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So Glad You Asked: The Pelvic Floor (Episode 1)

Pelvic Floor Therapist

In an ongoing series to normalize talking about women’s health, Leila Brier, Head of Brand and Culture at Attn: Grace, sat down with Dr. “Babs”, Harvard Affiliated OBGYN and Attn: Grace Medical Advisor, to answer the top questions women are googling about the pelvic floor — from “What is your pelvic floor?” to “How do I do a kegel?”. Episode 1 is live on Youtube, and you can read the full transcript of the interview below: 

Leila Brier: Dare I say it, pelvic floors are kind of hot right now.

Dr. Barbara Frank: Yeah, they are. It's all the rage.

Leila Brier: A lot of people though, still have hesitation about asking questions about their pelvic floors.

Dr. Barbara Frank: For a long time all of this was kind of hidden and it's in your pants. Women need to figure out that it's empowering to talk about their bodies ask questions when they don't know.

Leila Brier: We figured out what the most popular questions are. And so this is what the women on the internet are asking.

Dr. Barbara Frank: I'm Dr. Barbara Frank. And this is an Attention: Grace. I'm So Glad You Asked interview.

Question 1:

Leila Brier: What is a pelvic floor?

Dr. Barbara Frank: That is a great question. I'm so glad you asked. So the pelvic floor is actually a hammock. If you imagine a hammock, and it's holding all your insides in. So all of your internal organs are being held by the pelvic floor. That's a lot. It's a lot to carry your pelvic floor.

Question 2:

Leila Brier: What causes a weak pelvic floor?

Dr. Barbara Frank: So weak pelvic floor can happen for many reasons. If you are a trampoline jumper, then that increases. There are studies that show that women that jump on trampolines have high risk of - 

Leila Brier: Oh, I'm a mom I know.

Dr. Barbara Frank: Exactly. Anything that you can imagine that would increase pressure on the pelvic floor, like childbirth, even how much weight you're carrying around can change the dynamic of the pelvic floor and good old genetics.

Question 3:

Leila Brier: What's a kegel? Keegel? Kaegel?

Dr. Barbara Frank: Kegel. It's kegel. I'm doing one right now.

Leila Brier: Oh, me too.

Dr. Barbara Frank: You do?

Leila Brier: Yeah.

Dr. Barbara Frank: Oh yeah. Good. We're exercising. So just like you can do a bicep curl. You can strengthen your kegel muscles. And if you imagine like you have, you're sitting on the toilet and you're urinating, and you let some out and then you stop and hold it in. That is the set of muscles that you are tightening. That is your pelvic floor. Now, I don't recommend you pee and stop, you pee and stop, that's actually bad for your bladder. But just the first time to learn. That's how a good way to teach yourself. And don't forget to release. There's also relaxation. Because what can happen is, people get too focused on their pelvic floor, they tighten it, and then they're not able to relax. So you have to work on both.

Leila Brier: So, pelvic floor therapy, also very hot right now.

Dr. Barbara Frank: Very hot right now.

Leila Brier: I think there's a myth. If you go to see a pelvic floor therapist, they're going to teach you how to do kegels. There's more to it. Right?

Dr. Barbara Frank: There is more. I mean the best thing before getting into pelvic floor PT, is go talk to your doctor. Go to your gynecologist and say to them, "Hey, I hear all the rage about kegels. Can you show me how to do it? And it's a simple internal exam. We call it bimanual, which you get done at the time of any GYN exam. And I'll say to the patient, "Okay, tighten around my fingers," and I'll give them a score. Zero being no muscle tone, five being strong muscle tone. And you can actually gauge what the tone is based on how tight you can make a muscle. Kegel is all the rage, and pelvic floor is all the rage, but you have no issues. Your vagina is lovely. You can have sex. There's no problems. You're not leaking urine. Then it's not a problem. It's only a problem if it's a problem for you.

Question 4: 

Leila Brier: Pelvic floors and painful sex. I suppose that's not a question, but I think we can intuit.

Dr. Barbara Frank: Is painful sex always a problem with your pelvic floor? No. There's lots of reasons to have painful sex. Are you not well lubricated? Are you not relaxed? Do you have some other trauma around intimacy and intercourse? But in terms of painful sex in the pelvic floor, if your pelvic floor is too tight and there are many reasons for that, then that can cause pain with intercourse.

Leila Brier: Well, that's interesting. Because I feel like women are often talking about, again, kegels and pelvic floors in terms of it being too weak or loose.

Dr. Barbara Frank: Or it can be too tight.

Leila Brier: Which is its own problem.

Dr. Barbara Frank: Yep.

Question 5: 

Leila Brier: What is pelvic floor therapy?

Dr. Barbara Frank: So you and your pelvic floor therapist are going to get very personal. As personal as you get with your gynecologist. Pelvic floor physical therapy is training of your pelvic floor. So, whether it's too tight or too loose or too painful or whatever it is, it's kind of what you would think of if you hurt your arm or leg and needed to go rehabilitate that muscle. I send people home with homework, like dilators, to help relax the muscles but then also work on strengthening so you have some of that feedback. So expect a very personal new relationship with your physical therapist, but it's all muscle work.

Leila Brier: And is peeing when you sneeze normal? Asking for a friend. Do you have to cross your legs before you sneeze?

Dr. Barbara Frank: There are many, many, many women that have to cross their legs when they sneeze. And do I think that it's normal? If you are out with your girlfriends and you're giggling and laughing, and you forgot to go to the bathroom because you're in such great conversation, and you laugh really hard and a little pee comes out, is that a big deal? No. It's a mess. But is it a big deal? No. If it happens all the time, meaning, you like to run and you're going for a run and you're leaking, or you can't make it to the bathroom in time. You get to the door, you go to unlock the door, you got to go right now. And it's an urge feeling. Those feelings are things that we can work on and fix. So, is it okay to do it a little bit here and there? Sure. Is it normal? No. Your bladder, your urethra, your sphincter, everything in there is supposed to hold your urine in. But if it is something that's happening a lot or stopping you from doing your activities, then yeah, it's not normal.

Leila Brier: I'll tell my friend. Thank you. When are you too old to fix your pelvic floor?

Dr. Barbara Frank: Never. Never too old to fix your pelvic floor.

Leila Brier: No. I think this is really important because there's a lot of women out there, especially a lot of our customers who this is definitely a new phenomenon. And there's a lot of women in their 70s plus who are only now hearing about pelvic floor physical therapy. It's good to know that it's never too late.

Dr. Barbara Frank: Too late. Yeah. I think that for a really long time, you didn't speak about that. No one would talk about it. Or you would say to your mom, "Oh, I peed a little, does that happen to you?" "Oh yeah, that happens to everybody." We're women. We're postmenopausal. We had kids. That's what's supposed to happen. But it doesn't mean you have to live with it. And you definitely don't have to live with it without dignity because you don't have to hide behind your incontinence. You don't need to stay home because your pelvic floor is weak. You should talk to your doctor because it doesn't have to be that way. Either we can work on the muscles or find products that will work so you don't have to be embarrassed.

To watch the full interview click below:


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