Raising Healthy Families with Moms Meet and KIWI

Supporting Your Pelvic Floor: Women’s Health Advice from a Pelvic Floor Physical Therapist

March 22, 2022 Moms Meet and KIWI magazine Season 3 Episode 4
Raising Healthy Families with Moms Meet and KIWI
Supporting Your Pelvic Floor: Women’s Health Advice from a Pelvic Floor Physical Therapist
Show Notes Transcript

For women, and moms especially, understanding what the pelvic floor is and how to take care of it is incredibly important for our long term health and wellbeing. But what is the pelvic floor and why has it become such a hot topic? We’re joined by Dr. Gina Cunningham, a pelvic floor physical therapist, to learn more about what our pelvic floor is, why it’s so important, and what we can do to support it.

Chrissy:

Welcome to Raising Healthy Families with Moms Meet and KIWI. We're giving you the tools to enjoy the beauty and chaos of life with little ones in the healthiest way possible.

Maureen:

Hi, everyone. I'm Maureen Frost editorial director and today's host. Recently the term pelvic floor has popped up more and more frequently across social media. But what is the pelvic floor and why has it become such a hot topic? Today we're joined by Dr. Gina Cunningham, a pelvic floor physical therapist to learn more about what our pelvic floor is, why it's so important and what we can do to support it. This episode is brought to you in part by Truly Grass Fed. Truly Grass Fed cows spend most of the year outside in the fresh air grazing on the lush green grasses of Ireland which produces the silky sweet milk that goes into making Truly Grass Fed natural creamy butter. When you choose Truly, you can be confident you're choosing products that adhere to the highest standards of nutrition, flavor and quality. Their products are always non GMO growth hormone, rBST free and antibiotic free, creamy and texture with a pure rich flavors. Nothing tastes as delicious as Irish butter on your morning toast or spread on a baguette. Today we're joined by Dr. Gina Cunningham, a physical therapist and board certified specialist in women's health who focuses on pelvic floor rehabilitation. As the director of Axia's pelvic health physical therapy program, Gina offers an interdisciplinary and conservative approach to patients across Axias practitioners. Thank you so much for joining us today, Gina.

Gina Cunningham:

Thanks, Maureen. I'm excited to be here and talk about it.

Maureen:

I'm so happy to have you. Full disclosure to everyone, Gina and I went to high school together. And I you know, I follow her she's such a wealth of knowledge. And I thought it would be so amazing to have her share with our audience today. Since she's she you know, she's basically my pelvic floor guru that she can offer that to everything else too.

Gina Cunningham:

Yeah, I can just scream on top of my mountain about this. So I appreciate this opportunity to be on a podcast and other people to hear what the pelvic floor is and what we're going to talk about.

Maureen:

So it's so important and I'm just I'm happy to have this conversation out there. And the more we talk about it, the less stigma there is around about this and get and then more people will get the help they need sound great. Alright, so let's get started. So what, what really made you go down this road for pelvic floor, I know that you went to school to become a physical therapist.

Gina Cunningham:

Yeah. So you usually don't go to physical therapy school thinking at least 10 years ago thinking to do this. It wasn't even really taught in physical therapy school. I had like one lecture one day that basically just said, teach women to do keegles when they're pregnant. So what happened was on one of my clinical rotations, you know, I went to PT school, you go to undergrad for four years. And then PT school is three or four year programs. So you have clinical rotations, and I went to PT school thinking I was going to work at Bryn Mawr rehab on like the Brain Injury Unit or work for the Eagles. You know, that's what everyone wants to do for being a physical therapist. Um, and then on one of my clinical rotations, there was a physical therapist who was helping woman in her 20s, who was having pain with sex. And I was like, one would, I didn't even know this was a thing that we could help out with that it was something we could treat and do. So it kind of sparked my interest. And side note I grew up as a dancer, I danced like six days a week from when I was four years old till into college. And I always had hip pain. And doctors couldn't figure out what it was It wasn't my labrum wasn't arthritis, and I just kind of dealt with it and lived with it. So anyway, when I learned about this kind of physical therapy, I took a course. And of course, you are the therapist, and you're the patient. So you're on the table and learning the muscles and my partner, she was palpating in my pelvic floor and touched a muscle in my hip, and I jumped off the table in tears, and it was my hip pain. And I had it treated for myself. And I couldn't believe that this kind of treatment worked. And that was my pain for so long. And that's kind of how my passion started for this. And when I got a new job right out of school, I was mentored very well and it just grew from there. And here I am 10 years later.

Maureen:

Wow, that's crazy. Oh, I can't believe that that you know the connection between that. That's so nuts and and it's true because I remember when you were in PT school it's not one of the things that you necessarily think like, I'm going to do this and then I'm going to go do that. But it's such a such a needed field. And it's so amazing that like your path lead that way. So that's awesome.

Gina Cunningham:

Yeah. And then I was pregnant in 2016, and had my first baby in 2017. So I really had a different understanding and appreciation for everything and learn so much more, and my conversations changed so much. Not that you don't have to be to have a baby to be a pelvic floor therapist, but it's just going through that kind of experience and everything being pregnant and postpartum. And it really changed my perspective on that realm.

Maureen:

Yeah, cuz there's so much uncomfortableness you go through when you're pregnant. And then after, and so like, totally, totally, and we don't all understand it on our end, we just feel sharp pain. So Alright, so let's talk a little bit about what the pelvic floor is first.

Gina Cunningham:

So the pelvic floor is a group of muscles. And it runs from your pubic bone, which is right in the front all the way to your tailbone in the back. And then you're too hip to sit bones on the side. So it's kind of like a hammock at the bottom of the base of your pelvis. And what it does is it helps support your pelvic organs, your bladder and I, when I'm speaking today, I'm just going to generalize into female I you know, that there's men have pelvic floors, so do you know, transgender, I'm just when I'm talking about anatomy, today, I'm just going to speak about female. So pelvic floor, they hammock and hold on to bladder, uterus, and colon. So what they do is help support those organs. And they're in charge of our urination and our bowel movements and sexual function. So without these muscles, we would be paying ourselves and having people leakage. And, you know, they also they're a part of our posture. So we actually activate them all day long. They're kind of like, they're a part of our autonomic nervous system that we don't even realize you're using them. And they're working automatically for you. So we have, they're working automatically, but then we will actually have active control of them. So they're, yeah, they're a part of our posture. They're a part of our core, people think your core is just your abdominals, when actually your core is your pelvic floor, your abdominals, your deep back muscles, and your diaphragm is your breathing muscles. So they play a huge role in that. So so many people don't even know they have a pelvic floor. So I, everybody needs to know that they have the pelvic floor and where it is, because it's so important.

Maureen:

And how it works with the rest of your body. So what are some of the main issues and dysfunctions that are associated with the pelvic floor.

Gina Cunningham:

So a lot of people they think pelvic floor therapy and they think about keggles or you know, leakage. So a big part of what I treat I see women and that have urinary incontinence, incontinence means leaking. So urinary leaking, when and there's two types of incontinence, their stress incontinence, which means there's an external force putting pressure on your system. So like when you cough when you sneeze, when you run when you don't. Or there's urge incontinence, which means you get that strong urge to go to the bathroom, and you can't make it in time. It's called keyhole syndrome, where you really are about to put the key in the door, and you're like, not gonna make it to the bathroom and timing my drip a little bit. And my biggest thing is, that is not normal. Women should never be peeing themselves even if you you know, drip a little bit when you sneeze when you cough that tells me that something's wrong. And I want to treat you and see you now, when it's less severe and mild like that, then in 1020 years from now, when you're going through pads, so, you know, I see women that have fecal incontinence, which is bowel loss, especially if they tour a lot during the vaginal birth, like women in their 30s. Not not older people too. So I see women that have pelvic organ prolapse, which is when your bladder uterus or your rectum starts to descend through the vaginal canal, and it doesn't necessarily have to just be treated with surgery, we can help. And then the other group of patients I see is pain. So it's a pain that usually cause because your muscles aren't weak. They're actually they're too tight. They're called they're hypertonic. And they're more in a spasm. So there it's called a shortened to pelvic floor, and different diagnoses associated with that are. It's called vaginal dryness when women have pain with any type of insertion like with intercourse with tampons with GYN exams. Vulvodynia is when we have just generalized pain at their vulvar area when sitting and different kinds of activities. And then kind of I even see patients with interstitial cystitis, which is bladder pain. And I see patients with endometriosis. You know, tailbone pain and other I could keep going and going. But I know we're short. We don't we don't have all day to talk. But another thing is related with pregnancy. Postpartum, I see patients that have a diastasis recti where your abdominal muscles are separated from the midline. And a lot of pregnant patients that have pubic symphysis dysfunction, it's right at their pubic bone where they have difficulty walking or sharp pain at the pelvis. So those are the main I want to say the main ones that I usually say.

Maureen:

Yeah, well, Gina knows this. And I have interstitial cystitis and I dealt with it for like 10 years in my 20s just being like awful, awful, awful, no doctors were able to make it better or help and everyone was just giving me different like medications and and never did anything. Yeah. And then when I was pregnant, the first time I just had a bad flare up. And they finally a uro-gynecologist was like you need to go to see a pelvic floor physical therapist and like that, that did so much more.

Gina Cunningham:

That's when you reached out to me.

Maureen:

It was so much more relief for me. And like it was muscle movement. It was exercises and it was like, like making sure that I was relaxing and things like that. So it just it opened my eyes. That's how I, you know, came to understand the importance. It opened my eyes to like how interconnected everything is, I never realized that that was the reason because no one no one else no other doctor really, like brought that up. And then I got more relief. Just seeing that physical therapist for a couple months while I was pregnant then. And ever since it's just been, you know, very minor in the background of my life instead of like taking over so it's crazy. All the different ways that you could have trouble and then you know, just working with with a physical therapist to kind of understand and treat these things.

Gina Cunningham:

With interstitial cystitis, it's your bladder, people don't realize, Oh, I could get physical therapy for my bladder, when actually I see is it just about bladder pain, it is about the myofascial tissue and your pelvic floor connection and how you know, neuromuscular is with your brains not relaxed, how it's going to connect to your pain. And same thing with endometriosis, I'm not going to cure or treat the Endo, but endometriosis is when when you see that tissue lining of the uterus on the outside of the uterus. And it can add here and attached to all different organs within the pelvis and my job, what I could do is visceral mobilization, which I'm sure you got during physical therapy that they helped to mobilize your pelvic organs. And it's a lot of hands on manual work is what I do all day. I don't just, you know, watch you do exercises. It's one on one treatment, and it's very hands on.

Maureen:

I'm part of I think people's lack of awarenesses is a lot of people, women, in general, it's hesitation to get help for these areas, if they're in pain, and there's a stigma surrounding women's health and reproductive issues. And many women sometimes feel ashamed or like they should keep these issues private or they just suffer in silence. Which is awful. Do you feel like you know, the tides are kind of turning in that area? Or where do you think we are with that?

Gina Cunningham:

Honestly, I really believe in the past few years, and really with social media that my profession is being talked about so much more and becoming more normalized. It's definitely a generational thing. I know I have women in their 50s and 60s that might have a harder time talking about how they have incontinence, or having pain with sex. They have a hard time, you know, talking about sex or describing their symptoms versus a woman in their 30s or 20s. And I don't I again, I don't know if it's a generational thing but also to really with with Instagram and Tiktok so many people are talking more about this stuff. It's I'm seeing more patients because they're learning more about it through social media content and people are learning that they have the same kind of symptoms too and that there's actually something they can do about it. I really think to OBGYN You know when you have when you have pain when you have pain down there or anything with your bladder, you go to your OBGYN First, so instead of, if they don't tell you what to do or who to go to, and you don't know a friend or look it up yourself, you're kind of lost. So I really think the education of the OBGYN has improved. And the new generations of even I see OBGYN that are that are learning more about pelvic floor and treatments for their patients that they know to send to physical therapist and pelvic floor therapist too. So it's definitely being educated even more to within my field. Like when I went to PT school, I was one of the only ones that graduated and ended up doing it where girls, women, now physical therapists are learning about it in school, they're going to continuing ed classes then and learning to specialize in it when that wasn't even thought about that. So I really feel like on the educational level to that people are getting into it sooner than later in their career.

Maureen:

Yeah, that's good. I mean, it feels like this progress, like on every front, which is great. And it is, it's crazy to think how social media is kind of helping lead the way like break down stigma educate, and it's cool. It's one of the good things about social media. So for women, when, when should they be reaching out to their doctor about any pelvic floor issues.

Gina Cunningham:

So again, pain is not normal. You know, if you're having pain with sex pain, putting in a tampon, you know, going to the GYN is unbearable, it shouldn't be like that. So women that have UTIs, or you think you have a UTI, I see that a lot that women have these symptoms of a UTI, and then they get a culture and the culture is negative. So when the culture if you have the symptoms of a UTI, and it's negative, that could be because of the tightness within your pelvic floor. And I now work for your gynecology team. And that's what we see women they have complaints that they have a UTI and their cultures are negative, and it's actually the same kind of symptoms like burning frequency or urgency. That's it. It's the same thing could be because of a tight pelvic floor and not, you wouldn't really necessarily think that so, you know, don't know.

Maureen:

I would have never learned, that was me I would have never known.

Gina Cunningham:

Yeah, don't self diagnose yourself with a UTI. So many people just pop Azar or take some cranberry and it could be something else. So talk to your doctor if you have chronic UTIs or think it's a UTI. Same thing with leakage, like like I said, having any kind of leakage is not normal. It tells me something's going on with your core system with with your pelvic floor whether it's too weak or too tight or uncoordinated. It's not normal to pee yourself. It's common but it's not normal. So you know mentioned to your doctor hey, I do pee myself a little bit when I cough and sneeze get treatment now instead of 10 years from now when it's worse. You know I even see new moms.

Maureen:

So if they get it when it's when it's less than it's easier to treat one for sure down the road it'll be harder to kind of heal that situation.

Gina Cunningham:

It's way easier to treat someone that has a few drops when they cough and sneeze or feel that strong urge to go to the bathroom versus changing your pad five to six times a day that your pads saturated you know commercials and media can is glamorizing pads and you know incontinence and it's sexy to wear this huge diaper when you're dancing like that's no you don't have to live like that even old later in life and you know you walk down the grocery aisle What do you see menstrual pads, the progression of life you know diapers and then menstrual pads and then your urinary pads when you get older and it doesn't have to be like that I have a patient right now in her 50s and she came to me because she was having some urinary leaking and pain with intercourse postmenopausal and she was shocked and all this therapy a hidden gem because she had no idea that she could get treated for it and her doctor just told her she could get surgery or she was kind of had to live this way because she went through menopause and it's not true I'm she's being discharged having pain free sex and not being herself anymore. Whoa. Yeah.

Maureen:

I mean, that's that's so helpful. I'm sure people are listening to this like, like that's really eye opening that that there there's a way to to work through your issues work through your pain and have a better you know,

Gina Cunningham:

Better outcome, the life quality of life. Yeah, yeah, better quality of life.

Maureen:

That's the word. Yep. Um Yeah, that's amazing. So okay, so we've both had two kids and most of the people listening are also moms and what are some of the issues that women who have had children face when it comes to the pelvic floor.

Gina Cunningham:

So I do see women that have they're getting away from doing a PC atomies which is where they cut your muscle, they cut your when your during delivery where they cut the muscle. I mean, they're still doing it if needed, but it used to be protocol where now natural tearing is actually better than having an episiotomy researchers found. So I see women they have anything more than a grade one tear, you're tearing through muscle. So imagine an athlete tearing through muscle, he's gonna go to physical therapy, or she's gonna go to physical therapy for months and months repairing that muscle, but we literally tear through muscle push a baby out and supposed to be fine and take care of this new baby like, it makes no sense. So it's wild really going through it myself and, and I knew about this stuff. So I work with women that you know, kind of the first couple weeks because your body went through so much trauma, you it is more normal to have some urinary difficulty holding your bladder, some urinary leaking it especially if you had an epidural or long laboring just because of the trauma that happened. But you know, after around 12 weeks, you should not be paying yourself. So I do see women that have you know, even scarring scar tissue from their, from their chair, and I work on doing like perineal massaging after and, you know, at six weeks, nothing magical happens at this six week mark when, except, you know, your uterus should be shrunk at six weeks, and your tissue should be healed. But it's not this magical, like, Okay, now you can have sex and now you can exercise and that's what happens. And you know, the first time having sex if you have a baby scary, so I prepare my patients, you know, how, what to you know what to prepare for what lubrication to use, what positions are better than others? And then how to do their own perineal massaging. And same thing with exercise, you're getting clear to exercise. But what does that mean? Like, you know, how do you know what exercises to get started with with safe what's not. So I help women after they have babies to kind of get back to their goals of exercising safely and appropriately? Yeah.

Maureen:

It always feels so hands off when you go to that six week checkup. And they're like, Okay, you're good. And you're like, I'm not in every single way. Yeah, that's the only question. And they're always like, yeah, you gotta go. You're good. You're good. And I'm always like, but not um, it's, it's yeah, getting doing the right exercise is yeah, that's hard. It's so important.

Gina Cunningham:

So backwards here in all other first world countries. You know, especially in France, they, it's protocol, that they get pelvic floor physical therapy after they have a baby there. It's covered by insurance, and it's talked about in their health care system. So I'm not sure if you know, but from doing this, I this is my passion. I helped pass a resolution in Pennsylvania in May of 2021. For fourth trimester care. And, you know, if I go to your baby shower, I'm giving you a fourth trimester book on what to do after you have a baby and I don't give a baby a gift, I give the mom a gift because I just feel like moms are just so you know, I don't want to say neglected, but it's the health of the mom. Yes, it's important for your blood pressure. And, you know, on the medical side, your you know, your glucose, everything to be important, but there's not really a physical or mental conversation that women are talking about, like absolutely not.

Maureen:

Now, the only thing you do, I mean, at my doctor's and I've been to two different ones is you I just like answer questions on an iPad. When I go in about like my very general mental health questions and I there's needs to be so much more of that there needs to be so much more of like getting your pelvic floor back into the state that it should be and I mean, hopefully this just empowers people to think maybe well, I should be putting this into my plan. After I have a baby and you know, we do become the after we do become the after thought after having kids. Oh, for sure. And you know, just putting yourself first in these like health areas is so important.

Gina Cunningham:

And I know and I always say to my moms, I'm like you need to be healthy and okay to take care of your family if you're not physically and mentally okay? And they coincide with each other. If you're not physically okay, you're not mentally okay? And if you're not mentally okay, you're not physically okay. So how are you going to take care of your kids and your family and I Make it accessible. Like I know myself and other physical therapists we allow, you know, bring your baby in, it's okay, you don't have to leave your baby at home. You know, I have patients breastfeeding their baby in the room, the baby screaming, I don't care, I'm glad you're here, we're going to work on its life. And I don't work in a big gym setting with a bunch of weighted machines, it's in a private room. And it's exercises that moms and women can do functionally at their home. So when I teach them exercise, it's things that you don't need equipment for, or things that you're already doing in your life. You know, like how to activate your floor, when you pick up your baby, how to activate your pelvic floor, when you do certain things throughout the day, when you put them down in the crib, when you change their diaper that, you know you're not leaking yourself or feeling that pain. So I try to make it as accessible for patients as possible. And we do we talk about mental health and how it's, you know, your autonomy changes. It's not just, you know, you're trying to be a mom, you're trying to be a wife, and you're trying to be a friend, and you're trying to even have some time for yourself. So I think it's really important that women and moms new moms make themselves important physically and mentally postpartum.

Maureen:

Yeah, I mean, it's really great that you are being active for that cause. And it's, I didn't realize that it had passed, I know that you had been working towards that in Pennsylvania, but that's amazing.

Gina Cunningham:

So it's called the fourth trimester, fourth trimester resolution in Pennsylvania. I mean, it's it's just the resolution, but it resolution just brings awareness to a problem for physical and its fourth trimester resolution for physical and mental health, health care. And I'm working with the American Physical Therapy Association, there's a pelvic advocacy and Alliance team that we're trying to do more on a federal level that, you know, it needs to be standard of care. It needs to be protocol that women have these kinds of services. So we're trying, it's not easy, but at least women, they hear this, that there are practitioners like myself, there's mental health therapists that specialize in with for women for postpartum care. So go see one of them, go talk to them.

Maureen:

Yeah, knowing that you are out there, and they're out there is like step number one. So that's me.

Gina Cunningham:

Yes. Yes.

Maureen:

Okay, so back to pregnancy. Is there anything that we should be doing? While we're pregnant to help our pelvic floor? I'm sure there is.

Gina Cunningham:

So yeah. So I tell my moms, hey, if you were running, Cross Fitting, doing whatever exercise you can keep doing it through pregnancy, you know, I think it's in that night, my you know, my mom's like, Don't back you when you're pregnant, or be careful walking up the stairs. I mean, again, unless you are high risk, I'm not speaking about high risk. But if you're just normal pregnancy, and everything's going well, I have patients that are 34 weeks pregnant, running four miles a day, so you do not have to them, that was not me. But you do not have to stop exercising or doing anything just because you are pregnant, you might have to modify or change things. And that's what I teach my patients how to modify due to their new body changes, to do the activities that they're doing. Now, I don't recommend starting something new. Like if you weren't a marathon runner, don't sign up for one while you're pregnant or like, don't start CrossFit while you're pregnant if you've never done it before, but there's no reason to have to stop activity unless you're high risk. So I usually recommend in the first two trimesters of pregnancy to work on strengthening and you know how your abdominals engagement some women, they don't even engage their abdominals. There, the whole 10 months, really, pregnancy is 10 months and not using your core. When you push your baby out, you're using your abdominal muscles. So you know, I teach women how to strengthen their core correctly and their pelvic floor, how it's coordinated with their breath. And then usually in the third trimester is when we should be more relaxing and stretching out our pelvic floor because when you deliver a baby your pelvic floor actually relaxes and does nothing. It stretches and opens up. So if it's not keep going it shouldn't that's the reverse it it needs to relax and widen and open so I teach moms how to relax and open their pelvic floor and different positions they can get their bodies in and how to use their breath and abdominals to efficiently push you know and even if you get a C section, how your core is, is changed and I still see women that have incontinence or you know pain with intercourse or different issues even though they had C sections. You know, just because you get a C section does That means you have a free pass that because your vagina is okay, so, so many women don't even know that they still bleed after they have a C Section I, you know, I tell women what to expect afterwards that that conversation doesn't even happen so and then even scar tissue mobilization how, after you have a C section usually the healing tiny after eight weeks, I teach women how to do C section scar because it's layers and layers of tissue that can adhere to each other. And you can't use those muscles that everything correctly. So yeah, there's a lot.

Maureen:

There's so much and then I mean, we were just talking about how it's so necessary after and postpartum. But it seems like women should be doing this as part of their prenatal care, you know, throughout the 40 weeks that they're pregnant, because there's so much that we don't know about and that we should be learning that will help us Yeah, and help us heal and me. Yeah, it's just crazy. I mean, I am a two times C section mom, so...

Gina Cunningham:

I didn't know you had a C sections.

Maureen:

Yeah, so yeah, there's there it is crazy. What they don't prepare you for going in and then, you know, afterwards, as long as like, I didn't have an infection. Everyone was just like, good to go. See?

Gina Cunningham:

Yeah. That's wild. Wild. I just had surgery, here. Take your new baby.

Maureen:

Yeah, don't pick them up, but take care of them. But uh, yeah, so one other thing diathesis wreck dye? Can we talk about that a little bit? So that's something that man Yeah, is that something that you treat as well, or...

Gina Cunningham:

so I know, a lot of patients that they're like, this wasn't even checked, my doctor didn't check for it. And so I haven't had a chance yet. Some do, some don't. So I don't want to generalize. But um, basically, your abdominal muscles connect, it's called your it's a ligament called your linea. Alba. It's connected from your sternum down to your pubic bone. So all your muscles connect to that that ligament and during pregnancy, your muscles stretch, and actually research showing that 100% of women are going to have some form of diathesis within their third trimester. But what should happen is, and it depends on your genetics, your collagen, you know, your how your muscle strength, how big the baby was it, there's so many different factors on how those muscles should come back together. So to test for it, what it looks like is if you're laying down and you put two fingers with wise on your stomach, and you lift your head, lift your head and shoulders up that you should not have more than two fingers wide, or one knuckle deep. Or if you lift your head up. And wherever you're pregnant, you lift your head, you see this like Alien belly, like, like triangle teepee kind of thing happening. That's, that's the weakness of the linea alba. And that's what diastasis recti is, it's where that it's almost like the hernia where it's that bulging of your internal intestines, that kind of going through this shallow, shallow sheath that definitely can be worked on and I test my patients for it. And it's something that doesn't necessarily need surgery for I can't stand that is one of my pet peeves when someone's like, oh, the only way to fix that is with surgery. I just did an eval last week and you know, getting and getting the dialysis RekSai repaired is considered cosmetic. Actually, it's not even covered by insurance, which is so ridiculous. But um, no, I definitely I check every I check every woman who ever had a baby years even later, so that that can be definitely worked on.

Maureen:

Yeah, see, there's help. Definitely.

Gina Cunningham:

And then yeah, when you have weakness in your abs, and that's going to again and play a role into your back pain, it's going to play a role into your pelvic floor health. So that whole system needs to function together.

Maureen:

Yeah, it is true, everything is so connected. So when one's out of sync, then the rest suffer too. So I'm back to just like the pelvic floor. So what really causes pelvic floor muscles to be weak or pelvic floor muscles to be too tight.

Gina Cunningham:

So definitely having a baby. You know postpartum and post menopause will cause more weakness and post partum is more because of the trauma and the strength over stretching of the pelvic floor muscles during a vaginal birth. And then post menopause. Well, it's due to a depletion of estrogen. And when we have a depletion of estrogen, we have atrophy within our tissue that the muscles they don't function like they should. And actually women don't even realize when you breastfeed, it's a depletion of your estrogen and it's kind of like we put our bodies in To this postmenopausal state. That's why we're more dry. The libido is down. I mean, yeah, it's because different hormones, but our estrogen is low. So you can also get pregnant when you're breastfeeding. So I'm clearing that myth that so many women have told that breastfeeding is a birth control, it's not you can definitely get pregnant when you're breastfeeding. So that's usually the two main causes of weakness. And then the tightness, when a muscle is there more in spasm and overworked. There is a number of different reasons. It could be something simple, like your posture and your pelvis being off, or you know, you sit all day, I've seen a lot of increased tension with COVID. You know, people are home, they're changing job, they're sitting all day. It could be due to stress, anxiety, you know, people have jaw pain, you don't even realize you're tensing the muscles in your jaw. Same thing, you don't even realize that you're clenching and tightening those pelvic floor muscles down there. And so many women, you know, they have a hard time just relaxing in, you know, girls, women were so you know, used to and trained to suck in and grip and tighten and hold everything in when that's not normal. And when you should be in this more relaxed position. So that can all contribute to tightness, abuse, I see a lot of women with physical and sexual abuse, that they have tightness within the muscles. So yeah, there's a bunch of different reasons for the tightness in the pain too. So trauma, surgery, surgical traumas, anybody that had any abdominal surgeries, pelvic surgeries, that can all be related to that as well. So

Maureen:

Yeah, it's good to know. So is there anything that we can be doing to prevent any damage to our pelvic floor or to protect our pelvic floor in everyday life?

Gina Cunningham:

So honestly, the pelvic floor is always working, it should be so your pelvic floor needs to be connected to your diaphragm. So even recognizing that those muscles are there. And I would say if you don't have a problem, don't search to try to fix it. But if you are, you know, don't just do your key goals, because you might be doing more, more harm than good. You know, go get them evaluated by a pelvic floor therapist and see like, Do you have a hard time relaxing? Do you have a hard time contracting? What's the reason why that you're having issues. So just like your bicep it needs to shorten and is to lengthen if you had a shoulder issue, right, you would go and get it evaluated. Same thing with your pelvic floor. So you know, even if someone never had a baby, it's not like you have to be doing your key goals all day, every day, if you're not having any issues, you know, tightening your pelvic floor, and that could be causing urgency, frequency, you know, any kind of irritation. So the best thing is to really practice connecting your breath work to your pelvic floor. And what should happen is, it's like a piston, if you take a deep breath in your pelvic floor should relax and expand. And then the opposite happens when you exhale when you breathe out your pelvic floor should contract and shorten. So practicing that connection is very valuable than to function in everyday life.

Maureen:

You've mentioned key goals a lot. Can we just talk about them for a minute? What are they? And what are some of it? Because I sometimes hear like, Don't do your Kegel is do your cables. No cables can hurt. No cables get out. So can you kind of dispel like, everything about cables right now in a short little section?

Gina Cunningham:

Yeah, because everybody talks about you know, just your keegles. Yeah, or don't Yeah, it's good to hear the same thing. So cable is a contraction of your pelvic floor some this guy with less than Kegel though it's actually a female guide, abolish an article a female did in like the 30s. She recognized the connection between your breath and pelvic floor and then he published this article and the term the pelvic floor muscle contraction a kegel. So what it is it's a contraction of those muscles. So what a kegel is, you should feel like and I know every listener is going to do this right now as I describe it, you want to imagine that you're squeezing a blueberry and pulling it up in so are superficial muscles of our pelvic floor need to squeeze and then are backwards or deep ones lifted up. So that's how you actually should contract your pelvic floor. It's a squeeze and a lift. So that's how you correctly do it. It needs to be coordinated with our transverse abdominal muscles, which is our deep layer of muscle in our lower abs and also coordinated with our diaphragm. Like I said those muscles it needs to work with SAR breath so you can be giggling all day long. But if you're not coordinating it, it might not be helping you and it's not like, you know, doing 100 kilos at a time is going to benefit you. It's it's important to be able to be connected to those muscles and it depends what your problem is. If you're having pain if you're having urgency frequency, you shouldn't be contracting and cabling all day. But if you have, you know, I see endo vaginal smears, vulvodynia. But if you do have leakage, the pelvic floor muscle contractions and that coordinations can help you. So I like to say, it depends. You know, I get text messages or calls from friends and family are like my back hurts. Can you give me exercises? And I'm like, No, I can't. Because I don't know what's wrong. Same thing, like my shoulder hurts What's with what should I do for my shoulder exercise? I don't know, I have to see what's wrong with it. Or you can you know, exercise is medicine. So, as a physical therapist, that's my medicine. So I need to be able to evaluate and see what's up with your pelvic floor. So it really is dependent on symptoms. So if you had a baby, yes, I do recommend doing you know, just making that connection like 10 reps at a time and then kind of throughout the day in different positions sitting standing lying down that's more functional than you know just lying down when we don't go in that never happens as a mom. So yeah.

Maureen:

Yeah, with that. Yeah. Well, thank you so much, Gina, this has been the best conversation that I love talking about it could keep talking about it because I you know, the more we talk about all the like, issues that affect us as women, the easier it is to get help feel connected, feel heard, and to just like live a better life. I feel like so this has been amazing. To kind of dive into this with you.

Gina Cunningham:

Yes, thank you so much. I could literally I do I talk about this all day long and talking about proving paying sex all day long. But again, too, I hope that I helped this conversation, break the stigma that you have to live this way that you know, don't let it be normalized to pee yourself or to not be able to have sex because you have these issues that there's practitioners out there, that it's not just in your head that you know, if you're not doing well physically, it's gonna affect you mentally if you're not doing well mentally, it's gonna affect you physically. So there are people like me that you can get these recess for and help so I just want to say if you go to a PTA is the American Physical Therapy Association APTA pelvic health.org, you can locate a pelvic floor therapist like me are also pelvic rehab.com. I don't know if you can put these on your Yeah, we can post to your show but different resources that women can go and find a pelvic floor therapist like themselves. So for themselves. Yeah, I love that.

Maureen:

Here's what's new and Moms Meet and KIWI magazine. Make sure you register for WOW Summit '22 Virtual. join us for March 29 through 31st 2022 to attend educational workshops learn from compelling speakers network with like minded moms, and discover new products in our virtual exhibit hall. Plus, you'll have a chance to win amazing prizes such as an Apple iPad, Ninja Foodi, and more. KIWI magazine's 2022 Spring issue is out now. Featuring fresh recipes, family mental health advice, crafts, and more. There are so many amazing articles to check out this season. Plus dive deeper into what you need to know about climate change and its impact on your kids health. This episode is brought to you by Neutral Organic Milk. Produced with sustainability in mind Neutral is focused on delivering certified organic milk from humanely treated pasture raised cows. In fact, they're the first carbon neutral food company in the United States in the making of one half gallon of neutral organic wholemeal. 13 pounds of carbon were offset equivalent emissions from a 14 mile drive. Neutral Milk is certified carbon neutral from SCS Global Services and is made without antibiotics, pesticides or synthetic hormones. When you purchase a carton of Neutral Milk, you're helping support sustainable farming practices at family farms. Well again, thank you so much, Gina, and thank you everyone.

Gina Cunningham:

We'll be coming back for season four.

Maureen:

No, we should. We should do it again. But thank you everyone so much for listening and make sure you hit the subscribe button so you don't miss the latest podcast episodes. And thank you for conquering healthy living at all ages and stages of life with us.