How to Fix Pelvic Floor Issues Naturally | Breathing, Core & Recovery | Dr. Kayla Borchers

Hey friends, have you ever been told you have a weak core? Or maybe you've been laughing really hard and you slightly peed your pants. That is a pelvic floor issue. And today I am talking with Dr. Kayla Borchers, a pelvic floor and nervous system expert who's here to set the record straight. I'm so excited to dig into this because honestly, this is a little close to my heart. This happens to my wife and I'm not throwing her under the bus. But this is something that she has dealt with for many, many years, and I think she always thought it was her until she started going seeing someone like Dr. Kayla, who is a pelvic floor specialist. So, Dr. Kayla, thank you so much for joining us.

Thank you so much for having me, and truly, I'm excited to create a safe space to open this conversation because women's health issues, pelvic floor issues in general, it's not, you know, it's not just women. It can be men as well who have these pelvic floor issues, and So many write it off as it's just normal, especially moms. They're like, oh, I've had kids, so it's normal to laugh when I pee, or if I jump on the trampoline. It is common, my friend, but it is not normal. And so yes, I'm excited to break this stigma today and talk through, you know, ways you can really help yourself heal from a whole body approach.

Well, I, you know, I want to go right into the men thing just because it— in case there are any men listening, I want them to immediately know like, hey, this episode is for you too. Um, so obviously we're going to cover a lot of prenatal, postnatal, like, support for people that— for women that are going down that path. But is this connected for men? When you're peeing and then, like, you think you're done, and then you put up your pants, and then you still have more pee come out?

Yes, that is a sign of not fully relaxing the pelvic floor. Typically, there can be a nerve component where maybe the nerve is hyperstimulating the muscles in that area, But same thing, if the nerves are hyperstimulating the area, it's contracting the muscles. And so we need to draw the brain to muscle connection down to the pelvis. And so the pelvis is that structure that makes up our hip joint and then our sacrum in the back, our tailbone at the bottom. But there's this whole hammock of muscles that lay within that pelvis, and that is where our urinary and our bowel functions occur through. And so This can happen for both men and women. Yes, our anatomy is slightly different, but the underlying inner muscle structure is the same. And so we need to learn to downregulate the nervous system. And really, it starts with the breath. And this is appropriate for both men and women to truly learn how to diaphragmatically breathe. When we—

Okay, wait, what? Wait, wait, wait, slow down. That word, I'm sure most people are like, huh, what did she just say? Can you, can you share that word?

Yes. I, I, I will talk us through it. So diaphragmatically breathe is breathing with your diaphragm. So our diaphragm lays underneath our rib cage, and so often in today's society, our nervous systems are upregulated where we're breathing into our accessory muscles, into our shoulders, into our neck. So we have upper trap tension, neck tension, headaches, and I will tie this all into the pelvic floor, don't worry. So When we breathe, our diaphragm should drop, and when our diaphragm drops, it creates a negative airflow pressure in our lungs so that the air can just naturally flow in. We don't need any use of these accessory muscles. When the diaphragm drops, it activates our vagus nerve. The vagus nerve is the nerve that links us to our parasympathetic nervous system, which is your rest and digest portion of your nervous system. When the diaphragm drops, it also pushes all of those internal abdominal contents down, down into the pelvic bowl. And so the pelvic bowl is going to be that hammock of muscles at the bottom that again both men and women have. And that bowl of muscles should descend every single inhale. We should get a slight descent, and then every single exhale we should get a slight recoil where it's this gentle oscillation up and down. And so if that pelvic floor in either a male or a female is stuck in this up position because the diaphragm is not moving with your breath, you're just breathing into your chest, then it stays tight. And then it can be very challenging to fully empty your bladder. So to your point of you think you've eliminated everything and then you get up and you're like, wait, I have to go to the bathroom again, I literally just went. Or maybe you get up, you leave the restroom, you squat to pick up something and you leak a little bit and you're like, that is so weird, I literally just used the restroom. Well, it's because your pelvic floor wasn't fully relaxing to allow that bladder to fully empty. And so that's definitely one scenario that we see a lot in the clinic. Again, it can be either gender, and it really all ties back to this upregulated nervous system.

Okay. So this is great cuz we're really, I mean, we're talking about very ancestral biological concepts here because, you know, obviously nervous system regulation is something we're all struggling with in modern society right now. But it's something ancestrally that you probably, I mean, I think we can all assume that we would have these fight or flight moments, but then we'd have a lot of downtime to self-regulate, right? So we're very lopsided in modern life. But we're also, I mean, this is making me think about the fact that I've heard like people when they're in extreme fight or flight situations, particularly nowadays, they'll evacuate themselves. This has got to be tied to it, right?

Yeah. So you're talking about like a full bowel movement or something like that?

Like, I've heard that happen in war. I've heard that happen in extreme violence.

Yeah. And it can be the body's way of just saying, I want to clear everything out. Um, so we can definitely see it kind of go that way too, or we can see it as significant constipation. And because we're not getting into that rest and digest portion of the nervous system to be able to relax enough to move things through. So we can definitely see things on either end of the And we wanna be kind of in the middle, right? Where we have that normal flow of our nervous system where we can have 1 to 2 bowel movements a day would be normal. And the bowel movement should be shaped like a banana. We want it to be soft but formed. So if you are just like diarrhea, we're clearing everything out, that can be a sign of way too high of cortisol and way too high of stress. And then on the opposite end, if you're very constipated, those stools are really hard formed. They look like little rocks coming out and it's, you have to bear down to get them out. That is also not normal. And so we want to find that happy middle.

Yeah, I, I'm, I'm actually love that we're talking about, um, this, this, you know, and stool, the way things look. So I'm always telling people like, look, I know that on a certain level we're taught to think this stuff is gross, but it's, it's key. It's crucial to understanding how your body is responding to your environment, how it's responding to what you're feeding it. You have to look after going to the bathroom. You need to look and see what, what does it look like? Is there blood? Is there this? Is it, you know, it's going to give you more information than anything else you do.

Mm-hmm. And as a parent, I am a mom of 3 with my 4th due any day now. And I have that open conversation with my kids. My, of course, when you're potty training them, it's very normal cuz you're in there with them and so you're seeing their bowel movements. But I quickly learned my oldest is 6 now, and so she's in kindergarten. And even when she became very independent, I mean, she potty trained by 2, she was like, Independent, and I started to think, okay, I need to know what's going on with her stool still because is she constipated? Is she going every day? Because it's really easy to lose tabs on that as a parent as your kid ages, and so just it's not something weird to talk about. It is a very common bodily function that we should be having every day, and if your child isn't, we do want to consider things like are they getting enough magnesium in their diet? You know, in the summer it can be. Easy to, to be more constipated just 'cause you're sweating more. And so making sure you're replenishing the body's electrolytes. And so that's something as a parent, I really encourage you if you have children to just be very open with your kids about like, have you gone number 2 yet today? Or, you know, just make it kind of a natural part of life so that it's at the forefront of their mind too. If they are not going, like my daughter at one point this summer was like, mommy, my tummy kind of hurts and I don't think I've gone number 2. Yesterday or today, and I was like, okay. Like, so I did an abdominal massage on her with magnesium lotion. Our colon empties on the left side of our abdomen, so you want to start in the right lower quadrant, stroke upwards, and then strike underneath the diaphragm, and then down on the left to facilitate the emptying of the colon, which is where our stool forms. And magnesium helps those stools to soften. So if somebody is constipated where their bowels are a little bit backed up, magnesium, especially topically right over. the digestive tract can be really helpful for stimulating that peristalsis to move things through. So we did that, and then I gave her some electrolytes. You can use coconut water with kids with a squeeze of orange juice and then some, some good quality salt, or we use LMNT. I'll give them like half a packet of that. So there's a lot of good options. And then she was able to clear everything out and was totally fine.

That's great. I mean, what great tips. I mean, from the massage to the magnesium, this is really helpful for parents. Parents and individuals that can right away apply these very natural, very kind of, you know, just human results. You don't have to go to the doctor. You don't have to necessarily go and take some weird pharmaceutical. You could just use what, you know, your body and what nature provides. I think it's fascinating that You don't really hear the pelvic floor discussed until you've had a child. Why do you think, A, it's not talked about much, and then B, why are we talking about it only postpartum?

Yeah, it's a great question. I think the mind gets drawn to it postpartum because most women have vaginal deliveries, and those muscles have to expand to allow a child to move through them. And so trauma is certainly involved with Childbirth and then postpartum. And so that is why it is most talked about there. But we don't have to wait for a traumatic event to occur. And I don't mean that birth is, is trauma in a bad way, but it, it's a huge bodily change and this huge expansion in your body, and it can cause trauma, right? So that is why it gets brought to the forefront of the mind there. But my whole approach is really proactive. And so as a physical therapist, I started out in sports medicine. I was treating professional and Division 1 athletes as well as regular men and women like ourselves. And I saw a lot of women who were postpartum getting back into running or CrossFit or whatever sport it may be, and they would have hip labral tears, they would have terrible sciatica, they would have low back pain, they would have leakage. And I at the time didn't have children yet, and I was like, I do not want that to be my story. So I started diving into things from a preconception standpoint and realized I actually did have underlying pelvic floor issues myself. I had been a 4-sport athlete in high school. I had struggled with urinary leakage with running way before kids. This was in high school, but I was told that was normal. I was told it was normal to pee your pants during a cross-country race because that meant you left it all out on, on the, on the course. And, um, we, like everyone on our team, had an extra pair of shorts that we would change into afterwards. It was normalized. And so I quickly realized, okay, this isn't— that wasn't normal. It was my muscles not functioning properly. And so I started to become my own first patient in the pelvic floor space and learned how to relax those muscles, kinda coming back to that first topic so that they oscillate with your breath. And then I was able to think about the surrounding muscles of our pelvis. Like, how do we strengthen our hips and our glutes so we can offload those pelvic floor muscles? Because a lot of times, we're just thinking about working, like, your main mover. Like your glute max and your quads and your hamstrings, but there's all these little stabilizing muscles in our pelvis that we oftentimes forget about that can help support the pelvic floor. So I dove into that. And so really coming at things from an even before kiddos approach, and then during pregnancy learning to support the pelvic floor, because whether you have a vaginal delivery or a C-section, your pelvic floor muscles are taking on extra load that entire pregnancy as baby grows, right? I am currently 38 weeks pregnant as we are recording this, and I am 27 pounds heavier than what I was before I got pregnant, right? I am like walking around with almost a 30-pound weighted vest all the time, and that starts to take its toll on the pelvic floor muscles, right? And so again, I think that's why the brain is, is brought to that area during pregnancy and then postpartum. But really, we can look at the pelvic floor from a proactive lens across the lifespan and then can better avoid issues in terms of trauma to the pelvic floor with labor and delivery. So my whole goal with my patients that I work with during preconception, then pregnancy, is to prepare the pelvic floor for labor and delivery so we can reduce risk of tearing. So often, you know, it's not brought to a woman's attention until she's had an episiotomy where they've cut the pelvic floor muscles, or she's had a significant tear during childbirth with stitches put in, that then they're referred to pelvic floor PT. And a lot of my patients are self-referring. I'm a doctor in my field. You don't need a referral to see me. And they're self-referring because they're like, I want to avoid tearing. I don't want to come to you because I had an injury in birth. I want to prepare for birth, avoid injury, have a successful vaginal natural delivery, and avoid significant tearing and scarring and set myself up for a more ease-filled postpartum experience.

Yeah, that's a great tip, you know, just to— for everyone out there to be thinking ahead of the game, you know, versus waiting till they actually truly need you, you know. Like, but, but to really be thinking about, hey, this is preventative. What do you think this is all stemming from? Because I gotta imagine, I tend to default that the human body was designed perfectly, you know, beautifully. And I mean, that, that nature had it right, you know, or source, whatever you see it as, like, that, that had it right. So why are we having so many issues?

It's a really good question. I mean, I I'm a faith-filled person and identify, you know, as a Catholic and Christianity. And honestly, my mind goes back all the way to Adam and Eve. Like, if we think about, you know, when they ate from the forbidden tree and then they realized they were naked and they had to cover up, right? We think of the pelvic floor, that was an area in both males and females that was covered up. And so it did just become this area that wasn't talked about as much, right? And I think naturally so, just because it's, it's not like a biceps or a quad that like we physically see all the time. It's always covered up. And so it makes sense that we would have a little bit more reservation around talking about our private areas. There's definitely, um, you know, a sense of intimacy in that, but also understanding God gave us a pelvis and God gave us a pelvic floor, and it is a natural part of our body, and it does need to be supported just like anywhere else, you know. And so I think just letting go of the awkwardness of it and the stigma of it and It's, it's okay to talk about having issues in that area. And the other thing that I think makes it challenging to talk about pelvic health concerns is our medical system. So I worked in the traditional medical system for 5 years before starting my own practice, and I was in a clinic of 40 other practitioners, huge open space. Again, we saw professional athletes, Division 1 athletes, and then regular men and women. And like all the way down to junior high athletes, adolescents. We had treatment tables about 3 feet apart all throughout the clinic. And so it's really hard for somebody to open up about having leakage when they run or pain with intimacy when they're coming in for hip pain and there's somebody sitting 3 feet to the right of them who they don't know, right? So having just trust with your provider, I think, is a big part of this because it is an intimate area. And so in starting my own practice, I really created like a very holistic calming space. I tell my clients, I want you to feel like you're at a holistic spa and not at a sterile medical clinic. They sit in a comfortable chair, you know, and we start and it's only them and I in that room. There's not somebody sitting a few feet away who's hearing what they're talking about. And so they have a safe space to open up. And I give a full hour to each patient as well. The other thing in the traditional medical system, if you're seeing your doctor, they have patients every 15 minutes. If you're seeing a physical therapist in an insurance-based setting, they're having patients every 30 to 45 minutes, usually sometimes overlapping patients. You're lucky if you get that therapist for a full hour. And so that just creates an environment where there's not time to unpack those harder to talk about areas.

You mentioned breathing earlier in the, in the episode. Do you think that The issues as well stem from just, I have to, I just want to, at least how I imagine is ancestrally, like, we didn't have as much stimulus affecting our breath all the time.

Yeah.

You know, or limiting our breath or like the trauma that, that I think beyond trauma of experience, I'm talking like trauma of like, uh, you know, light exposure to EMFs to these, these unseen things that are constantly happening to us, whether it's toxins in our air and our water and our food to the waves that are constantly bombarding our body, right? So there's those kind of things, let alone actual physical and emotional traumas that are happening due to other humans. But I have to wonder if our diaphragms have gotten tighter and tighter from modern living, from the way the path humanity is on. So So, if you agree, like, what are some things people can start doing immediately, you know, upon hearing this podcast where they can start affecting their breath to support their nervous system to be kind of retap that ancestral nervous system?

Yeah. And, you're so right. I see all the time in the clinic when I assess somebody's breathing that they can't access that diaphragm because they're so used to breathing into their upper chest. And so sometimes that looks like doing myofascial release of the diaphragm. And a way you could do that on yourself would be to just lay on your back, both knees bent, so that your low back is flat with whatever surface you're laying on. Your tummy is nice and relaxed. You're just going to go in with broad fingertips right underneath your rib cage angle and massage, because that's where your diaphragm lives. It arcs up right underneath that rib cage angle, and you just massage. And you might notice that there's tender spots. That tender spot is an area of myofascial tension, meaning muscle and fascia. And fascia is really this like spiderweb network that is all throughout our entire body. And when we hold tension in that fascia, we just can't fully relax and open through that muscle. So you can try self-massaging that area. If you're like, I don't know what I'm doing, then you can definitely reach out to a pelvic floor physical therapist local to you. I am in Ohio. I also see clients virtually, and a lot of times my virtual clients, it's like A one-time visit where I'm just giving them a ton of education because it's a video call. And so I can see what they're doing. I'm like, no, put your hands a little bit higher, make your fingertips a little bit broader, go a little bit deeper on your pressure. What do you feel now? Oh, now I'm feeling a tender spot. And, um, okay, keep massaging there. And the other thing is we want to get deep into those layers. And so you might be on one trigger point, which is that area of increased balled-up tension. for 60 to 90 seconds before you move on and find another one. And so I like to tell people it's kind of like peeling away layers of an onion. You're not gonna just like get there with one fell swoop. Like, it's going to take layers upon layers of releasing tension to get that muscle to fully relax. And so day one, you might release 3 trigger points, right? Well, the next day you do it, you might release 3 more. And so we start peeling away the layers. Then after you do the myofascial release, you want to practice the deep breathing. And so we can all do this together. Now you're gonna place one hand on your chest and one hand on your belly. If you're sitting, that's fine. If you're standing, walking, totally fine. But if you have the ability to lay down, I invite you to do so. And as you inhale, I want you to notice which hand moves first. Do you feel that top hand move first in your chest, or do you feel that hand on your belly expand first? And as you inhale, as you keep breathing here, I want you to see if you can just get that bottom hand to expand, letting your belly inflate with air, side ribs, low back, letting the air move all the way down through your pelvis. As you exhale, think of a balloon losing its air, gently recoiling in all directions as the air moves up and out. As we inhale through our nose, our jaw stays relaxed. Belly, side ribs, low back, pelvic floor all expand like a balloon filling with air. And then as we exhale, we feel that gentle recoil in all directions. Now, as you practice this type of breathing, I invite you to close your eyes. Like I said, just, just really tune in with your body. And sometimes we have to practice it in different positions. Lying down on your back with knees bent, it's always my starting position because it can be most relaxed. But that belly's having to expand against gravity. And so if you're having a hard time with that belly expansion, Flip over onto your hands and your knees. Now gravity is pulling belly down, so it can be much easier to relax the belly there. You just don't get that tactile feeling of like hand on your chest and on your belly. You can practice it in sitting. When you're in sitting, now gravity is pulling the pelvic floor down. So if you're having trouble feeling the pelvic floor move, sitting and really finding those sit bones on your sitting surface and feeling that pelvic floor descend into your sitting surface can be really helpful. And I invite you to practice that for 2 to 3 minutes, 3 times a day. So do it once before or after breakfast, lunch, and then dinner. And whenever we sprinkle that in throughout the day, it's going to give the nervous system those times of calm. To your point of we're constantly bombarded with information and go, go, go. But when we invite moments of calm sprinkled in throughout the day, it gives that nervous system a reset to then stay in that reset for a little bit before we get upregulated again. And, you know, with my clients, I invite them to habit stack it with something they're already doing as well. So, you know, every time you're at a stoplight, instead of being tense and frustrated because this traffic is slowing you down from getting where you want to go, take 2 to 3 deep breaths. Okay, so what we just described, what we just practiced there, is true diaphragmatic breathing. So sprinkle that in throughout your day. That will help calm the nervous system because again, it links up with that vagus nerve every deep breath we take. But it's also physically massaging those internal abdominal organs, releasing tension in the pelvic floor. It has this whole cascade of positive effects throughout the body.

I love this. And it, and I think I would welcome everyone too to recognize that. Let's just say you're like, oh, but when I'm looking at my social media, I feel like I'm breathing, you know, fine. And I'm in parasympathetic mode. And I'm like, I don't think so. Like, I think this is a really good gauge of like, check where you're actually breathing when you're doing these things that are very tech heavy that you think are relaxing. Because what's happening is typically your body is being affected in a way that you're not acknowledging and or feeling. And so I would almost welcome like, hey, the next time you've, you, you're in line and you're like, your, your knee jerk reaction is to open your phone and to, um, go to that social media is to put it away and actually just practice this Breathing, because it's very, very different.

Or do 2 to 3 deep breaths first, right, to calm that nervous system. Then maybe check your phone and then notice like, oh yeah, now I like tensed up, I'm breathing more into my chest. Downregulate, cue yourself to be able to continue that diaphragmatic breathing even as you're doing a more stimulating activity, because we can train our nervous systems just like we train our muscles. So that's a really good practice to implement as well.

Is there something to in a sense, like box breathing, where you're making sure that the amount of time you're breathing in matches or doesn't. Maybe, you know, that's kind of the question is, should it match or should it not? The out-breath as well, because I do, I noticed even like last night for the first time I was, when I was laying in bed with my wife, I noticed she was breathing in longer than she was breathing out. And I said, hey, would You know, I asked her just straight up, I said, would you like, would you be willing just to try something and like just try breathing out a little longer or equally with how much you're breathing in? And she did. And I felt her body relax more.

Oh yeah, that's, I love that you bring this up. So it depends on what we're working on, but very few and like no instances are coming to mind right now. Times would I ever suggest that the inhale should be longer than the exhale? Because you're exactly right. If our inhale is longer, we're pulling up tension and then we're not letting it go.

We're not You're not releasing, right?

So typically I am cueing that we want our exhale to be twice as long as our inhale when we are practicing the diaphragmatic breathing. And so as we inhale, we're really filling those lungs with air. We're breathing all the way down through our pelvis is what we're visualizing. And then exhale, it's this slower recoil of everything up and out because we don't want this forceful exhale where we just bring back all the tension. So if somebody is inhaling for 5 seconds, then I cue them to exhale for 10 seconds. Inhaling for 6 seconds, we're exhaling for 12. Those are kind of the 2 ranges that I'm typically working with people up to, because sometimes initially it's like 3 or 4 seconds in, and then it's like hard to make it longer than 5 seconds out because people are so upregulated. Now, box breathing has its own benefits where if you're not familiar with box breathing, you can kind of visualize a box where you're inhaling for, let's say, 5 seconds, you're holding your breath for 5 seconds, and you're exhaling for 5 seconds, and you might pause before repeating. And That more so has the mindset piece where you're really focused on what you're doing. You know, there's apps where you can watch something fill with water or move across the screen, you know. So there's more of like a visualization aspect to that where it can be helpful if somebody's mind is spiraling or they struggle with anxiety. So that is more like that category. But for me, especially in terms of the pelvic floor, if we're working on strengthening it or if we're working on downregulating it, I'm more so focusing on the exhale being twice as long as the inhale.

That's great. And now let's touch base about, you mentioned nose breathing when you're doing this. So breathing in and out of the nose. A lot of people are mouth breathers, particularly as their heart rate increases when they're doing any athletics. But in general, of course, when they're sleeping, sometimes they're mouth breathers. So you hear a lot more about like mouth tape to keep it closed. Talk about that.

Yeah, I mean, from like a pelvic floor standpoint, I don't get into it too, too much. Like, I definitely will refer out to an airway specialist if somebody is struggling with breathing through their nose, like through the night or things like that.

Breathing through their mouth, you mean?

Breathing through their mouth, yes. Thank you for clarifying. Yeah, because we want to breathe through our nose. But I am cueing it from a— we want our jaw to be relaxed It's if we hold tension in our jaw, we hold tension in our pelvic floor. And so we want our mouth to be closed, jaw relaxed, tongue gently resting on the roof of our mouth, inhaling through our nose. And then I will cue exhaling through our mouth because if, if we're working on accessing the pelvic floor from a strength standpoint, when we exhale through our mouth, we can purse our lips and it can be easier to connect with those muscles. So we've talked about a lot about restful diaphragmatic breathing, but there's also the active form. And so you bring up exercise, that is when we would want more the active form of our breath. So inhaling through our nose still, exhaling, we want to think about lifting from the pelvic floor from the bottom up. So you can think about as we inhale, pelvic floor lowers. As you exhale, you want to think about wrapping that pelvic floor around a marble. So you're thinking about closing that pelvic floor around a marble and then lifting that marble up and in, up and in, up and in as you breathe out. And if you breathe out through pursed lips, it can make it easier to access those muscles from a strength standpoint. As you keep breathing out, you'll also feel your core engage. And this is where the core is very well linked up with the pelvic floor. We cannot get maximal core contraction without the pelvic floor contracting first. So if we're talking about weightlifters, talking about CrossFitters, We want a good inhale down, exhale lift that load. Pelvic floor lifts first. It sets the base for our foundation. And then as we keep breathing out more forcefully through our mouth, we feel that core wrap and we exhale on the effort as we rise up. So there's a lot of nuances when it comes to the breathing. And, and I know you asked kind of about through the nose versus the mouth. So we're never— never is there a time where we're cueing to breathe in through the mouth. Always in through the nose, but there are times where we breathe out through the mouth because it helps us more forcefully access our muscles during activity. But at rest, we want that jaw relaxed, closed, and just breathing in and out through our nose.

This is great. Now, you brought up the visualization of something, you know, being held inside you, and that brings up a question I have. And admittedly, I know this can be a sensitive subject for some people, but I think it's one that's important to talk about because Everyone's hearing about this stuff, but I don't know if everyone understands it. So there's a couple of things I would love to now dive into. One is Kegels, and another is like jade eggs and things like that. Now, this obviously comes up a lot with, um, postpartum, like so after having a child. But could you talk— let's just say first, let's talk about Kegels first. Can you talk about, A, what it is, and then B, is it— does it help? Can you do too many? Things like that.

Absolutely. So Kegels were developed by a physician in the 1940s for non-surgical treatment of the pelvic floor. So that sounds great, right? Um, initially women's only option if they were struggling with leakage or prolapse— another big concern with women postpartum where internal organs start prolapsing through weak spots in the pelvic floor muscles. And so they would do surgery where they essentially tighten things up down there. Well, that caused its own whole host of issues and still does today. But this surgeon was like, well, Kegels— and his last name was Kegel— Are an exercise we can do for the pelvic floor, and so a kegel is a tightening of the pelvic floor muscles. So usually women are told to act like you're stopping the flow of urine. So just sit, act like you're stopping the flow of urine, hold that for as long as you can, and then let go. Hold that for as long as you can, and then let go. The issue with this is that kegels are only cued at rest, and so sitting here right now, as I was saying that I was doing a kegel. Now, what that has taught women and males, if they're prescribed them, is to just tighten the pelvic floor and that that's like the only issue. But if we think of the pelvic floor like your biceps muscle, and the pelvic floor, back to our earlier conversation, is already tight, it's already shortened. It's like somebody walking around flexing their biceps all the time. And then you go and you say, okay, I just want you to do bicep curls just when you're sitting at rest. Just do some more bicep curls, but they're never fully extending their arm because they don't know how to. All they know is holding it in this flexed position. What's that going to do? It's going to further worsen the issue. It's going to further shorten that muscle. They will become strong through that very end range of motion, right? Because that pelvic floor started lifted because they were upregulated, and then they're tightening it. More with every Kegel, but it's not lengthening all the way. And so that is my huge issue with Kegels, is that we need to learn to lengthen the muscles before we can strengthen it. And that's exactly why the first part of this episode we talked about nervous system regulation, learning to relax and lengthen those pelvic floor muscles with your breath. Then we can work on the active lifting of the pelvic floor muscles, which is the strengthening component. So I am never prescribing just Kegels, which is simply the contraction of the pelvic floor muscles. I am always first prescribing breathwork to lengthen the pelvic floor muscles, to get them back to their full range to start with, and then we can work on strengthening, but pairing it with functions. We're gonna pair it with the breath. So on the exhale, we get that lift of the pelvic floor muscles, and there's a lot of cues we can use. I gave the cue of thinking about closing that vaginal opening around a marble and lifting it up and in.

Mm-hmm.

You can also think about stopping the flow of urine, but with that, I find that sometimes people just like tighten everything. Um, another good cue, and this would be more for our males as well, would be to pull your sit bones together. And you can practice those different cues again on your exhale. So inhaling, you're lengthening, lowering pelvic floor, and then exhaling about pulling your sit bones together as that breath moves up and out. And then you'll feel your core kick in as that air continues to lift out. Then the next layer would be pairing that with activity. So inhale, I squat down. Exhale, I lift my laundry basket. Inhale, I squat down. Exhale, I lift my kid. Then we can extrapolate that to further exercises. And, and then your other question was about inserting something into that vaginal opening.

Yes, like a jade egg or something. Yeah, that's what I remember learning about that when we had our first child.

Yes. So are you talking about essentially like vaginal weights, that kind of thing?

Vaginal. Yeah, exactly. And then using, yeah, the weight, but then I think you're also using it as instead of visualizing some, something, you actually have something there that you're, you're trying to contract the muscle over.

Yes. Where you can get some biofeedback.

Yeah.

So that's a great question. You know, I think we have a lot of tools in today's modern society that That a lot of therapists enjoy using of, oh, we have this fancy tool, let's, let's use it. I am much more of, to your point, the ancestral approach of, you know, what were our bodies designed to do? Where our bodies weren't really designed to contract with something in it, you know, other than with intimacy. But that's different, you know, if you're, um, having that experience where we're not just at rest practicing inserting something and contracting with that, right? Um, so it can be helpful if somebody's having a really hard time with that brain-to-muscle connection, but I never start there. And in fact, do I rarely pull out those kinds of tools? Um, because again, you're inserting a foreign object and then you're working on contracting and holding it up and in there. And that's not something we're going to functionally do in our daily life, right? Again, outside of intimacy, but that would be a relaxed experience, not something where you're working on like contracting and holding something inside of you. And so, you know, I think it deserves a lot nuance to the conversation, but starting with what our bodies were naturally given. And so for me, you know, it comes back to exactly what I was saying before of not the Kegel, but let's lengthen first, exhale, engage, and lift, and then we're progressing our movements. So if somebody's goal is to get back to jumping on a trampoline, well, I would rather have her do 5 little jumps in the clinic working on each exhale we're lifting the pelvis floor with those quick jumps in place of inserting a device to work on just contracting at rest, if that makes sense.

Yeah, absolutely. Now, though, it does make me wonder about this very real, rarely talked about issue slash societal shaming, I guess, for lack of a better word, where women get very worried about once they have a child that their tightness of their vaginal wall is no longer there, expanded. So does— I know that people are— that, that is definitely something that people experience and/or are scared about, um, and like I said, are potentially even shamed about in society from particularly men, obviously.

Oh yeah.

And it's not cool. Like, I don't condone it. I think it's absurd that, that women are scrutinized the way they are in society. I think It's truly, truly absurd. But can you talk about that? Like, whether it's to kind of like make the person that is scared of it reassured and empowered, or like, how is this something that's real? Or is this more of like, no, the body will go back to the way it is. You just have to support it. Can you address that?

Yes. Well, thank you for creating a safe space to talk about this. Is I often see the opposite. So you're right, like people think, oh, it's just going to be loose and expanded afterwards. Usually it tightens up. So if we think about straining your hamstring muscle, right, you're playing baseball or softball and you went for a ball quick and you strained your muscle, what happens afterwards? It balls up. That muscle balls up and then it's hard to fully extend your leg. Like you lose mobility in that muscle because it just went through this huge expansion And then it comes all back together. That's what our pelvic floor essentially does. It goes through this huge expansion, and then it tightens back up and comes back together and gets on guard. And so I actually typically see the opposite, where women's pelvic floors are tight postpartum in regards to just being very like upregulated. So I I just want to encourage any woman listening who hasn't had children or anybody who has felt just. Like shame around the change in their area post-delivery is that A, it's normal for our body to deliver children and to change. That's a beautiful part of life. But B, those muscles are meant to expand and then come back together. Anatomically speaking, our pelvic floor has a circular muscle. So the vaginal opening is circular. It's called a sphincter. The only other areas we have that are at our anal opening for bowel And then around our mouth. And so those muscles work different than just like a biceps muscle or a hamstring muscle that are just long muscle fibers where they can only expand, you know, in one direction. A circular muscle is meant to expand in all directions. Think about a baby's head, right? Like, that is a circular area coming through that birth canal. And so it's meant to expand, it's meant to come back together just like any other muscle. The other tidbit I'll give there is Is think about if your goal was to do splits. What are you going to do leading up to that goal? You are going to stretch your hamstrings and your hip flexors, stretching and stretching to allow your body to be able to do the splits. Does that mean your hamstring muscle isn't as effective anymore, or that you can't be as athletic anymore because now you've lengthened that muscle? No. In fact, it's going to actually help you be more athletic because that muscle has a greater range. So thinking of the pelvic floor like that.

I love it. That's such a great analogy to it and definitely helping to ease people's minds and concerns around that.

Yeah.

Before we go, I want to address C-sections. So because we've talked a lot about natural birth, obviously you did briefly mention it, you know, when, when, when you're getting sliced into your abdominal muscles, there's scar tissue that comes up there. I mean, there's so much emotional trauma that happens for women sometimes, particularly when they didn't want a C-section. How can people listening who have had that or are concerned about that, how can they address that specific procedure and recovery around that?

Yeah, absolutely. So during a C-section, 8 layers of tissue are cut through in order to access baby and deliver baby. And then a woman has stitches. In all of those deep layers, right? And so oftentimes we just see the scar on the outside, but we forget that there are 7 additional layers beneath that skin layer that were also affected and needed to be stitched together. And so there's healing that occurs on various levels, and we need to make sure we're addressing the scar tissue. So with every other surgery that has a scar like that, a woman or male would be referred to physical therapy. After a C-section, most women are not automatically referred to PT.

No, I rarely.

I think yeah, rarely. The only time they're referred is if there was a complication typically, or if they have like keloid scarring and the woman asks about it at her six-week post-op check, and they're like, "Oh, you could do pelvic floor PT," but it is not a gold standard referral in the United States. Now, in Europe, every single woman is referred to pelvic floor physical therapy postpartum, whether they have had a vaginal. vaginal or a cesarean delivery, and they are typically receiving 10 to 20 visits postpartum. Let that sink in. Here in the United States, women are not given an automatic referral no matter what form of delivery they have had, when every single woman would benefit from postpartum physical therapy.

That makes me so frustrated. I feel like we talk about America pride so much, you know, just America first. But the reality is, is like the US does not have Americans' backs. It's like you go to Europe and now you're sharing this information. But I remember when I went and we had a, a procedure done due to an accident, that we were given an antibiotic and a probiotic that went with it. Like there was a holistic and a thought process of like beginning to end. And that's what I hear you're saying right now. When someone has a cesarean, it's like they're thinking of it from beginning to end. And they're supporting the body holistically. And it's like, why? We have the capacity to do that. Why are we not doing that?

We have a long way to go when it comes to healthcare. And that's why I stepped outside of the traditional medical system and opened my own practice, because I wanted to be able to operate outside of the confines of the medical system or the insurance system here in the United States. It's very challenging. And so again, like many of— most of my patients self-refer, and they want to stay ahead of the game. Want to have future children. So if you have a cesarean section, you know, there is scarring. And so it's very important that we work on that scar tissue, especially if you want future children, right? Um, because it can— C-sections can affect fertility, and that's never talked about, you know. Um, so we, we work on the scar tissue with scar tissue mobilization. We can do that, um, with our fingertips, but we also utilize things like dry needling and cupping. And for a woman at home listening Who's like, I have a scar tissue that I've never worked on from a C-section. A lot of times those tissues are really sensitive. And so once your stitches have healed, you know, around 4 to 6 weeks postpartum, you can start rubbing different materials around and on your scar. And so you can do something soft like silk or a plush blanket, and then you can do something a little firmer like a loofah. Just rubbing different materials on it will help normalize the nerves to touch again. Again, just like any kind of knee surgery or something like that, we need to rewire the nerves around the area. So that's one thing. And then cross-friction massage, which is where you come in contact with that scar. You overlap your pointer finger and then your middle finger on that scar, and you're going to move that scar tissue around. What's really cool about this is you're essentially moving that skin on those healing layers beneath it. And so as you do that, you can actually feel adhesions break up, and it might feel like bubble wrap popping. You can like literally feel this popping Beneath the surface. It's the nerd in me being like, it's so cool. But I, I like to mention that because patients, if they feel that, they're like, oh my gosh, what just snapped?

Yeah. Did I break something?

Yeah. I hurt something. And it's like, no, no, no. You just alleviated scar tissue. Like, you just broke up scar tissue. So it's really cool and, like, neat for people to feel that themselves because they understand, like, oh, wow. Like, I'm actually making a change in my body. And so that's one point of it. And then the other thing would be obviously core rehabilitation. You know, anytime muscles are cut through, that's going to impact the muscle fibers and our ability to access them. And so I will see a lot of women struggling to access the lower core after C-section. And so that's again working through— I highly recommend pelvic floor physical therapy, or, you know, if that's not accessible to you, I did create an online postpartum program to walk women through the healing stages of postpartum. Because the reality is, when you have a newborn You do need to rest, and so it's hard to get out of the house for appointments. But you can literally start healing your body from day one. And so my postpartum program starts week one. You can begin it whether you have a vaginal delivery or a cesarean delivery, and you simply press play, and you can be from the comfort of home. My baby is with me in all of the videos. I recorded it during my own postpartum with my third child, and it's so nice because you can do it in bed. You can do it. it on the floor of your nursery. If you need to press pause to breastfeed your baby, you can do so, and then you can come right back to it. So I really encourage women to start that program week 1, or if you had some complications, maybe you start at week 3 or 4, and that's totally fine. And then it goes through 12 weeks of programming to progressively build upon re-accessing and healing those muscles.

That's fantastic. Final question, It's one I ask all my guests. If you could wave a magic wand and bring back one ancestral practice, what would it be?

Ooh, I love this. Hmm. I would say just more time outdoors. You know, so much of our life now is lived indoors, and for just— if our schools were able to have like outdoor classrooms, right?

Right.

For kids to learn outdoors throughout the day anytime the weather's appropriate, but even when it's not to have like, okay, we're going to bundle up and this class we always go outside. And even just within our work environments, having outdoor space and that being more of a regular part of our routine would be amazing. That natural sunlight just has so many positive effects on our circadian rhythm and on our nervous system, and then fresh air. Outdoor air quality is always better than our indoor air quality. And so for both myself and then for my children, that would be a magic wand I would wave.

Love it. Well, Dr. Kayla, thank you so much for joining us and congratulations on your impending birth. And by the time this airs, you will have birthed a beautiful new child. So many just loving thoughts and energy towards you in having this birth. Um, where can you mention your program? Um, obviously you have virtual ways people can see you, so where should people go to, uh, learn more about these programs?

Absolutely. So if you go to drkaylaborchers.com, you will find my preconception, pregnancy, and postpartum online programs. So they're all self-paced, you get lifetime access, and I did develop one for each of those seasons of life. And then you'll also see the option to work with me or my team. One one-on-one, um, but the programs are really just so much love poured into them for you to be able to access from the comfort of your own home. And if you want to get a feel for working together, you can go to drkaylaborchers.com/resources. I have free guides specific to preconception, pregnancy, and postpartum as well. And then I'm @drkaylaborchers on Instagram, so you can come say hi to me there. And then I had James as a guest on my episode of Holistically Well. So I have a podcast as well. So be sure to check that out too.

Excellent. Well, thank you so much for joining us and for sharing just such amazing information that I believe will help everyone, whether they've had a baby or not. I think we covered a lot of really, really good value topics. Thank you all for joining us on this episode of Everyday Ancestral. If you enjoyed the episode, make sure you like, subscribe, share it with a friend, give us some feedback. I love this topic and I hope you did too, but if there's topics you want us to cover, we need to know. So let us know through your comments or feel free to reach out to us on our DMs on socials. But thank you all. And remember, stay curious. Thank you so much for joining me on Everyday Ancestral. If you enjoyed this episode, hit subscribe so you don't miss the next one. You can find the show notes, links, and resources mentioned at eatpluck.com. That's eatpluck.com. And hey, if you know someone who'd get something out of this, share it with them too. Stay curious, live well, and keep it ancestral.