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About this episode

Pelvic floor health is a topic that's often shrouded in mystery and silence, yet it is fundamentally linked to our overall well-being, affecting everything from incontinence to intimacy. Many individuals, particularly those with female bodies, face the challenges of pelvic floor dysfunction post-pregnancy, during menopause, or even as athletes, without realizing that it is common but not normal and certainly not something they have to live with. Ignoring pelvic floor care can lead not only to physical discomfort but also strain in relationships due to issues like pain during intimacy or a lack of awareness surrounding one's own body needs.

In this episode, we delve deep into the world of pelvic floor rehabilitation and prevention therapy to uncover the importance of addressing these issues head-on. Through holistic approaches, including exercises, education, and community support, listeners will learn about the often-overlooked muscles that play an important role in our bodily functions and intimate relationships. By shedding light on the resources and techniques available, listeners are encouraged to break the stigma, embrace their journey to healing, and ultimately improve their quality of life and connections with others.

Patricia Siegel is a German native and Sports Scientist specializing in pelvic floor rehabilitation and prevention therapy. A former semi-professional track athlete, she is now the STRONG Fitness expert columnist regarding pelvic floor health.

Episode Highlights

04:32 Understanding postpartum health: Pain, support, and recovery.

10:16 Hormone therapy alternatives during menopause.

11:45 Inspiring personal stories of fitness and overcoming challenges.

15:52 The benefits of regular exercise and fitness recommendations.

19:03 The role of breathing techniques in pelvic floor health.

20:27 Athletic performance and pelvic floor strength.

23:54 Navigating postpartum intimacy and emotional health.

29:12 Breaking the silence: Educating women on pelvic health.

32:56 Addressing trauma’s impact on pelvic floor health.

36:37 Communication’s role in postpartum relationships.

38:09 Developing a holistic program for pelvic health.

42:15 Promoting awareness and education on pelvic health issues.

46:52 Practical tips for maintaining pelvic floor health.

Your Check List of Actions to Take

• Educate yourself about the pelvic floor, its muscles, and their functioning. Recognizing its significant role in overall well-being is crucial.
• Aim to engage in endurance exercises like swimming, running, or cycling at least three times a week to enhance overall fitness and pelvic floor health.
• Begin with simple breathing exercises to promote relaxation and strengthen the pelvic floor, focusing on deep inhales and exhales.
• If experiencing pelvic floor issues like tightness, consider exploring emotional or relational factors that might contribute to these symptoms.
• Discuss pelvic floor health openly with your partner to address any existing concerns and foster a supportive environment.
• Join local groups or clubs that encourage physical activity and provide social support, such as running or swimming groups.
• Consider using pelvic wands, Kegel exercise weights, or vaginal dilators to aid in strengthening exercises and improving pelvic health.
• Break the silence and share experiences related to pelvic floor health to normalize the conversation and reduce the stigma around these common issues.

Mentioned

Squatty Potty

ERP 125: How Kindness Can Strengthen Your Love

The McKibbin Brothers (YouTube Channel)

ERP 071: How To Use Sexual Energy To Improve Your Health & Relationship – With Sarina Stone

A Beginner’s Guide to Mula Bandha (Root Lock)

ERP 459: How To Support Sexual Desire In Relationship – An Interview with Dr. Jenn Gunsaullus

Evolve in Love (program)

Connect with Patricia Siegel

Websites: thefitpelvicfloor.com

Instagram: instagram.com/thefitpelvicfloor

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LinkedIn: linkedin.com/in/drjessicahiggins 

Twitter: @DrJessHiggins 

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Email: [email protected]

If you have a topic you would like it to be discussed, please contact us by clicking on the “Ask Dr. Jessica Higgins” button here. 

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Episode Transcript

Patricia, thank you for joining us.

Thank you. Thank you for having me.

Yeah, and we were just chatting and we're so close that we could be in-person, we didn't know that. This is perhaps not the usual topic. Even when my team was vetting this idea of having you on the show and really focusing on the pelvic floor for female bodies, I was getting a no from my team. I was like, well, let's just see what she has to say about how this fits with intimate relating and long-term relationship. 

Part of my hope, and also desire, in having your voice on the show, just a little aside. Long ago, I did a group, and it was four professionals, one of which was a physical therapist, PhD level, but focused on women's health. I was just so appalled at how ill-informed or not educated we are as a culture and families around, particularly she was identifying postpartum, which I'm sure is part of the mix of what you're going to be sharing with us today. But I was like, let's just see what she has to say. Then you came back with all this information, and I was like: Okay, she's got a lot to say as it relates to relationship, let's say yes. So here you are.

Yeah, thank you. That was very sweet.

Yeah. So for people that are just getting to know you, what would you like to share about how this is such a passion, a focus of yours professionally?

So I'm originally from Germany, I was born and raised there, and I studied sports science there. It was a very intensive program of six years total, specializing in rehabilitation prevention. So it's a full sports science program, including everything from sports, medicine, pathology. Then you go into a clinical setting and you work with a lot of patients, from Parkinson's, to pregnant, to depressed people, applying all the knowledge from sports science. So I really love that field of study.

Then at the same time, I was a semi-pro runner in Germany. So I got recruited to run track in the United States, and so that's how I came on a sports scholarship—sports and academic, it was twofold. Then I studied there. So I have two degrees: one from Germany, one from the US. So I moved to the West Coast, 2016, Santa Barbara where you were too. I got pregnant in 2020, and I was considered high-risk. I got pregnant when I was 39, got my kid when I was 40. My labor was 57-hour long. It was super traumatic. It was still vaginal, thankfully. I didn't have a C-section. But as you can imagine, being in labor for 57 hours, not only emotionally, but physically, what that does to your pelvic floor.

That's more than two full 24-hour days.

Yeah, it was wild. So I'm like, I don't know, I'm good. Like, I don't need to do this again. She's great. She's healthy. Everything is well. But what it does to your pelvic floor, it was completely shocking. Even then, I myself went to pelvic floor therapy and they realized. They do the assessment and they give you certain exercises, and I'm like, I'm going to do a clamshell and I'd do some Kegels. I was a semi-pro runner. I went to the track and peed myself. Two steps in, I was completely wet. I'm like, what is going on? That's still 18 months later, and I got super depressed. When you identify yourself with sports, like that's you, and if you can't do it anymore because of that, it was awful.

I thought, I studied all this for six years, what am I doing? I'm going to all these different therapists and they telling me the same thing. So I put all this knowledge together, applied it in a more holistic way, addressing not only the pelvic floor, but associated muscle groups and functional movements in running or swimming, and all of that that nobody talks about really. I created this program, and then I applied it myself. I'm like, okay. Three months in, I still had the adult diapers, but then I was running and it was barely wet. I mean, that was life-changing for me.

Oh my gosh, I'm free again!

I know, it was great. So I applied all that and I created this holistic approach that more women should apply. Not only that, but only finding a pelvic floor therapist, getting an appointment, having a kid, being pregnant, daycare. Insurance covers six sessions, if you're lucky. Then after that, what's that, $200 on the spot for somebody telling you to do more Kegels. It's ridiculous!

Well, first of all, I'm just so grateful that you're being so open and honest about where this originated, and how you were able to really pull back from your experience and then really curate and put together something that is so holistic and effective. That as you're describing all the hurdles that make this difficult to access, you're making it so accessible mm-hmm. Also, it sounds like you're really normalizing this, that this is a part of our health and our wellbeing, and that it's probably still deemed, maybe less now, as such a private thing. I know there's a lot of people that are trying to help bring more attention, and also, still, it's like, I'll hear behind the scenes of people questioning. This might be a little too much to say on the show, and it's my show, but where there's different therapies for reconstruction of the vaginal, helping it be tighter for women that are concerned about that. I know that people with female bodies are caring about their health, but is it really approached in this health and wellness way that you're helping us understand, that you can restore? It sounds like there's a real restorative aspect to what you're describing. I might be saying too much. But tell me, am I hearing that right?

Yeah, for sure. Well, and back to the TMI, I have people in my DMs saying: It might be a bit TMI, but I peed myself. I'm like, this is not, I've heard way too much. You can say it all, I don't care. Then when you're posting on social media, when you just put the primary sexual organs in a thread, and I get a popup saying: You might need to edit your post. Like, we considered this, edit it out. It might be flagged. I'm like, I'm not talking about anything inappropriate, this is our body. It's so frustrating. We talk about giving birth and push presence, and everybody celebrates that. But then when it comes to that, we have to shut up about it? That's not right.

Yes. This is for people who are going through pregnancy and birthing, and there are also many people that are still experiencing pelvic floor issues that maybe hadn't given birth. Is that right?

Exactly, yeah. You mentioned the restorative aspect. 

Actually, the success rate of pelvic floor specialized exercise is 80%. So that's insane.

It is insane.

Why are not more doctors educating about that? Why am I getting messages saying, what is pelvic floor therapy? They told me go straight to surgery. I'm like, what? Why is nobody talking about that?

Yes, I know. Thank you for saying that. Because I actually have heard people really describe the cost of not keeping the pelvic floor in health, that there's the prolapsed bladder? Is that what it is.

Yeah, bladder or uterus or rectum, there's three different.

Can you say a little bit more about that for people who maybe aren't as familiar, the cost of not having the health of the pelvic floor? I mean, we're talking about female bodies. But also, male bodies have pelvic floor as well.

Yeah, the pelvic floor helped our ancestors to move upright. So it didn't just help the women to move upright, and the man is still crawling. So everybody has a pelvic floor. There's two sides. One is a too weak pelvic floor, and one is a too tight pelvic floor, and both can lead to pelvic floor dysfunction. It supports our internal organs: bladder, uterus, rectum. It's responsible for urination, sexual function, and even fecal function. So when those muscles get too weak, it could lead to organ prolapse—bladder prolapse, uterine prolapse when a uterus comes through, or a rectal prolapse. The same goes for the male body too. At the same time, when you have too tight pelvic floor muscles, which you can see in a lot of athletes, gymnasts, cyclists, track athletes. Young women that never had a baby, they have too tight pelvic floor muscles, and they suffer from incontinence. They stop their sports because they're embarrassed. Volleyball players, 75% of volleyball players experience incontinence. Look at the beach volleyball, what they're wearing. They're wearing a G-string almost. Imagine how embarrassing that is. But it can be fixed, but there needs to be more education around it.

The prolapse is significant. I had the PT colleague friend that I was describing, she was saying the intervention, I don't know if this has changed, but that there's wire meshing.

Yeah, there's a mesh, puts it all up. But again, that should be last resort though. It shouldn't be the first resort. I mean, this is a serious intervention in our bodies, that's serious stuff. Why are we not trying? I'm not against that if it's last resort. I'm so for the traditional school medicine. Without it, we would not be where we are now. But I'm always supportive of, let's try the alternative, low-impact, and less invasive first.

Not a band aid. Again, that restorative, helping the body actually totally strengthen from its own resource and its own muscles.

Yeah, I agree. I think it's so important to educate women about that and not just leave them suffer in silence. Okay, I'll never be able to join my kid on a trampoline, or I could never be a D1 athlete today because I'm peeing myself. It's just sad.

It sounds like there's a lot of shame with this, as you're saying.

A lot of shame, oh my gosh.

Like you said, even the DMs, people are like, ooh. And you're like, no, honey.

Yeah. The crazy part is not that the men are shaming them, it's all the women shaming them. When I post something about incontinence postpartum, I have 60 or 65-year-old women commenting: Well, good luck peeing yourself. I did my Kegels, having a loose. Good luck to you, that's not happening to me. I'm like, wow, that's just sad. I don't hear that from men. I hear that from other women, and that's crazy.

It is really the culture around it, the stigma associated, and really trying to normalize. So talk to us about relationship, and even families here, where maybe the information and support is not available. How does this impact relationship?

So we can start with the young women that have too tight pelvic floors. So a too tight pelvic floor makes it so difficult, almost impossible, to have medical exams, insert a tampon, and lastly, having intercourse. So that can deteriorate relationships. In addition to that, the partner pushing for that, which is a vicious cycle, because our pelvic floor is also connected to our emotions. If we are not ready for something or not okay, we are unconsciously even tightening up this more. So it's a painful experience, and it can lead to loneliness and isolation, and just being afraid of intimacy, period. Then another factor is trauma or abuse, pelvic floor stores that. So people of sexual abuse, they have a really hard time, emotionally obviously connecting step, but that transfers to pelvic floor tightness. So that's one part.

The second part is for moms that just had a baby. Your other podcast guest was talking about that. We are not thinking about intimacy right now, we want to sleep and care about the baby. That's what we think about, and it leads to less desire. I mean, we're flushed with a lot of hormones, there's a lot going on down there. Even with me, my recovery was awful after this 57-hour birth. Just not in the mood for intimacy. Then when we are in the mood, it hurts. I talk to a lot of moms at these mom walks, at the end, saying, you have any questions? Anybody has any questions? They're embarrassed. They say it hurts when I try to reconnect with my partner and try to be intimate. I want to, but it's so painful, what can I do? Then they want to be understanding, or some men are not understanding. They're like, six-week track is over, now let's get to it. It's not right.

Then third phase is in menopause or perimenopause, where we undergo changes with estrogen, decreasing lubrication, pain, weaker pelvic floor muscles. Again, embarrassment about intimacy, also a lower sex drive just because. So that's all a vicious cycle too for the pelvic floor. But again, the trauma part, there has to be pelvic floor specific exercises, combined with mental and emotional help, for sure. It's all interconnected, to release the trauma. But everything else, there's pelvic wands that help with scar tissue and trigger points and the vaginal tissue. There's vaginal dilators that help dilating. You can start with a little tampon size and then work your way up, all at the comfort of your own home, no pressure. Just lay in your bed some candles on, and just do that. Or do it in the shower.

There's Kegel exercise weights. It's not a dumbbell for your vagina, some people are imagining that. It looks like a little tampon, but it has weight in there, and you just try to hold it with your pelvic floor muscles, and then you work your way up in weight and all the things.

Swimming, especially for menopausal, perimenopausal, postmenopausal women. 

It works your deep core muscles that are connected to your pelvic floor. It helps even with the relaxation of the pelvic floor. So even if you have too tight pelvic floor muscles, the breaststroke swim where you open your hips, it's wonderful. So I talk a lot about swimming all the time. It increases self-esteem, especially when we go through perimenopause. I mean, I'm 41, considered perimenopausal. Just having that, or having a group that I can swim with, having that social connection again and some sort of accomplishment and empowerment, it just makes you feel so good too. I'm like: Oh, I feel kind of like frisky today, it feels great. Things like that. And what your other guest said, it starts here, and then you get into your body and you feel, and you want to be intimate again. It's so great.

Yes. I was just about to say that, the mind-body connection, and also the connection with others in the sense of social support. That was one of the things I was even feeling as you were describing what you're trying to provide for people, is just an acceptance and a real non-judgment. That if we can slow down, whether or not it's in the space you provide, or in relationship, if there can be a pausing and just a curiosity about what's happening here. Because as you described, there's so many things that could run interference with the partner, maybe feeling rejected. While they might have every intention to be supportive, just the lack of knowledge, the lack of understanding, and then also the lack of knowing what their partner is experiencing specifically. Or even for the person in their own body. I love my partner, I'm attracted to them, I want to be intimate, orgasm feels great, and how do I access my desire, my arousal? Is my partner approaching me too quickly? There's just so much in the media. Talk to us a little bit about that arousal piece.

Yeah. You probably know this, the average time of a man to get aroused is two to five minutes. Average time of a woman is 20. So we need a little bit more stimulation, and it often comes with a safe place and emotional connection. Whereas, men are often just visual, and they see something sexy, they're ready to go. But we women, we want to feel safe and heard and understood, and take the time.

For the body to start responding. If I remember correctly too, there's some neuropsychology or neurobiology, that the arousal pathway actually goes through the brain.

Yeah, the biggest sexual organ is right here, so true. 

When people realize that, they're like: Oh my gosh, I'm interested now, talk to me.

All incredible functions, very vital functions.

Yeah. So you can actually increase intimacy, even without having symptoms like incontinence. It's amazing.

Oh my gosh. One of the things that I'm also hearing too, is that with the health of the pelvic floor, you're talking about all these bodily functions. But also just a sense of, again, that mind-body connection and that vitality, that inner core, that strength, that feeling. I am a yogi. I don't know what I have to be to be an actual yogi, but I've been practicing yoga for a very long time. They talk about the mala bandas, is that what it is? There's these energy locks. But it's also the pelvic floor lock. So it's essentially like, you don't want to just be relaxing to be in a place of solid strength. I'm not describing it well. But what would you say about just the overall health and ability to hold oneself, just the overall vitality in the pelvic floor?

It's the center of pretty much our existence. So just having a healthy pelvic floor is the epicenter of pretty much everything, and completely underrated.

No kidding. I am even thinking about some disciplines like Daoist practice, just that there's this center as you're saying, and that that's so connected to our vital energy, but also our strength and also our emotional center. It's incredibly powerful.

It is.

Yes. Well, is there anything else you want to say? So we touched on a little bit of the arousal, and just if there's apprehension around the start or the foreplay, if you will, that if there's a little bit more space for the female body to be more aroused, or that there's time there for having that connection. You also mentioned the trauma, or just emotional, like if there's worry that it is going to be painful or some problem might occur. That you said, with the pelvic floor exercises, bringing that awareness, but also being able to do a little bit more of that emotional processing that might become more accessible with that intention. Is that right?

Yeah. It's also interesting because sometimes it's kind of like a warning sign of us, that we are not safe. If something is pulling up a red flag in your relationship, something is up, and you cannot pinpoint it. You're not feeling safe with your partner, something happened. It's a self-preservation mechanism of our female body to protect ourselves from harm is tightening up. So sometimes even thinking about it and reverse-analyzing, why am I tight, what's wrong? Going from another point of view to relationship, maybe addressing what's wrong in the relationship. Not like, let's have sex, but I'm tight. Like, let's talk, or maybe we need to go to therapy, or something like that, for sure.

She might be in pain if she's tight. That's not a compliment. If she's loose and full of lubrication, and it's smooth, that's a huge compliment. So men need to understand, being tight doesn't really mean you're a great guy. That could mean the exact opposite. So that's one.

Then during postpartum, understanding what that means for what a woman can go through. I even didn't understand, I was seeing myself from outside, watching myself, what am I doing? I realized that's not me. I'm saying things that I don't mean. I'm doing things that might hurt people. I can't help it, it's just what I'm doing. But what am I doing, what is that?

Would you give us an example?

You know, saying some things trying to be overprotective of your child, not letting family members in, and being almost off-putting thinking about it after the fact. It's like, wow, that must have come up super rude. But in the moment, I don't know, it's such a raw feeling. It's just raw motherhood. I'm thinking about the mama bear or the tiger. All it can think about is the cub, screw everyone else. That's how I felt. But then in retrospect, thinking: Damn, that was pretty intense. I mean, men are not educated enough about what could happen and how long that might last. It's not just two months and she should be fine now. It can last postpartum two years. Understanding that and pushing through that and not saying, I'm going to give up on the relationship. It's like, we can work through that.

No kidding! Actually, a client comes to mind, where she reached out, it was a year postpartum, I believe, or almost, and she was confronting divorce. I think this did play a part, that he interpreted her overwhelm or her lack of interest in maybe his own insecure ways. But it was one of the factor, not the only, but one of the major factors of their separating and ultimately divorcing. I never met with them as a couple, but it was super tragic.

Yeah, it's sad.

So I don't know if you're willing to share if you were partnered in postpartum. I mean, it's not going to be the same for every mother. But do you even think it's realistic to still have intimate connection? Not necessarily saying sexually having intercourse, but do you think there's still capacity? Or what do you see from your vantage point around how to still nurture the partnership even in postpartum? Is that something you would say could be start being explored at six months? Tell me what you see.

I mean, intimacy is not just penis and vagina. There's so much about it. It's a little good morning text, that's how it starts. Something like that. Or: Hey, you're such a great mom, I see what you do with our kid, I'm so proud of you. That just makes you feel good, and that could lead to a massage, and that could lead to kissing, and it could lead to anything but actual intercourse. That's intimacy too. If you are understanding and patient with your partner, you can go back to before even better. Even with pelvic floor exercises, you can even have a better intimacy after the fact. A lot of women think: Well, now I'm a mom, that's just what it is. Maybe say: Because I'm a mom, that's why it is going to be great.

Oh my gosh, what a good model. Also just for the family health, that mom is experiencing pleasure and happiness and she's connected to her body. So there's nothing prescriptive here that you would say for people to have a sense of. It's just really nurturing the connection and the intimacy holistically, and then really responding to what's there physically. There's lots of range, again, you said there's lots of opportunities beyond just penis and vagina if we're talking about a heterosexual relationship, or any penetration.

Yeah, and everybody is different. People have a longer recovery. I had a really long recovery. Pain is always your biggest indicator. If it's painful, go by that. For some people, it happens earlier, some later. 

That's so important also, going through postpartum, having that support system. But definitely wait for that six-week checkup, where they check you for any issues of prolapse and that matter. Then go little by little, and if you feel like it, just go for it.

Well, it sounds like really listening to the body. The body's going to be giving cues, and pain is a real good indicator, and just really attuning to the body. Even if there is pain, that there can be inquiry around what is happening for me exactly, or what do I need, or what am I wanting?

Yeah, for sure.

Okay. Is there anything that you would say, I know you do a lot to help people that are perimenopausal or menopausal. Would you apply the same principles? Is that your focus? Or what would you like to say about that phase in life?

Regarding intimacy?

Anything. Either both.

Yeah. I hear a lot about hormone therapy, and again, I'm more a proponent of finding alternatives first before we go the hormonal route. Because there could be some negative side effects associated with that. But your pelvic full muscles get weaker during perimenopause—you have increased vaginal dryness, increased DTIs. Just knowing that with regular pelvic floor exercises and strengthening, in addition to endurance training like running, swimming, or cycling, your overall wellbeing in regards to hot flashes and sleep disturbances and anxiety and mood changes, all of that. So many studies have proven that regular endurance exercise can combat that and strengthen your pelvic floor at the same time.

Best example, my mom. So I was always a runner. She started running in her late 60s, because I started joining a club and she was like, I might as well. First of all, the social aspect was huge for her—for her self-esteem, sense of accomplishment. But also, once she started running, she experienced incontinence. The first two months, she was running with incontinence pads. It was embarrassing. But she kept running, she kept swimming, she kept doing the exercises, and two months in, she didn't need incontinence as a 65-year-old woman. She didn't have issues with menopausal symptoms, didn't have issues with hot flashes. If anything, reduced hot flashes. She swam in our lake in Germany every morning, a cold plunge, which is also proven to reduce hot flashes significantly, because of the thermoregulation of our bodies. So that one example of my mom pretty much can tell you everything. You can experience incontinence in your late 60s and can still be cured. You don't need to go that crazy route, and you don't need to stop. Never stop. Our bodies are so fascinating in that aspect, always adaptable at any point in time. It's great.

I love that you have so many stories, and I imagine you have all the stories to keep reinforcing the power of this work. Well, I know that you probably can direct people towards what you want to share around how they can get engaged with the practice of this. But just for people listening, is there any tips or recommendations around how much they should be incorporating the pelvic floor exercises? Anything you want to give people here of just a taste around what that could look like, just to get their mind around how to implement this?

I would say if you experience symptoms, or even if not, the rule of thumb is to do three times a week of focused exercise and training, to increase a fitness level in any sport, exercise, anything. So if you can incorporate three times a week for 30 to 35 minutes, you can see a huge improvement already.

That's not even specifically pelvic floor exercises. That's just exercise in general.

No, exercise, a run, a swim, a bike ride. It will already change a lot of things. But the minimum should be three times a week, for sure.

Okay, great. Then what about specific to pelvic floor health?

You could start with simple exercises. A breathing exercise. Our diaphragm is directly correlated to our pelvic floor. When we're stressed or even just sitting, or in normal life, we do a lot of chest breathing, because it's what we do. We have a lot going on in our lives, we forget about the connection. So just being focused on breathing in through your nose and letting your belly fill with air. You can even put your hands on your belly, let it fill with air, and then breathing out through your mouth. That is already the simplest pelvic floor exercise you could do. Because when you inhale, your pelvic floor muscles relax. When you exhale, they contract. So that's the foundation of a pelvic floor exercise. It's just that. You can apply that to any sport, anything where you land. When you land somewhere, you breathe out because your pelvic floor contracts and holds your organs in. That's what I try to tell all these athletes too, they don't know about pelvic floor specific. Breathing in triple jump, in high jump, in volleyball, just applying that breathing in a volleyball jump. You jump up to the net, you breathe in, and once you hike, before you land, you breathe out. Just that simple thing could change everything.

Yes. So I don't know if you know, but I played a lot of beach volleyball, and I still do. One of the things, I think it's the McKibbon Brothers or something, they were on the AVP tour. I think they had some channel, I don't know if it was YouTube or what. But I remember my husband had watched something and he was referring to it, and they were all about, grunting is good. So when you hit, or whatever the grunting, they were really encouraging, which is related to the breath.

Yes. You're like, why are these women grunting? That is good. The thing is, even in weightlifting, if you hold your breath, you push away and you hold your breath, all this pressure, it's like a Coke can with the opening being on pelvic floor. If you hold your breath and not letting the air out, the last thing that gives up is your pelvic floor, and that could lead to organ prolapse and craziest things. So you see weightlifters, when their veins pop out and their face gets red, that's so bad. Let the air out.

No kidding, yes. It's reminding me of a friend in Santa Barbara, more of an acquaintance than friend, and she was talking about the importance of not pushing when you pee. Do you want to say anything about that?

Yeah, that too. Not pushing when you pee, not pushing when you poop. Not rushing when you pee. Sometimes you're like: Okay, let me go pee real quick, I'll be right back. Then you push through. It creates this enormous intra-abdominal pressure, and it pushes everything through the pelvic floor, so that could weaken your pelvic floor muscles. Then, the invention of our phones. I mean, we have a phone, we sit on the toilet, just scrolling. I mean the man more than we. It's like, what are they doing for 30 minutes in the bathroom just sitting there? But having this posture on the toilet for that long time, it's ridiculous. It's so detrimental for our pelvic floor.

Just sitting on the toilet for that long? Oh, I didn't know that.

Yeah. So anything longer than eight minutes, you should not sit on it. You can tell that to your husband.

Okay, all right. Then, I also know friends, and it intrigued me, but I never purchased it.

The squatty potty, yes. It changes the angle of your rectum, and so it makes it easier. You don't strain as much. So you should also not push. If you need to go and have a bowel movement, you shouldn't be sitting there trying to push. You should only go to the toilet when you really have to. I know sometimes it's hard when you have constipation. But when you are constipated, try to move your hips clockwise, counter-clockwise. If after eight minutes, nothing happened, get up, walk around, do some squats. But don't keep sitting on there and pushing. That could lead to all these issues.

Okay. Well, coming back to your breathing, another TMI, I am sure. This was probably 2006, maybe 2007. I was in a program, and part of one of the classes was an experiential meditation workshop. It was doing the Buddhist loving kindness meditation, and obviously, really deepening the breath. So mind you, I was in a graduate school program and there was lots of stress. So the chest breathing was, I'm sure, something I was doing frequently throughout the day. Well, all that to say, with the experience of this deep breathing into the abdominal diaphragm, lower abdomen, it was like an internal massage. Literally, again, TMI, later that night, I was waking up and having to go to the bathroom, having very sufficient bowel movements. I could only correlate it to the meditation, it wasn't like I was eating more fiber. But that deep breathing had such an impact on my system, and it was notable.

Everything's correlated, that's why I don't like to just focus on one. Even if you have a knee problem, focus on what might be wrong with your hip, what might be wrong with your torso, what might be wrong with your teeth if you have Achilles heel issues, and not just treat the actual issue. I'm a big fan of holistic approach. Everything is connected. So what you said, it just makes sense, for sure.

Okay. Well, wonderful. Patricia, one of the things that I'm getting from you, and I'm not sure, I would love for you to tell us about what you offer, so I have a better sense. But it sounds like there's a community aspect, or there's social aspect to what you offer. Is that right?

Yeah. Well, I did create that online program that you can do by yourself. It's self-guided, super easy to follow. I have swimming training plans and running training plans you can print out and pop on your fridge. But I do present at a lot of mom walks, and when they all go on the stroller walks, talk about pelvic floor health. So that's mostly my community aspect of that. But when it comes to the community aspect during menopause, perimenopause, or even postpartum, going to the gym, the gym I have here, most gyms or even the YMCAs or public pool, they have master's programs for swimmers of all fitness service. It doesn't matter, you don't need to be a professional swimmer. Just swim in a group for an hour, find friends. You can be the slowest, they don't care. You just follow the program and you go as far as you can. Finding a running group, it's the best thing you could do, not only for your mental, but also physical wellbeing.

That's beautiful. So you're really encouraging for people to talk about this with other people, to find groups where there can be more open sharing and support, and also to participate in activity that supports the pelvic floor health and the overall fitness and health. 

Yeah, for sure.

Wonderful. Well, tell us a little bit more about your programs and what you have available for people.

Yeah, so you could find it on my website, TheFitPelvicFloor.com. It's an online course I created with an intro about pelvic floor anatomy, going into different chapters, too tight pelvic floor, too weak pelvic floor, hemorrhoids. That's another thing we haven't talked about. But hemorrhoids are a whole chapter. Pelvic floor issues during menopause, postpartum. Then it goes into the traditional pelvic floor exercises with videos. It goes into gym exercises such as squats or deadlifts that you can incorporate. Then it goes into the endurance aspects, running, cycling, and swimming, together with these training plans. Three times, 12 weeks of training plans. Then I also partnered with Intimate Rose. It's a brand that developed pelvic floor tools, like the Pelvic Wand, the Kegel exercise weights, and vaginal and rectal dilators. So you can get a complimentary tool of that with the course too. You just message me which of the three you like, and then we ship it out to you with the course.

I love it. Well, I'll make sure to have the link to that on today's show notes.

I appreciate it.

You're welcome. Is there anything else that you want to mention that we haven't touched on that feels helpful to say here?

Yeah, a few things. If you want to, if you are embarrassed of sharing anything out in the open, on my social media, feel free to directly message me. There's no TMI for me, I've heard it all. 

So normalizing the fact that you know it's curable, and not just saying: Congratulations, you are a mom now, or you're in menopause. Even going to the doctor: Well, I have this. But you know, you're 65 years old. Like, okay, what can I do to help this? So just knowing that, and thinking about my mom as the best example. It's common but not normal, and it can be fixed at any age.

Such an important message, common but not normal. There are many things that one can do to restore the pelvic floor, and the health and the incontinence, or any other kind of symptoms, if you will.

Wonderful! Well, Patricia, thank you so much. It was fun. For people listening, you're at the gym now. You've got a conference center, so I can hear a little bit of the gym activity.

Yeah, my little daughter is in the kids’ club, it's perfect.

Nice, wonderful! Well, thank you again.

Thank you so much.