The Postpartum Dilemma and How to Navigate It

In many respects, there is a lot of beauty in the postpartum period.

A new life is introduced to this world, your heart opens up like you never knew it could and all of a sudden, you have a bigger purpose.

But there is also a side of it that almost feels like bad design.

Your body has accomplished the most impressive physical task it is capable of: growing a baby and then getting that baby out of you. It is more significant than any workout or any surgery you will ever undergo.

Rest and repair are more important than any other time in your life.

You are forced to rebuild from the ground up and your body will no longer get away with any dysfunction. It’s an opportunity to reset and rebuild, to do it all over again but in the right way this time.

But you have a baby.

And with that comes minimal sleep, nutritional deficits, hormonal imbalances and lots of lifting. In other words, it is the most inopportune time to rest, replenish and rebuild.

This my friends is the Postpartum Dilemma. 

It’s easy to get caught up in the frustration of all of this. Your body is telling you it needs to sleep and lie down, yet a screaming baby has a totally different agenda and unfortunately, the baby’s needs have to be placed before yours. It’s common to feel like you can’t do anything right, that you are unable to do what you should be doing and even when you manage to do something, you feel like you aren’t doing it all that well. 

So what to do about it…

Here are my recommendations for navigating the Postpartum Dilemma: 

1. Do what you have to do when you have to do it.

Often times postpartum is more about surviving and less about thriving. You must meet the needs of your baby and in the beginning, it is often at the sacrifice of your own needs. Its just the way it is. So do what you have to do, when you have to do it and you should feel really good about doing so. You are keeping a baby alive. That’s a big deal. 

2. Don’t do more than you have to.

There is already a huge demand on you in making sure that kid is fed, changed and rested. Don’t do more than that. Ask for help or pay for help. DO NOT touch those dishes. 

3. Make the have-tos as restful as possible.

There are more restful ways of doing things even if it doesn’t look like what you would consider rest. For example, lie down while playing with your baby instead of sitting, sit to rock baby instead of standing, lie down while baby naps instead of being out on a walk or baby-wearing, feed the baby while lying down. Even if you aren’t sleeping, you can still be resting your body while accomplishing some of the have-tos. 

4. Incorporate your rebuild into the have-tos.

Once your body has gotten ample rest, you will feel the need to move and the desire to strengthen. The cool part is that you have built in strength training throughout your entire day AND your weight gets heavier every day too! This is when you focus on your posture and your breath to make the diaper changes, carseat transfers, crib transfers and walks your strength training. These same demands have the potential of depleting your body even further but its all about how you do them. If you pay attention to form and do them with intention, they become strength builders that only contribute to you feeling better and stronger! 

5. Practice self-compassion always.

You will often feel like you fail at all the things on most days. Recovering physically while transitioning into parenthood is straight up hard. But our self talk can be like twisting the knife when it involves shame, blame and guilt. So be kind to yourself. You are doing your best. And that is enough. You are enough. You are doing great. Remind yourself of that every minute of everyday.  

6. Your time will come.

This isn’t forever. You will sleep a full night again. The postpartum dilemma is temporary and your rehab potential will be waiting for you when you have the ability to take it on. Just make sure you watch for that door opening because it can be easy to fall into the sacrificial parenting habits and never take back self-care simply because you aren’t used to being able to do so. It’s never too late to start but you have to make sure you do.

Do you want more guidance through your postpartum rebuild? Click here to be the first in the know about my postpartum program: Whole Again.

Pain and COVID-19: Why Some Are Thriving and Some Are Suffering

COVID-19 has changed life as we know it.

For some, these changes have been positive and for others, detrimental. But how does this related to an individual’s experience of pain? It all has to do with what these changes have done to each person’s nervous system. I think the best way to illustrate this is to introduce two very different people who both have chronic pain, let’s call one Jane and the other John.

Meet Jane

Jane thrives off social connection outside of her home. She also loves her job, specifically because of those she works with. She doesn’t have a great relationship with her husband and her two teenager children want nothing to do with her at this point so she has found her happiness elsewhere. The happiest times with her family are always when they travel, especially outside of the country so she makes sure they go on a few trips a year. Jane has had neck pain for years. She believes it is likely because of a few horseback riding accidents in her childhood as well as a car accident in her late 20s. She manages it through massage and group exercise classes. She does yoga 3x a week and strength training 2x a week. She is extremely consistent with her exercise and looks forward to connecting with her instructors and her community, plus it helps her pain so that’s an added bonus.

Meet John

John is as introverted as it gets. He loves quiet, he loves to be alone. His happy place is reading in his favorite chair with a good cup of coffee. He also has a very stressful job as an engineer. The amount of work he is required to do for his job is ridiculous. He often puts in 60-70 hour work weeks but if that were the only stressful part, he could manage. What makes him miserable with his job is the toxic work environment he is in. Everyone is out for themselves and there are some very wealthy and equally needy clients that are just impossible to please. Every weekend he tries to escape to the outdoors to breathe fresh air, move and be immersed in nature but often he is forced to work through the weekend just to get the required projects done. John has low back pain and it’s just gotten worse over the years. He thinks it started when he got this job with the commute increased time at his computer. He knows that movement helps and feels better when he can go on walks but he just doesn’t find the time to do it all that often. He has resorted to pain medication to help him get through his day and he feels it’s becoming less and less effective. He is afraid to go get an MRI because he doesn’t want back surgery. He just can’t deal with that right now.

Then COVID hits.
Can you guess who is feeling awesome and who is in struggle town?

Everything that brought Jane joy has been eliminated. She got laid off from her work because of COVID and is now spending all day, every day inside with her family where her husband works from home and her two teenagers are doing distant learning. In many respects, she feels like she has become the full time house nanny and professional nagger to people who never want to listen or do as they’re told. She feels stuck and with the travel restrictions, she literally is. For awhile Jane tried to do her exercise classes virtually but it made her realize that she didn’t do them for the exercise, it was all about the community that was there. It was her social time and without that piece, she has no motivation to do them. Here massage therapist has also been shut down and she needs the bodywork more than ever. Her neck is killing her. She is carrying the weight of the household and is extremely worried about getting COVID. She has asthma and an autoimmune condition that puts her at risk. Everyday she watches the news and it just keeps getting worse and worse. Jane is struggling and she doesn’t see any way out of it.

Meanwhile, John is living the dream. He no longer has to commute to work and there is less work for him. He doesn’t have to be surrounded by any of the toxic co-workers and he finds he can accomplish what he needs to far more efficiently. He is also able to go out for a walk or go read by the ocean at his leisure. He has even started to make home cooked meals with his extra time and is finding a lot of joy in experimenting with recipes. He’s lost 20 pounds without trying and is finally feeling what it is like to live exactly as he wants to. John’s pain is basically gone. He notices it comes back a bit after a long zoom meeting with his boss and co-workers but he found that if he goes for a quick walk after, it’s goes away. He is amazed!

Do you relate to either Jane or John?

There are many reasons that Jane’s pain increased while John’s decreased, the most obvious being that they each has a change in their physical movement/position/activity level but there are also some not so obvious reasons that their pain was effected by the way life changed with a pandemic.

For instance, Jane lost all of her social connections and her work which made her feel like she wasn’t contributing or participating as much in the world. She feels solely responsible for the household and the success of her teenagers with distant learning. She is also incredibly worried all the time. Worried about getting COVID, worried about her family and friends getting COVID and mourning everything that is being lost every day and every minute. This stress, worry, grief, anxiety and lack of joy are all contributing to the increase in her neck pain.

In John’s case, most of his stressors have been removed. He feels like he can enjoy each and every day now and do exactly what makes him happy. He is sleeping and eating better in addition to getting outside every single day. This absence of stress, freedom to find joy, ability to sleep more and exposure to the sun are all contributing to his decrease in low back pain.

These not so obvious factors for each individual all have to do with the nervous system. Chronic pain is a nervous system problem. It is the point at which pain does not correlate with tissue damage and it becomes more about the faulty alarm system of the brain. So anything that turns this alarm system up, or heightens the nervous system, will increase pain while anything that calms the nervous system and quiets the alarm will decrease pain. And this is how the pandemic can have extremely different effects on individuals with chronic pain.

So what is there to do with this information?

If you are more like Jane, think about all of the things that you have lost. Think about what you are missing and brainstorm how you can achieve a similar outcome but with a different means. Social connection was really big for Jane so perhaps she can find that same joy by doing a socially distant walk with her friends or a zoom happy hour. Then think about the things that stress you out even further. Can you eliminate any of them? Sure, Jane can’t remove her teenage children but maybe she can stop watching the news or at least limit it so she isn’t adding to her stress.

If you resonate more with John, good for you 🙂 but also, this pandemic isn’t going to last forever. Think about how your life has changed for the better because of COVID. How can you keep what you have gained once the world starts to return to a more normal state. You have felt what it feels like to live, don’t give that up.

Do you want to learn more about pain science? Check out my pain science blog series part 1 here.

Do you want to be out of pain? It’s time to address your nervous system. Check out my Conquering Chronic Pain program here.

Mama Care

The first step toward change is recognizing that there is a problem and I believe we are there when it comes to peripartum care in the United States. Research is showing that as a first world country, the US is falling short, especially when it comes to postpartum care for mothers (article).

I have experienced this first hand even with the best insurance, the most amazing OB and my own medical background. I can only imagine how poor the level of care is for mothers that are not as privileged as I am. A big step in the right direction happened in May of 2018 when the ACOG (American College of Obstetricians and Gynecologists) released new recommendations for peripartum care (article). It finally includes a visit for mom within 3 weeks of baby’s arrival versus the standard 6 weeks. IT’S ABOUT TIME! It also states that “postpartum care should become an ongoing process” and include a “comprehensive postpartum visit with a full assessment of physical, social, and psychological well-being, including the following domains: mood and emotional well-being; infant care and feeding; sexuality, contraception, and birth spacing; sleep and fatigue; physical recovery from birth; chronic disease management; and health maintenance.” Pelvic physical therapy even got a shout out!

Now the real question to ask is whether moms are actually receiving this recommended peripartum care. In a study surveying the office visits of postpartum women from 2008 to 2016, less than 50% of most recommended services were performed during a comprehensive visit and this was consistent across all insurance types (article).

I think there are many reasons for this shortcoming. First off, a comprehensive visit requires time: something most doctors do not have in our current medical system. I believe it is unreasonable to expect an OBGYN, midwife or family doctor to cover all of these areas in the 20 min they are allotted per patient. They are doing the best they can within the model that they work which means screening for life threatening conditions and moving on to their next patient.

Another reason is that mothers don’t know they deserve and need more than what they are currently receiving. I know many that are itching to get back to things so when they are given the “all clear” at 6 weeks, they are stoked! What they don’t know is that this is a disservice to their body in the long run. Many have symptoms they are experiencing but don’t know something can be done to help them, aren’t comfortable talking about it or aren’t asked in the first place. Too often, women accept that they will pee themselves when they sneeze or have pain with penetration because these common symptoms are a “consequence” of having kids. Women just don’t know that it doesn’t have to be this way.

Motherhood is also a place of selflessness. The needs of the child are prioritized and mom is often left with no time, space or energy to take care of herself. There is so much emphasis on the baby’s health and well-being, mom doesn’t realize that her health should actually come first so she can be there for her child fully. I wish more moms believed and lived by the saying “happy mom, happy baby”. Instead, most mothers sacrifice their own needs for the needs of their child. I believe its up to perinatal professionals to make sure moms know that their well being matters too. In fact, it matters first and foremost.

So here is my contribution: some education regarding what peripartum care should look like. I recognize there are many barriers to this actually happening including but not limited to socioeconomic disparities and racial inequality but I figure the first step is naming what it should be. Once more people know the destination, we can start to figure out how to get there. If you aren’t a mom or expecting to be a one in the future, please tell your friends and family. And any stranger that might listen.

Dear mamas,

Peripartum care should start with a preconception visit. It provides a space to ask questions, voice concerns, talk about fears, understand what to expect and get some basic tests to confirm your body is fit to grow a baby. This is also where difficult but ever so common occurrences like miscarriage and infertility should be discussed. By knowing about all of these things BEFORE they happen, women can be better equipped to deal with it when it is happening.

Once pregnant, the education should shift toward what to expect during pregnancy. It’s actually quite simple, expect anything and everything. But knowing this before the skin rash, insomnia, discharge, dizziness, shortness of breath etc. comes on would again be helpful. Pregnancy can be scary and it’s important for expecting mothers to know what constitutes a reason to call the nurse or head to urgent care. All of this should be covered in prenatal visits to a nurse, midwife or OB but sometimes it won’t be volunteered information. So ask questions mamas! No question is dumb. In fact you are likely wondering the exact same thing as that pregnant person sitting next to you in the waiting room. This is why I absolutely love prenatal yoga, prenatal fitness classes and group prenatal care. It’s so important to know and feel that you are not alone throughout all of this. If you are in Santa Cruz, check out Luma and Fit4Mom. We are so fortunate to have such amazing programs in our backyard. Go take advantage of it!

I have to refer to doctors, midwives and doulas for most prenatal education but when it comes to the musculoskeletal system, a pelvic physical therapist is the expert to consult. One day I hope pelvic PT will be part of routine prenatal and postnatal care but until then, it’s important you seek it out on your own. You don’t need to wait until you have pain or incontinence to see a pelvic physical therapist. Even before you’re showing, you can learn about how to engage your core, how to contract and relax your pelvic floor and how to stand properly so that when the belly is big and the system is challenged, you are better equipped to manage it and prevent pain, incontinence and prolapse. Sound like a good plan? I think so! During the later stages of pregnancy modification of exercises, sleeping positioning and preparation for delivery can be addressed. Doing so can minimize tearing, hemorrhoids, prolapse and diastasic recti. What an opportunity that is so often missed!

Ok so you have the baby. Chances are good labor and delivery aren’t going to go as planned but its a good lesson in letting go of control and expectations. All attention is turned toward baby and let me tell you, the baby always wins. But what about you? Your body has just performed a miracle! It grew a baby and now that baby is out either through a small hole or through a cut in your abdomen. In my opinion, neither are great options. If prenatal care didn’t fall short, postpartum care definitely will and this is why I am spending the time to write all of this and get it out there for anyone who wants it. Very little time goes into preparing a mama for what to expect physically after delivery. Again, I have to leave most of this up to doctors but ask the questions! If something isn’t working or feeling right, if you’re depressed and nothing brings you joy, or if you’re just wondering if something is normal, go see your doctor and ask questions! You are just as important as that baby you just made. In fact you are more important because a healthy and happy mom is going to nurture a healthy and happy baby.

What I can tell you is this, everything is going to hurt at first and pooping is going to be very painful and scary so take your stool softeners! Rest is the most important thing at first which is hard because you have a baby to keep alive and likely feel like you don’t know what you are doing when it comes to parenting. But rest. Please rest. As tissues heal and hormones level a little, a new version of your physical self will emerge. The most important thing I can tell you is this, you DO NOT have to live with pelvic pain or incontinence or anything else for that matter! Fancy diapers that look like panties or avoidance of sex does not have to be the answer! Go see a pelvic physical therapist. A pelvic PT can help guide you through low or mid back pain from lifting and nursing a baby, return to exercise safely so you can avoid injury, scar tissue release so you have less pain, so your c-section mark is less visible, so you can heal your diastasis recti, find you abdominals again, and train the pelvic floor so panty liners are no longer needed. The rebuilding process is just that, a process. And it doesn’t happen naturally, especially if you are having a kid any later than age 18. It’s hard work but if done properly, you can have a body that functions better than it did before having children. Trust me. You just need the proper guidance and support.

It’s also never too late to get the care you might have missed. Sure the “fourth trimester” is a very important time but technically, every mama is postpartum for the rest of their life. It’s never too late to work on scar tissue or strengthen the pelvic floor. We can wallow in what should have happened or what peripartum care should have looked like but instead, its best to look ahead. Spread the knowledge and know that postpartum care today was better than yesterday and will be even better tomorrow.

If you are a new mom, pregnant or planning on having a kid in the near future, click here to be the first to know about the release of my virtual postpartum program, “Whole Again”.

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Schedule a Free 30-minute Consult


Schedule a Free 30-minute Consult


Endocrine Disruptors: The Invisible Cause to Internal Chaos

What is an Endocrine Disruptor?

Let’s first define what endocrine means. Endocrine is the body’s system of hormones (chemical messengers that are both produced and used throughout the whole body). An endocrine disruptor (also known as endocrine disrupting compound, EDC, or hormone disruptor), is anything that gets in the way of proper messaging throughout the body. The unfortunate fact is that we are exposed to such disruptors everyday through our environment and the products we use.

Biphenols (ex. BPA), phthalates and parabens are the most commonly known and researched hormone disruptors but most research looks at less than 5% of known endocrine disrupting compounds.

EDCs can interrupt the messaging system in several ways. Some mimic hormones and bind to receptors causing too much of a hormone to be produced or released. Others actually block the activation of a hormone or cause too little of one to be produced or circulated in the blood. The more these compounds are being researched, the more we are learning about how they can effect expression of DNA and the metabolism (removal) of hormones resulting in disease passed on to subsequent generations.

Why should we care about them?

The description of what an EDC is should explain most of it but in case you still aren’t convinced, I’ll break it down a bit further. Hormones literally run and regulate every system in our body. This includes sex hormones (estrogen, progesterone, testosterone etc.) as well as the thyroid hormones, insulin which regulates blood sugar and our stress response (cortisol, epinephrine, norepinephrine). We may think about these different hormone loops as separate when in reality, they are extremely tied together. Cortisol effects insulin effects thyroid which effects estrogen and thats just ONE connection. So you can get an idea of how disruption in ANY of these messaging loops will have a cascade effect throughout the whole body.

This is how EDCs have been shown to be the cause of disease and dysfunction in literally every system of our body. The diseases and conditions most heavily researched include heart disease, cancer (especially breast, prostate and testicular), infertility (male and female), immune and autoimmune conditions, ADD/ADHD and lower IQ, autism, birth defects, obesity and type 2 diabetes. And just a reminder, this is looking at 5% of known EDCs.

The other alarming fact is that the effects of these synthetic chemicals are not dose dependent. Research shows that for some, a low dose exposure can be more harmful than a high dose. Research is also demonstrating that although most of these chemicals are often eliminated from the body within a few days, they can leave lasting effects which can be passed on from generation to generation through the effect they have on gene production and expression.

In 2012 the World Health Organization and United Nations Environment Program published a report calling the endocrine disrupting chemicals a “major and emerging global public health threat” and yet most of these chemicals still aren’t regulated. I don’t mean to instill any sort of fear into you but I do think its important that we all know what the ingredients are in the products we use and how they effect us so we can make educated decisions in purchasing and using them.

So where are these EDCs commonly found?

I’ll start with the heavy hitters…

BISPHENOLS: used to line food and beverage cans as well as in thermal paper receipts. Bisphenol A (BPA) is most commonly known but replacements including BPP, BPF, BPS, BPZ and BPAP are just as harmful, if not worse.

PHTHALATES: used to make plastics softs especially in food packaging. Also used in lotions, deodorants and cosmetics to enhance scents.

PARABENS: preservatives used in cosmetics to prevent growth of bacteria and mold.

But also…

Flame retardants (organohalogens especially polybrominated biphenyl ethers or PBDES): found in plastics used for furniture (sofas, chairs and mattresses), electronics, wire insulation, carpets and foam used in car seats.

Perchlorate, thiocyanate and nitrate: found in food packaging such as plastic wrap, baggies and to-go containers.

Perfluoroalkyl substances (PFASs): used in teflon or any non-stick surface. GenX, a chemical developed to replace teflon, has also been shown to have similar harmful effects.

Pesticides (organophosphates): used to prevent, destroy, repel or mitigate any pest on crops.

Small changes can go a long way.

I know this information can be overwhelming and it’s tempting to ignore all of it instead of going down the rabbit hole. I lived in that space for quite sometime until my daughter’s skin and gut issues forced me to do otherwise. But I’m here to tell you that small changes can have a dramatic effect on your overall toxic burden. Here are some tips for where to start:

  1. Eliminate products that you use daily first.
  2. Prioritize products that you consume or place on your skin.
  3. Use the rest of what you have and gradually replace as you run out of something.
  4. Look at the ingredients of the products you use and prioritize eliminating what is most relevant to your health concerns (EWG.org).

And here is a list of steps to take. By doing any of these swaps, you are significantly decreasing your exposure to EDCs so always remind yourself, something is always better than nothing.

  1. Buy organic for the “Dirty Dozen”: strawberries, apples, cherries, celery, spinach, grapes, pears, potatoes, nectarines, peaches, tomatoes and peppers.
  2. Minimize consumption of foods stored in cans and plastic. Glass storage is ideal but stainless steel is a great alternative as well. Remember, “BPA-free” doesn’t mean much when the BPA replacements have been found to be just as harmful. When you do use plastic, never microwave it, never wash it in the dishwasher, don’t reuse it and keep an eye out for the recycle number 3 which indicated phthalates.
  3. Avoid all “non-stick” cooking surfaces. If you do use them, avoid metal cooking tools and store carefully to avoid scratching. Also cook at the lowest possible temperatures. Stainless steel and cast iron are the most ideal substitutes.
  4. Avoid all cosmetics that contain the term “fragrance” and eliminate products that contain phthalates or parabens (commonly found in lotions, creams, nail polish, hair sprays and deodorants). Look for products that are labelled to be free of phthalates, parabens, triclosan and benzophenones (the EWG database called Skin Deep is a great resource).

Human safe and effective products.

There are a few companies that I stand behind and I will continue to look for more. At this point I have personal experience with these products and can say that they actually work! I am hopeful that one day many of these EDCs will be regulated so we can all purchase anything on the shelf without being worried about harmful ingredients but until then, we need to be our own health advocates. By purchasing only human safe products, our dollars can help contribute to the movement toward permanent change.

Beautycounter: a certified B corporation that has banned the use of 1,800 ingredients from their products, has a large presence in the movement to change legislation and produces some of the most effective products I have ever used.

Primally Pure: completely natural skin care.

Branch Basics: plant and mineral based, fragrance free, biodegradable cleaning products.

The Research

  1. Diamanti-Kandarakis E, Bourguignon J-P, Giudice LC, et al. Endocrine-disrupting chemicals: An Endocrine Society scientific statement. Endocrine Reviews. 2009;30(4):293-342.
  2. Bergman A, hinder JJ, Jobling S, Kidd KA, Zoeller RT, eds. Global assessment of state-of-the-science for endocrine disruptors. 2012; Available at http://www.who.int/ipcs/publications/new_issues/endocrine_disruptors/en
  3. https://cerch.berkeley.edu/publications/directory-publications
  4. https://med.nyu.edu/faculty/leonardo-trasande

Resources

  1. https://www.ewg.org
  2. https://www.ewg.org/skindeep/
  3. Sicker, Fatter, Poorer: The urgent threat of hormone-disrupting chemicals to our health and future…and what we can do about it. By Leonardo Trasande, MD, MPP

Why Everyone Should Get to Know Their Pelvic Floor

There is a common misconception that the pelvic floor is only relevant for women who have had kids. I’m here to tell you this is bonkers. Sure, having a child tends to lend to more obvious pelvic floor dysfunction, but there are many signs of impairment that aren’t recognized as coming from the pelvic floor. Also, why has it been deemed acceptable to completely neglect a part of the body until a baby is shoved out of it or cancer shows up in the prostate? We wouldn’t ignore a person’s right leg until it needed amputation right? And yes, males have pelvic floors too! There is definitely more talk about the pelvic floor within the perinatal population which is progress, but male pelvic health continues to be taboo leaving most men to suffer quietly not knowing there is any other option. I can’t bring up quiet suffering without also acknowledging the fact that those who don’t identify with the genitalia they were born with and those who have experienced physical and/or emotional abuse or trauma are even more likely to be silent. This can come from not knowing there is something that can be done, feeling uncomfortable or too ashamed to bring it up and/or not trusting that a medical professional will listen and actually hear them which is unfortunately a valid concern. Each one of these barriers to pelvic floor health can, should and will be a blog post of their own but my main purpose here is to just convince you that it’s time you introduced yourself to your pelvic floor if you haven’t already.

Why is the pelvic floor important?

The pelvic floor is a group of muscles that are responsible for poop and pee control, all sexual functions, lymphatic drainage, support of the organs that lie above it and stability of the spine, hips and pelvis. Do I need to say more? All of these functions are absolutely essential to our ability to be functional and happy people in the world.

Even further, the pelvic floor is our emotional holding place and our energetic center. Did I lose you with that one? I never thought these words would be a part of my western-based practice either but when you specialize in the pelvic floor they have to be. Again, I’ll save most of my words and RESEARCH to back it up for another blog but for now, just think about how the root chakra has been a part of many ancient practices that still hold true and effective in today’s modern world.

What are signs and symptoms of pelvic floor dysfunction?

The most obvious signs of dysfunction include: peeing yourself, pooping yourself, erectile dysfunction, pain with penetration, feeling like your organs are falling out of your vagina and/or butthole, and inability to sit because of tailbone pain.

The not so obvious signs include: peeing too frequently, always feeling like you have to pee, having to rush to the bathroom, difficulty initiating voiding, non-continuous urine stream, post-pee dribble, not feeling like you empty poop or pee all the way, waking up at night to pee, feeling like you have a urinary tract infection when you don’t, interstitial cystitis, overactive bladder, not being able to hold a fart in, not being able to discern whether its a fart or poop that is waiting to come out, having to bear down to get poop or pee out, pooping taking longer than 10 min, not pooping everyday, clinically diagnosed constipation, constipation-diarrhea yo-yo, irritable bowel syndrome, hemorrhoids, premature orgasm, inability to orgasm, decreased natural lubrication, decreased libido, enlarged prostate, fibroids, cysts, endometriosis, the feeling of pressure or heaviness, peeing/pooping/farting a little when you laugh/cough/sneeze/run/jump, poop getting stuck in a pocket, having to splint to poop (if you have to do this you will know what I mean), pain with pooping or peeing, painful menstrual cycles, perineal, testicular, scrotal, sacroiliac and pubic pain. Whew! Anyone else winded from that?

And the signs that you wouldn’t guess had anything to do with the pelvic floor include: abdominal pain, hernias, diastasis recti (abdominal separation), hypersensitive nervous system, PTSD, piriformis syndrome, sciatica, groin pain, hip pain, low back pain and get this…even knee, neck and shoulder pain! How can this be? It’s because the pelvic floor is the bottom of our core which stabilizes the spine. Without spinal stability, nothing works right. You can read more about this in my previous blog post, “Spinal Stability”.

What can be done to improve pelvic floor dysfunction?

SOOOOOO MUCH! As I mentioned right off the back, the pelvic floor is a series of muscles. As with all muscles of the body, their strength can be improved leading to more functional capacity and decreased symptoms. Sometimes this has to start with learning how to relax the pelvic floor (again, needs to be another blog…I have created quite the list for myself), sometimes it has to begin with posture and breath, and other times its pressure management, loading the system and introducing impact. It never ever ever ever, is just kegels. I will save that soap box for another day.

When the dysfunction is beyond what can be fixed through muscle strength, there are many surgeries to fix any ligamentous or tissue damage. This is the equivalent of when leg strengthening isn’t enough to return to soccer without an intact ACL. The surgery replaces the ACL but then rehabilitation after the surgery is a must. Same goes with any pelvic floor surgery (having a kid counts as such). The post-op rehabilitation is absolutely imperative to gaining proper function afterwards. Scar tissue doesn’t magically disappear and muscle strength doesn’t miraculously pop back.

Who can you talk to about your pelvic floor?

I encourage everyone to start using the words poop, pee, vagina, penis and sex in their day to day conversations. I think part of the problem here is that we aren’t comfortable saying or hearing, let alone discussing these things with anyone, especially doctors.

If you are experiencing any of the above signs or symptoms, don’t sit and wait for your doctor to bring up the topic. While it should be part of their routine screen, it’s often forgotten or breezed over. If your doctor asks you the questions, feel comfortable answering them honestly. It does nothing for you to lie and say no just because it’s an uncomfortable conversation. It doesn’t have to be!

When you do bring it up or answer honestly, don’t be surprised if your doctor goes straight to prescribing a medication or giving you a urologist or gynecologist referral. This is when you need to be your own advocate and ask for a pelvic physical therapy referral first. Pelvic physical therapy is a relatively new thing in America so it still isn’t the go to for most doctors. Heck, we are still trying to get some doctors to refer to physical therapy for back pain. It will definitely be some time before doctors routinely refer to PT for incontinence. So ask for it yourself. You wouldn’t sign up for a back surgery before trying to strengthen your core first nor would you choose to be addicted to narcotics for pain before trying to improve your musculoskeletal impairments. Same goes for the pelvic floor. Address the muscles first before signing up for bladder surgery or viagra.

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The Pillars of Health

Most of us want to be healthy or know we should be. But what is health and how is it measured? When do we know that we have achieved it and how can we achieve something that we haven’t yet defined? We can’t. My aim is to briefly outline what I would consider the pillars of health. I am going to keep it simple here. In future posts, I will dive into each one of these pillars and their components with research to back it all up but I want to start with an overview of the big picture, of what it means to be healthy and what our bodies need in order to function at an optimal level for as long as we are on this earth.

HAPPINESS

Happiness: another vague term just like “health”. I always hate it when people define something with yet another word that needs a definition, but here I am doing it. I use the word “happiness” because there is a lot that goes into our mental well-being and it’s the best we have when it comes to summing it all up. Our mental state is foundational to our health. Feelings and thoughts drive our actions and results. Negative emotions are also absorbed in the physical body and manifest disease. For these reasons, I would argue that nothing matters more to our health than our level of happiness. It over-rides everything else we do or don’t do for our body.

So what is happiness? It’s the state of being happy, obviously. Ha! Sorry, couldn’t resist that one. In all seriousness, I believe there are many components to achieving the state of happiness. In my opinion, this includes proper stress management, permission to feel with a high level of emotional intelligence, positive self talk, unconditional self love, the feeling of purpose, deep social connection and support. Easy peasy right? Absolutely not. I don’t think we put enough time and effort into improving these areas. Nor do I think people realize how essential they are to our physical health. I could write a novel on each of these components and I eventually will but for now I am going to leave it at this: you can’t be physically healthy unless you are happy. Period.

FOOD

Food: a simple but not so simple thing. Everyone knows you are what you eat but there isn’t a lot of agreement on what that should be. Sure, we can all agree sugar intake should be limited but what about natural sweeteners? what about artificial ones? how much sugar is too much? and are carbs considered a sugar? The same confusion exists when considering meat, dairy, alcohol and carbohydrates. I have even witnessed debate around which vegetables and fruits are quote-on-quote “good or bad” for you.

Again, I could spend my whole life writing about food and I will write more in future posts but for now, I just want to highlight what I consider to be the most important principles to follow when it comes to what you eat. I think Michael Pollan sums it up nicely when he says “eat food, not too much, mostly plants”.

  1. Avoid processed food (this includes sugar, all-purpose flour, food with long shelf lives and most foods that have more than five ingredients especially containing ones you can’t pronounce)
  2. Limit alcohol
  3. Mostly vegetables (especially green ones)
  4. Include healthy fats (nuts, avocado, chia seeds, extra virgin olive oil, coconut)

EXERCISE

Exercise: finally one that is easy to define but not necessarily easy to consistently do. When it comes to what type, how much and how often, I would say that variety and consistency are key. It’s important to have both a strength and endurance component to your exercise as well as a form of recovery like stretching, yoga, hot tubs or bodywork. From there, it depends on what your goals are and what you enjoy doing. I think exercise is most effective when it is functional aka it looks a lot like what you want to accomplish in your day to day. But nothing is effective when it’s not consistent so it’s important that you choose forms of exercise that are enjoyable so you are motivated to do it and keep doing it.

SLEEP

Sleep: something so simple and yet so difficult. There are two components to sleep: quality and quantity. In order to attain the restful sleep that our body needs, you have to have both. There are many reasons that sleep can be disrupted (which I will write about in the future) but sleep also tends to be something we don’t prioritize. Often we feel there is too much to do and no time to sleep. Or we develop habits that we think are necessary to get everything done that interrupt our ability to get deep sleep like loading up on caffeine or working on the computer late into the night. The reality is that we would be far more effective in our day and feel better if our priority was sleep. Try sleeping 8 hours every night for one week. You will be amazed at how much of a game-changer sleep is.

ENVIRONMENT

The environment: the often forgotten and oh so covert component to health. I’m still wrapping my head around all of the things in our environment that we can’t see or aren’t aware of that have a profound impact on our physical health. Infections and parasites are the most obvious ones but then there are heavy metals, pesticides and plastics that we can’t see but are in our water, on our food and in most of the products that we use. It’s a scary rabbit hole to go down which is why I avoided for as long as I could but there are small changes you can make that go a long way like removing plastics from your kitchen, replacing your make-up and skin care products with ones that don’t contain metals or hormone disruptors and using cleaning supplies that are made from natural products instead of chemicals. Once again, there is a lot to talk about here and I will write more in future posts but for now, just start looking at what you use in your house and on your body. Items or products that you use everyday are worth replacing even if you only just opened the bottle. Your body will thank you.

Want to see the research?

I have none for this one but as I address each pillar in future posts, I will be sure to provide the evidence for everything I say or I will make it clear that it is my opinion 🙂

Are you interested in a specific pillar? Let me know which one you want me to dive deeper into by emailing me here.

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