Sara Reardon

No, we definitely see young people, young men and women. So I would say in the female population, it's unfortunate because for women, we often think like, well, it's after you have babies, you have pelvic floor problems, or it's when you're in menopause. But there are so many young women who have painful periods, painful sex, urinary leakage, and they don't know where to go to for help.

They're not even seeing a gynecologist yet. And so they're learning about us on TikTok and social media and YouTube because they're looking for answers, right? But I think for men, if you have an issue as a young man, it's likely not a hormone issue and it's likely not a prostate issue. Those are issues that come on later in life. It could be muscle tension.

It could be which muscles affect nerves, right? Muscles affect connective tissue. They affect relaxation. So different things like a hard time urinating or starting your stream, feeling like you can't empty completely, feeling like it's burning when you urinate, pain with sitting. pain with bowel movements, hemorrhoids. I mean, all of these things are pelvic floor related.

And if you've gone to see a urologist and they've ruled out infections and you still have symptoms or you've taken antibiotics and you still have symptoms, your pelvic floor should be assessed.

You know, I think exactly the way that we're doing this. I think, you know, bringing it to people themselves, I feel like a lot of medical information, it was like gatekept behind physicians. And maybe we're lucky enough to be in a city with a physician who maybe knew about pelvic floor therapy, but it was still a last resort.

Like, oh, we've done all these tests and we can't find anything, then go. And then you've suffered for months or years. So if you have an issue with anything from pelvic pain, painful sex, bladder leakage, frequent urination, sexual dysfunction, pooping issues, I'm like, just go see one. And we'll tell you if there's no pelvic floor component, we'll be like, sorry, we're not finding anything.

But more often than not, there is. And if there's other issues like an infection or you know, something else more pathological going on. We collaborate with other physicians. We refer out. I mean, I work with acupuncturists, dieticians, nutritionists, personal trainers, psychotherapists. I mean, hormone specialists, like we're just one piece of the puzzle.

I don't think that we can always solve everything, but I think we're a piece of the puzzle that's often missed. And by the time people reach us, they're like, why didn't anybody tell me about this sooner, right? Now they've suffered for months or years and their quality of life has changed or they spent gobs of money on treatments that were ineffective.

And so I think it just needs to be brought in earlier. I think medical providers need to ask the questions. We talked a little bit earlier about sometimes people are uncomfortable talking about this, and that means medical providers are uncomfortable. And I'm like, get over it. Our job is to help the patients.

You know, I wish I could take credit for it. So I am a physical therapist by training. I have a doctorate degree. And then I specialized in pelvic floor physical therapy. And when I was after graduate school practicing, I would get together with my girlfriends and their families every summer and practice.

And if you don't screen for these issues by asking about peeing, pooping, sex, menstruation, birth, hormones, then you're missing a big picture here, a big piece of the puzzle.

Totally. And I think that to your point, one, I mean, I am a woman. I have two kids. I'm in perimenopause. I have had my own issues. And so people are like, how are you so vulnerable? I'm like, if I'm asking other people to come see me and talk to me about these really intimate parts of their life and things they maybe never told anybody, I feel like they deserve that same thing from me.

They deserve compassion, transparency, vulnerability. And the other thing is that like People are not alone. I think so many people don't talk about these issues and they feel like they're the only one. But I've been in this practice for 18 years. I've treated tens of thousands of patients.

I tell a lot of stories in my book because I think it's important for people to know that if you're experiencing it, somebody else likely is too. We're just not talking about it. So I always say I want to normalize the pelvic floor conversations. I don't want to normalize the pelvic floor problems.

And that's where I think that we really need to shift the narrative of let's talk about these things. And then we're able to find solutions for them instead of dealing with them kind of so quietly, but then not even knowing that there's help out there.

A few summers after I specialized in this field, I ended up like sitting in a hot tub with all of their moms talking about their bladder problems. And all of my friends said, oh my gosh, she's like the vagina whisperer. And then when I created my Instagram account in 2017... I created it for my group of girlfriends. I was pregnant. We were all going through pregnancy and postpartum.

So the full title is Floored, A Woman's Guide to Pelvic Floor Health at Every Age and Stage. So it is for women. And I say it's for everyone with a pelvic floor because if you have a daughter, if you have a mother, if you have a wife, I mean, I get men reaching out to me saying, I found you on Instagram. I think my wife has this problem, you know? And so they're searching.

I mean, not to generalize, my husband, he wants a solution. And if he can't find one, he wants to keep searching for one. And so I see a lot of men doing that to support their partners. But it's a woman's guide. And I think one of the things I want women to understand by reading the book is that, one, these muscles exist. And there are things you can do to prevent issues.

I think we live in a healthcare system where we're always doing damage control. We're like addressing problems afterwards where I'm like, there's a lot you can do to prevent issues, whether it's you're becoming sexually active, you're pregnant, you're recovering from a baby, you're heading into perimenopause, at every stage in life, your pelvic floor requires different things.

And I want to give you the tips and tools to take care of it. And then also, if you are experiencing a problem, there's resources in the book to help you. Like, what are the exercises to start with? How do you massage? How do you know if you're doing a Kegel correctly? How should you be sitting if you have pain? If you have pain with sex, what are different positions to try?

You know, just so many things that over the years I've been practicing, this is the daily things that I tell my patients. And yet not everybody can come see Sarah. Not everybody can see a pelvic floor therapist. So how do we get this information into women's hands in a very easy, accessible, and affordable way?

The second part of this is I really want us to change the experience of the next generation. I have two kids. I have so many friends who have daughters and children, and they're like, I don't know how to teach my daughter how to use a tampon, or I don't know how to talk to her about sex or like, how should I teach my kid about how to poop properly because he's constipated.

And so if we can, we know better than I think we can teach the next generation better as parents and really help them have a different experience. And I think my generation or even my mom's generation had with respect to pelvic floor healthcare.

Yes. And I will say right now, it may be the last, hopefully not, but it's a huge endeavor. I mean, it's a two-year process. And I mean, I had a research assistant. I mean, we dove into the research. I looked up my old cases from over the years to have really rich patient stories. I used kind of all my old techniques and tools. I mean, everything.

I mean, there was so much in this book that I wanted to put out there. And I could have written a book just about pregnancy or just about menopause. I was like, we need to start just from the basics. People don't even understand the basics of this part of their body. So it was a two-year process. But the really cool thing is the way that I got the book deal was it was a follower on social media.

And she worked for HarperCollins Publishing Company. And she said, I think that what you're saying is really important. And would you ever consider writing a book? And I was like, I'm going to have to think about that. I'm really busy. But I owned a physical therapy clinic in New Orleans at the time. And I was building up my online exercise platform. And I was like, I just don't have the capacity.

And I just was sharing tips on social media for them to find so they could know how to prepare. And I named it The Vagina Whisperer because that's what they called me. And so it really has blossomed, you know, over the years, several hundreds of thousands of folks following along. And I think that that growth is a real testament.

So I ended up selling my clinic. And the day after I sold my clinic, I signed the book contract. And so I had to make some shifts in my personal and professional life to take on this endeavor. And I still work for the clinic. I sold it to the two women who were my employees at the time. And now I work for them.

But yeah, it's been a pretty interesting journey just to kind of follow this path, just like you, Dylan, of like, where am I headed? You don't always know, but you just kind of go to where you're called.

I'm thankful for them too.

They do. And the imprint I'm under, which is a specialty imprint, is called Park Row Books. And that's where my editor, Erica, is. And I met with this team, and it was all women. And they were really behind this mission-oriented book. And they've just been great. I mean, I have a great team. And yeah, I mean, it's just wild. Literally like a cold email.

And then two years later, you're a published author. And it's just a really cool experience to kind of have gone through this and to be where I am now.

Yeah, thank you. So it's called The V-Hive. And I started this post-COVID because a lot of people weren't able to access pelvic floor therapists in person. And people were working out from home and not back to gyms. And so I created online pelvic floor workout routines. And some of them are strengthening. Some of them are relaxation.

A lot of them are like pregnancy, birth preparation, postpartum recovery. Also, I just launched a perimenopause and menopause program, which adds in weight. But all of it is pelvic floor focused. So it's teaching you how to contract your pelvic floor, how to relax your pelvic floor, how to modify exercises if you're having a pelvic floor problem. I'm not a fitness professional.

I'm a pelvic floor therapist, and I really try to stay in my lane. But I mean, if you, a lot of people are scared to exercise or they don't know what's safe or what's not if they leak or if they have prolapse or abdominal separation or diastasis recti. So I wanted people to have a resource of how do you do this at home? And it's 10, they're 10 minute workouts, 10 to 20.

So you don't need 45 minutes. I mean, if you're a busy mom, you don't have 45 minutes three times a week, right? You maybe have 10 minutes, but I'm like, everybody does have 10 minutes. Like you scroll for at least 10 minutes a day. So if you can carve that out a couple times a week and really start working on your pelvic floor, I mean, the benefits are huge.

And I've had women over the years that are like, I did this before my birth and I had the best birth experience. I had no tearing or... I've been leaking for years and I'm finally able to run again. Or, you know, my mom has prolapse and I don't want to end up like her in diapers. So like, thank you for giving me resources. And it's very affordable. It's like $21 a month at the cheapest level.

One, maybe the name is funny, but two, that women really want this information about their pelvic floors and they're not getting it from anywhere else. So it's just been an incredible journey to go from starting an Instagram account to now being a published author, talking all about the pelvic floor and the vagina.

And that's important because not everyone can access, you know, in-person therapy or out of network, you know, private services. So I really want this to kind of become the normal for women's healthcare so that they can work on their pelvic floors and prevent issues.

Yeah. So prolapse is when your pelvic organs aren't supported well by that hammock of pelvic floor muscles. And so your bladder, your rectum, or your uterus kind of starts to drop down into the vagina. You might feel a bulge at the opening of your vagina or like something's like falling out.

And it sounds scary, but it's really an issue where your muscles are tense and you might be straining or they're weak and the muscles or the organs are kind of pushing through. And so by strengthening your muscles and working on relaxation, you can kind of actually relift those organs and give them more support.

But it's 50% of women who have given birth have some degree of prolapse walking around out there. And if you're lifting heavy weights and not breathing properly, you're engaging your pelvic floor. If you're straining with bomb movements or you're pushing when you pee, I mean, all of those things can contribute and make this issue much worse.

Right, so in the female body, your uterus, your ovaries, your bladder, and your bowels. And then you also have your balls are kind of connected to your colon, so any kind of digestive issue. For males, it's their bladder, their balls, which hold stool, and then their prostate. And men only have two openings.

Men only have two openings in the pelvic floor, one for the urethra through the penis, and then the anal opening. Females have three openings. They have the urethra, where urine exits, the anus, where poop exits, and then the vagina for vaginal birth, vaginal intercourse, menstruation. So, you know, females just have more susceptibility to weakness too because they have an extra hole.

But we see that's the difference between female and male bodies too.

Yes, I see this all of the time. I see it in teachers, medical professionals, people who don't like to use the bathroom in public, holding your bladder too long. So the normal frequency to pee is two to four hours. If you're going more frequently than that, you're going too frequently. It's like overactive bladder syndrome, which your pelvic floor is a component.

But if you're holding it longer than four hours, you can create hypertension in those muscles and then your bladder gets really full. And then when you try to pee, you can't relax. So then you try to push, you have to sit down, you strain, you have to push in your stomach to try to get your bladder to empty. You know, there's all of these things that it can...

totally lead to a pelvic floor issue. And it can even lead to a urinary tract infection because you're not emptying your bladder frequently enough. And then bacteria accumulates in the bladder and creates an infection. So I always tell people pee when you have the urge to pee, like don't overhold it. And I think people can go too frequently or too infrequently.

And both of those are pelvic floor problems.

Yeah. This is such a great question because these are muscles like any other muscle in your body. You can absolutely overtrain them. You know, I had a gentleman who years ago I was seeing him, he had urinary leakage after his prostate was removed. After you have prostate cancer, they can remove your prostate and it can lead to erectile dysfunction and urinary incontinence.

And he was doing 2000 Kegels a day. And when I went in to assess his muscles, he was, had so much pain and spasm in his pelvic floor. And he was like, I'm sitting in a truck and I'm a truck driver. So I'm just like doing Kegels all day. And I was like, but you don't need, just like, you don't need 2000 bicep curls, right? No. Like, what would you say?

You want to load, you want to work to fatigue, you want to gradually increase intensity, you can do heavier loads, you can do more reps, but like you do three sets of 10 max, right? And so it's about gradual strengthening, but you don't need more than 30. But the other thing is you have to bring this muscle into function.

So if you're at the gym and you're like, oh, I have pelvic floor weakness, right? Or I want to make sure I'm protecting my core and my pelvic floor. I would guide you to engage your pelvic floor. So pre-contract. A pelvic floor contraction is what we also call a Kegel. Do a pelvic floor contraction prior to lifting, prior to squatting, prior to lunging,

you know, contract these muscles before you load and then make sure that you're breathing. A really common thing that we see with a lot of heavyweight lifters and trainers is that they hold their breath when they're lifting heavy loads. And it's a compensatory technique and it's fine to lift heavy loads, but as a long-term strategy, it will blow out your pelvic floor.

I mean, you'll have hemorrhoids, you can have rectal prolapse, you can have a hernia, diastasis recti, because that air is getting trapped and it doesn't have a place to go. So it's going to find the path of least resistance. So in a male body, it might be an umbilical hernia or a hemorrhoid. But in a female body, we have vaginas and we have that extra layer kind of opening of weakness.

So it will lead to prolapse, urinary leakage, pelvic pain, because you're not breathing while you're contracting. And over time, it can cause dysfunction. So that's a kind of an icky situation because I want women to be able to lift heavy, but I'm going, if your bladder contents are spilling out as you're doing it,

Reach your PR goal, but just know you're likely causing some pelvic floor dysfunction, just like you may cause a muscle strain or strain somewhere else in your body, but it is affecting your pelvic floor, which could lead to a more severe issue.

Right.

Yeah, you have – the way that your brain works, Dylan, is you're really like following this track and the answer is yes. It's like you're like cluing into all these things. I'm like, that's correct. So you have different layers of your abdominals. And the deepest layer is called your transverse abdominals. That kind of wraps, you know, all the way around from your deep abs to your low back.

And then you've got your layers of oblique abdominals. And then you've got your six-pack rectus muscles, right? Those are kind of the out muscles that you would have. I know you've seen yours. I've never seen mine, but I've heard that they're in there. But all that being said, that deepest layer, the transverse abdominals, connect to your pelvic floor.

So when you activate your pelvic floor contraction, when you contract, your deep abdominal transverse muscles contract at the same time. They work in synergy. You can't isolate them separately. So if you're engaging your deep pelvic floor muscles, your deep ab muscles are also firing.

And that's actually the biggest reason that a lot of people have back pain or they can develop hernias or is because they're not activating the deep core. They're only doing rectus work or oblique work. And so before you even do any ab work, I'm like, pull your pelvic floor, your perineum, which is kind of the midline of your, we call it the taint, you know, in like urban dictionary. But

The area kind of just at the base of your vagina or penis, and you lift that up, and that activates those deep core muscles while you're working out. The hernia is caused by not having the correct pressure management, which likely means you're not breathing well. Like it likely means you're holding your breath and that breath is trying to find a place to go. So it goes towards your belly button.

Awesome. Thank you. You know, and I think that that's one of the thing is I'm a medical professional. I'm a medical provider. But I think when we start using this jargon and all of these really medical terms, people get lost and then they can't understand what we're talking about. And so I want to meet people where they are.

It goes towards your inguinal area and you've got a hernia. It's also why disc bulges happen, right? That pressure from heavy lifting or poor posture has to go somewhere and you bulge a disc. Right. Or you get prolapse or you get a hernia. So it's trying to find its outward maneuver. Right. Dr. Anneke Vandenbroek

And I have a lot of postpartum moms who get this after giving birth and their belly stretches out. There's so much pressure in there. It doesn't have anywhere to go. But if you fix it, there's a 50% chance of it failing and happening again because you never learned the right strategies.

So to get to your point earlier about like you have to kind of look for what's causing the problem, your breathing, your lifting, your posture, your core, and that will help kind of give you long-term relief.

Yeah, I mean, the basics are like if you have constipation, you're at a high risk of pelvic floor dysfunction. Constipation is the number one GI complaint in the United States. And it's super common with kids as well. So if you're eating too many processed foods, not enough fiber, you're not getting enough hydration. I mean, the basics are like you need fruits and veggies.

And the other thing is, you know, I've treated, you know, thousands, tens of thousands of women. And this is a really intimate part of their body that we're talking about. They're sharing things with me that they've never told anyone sometimes. And I want them to feel comfortable doing that and less alone in the process and that I also understand it as a woman.

You can take natural fiber supplements if you want. I'm a big fan of taking magnesium citrate for constipation. You take it at nighttime. It makes you a little bit drowsy, but a side effect is to soften your stool. And so you can have smoother, easier bowel movements. So yeah, it's a little bit of the chicken or the egg. If you're constipated, your pelvic floor is going to be tight.

Or if your pelvic floor is tight, it can cause constipation. But either way, looking at what you're Eating is super important. On the flip side with your bladder, some things that can irritate your bladder, you can have them, but if you have urinary urgency or leakage, you may want to just minimize how frequently you have them.

So citrus juices like grapefruit juice, orange juice, spicy foods, wine, beer, chocolate, anything acidic will cause more bladder urgency and frequency.

So, you know, if you leak urine and you're going to go stand at a football game for hours and you love to have beer, like just be, know that you're going to have to pee a lot and you might want to be prepared to, if you leak urine or something like that, to have a backup.

But if you, or if you have a really important meeting and you know coffee irritates your bladder and makes you pee, then, you know, maybe hold on the coffee until after the meeting. Things like that, they're fine to have, but just knowing the effect on your body is important.

When it comes to supplements, so I, I mean, I take my own for perimenopause, which, you know, I take ashwagandha, I take fish oil, I take Vitex berry. I mean, I kind of take the standard ones that I think a lot of folks take. I'm actually a huge fan of CBD because I think that it can kind of have a very chill effect.

And often when people have really upregulated nervous systems, they have tension in their pelvic floor. So everything from oral CBD, CBD lotions, but I also recommend CBD suppositories that you can put in your vagina or your rectum to help the muscles relax. It can also be found in some lubricants if you're using it for sexual activity.

I'm a big fan of collagen because we have estrogen is responsible for making the protein of collagen. And when you have less estrogen when you're postpartum, And breastfeeding, when you're on hormonal birth control or you're perimenopausal or menopausal, you have less collagen. And collagen can weaken your tissues, give you less pelvic organ support and lead to incontinence.

So I like people to take collagen. I don't know much about creatine, so I don't comment on that a ton. But I think that there are some supplements that you can take, but it's a combination. It's like you can't just take ashwagandha and think your pelvic floor is going to be better. It's always a piece of the puzzle, but it's not just

I think our society still wants this like magic pill or this like silver bullet and it just doesn't exist.

And so I think all of those things have really just, yeah, been able to help me connect with so many people over the years and provide them help and resources for these really kind of intimate and often embarrassing issues.

You know, I mean, totally. And people like, how do you strengthen your pelvic floor? I'm like, you have to exercise. And they're like, well, do I have to do it forever? And I'm like, well, do you have to brush your teeth forever? Like, you don't have to, but your teeth will get like gross and you'll get cavity. So it's really a choice, you know, and I don't mean to be glib about it.

But it's like, this is if we want to take care of our bodies, we like, have to take care of our bodies. And You know, pelvic floor dysfunction is associated with depression, higher risk of ending up in a nursing home, higher rates of surgery. And so I'm just like, what can we do to care for our bodies in the long term? I don't want to spend gobs of money on diapers when I'm older.

I want to be able to travel. I want to be able to run three miles for the rest of my life. And so how do we help keep people with a really high quality of life into our later years which is now 40s, 50s, 60s, we start seeing our body changing so significantly. But if you have a pelvic floor issue, it can really affect that.

And even relationships, like if you can't have sex or it's painful, I mean, these can cause a lot of marital relationship challenges. If you can't have sex, you may struggle to get pregnant. I mean, the effects go so deep that I don't think we realize how much pelvic floor issues can really influence someone's life. But that's why I'm so passionate about giving people the resources for help.

Right.

Yes and yes.

Yes. When you are pregnant, that is the time that we often see pelvic floor issues arise. And we don't have any standardized postpartum rehab for women in the United States. In other countries, they are sent to postpartum therapy, physical therapy, like automatically. And we don't have that system here yet. But during pregnancy, your pelvic floor muscles are getting weaker over time.

Your pelvic ligaments are softening and loosening, and you have less stability in those joints, which that's what our body's supposed to do. It's designed to do that, but you can get pelvic floor issues as a consequence. So... I always say, you know, your pelvic floor is this basket of muscles that supports a growing baby, right? Your uterus is inside that basket.

And the beginning of pregnancy, your baby's a size of an avocado, right? And then maybe the size of a papaya. By the end, it's the size of a watermelon. And so if you think about a hammock holding an avocado, it's not going to change very much. But if you think about a hammock holding a watermelon, that hammock's going to sink down. It's going to stretch out. It's going to get weaker.

And that's what happens during pregnancy. Your pelvic floor gets weaker just during pregnancy. And low back pain and urinary leakage are present in over like 75 of pregnant moms. Unfortunately, doctors will say, oh, just wait until after pregnancy. But if you don't address it during pregnancy, it's likely to persist after the baby's born.

So I always tell women like during pregnancy, I really recommend strengthening during the first and second trimesters. I have a whole online program for pelvic floor strengthening during pregnancy. And then in that third trimester, focus a lot more on relaxation and stretching because you need your pelvis to open up and your pelvic floor muscles to relax for a vaginal birth.

We don't need super tight pelvic floors for a birth. We need relaxed muscles that can lengthen and coordinate and get out of the way for baby to come down the vagina. So if they're super tight, it's almost like doesn't allow baby to come down. So I focus a lot more on like yoga and breathing and learning how to push properly and different positions to push in that third trimester.

And then postpartum, you should do recovery. You should do You know, retraining, re-strengthening, reconnecting to your pelvic floor and core because it's been through 10 months of change and then birth, sometimes which required a surgery. So it's definitely a time I think women need to be proactive. And we also see a lot of issues arise postpartum.

And I really encourage women to get them addressed, whether it's, you know, you gave birth three months ago or three years ago. It's never too late. I would definitely get help for the issues or read the book and kind of get started because there's a lot that you can do and it doesn't get better as we age.

Yeah, people with vaginas.

No, but really, you know, I think that when people like even, you know, my mom's in her 70s and she's like, well, I don't know if I need this book because I'm in my 70s. I'm going, well, you're at a risk of leaking urine. You could end up in a nursing home. You pee every 30 minutes when I'm with you. Like, yeah, you definitely need this book.

Or it may be a young woman in her 20s that has pain with sex. And she's like, well, I don't I'm not pregnant, but and I don't leak. And I'm like, yeah, but you might have pain or you're sexually active. What I really think that I tell everybody is read the first chapter and the last chapter. Those are my two favorites. I just did the audio book recording and reread the whole book.

And those two chapters, I think, really sum up what's important, what's kind of total BS, because there's a lot of like wellness industry stuff for the vulva and vagina, why we need this. And then you can kind of cherry pick which chapters you like. Like if I have a peeing problem, then I'm like, okay, read the bladder chapter. If I'm pregnant, read the bladder chapter.

then read the pregnancy and birth and postpartum chapters. If I'm perimenopausal, read the menopause chapter, you know? So kind of go to what you need it for, but you're going to go through every stage of life as a woman and you may be pregnant and postpartum and then a couple of years later be perimenopausal, you know, or start having pain with sex and then you need to read the sex chapter. So,

I think actually when people read it, what I do is I tell you what's normal, how often should you be peeing, what should sex feel like, how do orgasms work, how to insert a tampon. I mean like everything from the basics of your body to how should you be peeing and pooping and lifting and breathing so that you don't cause an issue.

And then if you are experiencing an issue, what can you do at home to start helping with it? Like you can start these things right now. And you and I talk a lot about like, hey, it's just 10 minutes a couple of times a week. And I know some people are like, oh my gosh, I can't put another thing on my plate. But these are really small changes you can make.

So I went into college. I went to Washington University in St. Louis in the Midwest. I was born and raised in New Orleans. And the first time I ever flew on a plane, I was 17 and going to college. Like, I mean, I was kind of a small town girl. And so even being from New Orleans and I went to WashU knowing that I wanted to be a physical therapist. I said, I don't want to be a doctor.

Literally like just changing how you sit when you poop or changing how you breathe when you lift or how to relax your muscles to pee. And all of those small changes add up to make a very big difference with your body. And so they're not big life overhauls I'm asking you to make. It's really small changes, but you have to be consistent with them and it can go a really long way for you.

Right. Great point. Yeah.

No, in every state in the United States, you can go to a pelvic floor therapist without a referral from a physician. Sometimes insurance or the state requires you to have a physician's approval to continue. In Louisiana, we don't have that. You can absolutely just keep coming. But in every state, you can at least get an evaluation.

So if you're like, hey, I'm not sure I want to talk to my doctor yet, or I'm not even sure if there's a problem, you can find a clinic. go to Google, ask your friends, you know, there's, you can go on social media and literally type in like pelvic floor therapist near me or pelvic floor therapy, you know, Louisiana. And there's so many people who will pop up. So they're all over the place.

I don't want to be in school forever. I don't want to be a nurse, but I'm active. I run track. I swim. I don't want to sit behind a desk all day, and I want to work with people. And just kind of following those small things I knew about myself led me into this field. And so I was at WashU for seven years, undergraduate and graduate school.

And I would even say like, go check out my blog because there's a ton of information on there, not just for women, but it's also just like, what is your pelvic floor? What's normal to pee? How should you poop? Like, sign, do you have a pelvic floor issue?

And so I think people can start going down these rabbit holes and then look around and actually you'll realize how many other people are seeking help as well, or there could be a clinic down the street. So I would say at least get an evaluation and see, and then you can always try some of the things that help.

You can get them from your therapist, you can do them from the book, whatever the case may be. You can do my online program. But I think that the biggest thing, and we talked about being proactive about health, is I'm like, you get one pelvic floor and you can't replace it.

If we know that it can lead to all of these dysfunctions, you have to proactively take care of it and recognize early when there's an issue. Because a lot of us will have back pain, hip pain, or pelvic floor problems. None of us are immune to these issues, but if you have them, then I would seek help sooner than later because they can be so easy to address and so easy to overcome.

We just don't talk about it, you know, but it's what I talk about all day. And so I know how common it is.

Correct. So, um, yes, I would say that There are 36 muscles that attach to the pelvis, your core, your glutes, your abs, your pelvic floor muscles, your low back muscles. So anything that is influencing one of those muscles can influence your pelvic floor. Literally, if you have a labral tear, if you have a bulging disc, if you have SI, just joint dysfunction, where sometimes there's

like a misalignment issue, if your pubic symphysis is separated or kind of misaligned, all of those things will change the alignment of your pelvis and therefore change the tension and tone in your pelvic floor. So that basket of muscles may be tighter and shorter on one side or longer and weaker on the other side.

And sometimes it's an injury or an episode that does something like say you had a back injury. But the other thing is also chronic postures and positions that we assume. So if you sleep a certain way or you always hold a baby on one hip and your right side is always short and tight or you've got weak hip muscles on one side because of an injury.

So all of those imbalances influence your pelvic floor. And so the way that we actually treat, it's not like we go straight to the vagina or anus. It's really like peeling layers of an onion. Like I look at your posture. I look at your back. Do you have surgery, scoliosis, abdominal scars, diastasis recti, a hernia, all of those things. I look at your glute strength, your hip mobility.

I got a degree in psychology, and then I went on to get a doctorate in physical therapy. And while I was in physical therapy school, I had a professor who's still my mentor to this day, 18 years later, who gave us this two-week lecture on women's health.

And then I work on those things and then help kind of get closer, peel that layer of the onion, get to the muscles and tissues and fascia externally, and then work internally. Because I could go in and release your pelvic floor muscles till the cows come home.

But if you have overactive glutes and a piriformis syndrome and a tight QL and, you know, rotation, then I'm like, I'm not going to get very far because those factors are still influencing your pelvic floor. So, and to your point about the core, it's like... I think again, we look at the outside core muscles, but we don't look at the deep core muscles.

We don't look at the pelvic floor and the transverse abs. And I'm like, we're putting walls on a house that doesn't even have a floor. Like you literally haven't built the foundation. So oftentimes- I think a lot of athletes that I work with get frustrated because I'm like, okay, let's just work on some heel slides or some leg marches. And they're like, God, this is so boring.

But I'm like, if you don't get the foundation, you can't, you're getting to that next level isn't serving you because you don't have that deep core engagement and support to support like super strong abs and upper body and thighs and all these things. So again, you kind of have to look outside and inside about what's going on.

So it's in conjunction with. So if somebody has kind of a pelvic misalignment or they need some kind of chiropractic adjustment, I'll continue to see them while they see the chiropractor. Because if you get adjusted, but the muscles are still spasmed or overactive, then that displacement is going to reoccur. Like the chiropractor is kind of putting it back in place.

But if you don't fix the muscles and tissues and ligaments that are influencing that, then it'll persist. So I work on, say you get realigned or I release the muscles and tissues. It makes it easier for a chiropractor to adjust you. So it's very much in conjunction. I don't do, PTs don't do any x-rays. We're not licensed to do them, but I also, people aren't coming in to see me for a fracture.

Now it's called pelvic health, but it was just talking about how a woman's body changes and how muscles influence that, like everything from giving birth to exercise, but also just sex and peeing and pooping and periods. And I was like, I've never heard of muscles controlling those things, but it made so much sense. And then I loved understanding my own body as a woman.

Yeah. Most often people aren't coming in to see us for acute pain. We can work with chiros and physicians to get that, but I would say most often that's not what we see.

What I do do though is I absolutely refer to a physician of like, I think that there's, you know, I've had two women come in who have pain with sex and when I'm working on them, they have this deep hip pain and their hips are so overactive and they've got popping and clicking. I'm like, I think you have a labral tear.

And then I'll refer them to an orthopedist and they get an MRI and they do have a labral tear. but the hip dysfunction is influencing the pelvic floor. So you kind of just have to have your thinking cap on is to like look outside the pelvic floor muscles. But we work with and collaborate with other practitioners all of the time. I think that that's, a real strength of physical therapists.

I think sometimes other practitioners are like, no, we're just going to do this or we're just going to do medicine or we're just going to do surgery where we're really thinking about like all the different aspects and really trying to collaborate to do what is most supported in the evidence is to have like multidisciplinary care.

It's not a prank. I mean, it's what we're trained to do. You know, like our system is siloed. Like you go see one person for the one thing. But I think as we grow as practitioners, like I didn't used to work with chiropractors and now I, all of my pregnant patients are seeing chiropractors and, you know, things like that.

And so I think it's a way you kind of find, you also find the people who kind of align with your philosophies, you know? And so I think that, you know, as I practice, I'm like, I don't know everything by any means. I just know a lot about a very small topic.

That I can help you with. Outside of that, we'll find the right person for you.

So on social media, my handle on Instagram is TheVaginaWhisperer where you can just – I have so much information on there. And then I also have my website, TheVaginaWhisperer.com has all my blogs, which is totally free. I have a bunch of free guides for everything from birth to pelvic floor, you know, relaxation for painful sex, for – perimenopause, just, you know, resources for folks.

And then we offer online consultation. So if you do want to meet with somebody one-on-one, it's a really easy way to do that. And then, of course, the membership where people can have kind of at-home pelvic floor training programs. And you take a quiz so we kind of know what you need help with and help direct you down the path.

And then when I started kind of practicing in the field, even as a student, I said, I really love educating other women about their bodies. And I think for all of them, this light bulb would just go off of like, oh, this is just muscles. It's not like something super weird or scary or foreign. It's just muscles. And then to see them get better with just exercises and movement and

So all of that is free except for the membership is paid, but it's super affordable. I mean, somebody's like, I'm like, it's the cheapest program is $21. It's so cheap. And I was like, the other day I went and, you know, my kids wanted Chick-fil-A. I'm like, I just spent 50 bucks at Chick-fil-A. What kind of economy is this?

You know, but it's like you, when you think about what you spend money on, I'm like, this is your health. And as you mentioned, like this is, probably the most important thing that we can take care of. We do live in a system where I'm like, you have to be the advocate for yourself. Solutions are not going to fall into your lap.

Physicians are not going to always ask you the right questions and lead you to the right person. You have to really dig and fight and advocate for yourself because it's just the way that it is. And so I really encourage folks if they think they have a problem or they're

Experiencing one to like check out the website buy the book take the quiz whatever it is But just just start somewhere just make one change And I think you'll realize that again like these really simple things can go a really long way And i'm also like I want to have great sex until I die. I don't I want to run forever I want to work out forever. So like why?

Would I not do the things to help me be able to do that? and um You know, I'm in perimenopause right now, and I think that there's a lot of doom and gloom around kind of this stage for women, but I really see it as like a runway. I'm like, okay, I've got the yellow light flashing. I'm like, you need to strength train. You need to eat better. You need to take care of your body.

You need to strengthen your pelvic floor, right? You know, like just like we take care of our skin externally, like take care of your insides too. And so I really look at it as an opportunity to like I get this warning signal before my hormones completely shift. Listen to them. Like be proactive and feel in control of your health instead of feeling like it's controlling you.

No. I mean.

Not yet. I mean. You should. You know, I love this topic and I, it's like just a body part to me. It's like an ankle. It's not that big of a deal to work with it and talk about it.

And I'm just really appreciative to be able to collaborate with folks like you who are open to sharing this information with their communities and not making it weird or awkward, but like, hey, let's talk about this because, you know, people need to know.

But no, it's really, you know, when people are like, where did you come up with these ideas? And I'm like, oh, I didn't. People asked. People said, will you write a book? Will you do a post about this? Do you have a blog about that? Do you offer home workouts? You know, and so it's really like I just kind of listen to what people say. And if I'm able to do it, I'll do it.

And I think it's really important. you know, the strength of you and me. It's just like, if you listen to what people are saying, like they'll tell you what they need and if we can help them, we'll do it. And so it's just been a real, it's been a real honor to be honest, to literally throw up some Instagram posts in 2017.

And then here I am later, you know, just really loving this work and being able to kind of just improve the healthcare of people and their pelvic floors has just been a real honor. So it's, I'm having a blast doing it.

And physical therapy changed their lives. And I was like, this is exactly what I want to do. And so I started eight years ago in the field and I've bounced around to a couple of different cities and states, but it's all that I've ever done. And I still practice in a clinic today, seeing women and men.

Thanks for having me, Dylan.

I only do pelvic floor therapy. So the way that we assess the pelvic floor, and I think that this is really the mystical part of it is- Yeah. These muscles are kind of deep in your pelvis. So when you think about the bones that we all have, like you put your hands on your hips and you're on your hip bones, but that's really the top part of your pelvis.

You put your hands kind of in the lower front part, that's your pubic bone, and then you've got your tailbone in the back. At the bottom of that bowl of bones is a basket of muscles, and that's what we call your pelvic floor muscles. And those muscles support your pelvic organs. All bodies have them, men and women and kids, everyone.

So those muscles support your bladder, which hold urine, your balls, which hold stool. In the male, they hold the prostate. In the female, they hold the uterus and ovaries. These muscles support growing babies during pregnancy. They support your spine. They hold in pee and poop. They help with erections, ejaculation, orgasm, sexual activity, the passageway for menstruation. So

I mean, they're so important, yet we don't talk about them. And we also don't even know they exist until we start having a problem in this area. And so that's really the story behind Florida is I wanted people to understand their bodies. I focused more on women, all on women in the book. That's who I have more experience treating.

And they also just experience more pelvic floor problems than men because they have a vagina. So yeah, these muscles kind of influence all of those things. And that's what we help with in physical therapy.

Oh my gosh. Yes. So many men have pelvic floor issues like pain, sexual dysfunction. It could be anything from premature ejaculation, difficulty maintaining erections, painful orgasm to pooping problems, painful bowel movements, rectal pain, tailbone pain. I mean, so much.

Absolutely. So these are muscles like any other muscles in your body. They can get tight and tense, like we maybe get in our neck and shoulders, right? And that could be from posture, that could be from stress, could be from weightlifting, and whatever it is, the muscles respond in a way that causes tension, and maybe we get neck pain and headaches. The same thing can happen in your pelvic floor.

It could be sitting with your legs crossed. It could be clenching your butt because you're stressed out and nervous. It could be holding and pee and poop for too long. It could be trauma. For women specifically, there are three times in a woman's life that directly influence their pelvic floor and make them at a higher risk for pelvic floor issues.

And it's pregnancy, it's childbirth, and it's perimenopause and menopause. During pregnancy, the muscles, these pelvic floor muscles support a growing baby and they get stretched out and weaker during pregnancy. During birth, they can have a tear into the muscles. They're stretched out from pushing. You can have a C-section, which creates abdominal tension and scar restriction.

So all of those things influence the pelvic floor. And then...

perimenopause and menopause your hormones are changing you have lower estrogen lower testosterone decreased collagen so those muscles get weaker and thinner over time and this is why women have more issues than men typically when it pertains to weakness or pain because they go through these life stages that men don't got it okay cool i'm taking notes by the way okay sweet so

So typically, the way that the medical system works here in the US is that they go see a doctor. The doctor says, let me run all these tests and see if something's wrong. And then if they don't find anything, they send them to another doctor and send them to another doctor. By the time people reach pelvic floor therapy, sometimes they've gone through seven to eight physicians.

And they're like, all the tests are normal. The blood works normal. But we can't figure out why you are peeing all the time or you have pain with urination or whatever the case may be.

So my goal is that people can get to pelvic floor therapy sooner. When we see someone in pelvic floor therapy, some of the common things that we see, I'll focus on the female population, is urinary leakage. So they leak with coughing, sneezing, running, jumping, laughing. No amount of leakage is normal, but any type of leakage, there's a pelvic floor component.

What's called pelvic organ prolapse, when the pelvic organs aren't as supported by that hammock of muscles. So they start to push into the vagina and it can feel like a bulge in the vagina, like something's falling out. It sounds pretty scary, but it's really just kind of a muscle weakness or tension issue. Pain with sex is another one.

Thank you for having me, Dylan. And yes, I am the vagina whisperer on social medias and to all of my friends.

These muscles can be tight or tense, or you can have vaginal dryness that leads to pain with initial insertion, deeper insertion, or both. It can also cause hip pain, back pain, abdominal pain, constipation, painful periods. So kind of anything in this pelvic arena, the muscles can be affected. They may not be the initial cause, but they're often a component that needs to be addressed.

And then when somebody comes into our clinics, it's a private session. It's not in like a big gym, like it would be another PT session. It's one-on-one with a therapist. And we ask you questions about all of your pelvic floor stuff. You may be there for painful sex, but I'm asking you about pooping and menstruation and childbirth. And then we do an internal pelvic exam.

So this is how we assess the muscles is inserting a glove lubricated finger into the vagina and assessing the pelvic floor muscle through the vagina. In male bodies, we do this through the anal opening. So that's how we access the muscles to see if the pelvic floor itself is affected.

This could go many different directions.

You know, I would say 70-30, just a guess. Like I would say over the course of my career, Sometimes I have men as 50% of my caseload, sometimes less. But I would say, you know, it's typical for me to have majority female bodies and then a handful of male bodies. But I'll tell you this. I think that a lot of men experience pelvic floor issues that are underreported.

I think females for sure have underreported symptoms, but we go to see a gynecologist. We talk to our girlfriends. We go online. We kind of do the health investigation. I think that there's as much shame and embarrassment as women have around these issues. I think men also have it, and that's a barrier for them to get treatment.

And oftentimes I'll be seeing a woman, the wife, and then she's like, I think my husband might need to come in, you know? And so it's just to kind of be, you know, make a generalization. I feel like men can have urinary issues, rectal pain, you know, abdominal pain, all these things, but it's when it affects their sexual function is when they start being like, okay, I need to get help.

And yet then it's gone on for a really long time. And we're like, okay, now we're peeling layers of the onion for a bit before we get to the pelvic floor. But it usually takes something pretty significant for them to say, okay, now I need to get help.

Sie müssen Pelvic Floor-Exerzise auch in ihre Workouts einbringen. Und es ist wirklich einfach. Wenn du bereits ins Gym gehst, drückst du dein Pelvic Floor mit. Und behalte einige dieser Übungen durch den Tag. Pelvic Floor-Exerzise, wie sehen sie aus? So, for strengthening, the most popular one we know about is called a Kegel, which is named after a male gynecologist from the 70s.

We need one named after you. We need one named after a woman. The Sarahs?

It matches the book very well. We've already talked about it. So two things. So this straw, there's two things I would tell somebody to do with it. One is when you're pooping, I would blow out through the straw. So when I actually keep one of these in my kids' bathroom.

So when they go to the bathroom, yes, when they go to the bathroom, because again, we have to teach our kids how to go to the bathroom properly. So when they're pooping, I put their feet on the stool and I say, okay, buddy, blow through the straw. Can you feel your pelvic floor push down and let go? And that's what we want to happen during a bomb movement. Wow, okay.

Ich glaube, ich werde nie wieder die Zähne auf die gleiche Weise sehen, aber ich verstehe. So with pelvic floor exercises, how often should you be doing them? So think of this like a strength training regimen that you have at the gym. The research really shows that doing three times a week, five to ten minutes of exercises is sufficient, which is amazing.

It's not a huge lift for a woman to really focus on these pelvic floor contractions. And I give you exercises in the book to kind of walk through and how to do them. But if you have an exercise routine that you're already doing, Pilates, bars, strength training, you can bring that pelvic floor contraction into it. And that really can be your pelvic floor workout. Yoga, Pilates, those help?

It's a balance. So if you're doing Pilates, which is kind of a lot of tightening and pulling in and strengthening, you want to just make sure that you're relaxing it after. We don't want to walk around with tight pelvic floors and vaginas all day. That doesn't Das ist nicht eine funktionelle Pelvic Floor. Du kannst Pelvic Floor-Tension haben, aber das bedeutet nicht, dass es stark ist.

Es muss also kontraktieren und entspannen. Yoga ist auch großartig, aber du musst noch etwas stärken.

Es ist nie zu spät. Ich meine, es ist wie zu sagen, ich bin 60 und ich will meine Muskeln stärken. Soll ich jetzt einfach aufgeben? Absolut. Das ist ein Muskel wie jeder andere Muskel in deinem Körper. Du kannst es trainieren, bis zum Tag, an dem du stirbst. And even learning about it will empower you to understand more about how your body works. How do I pee? How do I poop? How do I cough?

How do I exercise? It really can be so amazing to learn more about your body at any age or stage.

You know, it's interesting because I just occasionally drop in these little tips, you know, like don't push when you pee or squeeze before you sneeze.

Und das habe ich einfach gepostet. Es war literally ich, die auf der Toilette sitzt, was ich in vielen meiner Videos tue. Und ich habe gesagt, Dinge, die deine Mutter dir nicht erzählt hat, drück nicht, wenn du pflegst. Und es hat einfach explodiert. Und es war überraschend, wie viele Leute das nicht wissen. Und es ist einfach ein echtes Testament, wie viel wir in dieser Bildung weiter tun müssen.

Es ist ein Ring von Bohnen. Und am Boden dieses Ringens befindet sich ein Schrank mit Muskeln, die von vorne nach hinten und von Seite zu Seite verbunden sind. Und es ist wie ein Schrank. Und das ist, wo dein Pelvifloor ist. Das ist dein Pelvifloor. Es sind Muskeln, die deine Organe unterstützen, wie dein Uterus und deine Ovarien, dein Bauch und Blatt.

Weil nur ein Veränderung kann eine Welt der Unterschiede machen, um deinen Pelvifloor zu schützen.

Also, mein Instagram-Account heißt The Vagina Whisperer, das ist eigentlich ein Name, das meine Freundinnen mir nach der Hochschule gegeben haben, als ich in diesem Bereich trainiert habe. Und wir würden zusammenarbeiten während der Sommer. Und einen Sommer endete ich mit all den älteren Moms in einem Hot Tub über ihre Blätter zu sprechen. Und sie sagten, sie ist wie The Vagina Whisperer.

Und sie nannten mich das. Und als ich den Account begonnen habe, war es wirklich für meine Gruppe von Freundinnen. Wir waren alle krank und postpartum. Also habe ich Tipps mit ihnen geteilt. Aber, du weißt, ich teile alles darin, von, du weißt, Kindesberufstipps, Menopausen-Bedrohungs-Tipps, offensichtlich Schmerzen- und Schmerzen-Tipps, aber auch viel Anwesenheit.

Ich meine, ich denke, es ist wirklich wichtig, diese Gespräche zu haben. Ich sage immer, ich will die Pelvische Flasche normalisieren. Ich will keine Pelvische Flaschenprobleme normalisieren. Ich denke, die Geschichte hat so lange gedauert, dass Leaks nur ein Teil einer Frau sind oder dass man Liner tragen muss, wenn man ein bisschen Leakage hat. Und ich denke mir, das ist nicht akzeptabel.

Ich werde nicht akzeptieren, dass Stiefel mein Destinat sind. Und es gibt so viel, was wir tun können, um Frauen eine bessere Lebensqualität zu haben, je älter wir sind.

Right, and we don't think about how even things that are happening in our 20s or 30s, whether it's pain with sex or, you know, the inability to have sex. Some women can't have sex and they're not able to get pregnant. Or they've had pelvic floor trauma and they don't want to have another baby. Or they're leaking now and I'm like, what is that going to look like?

You know, at 30 it's a little bit, but what about 40, 50, 60 when we don't have our hormones to prop us up anymore? Und ich sage nur, um Frauen wirklich zu ermutigen, jetzt kleine Veränderungen zu machen. Es muss nicht ein komplettes Überholen sein. Wir alle haben sehr lange To-Do-Listen.

Aber nur kleine Veränderungen und ein paar Übungen, einfach eine sehr lange Weile gehen, damit du später in deinem Leben reisen kannst. Du kannst mit deiner Freundin hangen, du kannst reisen, du kannst Sex haben. Ich meine, wirklich eine erfüllende Lebensweise leben, in welcher Weise du es dir vorstellen kannst.

Sit, chill, lean forward and breathe. To poop? Yeah, so the right way to poop, I love this again, okay. The right way to poop is sit down, obviously, elevate your feet, so put them on a squatty potty, put them on a step stool, put them on an Amazon box, I don't care what it is. But you want your knees to be above your hips level, so you're in a squatting position.

And then when you're pooping, instead of holding your breath, I want you to bear down, so it's okay to push when you're pooping, but exhale, like you're blowing out a bunch of candles. So it's like... So you're breathing, but you're also bearing down. You're just not holding your breath.

Und es hat auch die Öffnungen für Urin, um rauszukommen, für Bauchbewegungen und dann auch für vaginale Unterkunft, vaginale Geburt und Menstruation. Also ist es wirklich wichtig. Jeder hat einen. Und es benötigt verschiedene Arten von Sicherung und Übungen für alle unterschiedlichen Phasen einer Frau. Und wir haben nur gerade darüber gesprochen.

Also Urinär-Traktinfektionen sind, wenn eine Bakterie die Urinär-Trakte aufkriegt oder es gibt eine hohe Bakterienzahl im Urin und es wird natürlich mit Bakterien gefüllt und man bekommt eine Infektion. Die Art, sie zu behandeln, ist Antibiotika. Aber es gibt zwei Dinge.

Einerseits sind sie mehr oft vorhanden, wenn man perimenopausal und postmenopausal ist, weil die Epithelial-Layer der Tissue mit weniger Estrogen verändern. Man ist mehr verpflichtet zu Infektionen. Aber die Symptome von Pelvoklorveränderungen und Ästrogenveränderungen in der Tissue können auch eine Urinärinfektion mimikieren.

Also wenn du rein gehst und es ist so, dass es nicht sagt, dass du Bakterien hast, dass die Infektion negativ ist, aber einfach die Antibiotika nehmen, dann hast du keine Infektion. Du könntest ein Pelvoklorproblem haben, wo es Tension in der Gegend gibt, die Nerven sind irritiert, es gibt Schmerzen und dann fühlt es sich wie eine Urinärinfektion an, aber es ist nicht.

Das andere, was passiert, ist freundliche Urinierung. People will go to pee in the middle of the night once or twice when they never used to. Or they'll have to wake up three to four times before actually going to sleep to empty because they feel like they're not emptying. These are all bladder and pelvic floor changes that really need to be addressed because they don't get better.

Ich empfehle immer, es auszuschauen. Ich gehe zu einem Physiotherapeut und schreibe es an und mache sicher, dass du einen Test erstens gemacht hast. Zweitens schaue ich es auch mit einem Pelvophore-Therapeut an, weil Muskel-Overaktivität oder Anstrengung eine Urinär-Traktinfektion auslösen kann.

Es könnte einfach nur ein Muskel-Spasmus sein, das dich dazu führt, mehr Nerven-Sensitivität in der Gegend zu haben. Also schreibe es an und tritt es dann auch an. Oder ich habe Tipps im Buch über Pelvophore-Relaxation und Strecke und sogar interne Massagen, die du machen kannst, die Blatt- oder Schmerzen lösen können.

Es ist interessant, weil wir oft darüber sprechen, die Pelvische Fläche zu stärken, nämlich die Kegel-Kontraktionen, aber man muss auch die Pelvische Fläche langsamer und entspannter machen. Um diese Muskeln wirklich gut zu funktionieren, müssen wir sie konzentrieren, aber sie entspannen. Die Weise, wie wir das tun können, ist intern mit Massage.

In unseren Therapie-Offices benutzen wir oft einen Finger, aber zu Hause kann man ein Therapie-Device nennen, das eine Wand ist, die inseriert ist, um die Muskeln zu lösen. Man kann auch Strecke und Atmungs-Exerzise wie Yoga oder Kinder-Pose machen.

happy baby pose and just taking some big deep breaths our pelvic floor relaxes when we take big deep diaphragmatic breaths yet we live in a day where we're all tensing our muscles we're holding our breath we're you know breathing with our chest you know in shallow breaths and really if you just uncross your legs Sit up nice and tall, unclench your butt and just take these big, deep breaths.

It's a way to really naturally relax your pelvic floor muscles without having to strain. You can't see these muscles. It's not like you can tell them to relax. So just breathing can help with that.

Es tut es. Und du weißt, ich bin in diesem Bereich seit 18 Jahren. Also war ich ein Pelvic-Floor-Therapeutin, wenn Leute hören würden, was ich für ein Leben gemacht habe, und sie würden zwei Säge überstehen und sagen, oh, das ist wirklich seltsam. Und jetzt sind sie so, hey, kann ich später mit dir sprechen? Ja.

Wenn Sie Sex haben, haben Sie ein kleines Blut. Ja, sicher. Es gibt ein hormonales Problem, aber wenn es um das Pelvische Problem geht, kann es passieren, dass es zwei verschiedene Lagen von Muskeln in der Vagina gibt. Es gibt ein Entryway-Set von Muskeln und es gibt tiefe Muskeln, die das Bowl sind. Wenn Sie steile, tensere Muskeln haben, ist nichts ermöglicht, in die Vagina zu kommen.

Es könnte also ein Tampon sein, es könnte ein Pelvischexamen sein. Es kann aber auch etwas sein während des Vaginalen Interkurses und es fühlt sich an, als ob etwas eine Wand befindet, als ob die Vagina geschlossen ist. Ein weiterer Art von Schmerz ist tiefer Schmerz mit Penetration.

Es fühlt sich also an, als ob jemand etwas befindet, wie es lecker oder schmerzhaft ist und es kann eine tiefe Pelvische Flur oder Hüftmuskeln sein. So wie wir Knochen in unseren Schultern und Nacken bekommen und wir Schmerzen oder Migräne bekommen, ist es wie eine Tension in deiner Pelvischen Flur, die ausgelöst werden muss.

So I would work on the muscle component with some of the things we described, like stretches or internal massage. But then I would also, you know, think about using a good lubricant. I think we used to think that lube was like only if you're not aroused. That's not the case. Using a great water-soluble lubricant proactively can also be helpful.

Ja, es ist wirklich so. Und ich denke, das ist der Grund, warum wir über sie nicht sprechen und wir nicht wissen, dass es Hilfe für sie gibt, was die ganze Mission hinter diesem Buch war, zu sagen, dass das etwas ist, das so viele Frauen erleben.

Ich teile Geschichten darin, dass ich von all den Patienten, die ich gesehen habe, so viele von ihnen in den 18 Jahren, in denen ich gearbeitet habe, und so viele von ihnen fühlten, als wäre es nur sie. Und ich sage, Mädchen. I see 40 patients a week and all of them are experiencing pelvic floor issues. So you're not alone.

And I think that we just want to really feel like there's help for these issues. But the shame and the stigma goes way back to when we are young girls and we're not educated about our periods. We're slipping tampons up our shirt sleeves. We're hiding kind of who we are as women from the age that we really become a woman.

Und ich denke, es sind wirklich Frauen, die mehr Aufmerksamkeit für ihre Körper brauchen. Sie hören über Pelvic-Floor-Therapie von Social Media, von Shows wie deiner. Und sie sagen, ich wusste nicht, dass das eine Option für diese Probleme war, die ich erlebe, die sie als eine normale Teil des Alteres oder der Frau seien, und sie sind es nicht.

And you're not alone. I mean, I've done that as well. And, you know, tampons and pads should be accessible like toilet paper, you know? I mean, if we think about, this is just kind of a natural part of hygiene, but... So I think that it starts when we're younger.

There's also kind of cultural and religious context that sometimes we're told that talking about this part of our body is bad or we should hide it or be ashamed of it. And we also just, even if we are comfortable talking about it, we don't even know who to go to. What doctor do you see? What specialist do you go to? Are there any other products that are helpful aside from lube?

You know, one of my favorite things to recommend to women is a vulva balm or moisturizer, just like we use something on our face for moisture. My favorite one is called, it's by Medicine Mama. It's a vulva balm.

I was going to say, if you didn't say that, that was going to be what I was going to tell you. It's amazing. It's amazing because it's... Ja. And so this really evolved into when you go through breast cancer treatment, you are pretty much postmenopausal. And so you experience those same changes with the lack of estrogen. And now we can see how it can benefit women at every stage.

To your point, especially if tissues become more sensitive or irritable, I would avoid thong underwear. Just anything really close to the ear. It can harbor bacteria and can be uncomfortable to sit with. Obviously, all cotton is best, organic. You know, I wear those kind of all cotton granny panties at nighttime. Or you can go completely commando at night and just let it breathe.

But obviously, the more natural the materials are going to be, the better ones.

No, and I think it's a great thing. And especially if you have dryness, irritation, sensitivity, I just say don't wear underwear at all, especially at night time. But even some women opt to do it during the day just because they feel like everything is too constricting or irritating.

Yes, it actually can. So pelvic floor strengthening can tone the vagina, give you more sensation during sexual intercourse. And orgasms are actually pelvic floor muscle contractions. So those contractions are waves that you feel or your pelvic floor muscles contracting and relaxing. So having stronger, more coordinated muscles can help with intercourse and also give stronger orgasms.

Okay, so that's good news. Yes, great news. That's incentive for you to do your exercises.

Das Erste, was ich sagen würde, ist, etwas darüber zu tun. Es gibt keinen Grund, ständig zu leiden. Es gibt so viele Ressourcen für Hilfe. Das ist auch, weshalb ich das Buch geschrieben habe. Es ist, weil ich, wenn du einen Pelvic-Floor-Therapeut nicht bemerken kannst, wenn du nicht bereit bist, einen zu sehen hast, einfach anfangen zu lernen und dich über deinen Körper zu erledigen.

Und in dem Buch gebe ich dir all die Normen, wie du schlafen solltest, wie du schlafen solltest. Das ist, wie du schlafen solltest. Das ist, wie Sex fühlen sollte. Weißt du, und einfach wirklich dich zu dieser Teil deines Körpers vorstellen, mit dem du dich noch nie kennengelernt hast. And then I think that there are a lot of online programs as well. I have an online exercise program.

There's a lot of information on social media. But I think that women really need a menu of options to access healthcare. And it's amazing that we're in a day that that really is possible.

Oder erzählen, wo man sie finden kann? Ich denke, manche von ihnen können nicht auf der Kamera sein. Okay, das ist okay. Die meisten können es. Einer der einfachsten Wege, wie ich Menschen mit ihnen identifizieren kann, ist, wenn du urinierst und du willst, dass dein Urinstrument aufhört, dann ist das eine Pelvokontraktion. Also du öffnest deine Urinärsphänke.

Mythos, totaler Mythos, nicht akzeptabel. Es gibt etwas, was man definitiv tun kann. Keine Anzahl von Leckungen ist normal. Just do Kegels fixes all pelvic floor issues. Myth. Absolutely not. It's like saying doing crunches fixes back pain. It's very nuanced what you should do to address your pelvic floor, which is what I cover in the book. What exercise path should you take?

Myth. They can affect you at any age or stage from periods to sex to perimenopause and postmenopause.

Explain that. So, your pelvic floor is muscles. And when you think about weak bicep muscles and you have a hard time lifting something, it's the same thing for the pelvic floor. If these muscles are weak or lengthened, you can't close the sphincters to hold in urine and stool. You can't contract for sexual health or orgasms. And you can leak or have pelvic organ prolapse.

Peeing just in case is good bladder training. Myth. You should only pee when you have the urge to go. We women are notorious for going to the bathroom every time we cross one and that can train your bladder to actually shrink and then you have to go to the bathroom more often. So only pee when you have the urge to pee. The normal range is between two to four hours during the day.

Before bed, before sex and before exercise are the only just in case piece allowed. Should you pee before sex or after sex?

Oder wenn du in einem Elevator bist und du musst Gas geben und du willst, dass es reinholt, dann öffnest du die Sphänke. Das ist eine Kegelkontraktion oder eine Pelvokontraktion. Okay. So it's there and you can contract it, but you also have to relax it for urination, for bowel movements, for vaginal birth and intercourse. So you can also use a mirror. You can use your finger.

Both? Yeah. Why? Well, one, it cleanses the urinary tract of bacteria. And sometimes if you have a full bladder, it can make sex feel like you might pee. Holding your pee is bad for your pelvic floor. Truth. You should, again, go to the bathroom when you have the urge to go. It should be between that two to four hour mark during the day.

Or at nighttime, it should be once or twice or none at all, but not more than that. Sarah, du bist so wundervoll. Wir werden dieses Buch natürlich teilen, damit die Leute wissen, wo sie es finden können. Aber wo können die Leute dich finden?

Wie wir erwähnt haben, bin ich auf Social Media als TheVaginaWhisperer auf Instagram und dann als TheVagWhisperer auf TikTok, weil TikTok das Wort Vagina nicht mag. Oh, lass uns das mal schnell erzählen.

Sie akzeptieren den Account mit Vagina, also bin ich TheVagWhisperer auf TikTok.

Yeah, Instagram will accept it. But I'm like a dinosaur on Instagram, so I've been there forever. So maybe I just got grandfathered in. And then my website with, you know, a ton of blogs, pelvic health exercises, and all about the book where you can pre-order it is thevaginawhisper.com.

And everybody who pre-orders the book gets 30 days of pelvic floor workouts along with it, so you can start your journey right away.

I go over it in the book in depth of how to kind of find it. But, you know, I think if you just use some of those those tests, you can really kind of see, oh, yeah, that's what it is.

In dem Buch spreche ich über jede Phase der Leben. Denn bei jeder Phase muss man etwas wissen, um sich gesund zu machen und sich zu identifizieren, wenn man ein Problem hat. Sagen wir, wir sprechen von einer jungen Frau, die eine Periode hat. Sie muss wissen, wie man mentale Hygieneprodukte einsetzen kann, wie einen Tampon oder eine mentale Diske oder eine Kuppe.

Sie muss wissen, dass eine Periode nicht schmerzhaft sein sollte. Sie könnten sich schmerzen, aber eine Periode ist ein früheres Zeichen einer Endometriose. Wenn jemand sexuell aktiv wird, muss er wissen, dass Sex-Ed ist etwas wie das Bein-Eig-Babys-Made, aber es ist wirklich, du weißt, Vaginal Intercourse, wiederum ist Muskel-Relaxation, es gibt Lubrikation, es gibt Freude und Erstaunlichkeit.

Dein Pelvische Flur spielt eine Rolle in dem. Wiederum, du solltest kein Schmerz mit Sex haben. Das ist ein Indikator für Pelvische Flurdysfunktion auch. And then other particular times are pregnancy, childbirth and menopause.

Those are the three most significant times for pelvic floor changes in women, when we really need to be proactive about strengthening and relaxing and preparing for the changes that our body is going through.

Es variiert. Also für die Pregnanz, fokussiere ich mich wirklich auf die Stärkung während des ersten und zweiten Trimesters. Wiederum, dieses Muskel ist wie ein Schlauch und wie das Baby wächst, so streicht dieses Muskel und es steigt und wird schwächer. Viele Frauen erleben also Leckage und Backschmerzen während der Pregnanz, was auch Pelvokor-Issuen betrifft.

In the last trimester of pregnancy, I really focus on lengthening and relaxing, because you don't want really tight pelvic floor muscles going into a birth. You want relaxed pelvic floor muscles. And then postpartum, we focus more on strengthening and rehab. For menopause and perimenopause, it's much more of a strengthening regimen.

We know how much muscle mass we lose, how much collagen changes, and you want to be really proactive about strengthening during that later phase in life.

How do I pee? How do I poop? How do I cough? How do I exercise? It really can be so amazing to learn more about your body at any age or stage.

Unfortunately, the research is showing that almost 50% of women have some sort of pelvic floor issue, and it gets worse with aging.

Über 50 Prozent der Frauen lehnen Urin nach dem Alter von 65. Einer der drei Frauen hat sexuellen Schmerzen zu einem Zeitpunkt in ihrem Leben. Also würde ich sagen, es ist nicht ungewöhnlich, diese Probleme zu erleben, aber wir wollen Frauen, um sie schneller Hilfe zu bekommen. Es ist wie Backschmerzen oder, weißt du, eine Knieerwärmung.

Du solltest nicht nur leiden müssen, sondern du solltest Hilfe dafür bekommen. I would say if you are experiencing urinary leakage, constipation, painful sex, pelvic organ prolapse, heaviness or pressure in the vagina, those are all common signs of pelvic floor dysfunction that I would say just go ahead and get therapy or get help.

Ja, also, du weißt, deine Pelvifloormuskeln unterstützen deine Blätter und sie haben auch die Sphinkter, die Urin inbaut. Also, als deine Blätter füllt, wird das Muskel fest und es hält die Kontente der Blätter in, bis du in den Restraum kommst und dann sind deine Muskeln entspannt, um zu leeren.

Wenn das Muskel nicht stark genug ist, um eine volle Blatte zu halten, oder wenn es von einem Rauschen oder einem Rauschen von Druck kommt, entsteht ein Leak.

Was passiert, ist, dass sich das Muskel immer stärker und stärker stärkt, je nachdem, ob es eine Pregnanz, eine Geburt, hormonale Veränderungen gibt, von Workouts, von Verletzungen, das Muskel wird stärker und es wird immer schwieriger, diese Leaks zu halten. No amount of urine leakage is normal. Not a little bit with a cough or sneeze.

And it ends up becoming full blown as we age, which is something I really want people to be aware of. I think it's okay to laugh off the little leaks, but I'm also like, let's get you help for that because we want it to improve. It won't get better by itself.

Ein paar Dinge sind, dass ich jedem sage, dass du siehst, wie du schläfst. Weil oftmals können wir unsere Blätter nicht gut öffnen. Das erste, was ich den Leuten sage, ist, dass sie sich unten sitzen, wenn sie atmen. Hüft euch nicht über die Toilette. Wenn ihr unten sitzt, öffnet ihr besser. Und drückt euch nicht, wenn ihr atmet. Ich nenne das Power-Atmen. Und Frauen sind für das notoriös.

Wir wollen nicht Power-Atmen haben. Also sitzt, lehnt euch voran, nehmt ein paar große, tiefe Atemzüge und lasst eure Muskeln sich entspannen. Und euer Blatt wird die Urin für euch ausdrücken. Du musst nicht drücken, wenn du atmest. Es kann wirklich deine Pelvische Muskeln verringern und zu mehr Leckage führen.

This is a muscle like any other muscle in your body. You can train it until the day that you die. Dr. Sarah Reardon is going to break it all down for us. She's a leading pelvic floor physical therapist. There is so much that we can do to help women have a better quality of life as we age.

Und dann die andere Sache ist, nur in den Kühlschrank zu gehen, wenn du die Anstrengung hast, zu gehen. Wenn du deine Blattentrips zu lange oder zu oft gehen gehst, kann es mehr Blattdysfunktion verursachen. Und der letzte Tipp ist ein wirklich einfacher. Es heißt der Nacken.

Und es ist, wenn du einen Schmerz oder einen Schmerz fühlst und du einen Kegel machst, bevor du einen Schmerz oder einen Schmerz machst. Und es verhindert einfach, dass die Leckage stattfindet. Und wenn du es nicht kannst, arbeitest du daran, sich zu stärken und dann weiter zu versuchen.

No, I mean that's one of the things is I think, you know, if we can really educate ourselves and educate the next generation, we can prevent so many of these issues. We're not taught how to pee and yet something we do six to eight times a day could really be weakening and damaging our pelvic floors.

Sind die gut für dich? Die sind gut für deinen Pelvifloor. Und die sind für Bauchbewegungen genutzt. Die sind genutzt für Pooping. Aber wenn du sie unter deinen Beinen benutzt hast, für Bauchbewegungen, dann bist du in einer Squat-Position. Und das ist die beste Position, um sich zu entspannen, um Straining zu minimieren, was, wiederum, deinen Pelvifloor verringern kann.

Ich möchte nur sagen, ich liebe es, dass wir über Pee und Poop sprechen. Das ist eine Freude für mich.

Oh mein Gott, du bist so willkommen, wenn du kommen möchtest. Ich liebe das.

Es ist komplett verbunden und es ist wirklich unerheblich. Ich meine, ich bin jemand, der glaubt, dass wir die Möglichkeit haben, freundlich und leidenschaftlich Sex zu haben, durch unsere gesamten Leben. Für Männer ist es eine kleine Pille, die sie nehmen können, um weiterzugehen. Und ich denke nicht, dass es fair ist, dass wir das nicht haben.

Aber was ich denke, ist, dass wir, als wir älter werden, und das kann auch in anderen Zeiten passieren, wie nach dem Postpartum, wenn man sich beibringt, oder wenn man das Gehirn kontrolliert, wenn sich deine Astrogen-Leveln verändern und reduzieren, wird deine Vagina leckerer, es wird dünner und es kann eine raue oder schmerzhafte Sensation während des Interkurses verursachen.

So, the recommendations are to one, do pelvic floor therapy to improve blood flow to the area, to strengthen the muscles and tissues, and then also use vaginal moisturizers to help, you know, moisturize the skin.

We have, you know, skin care routines that are 10 steps, and you can also have a vulva care routine, where you're applying lotions or moisturizers that are specific for the vulva, and use a lubricant during intercourse, and you can also use topical estrogen on the area.

So there is a lot that you can do, but we should not accept pain as normal for sex at any point in our life, whether it's after giving birth or with perimenopause or menopause.

One of the things I'll say is that women are hungry for help. Ja, absolut.

Ja, es ist Pelvic Organ Prolapse und es klingt wirklich schrecklich. Also Pelvic Organ Prolapse ist, wenn das Hammock der Muskeln nicht so unterstützend ist, wie es sein muss. Also dein Blatt, dein Rektum, deine Ballen liegen alle innerhalb davon. Und wenn das Pelvic Floor schwächer wird, was mit Erwachsenen, mit Strainungen während der Ballbewegungen oder vaginalem Geburt passiert,

mit hochwertigen Übungen, fallen diese Organe. Und es fühlt sich an, als würde es in deiner Vagina blöken. Frauen sagen oft, dass sie schlafen und es fühlt sich an, als würde es in der Vagina blöken, was wirklich furchtbar ist. Sie fühlen Druck und Gewicht in der Vagina am Ende des Tages. Es fühlt sich an, als würde etwas ausfallen. Oder wenn sie ihre Blätter oder Bauchwellen nicht öffnen können.

Und es ist wirklich ein Unterstützungsproblem. Also sind diese Muskeln nicht so unterstützbar. So pelvic floor therapy comes in to help strengthen the muscles, to show them how to minimize straining and things like that. But one out of two women will have prolapse if they walk into a doctor's office.

So, there are pelvic floor physical therapists located all over the country. If you literally just go to Google and type in pelvic floor physical therapy, they'll pop up. There's also a PT locator on our Academy's website, which is called the Academy of Pelvic Health. And then I say, ask your girlfriends. I mean, they are the best referral sources to say, like, hey...

weißt du einen Pelvic-Löhr-Therapeuten? Und sie können dir sagen, wer ein guter ist. Oder wenn sie einen gesehen haben, habe ich einen gehört. Ich meine, ich denke, dass wir wirklich alle versuchen, einander zu unterstützen. Ich meine, ich frage meine Freunde auch um Befragungen. Das ist der beste Weg, einen guten zu finden.

Richtig. In meinem Traum-Welt, ja.

Und ich spreche über das in dem Buch. Wenn Going to a pelvic floor therapist could be like going to the dentist. I think we would prevent a lot of issues because it would be proactive. So what would happen when you go to that appointment? So what we do is we chat. I'm going to ask you everything, Tamsen, about your peeing habits, your...

Ihre sexuelle Gesundheit, Ihre Bauchhabitats, wenn Sie Kinder hatten, wie sieht Ihre Übungsroutine aus? Und ich bekomme viel Informationen, um zu sehen, ob es etwas gibt, für das ich einen Bildschirm brauche. Und dann mache ich eine externen Untersuchung. Ich schaue auf Ihren hohen Backen und Ihre Hüfte, wie ein normaler physischer Therapeut.

Und dann, um die Pelvische Fläche zu beurteilen, machen wir einen internen Vaginalexamen. So that's how we access the muscles and we ask you to squeeze and do a Kegel contraction, relax. We check if there's tension or spasm in the muscles. And that just gives us a good idea. Is there weakness? Is there tension? Is there in coordination? And then we can help guide you with exercise.

Danke, dass du mitgekommen bist, Tamsen. Ich bin so begeistert darüber und wirklich begeistert, mit deiner Gemeinschaft darüber zu sprechen, über all die Dinge, die das Pelvische Blut, besonders mit Perimenopause und Menopause, aber in jeder Lebensphase einer Frau.

Und dann Postmenopause ist 40 Jahre manchmal. Der Rest. Ich werde das in zwei Weisen beantworten. Ich denke, wir müssen proaktiv sein. Ich sehe Perimenopause wirklich als diesen Rundweg, diese Gelegenheit, um unsere Körper für diesen großen Schiff zu vorbereiten. Aber während der Perimenopause und dann natürlich nach der Postmenopause steigen eure Estrogen-Leveln.

Estrogen ist das, was die Vagina plumpst und toniert, was Teil der Pelvische Flur ist. Es bietet auch Vaginal-Lubrikation zur Vulvan-Vagina. Und Estrogen hilft auch, eine Protein zu kreieren, die Collagen heißt. Und wenn wir über Collagen denken, wenn wir über unsere Haut und unsere Haare und unsere Nähmchen denken, Aber es ist auch in unseren Vulva-Füßen.

Und das Collagen reduziert sich mit dem Alter. Und wir verlieren fast 50 Prozent davon in der Vulva und der Vagina, nachdem wir älter sind. Das klingt wie ein schreckliches Aber. Aber ich würde sagen, seid proaktiv beim Stärken eurer Pelvische Fläche während des Perimenopauses. So wie wir Frauen ermutigen, Gewicht zu erhöhen, Krafttraining zu machen, euren Gewicht zu tragen, Protein zu essen.