[Samantha] Oh, hey, mama. You're listening to episode 11 of She's Not Selfish. Today's episode is an interview that I did with Katie Rush. Katie is a pelvic floor physical therapist and the owner of The Perfect Pelvis. That is not in reference to her own pelvis, although I'm sure it is quite perfect. It's in reference to her practice, which is called The Perfect Pelvis. Katie spends her days helping women perfect their pelvises.
Now, if you're new to pelvic floor physical therapy or you're thinking to yourself, "What the heck is my pelvis? Hey, no worries. I got you covered. We're going to get into all that in the interview. And I want to let you know that this is actually the very first interview that I ever recorded for this podcast. So there may have been a hiccup. Because, you know, technology definitely not user error. But the very tail end of the interview got cut off, which is so disappointing. However, the main meat of the content is all there, it's just the transition at the end isn't going to be quite as fluid as it normally is.
And now that you're aware that I am not yet a pro podcaster, I want to share with you that we live in a very exciting time because pelvic floor physical therapy is becoming increasingly normalized. such that, if women are experiencing symptoms, they're being encouraged and told, "Hey, you don't have to live with this." Whereas previously it was just assumed like, "Hey, this is just a normal part of life now." Now we're challenging that assumption and saying, no, it doesn't have to be this way. There's someone who could help. They're called a pelvic floor physical therapist. Go see one.
And that is such an exciting and important transition for women in general. And then, of course, women who have been pregnant and given birth. Especially if there were complications during birth or if a woman has been pregnant multiple times. Pelvic floor health is really important. And the pelvic floor goes through a lot during those processes. So for us to be able to say, "Hey, this is a big deal. You may be experiencing symptoms now, and it doesn't have to be that way." It's pretty incredible. So what Katie does is so valuable and so important for us as women. Which is one of the reasons why I am so excited to be sharing this interview.
Katie, I'm so excited that you took the time to have this conversation today about pelvic floor health. Actually, you were my first experience with a pelvic floor physical therapist, which is kind of cool. When I first saw you, I was dealing with diastasis rectus abdominis, and you were able to help me out with that. So I appreciated you then, and I appreciate you now. Thanks for coming on the show, Katie.
[Katie] No problem. Glad to be here.
[Samantha] So, Katie, a lot of times when we think about our health and our fitness, there are certain things that come to mind around that, and very rarely are we immediately thinking about our pelvic floor health as being part of that. Yet, you and I know that that's such an important piece of our overall health. For the women who are listening right now, who maybe don't have a lot of context to know that right off the bat, can you give them some understanding as to why pelvic floor health is important to our overall health and why it's important for us to be having conversations like these?
[Katie] The pelvic floor muscles are actually part of our inner core. So we think of our core muscles, you think about your glutes, you think about your abs, and they are certainly very important muscle groups. But the inner core is, I would make the argument, even more important. Because this is how we get our stability.
So those pelvic floor muscles, help support all of our inner organs they keep us dry, they give you the stability that you need to walk, to lift your children, to do whatever it is that you need to do throughout the day. And if they're not functioning correctly and they're not activating when they need to, if they're not coordinated with your other muscle groups, you're going to end up with pain. So that may end up with low back pain. And you may go to the doctor and you try to address that and maybe it gets better, or maybe it doesn't. But if they haven't addressed the actual issue, which in this particular case would be the pelvic floor health, how it's not going to have lasting results.
[Samantha] That's such an interesting piece of the puzzle that you bring up. And I only started hearing about pelvic floor physical therapy once I started to earn my certifications in prenatal and postpartum fitness. I never had a doctor or a midwife talking to me about pelvic floor physical therapy. I'm sure that there's a lot of other women who go through that same experience, where they just don't really know what it's all about, or that it's an option until it becomes a really necessary form of treatment.
So, Katie, how can people understand when it's necessary to seek a pelvic floor physical therapist's help? I mean, from my perspective, I'm like, "Every woman who's ever had a baby should go see a pelvic floor physical therapist." And I'm interested to hear what your perspective on that is.
[Katie] Well, I kind of agree with you. I think all of us need to have at least some basic screens done. Some particular symptoms that will occur that give a really good indication that you're having a pelvic floor issue. So if you're having issues with incontinence of any sort, then that's an indication your pelvic floor muscles may not be working the way they should. If you're having low back pain, that's another indication. If you're having issues with the diastasis recti, that's an indication that that inner core group of muscles may not be working the way they should. Also, if you're having issues with constipation, pelvic floor muscle dysfunction can cause that. Pain with intercourse is another big one. I see people that come in that maybe they don't participate in penetrative intercourse, but trying to use a tampon is uncomfortable, the tampon won't stay in. Maybe they have a feeling of heaviness in their pelvic floor region. All of those are indications that the pelvic floor muscles are not working correctly.
[Samantha] So Katie, for those different items that you're talking about and listing off, there can be a lot of secrecy and shame attached to some of that stuff where it's like uncomfortable to talk about, and a lot of times, I find that we can talk ourselves out of seeking help because it's just uncomfortable.
So what type of advice or thoughts do you have on stepping up and being willing to seek help when it's needed, as opposed to the natural tendency to just bury it? Because, as I said, it's uncomfortable. You know what I mean?
[Katie] I do know what you mean. And I think that we're starting to see a shift that people are being less uncomfortable about it because it's being talked about more, which I think is awesome. But yeah, you're right. There are still people that feel a lot of shame with that because they have this perception that they're the only ones that are dealing with this. Or that they're way too young to be dealing with this issue. You know this is, maybe leakage is something that happens when you're 80, and I'm 25. And so why is this a problem for me? There must be something wrong with me, personally. And I'm the only one that ever deals with this at this age.
So I think it's really important just to realize that this is something that's super common. I mean, as you get older, it does become more common. But on average, fifty percent of women will deal with this at some point in their life. That's a huge number of people. The likelihood that your friends are dealing with this, or somebody you know, or somebody you work with is dealing with this is pretty high. If you just ignore it, as some people have done, it just doesn't go away. If you don't address it, you're just going to be dealing with it longer.
[Samantha] Those are great points, Katie. As you're speaking through that, I'm remembering back to my pregnancies. When I was pregnant with my first son, I exercised throughout that whole pregnancy and I felt so great and I felt so strong. And I was loving living that fit pregnancy life. And at that time, I didn't know about pelvic floor physical therapy. I didn't really understand that the pelvic floor is part of the deep core system, as you were discussing, right out of the gate as we started. But in my perception, I was like, "I'm really fit. I am young. I am exercising. Certainly, my pelvic floor is fine. And yeah, the pelvic floor goes through a lot in pregnancy. I get it. But my pelvic floor is perfectly strong. I'm sure it's functioning well. I don't really need to pay any attention."
And then that kind of switched during my second pregnancy, because all of a sudden, even though I was exercising a lot, I started to notice different issues like what you were talking about, incontinence, diastasis rectus abdominis, starting very early in my pregnancy and sticking around for a very long time after that pregnancy.
So what I'm curious about is for the women who think to themselves, "I have a really strong pelvic floor. I'm really fit. This is not an issue for me." What are some things that women like us still need to be aware of and thinking about when it comes to our pelvic floor health?
[Katie] The reality is there are some people that don't have pelvic floor issues. And if you're one of those people, that's awesome. So how do you maintain that pelvic floor health, maybe throughout pregnancy or just throughout life in general? It's interesting to consider a few different situations. One is how you move throughout the day. We tend to think, "Okay, I just need to do Kegels, and that's going to take care of the problem. But the reality is if your sitting in bad postures throughout the day, or maybe just sitting a lot of the day, and not moving around as much, or maybe wear heels a lot, all of those things can affect the position that the public your muscles are in and that ultimately will affect how well they function.
So I think it's important to make sure that you're keeping some good mobility throughout your pelvis, which may mean arching your back throughout the day. It may just mean walking throughout the day. It may mean getting rid of those heels. You can wear them occasionally, but if you wear them on a regular basis, that can definitely cause some issues within the pelvis.
The other thing I would recommend is just to make sure that those muscles are functioning as well as you think they are. I've had several people that come into the clinic and they're like, "Oh, I'm dry. So, you know, I'm sure I'm good." And they come in for other reasons. And when we check the muscles, they just aren't working at all. People are dry for other reasons, but those muscles just aren't firing. They haven't noticed the issue yet, but maybe down the road, they'll start to notice it.
So what we recommend is that you have the full ability to both contract that pelvic floor and relax that pelvic floor. And if you feel like you can do both of those things, like you can pull it all the way up and you can relax it all the way, just where going the bathroom is just no problem and easy, then you just maintain that occasionally throughout the week.
[Samantha] Okay. So that's an ongoing practice that we can just be conscious of so that we can maintain optimal health for our pelvic floor if we have it. That's good to know. One thing I'm remembering right now, Katie, is when I first saw you, you did the exam of my pelvic floor and you were like, "Samantha, your contraction is right on, very strong, good to go. But you can not relax your pelvic floor." And I was like, "Well, I thought that the contraction was the most important thing." And when we hear about pelvic floor health, usually our brains immediately go to Kegels. So it's definitely different for some people to hear that and think through, "Oh, no. My pelvic floor should be going through a full range of motion in the same way that other muscles in my body go through full ranges of motion." So I think that's really a helpful perspective. Katie, that you shared with us.
I'm wondering when you are talking with your patients about how to accomplish that. So let's talk about someone who maybe feels like their pelvic floor is kind of abstract and understanding how to contract is or how to relax it is like kind of challenging. Could you maybe walk us through some simple like visual cues or ideas that you give your patients to help them accomplish that?
[Katie] First of all, to get that, it's important to know where the pelvic floor muscles are in your body. They actually attach to your tailbone and then they come all the way around to the front of your pelvis on your pubic bone. And so when you're contracting those muscles, you may feel a contraction at any point, or at all of those points.
So every once in a while, I have somebody and we're doing a pelvic floor contraction and they're like, "I feel that more around in my butt region." And that's okay, because those muscles are back there, too. So I think, first of all, it's important to know where you might feel a contraction. Some other cues I give people, as far as contracting the muscles, one of my favorite ones is just to imagine that you're on an elevator with a really cute guy who's not your boyfriend or your husband, and you have to fart really bad. So what would you do to stop farting? And so what I have people do, just contract right then. And generally, you can get a pretty good pelvic floor muscle contraction.
[Samantha] I definitely remember that one from our session.
[Katie] Yeah, that's one of my favorites. Now, some people don't fully get that one. And so we work on imagining picking up a blueberry with your vagina. So the sensation is you kind of draw all those muscles up and in to get that good contraction. So that's another one.
Now, as far as relaxation goes, the actual movement is what we call in therapy, we call it bulging those pelvic floor muscles. So it's kind of a gentle pushing out as if you're, the same general movement as if you were pushing out a baby or if you're having a bowel movement, you just certainly are not forcing anything out, it's just a gentle push.
[Samantha] Okay. Those are helpful. Thank you for that. So, Katie, your practice, The Perfect Pelvis is really geared toward helping women solve any issues that they're experiencing that's affecting their daily lives when it comes to pelvic floor function. Can you talk to us a little bit, Katie, about your path to pelvic floor physical therapy? Because I know that for those of us who work anywhere in women's health, it's usually because there's a story there. And because we're passionate about impacting women's lives. So I'd love to hear more about your journey to pelvic floor physical health if you're willing to share it with us.
[Katie] Well sure. So the actual way I got into it was maybe not quite as dramatic. I was chosen. The hospital I was at had started a pelvic floor program. At this point in time, this was a completely new type of treatment. It just simply didn't exist when I was in school. I had no idea that this was something that was even done. So they started the program. They had two other therapists. They bought all the equipment, they did all the advertising. They had things going. And then both therapist left. One had some massive medical issues of her own that she was dealing with, and the other one moved out of state for her husband's job.
So my boss just looked around the room and said, "Katie, you're going to go get trained for this." I'm like, "Awesome." So at the time, I had no children yet of my own. And when you do the training, anything that you have done to you in physical therapy, we've had done to us in training in a room of 40 other women. Sometimes men, and no curtains, no nothing. You know, you really have to get over modesty issues pretty quickly here.
[Samantha] That sounds like a character expanding experience.
[Katie] Yeah, definitely so. Once I got into it and I got to see how much we were missing in traditional therapy because we weren't addressing these issues. And, you know, especially in regards to back pain, because I'd had so many patients over the years that, you know, you're better. I mean, therapy was helping, but it wasn't completely getting rid of it. And it was a big eye-opening moment to realize, oh, it's because we have not been taking care of this part of the issue as well.
Then I would have people that came in that had been dealing with issues for on average, I mean, at that time, now the average is about eight years. People then dealt with it before they came to see me. But at that time, I mean, nobody had ever addressed it. I mean, people have been dealing with things for 20 years, 30 years, 40 years, and they'd come in and they're like, "I've been leaking all my life." And to go through a few treatments and then to not be leaking anymore or to be able to have a normal intimacy with their spouse was just life-changing for these people. And I just kind of became addicted at that point.
[Samantha] That's incredible. I can see how that would be addictive. I mean, the work that you do, Katie, is definitely special and important work. I'm so pleased that we have you in our community doing that because we need more of that for sure. So I'm curious, Katie, when people are thinking about pursuing working with the pelvic floor physical therapists, what do you think are some of the important questions they should be asking or attributes they should be seeking? Because like we've been talking about, this is a very personal thing and it can be uncomfortable to think about working with a pelvic floor physical therapist. So what can we do on the front end to ensure that we're going to end up with someone who's a great fit for us?
[Katie] The first thing you need to recognize is that this goes for any medical professional, needs to be able to take the time and really listen to you. If you're feeling rushed, if you're not able to really tell your story, they're not going to be effective in treating you because they don't know what specific issues you're dealing with. So I think that's probably the number one attribute you can look for.
Then when it comes to training, you want somebody that has had the training with the issues that you're specifically working with. For instance, the way they set up training and a lot of our courses that we go to, they have one course on incontinence and prolapse and then they'll have another course on pelvic pain and then they'll have other courses on pregnancy issues. And so you want to make sure that if you're dealing with pelvic pain, that you're going to somebody who's had the training specifically for pelvic pain. They aren't just winging it.
Then, as far as the other things that you're wanting to look for, you want to make sure that somebody is also very aware of their own personal limitations. Especially if you're dealing with a chronic issue. Many times you need a whole team of people working to help get the best benefit. So you need a good physician that you're working with. You need a good, in some cases, we need good counselors to work with. Sometimes we need massage therapists. You want to be working with somebody who's willing to refer you to the right person to help really get you that team benefit.
[Samantha] I like that one. I haven't really considered that before. But that is so valuable that they have a network to tap into and that they're willing to use that network for you. So, Katie, I'm curious what you would say to the woman who is dealing with some of these symptoms, who maybe feels like it's not that big of a deal. Whether she's dealing with incontinence or maybe she has some slight back pain occasionally that's perhaps related to pelvic floor function and she's just feeling like it's not that big of a deal. I'm just gonna, like, kick the can down the road or not address this because maybe she feels like it's too much money or it's selfish for her to invest the time and focus on fixing those issues. What would you say to her?
[Katie] Well, first of all, I would want to acknowledge the fact that especially as moms, we have so much on our plate and it is hard to take time to do those things for ourselves. But the fact that it isn't very bad is the best time to address it because, at that point in time, it doesn't take that much work to get it back to where you need it to go. I mean, maybe it would be a matter of two or three visits or maybe even up to four visits of PT, work on some scar tissue, maybe learn some new exercises. Maybe you end up spending five minutes a day on your exercises, which is generally very doable for most people. And you're good to go and then you don't have the issues down the road.
Whereas if you wait and now the kids have gotten bigger and now you're leaking where you really need a pad every day, or as you continue to wait, you get a little bit older, you go through menopause and those tissues lose their fluffiness because of decreased estrogen. And then you're really leaking a lot and you're looking at depends. It can become a much bigger deal. In fact, one of the biggest reasons people end up being admitted to a nursing home is because of urinary incontinence. And so if you can address it when it's not a big deal when you're younger, that's the best time to get it taken care of. So it does not become that big huge deal when you get older.
[Samantha] Yes. That's so good, Katie. And then how about the woman who's feeling ashamed of what she is experiencing? So like we talked about earlier, there can be shame attached to incontinence and pain during intercourse. These things are not comfortable to talk about. But for that woman who is feeling shame over those symptoms, and that is preventing her from seeking treatment. What would you want to say to her? What would you want her to know?
[Katie] Well, I want her to know that it really isn't anything to be ashamed about. This is just muscles that we're talking about. So like, if it was an issue with your shoulder, an issue with your leg, or issue with your back, I mean, most people would seek help and wouldn't feel ashamed. "Oh, my back hurts." I mean, you don't hear anybody being embarrassed that their back hurts.
[Samantha] Yeah, absolutely.
[Katie] It's the same thing. It's just in a slightly different part of our body that has a different function. And I mean, why wouldn't you want to get help for that? I mean, if you look for the right practitioners, then you're going to feel comfortable. Maybe you won't feel comfortable right off the bat when it's completely new to try to figure out what's going on. But you will feel comfortable with those people if you're in the right place.
[Samantha] Yes. So, Katie, can you give us a little context, for those of us who've never seen a pelvic floor physical therapist before, I think it might be helpful to break down just quickly what to expect during an appointment, or what sort of things are done in order to assess a pelvic floor. So could you walk us through that just a little bit?
[Katie] The first visit, a lot of talking is done because we need to get a really good feel for when issues started. What other issues you're having, how it's impacting your life. Because these are the things that help give us specific goals that we need to work on in therapy. And once we understand that, we'll do an assessment and we don't just assess the pelvic floor, we look at the back, we look at the hips, we look at how well those are moving. We also are looking at how well you're breathing and if your abdominals are functioning. So we're checking all of those things.
But I know the part that most people are worried about is exactly how do you check my pelvic floor? What we do is we use our finger, we go vaginally. For some people, we end up going rectally if there's more rectal issues, and we're feeling specifically for areas of pain or tightness. We need a lot of feedback from you as a patient. Be like, "Oh, yeah, that's painful, so don't go there." We're also checking to see, a lot of women have scar tissue from episiotomies, for C-sections. So we're checking all that area out and making sure that those are moving as they should.
Then once we have done that, then we check for strength, so we may have you squeeze around our finger just like you're doing a kegel, or you're trying to stop the flow of urine. Which we actually measure on a scale of zero to five, how strong those muscles are. We may have you push out, at which point we can tell how well those muscles are relaxing. We can also be checking to see if you have any sort of a prolapse, which is, in many cases it's a bladder, but it can also be uterus, or it can be rectum that's actually coming into the vaginal canal, just pushing on those muscles to the point where they cause some bulging.
[Samantha] Katie, you briefly mentioned scar tissue as it's related to episiotomies, C-sections. Can you talk a little bit about the impact of scar tissue when it comes to how well our deep core system is able to function?
[Katie] I think it's one of the most overlooked things ever. I don't even know why it's so overlooked. It's just such a huge deal. I work on this with probably 80 to 90 percent of my patients. So the scar tissue, if it's adherent, now I'm going to qualify this a little bit that you can have scar tissue in your system and it really doesn't cause any problem at all. It could be moving, does its thing and it's fine. And that's good. That's what we want. But a lot of the women that I see that are having pelvic floor issues, that scar tissue is somehow adherent or it's stuck for lack of a better word. If it's stuck on a particular muscle group, then those muscles just can't function like they're supposed to. So it may keep them really tight so they can't tighten any more than what they already are. They can't relax and that can lead to leakage.
It can also lead to a lot of pain. You think, "Okay, I had a C-section. I don't have any issues with my pelvic floor because I had a C-section and that's going to prevent it." But the thing is, those C-sections, though, they don't cut through abdominal muscle. They do cut through connective tissue. And that connective tissue attaches to your pelvic floor muscles. If it gets tight, then it's going to be causing a constant pull on your pelvic floor muscles that will keep them tight. And a lot of cases that lead to painful intercourse.
[Samantha] So it's all tied in. It's all connected. I think that's so fascinating. A lot of the women I work with actually have had C-sections, and oftentimes multiple C-sections. One of the conversations we always get to is seeing a pelvic floor physical therapist to learn how to mobilize that scar tissue because of what you're talking about, adhesions and the way that impacts the way the muscles are behaving.
It's really interesting to think about our body as this coherent system and the deep core system, as a coherent system, not just the abdominal wall or just the pelvic floor. Right. So continuing on that thought, on that track. Can we talk a little bit about the role that the pelvic floor plays in diastasis rectus abdominis? Because a lot of times we think of that as an abdominal wall issue. But certainly, the pelvic floor is playing a really important role. Right. So can you clarify that a little bit for us?
[Katie] Right. So the pelvic floor attaches to abdominal muscles via connective tissue. So if you have issues in either one of those systems, it's going to impact the other. For instance, suppose we have diastasis recti and you've got that gap. So the pelvic floor muscles should have something that's good and solid. Meaning your abdominal muscles to pull against when they're contracting. But if they don't have that good, solid base from your abdominal muscles, then they're trying to contract more than they normally would in order to keep you dry. And in some cases, that means they just can't keep you dry because they can't contract enough to make up the difference. So that's probably the most common one that I see.
[Katie] But you can also have issues if those pelvic floor muscles are really tight and somebody who's been trying to correct a diastasis recti and they just can't. They've been doing the exercises and it's just not working. Then a lot of cases, the pelvic floor muscles, or the C-section scar, or some other scar tissue is really, really tight, and it's actually preventing those muscles from closing as they should.
[Samantha] That makes a lot of sense. Thanks for walking us through that. Like I said, so many times, we get caught up on the abdominal muscles alone and not thinking about the way that the pelvic floor plays a role in that. So certainly if we're trying to do anything when it comes to healing diastasis or changing the appearance of the abdominal wall after pregnancy, which is something that a lot of women are interested in doing. They want their tummies to look the way they used to, we can't neglect the pelvic floor in that, can we? It's an important piece. So I'm curious, Katie, as to the, I guess, are there any consistent aha moments that you see from your patients when they're working with you? Specifically, let's talk about postpartum women if they're coming to you to resolve low back pain or incontinence or whatever it is when you start working with them. Are there these light bulb moments that you often see from your patients?
[Katie] I often that light bulb moment when I've been working with somebody whose pelvic floor muscle is too tight. If that muscle is just too tight, then they don't feel that contraction like they should. I asked a kegel and maybe they do a little bit of a kegel, but they're like, "I'm not sure if I'm doing it right. I can't really feel it." And then we get that muscle really released. So we've got that full range of motion of the muscle and then they tighten everything up and they can feel it. And so that's always a big, "Oh, that's what that's supposed to feel like. I Got it."
Then also we get that same light bulb moment when somebody has been dealing with a lot of weaknesses. If I can actually put my finger on the muscle and say it's here, this is the muscle. Because there are a lot of people that think that they're doing a pelvic floor muscle contraction, but they're actually using abdominal muscles or they're using glutes. so they're using other hip muscles. And so when I actually have my finger, "I'm like, no, this one, use this muscle." And that's another light bulb moment for a lot of people. They are like, "Oh, Okay. Now I get it."
[Samantha] Yeah, totally. I kind of experienced that light bulb moment when you were like, "You're not relaxing your pelvic floor." And I was like, "Yes, I am. What do you mean?" So, Katie, it's pretty straightforward, I think when we think about how to strengthen a muscle. Obviously we exercise that muscle and improve its strength over time. But when it comes to helping a muscle relax, that's a little bit harder to understand. So do you use exercises to help the pelvic floor muscles relax? Are you just using cues, like visualization cues? Are you using tools to help it relax? What does that look like?
[Katie] So I do all of those things, and it depends on the particular situation what each person needs. But the unique part of the pelvic floor muscle is that when it contracts, it doesn't have any other muscle that pulls it back out, which makes it a little bit more complicated. So, for instance, I'm going to use your arm as an example, because that's a little bit easier. If you want to bend your arm, you use your bicep. You know, you tighten everything up. And then if you want to straighten it out, you do relax your bicep, but you also tighten your tricep to get that full range of motion. Pelvic floor doesn't have that muscle to pull it back open again. So it is a matter of just learning how to relax it, and that can be really difficult.
[Samantha] So this is the part of the show where the perfect pelvis meets with imperfect audio. And this is where our interview got cut off. So I just wanted to remind you quickly that if you are interested in connecting with Katie or learning more about what she does, learning more about pelvic floor physical therapy in general, all of her contact information, her Web site, her social media handles are in the show notes for this episode. So be sure to check that out if you're interested in connecting with Katie.
Thanks for hanging out with us today on this little tour of pelvic floor physical therapy. I'm really curious to know if you have had an experience with a pelvic floor physical therapist, or if after hearing this if maybe you are feeling motivated to take action and go see one. Leave us a review in iTunes and let us know how today's episode resonated with you. And I look forward to talking with you next time, friend. I hope you have a great week.