Episode 012: Debunking Pelvic Floor Myths
In Shake It Off Episode 12 Lauren and Kendra speak with special guest Jen Martin.
Jen is a certified cancer rehabilitation phyisotherapist with the PINC & Steel international program, and the owner of a boutique physiotherapy and wellness clinic in Tugun on the Gold Coast, Australia. Her and her team are passionate about helping clients build strength and improve mobility through personalized programs.
During this episode, Lauren, Kendra, and Jen talk about the misinformation of pelvic floor health and just how important the pelvic floor is to your overall health and tips for a healthy pelvic floor.
You can find all the podcast episodes at https://www.drlaurenhodge.com/podcast/
We created this podcast to give you the tools, strategies, and stories to handle the unexpected BS that life throws your way. We plant ourselves firmly at the gates of truth-telling and we discuss how to optimize and prioritize your physical and mental health.
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*This is not medical advice. Please get in touch with your doctor or healthcare practitioner before making any changes to your healthcare plan.*
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Kendra Till
Welcome to shake it off a podcast that gives you the tools, strategies, and stories to optimize and prioritize your physical and mental health.
Lauren Hodge
Welcome back to the Shake It Off podcast today. Kendra and I are speaking with Jen Martin about the common pelvic floor myths that are out there. Jen, thank you so much for joining us. We’re really excited to talk to you about the pelvic floor today. I feel like this is a topic that is really relevant at this age for so many people. Gravity takes its toll as you get older, and there are problems that come from that, especially related to having to urinate all the time or in different scenarios. Thank you so much for coming on today.
Kendra Till
Thanks so much, Jen. And you’re right, Lauren, pelvic health just isn’t something that people think of when they’re going through their health checklist. But obviously, pelvic floor muscles are essential for overall health to keep your bladder regulated and bowel function and sexual function. But it does seem like there’s a lot of misinformation out there regarding pelvic floor health . Essentially just want to talk about the ones that we experience and also the ones that our friends experience that we’ve talked about at the dinner table.
Jen, just to give our listeners a little bit of an overview of you. You’re a certified Cancer Rehabilitation physiotherapist with the Pink and Steel International Program, and you have an absolute wealth of experience prescribing strength and conditioning programs, and having worked in the fitness industry for over 20 years. I personally have had the pleasure of working with Jen for a number of years, and I’m just so thankful for everything that you’ve taught me along the journey and just the things that I’ve learned from you and your expertise. Jen also has a boutique physiotherapy and wellness clinic in Sheboygan on the Gold Coast in Australia, and she and her team are really passionate about helping clients build their strength and essentially improve their mobility through personalized programs. So Jen, thanks again for being here, we’re just so excited for you to share your knowledge and expertise in this area. So we’re going to kick off their first question, and ask are pelvic floor issues only for women?
Jen Martin
Thank you Kendra and Lauren for having me on your podcast. No, everybody has a pelvic floor, males and females like any other muscle group that we have in our body. But just to give you a bit of background, your pelvic floor muscles are a group of muscles that form a small sling or a hammock from your pubic bone in the front to your tailbone at the back. And their role is to hold in or support the organs of your pelvis which is like your bladder, your bow your uterus or in males, the circumstances of the prostate to empty waste, such as feces and urine, and to maintain your core strength, and that sort of protects your spine and keeps your abdominals strong. And the muscles, the nerves that innervate your abdominal muscles also innovate your pelvic floor.
So in males, males can have issues with their pelvic floor, it’s generally as they get a little bit older, and they will start to develop an enlargement of the prostate, not all men, but generally, most men will develop an enlargement of their prostate, or some men will develop prostate cancer, and that will require certain treatments such as having their prostate removed or radiation for any cancer cells outside of that to capture any of those cancer cells. But it’s really important for males to know what is normal for them. Males generally feel… not self-conscious, but they generally don’t talk about their penises too much.
So it’s really important for males to know what is normal for them. So if they notice a change in their penal functions, such as even having a bending or a deformity in their penis, incontinence, which means like you’re leaking a little bit of urine, after you finish this will be dribble at the end, or any other erectile dysfunction can be a sign of pelvic floor dysfunction which requires some intervention. But most importantly, I think what’s lost on most males is that your erectile dysfunction is actually related to your heart and your cardiovascular system. There’s a saying that Craig Ellingham, who is a physio in Australia, male pelvic health physio in Australia has said multiple times that your hard health is related to your heart health. To be able to get an erection, you’re basically increasing the blood flow to your penis. So if you’re noticing any changes, even just the shape of how their penis is when it’s erect can be an indication of something going on with their heart as well. There is a window of opportunity for you to address those cardiovascular issues before they will ultimately become an issue and may cause heart disease or a heart attack or any of those sorts of things. For most males, that’s probably easier to get their heads around. It’s a heart thing, not their penis thing.
Kendra Till
Yeah.
Jen Martin
Tell them to seek advice and help. So if you have noticed that your husband or your partner is having issues with their pelvic floor, you really need to encourage them to get a heart or a cardiovascular check as soon as possible, because most of these issues can be treated, and can be resolved if they’re caught within that three year period. So there’s that good window to act and fix things.
Kendra Till
Yeah, and improve the quality of life.
Jen Martin
Yeah, absolutely. But they’re often quite embarrassed to talk about those sorts of things. Often, the first person that will know about those issues is their partner.
Kendra Till
Hmm, yeah, and like you said, that’s probably much easier for them to digest if it is something with their hearts versus directly with their penis.
Jen Martin
Exactly, and if you think about some of the medications that that men use, like Viagra, Viagra is a vasodilator, which is to increase the blood flow to your penis, which has a systemic effect on your body and increases your blood flow to all of your organs and all tissues. That’s why you can sort of see it’s interrelated. There is an interrelation, but it’s often lost on people. So yeah, it’s not something to be embarrassed about. It’s something you can fix, if you can switch it around to your partner and go, “Oh, maybe it’s something with your heart.”, they’re more likely to go and fix that and talk to someone about that.
Lauren Hodge
When you strengthen your pelvic floor in order to fix these things, like the strengthening pelvic floor supports this process, and can you strengthen it even?
Jen Martin
Absolutely, we often see patients that have been diagnosed with prostate cancer, that will have their urologist come and refer to us to strengthen the male pelvic floor before they have radiation or have a prostatectomy, and then again afterward, so at least they’ve got their background before they start, there’s a lot of information that comes and goes once they’ve had their surgeries and their treatment. So if we can teach them how to engage the pelvic floor before they’ve started, they’re sort of ahead of the game, basically.
Lauren Hodge
So is it possible to strengthen your pelvic floor? Is that a thing that we can do in men and women?
Jen Martin
Men and women, one of the little sayings I use for men is to engage your pelvic floor, you want to imagine you’re going into cold water, and you want to draw your testicles out. And most men know what that means. Straightaway, they just go “Oh!”, something that they know how to do.
Lauren Hodge
And what about some women? Because I can imagine that.
Jen Martin
Kendra would know one of the things that I often say is to imagine you are sucking a thick shake through your vagina. So it’s a lifting motion to contract, it’s not a bearing down motion, whereas I find most women especially athletic women, think of flexing their abs as bearing down and pushing and making some been hard, but it’s more of lifting and elevating and supporting your pelvis, all the organs focus, which is different when women are doing heavy things like heavy weights, CrossFit, jumping, running, and holding their breath and bearing down to contract their abdominal cavity, but that actually puts pressure on your pelvic floor basically pushes your insides out. We want to keep everything up and in.
Lauren Hodge
So can that cause… if it’s pushing everything out that’s in if you do it the improper way. Can that cause… What is the word that I’m thinking of?
Jen Martin
Prolapse?
Lauren Hodge
Yeah, yes.
Kendra Till
Incontinence
Lauren Hodge
Yes!
Jen Martin
It can cause all of the above, yes. If you think of your abdominal cavity, like your mouth, if you blow air into your mouth, and you close your mouth, your cheeks will fill up and they’ll become hard. But they’re hard because you pushed air into them, they’re not hard because you’ve contracted the muscle, you’re actually stretching that muscle. When you want to engage a pelvic floor, it’s like you want to suck up any like you want to suck a big shake up and in your actual cheek muscles should draw inwards and upwards. And that draws it back into your mouth, and in that same analogy, will draw your pelvic organs up and away from being pressed out. But most people think of bearing down and holding their breath and going up, and then feel hard on the outside, so they think that it’s actually hard, but it’s more that you’ve just pushed air into that cavity, it’s because there’s air in there.
Kendra Till
That makes sense. So if you do experience urinary leakage, for example, that is definitely a pelvic floor issue, is that correct?
Jen Martin
Generally, there are a certain number of cases where there can be a spinal cord issue or a nerve issue. But for most women, especially since they’ve had babies, most women over 35, generally as we age, will start to notice little issues, and generally nine times out of 10, it’s a pelvic floor issue.
Kendra Till
So with age is that generally with the strength of the muscles then essentially? They’re just losing that strength..?
Jen Martin
Think of your muscles like your skin, so you have collagen in your tissues, or your muscles and your skin. And the reason you have wrinkles is that you lose that collagen. So your ability for that tissue to contract or reform its shape is lessened over time. When you go through menopause, that really causes a reduction in your estrogen levels. That in itself reduces the amount of collagen you can produce, and that’s why you’ll see those general signs of aging all over your body. Women that have gone through, say breast cancer treatment and have had to minimize their estrogen levels to prevent cancer from coming back, will generally go through early menopause, and so they will experience that earlier. Everyone’s hormones are different, people have a lot of different things going on, and they’re things that you can’t generally control so much.
Kendra Till
Essentially, if you are experiencing that it probably is worth it to go and see a specialist or someone in your position that can assist with that.
Jen Martin
Absolutely, yes, yes, it is. So generally women that have had two or more babies have a 70% chance of developing some sort of urinary incontinence. But there are certain risk factors that will increase that not happening for you, where developing urinary incontinence and that is your age or the onset of menopause, the type of childbirth the delivery method that you have, so if you have a vaginal birth or have forceps during that vaginal birth, that increases your chance of having incontinence or prolapse and so does having previous pelvic surgery or ceases. So essentially they are cutting through your abdominal wall, and that is also cutting through the muscle and the nerve. So sometimes lots of times when you’ve had pelvic surgery, often women will say I can’t feel those muscles when I’m trying to activate them. I can’t feel them. But it’s often because those nerves have been cut, the muscles have been cut, and that neuromuscular connection needs to regenerate and come back for you to actually feel it.
So it’s not anything in your brain that’s wrong. It’s just that that actual physical connection is no longer there. It will come back, but it does take time and it will take about two years for your nerves to regenerate and reform into another path. But there is that period where you don’t feel like you can feel anything, but you do need to encourage blood flow to the area and try to do those exercises. So you’ve got that neural connection that your brain is telling you the nerve to innovate that muscle, and you have to keep trying to send the signal to stimulate that response. So even if you can’t feel it, yes, it will come, you’ve just got to be persistent. And sometimes it’s just the way someone explains it to you. Someone could just say, breathe out, lots of different things connect with different people. So sometimes it’s just the way that movement is explained to you that creates the connection for you to have that light bulb moment.
Lauren Hodge
Wow, I did not realize that. So you’re saying if you’ve had children, and you’re in that two-year period of time, where your neural connections are still kind of reforming, they should still try to do those exercises that you mentioned, because eventually that will switch back on, and you want to continue to encourage the blood flow to the areas to still try to do that.
Jen Martin
Absolutely, and your body around that time is in a really important and receptive growth phase. Like you’ve just made a baby, and you’re making milk and there’s a lot of things going on in your body, but you can’t really see, but it’s actually quite receptive if you just train it the right way. The worst you can do is say, oh, it’s all over, I’ve just got to accept it.
Lauren Hodge
I even know, as far as neuro-kind of plasticity goes, the time after having a child for men and women after you become a parent, is one of your biggest times for high volumes of neuroplasticity. So that’s many different parts of your brain. But then, as you’re saying, you can retrain your brain to embody it in the beginning.
Jen Martin
Your body will always find a way, you just made a baby. People just discount what’s just happened, but it takes about two years for your body to get over each birth and pregnancy. And generally, most people are wanting to have another baby by that time, and they’re generally pregnant within that two-year timeframe. So their bodies just got over that process, and then they’re pregnant again. And then there’s pressure on their pelvic floor again. So it’s essentially your uterus is going to be 40 times its size by the time you get to 40 weeks to get to full term.
So you’ve been carrying that around, it’s been stretched and it’s been loaded all of that time. And then you’ll often see people that look like they’ve just bounced back. But I’d say there’s an awful lot of photoshopping there. For most people, your body has a lot of skin, and all of your organs have to move back into another position. Everything’s been pushed out to the side and everything has to resolve and come back.
Kendra Till
Interesting.
Lauren Hodge
So if I do kegels, will I stop peeing a little bit whenever I laugh or jump on a trampoline? Is that true?
Jen Martin
Yes it’s true!
Lauren Hodge
Are kegels the thing that you described as if sipping a milkshake with your vagina, is that a kegel exercise?
Jen Martin
Yes, yes it is. So you’re learning to be able to close off that orifice and then lift the muscles up to keep them supported in your pelvis. Kegels are a great way to increase your pelvic floor strength but think of it like any other muscle, you want to train it. So first, you’ve got to learn to get your base fitness, which is your endurance. So you’ve got to learn to hold it for a certain amount of time. So most people struggle to even get the connection at first, then once you do, you might be able to hold for between five or 10 seconds for each contraction.
But ultimately, you want to be able to do that and hold it for at least two minutes, when you can hold it for two minutes, that’s a functional level where you can not have to think about it anymore. It just happens naturally. But then when you’re adding load to that to say when you go back to exercising when you’re squatting, you’re sort of moving into a position where you’re stretching your pelvic floor muscles, essentially putting a load on them, especially if you hold your breath. They’ve got to learn to then take that a step further and increase your strength and your power and your pelvic floor to keep it up under load. So it’s like a base level that you start with but it’s like any other muscle you want to train it to sustain the loads that you’re placing on it.
Lauren Hodge
So would the highest load be doing a squat?
Jen Martin
Squat with heavy weights and then jumping or jarring movements and with weight. But most importantly, if you’re holding your breath when you lift something heavy that helps you to feel stronger because it braces or splints your abs, but that splinting pushes against your pelvic floor, and if it’s overly stretched still and weak, the pressure has to go somewhere. And it finds the path of least resistance, and that’s when you’ll find you get the issues like incontinence or prolapse, which is where your insides are coming out.
Lauren Hodge
Okay, I didn’t know what it meant when it’s coming out.
Kendra Till
There are a lot of women that experience that. I know a handful of people that have experienced prolapse at different ages.
Jen Martin
It’s very common. I’d say 60 to 70% of women have experienced it, maybe more even. A lot of people just don’t really get those things checked, they just think that’s what it’s gonna be like, forever.
Kendra Till
But again, going back to the quality of life, it’s so important to talk to a specialist about it, because it is something that can be fixed, and so that you can improve and not have those issues.
Jen Martin
There are a few things that you can address yourself. So obesity is a big issue, obesity increases the weight on your pelvic floor. And that tends to lead to chronic long-term stretching of your pelvic floor. Smoking generally leads to coughing and prolonged coughing is a frequent burst of pushing against your pelvic floor. Having COVID, and if you’re coughing or a condition where you cough a lot increases the pressure on your pelvic floor.
But mostly for new moms especially, it’s when they’re lifting their baby, which they have to do all of the time, their baby is dependent entirely. They don’t realize how many times they lift their baby, just to feed, change them, to put them in their car, they get into awkward positions all of the time. But generally, as the baby gets heavier, they start to hold their breath as they’re lifting the heavier thing, just maneuvering a pram is quite uncomfortable, and it requires a lot of strength. And if you haven’t got that strength, you just hold your breath and push. But that’s how you gave birth. Essentially, you want to keep everything up.
Lauren Hodge
So when you’re pushing the pram, keep it up and lifting.
Jen Martin
Usually women start running, but they’re pushing their pram at the same time. So it’s kind of a double whammy on your pelvic floor because you’re pushing the pram but you’re jumping at the same time.
Lauren Hodge
I’ll mention that a pram for Americans that pram is a baby stroller.
Kendra Till
Terminology.
Lauren Hodge
Translating a little bit.
Jen Martin
Yeah, with this often that when you’re pushing when you get to start exercising, the first thing you can do is generally go for a walk and then you’ll want to start to run than if you’re running and pushing a pram at the same time. That’s when you sort of sometimes run into a little bit of trouble. Often women just go “oh, that’s just normal. That’ll go away eventually.” But they don’t make that connection. You’ve done two things that are increasing the pressure on your pelvic floor and you’ve just had a baby. That’s like a triple whammy.
Lauren Hodge
So instead of holding your breath, is it breathing as well? So it’s like holding it in, but then making sure you continue to breathe and do that.
Jen Martin
If you breathe out the air, the pressure will come out of your mouth instead of down into your pelvic floor.
Lauren Hodge
That makes sense.
Jen Martin
I usually say to my clients, if in doubt, breathe out.
Lauren Hodge
I even do it when I’m just sitting here.
Jen Martin
I often find if you tell someone to breathe in, it makes them hold their breath a little bit more. When you breathe out, there’s a reflex that makes you breathe in again. So you haven’t got to even think about it. In doubt, breathe out, and then you’ll naturally breathe in again. We tend to hold our breath a lot, and you don’t realize it. It’s the other thing that increases the pressure on your pelvic floor.
Kendra Till
Yeah. Interesting. Jen, that’s useful information, and I learned so much, just from what you’ve mentioned. So thank you so much.
