Episode #34: 5 common pelvic floor myths
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In this episode, Dayna shares 5 common pelvic floor myths she comes across in clinic often.
The 5 MYTHS are:
MYTH #1️⃣ That everybody should be doing kegels
MYTH #2️⃣ You should pee as soon as you feel the urge to go
MYTH #3️⃣ Your vagina will be looser following a vaginal delivery
MYTH #4️⃣ If you are having a bowel movement everyday, you are not constipated
MYTH #5️⃣ Heaviness means you have a prolapse
We hope that busting these myths helps ease some of your concerns about your pelvic floor!
Enjoy! ☕️🧘🏻♀️
Mentioned in the episode:
Sign-up for the 2 for $22 waitlist for Rhonda’s Strong at Home Membership for your chance to win a 1-hour assessment with Laura Holland!
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Episode #34: 5 common pelvic floor myths
Hey podcast friends, Rhonda here. Before we get into today's episode, I just have a quick announcement. So if you've been following me for a while, uh, you might know about my Strong at Home membership, which is my signature program to help clients get back into exercise with a plan and with support from me.
I’ll be doing another 2 for 22 trial at the end of September. So the doors for that to purchase open on September 16th and the trial itself will start on September 26th. Um, right now too I have a super cool giveaway going on with my friend Laura, @pelvicphysiobylaura on Instagram. She has offered to give away a one physiotherapy assessment to one lucky winner.
So how you're going to win that is, number one, get on the wait list for the 2 for 22 trial, which I'll put in the show notes, and also purchase that two week trial, um, at the end of the month. And if you do both of those things, you'll get entered to win that one hour assessment. So the cool thing with that is Laura and I actually work really well together.
We've helped a ton of clients. Um, she helps with the pelvic health symptoms. I help with the strengthening piece. Um, we've helped a lot of clients get back into fitness postpartum. And so a really cool way for you to see what it's like to work with both of us together. So click on that link, get your name on the wait list, and I would love to see you in a trial.
All right, let's get into today's episode.
We're excited to have you join us for this episode of Pelvic Health and Fitness. I'm Dayna Morellato, Mom, Orthopedic and Pelvic Health Physiotherapist. And I'm Rhonda Chamberlain, Mom, Orthopedic Physiotherapist and Pre Postnatal Fitness Coach. On this show, we have open and honest conversations about all phases of motherhood, including fertility, pregnancy, birth, postpartum, menopause, and everything in between.
We also provide helpful education and information on fitness, the pelvic floor, and many aspects of women's health, including physical, mental, and emotional wellness. Please remember as you listen to this podcast that this is not meant to treat or diagnose any medical conditions. Please contact your medical provider if you have specific questions or concerns.
Thanks so much for joining us. Grab a cup of coffee. Or wine. And enjoy!
Hello everybody and welcome to the pelvic health and fitness podcast. I am Dayna and I'm doing my first solo episode. Uh, and today I am going to chat to you about sort of five common pelvic floor myths that I come across almost weekly in clinic.
The first Rhonda and I have talked about, um, for some time on this podcast. And that is that everybody should be doing Kegels and that every pelvic floor needs to be strengthened. Essentially is what you're saying. Every pelvic floor should be strong and flexible. And what that means is we want this system, this core canister where the public floor resides at the bottom to be able to lift and contract for whatever the task is, but then also to be able to relax and let go.
And having this balance between strength and flexibility or the ability to relax is really important for all of the functions of the pelvic floor. Remember the pelvic floor is holding up our pelvic organs all day. Um, so our uterus, our, um, If that's applicable, bladder and bowel, it's staying contracted in order to keep in urine and stool, relaxing to let us go to the bathroom, it has a circulatory function, it has a sexual function.
If it's only ever contracted and never getting a rest, you can imagine how some of these functions might start to, um, suffer or not be working. as well if we're never giving that pelvic floor a rest. If you are somebody who is truly weak, um, and really the only way to know whether you are somebody who is truly weak or if you are somebody who has higher tension or tone in your pelvic floor is to have an assessment, um, either with a pelvic floor therapist.
I have had, um, some, you know, gynecologists and obstetricians do great exams for weakness as well. Um, That is really truly the only way is to have that internal exam to know if you are truly weak or in need of strengthening. Um, and Kegels can serve you very well there. If you are somebody who runs really high intention or tone and struggles to relax your pelvic floor.
That can be a situation where a Kegel could make any symptoms that you are experiencing worse. In general, a lot of people, I get to a place with a lot of people where we practice both phases a little, how to contract and how to relax. And then for my clients who tend to be on the higher tension and tone side, we always Um, and so we're going to try to stay in favor of those.
So maybe I have them do five or 10, a few times a week. Of the Kegels or the lifts and squeezes. Picking up a blueberry, if you will. Um, in order to make sure that we're still practicing that neural pattern and that muscle pattern, but we don't generally use it for a strength purpose. Our focus is to make sure that we're not running into that higher tension situation.
For my. And, and most, and again, so if you are someone who is weaker, I also will practice with those people relaxing the pelvic floor because that is always necessary. It's always necessary to be able to put down the load and let a muscle group relax. The second myth that I come across frequently in clinic is that you should pee as soon as you feel the urge to go pee.
Um, and sort of as a caveat of that, That practicing adjusting case P is not. potentially upsetting to like the balance of your bladder. We don't necessarily have to pee every time we feel it and holding pee for a certain amount of time isn't associated with a higher risk of urinary tract infections, bladder infections, or UTIs.
Those are sort of all synonymous terms. In general, the average person, our goal is to have them go pee sort of between every two to three, I say two to four hours on the high end, meaning that you shouldn't really have to go pee more than two every two hours in a given day with a moderate. Um, water intake so that when I tell people, do you go pee more than two hours are sort of our low end goal.
I often will have people say well I drink a lot of water, and I think a lot of water can be different for everybody. Sure, we want to. you know, that six to eight glasses of water, making sure that you're well hydrated, that should still keep you at no more frequent than going every two hours. Um, if you are sort of in that higher category, you're drinking two to three liters or up to 12 glasses of water, certainly depending on the training of your bladder, you might find yourself going a little bit more frequently.
Um, but that two hours, we generally don't want to be going any more frequently with that, obviously outside of pregnancy. And then We if you're easily going longer than three to four hours. we want to up your water intake or up your fluid intake because that is likely a sign that maybe we don't have enough fluid going into the bladder to make you have the urge to go pee.
Or for some people, certain professions it's kind of ingrained in, you've just trained yourself to go longer and longer and not really be, not really paying attention to that urge. So I give people that guideline. If you're easily, you know, going beyond three to four hours, let's try to up your water intake, or at least go pee and make sure that you take your time to fully empty your bladder at that time.
If you're barely making it to two hours, then we definitely want to maybe try to challenge that bladder a little bit. Um, maybe with some pelvic floor strengthening, or sometimes that frequency higher frequency can be associated with higher tension in the pelvic floor. So maybe you're somebody who. going to work on relaxing that pelvic floor, which I know seems counterintuitive, but you just have to trust me on that for now.
Um, and then making sure that you're fully emptying. So that's sort of a long winded way of saying we don't necessarily have to pee as soon as you feel it, as soon as you feel an urge. It depends when you're feeling or when you're clocking that urge. I like to think of the bladder as having sort of three fill lines on it.
When our bladder stretches a little bit, we get to that first fill line of urine. Most of us have had the situation where we feel an urge to have to go pee, but then we get distracted with kids or work or you're, you know, doing whatever you're doing, the dishes and 45 minutes go by and you realize, Hey, I never went pee.
Maybe you still don't really. Maybe you don't feel like you have to go anymore. Maybe you still do, but you've allowed that time to easily pass. It wasn't uncomfortable for you. So your bladder has continued to fill to sort of that middle fill line where you get more stretch of your bladder. Now your brain's tuning back in, Hey, I never went pee again, or now I really have to go.
And that's sort of that. Like I said, that average fill line where most people feel that urge, they'll find a bathroom, the brain will say, yep, that's a good amount of urine, go ahead to the bathroom and empty. If you're stuck in a meeting or stuck on the 401, When you get to that middle or average fill line, your bladder will continue to fill to sort of your bells and whistle line.
So that's a big stretch of the bladder, that's a lot of urine, that's, you know, you're bouncing in your seat, you're crossing your legs, you can't think about anything else except where the nearest toilet is. If we empty our bladder frequently at the very first urge to go pee, or sometimes before the first true urge to go pee, so this is for my just in case peers, those three fill lines can actually lower.
And so what happens is almost like a detraining or a little bit of an reduction in the bladder's ability to hold more urine. So if you are somebody who's getting to that first fill line and you're always emptying there, you're never really getting to that average fill line. And we want to be, that's a good amount.
That's your two to three hours volume. We don't necessarily want to be getting to bells and whistles every single time with that. you know, urgent pee that is a large volume. So when I say a large volume, again, at that average fill line every two to three hours when you void, a good test is sort of an eight Mississippi pee.
So from the time your stream starts to the time your stream ends, it should be one Mississippi, two Mississippi, up to eight, eight to 12 Mississippis, lets you know that that is a good volume of urine. The third common myth that I hear in clinic, and it's a big worry for postpartum women when it comes to postpartum sex, is that the vagina will be looser following a vaginal delivery.
This is not true. It can feel very true in the early stages of postpartum, certainly. Um, again, baby has obviously passed through the vaginal canal, those muscles can be a little bit weak. After carrying baby for 10 months, I don't know why we say nine, it's 10, it's 40 weeks, just here to change that for you 10 months.
Um, and then the workout that can come from pushing that baby out, not to mention if you were someone who has chosen to breastfeed, there is, um, a little bit of a reduction of estrogen, which can lead to some atrophy of the vaginal walls. Um, especially if you have a little bit more of a prolonged breastfeeding experience, that can happen, which that can lead to sort of that looser feeling.
Um, it certainly can sometimes change the. Um, shape or the length of the labias, especially initially, but ultimately the vagina is a muscular canal and with proper retraining, pelvic floor training, um, core retraining, those muscles can learn to, um, plump back up, especially, you know, if needed, not often, and needed sort of postpartum, it's sometimes, um, if there is any need for like a vaginal estrogen cream, um, to help plump those muscles up after a prolonged breastfeeding experience, then certainly that is something that can be helpful as well.
But it is not just this sort of, I had a vaginal delivery, so my vaginal canal is now looser or more open. It can be retrained. It is a muscle. It will not stay sort of in this open position necessarily until the end of time. So that was number three, number four. If you are having a bowel movement every day, you are not constipated.
This is also a myth and let me sort of just walk you through it. So people think that constipation is if you are not pooping every day. And Constipation really is sort of this yes, not going frequently, but also not fully emptying your bowels and or having to really strain to empty stool that is not sort of, you know, one cohesive piece of stool.
We've got to think about rabbit pellets or little marbles or really lumpy, um, can be painful, hard to pass stool. So all of those things are sort of under the umbrella of constipation. So I have plenty of people or clients who will say to me, well, I go every day, so I'm not constipated. But when I start to dig a little bit deeper, um, I don't use the Bristol stool chart in terms of a visualization very often, but if I give that description, oftentimes people will say, oh, you know what, I do sort of have, um, times where it is pebbles.
I certainly am straining. No, I don't. feel like it can completely empty and that is also considered constipation. So keep that in mind. Um, we want an. And, and it's different for everybody. What is considered a normal frequency is, has a little bit of, um, a range of what is considered normal. Um, I've had people who, and again, have gone to GI doctors and had this confirmed, that go every three days.
They always have, but when they go, they're able to have this nice formed soft stool come out. They're able to empty. They're not straining. Um, and they're not considered Constipated. So. I think it's really important for people who are thinking, no, I'm good. My pelvic floor, you know, I don't have any troubles with bowels related to the pelvic floor.
I'm going poop every day. So maybe have a closer look at what those stools actually look like. Constipation can be very challenging for the pelvic floor. It can actually cause a lot of, um, obviously pain. If you're not fully emptying, it can cause some heaviness and pressure into the pelvic floor. Um, Especially if you do have a rectocele or a little bit of a prolapse of the posterior wall or the rectum, it can put more pressure forward on any sort of bladder prolapse and it can actually cause urinary incontinence to be a little bit worse.
if you are not fully emptying your bowel. So again, often people will come in, I would say the most common reason that people seek out pelvic physiotherapy would be leaking or bladder urinary incontinence, whether that's with coughing or sneezing or urgency issues. Um, and we always, always chat about bowel health.
And I would say. Very commonly, eight to nine times out of 10, there is a little bit of constipation or just an incomplete emptying happening of the bowel that can create some issues for the bladder as well. Remember, it's all a system. All of those organs are sitting on top of the floor, and that floor is working with your abdominal wall and your breathing muscles, so it's all a system.
They're all on the same team and so a little bit of a kink in the chain can can cause a little bit of a ripple effect. And the last pelvic floor myth, um, that I hear quite commonly is that heaviness means prolapse. You get that pelvic heaviness into the vagina. That must mean that everything is falling out.
And this is, I would say a top three concern that people come to me following, um, births certainly, but just in general, they have heaviness in the pelvic floor. So they have prolapse and we've all heard these horror stories about what prolapse means from our grandmas and our aunts, everything's falling out.
The end is near. Um, and heaviness, just like in any other muscle group, if you were to hold your arm above your head for a really long time, your arm would start to feel pretty heavy. I imagine if you hold a stack of books out with your bicep, your elbows sort of bent with your bicep, you can start to feel that heaviness in your arm.
The pelvic floor muscles really are not any different than your bicep muscles. They contract and they relax and they can have this sort of heaviness type feeling start to build up if they are being overworked and that can happen for a variety of reasons. It can happen because the pelvic floor maybe is on the weaker side, so it's not tolerating the load of doing all of its jobs, plus being a mother and adding exercise in.
It can happen because there's a lot of tension. I would say more commonly it happens because there's a lot of tension in the pelvic floor. And so we're in this situation where that pelvic floor is having to stay clenched and tightened to compensate for all of this extra work and load of carrying a baby around during pregnancy or postpartum.
And it's it nobody's ever really talked about relaxing the public floor to before and so, um, it gets tired and that tiredness fatigue of the public floor muscles can come out as that heaviness. And certainly heaviness can be caused by a prolapse or a lowering of one or more of the pelvic organs uterus bladder or rectum, but it doesn't.
always equal. Heaviness doesn't always equal prolapse. There are sort of that, those variation of symptoms that can cause heaviness. And I would say more often than not, it comes from tension in the pelvic floor just as readily as it comes from a pelvic organ prolapse. So from the top, we chatted a little bit about how not everyone should be doing Kegels if we're sort of rewording them to make them not myths.
Um, that. You should go pee as soon as you feel it. Maybe we shouldn't be, maybe we should be challenging ourselves a little bit or more thinking about a more usual range to go pee being every two to three hours. That the vaginal canal will stay looser after babies. This is not necessarily true. It's a muscle and can be retrained.
That if you are going, to have a bowel movement or going poop every day that you are not constipated. You certainly could still be constipated if you're finding that you're not completely empty or straining to have that bowel movement and that heaviness always means prolapse. That's not true. It certainly can be true.
Um, but it can also be caused by a pelvic floor that is quite high in tension, um, with underlying weakness or just the inability to relax because being a mom is hard and you've got a lot of load on your body. So I hope you found these helpful. Um, they are sort of my most favorite things to chat about with patients and sort of reeducate what the way we've always thought about the pelvic floor and some of these symptoms.
Um, and hopefully we'll dive into a few of them a little bit more deeply on. This second season Rhonda, I guess we're calling that of the pelvic health and fitness podcast. Thanks for joining me Thanks for listening to today's podcast. We hope you enjoyed the conversation If you liked what you heard, we would love if you could share this with a friend Leave us a review or subscribe to anywhere that you listen to your podcast.
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