Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast, episode number 62.

Announcer:
Welcome to the Conquer Your Weight podcast where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Hello and welcome to today’s episode. We are talking about a very important topic, which is pelvic floor health. Before we do, I have a favor to ask you, dear listener, I would love for you to leave me a review and or a rating wherever you listen to podcasts. My podcast has been growing over the last few months and years and it has been so fun to see that happen. And one of the best ways that we can get into the ears of even more people to help support them in their weight loss goals, in their health goals is for you to leave a rating for you to leave a review so that it goes into the algorithm and feeds that podcast to more people. So I would love if you could take just a moment to do that. It’s really easy to do from the app that you’re on, and I would so, so appreciate it.

And imagine all of the people who have not yet heard my podcast who are maybe just waiting for you to leave that review so the algorithm will feed this podcast to them as something that they may be interested in. So I really appreciate you taking the time to do that. Thank you so much. And today we are talking about pelvic floor health. So it is not normal to pee when you sneeze. Let’s get into that. This episode is geared to women who have children or have other pelvic floor issues like having children that have led to issues with peeing, particularly when you sneeze or when you jump or something like that. And we talk about this all of the time, and I am here to say that is not normal. And before you say, wait, what? Dr. Stombaugh, all of my friends talk about this issue, I’m going to say yes, it is common.

It happens very, very frequently, but it is not normal. And I am saying this from a woman who has three children, one of which was nine pounds and six ounces when he was born. So I will tell you, my pelvic floor has been through a lot and we are going to talk today about how you can improve your pelvic floor health, which can be a really important thing When we look at our core strength, our back strength, and how we are supporting not just our weight goals but our health goals. And one of the things that happens very frequently in my practice is that people who have a weak pelvic floor have weak abdominal core muscles. They are having an abdominal pooch that can happen because of diastat recti. So we get the separation of the muscles that should hold our abdomen together. And when those are separated, which is often related to our pelvic floor, we can experience a abdominal pooch.

So for women especially who’ve had children, they experience, even if they’re like, gosh, I don’t really think that I’m that overweight yet I have this persistent pooch in my lower abdomen, people are always asking me if I’m still pregnant. If that is you, listen up because we’ve got some good stuff for you today and I have some things that you can do in order to support that. Men, if you are listening, maybe you’ve even tuned out. And if you are still listening, please listen to this. Men can also struggle with pelvic floor issues. It tends to present itself a little bit differently or please do share this with a woman in your life who may benefit from it. So as I said, not normal, but super, super common. So our pelvic floor, if you look at the pelvic floor, what I’m talking about is a whole series of muscles that come together at the bottom of our body, sort of within our pelvis, in inside of our hips, above our buttocks, above the vaginal area, above the bladder in order to or below all those things.

Rather in order to hold them all up into our body, it is all of these muscles that support each other like a bowl in order to support our body. And all of those muscles, they can be too weak, they can be too tight, which ironically is also as significant of a problem. And it can create issues for women and men related to going to the bathroom. Most commonly we talk about going to the bathroom with urinary leakage, but people also have issues with pooping and it is very socially acceptable to talk about issues with peeing. It is not as socially acceptable to talk about issues with pooping. But as a physician, I will tell you this is super, super, super common as well. And so we’re going to focus on that today because I have had patients who come into my clinic, we’re talking about issues related to constipation.

That is a common side effect from some of the medications that we often prescribe. And so if there’s any type of constipation and pelvic floor issues that are already in place, if we layer on a medication that causes that side effect, I am going to create a miserable situation for you. So we spent a lot of time talking about this and it is unbelievable how frequently people realize even if their children are 5, 10, 15 years old, oh my gosh, all of these years I have been struggling with my pelvic floor. I didn’t think I was because I wasn’t peeing myself, but they realized that some of their issues related to having bowel movements may actually be pelvic floor as well. So coming back thinking about the pelvic floor anatomy, we have many muscles, like I said, they come together in the bottom of our body in order to hold up all of our internal organs.

They interface so they are connected with the muscles in our hip, sort of supported by the muscles in our buttocks as well as then connect to the muscles in our abdomen and in our lower back. And it’s important for all of those groups of muscles to be in good health in order to best support our weight and to support our bladders and everything else. So one of the things that very frequently happens is that when women are pregnant, there is this laxity or looseness that happens that allows the pelvis to expand in order to have children. And then during the birth process there can be a stretching of sometimes even a tearing of muscles and the pelvic floor in order for the baby to be born. This is true whether you have a vaginal c-section or vaginal delivery or whether you have a c-section where they quite literally cut through those muscles in order to deliver the baby.

And with that there could be a lot of issues in those healing there. Also, we think a lot of times about anterior issues, so issues that impact the front of the pelvic floor, so impact the part of the pelvic floor related to the bladder. And when we have a weakness in those, we often have issues with urinary incontinence or peeing when we sneeze, peeing, when we jump, things like that, that is more common because of pelvic floor anatomy. If you look at most women’s uterus and the way a baby comes out of the body, most commonly there will be a bigger impact in the anterior pelvic floor, which is why it’s so common for women to experience bladder issues after they’ve had children. For a lot of women though, they may have a posterior facing uterus, and what this means is that they are more likely to actually have posterior issues with their pelvic floor or more related to their bowel and their rectum.

And what happens there is that weakness in that area can cause problems such that women are not easily able to have bowel movements such that when they sort of push down in order to have a bowel movement, their pelvic floor is not supported and it’s harder for the stool to move out of the body. But instead the rectum, which is the part of our colon that holds stool before we have a bowel movement, that rectum sort of expands into the direction of the vagina rather than exiting the body, which is the direction it should expand into. People will have issues sometimes where they can’t hold it. They feel like, oh my gosh, if I need to, whether this is I guess urination or defecation, so peeing or pooping, whether you need to go quickly, you realize you need to go and it needs to happen pretty urgently.

Sometimes women will have issues where they’re leaking and so if they have loose stool, like maybe they’ve had a GI bug, they literally cannot hold that in or they sort of pass gas against their will and that can be really embarrassing and create issues for them as well. So you may be asking, what does this have to do with obesity? Well, it’s interesting because when we also have chronic excess weight in addition to poor pelvic floor health, it makes it even more challenging for our pelvic floor to function in the way that it needs to. So when we look at improving the pelvic floor health, there is physical therapy that can be done for that and we’ll talk about that in a minute. And we know that losing weight is one of the best things that we can do in order to really just simply reduce the amount of weight or the amount of pressure that is constantly being held up by our pelvic floor.

So if you have not heard of pelvic floor physical therapy, anybody who is a patient of mine will know I am probably the biggest non-physical therapist who is the proponent of pelvic floor physical therapy. I think that pelvic floor or physical therapy is just magic. And I think that every woman who has had a child, certainly other people as well, but especially any woman who has had a child, should have pelvic floor physical therapy. Any woman who’s pregnant can learn really good tricks about how to deliver a baby in order to reduce the risk of pelvic floor injury. Women who are considering having children in the future, learning these tips and tricks in order to support their pelvic floor. But women, I am here to tell you if your pelvic floor is not working for you in the way that you wish that it was, whether you’re having issues with peeing, having issues with pooping, having pee leak out, having stool leak out, passing gas unexpectedly, having prolapse where you feel something sort of bulging into the vagina if any of those things are happening or a diastasis recti, that separation of the abdominal muscles feeling like you have a pooch even though you may not even be having fat in that area.

If any of those things are happening, you need to see a pelvic floor physical therapist. So let me tell you a little bit more about what a pelvic floor physical therapist does because it’s quite a bit different compared to traditional physical therapy. So most people are familiar with physical therapy in the context of their knee or their shoulder major orthopedic type issues. So it’s very common if you’ve had an injury, if you’ve recently had surgery, that you will be prescribed physical therapy by your care team and do that for a period of time while you’re recovering from that injury while you’re recovering from that surgery. There are also pelvic floor physical therapists who specialize in the pelvic floor. This is not done in a big gym. Typically this is done privately in an exam room where you meet one-on-one with a therapist and they do an evaluation of your pelvic floor.

So they will look, they will feel, they will use instruments to feel if there are areas of the pelvic floor that are too weak. If there are areas of the pelvic floor that are strained and under are constant tension, they will see if there’s areas where there’s prolapse, so where the bladder or the uterus or the rectum where those sort of fall into the vagina or fall out of the vagina, which can also happen, they will assess that there are then exercises that can be done in order to support the pelvic floor. So we often talk about Kegels and Kegels are very helpful for the pelvic floor, but they’re often done incorrectly and not done in a way that actually supports improvement of the pelvic floor. So we need to think about both contraction of the pelvic floor and relaxation of the pelvic floor, which is actually a way more common issue than people realize.

There are tools, there is a biofeedback where they can put electrodes on the outside of the vagina and near the rectum, sort of on the buttocks region and on the upper thighs in order to do biofeedback. So you can see as you contract the muscles, as you relax those muscles, as those things are actually happening, there are devices you’ve heard of, probably maybe not a Kegel weight, so weights that can be put into the vagina and in the way that you would do a bicep curl to make your biceps stronger. You can actually put a weight into the vagina in order to strengthen the pelvic floor. And there’s a lot of exercises that can be prescribed based on the specific issue that you’re dealing with. So like I said, that is done in a private exam room. It often looks sort of like a doctor’s office because there’s an exam table.

The pelvic floor physical therapist does a very gentle assessment where they’re using a gloved hand. There’s lubricant, they talk you through everything. So it’s a very gentle, a lot of permission that is asked to make sure that people who are there feel safe because it can be a very vulnerable time and it is amazing to see as you do those exercises with the support of your pelvic floor physical therapist, how those can start to improve over time, having less issues with urinary leakage, having less issues with stool problems like constipation problems, having bowel movements, leaking gas, and all of that can improve, which is so life-changing for people who are having those issues. So I will say if you were someone listening to this and you were like, oh my gosh, I had no idea that pelvic floor or physical therapy existed, I would recommend, depending on your state, many states will require that you have a referral from your physician.

Some do not. So some you can just literally walk in and do physical therapy on your own. But I would recommend that you go to your primary care physician to your OBGYN and ask them, can I have a referral for pelvic floor physical therapy because I’m dealing with urinary leakage, I’m dealing with constipation, I’m dealing with whatever it is. If you are having that, if I’ve talked about it in today’s episode, please talk to your physician about that and ask for that referral because this can be really life-changing if you are also dealing with chronic excess weight. Losing weight can also be really supportive of your pelvic floor as well, but it can be this chicken and neck thing. And so if you’re having problems like diastasis recti where you have that separation of abdominal muscles, you have a pooch related to that. Sometimes as we heal the diastasis recti, which can often be done with pelvic floor physical therapy or even traditional physical therapy, sometimes does require surgical intervention.

But for people who are able to heal that, it’s amazing because even if their weight stays the same, their body feels so much different for them because it’s no longer pooching out in a way that feels really uncomfortable. So if any of these things resonate, please reach out to your doctor, ask them, say, Hey, I learned about this. I’m interested in learning more about pelvic floor physical therapy. As I said, I think it is magic that any woman should go through. I prescribe pelvic floor physical therapy all of the time, so I talk to my patients about this. If they are having issues, I know that I can support them and helping to lose weight and then in recommending for them to see a pelvic floor physical therapist. So I’ve probably said it a hundred times now, I’m going to say it one more ask for that referral. It is not normal to pee when you sneeze. It is a very common, we all laugh and joke about it, but it is not normal and in most cases it can be improved. So please ask about it. Thank you so much for joining me today. I’ll see you all next week. Bye-Bye.