#269 | Healing, Protecting, and Restoring Your Pelvic Floor with Dr. Lizzie Kieffer

June 12, 2024

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Dr. Lizzie Kieffer is a doctorate of physical therapy with a specialty practice in women's pelvic floor health.  She joins us today to let us in on the little-known secret to protecting, relaxing, strengthening, and restoring your pelvic floor. She teaches us three simple techniques you can initiate immediately after birth to optimize pelvic floor recovery, how, when and why to do kegel exercises, what it means to have diastasis recti, and explains the differences in pelvic floor changes in a vaginal versus cesarean birth. Not only should every woman having a baby hear this episode, but also, every woman should make pelvic floor therapy a regular part of their life, even as they age into menopause and beyond.

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View Episode Transcript

If we are only working the Kegel or the tightening of the pelvic floor, when we go into birth, and we don't know how to actively relax it, that can absolutely get in the way of when baby needs to exit our body. And our pelvic floor stretches, you know, 200 to 300%, during birth, which is insane when you think about it, but it's so natural, and this is how our body is made. And that skin is made to stretch and those muscles are made to stretch. But we need to be able to work with our body to relax those muscles. Instead of holding our breath tensing up. Our pelvic floor is like the Goldilocks syndrome, it has to be not too hot, not too cold, but just right. Not too tight. Not too big, but just right.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Hey, guys, I'm Dr. Lizzie Kieffer, and I'm a pelvic floor physical therapist and I specialize in women's health, pelvic floor, postpartum pregnancy, all that good stuff. And I just I love sharing this content, I have a huge passion for it. And I just want every woman to feel empowered and encouraged going into pregnancy, labor, birth, postpartum, all that good stuff.

What prompted you to get into pelvic floor therapy? That's not a typical arena for No, for most practitioners? Yeah, for sure. In the past, probably five or six years, I feel like the pelvic floor world has kind of blown up a little bit. But I got into it because my sister, she had a C section several years ago. And, you know, she still talks about things that are an issue today, like sensitivity to her scar, and numbness and all of that. And then pelvic floor issues too. And so it just kind of started getting my wheels turning about how I could help other women with this kind of issue. And we really don't learn a ton of it in physical therapy school. So it's a lot of continuing education that I've done and diving into it. But ever since I dove into it, I have just been head over heels. And I absolutely love teaching women about this stuff.

What is your doctorate in? Is it a Doctorate of physical therapy?

Yes, it is. Yeah, physical therapy?

Do you find it interesting that they haven't yet created a curriculum for the pelvic floor? Health adults? Because all of you highly specialized women in this field, have done so much of the work on your own? And it's I think it's time that they create a formal curriculum, don't you? Oh, for sure, absolutely. It's something I advocate for and I really think needs to be. I mean, even for men to know about this. And just for general orthopedics. It's such an integrated part of rehab for all sorts of things like low back pain that doesn't resolve in like the typical setting, a lot of times that can be pelvic floor related. So just even have a base knowledge of that from our curriculum would be huge for the population. Men have a pelvic floor too.

Exactly. They have pelvic floor issues as well. So it's yeah, it's definitely something that needs to grow. And there's a need for it, for sure.

Well, we talk all the time, as you probably know, on the podcast about recommending pelvic floor, physical therapy, postpartum, even prenatally. But we haven't really offered our listeners a whole lot of information about it. We've only done two episodes on it so far. And we're really excited to speak with you. The last one was two years ago or so. So I know you've given a lot of thought to what we're going to cover today. And it's our understanding, you want to get into a lot of specific tips for women starting in pregnancy. Is that right? Yeah.

Okay, so the biggest thing is for women to know that there's so much we can do to prep our pelvic floor during pregnancy, for labor and delivery, and for setting ourselves up for postpartum. So pregnancy, you can almost look at as prehab, for postpartum. And there are so many different techniques for not just strengthening our pelvic floor, but also learning how to actively and consciously relax our pelvic floor, which we all know is so important for labor and going through birth and pushing and all of that. So I think it's really important for women to understand that it's not just about doing the key goals through pregnancy and having a strong pelvic floor. But the other component of it is so, so important. And I just I speak about that all the time on my page and to women, because it's so important for labor and pushing and all that.

When Should women start thinking about pelvic floor health? I mean, is this something that we should be you know, teaching girls when they get their PE Are you in like teenage years? I mean, I feel like we're way behind. We're addressing this.

I mean, how many of us like, think about our pelvic floor and how many of us, before we started having kids or anything like that have thought about our pelvic floor, probably not many. And so it's one of those things, too, I wish we did better with, you know, what we teach in school to high schoolers, like how to even track their cycles and learning about their anatomy, so that they can better understand what's going on with their body. And that just sets them up for success later down the road, or, you know, if they do or don't want kids, but just overall, to know what's normal versus not normal. And to seek help for two, I imagine we should be treating our pelvic floors the same as we treat any other part of our body, we want to keep our, our physical being in good shape through, you know, being active and exercising and taking care of ourselves. And our pelvic floor is probably right in that same category of need. That totally is, and nobody has any idea that it even exists or has a clue about what to do with it. Other than maybe like you said key goals, but there's so much misinformation around cables, too. So you're gonna have to explain that to us. Yeah, and, you know, they do get a bad rap for just being totally over prescribed. But I my stance is there's a time and a place for them. But it is not a fix all situation. So oftentimes, we hear providers say Just do your Kegel is if you have leakage or painful intercourse, or prolapse or anything like that. Oftentimes, it said just do the key goals. But what a lot of people don't realize is that many women have an overactive pelvic floor and a tight pelvic floor, and doing more key goals is only going to make the matters worse, and then they wonder, why am I not getting better, I'm doing all these strengthening exercises, all throughout my day. And I'm not getting better. And it's because so many of us have an overactive pelvic floor. And you think about our environment that we're in these days, too, and it's a lot of us are, you know, stressed or have a lot on our plate, which that alone contributes to a tight pelvic floor.

So would you say that most women that are entering pregnancy with an overactive pelvic floor rather than a weak pelvic floor,

I would say there's more than we think. And oftentimes, what can happen to is we have a tight pelvic floor that is also weak. And when you think about it, if you have a muscle that is constantly in this middle contraction or just overactive, when you go to try to tighten it, there's not much room for it to contract and to hold anything in. So you get that issue of having that tight and weak pelvic floor. So once we learn how to elongate that pelvic floor and relax it, then we can get that full contraction, and that becomes stronger and healthier. Because we have that full range of motion. It's just like your bicep, you would want to be able to have that full range of motion to get the full effect and full power from that muscle.

Can you please specify how a tight pelvic floor can become problematic during birth? And how a weak pelvic floor can? For sure, yes, so during pregnancy, of course, we do want to have a strong pelvic floor as our body changes, and there's a lot of pressure on the pelvic floor and you know the body is growing. So naturally, there's going to be a lot of pressure down onto those muscles. So we want to make sure that they are strong. But in conjunction with that, again, like I mentioned that full range of motion. So if we are only working the Kegel or the tightening of the pelvic floor, when we go into birth, and we don't know how to actively relax it, that can absolutely get in the way of when baby needs to exit our body. And our pelvic floor stretches, you know, 200 to 300% during birth, which is insane when you think about it, but it's so natural, and this is how our body is made and that skin is made to stretch and those muscles are made to stretch. But we need to be able to work with our body to relax those muscles instead of holding our breath tensing up and making those muscles tighter because that's just going to make it harder for one baby to get down into the canal and get out and to for that tissue to stretch and could cause issues such as like tearing, and just increase discomfort. Obviously they're too smart pelvic floor is like the Goldilocks syndrome, it has to be not too hot, not too cold, but just right now, but just right. Yes, and it when you do the practicing with the mental preparation and the pelvic floor mobility, and the labor prep flows and all that kind of stuff leading up to birth that can help significantly in the moment so you can use your breath as you're doing you know different movements during labor or as you're doing the pushing, which will help get your pelvic floor out of the way relax your jaw relax your body, which all correlates with pelvic floor tension to
how does a woman know if she has a tight or weak pelvic floor? Because everyone's wondering man, this is the magic question. This is a magic question and of course gold standard is to go see an in person pelvic floor PT because they can do an assessment and really determine if you do have a typers, weak pelvic floor. But if you're looking at just symptoms, it's very interesting because a lot of them are pretty similar. But the biggest differences are. So for a tight pelvic floor, typically you have more issues such as you hold tension within your body, maybe you have a tight jaw, maybe you do have painful intercourse or discomfort with inserting a tampon or menstrual cup or something like that. Maybe you have more low back pain, or tailbone pain. So those are more of the common type pelvic floor issues. But incontinence, for example, can be both tight or weak kind of issue. So it's a combination of symptoms. So it's really good to be able to work on your breath. And then if you feel yourself, you can actively relax that pelvic floor, then you know, maybe you don't have as much of that tension built up.

Why would incontinence be a result of a tight pelvic floor? I've only ever heard of it associated with weakness?

Yes, totally. So it goes back to if you are kind of in that middle contracted state, and say you go to sneeze or cough, if you're already semi contracted, it's hard for you to contract those muscles even more to hold in that urine or whatever else. And so that can cause the leakage of the pelvic floor. So we need those muscles to be able to go through that full range of motion to be able to brace properly from that leakage issue.

So what's the I know I don't wanna use harsh language that you wouldn't use, but like, what's the wrong way to do a kegel? And what's the right way to do a kegel? Because most women are just told clench, clench, clench, clench plan, right?

And how often like when not but first, describe the technique, what's the technique.

So let's talk about Kegel is and even just strengthening our pelvic floor. So whenever I teach how to strengthen your pelvic floor, or even do a pelvic floor contraction, which is a kegel, I always pair it with the breath, because we need that mind muscle connection to understand how to do that full range of motion, right. So I teach women how to do that full inhale, feeling that pressure gently go down into that pelvic floor, because our diaphragm and our pelvic floor, they sit on top of each other, right, and the organs are all in between. So when we inhale, that diaphragm is going downward, and that pelvic floor is going downward and relaxing. So that's where we get that elongation of the pelvic floor. And then when we exhale, this is when we engage our pelvic floor, so it comes up, and our diaphragm comes up. So it's like a piston of the diaphragm and the pelvic floor. So that's why it's so important to use our breath when learning how to strengthen and relax our pelvic floor. So you do that inhale, which is a relaxation. And then as we exhale, what we want to think about is a gentle squeeze of those muscles, which almost feels like you're stopping the flow of pee and gas from escaping, so it's front and backside. So you're thinking exhale, stopping that flow, gently lifting that pelvic floor and wrapping your deep core. And those two together that deep core and that pelvic floor, they work side by side in total conjunction with each other. And then again, you go through that inhale to release. So it's just a back and forth motion. As you use your breath.

Is it like you're okay, this is my question. Is it slowly working its way up? Like do you do the muscles at the low end of the vagina? slowly tighten and then you work it upward? Or is it just like clench the whole thing at once? Because I don't know it. Yeah, you exactly what you said it's more of that zipper kind of motion. So when you exhale and you're tightening your pelvic floor and you're wrapping your deep core, it's a very gentle lift, starting with the pelvic floor. Then we move to our hip bones and our belly button and then our ribcage. So it's like a zipper zips up from your pubic bone all the way up to your ribcage. So you want to think of your exhale being a little bit slower. So it's not just like a quick, exhale, squeeze everything as tight as you can. It's that mind muscle connection as you slowly exhale, lift that pelvic floor and then zipper it up to your ribcage. And this definitely takes practice. So a lot of times women can feel Yeah, women can feel a little frustrated, like I have no idea what I'm getting.

Do a lot of people do it backwards, because I would imagine that a lot of people are contracting on the inhale. Totally.

Yes. And I get that question all the time. And yes, so many women do it backwards. And so once you really get that connection down, it does start to become more second nature. And then it's very integrated within your exercise. And even like your functional daily activities, like lifting up your toddler or a box or bracing for a coffee or something like that. When you practice it with that mind muscle connection, it becomes just a part of your daily life.

So we don't have to think about doing key goals just at read.

Yes, exactly. No key goals at stop signs, no cables at stoplights. Nothing like that I hardly ever, ever prescribe women to do just like stationary key goals without their breath or anything like that. Really, it's that full range of my session that is going to have a lot more effect on the body and give you way better results too.

How does that skill show up when a woman has to birth out her baby using this. Sothis is where some women get very confused, I can totally see why. So when we're working on that full range of motion of the pelvic floor, and the tightening and the relaxing kind of breath, that is different than the push breath. So when you are in the pushing phase of birth, we want to relax our pelvic floor, right? So it's not going to be that exhale, squeezing the pelvic floor, lifting it and wrapping your deep core, right? We want those muscles to relax. So when we teach the pushing kind of breath, we don't want to, you know, hold our breath and bear down when we're pushing, we want to allow for those muscles to relax and open. So when we inhale, we're still relaxing. And then we exhale, we do what's called more of a down breath. So we bear down very gently onto our pelvic floor, and allow those muscles to open and relax and assist our body and our uterus and what it's already doing. So we don't have to feel like our pelvic floor is pushing the baby out. Because it's not. It is our uterus and our body that is doing it for us. And we can use our breath to help assist baby out to the vaginal muscles, not just the uterus. You're right. Yeah, they weren't baby out. Our job is to not resist it, is what you're saying?

Exactly, yes. So oftentimes, when we do hold our breath, or when we try to tighten those muscles, then it works against the uterus and what it's trying to do to get baby out and whatnot. So we yeah, we definitely want to work with our body to allow those muscles to do that 200 or 300% lengthening that they're supposed to do during birth.

And after birth, when should a mother start doing her Kegel? Some mothers are believing that they need to start doing them right away within hours or certainly days--

--which is impossible. It totally Yeah, and have given birth especially vaginally to this totally happens in C sections as well. But naturally, those first few days, you can feel like I have no pelvic floor, it is not there there. I mean, it just is not there. But what we want to learn postpartum is again, going back to that breath. So we don't want to do just straight to those key goals. We want to do that full body kind of rehab, so that we aren't leading into, you know, tight pelvic floor issues or anything like that. And we want to be able to integrate pelvic floor strengthening and that breath with full body exercises in our daily life. So usually, what I recommend women to do is, first of all, rest those first few days, few weeks if we can, and then slowly start to integrate the breathing techniques. So that diaphragmatic breathing, getting full range of motion, working that ribcage, working the diaphragm, allowing that pelvic floor to go through full range of motion. This is another time when a lot of women don't realize that they could get tight pelvic floor issues. And that's because they're constantly trying to brace their pelvic floor because it is so weak. And so we get into that chronic state of trying to brace things because we have the leakage or the prolapse or the pain. And so we get into that chronic state. So that's where that diaphragmatic breathing as the very foundation of pelvic floor rehab, postpartum comes into play in the in the best possible vaginal birth scenario and the best possible surgical birth scenario. So like nothing like no tearing in the case of the vaginal birth, no complications, in the case of the surgical birth. Can you describe for everyone what you typically expect to see in the pelvic floor after the vaginal birth versus the surgical birth? Yes, I don't think most women understand that a surgical birth also has an impact on the pelvic floor. But I'm personally curious, what is the difference? What would you could you ever meet a woman and guess what kind of birth she had? What What would you see in that as the difference between the two and what did each of them have to work on?

So that is a very common misconception is that if you had a cesarean birth, then you won't have any pelvic floor issues. But the thing is, you've gone through pregnancy and that alone puts a lot of impact on the pelvic floor. And so learning to rehab that once baby's not there is so important. So the other thing that plays into a factor with the surgical birth is that scar tissue that lays down through all those layers that have been sutured that directly affects the pelvic floor and how it functions and moves and all that fascia that connects you know, from your abdomen down into your pelvic floor that's been disrupted through a surgical birth. So absolutely, you can still have issues with painful intercourse especially, or leakage or any other sort of pelvic floor issues. You're not just kind of exempt from them, unfortunately. So you kind of have a double whammy rehab with that C section scar and the pelvic floor and then with a vaginal delivery. Even if you didn't have any tearing or anything like that, again, you went through pregnancy, and that has the impact on the pelvic floor, and then just going through birth, in general, all those muscles have been stretched. And there's been, you know, just general trauma to the area. So just going back to that breath for even both of those kinds of births is very, very important.

So you'd see like a weaker pelvic floor in both cases, they both have to return re strengthen. In the case of the surgical birth, the abdomen was involved, which is inextricably linked to the pelvic floor. So that is what kind of complicates that recovery. That's exactly.

And so when I do when I'm talking general rehab for the postpartum population, whether you had a surgical birth or a vaginal birth, it's going to look very similar as far as the pelvic floor rehab component. However, with the surgical birth, we're doing specific scar tissue work, such as starting with desensitization techniques, early on postpartum to help with the numbness that you're feeling. And then as we get cleared, and as the incision heals, then we do the on scar work. So different sorts of massaging techniques, abdominal work, fascial, Poles, things like that, that will help with that scar, healing, and prevent, you know, the aesthetic part of it, but also in moreso, the functional part of it too, and how those tissues move and slide and glide over each other. So that's the biggest difference with the Cesarean birth is just the scar work that you'll do in addition to the pelvic floor rehab.

If a mother who has no experience with pelvic floor therapy, maybe has never even heard of it, but she's about to give birth, and she hears this episode, and now she's thinking, Oh, my God, my pelvic floor, I've never really thought about what do I do? Can you give us like, the three things that she definitely should do in the first six weeks after giving birth? Yes, okay. So first six weeks after giving birth, even if you've never heard of your pelvic floor, like done anything for it, the very first thing is learning how to connect with your breath. So doing that diaphragmatic breathing that I've talked about with that bull inhale, bull exhale engaged in the pelvic floor. That is number one thing that I teach all women, and how many times a day. So I would say with the breathing, you would want to start that, really, as soon as you feel ready, you could start day one. But I would say most women are not up for that. So whenever you feel ready, I would start with that breath work. And I would spend at least 510 minutes just working through that breath in different positions. So on your back on your side on all fours. And so that allows you to connect in different ways to your pelvic floor. So simply just doing the breath is a number one foundational thing. Number two would be mobility, and especially upper back and thoracic mobility that has a big impact on how our body moves, how our ribcage moves, and then that correlates to that pelvic floor. So general mobility, we can add in different exercises for that with the breath work. And then number three would be incorporating that with your movement. So we learn that breath in sideline of fours, on your back in those different positions. And then we want to try to use that breath with maybe like a squat, or a lunge or an upper body exercise. So we start to integrate that into our daily life. So starting with the breathing, adding in some mobility, and then integrating that with our functional activities and with exercise as well.

How does the diathesis play into this? Totally? And yeah, and what in what do we need to pay attention to their and when? Yeah, another big topic. And this is something that even women who are several years postpartum can struggle with, because they never did learn that connection. So diastasis recti is separation of the abdominal muscles, the rectus abdominus. And if you go past 35 weeks of pregnancy, you most likely will have some sort of Dr. It's not something we can prevent through pregnancy. But there are things we can do to kind of decrease the severity of it. So postpartum if we are left with a diastasis, then there are ways that we can check it to see how deep it is and how wide it is. And again, this goes back to the breath work, the magic thing that is going to help with diastasis recti is learning how to connect to that pelvic floor and that deep core. So our deep core is the transverse abdominus. And this is like a corset muscle to our waist. And so when we learn how to engage that muscle, with that breath, that is what's going to help bring that diastasis back together, postpartum through the breath work and the exercises.

Is it wrong to say dialysis? No.I just personally go with diastasis Okay, well, it's off my tongue better. Yeah.

Must be the Kansas City and you probably

so probably so.

Is it ever too late? It isn't. Never Never too late. And I want every woman to know that because I think sometimes we feel like we're too far gone or, you know, we are 15 years postpartum or something. And we still have diastasis or leakage or painful intercourse or whatever the scenario may be. It is never too late to address pelvic floor rehab and even to heal a diastasis. Now, the timeline for that could look different for everyone. Of course, we're all individual scenarios. But absolutely, we once we start really connecting with that breathwork and figuring out how to do that pelvic floor integration in our daily life and find that deep core connection, we can absolutely see results even 1015 20 years later. And this goes for C section scars as well. Even if you've never worked your Susteren scar, and maybe you have what we call shelfing, or what a lot, a lot of women have heard the shelfing, which is the skin layer that kind of hangs over due to that scar being so tight, even years later, we can work that incision and that scar and help to reduce some of that and to improve the quality of it. And the function of that area as well.

Should every woman be doing scar therapy than after a C section?

Yes, yes, yes, every woman should do it. And the biggest thing with doing the scar work, postpartum, regardless of where you're at, is to make sure you're not too aggressive with it at first, even if you are several months postpartum, or even years, there is a kind of path that we want to go with that scar work. And like I mentioned, it's starting around that scar. So during the desensitization stuff, and it's like, if you had a tangle in your hair, you wouldn't go straight to that knot, you would kind of work the hair below it. So work through the tangle, and then you would get to and kind of tease through it. So it's the same thing with a scar, we want to work the area around it, to make sure that we have room for it to kind of move and slide and glide and not get too aggressive with it.

And this is something a woman can do on her own. Correct, she does not have to go to a pelvic floor specialist for this. But where does she learn it because probably not being taught by her OB. Right?

Right. Unfortunately, it is not something that is taught in a lot of offices, medical offices, but yeah, of course, if you go to a pelvic floor PT, they will 100% be able to guide you through how to do that. But there are ways that you can find out how to do this on your own. And I share even a lot of tips on my page about how to start scar work and where to go and how to progress and when to know to regress. So there's different YouTube videos on it. Of course, I always recommend making sure it's from a quality source or someone who knows what they're talking about. But you definitely can learn how to do these techniques on your own, and even learn different things like fascial pulling, or cupping, or that incision and that scar tissue. So like I said, I share a ton of those tips on my page. But you can find those through YouTube videos and whatnot as well. I'm a very big proponent of every woman going to pelvic floor physical therapy after birth, if not in pregnancy. And I mean everyone because and I know it's not usually covered by insurance. And it's I just want to say to them, like, name anything that's more important. This affects so many more parts of our lives than we realize. And then the other thing I think that many women don't understand is, it isn't just in the childbearing years that the pelvic floor matters. We need a healthy pelvic floor when we are old women. So not least go get a good thorough evaluation, and then learn the techniques to do at home. Maybe go back a while later and see how successfully you achieved some new metrics at home. You know, do you agree. I couldn't agree more. And I do wish and I you know, hope someday that this is standard of care that every woman at their six week checkup whether you know, wherever they gave birth, is just automatically going to pelvic floor PT for one visit at least just one visit, like you said just to get that base knowledge and even know that this could be an issue and that will carry them through so much of their life and like you said, into our older years and menopause and all of that and you know those POIs commercials that are saying we need pads for leakage when we're certain age or diapers that all can be somewhat prevented if we just understand the importance of pelvic floor health so not to someone I would say that that can be almost 100% prevented. I mean we have you know you can find a place to go grab a massage on every corner in every town or or you know now we have like stretch labs popping up all over the place like where's the pelvic floor?

I know office.

I'm it's so hard to find it I'm saying one thing yoga has really opened my eyes to after years of practicing yoga is that just being alive on Earth, especially being upright. Gravity takes a toll does Everything is subject to gravity. That's why everything starts to go downward. And, and that's the beauty of yoga, you're only using your body weight to play with gravity. To me, that's what yoga is, let's like put my arm up in the air, instead of hanging down by my side, I'm going against gravity. And just by simply doing that, I'm strengthening my arm. So this is like the part of our body 16 or so hours a day is being weighed down with gravity. So of course, when we're old women, this has been decades upon decades of these internal organs. Right, falling downward. So I think that that's the part that we don't think about enough. So my my last question for you personally, is, I know we said, Let's have everyone go after birth, that would be perfect. And I totally agree, it should be standard of care. It's, I believe that it isn't honestly, typical for this country, though. Where we don't have any holistic care at all. Exactly. You know, the doctors know nothing about breastfeeding, nutrition, postpartum depression, pelvic floor health, just everyone just literally has these blinders on to the things totally tangential to their work. But can you explain why if if a woman is postpartum, let's say she's three months postpartum, listening to this episode, she doesn't have an incontinence issue anymore. Maybe she did for a few weeks, but everything got better. Sex is not painful. She doesn't have any protrude. Let's say she didn't get any kind of suturing. And there's no scar tissue after her vaginal birth? Why should that woman consider going to at least one PT visit? What are they looking for in the woman who has no symptoms, if you have no symptoms, and you're feeling great, and there's no issues at all, even still seeing a pelvic floor PT, or getting an understanding of how to connect with your pelvic floor, is kind of going back to exactly what we've talked about. It just takes you through life, and allows you to be proactive in your care, and prevent issues later down the road. So like we talked about, you know, the prolapse kind of thing, or like the gravity being an issue as we age, through the years, and especially having childbirth. On top of that. I mean, that's a lot on the pelvic floor, even if we are symptom free three months later, four months later, whatever. So getting that evaluation, or just that understanding, will help with longevity of pelvic floor health, and just allow us to better connect to our bodies for everyday movements and exercise as well.

One of the things that I hear a lot of women complain about, and I personally experienced after my first baby was the sensation of a very heavy, full feeling in the pelvis after standing for too long. This was many, many weeks after giving birth. And I think a lot of women interpret that as a prolapse isn't necessarily a prolapse, or maybe it's a degree of prolapse. But how would you describe that? Is that normal? Is that totally abnormal? Is that definitely a sign that you need PT, what can be done?

Yeah, and this is a really important question. Because having pelvic floor heaviness, postpartum is actually quite normal and very common. And especially if you did give a vaginal delivery, then you're you will probably feel some that heaviness. And even if you did, the very most perfect technique of pushing and no tearing or anything like that. It's still all of that pressure and the trauma to the pelvic floor. And so having that heaviness is very, very common. Now, if you are experiencing that heaviness after 3456 weeks, or it's not getting any better than this is a sign that, okay, there may be some sort of prolapse issue here. Or maybe I'm just doing too much. And that's why that rest in those first couple of weeks is so so important. Because if we do too much too soon, that can contribute to especially that heaviness that we're feeling in this prolapse type of symptoms. So we want to allow gravity to do the opposite effects that we want to be reclined in those positions to allow for those pelvic muscles to heal and not increase that heaviness feeling that we're having. But yeah, basically, if you are having that heaviness, early, postpartum, totally normal and common, but we want to see that get better as the weeks go on. And if not, definitely go see someone or seek out that pelvic floor care. So I definitely should not have been baking Thanksgiving pies on day four postpartum um, you know, could have been the reason not recommended not recommend it. Yeah, I did learn my lesson.

Absolutely. Right. That was baby number one.

That was baby number one. She just happened to be a second right before Thanksgiving, you know?

All right. I do have one more question for you. How come every pelvic floor specialist that I know is obsessed with their work? passionate about what they do? They smile they're animated. They just can't talk about their work enough. Your though I passionate group of people tell me about it. Yeah, I love it. And I think it's because we can have such an impact and a change on someone's life because the pelvic floor effects so much of what we do in our daily life in our emotional sense or spiritual sense, like there's so much that the pelvic floor contributes to. And so when we can teach women how to address that area of their body, and even just connect to it, it can have significant impact on their life. And it goes into that holistic approach of it's not just physical, we're not just working massage or something like that. This is the emotional and the spiritual component of it, that all gets wrapped into it. And especially women who maybe have had trauma, there's so much that we go into so you really get to know your clients or people just kind of open up to you in a different level. When it comes to pelvic floor health and just with my personality type and just I love connecting with people in that way. It's been so so fun to be able to do that. I absolutely love, love, love teaching women about this stuff. It's been such a joy.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

The pelvic floor must be a really common area for women to hold their emotional pain 100%. And so many women don't realize when they have painful sex or lack of orgasm, but all they need is really a little bit of emotional release in the pelvic floor.

Totally, totally. And again, just having that connection to our pelvic floor. Like intercourse especially and orgasm that is so brain oriented. And so when we allow for the release of that tension or or the emotional release of that pelvic floor, it can change so much and in how we just like think about our pelvic floor in that area. And the different aspects of intercourse or whatever else our issue is, it just it changes so much of how our brain thinks about our pelvic floor and how we connect to it to so it's pretty incredible and and even when you think about like the energy that we carry through our body. And when we hold trauma or any sort of past issues, a lot of times we hold that in our pelvic floor and so we have to address that piece of it in order to actually fix or improve the physical piece of it too. So it's there's a lot going on with pelvic floor health.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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