump, and maybe you wear a liner or you stop that exercise class. With aging, once your estrogen levels and testosterone levels start to really decrease during perimenopause, and then, unfortunately, plummet post menopause, you're at a much higher risk for those getting worse. And so, leakage of urine and stool are some of the primary reasons for admission to a nursing home later in life.
[00:19:20] And I don't say that to scare anyone, but I say it because it gives you a sense of the gravity of how severe these issues can be. Chronic urinary tract infections, like waking at night to pee, and you experience a fall. I mean, these are the things that we see in our clinics. And I'm like, “We should have been educating and helping these women sooner,” but instead it's after the fact. And, you know, with Florida kind of people said, “Why didn't you write a book about pregnancy or a book about menopause?” And I said, “Because I don't even think people know they have a pelvic floor.”
[00:19:50] We have to start at ground zero and educate them about the normal, about how your pelvic floor changes during different stages of your life so that every woman at every age and stage can access this information. And then how can you start working on it at home? Because not everyone has access to a pelvic floor therapist in person.
Cynthia Thurlow: [00:20:09] What do you think are some of the lifestyle measures? Like, let's start with food. What are some of the foods or substances that can exacerbate that desire or need to go to the bathroom? And by that I mean, let's talk first about urinary incontinence or whether it's urge or stress incontinence. What are some of the bladder irritants that can make those symptoms even worse than they were prior to that?
Dr. Sara Reardon: [00:20:34] So, unfortunately, it's all the good stuff. So, carbonated drinks, caffeinated drinks, coffee, wine, alcohol, spicy foods, and acidic foods like tomato juices or things like that. So, all of those are what we consider bladder irritants, where it makes the bladder a little bit more urgent or they flood to the bladder really quickly. So, say you're at a party and you're having a beer or a glass of wine, that fluid gets to your bladder really fast and can cause a really severe urge. And if you have difficulty getting to the bathroom in time, you may not make it. And so, I say these things are fine to have, but one, you should complement them with water. Oftentimes people avoid drinking water when they leak because they think it's going to decrease their leakage.
[00:21:16] When it actually can make your urine more concentrated and make you have to pee more or leak more. So, make sure that you're sipping some water when you have some of these beverages that you have access to a restroom, or like you have a big meeting or you have a long car ride, you may want to avoid them until you're in a situation where you have access to a restroom more frequently. Another thing that women do, unfortunately, is we go to the bathroom just in case a lot like every time we leave the house or every time we arrive somewhere, we pee, just in case. But that actually can cause your bladder to shrink. And then you have to pee every 20 or 30 minutes when it's really not a full bladder.
[00:21:51] So, I encourage women to kind of stretch out their bladder trips, their trips to the restroom about every two hours. You want to get closer to that so that you can have your bladder fully expand and then relax. Like, you should be able to sit through a movie and not have to rush to pee.
Cynthia Thurlow: [00:22:06] I think that's important because I think for many people, they may not make those connections. One thing that I have seen with a lot of female patients is artificial sugar.
Dr. Sara Reardon: [00:22:14] Yes.
Cynthia Thurlow: [00:22:15] So, like sucralose, aspartame. I had one woman who was being worked up by her internist for interstitial cystitis. And what it actually was, when I had her do a diet recall, I think she was drinking Crystal Light. Sorry to Crystal Light, but Crystal Light, she was drinking a lot of it. And I said, let's just eliminate that from your diet and see if there's improvement. And she came back to me and she said within one day, she's like, “I have interstitial cystitis. I have a bladder irritant.” And so, I think for a lot of people, sometimes you have to keep a diary to get a sense, because you're absolutely correct, the coffee, the carbonated beverages, alcohol, etc. But I think for a lot of people, it could be that N of 1 just realizing it could be that one unique, I always say, like the Goldilocks effect. One particular substance is irritating your bladder enough. But I think about interstitial cystitis as this grab bag. It's like saying fibromyalgia, when we don't know what else to call something, we are going to loop it into interstitial cystitis. And if you read the research and the studies, it becomes this, I don't want to say innocuous, but in many instances, it's something people just have to live with.
[00:23:20] And if we know that there's a food or a substance that's exacerbating it and it can be easily eliminated, that is certainly one way to address it, along with a proper pelvic floor evaluation.
Dr. Sara Reardon: [00:23:31] Yeah, you're so right. I forgot to mention the artificial sweeteners and sugars, but that's totally right. And so, I remember I had a teacher one year who was coming to me and she actually couldn't start her urine stream. She would like, “Sara, I sit there and I feel like I just can't go.” Well, she was a teacher, so she was delaying the urge to go for many, many hours, like way past four hours because she didn't have coverage in the classroom. And then she also drank a lot of Mountain Dew. And I was like, “You can't--” [Cynthia laughs] And I told her, I said, you know what this is? It's a ton of sugar. It's carbonation. It's flushing to your bladder. It's giving you this really strong urge to go. And then you're having to hold the urge for so long.
[00:24:08] And then just cutting out that one thing and then going pee. When she actually had the urge, she would have an aide come in like halfway through, so she would have coverage. And she was like, “Oh, my gosh, I'm like 90% better.” But it's just those things that we don't always tie together because, again, we're never educated on it.
Cynthia Thurlow: [00:24:25] Yeah, absolutely. And I think about how many teachers, nurses, healthcare providers, EMS workers, they're in emergency or urgencies and they can't go to the bathroom. I remember when I was an ER nurse years ago, I would realize I needed to pee, and then it would be two hours later and there something had rolled through the door that we had to address. And so, I went years of subjugating the need to go to the bathroom. I remember being so grateful when I became a nurse practitioner because I could actually eat when I wanted to and go to the bathroom when I wanted to, which seemed a huge improvement over what I was doing before. Let's talk a little bit about different types of incontinence, because I think people are probably fairly familiarized with stress or urge incontinence.
[00:25:04] There was a long period of time after I had my kids that if I did too many jumping jacks, like more than a minute, I would leak urine. And I remember thinking, like, “Oh, my gosh, I'm going to curtail my activity because I don't want to have this issue.” But I think for many people, there are probably activities that they realize, I don't normally otherwise get this urge to urinate unless I have done, whether it's like jumping jacks or just something that's putting a lot of extra pressure on, presumably the pelvic floor.
Dr. Sara Reardon: [00:25:34] Right, that's correct. So, we have a couple different types of incontinence. One is stress incontinence, where there's any pressure down on that floor of muscles, and those muscles aren't strong or coordinated enough to hold against that. So, we see this type of leakage a lot with a cough or a sneeze, a jump, a laugh, a side step. And so, it's when the muscles just aren't responding to that pressure, that's stress incontinence. So, urge incontinence is when you hear running water or you're putting the key in the door and you get a strong urge to go and you can't make it to the bathroom in time. So, for both of these instances-- and then mixed incontinence, which is for a lucky few, have both of these.
[00:26:10] So, in these instances your pelvic floor muscles, which help hold urine in, can't respond to what the bladder is doing, whether it's pressure on the bladder or urgency of the bladder. And that's where pelvic floor therapy comes in, of either strengthening or core coordinating the muscles or teaching the muscles to contract. So, it quiets the bladder down. Now, what's interesting about what you said earlier, that I used to be able to do a minute of jumping jacks and then I would leak, is that these muscles fatigue. So, if you can do an exercise and it doesn't, you don't have leakage, but eventually that happens, or if you can run a mile, but if you run two, leakage happens. It means your muscles just can't support against what you're asking them to do.
[00:26:49] So that just means you need to kind of train them like you need to train them to contract when you're jumping, to have more endurance and more strength to support you for longer jumping jacks. And again, there are even internal devices like pessaries or bladder supports that you can use during those activities to help as well. So, it's not uncommon. But to your point, it can make someone not want to exercise anymore. It can make someone not want to travel or socialize or be intimate because of the pelvic health issues that they're experiencing, where we start to see what is a really small, occasional issue, become really impactful on our quality of life.
Cynthia Thurlow: [00:27:24] Absolutely. I mean, I know that I probably avoid some of the things if I know it's going to provoke something, just for the same reason that, when I'm home and I'm hyperhydrating, like I have a tendency, especially I've been traveling quite a bit, and I have a little bit of mild dysautonomia. So, when I'm not traveling, I make sure that I'm hydrating really well. But I jokingly will say to my husband when I'm hydrating like that, I have to be cognizant of the fact that I can't be sitting in two or three hours’ worth of meetings, I need to actually literally, legitimately empty my bladder probably every two hours. You mentioned in the book that there's common signs of under or overactivity of the pelvic floor.
[00:28:01] I found this particularly interesting because I realized probably at some times in my life, I've had a combination of one or the other. And I think that it really speaks to the fact that these conversations are invaluable because some people may just assume that they have a little bit of a poop stain in their underwear that, “Oh, maybe I just didn't wipe well enough.” And it can be of a sign of an underactivity of the pelvic floor. So, again, I think these conversations to destigmatize what we're dealing with are so helpful.
Dr. Sara Reardon: [00:28:32] No, you're so right and so, in the book, I say up front, this is not a one size fits all. It's a one size fits most because you can have pelvic floor tension and have leakage more often, you have pelvic floor weakness. So, I always say, “if you want to check in with the pelvic floor therapist, absolutely do so. So, if you want to start down one of these pathways, start and see how your symptoms respond. But when it comes to pelvic floor weakness, again, it's those either the sphincters aren't closing well or those muscles aren't offering your organs as much support. So, some of the common things we see are pelvic organ prolapse, which you mentioned earlier, difficulty holding in urine or leakage of urine, and no amount of leakage is normal.
[00:29:11] Like, even if it's a little bit with a cough or sneeze, it's information from your body that your muscles aren't responding the way that you need them to. Fecal staining, loss of stool, difficulty making it to the bathroom in time. Those tend to be more in the category of weakness of the pelvic floor. But a lot of women experience pelvic floor tension, and we haven't really been educated on that because our whole life we've been told, “Do your Kegels, tighten your vagina, strengthen your muscles, pull in your core.” But tension of the pelvic floor muscles is when they don't relax well, and that can lead to a hard time starting your urine stream, straining with bowel movements, experiencing hemorrhoids or fissures, painful intercourse, tailbone pain, hip pain.
[00:29:54] So, you don't want to just do strengthening and think that it's going to solve your issue. It's really important that you're walking down the right pathway. And to your point, it can fluctuate which way you go. And also, hormones influence this. If you are perimenopausal, postpartum and breastfeeding, menopausal, I really encourage you to investigate using topical estrogen or even what's like a DHEA suppository, because it can help slump up the tissues of the vagina, tone the pelvic floor. When you have more estrogen, you have more pelvic floor tone and endurance. And so, you could be doing just that, but you're not getting what you really need if you're using topical estrogen or you could be doing exercises, but the estrogen is a boost. So, it's important that you're really addressing both pieces.
[00:30:39] But that helps plump up the tissues, increase lubrication for intercourse, and just give you more tone to the area so that you're getting the most out of your exercises. But it's important to note the hormonal piece. And even if you're still menstruating, there are times in your cycle, your monthly cycle, when your estrogen levels are lower and you're like, “Oh, my vagina feels dry and itchy or I need more lube during sex, or I'm having leakage running, but I didn't have that two weeks ago.” And so those things make a difference. And we just really need to educate women to understand these fluctuations and understand their bodies better.
Cynthia Thurlow: [00:31:13] Yeah, and it's so interesting because I feel like there's now this resurgence over the past couple years that we're really speaking very proactively that you can start as a woman. vaginal estrogen or a compounded vaginal estrogen and DHEA or testosterone to your point, that can address lubrication and also the muscular layer of the vagina. You know, it's not a question of if, but when. Genitourinary syndrome of menopause is ugly as that. It's GUSM as ugly as that acronym is, it's not a question of if, but when. We will eventually get to a point whether it's at 50, 60, 70 or beyond. But by 60, it's almost 80% of women will experience this, that you can proactively address this with hormones, which can help alleviate a lot of symptoms that you experience.
[00:31:57] Maybe perhaps to get you to a point where you're comfortable doing pelvic physical floor therapy in a way that you're getting as much out of it as you would like to. Now, when I think about poop, and you do a really great job of talking about this and talking about it in a way that makes it accessible, because in medicine we call it defecation.
Dr. Sara Reardon: [00:32:18] Right.
Cynthia Thurlow: [00:32:18] Like, okay, let's be real, let's just call it what it is. What are some of the strategies you work on with your female patients if they are dealing with constipation? And let me be very clear, I would say easily 75% of the women that end up in our programs are dealing with constipation. It has become normalized. They think it's normal to poop two or three times a week. They think it's normal to have hemorrhoids and to really have to strain to go to the bathroom. And so, when you're working with a woman, what are some of your high-level strategies that you think are important for them to understand to ensure that they are able to have a healthy bowel movement before you get to the point where they need surgical intervention or something more serious?
Dr. Sara Reardon: [00:32:56] Well, the first thing I say is look at your medications, because constipation can be a side effect of a lot of things. It could be a side effect of allergy medication, steroids, these GLP-1s, which are weight loss medications. Constipation is a side effect of all of those. So, kind of be proactive. If you are on some of these medications, I highly recommend using magnesium citrate or magnesium glycinate at night. So, magnesium helps draw water into the colon to soften the stool. It's a great side effect. It also chills you out and relaxes you, which is why it's great to take at nighttime. But that will help all the water that you're consuming get to the colon to keep your poop really soft. I also recommend being active during the day.
[00:33:35] And this doesn't mean you have to go to a workout class. I'm talking, you need to get up and walk, like walk the dog walk outside, walk with your kids. Movement, literally, in research, just movement has been shown to help promote bowel motility. And we all sit a lot. We eat a lot of processed foods. We don't drink enough water. And so just movement, even if you're sitting at a desk, fluctuate between sitting and standing. Like, walk downstairs to get a cup of water, things like that. And then I do encourage everyone to get a pooping stool. So, a little squatty potty or a stool that you put under your feet.
[00:34:11] I'm in a hotel now in Los Angeles, and every time I travel, I either take a portable squatty potty with me, or I turn the garbage can sideways and put it under my feet. And I can tell you all the hotels that have the best garbage cans [Cynthia laughs] for pooping, because when you elevate your feet, it puts your knees higher and it puts you in a squatting position. And that's the optimal position to relax your pelvic floor muscles to have a bowel movement. If you think about, if you're in Asia or in nature you squat over the ground to have a bowel movement. Even little kids, you can find them squatting in the corner, hiding behind a tree or a bin of toys to poop.
[00:34:46] When you're giving birth vaginally, your knees are hiked up. And because it puts you in a squatting position to open the pelvic floor muscles. So, squatting helps you relax the pelvic floor muscles. And if you're straining to poop, I tell you to, you can either take a little straw or you can just blow out of your mouth. But try not to strain and hold your breath. So, breathing out like you're blowing out birthday candles or I keep some of those little twirly straws that my kids get from birthday parties in the bathroom. And you can blow through that, but it gives you enough pressure to push out to help with the bowel movement. It's really interesting because when we were doing some research on pelvic organ prolapse, there was a study that came up that showed that straining on a toilet seat weakens your pelvic floor more than running, jumping, coughing, crunches.
[00:35:33] And if you think about if you're constipated and you're straining every day for years, that in itself can lead to pelvic floor weakness and dysfunction. And this is why, it's not just pregnancy and birth that can cause pelvic floor problems. I've seen women who have never had kids and they have prolapse, because they've had chronic constipation since they were a kid. And one of the other things is like, don't delay the urge to have a bowel movement. If you have to go ahead and go. Because then the stool gets harder, the poop gets harder, and it makes it more difficult to empty. So, just these little tips can. Can go a long way, and it may take a little bit of time and practice, but I'm really comfortable talking about poop. It's like dinner table conversation at my house. But if we don't know these things, we could be doing these daily habits that really affect our pelvic floor in the long run.
Cynthia Thurlow: [00:36:21] Well, there's something called the Valsalva maneuver, but it's when you increase intraabdominal pressure. And I think for a lot of my patients, when I am asking them questions about constipation, they'll just say, “Oh, well, I've just learned that I have to push.” And I was like, explain to me what you're doing. And what they're doing is creating all that intraabdominal pressure in the hopes that it'll put pressure on the pelvic floor, and then they can actually poop. Talk to me about the significance of fecal staining. Again, I'm a nurse, you're a PT person, we can talk about poop for days, but I think this is significant. And it was something that started clicking in my brain a lot of conversations I'd had with patients over the years, why is this so significant?
Dr. Sara Reardon: [00:37:00] You know, one of the most popular blog posts on my website is called skid marks.
[laughter]
[00:37:06] When there's staining in your underwear. Because when we start to see this is, it's typically that you feel like you're having a hard time cleaning the area, or you go to the bathroom, and a little bit later something else comes out. Or you have staining in your underwear. There's some seepage and it can actually be due to constipation. So, one of the most interesting things is when you have a lot of stool and poop in your rectum, it can be like hard balls, but then you have this seepage or liquid coming through and that seeps through. It's like pouring applesauce over a bunch of rocks. It seeps through and come out in onto your underwear.
[00:37:41] So, many people think that fecal leakage is due to, too soft of stool or weakness, but it actually can be due to constipation. We have to treat the constipation first. The other thing is that the sphincter, so the anal sphincter is not holding things in as well and it can be due to tension. I've actually had a lot of women come in where their muscles are so tight that they can't close that sphincter as well or it can be due to weakness. And actually, depending on if you've had a vaginal birth, where you had a tear into the anal opening, which is a third or fourth-degree tear, that puts you at a higher risk for fecal seepage and incontinence, aging because the muscles get weaker, and also chronic straining with bowel movements, all of those things cause weakness in those muscles as well.
[00:38:22] And some of it we have to work on strengthening their muscles. Some of it we have to work on lengthening their muscles depending on the patient. But a lot of it is also that you need your poop to be coming out in one long sausage. So, if you have these soft bowel movements and you're going multiple times a day, it's like you're never emptying. And then it'll keep coming or you have hemorrhoids and you feel like you can't clean. Well, hemorrhoids are typically from straining during bowel movements and so, if it's not related to birth-- and so kind of poop gets stuck in there. So, I would start with changing the mechanics of how you're pooping feet up, you know, breathing out.
[00:38:57] Valsalva is when you hold your breath, you want to not do that. You want to breathe out when you're pooping to bear down. And then making sure that your poops are really good consistency, soft and smooth, not too hard, not too loose. And then thinking about, how do I train my muscles as well. But it's not uncommon and it's also really embarrassing for women. It's like you're worried about smell, you're worried about your underwear, you're worried about a change of clothes. And I think it's one of the more challenging things for women to face because it can really impact how we live our lives.
[00:39:28] Like whether we're socializing still or we can't eat out because we're worried about, how our stomach's going to respond, or we can't travel because we're worried we won't have access to a bathroom or we don't want to be intimate because we have stains in our underwear. I mean, all of these things really ripple over into other arenas.
Cynthia Thurlow: [00:39:43] I was told years ago and correct me if I'm wrong, that if you have to wipe more than twice, it's oftentimes a sign of a weak pelvic floor. Now, I know people listening are probably like, “What are you talking about?” But like you mentioned, you want to have that long, the Bristol Stool Chart. You want that three, four, which is that perfect long, not dry, not too liquid stool. But I was told if you have to wipe more than twice, it might be a sign that you have some pelvic floor issues. Now, that might be an oversimplification, but I thought if I could ask anyone, I could ask you if that's in fact. If that's in fact factual.
Dr. Sara Reardon: [00:40:19] [laughs] I don't know if there's research on that, but I think it's a sign. All of these things are information from our body and a lot of it depends on the consistency of your stool, even the size of your tush. If you have a step stool under your feet or a squatty potty when you're pooping. So, I think it all depends on those things. But I would say twice is like a kind of on the lower side. I think sometimes you can wipe a couple more times. But if you feel like you have to constantly wipe. The other thing is, I'm a huge fan of a bidet.
Cynthia Thurlow: [00:40:48] Okay.
Dr. Sara Reardon: [00:40:48] So, a bidet is like, you can get them over the counter, on Amazon now, hook them up to your toilet yourself, but they spritz water on the anal area and minimize how much you have to wipe or if you have hemorrhoids or you feel like you can't get clean, it just cleanses the area. It's great for also during your cycle or any time. And so, it just keeps the area cleaner without having to do excessive wiping. So, I love a bidet. I'm a huge fan of them. And I think it's just another thing we can have that. People think it's so weird, but I'm like, once you go bidet, you're never going back because it changes your life.
[laughter]
Cynthia Thurlow: [00:41:23] That's going to be a clip for the podcast, for sure, for sure. [Sara laughs] Okay, let's talk about sex, let's talk about, in particular, women in perimenopause and menopause this dyspareunia that many women experience. Let's talk about the impact of trauma. So, whether it's been birth trauma, emotional trauma, how that can show up for women with their pelvic floor and painful sex.
Dr. Sara Reardon: [00:41:48] So, there's a handful of reasons that women experience painful sex. One of it can be due to hormonal changes. Lower estrogen levels cause dryness and thinning of the tissue. So, I think that's one thing to make sure that is addressed. The other one is pelvic floor tension. So oftentimes, if we have tension in the pelvic floor, it can either feel like something's hitting a wall and can't enter into the vaginal canal, or we have pain with deeper penetration where it feels like tender or bruisy inside, or we can even have pain afterwards, it feels like a deep ache in our pelvis afterwards. And all of that can be due to muscle tension. Think of like when you have tight knots in your shoulders and you just want to like rub it out and it feels really tender. It's the same thing in your pelvic floor.
[00:42:31] The other reason is also scar tissue. If you've had a perineal tear during a vaginal birth, that scar tissue doesn't relax and expand the same way that the earlier tissue did. So, it can cause like a ripping or tearing sensation. And so, you can massage that scar tissue. You can do exercises to release pelvic floor tension. It can be stretching and breathing. It can be internal massage. In physical therapy, a therapist inserts their finger into the vagina and presses on the tender spots of the muscle. You can also do that at home. And I talk about in the book how to use these therapy tools to self-massage, which can be really effective. But there is also a social, psychosocial, emotional piece to this.
[00:43:13] And I bring that up because it's not that everyone who has experienced sexual trauma or pain will have painful sex, but the women who have painful sex have a higher incidence of having trauma. And again, it doesn't have to be just sexual trauma. There was actually a research study done that looked at assessing the muscle activity in the upper traps and the pelvic floor when women were watching violence on TV. It wasn't sexual violence, it was just violence. And there was activation of the upper traps and the pelvic floor muscles. Just watching something on TV that was violent. And what that tells us is that when we are experiencing something scary, upregulating to our nervous systems, traumatic, our muscles hold onto the tension in our pelvic floor. And that can make it difficult to have relaxation during intercourse. It can cause pain with sex. It can cause difficulty having orgasms. And so, we see the connection there. And it's so important, I think, as medical providers, if you're seeing someone who has painful sex, that it's a multimodal approach. We need a therapist in addition to a PT to really collaborate and help these patients work through the trauma as they're also working through the physical process of the pain and tension.
Cynthia Thurlow: [00:44:29] I think this is such an important conversation because there are probably women listening that may not be making those connections, that that is how it is showing up for them. No surprise about violent-- watching something violent, whether it's a movie or TV or what have you. I know the older I get, the less I enjoy that kind of stuff. I think I was on autopilot as a younger adult. Like, if I saw stuff like that, I was like, “Oh, it's not a big deal. But now as I'm older, I think probably because now I have kids,” [laughs] I think differently about everything that can definitely contribute. Let's talk about, because you mentioned the restriction that women can get if they've had a C section. I would imagine if they've had a perineal tear or rectal tear, probably the same thing.
[00:45:11] How will this show up for people? Because I would imagine maybe someone with a perineal tear or a rectal tear, they may have symptoms, but potentially that C-section, I've had two, and they weren't in the exact same spot. I would imagine that there are symptoms that for you, as a clinician, will help identify that they've got some degree of, we used to talk about how you can get adhesions or things like that underneath the skin that you, yourself can't see. But I'm sure as an expert, you probably can identify.
Dr. Sara Reardon: [00:45:39] So, what we see on the surface after an abdominal surgery or a C section is 10% of the restriction that's really occurring underneath that skin. And again, there are seven layers that are cut through of fascia and your abdominal muscles are separated and then you're surgically repaired and then again sent home. So, when something is tight or restricted, it doesn't get as much blood flow. It doesn't move as freely. We see a lot of women with what we call C-section shells, where it's like a puckering in at that scar where there's tissue below and above it because that scar is stuck and it doesn't move. And so, what that means is like the muscles and the tissues underneath aren't relaxing and contracting as well as we need them to.
[00:46:23] When you've had a surgical abdominal surgery or a C-section, some of the things that we see are painful periods, painful ovulation, painful bowel movements or constipation, like things on that left lower side just feel really stuck where the colon comes down, difficulty starting your urine stream, and incomplete bladder emptying and also painful sex because the fascia, this layer of tissue over your abdominal wall muscles wraps all the way down to your pelvic floor. And so that front-sided tension or restriction leads to pelvic floor tension and restriction as well. And it's actually really interesting.
[00:46:59] One of the stories I share in the book is I was treating a woman. She was a labor and delivery nurse, so in the women's health field. She was I think in her late 50s, early 60s, and she had three kids who she had all had via cesarean section. And she had a hysterectomy. So, had another surgery in her abdomen. And she was coming to me because she wasn't emptying her bladder well, and she was holding in like 200 cc's of urine, which is like half the amount of urine that's in your bladder. And she started to get urinary tract infections. But the thing is, she was treated with antibiotics. She was treated with overactive bladder medication. But then her doctor said, like, “Okay, go try physical therapy.” And she comes in, tells me her history, and then I look at her abdomen and her scar is so tight and she has all of this tension in her abdomen.
[00:47:41] And just by working on her abdominal wall with massage and breathing and stretching and releasing that scar, she started emptying her bladder better. And we would scan it after the sessions and she went from like 200 cc to like 40 just by working on her scar. But she had never connected that her C-section could be causing her bladder stuff. And I don't think that her doctor even knew to put those things together. But when I look at the whole pelvis and how everything's working, it makes so much sense to me. And she could have had surgery. And I'm like, “Oh, it was literally just C-section scar restriction.”
Cynthia Thurlow: [00:48:15] I think it's probably more common than people realize. For me, I had two C sections and then I had a laparoscopic appendectomy six years ago, and I was seeing a new GYN and she was doing an internal and external exam. And she said, “Oh, you know, you've got.” She's like, you probably have some degree of restriction from although obviously the laparoscopic appendectomy is not nearly as deep as having a C-section. But she said, you've had multiple pelvic surgeries at probably at some point. Which is why I started doing pelvic floor PT last year. She's like, “You probably would benefit.” And she's younger. So, I think that this younger generation of GYNs and midwives and probably NPs are probably initiating the conversation a whole lot earlier.
[00:48:58] In fact, I was just on vacation with my cousin who's an OB/GYN, and I mentioned I was interviewing you this week, and she said, “Oh, back in my training, which was 25 years ago, we never talked.” And she was like, “I was at one of the top OB/GYN residency training programs in the country. We just didn't know what we didn't know back then. So, I'm hopeful that this new generation of providers that's on their radar, maybe to start the conversations a whole lot earlier.
Dr. Sara Reardon: [00:49:25] I am too. And I think it's the conversations and the training, I think that some of the medical systems and schools need to figure out how to integrate this. I've been practicing in this field for 18 years and I was having to knock on doctor’s doors to be like, “Hey, we're here. And they're like, what do I need you for?” And now they're like, “Hey, can you come in and teach our residents about pelvic floor therapy? Teach us how to do a pelvic muscle assessment.” If you're already doing a pelvic exam, it takes one minute. And I'm like, “Yes, please. Like, it's so easy to do.” And I think it's a real disservice to our patients when we're not able to refer them out appropriately.
[00:49:58] For me, if somebody comes and sees me and I'm like this, I had a patient who she was coming in for painful sex and then hip pain. And I was like, “Her hip pain is just not getting better.” And I was like, “This isn't making sense, like you should be getting better from this.” And then I sent her out and she had a labral tear, like in her hip, I know how to refer out. But for other medical providers, they don't know where pelvic floor therapy fits in. So, I think putting those pieces together for them just will help so many women if we're able to integrate that into their education.
Cynthia Thurlow: [00:50:28] Now, as a clinician, are there red flags for you? Like things that clue you in pretty quickly that you need to refer a patient out? Now, obviously you're working concurrently with other providers, so it's very much a family of physicians and other experts that are working together, nurse practitioners, PAs, etc., that are all working together for the benefit of the patient. But are there red flags that come up for you on occasion where you're like, this is more than just a pelvic floor issue, this could be cancer, this could be a labral tear, this could be something else. So, if someone's listening, it's like, make sure that these things have been ruled out before you referred on, because it could be something that needs to be addressed first before you address the pelvic floor.
Dr. Sara Reardon: [00:51:10] 100% and usually some of the things that we look for are if we're screening for cancer, it's pain that wakes you at night. If there's weight loss or weight gain, muscles respond to movement. So, if you have pain that's unrelated to movement and are there been systemic changes. I'm like, that's a red flag. I've treat men as well and there's been a guy who had pain at night. I'm like, that's doesn't make sense from pelvic floor and he ended up having prostate cancer.
Cynthia Thurlow: [00:51:35] Oh wow.
Dr. Sara Reardon: [00:51:36] Yeah, we definitely see that. Some of the other things are chronic infections. There's like, we need to call more medical providers in to either deal with infections. There's a dermatological condition called lichen sclerosis or lichen planus, which is an autoimmune issue that attacks the vulva and the labia start to disappear, the clitoris resorbs. And I see that. I mean, I can look at a vulva and be like, “Okay, I've seen 10,000 vulvas and this is not a typical one.” And so, you can see-- I refer out to gynecologists to get treatment for that. Other things like endometriosis, if you have pain with periods that's so severe that you have had to miss school, miss work. You've had this for years. Like, painful periods are not normal, a little bit of cramping, but pain so severe that it's debilitating for you is a red flag for endometriosis or adenomyosis.
[00:52:25] And then, even things like blood during a pelvic exam, bleeding without a prompt for something like postpartum or menopausal, a lot of hormone changes. I've been referring out a ton to get some hormone support for my patients. I'm like, we can do pelvic floor exercises till the cows come home, but if you don't have topical estrogen or DHEA or using-- I recommend a lot of vulvar moisturizers. We need more. It's really a multimodal approach. And then sometimes with nerve injuries or pain like that, we'll need to refer out. Absolutely-- I think I know muscles and tissues, but outside of that, I'm like, I definitely call in support and help and have patients get prolapse surgeries, hemorrhoid repair surgeries, Botox to the muscles, like nerve injections.
[00:53:10] I mean, all of these things. This is one piece of the puzzle. But unfortunately, I think therapy piece, again, has been a last resort instead of an earlier intervention. And I think that why women suffer for so long is that it's just not being pulled in earlier or even proactively.
Cynthia Thurlow: [00:53:28] Well, and that's why these conversations are so important, because we need to destigmatize the conversation and allow women to initiate the conversation with their providers earlier. I know for myself, when I went to the pelvic floor specialist who was incredibly professional. Initially it started with external examination before ever was internal. But she left me with a plethora, if you will, of options. It's like, this is where we can start. These are the things I think you need. This is the equipment I think you need. And even as a healthcare provider, I went home and I was like, if I'm a little bit embarrassed, then it means everyone is probably this way. And it shouldn't be any different than getting your teeth examined or getting your eye examined.
[00:54:10] So, we need to have these conversations to not only just generate thoughtful discussion, but also get our patients thinking about things beyond just seeing another specialist and understanding that physical therapists work directly. It's a team of experts that are all working concurrently towards the same goals. Now, something that I think is, at least important to identify before we close up the conversation today. If you were thinking of some like top tips overall for pelvic floor health, I know we've identified urination, defecation, red flags, lots of important discussions about different things. What would be some of your top tips, high level things that you talk about that you can leave women with so that they could move forward and be thinking more proactively about their pelvic floor.
[00:55:05] So, we mentioned some of these with peeing, but I would say don't push when you pee. So, hands down, like, don't power pee. [Cynthia laughs] I tell I see women doing this all the time. We're always in a hurry or we want to be really efficient and empty our bladders, but that weakens your muscles over time. And you pee eight times a day. And so that's something that I'm like, when you pee, sit down, unless it's a yucky toilet, lean forward and breathe. And your bladder pushes the urine out for you. So, don't push when you pee. And then we talked about go to the bathroom when you have the urge to go, don't delay too long, but also don't go just in case. For pooping, trying not to strain. Don't sit on the toilet too long. If you're sitting on the toilet any longer than five minutes, it can put more pressure down on your pelvic floor. So that's something where I'm like, scroll in your bed, but don't sit and scroll on the toilet for too long.
Cynthia Thurlow: [00:55:50] [laughs] Don't read the newspaper like people used to read the newspaper on the toilet.
Dr. Sara Reardon: [00:55:53] Right. We talked a little bit about the Valsalva, but exhale when you exert effort. So, if you're picking up a grandkid or if you're lifting weights at the gym, if you are pushing a piece of furniture, don't hold your breath. That puts pressure down on the pelvic floor. So, exhaling with exertion. If you're at the gym, lifting weights and then pull that pelvic floor contraction into your workout. So, if you're at the gym, Cynthia, and you're like, I'm doing my strength training. I'm doing squats and bicep curls and lunges, I want you to pre contract your pelvic floor with every repetition because that's going to give that pelvic floor a workout and increase the muscle tone, but also make sure you're relaxing your pelvic floor, that relaxation piece is just as important.
[00:56:33] And then there, if you do need more support, there are internal supports like a pessary or even using a tampon as a hack to support the pelvic organs when you're running or jumping or coughing when you're sick, you can use topical estrogen or a vaginal moisturizer. I proactively use a vaginal moisturizer, a vulva balm if I have dryness. But really being in the proactive side of these things, I think can go a really long way.
Cynthia Thurlow: [00:56:56] And how can we find specialists like yourself? Obviously, I'm sure there's probably directories and obviously getting a referral from your GYN or other internists can be helpful. But if people are looking to find someone like you in their area, because I know you can't be everywhere. But you need to check out Sara's Instagram account in particular. I'm not as active on TikTok, but I was showing my husband last night. I was like, this is the young woman who's in the vagina costume, which is hilarious, but again, destigmatizing something that we should be talking about on the regular.
Dr. Sara Reardon: [00:57:28] So, my Instagram account is @the.vagina.whisperer, and I share a ton of tips on there. And I have an entire online workout platform called the V-Hive on my website, which is also at www.thevaginawhisperer.com where you can access exercises pelvic floor tips at home. If you want to see a pelvic floor therapist in person you mentioned, talk to your girlfriends, talk to your medical providers. But there's a couple of directories. One is www.pelvicrehab.com where you can go in and type your address or zip code, and the pelvic floor PTs will pop up in your area. There's another one called the Academy of Pelvic Health, where they'll have a provider director as well.
[00:58:04] Not everyone's on those, but you could even literally do a Google search now and put pelvic floor therapy near me and something will pop up. And one of the things you mentioned earlier about educating women, I also think we need to give them options because in person therapy, nothing beats it. But it's not accessible to everyone. There is 10,000 pelvic floor therapists in the United States, and there's, I think, tens of millions of women, right? And so, there's just not enough of us to treat. And they're not always in rural areas or smaller cities. So, do virtual telehealth options.
[00:58:38] You've got online programs like myself, my own, and then the book, I really wrote Floored so that you don't always have to just scroll through my Instagram post to be like, “How do you do that vaginal--" [crosstalk]
Cynthia Thurlow: [00:58:47] Very descriptive.
Dr. Sara Reardon: [00:58:50] [laughs] Yeah, Floored: A Woman's Guide to Pelvic Floor Health at Every Age and Stage. So that you have a real guide to kind of what's normal, what's not. If you're experiencing issues now, what can you do at home? And even how to self-examine or what to expect in an exam at a pelvic PT so that we're just really working to demystify this part of our body and to really get women help sooner.
Cynthia Thurlow: [00:59:12] Well, and I feel like even as a clinician myself, I learned a ton. And so, I always say, like, I'm a lifelong learner and I humbly learned a lot of new information.
Dr. Sara Reardon: [00:59:22] [laughs] Awesome.
Cynthia Thurlow: [00:59:23] Thank you, Sara. This has been such a great conversation. Thank you again for your time today.
Dr. Sara Reardon: [00:59:27] Thanks for having me, Cynthia.
Cynthia Thurlow: [00:59:30] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend.
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