Hope + Help for Prolapse with Jeanice Mitchell

• OT Pioneers: Intro to Pelvic Floor Therapy  opens Sept 16-20, 2024
• Introducing the Functional Pelvic Practitioner Levels and Certification - for OTPs Craving a Structured and Recognized Path to Specialize in Pelvic Health

More about my Guest (Jeanice Mitchell)
myPFM
myPelvicBra.shop, Integrityrehab.net
Where to find her on social media:  @mypelvicfloormuscles

Jeanice is a board certified pelvic health physical therapist.  She became interested in the field of pelvic health in 1999 after the birth of her first son.  Since that time, she has seen the power of pelvic floor physical therapy in her own life as well as countless others that she has connected with over the years.  She is the owner of a 10 location therapy practice in central Texas as well as a medicare certified home health agency.  In 2018, she started a nonprofit pelvic health awareness initiative, myPFM.com, to reach more people with hope and help.  In 2024, she launched a line of pelvic supportwear clothing. She loves her family, travel, and meeting new people!

Podcast Links:
R2R after baby
https://www.mypfm.com/post/return-to-running-after-baby

OASIS prevention:
https://www.mypfm.com/_files/ugd/a9e98c_3503eb8d31234b7583c1ba5ceea13ccc.pdf
https://www.mypfm.com/_files/ugd/a9e98c_02f9f56c634b4650873419339d6d6002.pdf
https://www.mypfm.com/_files/ugd/a9e98c_821edcd991624a4fba750391d89de340.pdf

POPQ
Third and Fourth Degree Perineal Tears Clinical Care Standard

Free 30 day Menopause webinar with letter to doctor attached

____________________________________________________________________________________________
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Inside Pelvic OTPs United you'll find:​

• Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other.
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• Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.

More info here. Lindsey would love support you in this quiet corner off social media!

Transcript

Lindsey Vestal Oh my goodness. My guest today is Jeanice Mitchell, who is a board certified pelvic health physical therapist. She became interested in Pelvic health in 1999 after the birth of her first son. Since that time, she has seen the power of pelvic floor therapy in her own life as well as all the others that she has connected with over the years. Which is a lot because she is the owner of a ten location therapy practice in central Texas, as well as a Medicare certified home health agency. In 2018, she started a nonprofit Pelvic health awareness initiative called mypfm.com to reach more people with hope and help. In 2024, she launched a line of pelvic support Wear clothing. And I'll tell you what, Jeanice loves her family travel and meeting new people. For anyone who's attended the to Inspire conference, she is there so colorful, usually wearing a pink boa, handing out mirrors for vulva checks and just filled with boundless energy. I am honored to welcome her to today's episode. 

Intro New and seasoned OTs are finding their calling in Pelvic health. After all, what's more adult than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving O.T. in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired, OTs. We are out of the box, OTs. We are pelvic health OTs. I'm your host, Lindsey Vestal, and welcome to the OTs and Pelvic health Podcast. 

Lindsey Vestal Jeanice, I am incredibly honored that you're a guest on the OTs for Pelvic health podcast. gosh. I have been a long time admirer of all of the incredible advocacy you're doing for our shared profession and not only client facing education, but also professional facing, facing education. I loved meeting you at the AOTA. Your booth was by far between the pink boas and the vulva mirrors and the stickers. It was by far my favorite booth at that expo and has been for the last few years. So all I have to say, I'm honored that you're here today. 

Jeanice Mitchell Thank you, Lindsay. It is a pleasure to be here. It was so great to meet you in person this year in Orlando. And we loved being in Kansas City last year. The response that we have gotten from the community has just been incredible. So I'm thrilled to be here and thrilled to be connecting with more Pelvic health OTs and possibly PTs and CODAs and whoever else listens to this. 

Lindsey Vestal 100%. We are a passionate bunch, and so when we meet someone is equally as passionate. We just tend to geek out. So I love it. Well, I got to know you have been a pelvic health for over 25 years, so you're you're one of the first you know, you are definitely a pioneer. And in that time, I know you must have discovered a lot of aspects to client centered care that you love. So I'd love to focus on one particular diagnosis, which is prolapse. Jeanice, what are some of the ways you like to support clients who have prolapse? 

Jeanice Mitchell Yes. Well, so I'm going to just be very, very transparent here. Okay. So one of the one of the reasons why this topic appeals so much to me and I have such a passion to share hope and help on this is that it affects me personally. So after the birth of my first son in 1999, I had some symptoms. I went to a class taught by Holly Herman and Kathy Wallace, my lab partner, you know, is like, I'm not sure what this is. She called Holly over. Holly was like, Yep, that's a cyst, a seal, you know? And so that was the first time that I'd ever heard about really prolapse or sister seals. Now, I had heard about family members having, like, you know, a bladder lift or a bladder suspension or, you know, these kinds of things. But it was a whole new world. And so I found hope and help in pelvic floor physical therapy myself personally. And then I've been able to reach so many people on a professional level. And so I just feel like it's not talked about enough. It's still a very taboo topic and people just don't even know about it. So understanding how our bodies work and being empowered to help make choices either before birth, during birth after birth or even if you haven't had birth, and being empowered about your body and being able to make choices with solid information is so, so helpful for us to live the lives that we want to live. 

Lindsey Vestal So thank you so much for sharing your experience with us and being so comfortable and being vulnerable about it. I it struck me when you were talking actually, we have a very similar journey. I my oldest is 12 years old. It was a it was a significant delivery experience. I had a three and a half degree chair. It was a vacuum assist. So I knew I had some trauma there, but I didn't know I had a prolapse until I attended my first one, Hermann and Wallace course, who was not taught by Holly Hermann, but the instructors were phenomenal. And yeah, right there during that exam is when I found out I had a cyst, a seal, and I was already on that path to to be an pelvic health and to serve my clients. But it definitely invigorated me in a very similar way, like you described, in the sense of what what can we do to be proactive and present and just, as you said, help people understand their bodies and have that sense of agency. So thank you for sharing that. And I got to tell you, I saw so much of myself in that story. 

Jeanice Mitchell You know, it's not that uncommon, right? I mean, one out of every two vaginal deliveries will have some kind of prolapse. So that's a huge amount of people out there in the world that this possibly affects. And, you know, thank you for sharing your story and I love what you're doing. So let's keep doing it. 

Lindsey Vestal Yeah, 100%. Hundred percent. I'm so curious if you kind of think about the future of assessing prolapse and doing best by our clients, how would you what would you like to see Pelvic health Ottesen be trained to assess prolapse. 

Jeanice Mitchell So I think kind of backing up from a big picture standpoint in terms. Of how many people this potentially affects. So we're not just assessing people that are coming in with feelings of heaviness or pressure. Every single person that we're assessing, we're considering this could be a possibility. So every patient, every time we're at least doing a baseline assessment and we're looking at risk factors. Did they have a virtual delivery? Are they hyper mobile? Are they on that spectrum? Do they have AEDs? You know, there's there's so much emerging here that is very, very validating for those of us. I don't know if you're in that category, but I'm certainly hyper mobile and I've been hyper mobile my whole life. A double jointed thumb, you know, like all kinds of crazy things that I could do with my body. But I didn't understand really until probably the last five years that there was a link to prolapse with Hypermobility. So that's validating. But understanding, okay, this is a risk factor. So let's screen for hypermobility of family history. So if you have a sister or a mother, an aunt, a grandmother, some female relative genetically to you that has had prolapse, they may not ever tell you they have prolapse or had prolapse, but did they have a hysterectomy? Did they have a bladder lift? A bladder suspension? Now, a hysterectomy isn't automatically indicative of prolapse, but it could be that they had that is directly due to prolapse. So talking to your family members, understanding their family history, I think is really important. And then as a therapist screening for that and then also looking at age ranges. So is this person perimenopausal or are they entering menopause? And so there's some big changes. And I know we're going to talk about that more later in the podcast, but there are some big changes that happen to the body. And so understanding that these are risk factors. Okay. And then before we dive into actually some pearls or some things that I'd really love to see in the pelvic floor assessment, I think looking at two key concepts of prolapse. And so I just want everybody to close your eyes and visualize the pelvis. So you have the pelvis is kind of like a bowl on the outside of that bowl. Those are the bones, the pelvic bones. And then on the bottom of that bowl, that's your pelvic floor muscle. So literally they connected the front. They go to the back and they go side to side. And so we have multiple muscles that make up this beautiful muscle group called the pelvic floor muscles. And the muscles have different jobs, which is just amazing how we are made that if if one muscle group gets taken out, you know, for whatever reason, we have other muscles within this group that may have a similar function that can help. Okay. So understanding the pelvic floor muscles there and then you have on top of those muscles, you have in most people with vagina, we have the bladder in the front, we have the uterus in the middle, and then we have the rectum in the back. And so these organs are sitting on those pelvic floor muscles and they're very susceptible to stress and pressure. Okay. So those pelvic floor muscles function kind of like a trampoline. So when you cough, that trampoline is meant to descend and then it rebounds back up. Let's say you jump the same thing, trampoline descends, rebounds back up. And so that's how we're designed to function. So pressure from above. And then we have support from below. So if you think of prolapse and those two key concepts, pressure from above, support from below, and we're trying to assess all the things that go into each of these different categories and then address so assess and address. All right. So now once we get into the actual pelvic floor assessment, I have a really powerful quote here. This is from the pop Q guidance put out. I mean, this is from the pop Q guidance, and I'm going to include links to everything that I'm going to be sharing here. So in your podcast, if people want to go click on these links, but this will be the pop Q link. And so what this says, because I've been advocating this for a long time, so I love that this is actually in this statement. So the patient is then positioned where the utmost magnitude of the prolapse is shown and can be confirmed by the patient. Positions may include supine standing or in a birthing chair and a 45 degree angle. And so that alone is huge. How many people have you heard that have gone to their provider and they've complained of symptoms and they were told everything is fine. No prolapse, everything looks normal. And so they're left feeling like what? You know, they're there. They're confused. They're frustrated. They don't know where to go. And so if all providers that were assessing prolapse would keep that in mind, that we want to position the patient where the utmost prolapse is confirmed by the patient. So too many times people are just checking lying down. And it might be in the morning. And many times it's happening later in the day is happening with standing activities That's happening when you know you've been on your feet for a long time. So I love that. All right. So we're going to look at physicians. We're going to look at the pelvic floor and we're going to assess prolapse in different positions. I also want to just back up here. There's two main prolapse assessment tools. One is called the Pop to pelvic. Yeah, pelvic organ prolapse quantification system, and the other is Data and Walker. I've gone through all of Herman Wallace. I've gone through all of the American Physical Therapy Association, you know, series of courses. And then I've done multiple other advanced training. I have never had in any of my pelvic floor training and a teacher that has gone through the full POC Q test. Okay. So what I believe is that most therapists are being trained on the bait and walker and it's very good and there's a lot of overlap and we have some really cool tools with my PFM to kind of compare those two tools. But I think that that's an important delineation to make. Okay. So most of us are doing Bain Walker because when you Google Pop. Q you're going to get all these different things like B.A and all these, all these measurements. And I think, you know, those can be very helpful. But in my experience and what I have seen, not a lot of therapists have been trained on the full pop cube. Okay. So that being said, we're going to we're going to look at position. We're going to look at that externally. So what are we you know, and this is a full like if I was going to talk you through a full pelvic floor health assessment, there'd be a lot more things. So I'm going to just focus on prolapse and the things that we want to look at. But there's a lot more that you can look at. So you're looking at scarring. You're looking at the position that that Perineum is sitting in. You're looking at is there any fecal staining? Is there you know, is there kind of a laxity present or does it appear to be kind of drawn up in in and we're looking at the perineal body link. So there's something called G H. And so this is a measurement that you're taking from the middle of the urethra to the posterior forceps. Okay? And then there's something called p D, and these are measurements within the pop cube. But I think that even if you aren't trained in the pop kit, you should still be doing G, H and PB. So p b is from the posterior four set to the middle of the anus, and then you're adding those two numbers together. And there's actually a scale that says if it's greater than seven centimeters, then they're at risk of developing pelvic organ prolapse. And so that's a really helpful tool to know and it's a pretty simple thing to look at. And you do want them to bear down. So they're doing a vow salvo when you're measuring this. Okay, So we have support. We're looking at movement as well. So have them cough or sneeze. And you're also looking at when they bear down what's happening to that perineal body. And I like to use the issue tuberous cities as kind of a landmark. So you're kind of putting your thumbs on the issue or tuberous cities to visually guide you and then you're having them cough or bear down and looking to see what movement happens with that perineal body. Does it stay above you or caudal to the I'm sorry, cranial to the issue to Bositis Does it come even to the issue of toothbrushes or does it go below or caudal to the issue to Bositis So that's movement. And now we're going to jump into the vagina. So we're looking at width. Okay, so the vaginal opening, how many fingers side to side are you able to comfortably insert? Is it one, is it two, is it three? And then we're also looking at depth at the opening. So again, how many finger widths AP are you able to insert? Then we're going deeper and we're looking at the width at the Levator hiatus. So how many finger widths at the width and then also depth at the later Levator hiatus? And then you're looking at length of the vaginal canal. So on the pop cue, that's called point C, and these are everything that I'm outlining. What I just said from G. H was PB to all of these vaginal measurements. Again, I have never had that in an in-person class. And so I hope that as curriculum is continuing to be developed, that we're incorporating these things because these are going to be really important measurements when you go to possibly determine if this patient is appropriate for a PSA re and what type of history they may be most appropriate for. So we're looking at that. And then we're also looking at muscle function. So baseline resting, tone intention. We're looking at strength. We're looking at endurance, We're looking at coordination. We're looking at return to baseline. We're looking at symmetry side to side. So do you feel the same? Or does it feel like maybe there's some muscle missing or like pretty kind of Gucci and soft area? If you think about that pelvic floor being that trampoline and the trampoline has those little hinges that attach to its frame. Right. The pelvic floor muscles are attaching to the frame of the pelvis in a very similar way. And so if some of those springs or broken loose, that is called elevator avulsion. And that that's a pretty common thing. In fact, I'd love to do another podcast, just elevator versions but especially anterior like where the pelvic floor muscles that pubic rectal is attaches at the back of the pubic bone. Are you feeling kind of like there's an absence there? There is some research on this to say that that's a fairly unreliable way to determine levator abortions, and I would agree with that. And you're going to have a lot of provider differences, you know, a lack of inter rater reliability. But I think it's still something to use that finger for, Like, let's just assess it. And the more pelvises you feel and the more muscles you feel, the more confident that you'll get in that. And then we're also feeling the muscles inside. So palpation is there is there pain? Is it increased tension, any abnormalities? And then the last thing that I would really say under the vaginal assessment here is tissue health. So is the tissue, is there good lubrication? Is the tissue fluffy? What color is it? Does it bleed easily? Does it tear easily? Is it fragile? And so that's an important piece in the management of pelvic organ prolapse and in Pelvic health in general. And the patient may not have gotten any feedback on that from any other provider. So you may be the person that connects that person with their key solutions to living the life they want to live. And then the last section here is get them up, have them get dressed, and we're doing some functional assessments. So we're looking at strength. We're looking at hip, we're looking at gait, we're looking at hopping. There's some really, really good assessment tools out there. What I like the best and what I've seen standardize the best is return to running postpartum. But I use these tests even if they aren't postpartum. Okay? Because I think that they're really helpful tools that give us some objective information about how, you know, how much in terms of symptoms and what people can do. And it's a really helpful way to target strength work and target where we need to work with them. So I'm including the link to that as well. 

Lindsey Vestal Amazing. Okay, now take a breath. Take a breath. Take your breath. I'm going to have to listen to that a few times because Janine's you just provided so much incredible knowledge there. And I will also say extra, extra, bravo to you, because so much of what you talked about in terms of the assessment is it's a very visual thing. Even you know, everything from the way we do it, but also the scoring of it and and everything. And so I just wanted to say that you did it incredibly clear and articulate job of of helping us understand that and realizing that there's so much to it to do right by our clients. So I just yeah, I just want to pause and thank you and also say to you that I'm going to listen to it several more times. 

Jeanice Mitchell Thank you. Thank you for that. If you could only see how my hands are moving, I'm a very active talker. 

Lindsey Vestal I will 100% attest to that. After watching a lot of your videos and meeting you in person. It's so much fun this. I have some super exciting news for you. O.T. Pioneers ensured a pelvic floor therapy is opening for enrollment January 13th through the 17th, 2025. This is your chance to dive into a 100% online course. With lifetime access, you'll get five group mentoring calls with me and two free months inside our off social media private community Pelvic TPP's United. Plus, we're hosting an optional in-person lab in Cleveland on February 21st and 22nd. Please come join over 1500 other voters who have already taken the leap. I can't wait to see you inside OT Pioneers Enrollment January 13th through 17th 2025. You know, you you mentioned a prolapse risk rate. It increases greatly when we have relatives that have had prolapse. And that's definitely that's definitely true in my family as well. What advice or perspective do you have for for people in your life or for relatives in our life when they reach the childbearing phase of their lives? 

Jeanice Mitchell Yes. So I have two daughters and I have multiple nieces. And so this is something that I'm sharing with them. I'm talking about. And, you know, I have to say, this is a funny story. So let me start with this funny story. My daughter has a G, so she's 22. She's in college, and she walks out to her jeep one morning and she felt like like the engine or whatever is underneath the jeep was lower than it be. And she's like, Mom, I think my jeep has prolapse. So I love that it's on her mind. But I also don't want to be create fear for them. And so it's balancing that. And so I try to talk about it in terms of, yes, there are there are bad things that can happen, but there are things that we can do to help reduce the risk that they that they can happen. And so I'm going to go over some of these things here. I have a little sheet here with multiple tips and feel free. I know I really don't pause very much, but please interrupt me. Like if you if you want me to elaborate on something, just just jump in there, please, Lyndsay, because I don't. Okay. So I know from listening to interrupt me and I want you to. Okay. All right. So, number one, knowing your risk for pelvic organ prolapse and also Oasis. Okay. So an oasis tear is a is a severe perineal tear. That's a third or fourth degree tear. And so for those of you that may not know what that is or just want a little refresher, if you visualize the perineum, you're looking at the perineum. So you have the pubic bone on front top and then the tailbone in the back. And then you have the vaginal opening. And then you have the perineal body and then you have the anus. So a grade three tear is where the perineum is tearing all the way into the external anal sphincters fibers, those fibers that wrap around the anus. And then a grade four tear is where it's tearing all the way into the inner rectum. And so, as you can imagine, those tears are very severe. They're very difficult to recover from as you as you personally have shared. Right. And so there's a huge push in many organizations to reduce the incidence of third and fourth degree tears. There's a fantastic set of guidelines that were released, I think it was in 21, and they are from Rann's colleagues at the Royal Australian and New Zealand College of Obstetrics and Gynecology. Okay. And so they created this amazing set. It's a it's a clinical it's a clinical care standard about how to reduce third and fourth degree tears. And I would love to see something like that, really this in all countries in the world. But a lot of this information that I'm going to share today is coming from that. And I have linked that that document so people can read it for themselves. It's 80 plus pages, but it's chock full of amazing, amazing information. And they have so many references in there. So if you're a research person and you want to know where this came from or where this came from, this is the document for you. All right. And so it's kind if you visualize. So I've had this question. Does a third or fourth degree tear increase your chances of having prolapse? And there isn't any research that I have seen that says directly, Yes. But it's kind of like a domino effect. Okay. So you have let's say you have a third or fourth degree tear that increases your risk of elevator avulsion, which is that deeper pelvic floor muscle tear. And what that levator avulsion does, remember where it attaches at the pubic bone on the backside of the pubic hair were the muscles attach there. And those springs have become detached. It can be bilateral. It can be unilateral, can be small. It can be big, minor major. There's a lot of different types. Okay. But regardless of the type that's going to increase the width of the Levator hiatus, this levator hiatus is meant to expand when the baby's head comes through with the vaginal delivery. But we don't want it to stay expanded because we want that levator hiatus to narrow back down. And if the pelvic floor muscles have been torn or. Ruptured then is not going to reduce and that's going to increase the risk of pelvic organ prolapse. So domino effect, oasis tear increases, levator avulsion, risk, levator of those are risk increases, prolapse, risk. So if we can help reduce the risk for third and fourth degree terrors, ultimately we may help to be able to reduce the risk of pelvic organ prolapse. Elevator ablation. 

Lindsey Vestal Yeah. Yeah. I, I really resonated with so much of what you said. But in particular, I think that the balance between education and confidence, not fearmongering, really resonated with me in terms of my question regarding like how to support our daughters in their childbearing phase. Because, you know, it is a topic that is really riddled with so much fear, misunderstanding, and that always lends itself to, you know, not being, not being in a place of agency and advocacy when we're when we're just scared like that. And of course, Dr. Google doesn't do much to to illuminate these things. Right. So I really, I, I love that story about the Jeep and your daughter. 

Jeanice Mitchell Yeah. But, I mean, I love that she actually knows what it is, right? Yes. And that she's going to want to do things to help prepare her body to reduce the risk that that happens. 

Lindsey Vestal 100%. 

Jeanice Mitchell So there are a few risks of pelvic organ prolapse. We have we talked about it a little bit earlier, Hypermobility family history and then also birth type. So a vaginal delivery does increase your risk versus a C-section. That doesn't mean that you have to have a vaginal delivery to have prolapse because there are people with prolapse that have never given birth or that have had a cesarean delivery. But a vaginal delivery does increase your risk. And there's other risk factors as well. We're going to jump into Oasis because we don't have time to cover every single thing. And there's a I still have a lot of notes. I'm only on page two, so I'm going to go pretty quick. So then in terms of the Oasis injuries or the three imports of Rita's, we have aged, so the older. So we have Aids. If the person that is giving birth is older, that does increase the risk birth, weight of the baby head, size of the baby. And then perineal body length. So there's been some research to show that South Asians have higher risk or people from South Asia. I have created infographics on all the things that I'm about to share in terms of reducing the risk of third and fourth degree terrors. And I've also included those as links. So there's three infographics that I really want people to download and share print, share on social media, share with your patients, put it on your website like I I've created these with my PSA and for you to share them. So the first infographic is B for Labor. So this is during pregnancy. And so we're going to go over some different things during pregnancy. And then we have some ways to reduce the risk during labor and delivery. And then we have some things after birth to do as well. So first off, before giving birth, we want you to prepare. There's something called pelvic floor reserve. And so this is basically building up your pelvic floor, muscle strength, bulk healthy tone coordination, making those muscles as healthy as you can before going into a stressful event. So if you think about this in terms of like an ACL injury. So if somebody has an ACL rupture and they're going to need surgery, a lot of times they are going to pre hab where we are working with them to build up their strength, build up their proprioception, build up the things that they need to do, and then that's helping their recovery. And so the same thing exists here. Building up that pelvic floor reserve may help reduce symptoms during pregnancy, but also reduce your risk of tearing during labor and also potentially help you improve and heal postpartum. So pelvic floor muscle training. We have perineal massage. We have practice birthing positions, practice, breathing. And this is something that I really think if you have the resources to do this would be birth preparation with a du lac. I never thought of that when I was pregnant. I don't think that it was a really big thing back when I was giving birth. But it is, you know, an exploding area of the birth world. And I think having that person there with you to help coach you and guide you beforehand, developing that relationship and then during birth, having that relationship and that advocate and then after birth, helping you get the things that you need, I think can be a really incredible thing. 

One 100%. In all of those ways. It just it helps us feel that when we're empowered and we have that support and we have that ability to use our voice and to exercise all of these things that we know ultimately lead to a calmer nervous system state and being able to be mind and body be prepared for labor and delivery experience. I mean, I just can't emphasize that enough. Thank you. Thank you for for all of that. 

Jeanice Mitchell Yes, go ahead. 

Lindsey Vestal No, go ahead, Denise, please. 

Jeanice Mitchell Yeah, A couple other risk factors. There would be also if it's your first baby. And then if you if it's not your first baby, but you had a severe tear with your first baby, then you are at a higher risk subsequent for subsequent vaginal deliveries. 

Lindsey Vestal Okay. Yeah. Yeah, that makes sense, right? Absolutely. 

Jeanice Mitchell So I encourage people to discuss these with your provider. Like literally print these out, take them to your birth provider and talk about them, you know, because we can be your advocates, we can share the information, but it's you feeling comfortable with that birth provider and, and discussing, you know, these various these various things. So now we're going to be open to options. A lot of people go into their pregnancies and they have a birth plan and they really, really want it to go a certain way. And I would just encourage people to be open and to be flexible before birth and and during that labor. So talk that's again, where you really want to talk to your birth provider and look at your risk factors. Look at what your what your goals are. Talk to your birth provider. You know how many all birth providers are not the same, right? All auto mechanics are not the same. All physical therapists, not the same occupational therapists are not the same. And so really getting with the birth provider that you can connect with and that you feel confident with is really, really important. And I would. Also say be open to a cesarean delivery if you have high risk factors and if your birth provider is recommending it. Because I would. There there's a lot of debate on social media and online because you have some people in the camp of of a vaginal delivery at all costs and then you have some people in the camp of no way I want to I want an elective cesarean. I don't want to even run the possible risk of anything happening to my pelvic floor. Okay. Which is it? That doesn't guarantee it anyways. So I think it's really important to be in the middle and just be open if you want that natural vaginal delivery. Great. Let's see. Do everything that you can. But if you're lining up where it might be better for you to have a cesarean delivery because you have high risks and your birth providers recommending it for a variety of reasons. Maybe your safety, maybe the safety of the baby. Just be open and be flexible. 

Lindsey Vestal Yeah. Yeah. 

Jeanice Mitchell The last thing that I want to say in terms of preparing for birth and what I would tell my daughters is this. Once you have your baby, if you had a vaginal delivery, ask to have a rectal check. So your check so your provider is inserting their finger into your rectum to check to see if you had a severe tear. Because sometimes the tears go undiagnosed. And so that can be so much more time and challenge to heal if it was not assessed in court. So the recommendations, the trans core recommendations are that you have to check. So you have your birth provider that's trained to do that check. And then you have another person that's also trained. So you have two people checking you. And I think that that's phenomenal. And that would also be something to discuss with your birth provider at those prenatal appointments. Right? Like you don't want to just pop this in to the end, you know, after the baby. I think that having those guidelines, requesting that, seeing what their comfort level is and taking it from there. But that is what I'm going to advocate for my daughters and my nieces and anybody else that wants to hear. 

Lindsey Vestal 100%. What a overlooked. You know what? And so many of these checks aren't happening anyway. Right. And we're often not getting the care that we need postpartum. But I would say I don't know of a single person. I have served any of my clientele who has gotten that check, even even myself, who had a three and a three and a half degree chair that went to the to my rectum. Right. And so, yes, 100%. This needs to be such a campaign out there because we know the risk factors associated with fecal incontinence. And so absolutely getting ahead of that. Thank you. That's I'm incredibly passionate about that. And I think we need to do an entire campaign just on that, because. 

Jeanice Mitchell Let's do it. 

Lindsey Vestal I know when we when we met in person, we had both shared that we are very similar in age and both going through perimenopause. 


Lindsey Vestal I'd love to turn to to this chapter of our lives. Right. So we I'm speaking a lot about pre and post natal. Let's talk a little bit about perimenopause. What do you think everyone should know about prolapse and menopause? 

Jeanice Mitchell Yes. So I do just want to say like I was maybe a little sarcastic when I said you were here, but what's the alternative? You know, we're here and I feel so good and I feel so excited to have this information that other people need to know. So let's do this. All right. So going into menopause, preparing your body, so knowledge, exercise, cardiovascular exercise, weight bearing, exercise, strength building for your whole body, and then pelvic floor muscle training. So like we talked about with pregnancy building, that pelvic floor reserve building that pelvic floor reserve as you're approaching menopause. And I'm not I, I have some resources and tips for pelvic organ prolapse in terms of managing pressure and optimizing support. Kind of like we talked about at the beginning of the podcast. And I'll link that. I'm not going to go into all of those tips. I'm just going to say that menopause is a risk factor for pelvic organ prolapse symptoms, okay? So that many people may have had a baby and they may have had ten, 15, 20 years of being asymptomatic. But then as they're approaching menopause or in menopause, they're like, man, I have this. I have. This. You know, I have this vegetables, I have heaviness, I have vaginal dry dryness. I have all these pelvic health symptoms. Okay. And so that doesn't mean that you just developed prolapse. The prolapse may have been there the whole time. You know, I think the stats are like only 10 to 15% of people are symptomatic. So just understand, you probably didn't do anything right now that caused this to happen. You likely had some laxity in your vaginal walls, you know, since since a vaginal delivery. And that being said, you can definitely have symptoms without having a vaginal delivery. All right. So now okay, so we're preparing, right? Knowledge, exercise and then pelvic health good habits. Go to my pfm.com. We have a ton of downloadable handouts on a happy bladder. So that includes like happy bladder tips and happy bowel. Good tips for the bedroom. So orgasm tips. And if you're having painful sex, there's a lot of things that can be done and then also be on the bedroom. So in daily life, travel, work, you know, having good pelvic health habits and good pelvic floor muscles can help in all these areas. And then the last piece in the prepare part is hormones, because that's the big thing that's happening, right? Our estrogen is dropping. Our hormones are not what they were before. And so navigating the hormone piece and I'm going to be very transparent here that I'm 51, I'm still having a regular cycle like the definition of menopause is like 12 months, 12 consecutive months of no cycle. I think over the last year maybe I've had two cycles that were a little bit spaced further out than I thought that they would be. But other than that, like I'm still, you know, kind of in my regular routine. But I'm definitely I know I'm in. Perry Right. And I'm approaching menopause. And so my estrogen is dropping. And understanding the hormone piece, there's a lot of debate out there about hormones. I don't consider myself to be the ultimate expert in all things hormones, but I will say that there is too much fear around estrogen, whether using it locally on your vaginal tissue and your your vulva and your clitoris, or whether you're taking it, whether it's systemic, whether you're taking a pill or whether you have a patch. There is a study that has been debunked. Okay. The study that said estrogen was bad has been debunked. And so I have a handout on this, too, is not quite ready. It's actually a letter to a provider and I'm going to read a section of it in a little bit. But basically, this handout will have QR codes. It'll have a written statement. You can take this to your provider and literally, Lyndsey, I have an appointment this coming Tuesday. And I and that is the reason for this appointment. I had a webinar last week on pairing on menopause and hormones, and so I had a couple pelvic floor physical therapist on here that did a fantastic job with advocating for all things related to hormones, right? And so I'm going to share some of their resources, but they were really the catalyst. I'm like, I need to get this letter and I'm going to upload it to my pfm.com was shared on social media. It'll be linked here. And so we want you to give that to your patients. We want you to give that to your provider so you can advocate for yourself as well. And, and there's links to help them feel better about prescribing hormones. And there's research. Okay. So that so we have. 11 common conditions that are related to estrogen. Okay. I'm going to read this sample letter, just a little excerpt of this. So 60% of women first of all, the letter starts off as dear trusted provider. I'm having these symptoms. And so then I break it down bowel, bladder, sexual health and so forth. Okay. And so then underneath that, there's also a section where they can check some of the other common conditions that may exist in menopause. Then right under that, here's this statement. 60% of women in menopause suffer from multiple disorders at once due to the fact that I am in menopause or perimenopause. And many, if not all of my health issues may be connected to changing estrogen levels. I am respectfully requesting that I be evaluated for systemic hormone replacement therapy and local vaginal estrogen. I'm excited about the possibilities and would love for you to help me explore these options. I know you want what is best for me. There is quite a bit of research and information on hormone replacement therapy that you might find interesting. Please check out page two for links and summaries. Okay. So we want our providers to be our advocates. We want them to help us navigate this. And so some of the common 11 conditions are cardiovascular disease, musculoskeletal disorders like osteoporosis and osteoarthritis. Cancer. Breast. Lung. Colorectal. Ovarian. Cervical. Cognitive decline. Alzheimer's. Dementia. COPD. Diabetes. Metabolic Syndrome. Depressive Disorders. Vasomotor. Symptoms like hot flashes, night sweats, migraines and sleep disturbances. And so they'll check their pelvic health symptoms and then they'll check the the other things that they may be having. And then we're going to give this to the provider. And so I'll check back in with you, Lindsay, and I'll give you an update on how it worked with my provider, because I'm anticipating, honestly, obstacles. 

Lindsey Vestal Well, and I it's unfortunate because I think that I that's exactly what I was thinking as you were talking. I was like, ooh, I wonder how that's going to go. But you know what? You being this advocate for yourself, setting that example and also creating these materials that we can all share far and wide. This is how change happens. This is how change happens as we continue as a collective community and raising our voices and demanding better. And I and I think it was written so articulately and respectfully and and and it was awesome. And I just also have to say, yes, you are just like fasting. All of the important missed out there because it has long driven me so crazy how that very un respectful study has scared everyone off of estrogen. And it just it's such a powerful ripple effect that I can't tell you the number of times I sit across from my clients, like sharing with them how it's actually, you know, not not, not really evidence based criteria that we should be using to make these decisions about. So you are just continuing to raise the bar for us all. And I just I'm really in such and I have so much respect for the work that you're doing. 

Jeanice Mitchell Thank you so much. I mean, it really was just like last week we had this webinar, I had people on there. It was just like me and this needs to happen and I need to do this for myself. Like I, I been thinking like, yes, I mean, I have, I have like a estrogen cream and I love it, right? I love it. But I haven't even talked to my provider about doing something systemically. And I know that it's a good thing. Right? So it's just that catalyst to get me going. And if this is effective, I'm honestly thinking that this might be a good idea for other things too, like perineal tears. Like if someone has these risk factors or pelvic organ prolapse, like letters to the provider, like hi provider, we know you want what is best. I'm having these symptoms. Can you please help me navigate X, Y or Z? And here's the research. 

Lindsey Vestal Yeah, exactly. Exactly. Let's do this. And you know, it's very clear from from everything that you're sharing with us just what what how passionate you are about education. And so, you know, for those who may be less familiar with my pfm.com. Right. It's it's an incredible pelvic health awareness initiative. I would love to hear from you what your favorite aspect of this platform is and really like what has surprised you throughout the years in offering this support for everyone? 

Jeanice Mitchell Yes. So I'll just back up and give you a summary of my PFM. So it's a nonprofit pelvic health awareness initiative. I started it in 2018. And funny enough. There wasn't even a website at the beginning, of course. Right. I'm just starting out and I make this YouTube video and the YouTube video has stock images. And I actually paid a narrator to do the voiceover narration because I didn't want my voice on it. I didn't want my picture on it. So I've come a long, long ways in six years in terms of, you know, putting myself out there. So I think that that actually was a surprise to me, too, like where I've come in terms of my comfort level with, with, with sharing publicly, because you really don't know what my mom says. She's like, I'm just worried about your safety. Like, there's so many creepy people in the world and dangerous people in the world. Like, I'm just worried about somebody doing something to you. And I get that. And there was, you know, I think a little concern. And there have been weird messages occasionally, but you just ignore them and you just keep moving on. And I haven't ever felt threatened. So my fear form.com is the the awareness initiative. So we have on there a tab called handouts and solutions. And so if you go there, you can drop down that menu and you'll see is categorized by symptoms and body body areas. And so we have like bowel bladder prolapse, pregnancy, postpartum and multiple categories. So then you click on a category and then you go there and you'll see kind of all kinds of resources. There might be PDFs to download that you can share. There might be social media resources that you can download and share in your social media account. And the really cool thing is they're they're multilingual. So we work with volunteers and this is something probably it's 1 or 2. My first or second favorite thing about my plan is that I'm working with volunteers all over the world to create these resources in multiple languages, and then we upload it to my pfm.com so anyone can download it. So I'll create a handout on prolapse, right. Or on perineal tear prevention, and then we'll give it to our translation groups and they'll help us. And when I say us, I work with a really wonderful graphic designer that isn't volunteering, but I think he actually does volunteer. I know that everything that he's doing, he's not charging me for everything he's doing. So that's really cool. That's a resource. And then we also have my PFM Academy, which is a platform for continuing education in advanced learning. So we have three live webinars each month that we want you to come on my PFM Academy and teach. And then we have a library of over 200 recorded ones because we started my PFM Academy January 2020. Do you remember what happened in 2020? Covid hit? And so we started in January, and then by March, April, Covid was in full swing. And so it was really a blessing to be able to have this ability to connect with people and to share information. And it keeps me on my toes and it keeps me fresh and current. Like I was saying, like that webinar last week, like, man, I need to do this. So it's pretty cool. 

Lindsey Vestal Amazing. Is there anything else that you would like our audience to know about how they can follow you? You know, get it get to get to learn more from your incredible wisdom. 

Jeanice Mitchell You know, I think those are the big areas for providers. Well, we have social media accounts with a lot of resources. And so I understand that being a clinician is a busy time. So if you're somebody that seeing patients regularly, how much time and energy do you really have into creating content for social media? Because it really does take a lot of time and effort. So I want you to know those resources are there. We're here to support and help. And if you have an idea on a post, on a video, on anything, a resource that you'd like to see that we don't have. Send me an email, send me a direct message. I'm on Instagram at my pelvic floor muscles. I'm on YouTube, my pelvic floor muscles, my pfm.com. I'd love to hear from you because I think that that's the number one thing I love about my fm.com is connecting people with hope and help, whether it be providers. So helping them help more people or whether it's direct patient contact through social or through events and that type of thing. 

Lindsey Vestal Oh yes, 100%. I love that help and hope that our two of the most powerful words and you are 100% providing that. Denise, I can't thank you enough for being a guest today. I'm going to include all of the ways people can find you in this show notes. Huge, huge gratitude to you. 

Jeanice Mitchell Thank you so much for this opportunity to connect with you and your audience. And I look forward to many more collaborations together. 

Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast.