E33: Pelvic Floor Health with Dr. Katie Taylor

Is urinary incontinence after childbirth just something moms have to live with? Not according to Dr. Katie Taylor, a pelvic floor physical therapist from Winston-Salem, North Carolina. On this episode of The Ordinary Doula Podcast, Dr. Taylor debunks common myths around postpartum pelvic floor issues and shares her compelling journey of starting a practice amid the COVID-19 pandemic. She sheds light on the often-overlooked importance of pelvic floor health, from pregnancy through postpartum, and tackles a variety of conditions such as incontinence, painful intimacy, and hemorrhoids.

Dr. Taylor guides us through the nitty-gritty of a pregnancy preparation program tailored for individualized care from 20 to 40 weeks. Listeners will gain a clear understanding of what to expect during a visit to a pelvic floor physical therapist, with detailed explanations of both external and internal evaluations. Dr. Taylor emphasizes the vital role of muscle function and relaxation techniques in labor, and how personalized treatment plans and home exercises can make a world of difference in a healthy pregnancy and postpartum recovery.

Finally, we dive into the critical need for postpartum pelvic floor therapy, challenging the misleading belief that the six-week medical clearance means full recovery. Dr. Taylor outlines the holistic approach necessary for better healing, highlighting the impact of factors like genetics, lifestyle, and physical activity. She encourages women to seek support, feel empowered, and take charge of their health by addressing even the subtlest signs of pelvic floor dysfunction. This episode is a treasure trove of insights and practical advice for better women's health and recovery, making it a must-listen for anyone invested in maternal well-being.

Special Guest: Dr. Katie Taylor 
https://taylorptandwellness.com/ 

Visit our website, here: https://birthlearning.com/
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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier
Voiceover: Ryan Parker

Transcript

Speaker 1: 0:10

Welcome to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice Helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

Speaker 2: 0:47

So welcome to the Ordinary Doula podcast. My name is Angie Rozier, I am your host and we are sponsored by Birth Learning, and we have a very awesome guest with us today. Her name is Dr Katie Taylor. She lives and works in Winston-Salem, north Carolina. She's one of my favorite practitioners to refer folks to and I have totally enjoyed my interactions and what I've learned from her over the years as well about pelvic floor physical therapy. So, katie, can you give us a little introduction about yourself and some background?

Speaker 3: 1:16

Thank you. I'm so excited to be on your podcast and chat with all the mamas. My, as she said, name is Dr Katie Taylor. I am a pelvic floor physical therapist. I own a Taylor physical therapy and wellness, which is a holistic women's health practice in North Carolina. So I I think you said a little bit about myself.

Speaker 3: 1:38

To start with, yes, please, and in this profession, I started this practice in 2020 as a I guess you could say product of COVID, because I had recently moved back to this area.

Speaker 3: 1:53

Literally the week North Carolina shut down and was supposed to start up a women's health practice with another group in town, with another group in town but with young children said nope, that's not going to happen, and ended up staying at home for gosh, probably six months with our kids and and that time just really, I say out of a lot of Jesus and wine discerned that there was a big need in this area for women's health, and so I began in November of 2020 with what I call my little tissue box room, with just me thinking I might have just a few people come and see me. And then we've really flourished and have multiple clinicians and just recently purchased our building and moved in September, and so we've got a lot of different things that we offer and so, yeah, I'm really passionate about helping women and lots of different life stages, and so today we'll dive into certainly the perinatal specifics of what we do and why it's important and every woman needs it Cool.

Speaker 2: 2:59

Very cool. I love what you're doing, and what awesome growth in just a little bit of time.

Speaker 3: 3:04

It's wild how God does things in your life, right, I mean? I was like blown away. I still am. I'm like oh my goodness, it's only been three years, and look where we are.

Speaker 2: 3:13

That's awesome. I love it. So tell us a little bit about, for those who may not know what pelvic floor physical therapy. Why it's good during pregnancy.

Speaker 3: 3:24

Yeah. So I will start by just briefly chatting about what the pelvic floor is, because I think that's gotten a lot more trendy in the last five to 10 years and it's a lot more on social media and so women are like curious and learning more about what they, what we have. So our pelvis is basically got this little bowl of muscles in the base of our body, right in the middle from our pubic bone back to our tailbone, and it's like a little hammock that supports our uterus, our bladder and our rectum, and so that is what's referred to when we hear pelvic floor. And so pelvic floor therapy is a specialization it's a little niche within physical therapy that really works on addressing issues surrounding that part of our body, and so we think of it as bladder health, bowel health, sexual health. They're sort of big buckets of function that that falls into, but pelvic floor therapies as an example, I'll touch on what our practice sees.

Speaker 3: 4:32

We see women only. We're specific for women's health, but that can be a wide range of things across the lifespan, so bladder health being one of those things I just mentioned. So we see incontinence, urinary urgency, frequency, recurring urinary tract infections. We see bladder prolapse In the context of pregnancy and postpartum. This is a very, very common issue that women can develop or if they had it existing, because it can happen outside of pregnancy that can often be exacerbated, and so really emphasizing that yes, this is a really common symptom that women can have, but very much not normal and very much things that we can do to help with that. With regards to bowel health, with regards to bowel health constipation, ibs, hemorrhoids, incomplete emptying we see a lot of women have bowel dysfunction, also something that we see a during their pregnancy and into postpartum, often a product of our iron in our prenatal supplements. Bowel changes can happen in that lifespan very commonly as well, but also, we like to say, not normal lots that we can do to help that. And then sexual dysfunction is something that we often will see as well. Women can have.

Speaker 3: 6:04

Painful intimacy is a very, very common thing women can experience again outside of the context of pregnancy, and that is a product often of perineal scar tissue, tension in the pelvic floor muscles, vaginal dryness and atrophy. That can happen in the context of postpartum, especially if we're breastfeeding in the context of postpartum, especially if we're breastfeeding in the context of menopause, and so we really love to help women get to a space where they feel happy and satisfied and whatever that looks like for them sexually. But just knowing that it's not normal for sex to hurt. And unfortunately, women are often told just use lubricant, just drink more wine, whatever it is from their poor medical advice they're getting or reading online, right, and so, yeah, those are, I would say, three big buckets of things that we treat when it comes to the bladder, bowel, sexual piece.

Speaker 3: 6:57

But we often will see women in terms of just pain. So a lot of pelvic pain will be common with things like endometriosis, interstitial cystitis, a condition called vaginismus there's another condition known as vulvodynia and even orthopedic things like tailbone pain, hip pain, low back pain. These muscles attach there and are often the root cause of why women have those orthopedically seeming pain. And so it's really important when we have patients with those symptoms and complaints that we're really looking at pelvic alignment, we're looking at hip strength and glute strength and posture and really the entire body and not just the pelvis.

Speaker 2: 7:38

Yeah, Very cool, so you can get pretty specific with that. Addresses other issues as well, right?

Speaker 3: 7:44

Yeah, okay, very cool. You know, most women out of everything that I just talked about, most women that have a form of pelvic floor dysfunction have pain in one other area of their body. So we see a lot of women that have a chief complaint of something pelvic floor related, like incontinence or painful sex or constipation, and they have an issue with their feet or they have jaw and neck pain, and so we really see that women that experience pelvic floor issues often really have issues in other areas of their body as well okay and you can address those.

Speaker 2: 8:17

So excellent, okay, cool. So tell me, um, and and you have a sense of I totally have noticed what you said that this is picking up some steam and some popularity pelvic floor PT over the last few years. But how many people know about it? Like, do you get most people before? Do you get a lot of people after, when they're like, oh, wow, I need some help? Or like, tell me how people are aware of this. Yeah, tell me how people are aware of this.

Speaker 3: 8:42

Yeah.

Speaker 3: 8:48

So unfortunately I don't think it's mainstream that most women, if they know about it, it's because they might've seen one or two videos on their social media, but they certainly haven't personally been to a pelvic floor provider.

Speaker 3: 8:56

Most women that are in our office have had issues for a while and have been to multiple providers, or they've just had their symptoms for a long time before they finally will have searched enough online and found us, or they have had a girlfriend that's been and their friends are like you've got to try this. And for me it can be really frustrating because women will have, you know, suffered with their issues for quite some time before they end up in our clinic and then we can really provide effective relief in a pretty short amount of time. And they get like pulling their hair out, like why wasn't I told about this or why didn't I get here sooner? And so to us it seems quite obvious, but unfortunately it's not a mainstream thing. I think physicians often just don't understand what we do, or women are just they've had this reading online or telling, oh, just do Kegels and that's the answer and that's just so not what they need to be doing, and so I would say that's a long way of saying no, it's still, it's not mainstream.

Speaker 2: 10:06

Okay. So there's a lot of work to do for awareness, really, how people be aware. So if people are aware which would be ideal for when, during a pregnancy, if they're preparing for labor, for birth, whether it's their first baby or their third or fourth, when is an ideal time to get some care?

Speaker 3: 10:32

Yeah, great question. When you jump or leak, when you sneeze, you already are constipated or already have again some form of pain issue. I would say right away, the sooner that we can be addressing these things and honestly even backing up prior to that, if we can have someone come in in a pre pregnancy conception even we'll see women during their infertility treatments. Addressing existing issues is key and doing that sooner than later really helps us to better manage that and give us more time to shift into a birth preparation focus and mindset, versus like addressing an existing issue.

Speaker 3: 11:14

We can see we've seen women as soon as they find out that they're pregnant because they, for example, relaxin the hormone. Relaxin peaks has its first peak at nine weeks during pregnancy and so women will often start to develop pelvic pain, pubic symphysis dysfunction, for example, really early in pregnancy. And while we don't do internal treatment that early, we have a lot of things that we can do externally pelvic alignment, core things, stabilization to really address that. Secondly, if we're not having any issues we don't have current symptoms, we are purely wanting birth preparation being proactive, et cetera then 20 weeks is where our pregnancy prep program starts at our clinic, so we have time to get to know the mom what her birth plan is, go through a lot of labor and delivery education um, and help prepare her still.

Speaker 2: 12:14

Okay, and tell me what. If you start at 20 weeks with someone, how many visits might they be looking at until they get to 40 weeks?

Speaker 3: 12:23

Yeah, like what's ideal and maybe it's different for every every person, but yeah exactly so if we have that again no symptoms, just regular pregnancy like regular pregnancy stuff. So our pregnancy prep program would be kind of what that I would say would be modeled after. And that's three visits and so it's typically 20 weeks, 30 weeks and then again once we're term at 36, 37 weeks. That's a time where we first visit, get to know your medical history, your birth plans and your body, so getting a good assessment.

Speaker 3: 12:58

Visit two is diving into all of the things of labor and delivery and breathing and pushing positions, et cetera. And then visit three is a early postpartum sort of check-in where we go from the minute you have baby until six weeks when you come back to see me. This is what we're doing and so that is something that we will have a three visits. If we have someone come in and they, like very commonly, are having like a lot of sciatic nerve pain or a lot of pubic symphysis pain or we're having a lot of incontinence, then we start visits weekly to really make sure we can nip those symptoms in the bud, get those resolved, and then we'll taper down as we're able to. So I would give that a big. It depends.

Speaker 2: 13:45

Absolutely. Every case is a little different. So tell me what does a visit look like, if we're doing three or if we're doing more when needed, what can folks expect when they come? I think in the clients I've talked to they are kind of nervous about this. They're like, okay, pelvic floor PT. Like what are we doing? What am I? What's expected in a visit? What can I anticipate? So tell us a little bit about what a visit might look like yeah, totally it is.

Speaker 3: 14:10

It's a very intimate part of our bodies and it's something that can be very vulnerable for women and very intimidating, especially if we've had any type of trauma before and we are just very nervous about that, or if we've had a poor OBGYN experience or a birth trauma, and just the idea of having anyone look, assess, treat your pelvis is just really anxiety producing anxiety producing. I think that it's important for women to find a provider that they really feel they can be relaxed and vulnerable with and they jive with. So that's, I think, a big thing. First, and if you don't spoiler alert, there's more people out there.

Speaker 2: 14:49

Keep hunting.

Speaker 3: 14:50

Yeah, when you come in our clinic you're going to sit down with your provider one-on-one. Our treatment rooms are very not medical, so they can feel a little bit calmer and relaxed. So we have time to just talk first and addressing like whatever they want to tell us that day, whatever symptoms they're having, and then we talk about okay, well, what are we, what are we comfortable doing? And so that for me, I usually am getting out my pelvic model, talking about what the pelvic floor is and we really want to make sure we can understand the ways to look at it. So I always say first is just visually. I want to look at your belly, I want to look at your pelvic alignment. If we're comfortable with the pelvic floor, then I want to look and see what your vulva looks like, what your urethra looks like, what your perineum looks like and just what the tissue quality is there, and then we can look at things externally. So everything I'm talking about is just with my hand finger, no speculum, no equipment. I'm on the table with you. You're not up in stirrups or anything that's kind of intimidating, like again and pap smear, for example, and their muscles just like anywhere else in our body, even though this is obviously a very vulnerable place of our body. This is just like you might get a neck rub if you had like a knot in your neck, and so I'm assessing how the muscle feels, how it moves, if I feel it has good mobility, if it's sensitive for the patient, and we just go muscle by muscle. We're talking the whole time seeing how we're doing, checking in. Are we comfortable still? And that's the second piece. And then internally we can treat and assess intravaginally or interrectally Most of the time if we feel like we're having pelvic floor issues, like I've chatted about, any kind of specific symptom, having the ability to assess vaginally is really going to give me the most clear picture of what's going on.

Speaker 3: 16:44

I relate it to sort of a mechanic that tries to identify what's wrong with the car without actually opening the hood. We can get some of it right by listening, looking on the maybe inside of the car, but not under the hood, if you will, and so also just with my finger. We have three layers of pelvic floor muscles, so that allows me to look at all three layers, how they function, how coordinated we are If we do a pelvic floor contraction or relaxing, which for birth is super important um to be able to relax your pelvic floor Um and then, based on that, we um that would all happen, you know, earlier on in our time together. Once we assess that um, then in a treatment, it's very similar. If we feel like we have tension or scar tissue that we're working on, we do very gentle release work. Externally or internally, there's always breath work.

Speaker 3: 17:33

There's always some lifestyle things like bladder retraining, bowel retraining I call them mom minutes to help us regulate our nervous system, like whatever it is I'm having you do at home. We're talking about that in our visits and we have a really clear definition. At the end of our visits. I call it the wrap up with our patients but like here's what we did today, here's what I need you to do at home over the next week until I see you again. This is what we're going to do at your next visit. So there's always a really clear like okay, this is my plan, this is what we're doing, this is where I'm at in my plan, and so we can kind of move forward.

Speaker 2: 18:03

So people go home with a little bit of homework, oftentimes something to do, okay, which could address a lot of different avenues of health. Yeah, okay, okay it's definitely not, you know.

Speaker 3: 18:13

I think it's important too because we're all busy people, right, Especially in the context of motherhood. So my homework like I just had a patient, um, I gave her literally I said I mentioned this but mom minutes. I told her I was like every day, five minutes a day. I want you to schedule it Like it's an important corporate meeting that it can not be negotiated. Other times it has to happen. You're going to drink your coffee on your porch by yourself, but that's your husband or your kids, and that helps you to lower your stress levels, which will help you regulate your nervous system, which will help you to have better bowel health, which will help you to have less pelvic floor tension, and you know there's a holistic approach.

Speaker 3: 18:45

right, right, it's a homework, you know, can imply, I think, people who've been to traditional PT or like oh, here's your handout of 20 exercises to do.

Speaker 2: 18:58

Not like that. Awesome, I love that, I love that. And it's a lot of self-care comes in, which is sometimes women, especially pregnant, busy pregnant people don't do that very well, so very cool, okay. So that's some before visits, and three could be ideal again, depending on what people are presenting with right, what challenges and things they might be presenting with. And then tell me a little bit about, because oftentimes and as I've sent people to I you know I love the results that they get.

Speaker 2: 19:27

But afterwards, let's say, somebody gives birth, they have a baby and, as I've worked with clients, they realize after delivery that they have a challenge, depending on how pushing has gone, if there's tissue separation, any tearing and recovery there. I had just a couple of these recently, some 3B tears that are pretty significant, even with amazing deliveries, perfect births, like what I would think was a great delivery position, and so what I'm seeing more too, and maybe you're sensing this in your area that providers and I'm talking more midwives probably are sending people. They're recommending like, okay, you need to go see a pelvic floor specialist. So tell me after delivery, what can that look like? And you did mention six weeks, like when people don't come in the next week after delivery right? Tell us a little bit about what visits post-delivery might look like and what you address there.

Speaker 3: 20:24

Yeah, great question. So postpartum women can see us again at any time. So we tell moms that if we need to have I've had women actually literally come to our clinic like on their way home from the hospital if they're having like, so it can be that early.

Speaker 3: 20:39

Yeah, again, we don't do intravaginal treatment because your cervix is still open and that would be risky for infection. But we definitely have a lot of options If you're hurting so bad you can't sit to nurse your newborn Like. That's just not okay and we need to be able to.

Speaker 2: 20:54

I hear that a lot, a lot of people. Like my tailbone hurts, you know I sitting is painful.

Speaker 3: 20:59

So, yes, so lots and lots that we can do to kind of help at any stage. But traditionally we will schedule a six week postpartum before they deliver and then we well, actually a two week and a six week, and just that two week visit, kind of a just in case we're having lots of issues, but otherwise I'll see you at six weeks. And then that is where we dive into the birth. I want to know how long you were pushing, what position that you were pushing in, what, if any, tearing did we have? Did we have any birth trauma? Did things go as planned or did we have to have an emergency cesarean or things like that? Um, and then really diving into. Okay, well, what are what are your goals Like? What are your wanting to get back to? Because if you are like family walks are my jam, or if you are wanting to get back to marathon running, that's going to look very different than for what I have as our part of our plan.

Speaker 3: 21:54

Um, and then really we cover women. So ACOG, or the American college of obstetrics and gynecologists, updated their guidelines a few years ago to say shocker to all of us. Care should be more than just a six week visits, it should be ongoing care, it should include pelvic health, it should you know all the things. So our postpartum recovery program is four visits that we have for women at six weeks and then three, six and 12 months. So we really can cover women throughout the entire first year, making sure that their pelvic floor, their scar tissue, their diastasis and their abdomen is healing, that they're back to the activity they love and really truly should be fully physically healed by the time that they get to a year, comparative to their pre-pregnancy state.

Speaker 2: 22:40

Okay, I love that, and I think a lot of people don't realize how long that may take, and I think some people wait a long time until things are quite challenging before they'll address some of those issues, so maybe do you see people at like eight, nine, 10 months postpartum?

Speaker 3: 22:56

Oh yeah, and they're like.

Speaker 2: 22:56

Hey, I have a problem and I'm finally ready to look at it. Exactly, yeah, you know it's.

Speaker 3: 23:01

it's again one of those things that, even though it's like the national guidelines, now I can hear to tell you that hardly any obese people to us, so it really unfortunately it's either women finding us on their own or they like you just mentioned your client you know that we have like a grade three or grade four tear and I'm like super symptomatic and they might get referred but yeah, they will come to us later. And now we even have moms who are like hey, I had my youngest five years ago and I'm still leaking like and they're like finally doing something to kind of resolve it. It's never too late. We have women coming in their late 40s who have had their all teenagers for their children. There's always, always, always things that we can do to help.

Speaker 3: 23:44

OK cool, I love that no-transcript normalcy on moms to say, oh, I've had babies, so of course I can't run, or of course I have to wear a pad when I exercise. I was just telling I speak with a newborn well, moms of newborns class just about every month with a local group and I was just there and saying how every time I go to the trampoline place with my kids, there's always on the side.

Speaker 2: 24:38

And they're always like chattering.

Speaker 3: 24:39

Oh, I wish I could jump with my kids, but I can't. I'm just like want to shake all the mamas out there and be like you don't have to.

Speaker 3: 24:47

you know, any loss of urine, whether it is just a little bit not requiring pads when you sneeze or like you're going through multiple pain lighters a day, is not normal. And I'm here to tell you that, while you're young and near those perinatal birthing years, I promise you you're going to do better and want to do something about it now, versus having to have surgery or having major incontinence when you're in your fifth, sixth, seventh decade of life. So fix it now, ladies. No, it's not normal and we don't have to accept that.

Speaker 2: 25:17

And you can avoid surgery. Right, like, that seems to be a fix, as I'm, like with some of my friends who are my age and older A lot of them are just expecting to get a bladder surgery, you know, and also not needed. Right with preventative care. Right, right, okay, yeah, exactly, awesome, I want to. I want to guess good, on two paths a very awesome, like, very, most ideal situation where there's no tearing, um, what, what is needed for pelvic floor PT for that person in a quote, unquote, perfect situation. Or very ideal. And then, on the flip side, when somebody has like a fourth degree separation, what does that look like? Because I don't want people just to say I have a huge problem, I need help. But what's for the least problematic case, what's good care or standard care? And then, of course, for the challenging cases, yes.

Speaker 3: 26:14

Yeah, great question. I'm just going to touch on also a couple of things for the pregnant people listening on preventing perineal tears and then going to go through what you just said, like those two things, because it is common with first moms. It is common if we have certain positions or if we have to have an instrument assisted delivery. But your position and working with a doula, as Angie I know chats about on this podcast, can really help with making sure you're in a good position to optimize the ability to stretch that perineum and not have tearing using warmth. So making sure that we can get in the tub, get in the shower, have somebody apply warm compress and just moving, moving and breathing help prevent swelling in the perineum and swelling in our bodies and that can really aid in the perineum being a lot more pliable um tears. So lots that we can do to help with that.

Speaker 3: 27:12

Then I would say, for the mom that comes in that doesn't have any tearing, those are the moms that typically will be able to just have those four visits we focus on. Do we have a prolapse? Are we still having pelvic floor tension or pain? Because you can not have tearing but still have a lot of like tailbone pain, for example, depending on baby's position, or have a prolapse or have a very weak core after delivery, and so there's still lots of things that we would do for that mom and helping her recover physically and get her prepared for whatever activity she wants to return to. Typically, with that we're not going to have as much painful intimacy because there's scar tissue and the tissue healing looks a lot different. So we again would be able to have typically a fewer visits as it comes to like physical healing of the perineum.

Speaker 2: 28:06

And I love that you bring up this addresses, even though it's pelvic floor PT. You've talked about tailbone. You've talked about, like, bony structures. You've talked about, you know, diastasis. So there's a lot of other weak core, a lot of things that extend beyond that right, that are tied back to the pelvic floor Totally Cool cool.

Speaker 3: 28:25

You know, women are given this magic clearance at six weeks, which is when they have medical clearance that your C-section scar isn't infected or your cervix is closed and that. And then birth control right, we're always asked about what do you want to do for that? Right, that's it. Like we're not given, you're told to go do everything. And then women are like, great, I can go run, or great, I can go back to my class or whatever, um, and we're like, no, that is, that's not a functional uh clearance, it's not going to give you any guidance. And most of us like, if you're not trained in it, like you don't know what to do and what's safe, and really gently return in a uh, sequential and intentional way. And that's really where we come in. So, yes, awesome, or the moms who have so a tear that is in any degree a grade one tear all the way to a grade four tear is going to impact the muscles around the vaginal opening and the muscles around the rectum as we progress through the grade one, two, three, four. That just is a degree of pardon my pun on words there but a degree of severity of how much of that tissue is affected. So, with a grade three and four tear, we see significant tightness and restriction in those muscles. So scars are super strong and tight. They're made of collagen and they do their job really well at helping to keep whatever was open closed. But that also means that it can really impact how well those muscles relax. So vaginally. When we have those muscles being pulled and being tightened because of the perineal scar, penetration is super painful. These are women that have painful intimacy. These are women that are going to have pain inserting a tampon whenever they get their cycles back, or a menstrual cup, whatever we're using. And then the external anal sphincter is a muscle around the rectum and when that can't fully relax and lengthen, women will have more hemorrhoids, painful bowel movements, tailbone pain and constipation. And so it doesn't click often for women that it's related we think of oh, that's my rectum, this is not related to my vaginal delivery. Or oh, this is my vagina, this is painful sex, it's not related to my you know, perineum. But they're so, so related and so really intentionally treating that scar and doing a lot of manual techniques to get that tissue moving are really really important. Then we add on normal postpartum hormonal changes. If we're breastfeeding, then we have dryness, then we have the atrophy and all the things that can happen with hormonal changes. Then we have this thick scar. It's just, it's an area that really needs to be make sure that we're taking care of healing well, and so it's.

Speaker 3: 31:16

I would say. Typically with the grade three and grade four they have more risk of bowel bladder issues, pain issues. That would be someone that would need much more than that just three, four visits and it totally depends on the mom. If we are like super healthy going in, like you said, had beautiful birth, like we're active, we have good tissue quality, they might not need as much as someone that is post third or fourth baby and we have, like older scars that haven't healed and we weren't really active during pregnancy because we were high risk and it's just going to take. That's a different kind of scenario. So I would say it depends on the mom?

Speaker 2: 31:54

Yeah, the situation Absolutely so, someone, if they have never been to pelvic floor PT and they've had a baby and maybe they had some tearing of some kind, it could be very, a very good idea to come in and address that scar tissue right Like help prepare to minimize that for a second or third delivery wherever they're at Correct. Yes, okay.

Speaker 3: 32:17

Yes, I would say anyone listening if you have a vulva you need to go see your.

Speaker 3: 32:24

It's going to be useful because even if you have no symptoms I like to kind of use my um kind of. If you envision, I had a piece of paper and a big black marker and I draw a big line, a big, uh, horizontal line across that, and that line represented symptoms like pain, leaking, constipation. You might be hovering just below the line. So you have some underlying tightness. You have some underlying stuff, we'll say, going on in your pelvic floor, but it's not quite bad enough to reach that big black line. Okay, well, help. Seeing a provider, seeing a pelvic floor PT or OT, will make sure that you are, like, super below the line, where we want to be. So that if you think of down the road whether that down the road means more babies, whether down the road just means you're approaching menopause you want to at least know where you are on that spectrum of being close to the line or well below the line, knowing that you have some control of where you are right, like you can do things.

Speaker 3: 33:27

Yes, yeah, it is standard of care in so many other countries that women after you have a baby is routine Like you see a pelvic floor PT or OT to just have that for that reason, just to be like where am I at, how am I doing? You don't have to have this big fourth degree tear and having fecal incontinence to go see a pelvic floor PT. We are here and we are here to help women, whether you have symptoms or not. And I think that's super important for women to know, because a lot of times they're like oh, I don't think it's bad enough for me to go see anybody and I'm like why wait?

Speaker 2: 34:01

Right, love that, love that, I love that. So this could be helpful and useful for anyone, and I think that's a big takeaway from this podcast is everyone and anyone can use this wherever they are in the lifespan. So you? I want to touch on one last thing before we wrap up, because you kind of brought it up and I'm making me curious. You talked about tissue health. So people have different types of tissue health, right. What impacts what in the lifestyle or genetics or whatever? Tell us what can impact tissue health, what can people do to maximize tissue health? And maybe that's a bigger question for a totally different podcast, but you got me thinking as you talked about that. Yeah, love that.

Speaker 3: 34:39

Yeah, I know that could be a totally like whole podcast episode. So there's a lot of things that go into how well our tissue heals, how healthy that it is. A few things are just genetics If we have connective tissue disorders that would lead us to be hyper mobile or have attention in our connective tissue, and these are things that would have impact like systemically that you would know about, not just the perineal tissue or pelvic tissue your age, you know if you're having a first time baby in your 40s, 50s or if you are like 18, 19, early 20s. I mean that's what our tissue health just is different Lifestyle factors that help us recover, having adequate mean, basic things that you know we always hear about, but they do make a big difference.

Speaker 3: 35:29

Are we chronically fatigued or do we feel like we get good rest? Do we have enough water in our diet so our tissue is hydrated, or do we drink coffee until one o'clock and then maybe switch to wine as soon as it's pm and we never drink water? Are we getting enough protein in the diet? Just when we think about nutritionally, there's a lot that we can touch on from that perspective, but I think just basics of like are we getting enough fiber? Are we getting enough protein? Are we getting enough water in our diet?

Speaker 3: 36:02

And then, from a tissue perspective as well, we know that women that are physically active tend to have better recoveries when it comes to birth, and so we, you know, the national guidelines are 150 minutes of movement a week, and so I tell my patients think of it like a big bucket that you're just popping minutes in throughout the week. It doesn't have to be like an hour at the gym at a time. But that same guideline goes for pregnancy and postpartum, and so just moving helps with blood supply and blood flow to the pelvis versus. You know, most of us can, especially if your work requires. If you have to sit all day, that's just going to impact that. And so standing, walking, taking breaks, I mean just really it's. These things seem so basic, and yet many of us are not doing those things on a regular basis to help improve that.

Speaker 2: 36:53

So it sounds like that is definitely something within your visits. Are you, as you have a holistic approach, you're talking about those things with your clients?

Speaker 3: 37:01

Yeah, every patient that comes in I use this barstool analogy of our pelvis is like a little circular barstool seat and we got four legs that hold it up, and if one of those legs is rocky or short or not working right, you're going to fall off that barstool. So sleep, stress, nutrition and movement yeah, Basic things, but they affect so many different systems in our bodies Cool.

Speaker 2: 37:25

Very cool. Thank you for answering that, and maybe we'll chat again in depth about that at some other time. Very cool, awesome. Well, I hope that people have learned a little bit today and gained some awareness of what pelvic floor physical therapy is, the benefits of it and I love what Dr Katie said Anyone with a vulva could use a visit, regardless of your age, where you are in the lifespan, whether you've been pregnant, never have been pregnant, plan to be pregnant, never want to be pregnant. It sounds like it could be helpful for anyone. Yes, everyone can use it. So, katie, any last words as we wrap up this this portion.

Speaker 3: 38:05

Yeah, thank you so much. I think women just I would encourage moms whether you are thinking about being pregnant already, pregnant postpartum wherever you are in your lifespan, just know that you can feel healthy and empowered in your body, and the profession to help you do that most often is a pelvic floor PT, physical therapist or occupational therapist. Many women get dismissed with their symptoms. Many women feel hopeless in their bodies and just know that there's so much support out there and resources out there to help you feel empowered and feel healthy in your body and you don't have to live with the issues that you're having.

Speaker 2: 38:46

Very cool and I think a lot of times, with what we call pregnancy symptoms which you know, that can bleed into a lot of parts Our providers a lot of times say, yep, that's normal. Yep, that's normal when we can find some solutions to a lot of those things. So perfect Cool, dr Katie. Thanks so much for being with us today. Perfect Cool, dr Katie. Thanks so much for being with us today. We appreciate your time and your expertise and hopefully people can make some changes and have an awareness to prepare themselves as best as they can.

Speaker 1: 39:34

So this is Angie Rozier with the Ordinary Doula podcast. We are so glad you're with us today. Hopefully you do something today that makes you feel happy, reach out to somebody else and make a connection, and we'll see you next time. Thank you for listening to the Ordinary Doula Podcast with Angie Rozier, hosted by Birth Learning. Episode credits will be in the show notes Tune in next time as we continue to explore the many aspects of giving birth. Thank you.