Where are my shoulders? Where's my jaw? Where's my pelvic floor? Where are my feet? Because it's all related to.
So we often tell people to do a body scan of like, check-in with your jaw first. It's already going to tell you what your pelvic floor is doing. So jaw, shoulders, core, like belly, pelvic floor, and then feet. Because a lot of times people will curl their toes too. Yeah.
Welcome back, my friend. Today, we are talking about something that just should come up when we're talking about women's health, and that is Kegel exercises. So that's right. If you have little ears in the car, you may wanna turn this off. It won't be too bad, but you never know.
We're talking specifically about the pelvic floor and what happens if it gets too tight. Oftentimes, when we're thinking about the pelvic floor, we think that it all must be loose and we all just need to do more kegels, but very frequently, we see it cause problems when it's too tight. So this can contribute to issues like pelvic pain, pain with sex, urinary urgency, constipation, even core weakness or back pain or hamstring pain. So often when we hear about the pelvic floor, we're talking about how to strengthen it. But for a lot of people, the problem isn't weakness, it's tension.
Muscles that are too tight, too guarded, or just not coordinating well with the rest of the body. So here to explain all of this and tell us all about it is my guest, doctor Betty Delas. Betty is a physical therapist who specializes in pelvic floor health, and she is known for helping women finally get these answers to figure out what's going on in their bodies. She's very passionate about educating women in a way that's empowering and not shame based. So we are going to dive right in and talk about what is the pelvic floor and what does this actually mean if we have a tight pelvic floor, how you might know if it's your issue and what to do about it.
We're also talking about how exactly the tension in the pelvic floor could be affecting your digestion, intimacy, why kegels are not always the answer, and what real healing can look like, whether that's movement, breath, awareness, and finding the right team to work with you. Please share this with your friends if you enjoy this podcast. Please leave us a message, send us a DM, share, subscribe, do all the things because that's how we continue to offer this nice free resource for you that can teach you all about your women's health. That pelvic floor is that hammock sling of muscles in the bottom. It supports your organs.
It helps with sexual function. It's core stability. It's a sump pump with your diaphragm to move lymphatics and liquids and, all of those great things. Well, Betty, thank you so much. I am so excited to dive into this.
We have spoken, for a long time about having you come and talk about all things pelvic floor physical therapy. So thanks for being here. Thanks so much for having me. My pleasure. Now today, we're going to go back to basics a little bit and talking about the pelvic floor, but then specifically talking about one of the issues that comes up really frequently, but people don't really think about.
So we're talking about pelvic tightness and over tightening and all of the things that can come downstream of that. Tell us first, how did you get to be passionate about pelvic floor physical therapy specifically? What brought you to this point? Yeah. Absolutely.
So I've always been interested in pelvic health. It was kind of this like black box. Yeah. Of like, Oh, what's that? Like one, one or two hours in PT school, they like talked about it and it was kegels and biofeedback and kegel weights.
And like, that was it. I was like, okay, but there's gotta be more. And And so I actually did a part time clinical in it, but I had to stay at the head of the bed by the patient's head, couldn't know what was happening down the road. And so I was just kinda like, this is just a mystery still. And then as a new grad PT, I was in orthopedics and wanted to do pelvic health, but there's already someone doing it.
And so this was before it got a little bit more trendy and buzzy, which is Wonderful. Wonderful. But also like, that's the problem. Like it's everyone has a pelvis. So like, why is it a trendy buzzy thing?
You know? So anyway, that's a different tangent. But, so I think a lot of things just have to do with timing. And so, like, my timing isn't always the best timing. And so I thought, like, I should do this right away, but, like, there's another plan.
And so I didn't get into it until after my first. So I had my first baby and the first week postpartum, pushing my daughter in the stroller, I sneezed, peed my pants, literally soaked my shoes. Yep. Whole thing. And then same thing, like being intimate with my husband first time, painful.
Trying to go for a run, first time, feeling like everything's falling out. Like, so I was like, what is this? And like being a PT myself, I was like, oh, I know a Pellet PT. I'm going to go to a Pellet PT. So I went to a Pellet PT and they gave me kegels and biofeedback.
And I got worse, which plays in perfectly because I actually had a tight pelvic floor. And from like stress, anxiety, pain, birth trauma, all things like that. And so I was like, this cannot be what we're doing for people. Like, I have to do this for myself personally. So selfishly, was like, I gotta learn how to heal my own body.
And so when I opened Pandora's box and took my first pelvic health course myself, I was like, oh my goodness, this is where I belong. This is what I've been made for. Like, and so I just went down the rabbit hole and got very educated in all the things and then combined my orthopedic background with pelvic health and really blended it together to be like, this is what pelvic floor physical therapy should be from a comprehensive standpoint. And so that's how I got into it is purely because I went through it myself and didn't get the answers I needed. And now I'm like, here we are to change the world.
One, one pelvis at a time. Well, so layout for us the anatomy. I know this is easier when we have a model and we can do it more visually, but tell us for those listening, like what, what are we talking about when we're talking about the pelvic floor? So your pelvis, right? Your bony structures, and then you have your pubic bone in the front, tailbone in the back, and then your sits bones on the bottom.
So all the muscles between that and a hammock are your pelvic floor muscles. And so really the core is the pelvic floor there, the core abdomen, abdominal muscles in the front, your low back muscles, and then your diaphragm on top. And so that whole core canister, actually our logo is kind of a resemblance of that. It's just tipped upside down because I see it on your t shirt. Yeah.
Three layers of the pelvic floor and then front back. So clever. So there's a little bit into the logo there. But, so it's this core canister of, from an anatomy standpoint and you need all four areas to be working properly for the system to work. And so specifically that pelvic floor is that hammock sling of muscles in the bottom.
It supports your organs. It helps with sexual function. It's core stability. It's a sump pump with your diaphragm to move lymphatics and liquids and, all of those great things. Well, you just made that sound very exciting and very important.
So we want to know how we take good care of it. Yeah. Why isn't this just normal? Like, why is this the thing? Because humans have been around for a long time and presumably no one was helping cave women figure out how to, like, breathe and use their pelvic floor.
Why is this not just the default? Why Right. How does dysfunction happen? So I think, like, why this isn't talked about a lot is because rehab is only so, so much old in medicine. And then in that, pelvic health is only so old within rehab.
And so I think some of it is too generationally. We, like, women in general, it was very taboo. Don't talk about it. Like hush-hush. Like, it just is what it is.
I'm embarrassed by it. I'm not going to say anything. Where I think times have changed and social media has helped with that. Women like us stepping up and speaking on platforms like this to be like, Hey, listen up. Like this isn't the way it needs to be or should be.
And there's a solution, hope and healing for this. And the pendulum has swung, so to speak. And so it's just beginning the momentum starting. That's a really exciting time to be part of. And it's also in the same sentence, like also sad that like, it's just now happening.
It's like, we're half the population. Yeah. Why are we just now getting the attention of these things? So that's a little bit about, like, why I think it, like, hasn't gotten the the press that it should have or the education to providers like it should be. Mhmm.
So So when we talk about pelvic floor, there's a lot going on there and we don't have time to dig into every single thing that happens because that's your that that was a long training for you to go through that. So today we're gonna talk mostly on what happens when the pelvic floor is overly tight. Mhmm. I think when we think about pelvic floor, a lot of people, if they even think about the pelvic floor, will assume that they're weak. Right?
Right. That their pelvic floor is stretched out from having babies, and therefore, they have prolapse or they have, you know, discomfort during sex or they're leaking urine. Whatever it is, it's because either everything is just so weak and stretched out or torn and damaged. Yep. Talk to us a little bit more about this idea of the pelvic floor being tight.
Yeah. Why maybe let's start with what are the problems that come from the pelvic floor being overly tight? So things that come from the pelvic floor being overly tight would be anything with like pain with intercourse, pain with orgasm, pain with sitting, tailbone pain. It could be some leaking, could be some prolapse, could be, even things like conditions like interstitial cystitis or painful bladder syndrome, where you're having urgency frequency burning type things like that. It could be from a C section that was the fascia was pulled tight when it was all stitched up and it's causing tightness in the pelvic floor.
It could be from trauma. It could be from a bike accident, could be from a car accident, could be from repetitive overuse, gymnastics, you know, like all sorts of things can play into like what caused it and what are the symptoms that you're experiencing by having a tight pellet floor. And honestly, most of what we see is tight pellet floors. Like we do also see weak, but there's also a lot of weak tight as well. And there can be weak lax on the flip side too, but a good chunk is tightness or over hyperactivity that's in the pelvic floor.
When you have tightness in the pelvic floor, does it ever spread to other parts of the body like hamstrings or quads or, or up into the lower back? How does that tightness in the pelvic floor affect the organ surrounding or the muscle structure surrounding the pelvic floor. Totally. And it can go both directions on that. So like we have a lot of people that have a tight pelvic floor that then plays into hamstring adductors, inner thigh, or they're having plantar fasciitis or TMJ because it's all in the same fascial line.
So there's a fascial line and for listeners, if they don't know what fascia is, it's a spider web material in your body that holds everything together without it, you'd be a blob on the floor. And it's your also your nervous system highway. So it's highly innervated with nerves and blood flow and things like that. And it communicates all over your body. And so there's a deep frontal fascial line that goes from the side of your head, your jaw, your neck, diaphragm, your hip flexors, pelvic floor, inner thighs, adductors, all the way down to your feet.
So it's a whole line. So if one area is tight, then you could have tightness in other areas affecting other places. So if the pelvic floor is tight, you could have TMJ pain or plantar fasciitis pain. We see a lot of combinations with that. And sometimes the pelvic floor is just trapped in the middle.
And so we'll use a modality called dry needling in like the hip flexors, the neck, the inner thighs and all this stuff like that. So someone who has a tight pellet floor might not actually have a tight pellet floor. It's everything else is tight. We get those loose and then all of a sudden their pelvic floor moves. No problem.
So it's kind of like chicken or egg. What's actually the root cause here? Sometimes it's pelvic floor. Sometimes it's outside the pelvis that's causing pelvic floor dysfunction. We'll kind of slow down a little bit because this is going super speed into all of these details.
Yeah. Go back and talk a little bit more about what are these key symptoms that make you suspect. You mentioned a bunch of symptoms and causes that can go along with that. Let's go back to the symptoms a little bit. What are the classic patients who come in and start talking and start telling you about how they're feeling that your brain is saying this sounds like a tight pelvic floor?
Pain with sex, can't get a tampon in, and then burning, your urgency frequency. Yeah. Those would be the main things that we think, okay, probably a hypertonic pelvic floor with those things. I I wanna just pause for a second and bring that up because I think a lot of people don't necessarily think about going to a pelvic floor physical therapist if they're having urinary issues. Mhmm.
I think maybe leaking urine or pain with sex might get you to a like, someone might recommend that you see a pelvic floor physical therapist. But just a a shout out for people who may be having these symptoms. Number one, if you're having multiple symptoms in the pelvis, you should see a pelvic floor physical therapist because oftentimes, if it started with inflammation or something else, it can still show up in the muscles, or sometimes it starts in the muscles and then shows up in the organs. Mhmm. Will you just comment on that?
Yeah. Everything's connected. That's the, that's the, the key pieces. So from a mechanical stand point, that's our wheelhouse. Like we're the one when the check engine light comes on, you're like, I don't know what's on or why it's on, but something's not like, I gotta get my car looked at.
It's very similar for us. Like if there's a check engine light on anywhere around the pelvis, like that's your sign to be like, maybe this is where it can go. And it's mechanical. That's what we treat as mechanical pain. So it's musculoskeletal, neuromuscular.
That's our wheelhouse. Now, if it's a true organ thing, that's where it's like the collaboration with someone like you is like, okay, this is not in our scope, but we can help with any pain management, movement things, whether it's sitting, walking, sit to stand activities of daily living, like going up and down the stairs, feeding your baby, pooping, peeing, sex. It's like all of those things, if they're those are all mechanical things. So, like, we can help with those pieces. Yeah.
Yeah. You mentioned them quickly, but go back through why someone would have a hypertonic pelvic floor. Why would someone be sitting here flexing their pelvic floor all the time? That sounds exhausting. Right?
Like, I'm not gonna sit and hold my biceps in in a flex nonstop. That would be exhausting, and I would I would let go. Right. What's different about the pelvic floor that makes it feel normal for us to hold everything tight? Right.
I think that can be multifactorial through that for sure. So one thing is, is the pelvic floor is a postural muscle. So it's always on to some degree. It's never like off. And so its resting tone has some tonality to it.
However, we live in a world, and especially in The United States, where stress levels are high, anxiety is high. There's a lot of things environmentally causing stressors in our life. And so hyperally over anxious people or type a people, like, they just tend to upregulate a little bit more. So that could be why, there could be some past trauma involved, whether that's birth trauma or sexual trauma or a whole host of other traumas where that's just a way that the body keeps score and it and it holds on right there. And so there's a lot of emotional things that can be stored there too, that cause that upregulation.
Like we're all sitting here with a pelvis right now and we're all kind of wondering like, what are my muscles doing? Yeah. But, but if you think about it, no one's going to intentionally be sitting here flexing consciously. Totally. One of the things that's so fascinating to me about the pelvic floor is because it's an entryway and an exit of the body, right?
We don't have many of those. Yep. Just that one down there that has the three entry and exit holes. Yes. But that area, those muscles become kind of gatekeepers a little bit.
And so I think especially the idea of trauma, and I use trauma and that can be big t or little t. Right? That could be major, horrible, unspeakable things, or that could be things like I have had painful periods since I was younger or I had a baby and it kind of freaked me out. Or I've seen patients, I'm sure you have too, who had a somewhat traumatic birth and that they were planning on a natural vaginal birth and they ended up with an emergency c section. And even that trauma, that emotional trauma, those muscles will be like, got it, not safe.
Don't trust the environment. And let's gatekeep. Let's hold everything safe. Do you wanna elaborate on that, I mean, more than that? Yeah.
We talk about this all the time with our patients. You are a nervous system. And so we really have to interplay and have a communication and conversation with the nervous system and figure out, like, okay, why is the nervous system guarding this? Yes. And so that's what we do is we're looking at, okay, the pelvic floor is guarding.
Why is it guarding? And there might be pieces of their subjective history or their past and things like that that are tying into that. But a lot of times people don't realize it's a it's honestly a very simple solution, obviously complex in, like, how we deliver that, but simple in the sense that, like, we just have to communicate with the nervous system that there's no lie in here anymore. It's safe. Let's get you moving.
And so we do a lot of techniques, manual therapy wise, whether it's dry needling, hands on, bimanual mobilization, like through an osteopathic lens of treatment to create a environment where the nervous system goes, Oh. That's new. Yeah. And, like, let's go. And then we can continually repetitively do that in all the areas that are somewhat guarding.
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And this is where I think physical therapy, again, can be so valuable because as people are listening to this, there may be, like, well, that makes sense. Right? If you had something scary happen in that pelvic area that your muscles are gonna guard, right, and and resist that. I think that makes logical sense. But one of the pieces that I find just super intriguing about the body is the brain will inform the body in that way.
Right? The brain will be saying danger, danger. Like, any sort of intimate experience might be perceived as danger. There's lots of different connections that the brain can make there, but if the brain is perceiving danger, then it will flex those muscles. But if you've as I'm pet flexing, I gotta relax now as I'm talking.
I can feel my pelvic floor tightening. As we talk through that, a lot of people might say, yeah, but I dealt with that trauma. I went to therapy. I did all the things. But that doesn't necessarily inform the muscles to get back online.
I think of it I call it dominoes because whenever we have any sort of stressor or trauma, it can have a physical effect on the body. Right? Totally. And that's fine. I think of the trauma or the stress as the trigger that's knocking over the line of dominoes, and that's fine.
We stop the trigger, like stop knocking over the dominoes. But You still have to pick up all those dominoes. Then you have to set up the dominoes. And that's really where you come in is sometimes recognizing, like, there's still a trigger there, right, that needs to be calmed down. But then what do we do to pick back up the dominoes?
So will you explain to us how what your role is with that and how you're partnering with other care providers to help people in that bidirectional relationship of the brain and the nervous system and the perception of tension? Not just not again, this doesn't have to be some people will be like, well, I've never been sexually assaulted. Heaven forbid. Right? Yep.
But it's and that can definitely play a role, but it can be any number of things. Totally. Pain putting tampons in or chronic discomfort with tampons that eventually you abandon. That's enough to be like, I'm uncomfortable and I'm gonna tighten everything. So go from there.
K. I'm gonna I'm gonna lens out a little bit to get a little bit bigger picture on that first is so if you think about the body's really good at healing. Yeah. It's it's going to heal. We are designed wonderfully.
And so the body knows how to heal. Sometimes it just doesn't heal appropriately or in the right direction. And that's really where we come in is to help guide that process. So if you think about if you had a knee surgery, what would happen to your knee? What would happen to your quad after surgery?
It would be inhibited, right? It wouldn't work. It'd be a little atrophied, less muscle, all things like that. And so you have to do specific exercises to kind of get that quad back online, plug the computer back in, so to speak. And so when we have a baby or any other trauma there, there is a threat to your nervous system, whether it was this beautiful experience or actually a traumatic experience.
There it's, it's still something that happened majorly. Right? And so all of the muscles around there, your pelvic floor, your core, your low back, your diaphragm, all go offline, just like your quad would. And so then we're just like, okay, well the body can heal, but the body is healed, but it's going to compensate in the path of least resistance. And so it's going to take that path of least resistance.
So it's going to be like, okay, well then I'm just going to use my back and my hamstrings instead and not my glutes. Cause mom, that's a real thing. And that's why. And so we really come around that and say, okay, let's get your glutes firing. Let's get your core firing.
Can you connect with your pelvic floor? Can you connect your breath with your pelvic floor? Can you get your rib cage back down and then Yeah. And create that back to that system canister of like, can we get this moving the way it should? And then all of those other things go away.
But if you don't intervene and and and make sure you take care of those things, then it it's gonna end up in those dysfunctional patterns. And then it creates more pain and that's that even further domino effect down. And so for us, kind of spinning back onto the collaboration piece is we focus on the neuromuscular mechanical nervous system things from a PT lens, but then we rely on people like you for like, okay, there looks like there might be an infection or we need some vaginal estrogen or, Hey, mental health therapist, we have some other things going on here or relationship counselor, or this person actually has exhausted all conservative measures and they need surgery. So like we have to collaborate. And that's one of the really cool things in Utah is we're the first in the nation.
I don't know if you heard this or not. It just passed in legislation that physical therapists are now primary care in Utah. I haven't heard that. Which is huge. Yeah.
Huge. And being primary care, the entire premise of that is relationships and referrals and getting people to the right provider at the right time for the right modality. So I'm like really excited about that for our profession and for Utah as a whole with practitioners because it just it just brings more alliance with what we're already doing. Well, and it just takes down some of the barriers of you need this form from this person. Totally.
Yeah. Totally. Yeah. Well, that is exciting. And and really just speaks to this integrated nature of it, right?
Like the pelvis isn't this isolated body part that you go to the pelvis place and then you go to the other place. Like it has to all coordinate together. It's the cornerstone of movement and everything connects to your pelvis. So it's it's a very vital piece in everything that you're doing. Yeah.
So if the pelvis is overly tight, how does that actually cause we'll start with pain with discomfort. How does that actually cause any issues there? Your muscles, they normally contract and relax. And if they're really tight here and they're not moving and gliding and stuff like that, it causes tension other places. And so I'm going to nerd out.
Can I nerd out really, like really nerdy? And this will segue into why we love dry needling because it goes right into this. So normally your muscles contract and relax like this. They get tight, right? Once they get tight, physiologically speaking, what happens, and this is like a trigger point or not, and this can be little traumas, repetitive movements, big T trauma, like all sorts of things, trigger points.
And they condense that nervous system. Blood flow drops, oxygen drops, pH drops, all these neuropeptide chemicals sit there and they signal to your brain, ow, pain, sharp, stabbing, dull, throbbing, whatever your brain's perception of that is from a pain standpoint, which then does a lot of brain changing things. And so if it's, if more and more of these keep happening, you just have tight and it's just a repeat cycle. And then what we do is we love to use dry needling as a modality to break that cycle because it's a direct interface with the nervous system there. And dry needling is, same needle as an acupuncture needle, not acupuncture.
That's a whole separate thing. And then, but most people know what acupuncture is. So we take that dry needle into the trigger point or not, and create a reflex, kind of like when you hit your knee for a reflex, right? You have no control over it and it goes like that. It So it tightens more and tightens more.
It tightens and then releases. And so, it feels kind of like your eyelid twitching with some spicy sparkly electricity because you're an electric bean. We don't have any electricity that's hooked up to it. And then immediately blood flow increases, oxygen increases, pH gets restored, and those neuropeptide chemicals release immediately have better range of motion, better activation, less pain, like all of a host of wonderful things, not only locally there in the nervous system, but because it's a spinal cord reflex goes to the dorsal hornens in the spinal cord, which I know this is really nerdy, but for those of you out there following me, it's like really cool stuff. And then all the way up to the brain too.
So it's like a big nervous system reset. It's awesome. Kind of what happens is like the tissues just pile on top of each other with trigger points. Yeah. And then that creates all that pain generation.
Yeah. I love hearing about that. This is something that as a gynecologist, we can feel for. And oftentimes when we do a pelvic exam, if someone says they're having pain with intercourse, we can feel inside. And when you feel inside, you can really localize with with fingers.
You can kind of say like, do you have tenderness here? And people can often really localize in this sort of like, ouch, sort of way. Like, oh, right there is where I always get pain whenever I have any sort of penetration or any sort of stimulation in that area. And so I'm glad and very happy that there is an approach to this. I don't wanna belabor this little detour here, but I just think it's important when people have discomfort and have pain, it's really helpful to be quite detailed about it.
Because as practitioners, we have a list of things that could be going on. We call it a differential diagnosis. Right? Yep. We have this list of things that could be going on.
And the more that you can give us, the more that a patient can give us details about that, the more that we can start to limit that possibility of diagnosis. And so one of the things, if someone just says it hurts when I have sex, then we're thinking, is it the skin? Is it the muscles? And so on and so on. And so really being able to say, my skin feels dry or it feels burny and stretchy or tearing, that's very different than it feels very tender or it feels spasm y or it feels tight.
Anything you want to add to that? I think there's a little bit that I want to add to that. I think everything completely on the same page with that. I think too is when patients come in, there's nothing we've never heard. Right.
You will not shock us. You will not surprise us. Like, we've heard it all. We've seen it all. It's what we do all day every day.
It's not weird for us. We would try to make it as comfortable as possible for you. So that's one piece that I'd like to add on. The other piece is, it's okay if you don't know. Yeah, yeah.
Because a lot of people come in and they aren't the expert of their own body. We know more about how to use our cell phone than we do our own pelvic health, which is sad. But we're here to help, like, meet that need. And so when you come in, you will leave the expert of your own body. You will know what that muscle is.
You will know how to describe it. You will, you will become more in tune with who, what is going on. And then you'll be able to help like keep that in maintenance or know what to do to help yourself. And then you leave a completely different person because you're, now you're the expert. And it's okay if you have no clue.
We will help you have all the clue. Yeah. Yeah. I love that, by the way. Talk about the pelvic floor and periods or uterus or any of that relationship there because I'm I'm kind of visually moving through the pelvic floor in my mind.
You mentioned that it's sort of the bottom of this canister, and there's three outlets. Right? There's the where the urine comes out through the urethra connecting to the bladder. There's the vaginal opening and then there's the rectum or the where the bowel's empty. And so we've kind of talked about the vagina, but but the upper part of the vagina is connected to the cervix and the uterus.
Yep. So tell us about the tightness of the pelvic floor and the uterus and ligaments and how that is connected. Yeah. So I think even another layer on top of that is all of your organs, even including above that too, like intestines and diaphragm and liver and stomach and all the things like that, just like your joints move, your organs also need to move. And so a lot of times with painful periods, it can be either tightness in the abdominal wall, tightness in the pelvic floor that's not letting the organs move that can create a visceral somatic reflex of pain, which is basically organs to muscle, muscle to organs, and then it just spirals on itself.
And then also a lot of times there's underlying endometriosis or adenomyosis that we need to like, it takes like seven years on average for people to actually get a correct diagnosis for that. And we've, because people are able to come see people like, pelvic PTs like us, we are able to catch that sooner, get them to the right provider at the right time, get the excision surgery, get the pain management techniques, and then provide that overall wrap around care to help that person. And so painful periods are not normal. And I don't know how they've been normalized. It's just not normal.
And so being able to recognize those things of like, where is this pain generator coming from? And oftentimes it's a looping effect of like, there's actually endo going on and a tight pelvic floor and the tight pelvic floor is flaring the endo pain even more and vice versa. And so can we get everything calmed down both with the organs moving well, which is a technique we use called visceral mobilization. So we do a lot of visceral mobilization and then also pelvic floor work to make it a happy hospital environment where everything's going, oh, I can move how I want to move. And there's no like pain generation happening.
Yeah. Because what would you say are the chances if someone has chronically painful periods? What are the chances that they have some amount of pelvic floor over tightening? Oh, very high. Yeah.
Very, very high. It's like, I almost guarantee it. Yeah. And so it's worth seeking out if you have chronically painful periods, number one, yes. Like, we should do something about your periods so they're not painful.
Yes. I always tell people that their periods should sneak up on them, not in a timing way, because you should know exactly when they're coming, but there shouldn't be these days really of horror leading up to the bleed. You know, it should be like, oh, I'm bleeding now. Like, and and a lot of people are quite baffled by that, but it's possible. Yep.
But after the fact, if you do have painful periods, if you've had, you know, endometriosis and you end up with an excision surgery or a hysterectomy or, you know, whatever resolution point you get to, once we get those painful periods under control, chances are you also need pelvic floor physical therapy to then relearn both the trauma response because painful periods are extremely psychologically traumatizing, you know, being being forced to plan your life around a painful period of saying like, oh, I can't do that meeting that time because I'm gonna be leading up to my period, so I better not you know, these things that are going through in our heads of like, I can't leave the house, so I better not plan something that day. You gotta cope with that. Yes. Hopefully, once we get those painful periods under control. But also that rehab of the pelvic floor.
Yeah. And same thing too for any surgery. So whether it's a c section, Yeah. Hysterectomy, even a low back surgery, like appendectomy, gallbladder removal, like all types of things like that affect the pelvic floor because it's within that canister and those organs that are moving and scar tissue that's there. And so there can be responses just from surgical intervention on the pelvic floor too.
Yeah. Yeah. Great point. Well, so let's keep marching through here. We've talked about the vaginal opening and at the top of the vagina is the uterus and cervix.
Another opening is the rectum and where we have our bowel movements through. So I think that this is something that people don't think to go to a pelvic floor physical therapist for is something like chronic constipation. Talk to us about that over tightening of the pelvic floor as it relates to our bowels and bowel movements. Absolutely. So our bodies again are designed very well.
And so the rectum comes down and it has a, a kink. So let's say that this is a rectum and then your pelvic floor wraps around and kinks that so that it stays where it should be. Right? And so when you go to have a bowel movement, you need to be able to lengthen and relax your pelvic floor, which opens that angle and then everything can come out. So you're showing it visually, but for those listening then it's the bowel is in sort of a little curvy thing that dumps into it.
Think of like Correct. You know, you can see on the bottom of the toilet, you can kind of see that outline of the the s curve of the pipe. Right? And that's what the bowel looks like. Yep.
Tell us more what you mean when you say, so the pelvic floor is kind of supporting the base of that. So the I mean, we have a sphincter there too, but the pelvic floor is supporting that so we our stool just doesn't, like, fall out all the time. Right? Correct. So you say lengthen and expand.
Tell us about lengthen because visually, that's always been difficult for me to Yeah. Conceptualize. So I'll give two analogies with that. One, the bicep analogy. So, like, pelvic floor sits kinda halfway here.
That's where it should be. Halfway flexed. Halfway flexed of, like, on some kind of activity. And then it needs to lengthen all the way to evacuate things, whether that's stool, urine, baby. Yeah.
It needs to go that direction. And then if you're seizing coughing or doing a higher level load lifting of something, it needs to come up to help. So when you say lengthen, you're meaning release. Lengthen and release. Yes.
Correct. So that's what I mean by that piece. And so when you have a bowel movement, your pellet floor needs to be able to relax. If your pellet floor is tight and you aren't able to lengthen or relax that muscle, it can create continued backup or constipation of like, you can only get so much out or like not enough or, you know, that kind of thing like that. And then it just compounds on itself because more water gets to that evaporated and then it's harder stool.
And then the same thing too, if you've had prolapsed rectal, like a rectocele where your rectum is prolapsing into the vaginal canal, that can create issues too, where things pocket or don't come out as well. And so we can help with a lot of those types of things too, to make sure that the mechanical pieces of those are working. And then as well up the chain too, with the visceral mobility and the organ mobility that we do too, is to stimulate all those intestines and get you on a regular bowel schedule so that your body is tuning into all of those things. And it has a nice little transit all the way through. When it comes to prenatals, I'm really picky, and Needed is the one that I personally use and love.
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The tightness in the pelvic floor, typically. Yep. It's just holding it, locked in that s curve instead of letting it open and come out. I think what a lot of people end up doing is they say, oh, I need to go poop. I need to push down really hard.
Right? Take a deep breath, push down from the abs and from the upper abdomen. Tell us what really should be happening. What, what should that I know this is kind of weird to talk about, but I Pooping how long? We all poop, you know, like we all poop.
And I, I don't, I don't know if you know of any statistics about how many people poop incorrectly, but I think it's high. Yeah. I'm sure that's high. Especially if you start, you know, if you say like, I've been constipated since I had my third baby, or I've been constipated since I had my hysterectomy, or my periods are really painful and I'm constipated. Like, that can be over tightening of the pelvic floor.
So walk us through what's supposed to happen. You feel the urge to you feel like, oh, I think I need to have a bowel movement. What should happen when you sit down on the toilet? So in an ideal perfect world, and this is what everyone should strive for. And this is personally what I do and what we teach patients to do is get a squatty potty.
It's the best thing ever. What it does is it brings your knees up above your hips and it allows your pelvic floor to lengthen and that, you know, rectal sling that happens, it opens. So that sets you up for prime success there. So you're letting go of it's like you have, like you have a death grip on the bottom of the plumbing. Right?
And you're trying to go poop, but you keep that death grip going. And so the Squatty Potty allows your death grip of your pelvic floor to let go and open. And then, blowing out candles, just like because that's going to help pressurize your canister and create a lengthening effect too. And so, yes, there's a little bit of like initial, like, bear down push, but it shouldn't be like straining. It should be like smooth.
A release with a gentle push behind it. Yeah. That's a great analogy. And so really you should just knock, knock. I have to go, you sit on the toilet and out everything comes and then you wipe and you're on your way and like wipe once.
If you're wiping more than once, then we might want to talk about some other things with pelvic floor tube. You might have a little bit of like hemorrhoids or something going on where you're not incomplete emptying. There could be another thing, but you should be able to just wipe once and move on. Yeah. Thank you.
I know it is sort of silly to talk about, but I think this is one of those things that no one talks about. Like, no one watches you poop and so you don't know if you're pooping right or not. Yeah. And if you're the one who's sitting there having to bear down super hard, yes, that can be because the stool's really hard and we use stool softeners and hydration and fiber and all of those things. But sometimes for people who are like, I I and this these are the patients that I see.
Right? These are the questions that I ask. And I get patients who will say, what I say our bowel movement should be is bananas. Right? We should sit down and poop a banana.
Right? It should be long and it should be soft and it should be normal size. Yep. And if you're pooping small pellets, like deer pellets, or especially larger balls where it comes out in just ball after ball after ball, that's constipation. That's not normal.
Even if you're pooping three times a day, but it's a ball every time, that's constipation. And so what we should be having is this, this ease with defecation. This might be a little bit of a, of a rabbit hole here, but what happens to the pelvic floor if we are chronically doing this incorrectly, either keeping that pelvic floor tight and not lengthening and relaxing it and then pushing against it Mhmm. Or another scenario that I'm not thinking of, what happens with that chronic increased pressure of bearing down really hard to have a bowel movement? Prolapse.
Tell us more about what's actually happening there. Yeah. So the pressurization, you're just you're you're putting so much pressure down on your organs and your organs are actually held by fascia first and then the pelvic floor. And so if you constantly put pressure and pressure and pressure, you're just gonna stretch, stretch, stretch that fascia. And so then that then it leads to prolapse symptoms and things like that.
So that's the main thing. And I would say hemorrhoids are somewhere in the prolapse family, right? I mean, it's not the same thing, but it's just A venous prolapse. Yeah, exactly. It's increased pressure that just, you shouldn't have that much pressure on the system.
And speaking specifically GI then related hemorrhoids, fissures, like all sorts of things like that can also be consequences of chronic. Yeah. So just another shout out. If you've had chronic constipation, just like if you've had painful periods chronically, there's a really good chance that you are used to tightening your pelvis just from a guarding sense and that you need to retrain how to relax it. We need to address constipation from a medical standpoint of, you know, like I mentioned, whatever we're treating, but also then reprogram the mechanics to make sure that once you have regular stools, that you're actually letting them out and that you're, you're not holding it in.
So if you're always having a tight pelvic floor, another thing that can happen too is conditions like pudendal neuralgia or proxalgia fugics, where it's like lightning in your rectum, just because it's over tight and spasming. And then same thing with like pudendal nerve irritation of just being really tight and causing lots of pain, whether it comes all the way to the clitoris, the perineal body, or like middle of your perineum between your urethra, your pee hole, and your vaginal canal, and your rectum, like it can cause a lot of pain because then you're compressing nerves because your muscles are tight in the nerves. So that's another symptom that can be exposed with all of that too. As we're walking through the anatomy here, we've talked about the, where the, the rectum comes out. We've talked about the vaginal opening in the uterus.
We haven't talked much about the bladder. Will you talk about the bladder and how that pelvic tightening, we mentioned the symptoms earlier, but how does the pelvic floor tightening actually affect the bladder? Pelvic floor tightening, if it's really tight, could lead to leaking if you can't empty completely and then you're overfilling or it's causing, urgency frequency and then urgent incontinence along with like, it could be all sorts of things with that. And then also to having a tight pelvic floor with that chronic bear down constipation on top of it can cause the bladder to prolapse, which can also then cake the bladder in the urethra to then create other issues. So you could have increased UTIs, you could have incomplete emptying, you could have frequency, urgency, things that I've talked about already.
So it's really just making sure, like, can we get these systems where they're optimized and moving the way they should so that you don't have all these other symptoms going on. Before we kind of shift gears to evaluating it, is there anything else about the pelvic floor? You mentioned the pudendal neuralgia. You mentioned, we talked a lot about the rectum, the vagina, the bladder. Is there anything else we should know about when it comes to an overly tight pelvic floor?
Birth. Yeah. Tell us more. So if you have a really tight pelvic floor, it's really hard to get a baby out through there. And either it's either it could, not saying that it will, but it could end up in a c section if your pelvic floor can't get out of the way.
A lot of people are told to do a bunch of kegels when they're pregnant. Yeah. My wife's like, no, please don't. Yeah. Please do reverse kegels, which is the lengthening of that because your uterus will push your baby out and your abdominal wall will push your baby out, but your pelvic floor needs to get out of the way.
And so that's a piece. So how much does an epidural relax the pelvic floor? Is it possible to still have too tight of a pelvic floor with an epidural? Totally could be. Just if there's like that static tight or just they're tight just in general and they haven't loosened up that entire fascial chain like we talked about earlier.
And so epidurals typically help. They're actually proactive to decreasing risk of tearing and things like that because the person's able to disconnect from that feeling. Where a lot of times when you don't have an epidural, the reflex is almost like, tighten up. And like, oh no, that's scary. Because it feels like the biggest bowel movement you're ever gonna have in your life when that baby is coming through.
And so I think epidurals, we know with research that they are preventative of, like, pelvic floor tearing and things like that because people are able to, like, let go. And so a lot of things with pelvic floor BT when you're in during pregnancy is we work on you being able to control your pelvic floor, have your pelvic floor kit out of the way, teach you how to push appropriately, loosen anything that's tight, make sure your hips are mobile, your back is mobile so baby can get in a good position. All of those things like that. So there's a lot of birth prep that can go into, making sure that your pelvic floor isn't tight leading into labor and delivery. You just said so many wonderful things right there.
First of all, if someone does want to see a pelvic floor physical therapist during pregnancy, just for birth prep, how long is that typically done? Is that a month or a month? Totally depends. So we love I mean, we would love to see people as soon as possible. Right?
And typically we see people like maybe in their second trimester because usually first trimester people are not even able to do anything. Yeah. Yeah. Right? Morning seconds.
They're busy surviving. Yeah. They're just trying to make it through the first trimester. And a lot of times people will start to have things creep up too outside of even the pelvic floor tightness, like pubic symphysis pain or low back pain or astro joint pain or sciatica and all those things like that. We can address those things because in pregnancy, subclinical orthopedic thing gets a magnifying glass shined on it.
It's like, oh, did you know you had some massagerant dysfunction? Now you do. And so we can address those as they go so that you can still be active. We know with research, active moms have better outcomes and the babies have better outcomes as well. And so we want to keep you active as much as possible within, you know, medical reasons.
Obviously if someone's on bed rest, we wouldn't do that. But, and then, so it's from an orthopedic standpoint and then being able to help you understand where, where your body is, how to do the things, be empowered with yourself so that you can make all, all of those things happen as beautifully as possible. Yeah. Okay. Now going back a second, Eric, you mentioned that one of the things you do during pregnancy is helping women train to get stuff out of the way.
Tell us more about what that actually looks like when you're working with a patient. Yeah. So we practice all different positions because birth is unpredictable. So we'll practice on your back, we'll practice on your side, we'll practice squatting, we'll practice on hands and knees, we'll practice all different things and making sure you know how to push appropriately and that your pelvic floor moves and, and has, has space. We also do a lot of manual therapy techniques to make sure that the vaginal canal can stretch all directions and you don't have any pain when it does that.
We'll teach your partner or significant other how to do perineal massage and how to do all that stuff so that you can also do that at home. We'll give you a public wand to also do it so you can do it yourself. So there's all sorts of tools. And then kind of wrapping back to like how often we would see someone totally independent of like what they're coming in for Ideal scenario, perfect, which happens like once in a blue moon is like nothing's really needed and we're just monitoring just like you would a normal pregnancy of like, okay, check-in, check-in. Yep.
Everything's going good. And then generally speaking, we would want to mirror very something similar to an OB visit of like, okay, little less frequency, more frequently, unless something's popping up, then we're going to address it and increase frequency of visits. But we would love to mirror the same thing because your body's changing so rapidly. Yeah. Yeah.
Yeah. This is, you know, as an OB, I've delivered thousands of babies and it's so fascinating because I've seen every one of these circumstances pop up. You know, I've seen women who are and by the way, this is not an endorsement for an epidural. Do or don't get one. Yeah.
It's just fascinating to understand how it all hooks together. I've seen women who are going unmedicated and because of could be psychological stress or it could be physically unable to relax the pelvic floor. It I've seen it so many times where they will struggle and struggle and struggle and then they'll finally get an epidural and they deliver like an hour later. The body just opens. So there is there are mechanics and and psychological and nerve and muscle things at play that we just we don't we understand it in theory, but, like, I wish we could do it.
I wish we could just push a button and make it happen, my understanding. But but it is really interesting. On the flip side, I've also helped support the pushing process with many, many women, unmedicated and with an epidural. And it is fascinating. Both women with an epidural and without an epidural, sometimes they'll push and you'll actually see the baby's head go up further inside.
Yep. So there's a lot of coordination that happens too. So we help we help cut that. Right? Because I would say fifty percent of people that come into our offices have a pair what we call paradoxical contraction where they're like push and it's They pull in.
And they pull in. Yep. Yeah. And so it's just, I guess I just share that as sort of a fun anecdote, but but just, we think it's so natural. Right?
Like, and and I do I will say a lot of the birth prep courses that really, really strongly advocate for unmedicated births, You and I have both had unmedicated births, so it's great. I'm a big fan. But I think that if you are in a course that makes you feel guilty if you quote unquote fail to have an unmedicated birth, I don't like that. It's not not what we should be talking about. All birth is natural.
Yes. Exactly. So but but some of those courses that will pressure women to have an unmedicated birth, sometimes I do see that happening is it's like you are so intent on doing it quote, naturally that you can't assess if things are going awry. And just to say, like, we don't always know how to do stuff. And so I guess I'm just advocating for the evaluation and the learning because we don't all know how to poop and we don't all know how to push a baby out.
Correct. There are wonderful ways to do that that can, can help the body function very normally and very naturally. And the body is a machine that is all hooked, One system connected to the other, connected to the other. And so when you do fix one part of it, everything else works better. So Totally.
I don't know where I was going with that, but just advocating for, you know, it's it's not always as straightforward as it seems like it should be. Yep. Educate yourself. Get in. Get seen.
Yeah. Understand your body, for sure. Talk to us about abdominal tension and pelvic floor tension. I think with the size, you know, this idea of, like, we're supposed to be smaller as women. Right?
We're supposed to suck in your don't let your gut hang out. Don't let your butt hang out. Like, get smaller. Right? This idea to do that leads to a lot of people kind of constantly sucking in or pressing in or tucking in or talk to us about that as it relates to the pelvic floor.
Yeah. That can, that can really spiral into tight pelvic floors too, because if you're constantly sucking in that abdominal wall is linked to the pelvic floor. So like they co contract together. So sucking in will cause it can cause a tight pelvic floor as well. And so I think it's important that people know that it's normal to like not have a flat stomach.
It's normal for things to move. It should move. It's uncomfortable not. Yeah. So I don't know why people do it, but, I think that's, that's the biggest thing.
Like having a strong core, being strong is absolutely important, but you don't have to have it like flat and sucked in. Yeah. And that causes also constipation issues. Yep. So things need to move in order to move bowels along, in order to move pelvic floor.
Otherwise things just tighten up and lock down. Yeah. Yeah. As we move into the last section here, are there things people can do at home to know the status of their pelvic floor? How do they know if they are one of these people who has hypertonicity, if they, if they're hypertonic in their pelvic floor muscles?
So any of the symptoms that we talked about before, like if you have pain with sex, can't get a tampon in, painful periods, urgency burning frequency, urinary symptoms, things like that, you probably do already. So like that in and of itself, you'd be like, maybe I have a hypertonic pelvic floor. It doesn't mean you absolutely do. It could just be some trigger points in there that are creating those symptoms. Those would be the things that you can always take a mirror down there and, like, can I do a kegel?
Can I bear down? And do I see everything move up? And do I see everything move the other way? As it should. As it should.
So explain that just a little bit more because I think when we talk about kegel exercises, there's so, so much weirdness. Right? Mhmm. A lot of people are taught that a kegel exercise should be stop your urine stream. When you say, you know, you can do a kegel while you're looking in the mirror.
Mhmm. Tell us what that should look like. Yep. So we do use the that language of, like, stop the flow of urine. That is the action of the muscles.
So you can do that. You can think of it as I'm going to lift a blueberry up with my vagina. Yes. Or I'm gonna suck a smoothie up with a straw with, like, the my vagina is the straw. Or you could, like, you could think about, okay, if I put my hand underneath my pelvic floor, can I lift my pelvic floor off my hand and bring it up?
Those are all cues we use and a variety of other things like that. If you can't do any of those things by just thinking about it, sometimes you might need some overflow from other areas. Can you contract your core with your pelvic floor to lift it? Can you squeeze your inner thighs, like put a balloon or a ball between your knees and do it at the same time to get a lift? And those are all techniques that we take people through in the clinic as well to make sure like, okay, can you do it?
Or if you are weak, get it stronger. And then to bear down, it's the opposite of that, of like, can you drop that blueberry? Can you, you know, push down? Can you push into your hand? But do this as you're talking.
Right? Yeah. Can you push into your hand that you're sitting on and and feel your tailbone come towards you? You can even put your finger on your tailbone. Yeah.
And, like, if you contract up, your tailbone will curl in. Yeah. And if you bear down, your tailbone will come out. Yeah. Because that tailbone should move there.
Yeah. So when you mentioned, like, doing a kegel while you're looking in a mirror, if you are bearing down, the vaginal opening should open up a little bit. And I think then people, you're going to get lots of calls about people saying I have prolapse, but it's supposed to It's supposed to give. Yeah. It's supposed to open up when you push down and there can definitely be some flexion of tissues down.
Yep. But if you are bearing down and you don't see those curtains, those labia, if you don't see the curtain spread, you're not doing it right. Right. Yep. And so there's, there just needs to be movement that direction.
Whether, like some people it will open up, some people it won't open up. But as long as there's movement that direction and movement the opposite direction, great. That's a perfect place to start. Yeah. Yeah.
I just think it's so important. I think that even just sitting here, you know, people can kind of assess. I think we sit in a in whatever our baseline state is. Right? And if that is pulled up and in, then you won't know until you say, now relax.
And then you're like, oh, I didn't know how much I was holding up and in. You know, I I now see that I now that I can push out that I actually was holding up and in. Yep. And if you weren't holding up and in, then you shouldn't really be able to push out that much more. Right?
So I think even just sitting and and evaluating, like, with the belly is the same way when when they get ready to have a bowel movement of sitting on the toilet and saying, like, can I release my belly at all before I have a bowel movement? And if you can, then you were holding in, which means you're chronically holding in. It means you chronically need to learn how to not hold in. This is just a self check-in. Right?
Like, where are my shoulders? Where's my jaw? Where's my pelvic floor? Where are my feet? Cause it's all related to.
So we often tell people to do a body scan of like check-in with your jaw first. It's already going to tell you what your pelvic floor is doing. So jaw, shoulders, core, like belly, pelvic floor, and then feet. Because a lot of times people will curl their toes too. Yeah.
Yeah. I just have to say as a type a person myself, like, this is 1000% me. Like, my traps me too. Yeah. My my shoulders are chronically tight.
My jaw is chronically tight, chronically sucking. And these are things that I've had to learn and go through as I've learned like, wait, my belly was in? Why is my belly in? I wasn't trying to hold it in, but it wasn't. And so this is, if you're out there and you're feeling like you're not allowed.
You're in really pleasant company, but we all want to learn. There's a reason why you're an OB and there's a reason why I'm a post for PT. Right? Yeah. But the the great thing is, I mean, I'm such a hippie, but I get into the mindset of it.
You know, the more that we learn to relax our physical body, the more we really learn a lot about where our psyche is and a lot about how we're approaching life and approaching just our mindset. And the more that you can learn how to, like, okay. Let's just not hold everything in, then psychologically you're like, yeah, let's not hold everything in. Let's just let it out. So there's some really, really nice metaphors in there somewhere.
Totally. Totally. As as the last question here, is there anything we should have talked about that we've missed? Is there anything that that has come up that you feel like you want to fill in the gaps of? Not necessarily.
I just more of a plug of like, if you're curious, go in. Yeah. Get seen, like, ask the questions. We love it. We're here for it.
Like, we're here to help you. We're here to serve you. We're here to empower you. We want you to be the expert of your body. So, like, there's no dumb question.
And, like, if you are thinking about it, there's been hundreds of other people that have asked that question already Yeah. And we have the answers. Yeah. So I love that. I love that.
I think behind all of this, you and I just wanna help people not suffer and not struggle. And it's it's still, we're getting the word out there, but there's still so many people going through things that you're like, you don't have to do that. Like that's fixable. And pelvic floor therapy is life changing. Like period, end of story.
Like so many people, everyone who comes through our doors and I'm sure other places too, is like, they're like, oh my gosh, this changed my life. I'm like, yes, yes, yes, yes. So like, don't hesitate anymore. Like, it's worth it. I agree.
I agree. Well, Betty, tell people where they can find you in your clinic. Yeah. So I own Reborn Pelvic Health and Wellness. We're a pelvic floor, therapy company.
We actually just hired our first OT, so I need to stop saying physical therapy. Yeah. But we have physical therapy and occupational therapy. We have four locations. We have one in Layton, one in Murray, one in Lehigh, and one in Provo, and 15 providers, all female at this point in time.
And we primarily treat women, but we've also added services for men in pediatrics too. So the whole gamut. That's that's so wonderful. Well, I encourage people to check out Betty and her physical therapy clinics. They are a joy to work with and really good at what they do.
So thanks for doing what you do, and thanks for sharing your time with us. Thank you. Thank you so much for tuning in to today's episode. A huge thank you to our guest for sharing their insights and time with us. We are grateful for the incredible support from our sponsors and to all of you listening.
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