The Hidden Link Between the Pelvic Floor, Breathing & Constipation

like when it comes to pelvic floor, everyone always thinks like Kegels, Kegels, Kegels. But if you notice you have a symptom that's associated with more tension, you'll notice if you just do Kegels, your symptoms are just gonna get worse, not better. Especially if you don't know how to open and close it, you're just like tightening it and tightening. So then they'll come to me and be like, I do Kegels all the time. I don't know why I'm not better.

And I'm like, welcome to the Untethered Podcast. I am your host, Hallie Bulkin. I'm a certified myofunctional therapist, feeding specialist, podcaster, business owner, and mentor. This podcast is all about getting your questions answered and collaborating with colleagues to bring you the most up-to-date information in the orofacial myofunctional therapy, airway, tethered oral tissue, and pediatric feeding therapy space. If you're new here, I challenge you to keep an open mind and join my mission to spread this message far and wide. If you've been around since June 2019, thanks for being a loyal listener. As we jump into today's episode, remember to listen with correct oral rest posture— tongue up, Lips closed, teeth apart, breathe through your nose. Let's get started.

Hi, and welcome back to the Untethered Podcast. Today we have Svetlana and Melman joining us. Svetlana is a doctor of physical therapy specializing in pelvic health, back pain, and lymphatic drainage. She earned her bachelor's in human development from Cornell and her DPT from NYU and trained through Herman and Wallace, APTA, and the Academy of Lymphatic Studies and the Postural Restoration Institute. Her passion for pelvic floor PT started while practicing in Western Massachusetts, where she saw how few resources existed for pregnant and postpartum patients dealing with pain and pelvic floor dysfunction. She specializes in pregnancy, postpartum care, diastasis recti, urinary and fecal incontinence, pelvic girl pain, prolapse, and constipation, SI joint dysfunction, and low back pain. She's also a mom of 2 girls with 1 vaginal delivery and 1 emergency C-section under her belt. So she brings both the clinical and the lived experience of healing the body after birth. Svetlana, welcome to the podcast.

Thank you.

I'm excited for you to join. Everyone's going to hear about this, I'm sure, that you are like my pelvic floor PT, but Today we're going to go somewhere that most podcasts don't. We really don't talk about this, especially here, very often. It's definitely somewhere that most feeding therapists, they don't think about this topic enough, and that is the pelvic floor. So I know you're going to walk us through some different things. We'll talk about breathing, stress levels, posture, all schedule throwing off your gut, your bowel habits, and there's a whole list of things downstream. So if you're somebody who treats kids with constipation, or even adults potentially, because we all, all of us work with adults in the Mayo world, Or if you've ever been told that you have a tight pelvic floor and you've got no idea what that actually means, this episode is for you. So let's jump in. Okay. So where I would love to start is where I think most people are confused, probably because I've started out a little bit confused here. So can you walk us through what the pelvic floor actually is and maybe tell us a little bit about what it's doing during a bowel movement? Okay.

So the pelvic floor is actually part of your core. Most people don't realize that. It's like a whole system that's part of your core. When you think about the core, you have in the front your inner abdominals, the back, your inner back muscles, your multifidus, the top, your diaphragm, the bottom of the pelvic floor. The whole system's like a pressure gauge and just needs to work together, right? It needs to come up, come down, come up, come down. So the pelvic floor sits in the bottom of this sling, and it's just like any other muscle in our body. It's constantly moving. It's coming up when you need it, it comes down, it comes up, comes down. And then we start to have issues, not so much of the muscles too weak or stuff. It's when it doesn't move. When our muscles stop moving the way they need to move, just with our breath, with everything that we do, that's where we can have issues. And if those muscles kind of get too tense or stay up when we clench all day or when we stay tight and they don't come down and relax. After a while, that's what can cause constipation. And those muscles, when you have a bowel movement, really need to also be able to relax. So if you can't, even though people are still going, if they're not fully relaxing, then that can inhibit from you having a good complete bowel movement.

Okay. So a lot of people feel like tight is the goal, right? So tight is not the goal. We don't want things tight. Cause I know like when you're here, you're always helping to make things more mobile, if you will.

Yeah, everybody want— everybody said they want tight, tight, but that in reality, what other muscle are you always trying to keep tight? If you want a strong bicep, are you just going to walk around keeping that muscle tight all day? No, because then it won't be functional. You want a functional muscle. You want a muscle to be able to contract when it contracts, relax when it relaxes. And if you are a CrossFitter or lifting a lot of weight, you need a particularly stronger pelvic floor. If your average day is not anything crazy, then you really just want a moving pelvic floor.

Amazing. Okay. So I know you're a big proponent of the Squatty Potty to prop your feet up. What is actually happening anatomically that is something that you think is important for people to all have in their bathroom?

So you have a muscle, your puborectalis muscle, and when you sit and your knees are below your belly button, That muscle is taut. It kind of turns into this little triangle. So then what happens is when you're trying to have a bowel movement, you're like fighting a whole system.

Interesting.

When the knees are above the belly button, that's when it kind of creates a straight line and it relaxes the muscle. If you just think of that evolutionary bowel movement, you just think of people on the street in a deep squat, and then we started making toilets, and then we started making it higher so it's easier to stand up. But the higher you make them, the more of that angle. And particularly with kids, like when you're potty training or even smaller kids sitting there, you really want the step stool because otherwise their legs are just really hanging down and there's none of that angle for them. And they make higher step stools for kids too.

So interesting. And I thought about it too because we always had the kids' legs propped up. We put the little kitty potty that attaches, like you have the, the seat with the kitty one that flips down enough so adult and kids can both use basically the same, but you need them to have their knees And it's interesting you say this because even for feeding, we want that angled position. It's so important for chew. We need that base of support for the jaw, right? So like on the hips, on the lip, like it's so interesting how everything is so interconnected. And basically we want to be in that position.

And if your breath is wrong with the bowel movements, we always teach like when you have a bowel movement, you don't want to do that Valsalva, right? That breath hold. So you want to do that nice exhale, pushing down. And if the mouth is too tight, then the pelvic floor will be too tight too.

Makes sense. Makes sense. What we see in the lips, we see in the hips, and vice versa. Okay. So, all right, if somebody's been straining for a long time, does that impact— I'm assuming that impacts like the pelvic floor. And if you have chronic constipation, and I know that we could be thinking about adults here, but I'm even thinking about children because I work with a lot of kids who don't chew their foods properly. They are maybe not getting proper nutrition because they're very selective. Maybe there's something medical going on. Maybe it's oral motor that's led to certain behavioral choices when it comes to foods or whatever, right? But also if they don't have the skills and they can't break it down, they swallow full pieces of food. It's not properly— it's not ready to be digested. And a lot of these kids struggle with constipation. I think that's one piece of it. The other piece of it, I think when their fascia is tight throughout, so we get a lot of these tongue-tie babies and kids who struggle with constipation. I know that was my daughter, and the day after we released her tongue tie, She became regular and was never constipated again. It was insane. And I was just not expecting that, but it was literally something I was giving her supplements for on a regular basis. And I just, I was able to just stop. And so it really opened my eyes to, oh my gosh, well, what happens if this continues? That was pretty long-term cuz she was already 24 months at that point, but even longer term for older kids, adults, or— Yeah, there's a lot.

When one, I always tell patients, kids, adults, you're constipated until proven otherwise cuz I even know my daughter when she had something and she was not the kid I would've ever thought constipated, but when she had an X-ray, it showed it. So I think most parents don't realize that even if you go every day, you are still constipated. But what happened is your bladder and your rectum are pretty close together. And if you're not going good daily complete bowel movements, that rectum starts to get stretched and it's pushing on the bladder. So I'm not a pediatric pelvic floor physical therapist, but I think dabbled, taken a few courses. The main thing, especially for bedwetters, I know rule out constipation, rule out constipation because when you are constipated for kids, you can have the bedwetting. For adults, you can have incontinence, urge incontinence, stress incontinence. Because if the bladder has something pushing on it, it's not going to be able to work correctly. So in all pelvic floor cases of regardless of what it is, I'm always treating constipation even if the person swears. That they are not constipated. Oh yeah.

It's when you were like working on my stomach, I was like, what are you doing? And then I realized what you were doing and I was like, oh, okay. That, that seems, that's helpful. Not gonna stop that.

Not really for anything. Literally, I can't even think of a condition that comes to me that I'm not working in the stomach to release stuff. Cuz if it's not moving and you don't have the right movement in the belly, the, the rectum, everything, none of it is going to get better. And people could get back pain from it, pelvic floor issues, prolapse. Any of that kind of stuff can all be associated with constipation.

So fascinating.

Okay.

So aside from that, are there other signs that, or maybe even before these things happen and it gets that bad, are there signs that people should be going to a pelvic floor PT? Like, how do they know?

I mean, I think if people notice any, any dysfunction that we think is normal, I'm not too educated with the kids, but I know we keep pushing back the normal age for bedwetting at night. So that, or a mom that jumps on a trampoline and leaks, or the one that just has that bloating, that just all these things that women, kids aside, they're like, oh yeah, that's normal, that's fine, I'm just a little constipated. But the earlier we can fix it, the earlier you can fix your routine, your habits, like all of that, the better it'll be for long term.

Yeah, I saw you yesterday and this morning in the mirror at Pilates. I was like, oh my gosh, my stomach is so flat. It's so flat and I'm so regular right now. This is so good. I literally was thinking about you this morning while I was doing Pilates because I was just like, huh, it really does work.

It really does. There are massages that you could do on yourself. It's called the I Love You Massage, and there's like a few different ways that some people teach it, but the main concept of it is that you're really massaging along the large intestine to help with the movement from going down Even with my kids, they'll know, like, if they, like, their stomach hurts, they'll see, like, right away I'll just start doing on their stomach because I'm always— anytime something, I'm always like, you're constipated.

Oh my gosh. I actually did that with Mia, with my younger one when she was a baby. And that was something that infant massage therapists taught. It was that I love you thing. I thought that was just cute for a baby, but it's like, yeah, no, it like heals for everyone. So good. So good. Okay. So I wanna go into like talking a bit about breath nervous system. Cause I think this next part will sound like more familiar to our audience here because we talk about mouth breathing and airway and nervous system regulation constantly. So that's just, it's usually like higher up in the body and now we're kind of a little bit lower.

Yep.

So maybe walk us through how breathing affects like digestion and the bowel habits.

So one of the things like all pelvic floor therapists, and this usually is like our, we kind of call it our desert exercise, right? If we can pick one thing to do for any patient, it would be to teach them diaphragmatic breathing. And what diaphragmatic breathing is, what we're really doing is we're trying to connect the diaphragm to work with the abdomen and the pelvic floor. So we want to kind of teach that everything comes down and up. So when you inhale, your diaphragm comes down and your pelvic floor comes down. And when you exhale, it all comes up. So when we do diaphragmatic breathing, you want to put your hands around your ribs and really concentrate on that inhale expanding laterally, not so much from the chest, but lower down. And on the inhale, like really feeling your pelvic floor descend. You want to feel it to come down because like I think we're also used to kind of like breathing fast, saying everything, saying stress, clenched, that pelvic floor is just sitting like this all day long that you want— I always tell patients try to do 2 minutes, 4 or 5 times a day of just that nice, like breathing in, feeling everything relaxed, and then just exhaling regularly, really working on that relaxation. Because if you don't have the relaxation of the pelvic floor, you're not going to have your parasympathetic nervous system working, your rest and digest. And if you don't have the rest and digest, you're not going to be having your good daily bowel movement.

Yeah. Yeah. I love that. And we were talking too about how in feeding we talk a lot about the nervous system and rest and digest versus fight or flight and everything. And so again, it's just, it's all so interconnected. So yes. Okay. And I know, and I, and we talk to families a lot too about how we don't digest well, like when we're stressed, when we're in that fight or flight, it's so interconnected. Okay, amazing. So do you have any tips if people are like, how do I move into rest and digest? Or how do I know what this diaphragmatic breathing looks like? Or how maybe like they wanna move into that before they eat a meal or before they go and try to use the bathroom. Do you have any pointers?

Really just kind of like to sit, lie down somewhere comfortably, have your hands on your ribs, feel what your body's doing. Try to feel some nice relaxation in the pelvic floor. I say you're not pushing out, but you should just feel it coming down a little bit every time you inhale. And just try to relax your nervous system when you do it. Just nice deep breaths, nothing too much. Sometimes I'll send patients home with diaphragmatic breathing and then they'll come back and I'll ask them to show me and they're like taking these inhales and I just see the whole body tensing and I'm like, no, no, no. Remember, this is relax, safe, nothing crazy. I just want a nice inhale. Feel everything calm down with a good exhale. Hallie Bulkin, try to start your day, try to do it before you eat some food, after you eat some food, when you're sitting in the bathroom, just that nice relaxation feeling, everything. And like you say, like with the mouth, like if you're doing it and you're like clenching, it's not going to help relax that pelvic floor.

Yeah.

Amazing.

Amazing.

Okay.

So helpful.

So I think this is going to help people feel a little bit more seen maybe, but when we talk about, and especially like in my own family, but I won't mention any names. I feel like the body resists change when we have like a routine change, right? For traveling, for example, and somebody like cannot go to the bathroom. Like, what is actually going on there?

There are a couple— there's a couple different things. The one, when we travel, we definitely say we're drinking less water, our food changes, like all the things we talk about. But I think like a big thing with traveling and also like daily lives is that our body's a creature of habit. Wants to, it really wants to do the same thing every day. So I actually have a story of a friend from college. She came to visit me a few years ago and she's like a surgical sales rep. So a bunch of the time she's like traveling across the country and she tells me, she's when I'm home, I'm like always fine, right? I go daily, but when I travel I'm always constipated. So I'm like, okay, tell me like what's your day like when you travel? She's like, okay, I'm at a hotel. I'll wake up, I'll go to Starbucks, and then I'll drive to the hospital and I'll start my day. So I'm like, okay, and what about your day when you're home? She's like, I wake up, I have my coffee, I sit, I read a magazine, I'll read a book, and I'll go to the bathroom. I'm like, there's your problem right there. Like when you're home, your body like does what it wants in the morning. You have your coffee, you're relaxed, you're doing your breathing, you Even without you realizing, and every day you'll go to the bathroom at the same time. When you're traveling, I'm like, when are you supposed to go? You're not giving yourself any time to actually have a bowel movement. You're waking up, driving to Starbucks, and then like flight and like fight or flight the rest of the day. So when I tell people when they're traveling, and I know like especially one of those trips they have a lot, try to wake up a little early. Give yourself that routine that you have at home. If you always kind of, and, or if you don't have it at home, you should, that morning of sitting, relaxing, drinking something hot, letting things calm down before you go into that like busy day. Because if you're not going to give yourself that time, I always say, adult kids, you need poop time. And if you're not giving yourself that poop time, it's not going to come.

Yeah, it's amazing. In my house, I feel like my kids are like, I have to poop, and they'll just run to the bathroom and they used to strip down naked too. I was like, can we not do that anymore? I think you guys are now 8 and 10, but it's amazing because, or I was doing the GI map test on my younger one recently and she just kept pooping at school and I was like, I'm not gonna, I'm not gonna tell you to hold it or not poop. And I was, it literally took us almost 2 weeks to have a bowel movement at home when we were together so that we could do this freaking test. And it was actually funny because I'm like, normally I feel like this kid poops at home all the time. I'm like, are you avoiding doing this test?

Are you like just pooping?

Yeah. Disrupting your routine. But anyways, and then there was my other one who's like, oh no, no, I'm not using the bathrooms at school for that. So it's when you hear how people like control their bowel movements sometimes, it's very interesting.

It's funny too, cuz that is a big thing for a lot of people. I can't have a bowel movement if I'm not home. And one is the comfort. Two, I think we've gotten too much with germs and you can't sit on a public toilet and that's a whole issue altogether. But the Yeah, I'll definitely tell people, if you have to poop, you don't wanna hold it. You really shouldn't do. So your daughter was doing the right thing despite you not being able to get that test done for a while.

100%. No, at one point I also was working with a kiddo. He was autistic. He was maybe 4 at the time and he would withhold bowel movements and he would be like to the point where he was like jumping up and down, like squeezing everything, trying to, keep himself from going, like, in his pull-up. And he wasn't— he wouldn't use a toilet. And we had, like, ABA in there. And anyways, they were actually doing, like, verbal behavior therapy. So it was, like, real, like, actual good ABA, not the change the child and make them follow our constructs ABA. Anyways, he— it was really interesting because there were some days I would go in and I'm like, he's not available for learning. He is working through something else right now, and I can't expect him. I had taken over the case from another therapist in the practice that I was working for at the time. She'd given me all these different things, and he wouldn't do, like, really anything for her in the first. I went and observed a session before she went on maternity leave, and I'm sitting there with him and I'm just like, he's spinning some wheels and I'm spinning some wheels. And he says, so I started to get down on his level with him. And he started to interact with me. He's like, oh, like you speak my language. Okay, cool. We can be friends.

Right.

I trust you. So we started building rapport. And it was interesting because over time he, the bowel movement thing would come up like once in a while. And I would tell the parent, I was like, he just wasn't available. He was withholding a bowel movement. He was very uncomfortable. And there were other times where it was like I wasn't sure that he was withholding a bowel movement, but I was like, he seems constipated. And he was like, it was just, I was like, he seemed very uncomfortable. He was very distracted. And I think that's where I try to even highlight for people, like even with adults, right? Like when we are not at our best for whatever reason, but let's say we're constipated, you don't feel well, your body's like holding onto something that it needs to let go, like energetically, physically, all the things. And I'm just like, this for a kid was just— it was such a life lesson to me because I'm watching him and I'm like, not all children are available. They're not little mini adults. Yeah, like, they really need to be in that rest and digest, and he is so in fight or flight right now. Like, even if I try to do something, we're not accomplishing anything today. And so, Mom— and the mom, this mom was like lovely and totally understood. And some parents don't get it. They're like, what do you mean you didn't do anything in speech therapy today? I paid you. Yes, I know, but also, this is a child. This is not a computer. You can't just make it work. But it was very eye-opening though, because then I was working, I was working with more and more children who were autistic at the time. And that's what really threw me deeper into the feeding world with younger ones too, because I would watch, they would eat all these beige foods, these foods that mash in your tongue and in your hard palate with your saliva. Maybe you didn't have to chew them, or they weren't chewing their foods and breaking them down enough. And I know we alluded to this earlier in the episode, but it was really fascinating to watch what they were eating, how they chewed or didn't chew, and then what their bowel movements were like. Because when you're in preschool and you're dealing with birth to 5, you're there for all of it, right? So it was definitely impacted, and I just saw it across all of these kids that I was working with. They were all constipated, every single one of them, and it really impacts just their ability to function.

Yeah, adults too.

Oh, for sure. I mean, I won't mention who in my family, but there is an adult in my family where if they are in a bad mood, we literally look at them and go, you haven't pooped today, have you? That is a, and they're like, no, no. We're like, we can tell.

Yeah. No, it really is like, it's a primitive thing that we need to do. And when we're not doing it, it'll affect everything.

Yeah. So I love that tip of trying to see if you can either create a routine if you don't have one, or build your routine in, even if you just have to wake up a little earlier on vacation. Yeah. It's so true.

And not even on vacation. Think of like the bit, like I have so many moms, like you think about it, like you get up.

Yeah.

And like Hallie Bulkin, like the first 3 hours you're like literally just running around all day, like having no time to do it.

So, okay. So let's go back to talking about the pelvic floor a little bit and what else maybe it leads to or causes, because I think there's other symptoms besides like constipation or issues with, I know you mentioned the urinary urgency and everything. I know you mentioned if the mom's jumping on a trampoline and 2 weeks. I know a lot of moms will joke like, oh, if I sneeze, I literally pee my pants. So are there other symptoms that might exist besides constipation where things might be a little too tight versus—

so when we talk about like weakness, we usually talk about stress incontinence, which is that you're weak with like a physical stress incontinence, like coughing, laughing, sneezing, jumping, that kind of stuff. And then also with weakness, you can have prolapse with things like falling out or getting loose down there. And then when you have a tighter pelvic floor, like more tension, and I just wanna really specify before we even talk about tight pelvic floor, it does not mean it's strong. Like a tight pelvic floor does not mean it's a strong pelvic floor. It just means it has tension. And that can be from weakness, from all that. So a pelvic floor with tension symptoms you can have are urinary frequency. So needing to go to the bathroom, like I would say more than 6 to 8 times in 24 hours. Despite how much you're drinking, everyone's like, I drink a lot. I'm like, no. Urinary frequency, going to the bathroom at night too much, right? So really you should be able to sleep through the full night without needing to go to the bathroom. Incomplete bladder emptying. So not being able to get it all out at once, or after you get up, you like still have to go. Incomplete bowel emptying. So a lot of people will be like, yeah, I, I'm not constipated. I went today, but like, they definitely, they felt like they had to wipe more than usual or they still felt it, but they didn't get it all out. You can have pelvic pain, rectal pain. A common one, more common than we think, is called dyspareunia, pain with intercourse. That can be with like increased pelvic floor tone. I think that's most of them. There's still more, but that's, that's good.

Yeah, no, I think it's, and I think it's helpful for people to understand like the symptoms and that what it's related to, right? That it, it's connected to the pelvic floor. Does it show up differently in women in different parts of life. So I'm thinking of a woman who might maybe hasn't had kids yet, a woman who's postpartum, maybe even like after menopause. I don't— does this change?

Definitely with like postpartum where we're like, if you're breastfeeding and stuff, and that kind of is the same as like perimenopause, menopause, cuz when you're breastfeeding you have decreased hormones. So especially with those women and the menopause, like once you lose the estrogen and all that, like a lot of the symptoms tend to get worse. 'Cause you have your muscles and they do, you have all these symptoms working to help you. And then when you start to lose a lot of those hormones, a lot of women start to see a lot more symptoms with that.

Makes sense.

And also a lot of these women, like when it comes to pelvic floor, everyone always thinks like Kegels, Kegels, Kegels. But if you notice you have a symptom that's associated with more tension, you'll notice if you just do Kegels, your symptoms are just gonna get worse, not better. So it's like, cause you're, yeah, literally you have a tight muscle and then all, and especially if you don't know how to open and close it, you're just like tightening it and tightening. So then they'll come to me and be like, I do Kegels all the time. I don't know why I'm not better. And I'm like, yeah.

Yeah. And I think it's like what you pointed out is so important too with like, it can be tense and still be weak.

Right.

Because like we see this a lot and just to give other people, if people are confused by that in babies with feeding, right. We see babies who have full body tension because they have an oral facial complex that's weak. And so the body's trying to compensate and make up for what the mouth was not doing, or that even happens, like the cheeks get tense or the lips might get tense, or the— we just see things happening as a result of compensatory strategies to basically accomplish a biological need, feeding, right? Breathing. So it— that's why I'm like, I like to highlight that because it's so important. I think people like— I thought Lily, my 10-and-a-half-year-old, when she was an infant, I thought she was so strong. Because she did hold her neck up at birth. And then it ended up happening with me too. No, they were tense. They had tongue ties, they had tension in their body. And then she was also the kid who could like literally hang from a bar at gymnastics at— I don't know, she wasn't even a year yet— for 80 seconds. She just hang there and it was like, oh my gosh. I'm like, yeah, she's like superhuman, like freak of nature or something. I don't know. And I realized later it's because she's so tense. Like, your body's so tense. She's not— it's not that she's strong. She's so tense. If she let go, she would obviously fall down. But like, she just held herself there. And I was just like, it was very interesting. But it just again goes to show, like, you can be tense but not necessarily strong. Yeah, weak in your body happens throughout life. Fun times. Okay, to that, on that same note, a lot of our listeners work with kids as part of like the feeding picture, right? And so I know I've mentioned that, but from an adult lens, even, I don't know if you'll have the answer to this, but are there certain patterns that you think start in childhood that you wish someone would have caught earlier? I know in the orofacial complex where their tongue is down their mouth breathing sometimes. If we could work on this as kids, they wouldn't turn into these adults with all these— this longer narrow face, mouth breathing, snoring, disrupted sleep, etc., which they oftentimes have as a kid, and then it just progressively gets worse and snowballs as an adult. So are there certain things that— I know you don't really work with pediatrics— or anything to be cautious or pay attention to?

I think that we've done— and I'm probably asking, what's my kids even know, like raising when it comes to pooping. But I do think as parents, we should, even as our kids get older, we really should be paying attention to make sure that they do have the good habits for bowel and bladder routine. Is your kid that's going to pee every 45 minutes? You have to stop every hour on a road trip? Try to figure that out sooner. Is it your kid that will go 3, 4 days without a bowel movement and you're like, whatever, that's fine. So I think like figuring out their habits is, are you a kid that constantly has, kid constantly has stomachaches or all this from being backed up? So if you try to see, really look into the dysfunction and find things you can then try to fix it from an early phase. So you can have, I think a lot of, especially parents of high athlete kids that are always running from one sport event to a sport event and all that, and you'll see their stomach is that 6-pack and real tight muscles and they're super strong, but then they will suffer. I'm not saying they all will, but then you can have a kid like that can also suffer from constipation cuz those muscles are so tight. So, you know, a kid like that, try to throw in more like breathing, yoga, make sure proper bowel habits, throw in a poop routine. That's just a time of day. Let's try to sit for a few minutes, see if anything happens every day until it happens. Vice versa, you have more of your low tone kid that has those kind of issues there. Try to throw in more sit-ups, more core work, just in a nice way. So pretty much just find and see, are there any issues? Where do I think my kid falls on the spectrum? All these little things at a young age I think can make a difference. Amazing. Thank you. And then also, I also wanna throw in one of the things that I know As parents, for that, like, we are like, none of us want to stop to have our kid use the bathroom. I do feel as parents, we're always like, go to the bathroom, go to the bathroom, go to the bathroom, when like the kid doesn't have to go pee. And there is like some thing about that because we don't like to be doing what we call just in case. We call them JICs. Because if you do a lot of just in case urinating, that can cause you to just throw off everything and have to go like pee more often. So I do think for parents, it's trying to avoid the just in case and let your kids sit on the public toilet seat. Don't hover for anyone, please.

Never hover. Because I actually heard that's like really bad for the pelvic floor, right? To like actually squat over a public body.

It's really bad. It's really when you are peeing or having a bowel movement, What should your muscles be doing? They should be relaxing. Same. Like, that's the whole point. That's when people have issues. The muscles can't relax.

Right?

So if you are hovering, you're not relaxing. Your thigh muscles are clenching, your pelvic floor. So you're like trying to fight like two separate things between like peeing and not going. So you're going to find you don't go complete. You're still going to have urine. You're going to have like false things. And for some patients, I've like never been able to win the fight to sit on the toilet. I'm like, put toilet paper on. They're like, I can't.

I'm like, it's— listen, I sit on public toilet seats and I'm like the healthiest person. So if nothing else, it probably is a really strong immune system. I don't know.

It's like, I don't know what the theater people think they will get from what they're gonna pick up sitting on a public seat.

I'm like, you go to a restaurant and you eat off of forks that other people have eaten off of that day. I know they went through like a dishwasher and everything, but put some paper down between the toilet seat if you're so concerned.

Yeah.

It's, I don't know. I don't know. It's very interesting. It's a very interesting topic for sure.

It really is.

Yeah. And it makes me think too, like, cuz that tension, right? Like you're in fight or flight, you're, you might be breathing differently, right?

Mm-hmm.

Your posture's obviously not relaxing.

Yeah.

Yeah. And, and I know like we talk so much about posture and like mouth breathing on this podcast. I don't know if you ask your adult patients about this, like their sleep or their breathing and stuff and everything, but if you do, I'm curious, do you notice that adult patients with pelvic floor issues often have airway or breathing problems that they've had for a while. Goes way back. I don't know if you track that at all, but I'd be so curious.

There's definitely a lot of talk about that and I know it gets more and more. And I really am planning, like I'm actually from now want to be asking, do you think, is there sleep apnea? I do ask breathing stuff for patients that wake up at night or patients that have urinary incontinence at night. That's usually the first thing I'll go to is do you think there's sleep apnea or not breathing right? But it's definitely good to look into it for lesser different issues too. Yeah.

I have a good sleep screener I can send you that you can even give to people so they can like read themselves and it's a very quick, you're like, hmm, there's some sleep disorder breathing here. Okay. So you also trained through PRI, which I love. You trained PRI?

Yes. Yes.

Yes. I was like, I was like, I'm pretty sure you did. For listeners who don't know it, can you share why maybe the whole breath posture lens changes clinical practice as a PT?

So PRI is very cool. I did one of the courses through like, I think it was like breath and pelvic floor, and I think there's so many. It's one of those, I think you need to take the same course 3 to 4 times to fully get it. It was probably one of the most complicated things I've done, but so educational. And yeah, it really connects of like someone isn't breathing well and then they can have left hip pain cuz they're like not connecting it to the right thing. Or you'll find 80% of patients will have more of this issue because the body isn't aligned. You'll have more organs on one side than the other. So then you gotta retrain all the muscles so then you can be like more naturally aligned with it. So it really shows of like how much you can have, like part of women, just regular, and that's the one I studied the most. That just like all these issues that start at the beginning because of the way our body is developed and then we have to compensate.

So crazy. So crazy. I worked with a PRI-trained PT. He was like, he said what he did was like modern counterstrain technique.

Yeah.

And he was like PRI-trained and everything. And so I've always been so fascinated about like when I talk to PTs who are trained in PRI, like Postural Restoration Institute for anybody who's not familiar, I just think it's so cool because I just think a lot of the dots that they're connecting makes so much sense. And it just— I don't know, I just feel like whenever I've had PT with a PRI-trained individual or somebody who's gone through at least one or two of their courses or something, you guys just look at things through a different lens. You have a different understanding of how, like, the interconnectedness of the body, which is cool.

Yeah, and it really is taking one exercise that will— we need you to do 4 or 5, 6 different things to just do it. So it is a very cool thing. I definitely want to take some more. Yeah. Yeah.

No, it's really cool. Okay. A huge percentage of our audience is women in their life. These and these, many are moms, not everybody, but definitely clinicians, if not moms or both. We gave, so we talked about so much. We gave them so many suggestions today. What is one shift, one thing that they could change this week or shift they could make this week that would help support their own pelvic floor and nervous system? Like any top thing you would recommend?

We talked about kind of like that, giving your body that time and a day. This is sometimes how I like will do with patients, like especially if they have issues, I'll kind of give them like throughout the day, give yourself what I call a vagina check. Where's my vagina? Where should it be? Like sometimes like people are like all day and they're just like, right? Like everything's off. Like your butt cheeks are clenched all day, everything. And just like throughout the day being like, Where am I? What could I be doing? And just kind of hit that wall. Relax. Okay. Let me not be all tense. Like my jaw all the way down to my toes and kind of take that time. And I think throughout the day, like when you become aware of it, then you'll be like, oh my God, I'm sitting here. Why am I like this? Give yourself, let the parasympathetic and rest and digest take over that body a little bit.

Amazing. Thank you so much. All right. So anything else you want to add before we start to wrap up today?

Well, thank you so much for having me.

This is great.

You're welcome.

Share where everybody can find you if they want to work with you.

Yeah, I have my website. I do— I work in Palm Beach County, often to your home. So I have— I think you'll have my website and email from there.

Yeah, we'll link that all to the episode, but I know wearepublicharmony.com is your website. We'll make sure we've got that and your Instagram for everybody so they can easily Find you, highly recommend. For anybody who's aware, I had a tailbone injury. It was— so backing it up, April 2022, I had just had my nasal surgery where I had my septoplasty, rhinoplasty, turbinates reduced, and nasal swell bodies reduced, and was packing. I think it was like maybe a month after the surgery, so it wasn't immediately after. We were packing because we were moving to our new house in June, and I slipped on a Nordstrom bag. It went across the wood floor, and I just went straight down on my tailbone. And I was trying to protect like my face and my nose. I was like, not the face! And so in, in making sure I didn't injure my nose and my face, I just went straight down and landed right on my tailbone, which we think was probably in a funky position to begin with. But I know you want me to get an x-ray to see like what it looks like. It'll be wild. Yeah. So my tailbone like was not bending as much. It was protruding. Like, you could literally just touch, like, in between my butt cheeks and feel it, like, right there. It's like right there. And it was painful when I would do certain, like, things in Pilates. And so finally, after 2 years of Pilates, I was like, maybe I should get this addressed because it's getting worse. And then I did. And I think we've worked together— I don't know if I've seen you like 5 times, 6 times. I don't even know how many times it's been now, but maybe about that many sessions. And within the first session, I was already like, oh, Okay, this is getting so much better. Like, it's not 100%, but like, I feel the improvement, right? And I remember you basically were like, yeah, this is not mobile. Like, your tailbone is not moving the way it's supposed to. And then we also discovered my, like, I'd say probably the lower third of my lower, like, my lower back was basically moving as like one unit. Like, it was compensating for the tailbone injury and not moving the way it should. So here I am in Pilates thinking like, I'm so strong and I got this. No, I was just tense. I was tense. Now I'm in Pilates, like having to relearn how to use the lower muscles in my back. And it's fatiguing, like it's tiring. And I was telling you, I'm like, like, it's hard. Pilates feels hard again because my back is now— I'm trying to move it the right way. Yeah, every vertebrae and not move everything as one unit, which I think a lot of people here can relate to because We talk a lot about how the tongue, the jaw, and the lips tend to move as one unit together. You're not using them properly. And so that's exactly what my lower back was doing to protect the tailbone. And anywho, it's all much more mobile now.

Yeah, it is.

Not as fatiguing, but I was sore. I was like fatigued and sore in my lower back in Pilates where I was like, why does this feel this way? I know why it feels this way. I haven't used it properly in 4 years.

And now you are.

And now I am. Thanks to you. Thank you. So anyways, yeah, but thank you. Thank you for helping me. Thank you for educating our community. I love this. Everybody, you at wearepelvicharmony.com. We'll link everything below the episode. And thank you so much for joining us today.

Thank you.

Quick disclaimer: all information, content, and material of this podcast are the opinions of the speakers and serves as informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified healthcare provider.

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