Pelvic Floor Health For Runners Ep 34

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All right. Welcome back to the Find Your Edge podcast. I am your host, Christina Fiumara Newport, and I am here today with a special guest, Bong Henry from Radiance PT. Welcome to the show.

Thanks for having me. Happy to be here.

Yes, same. This is a topic that probably not a lot of people feel comfortable talking about. So we're going to be talking all about pelvic floor health. So, Bong, give us a little bit about your background and then tell us what is pelvic floor health?

Yeah. So I am a physical therapist and I help postpartum runners who are frustrated with like leakage and back pain and they feel held back by those things. I help them discover like how to be confident, how to build strength in their bodies again so they can like run on the trails and have a good time with their spending time with their family, their kids. Right. Everybody wants to roll around with their kids. And I got into the field specifically for like pelvic health and obstetric health. After my first was born, I was training for a half marathon, as runners do, and I had pelvic pain at about mile 10 of a half marathon when she was about 9 months postpartum. So that timeframe is not bad, right? It's just that I hadn't built adequate capacity in my body. And as a good little PT, I prepared for everything, but I wasn't prepared to feel like I was splitting in half towards the end of my half marathon. So I had done many halves before too. So through the journey of getting help and then also realizing there is so much more than just like the physical piece that goes into postpartum recovery, looking at me as an individual, like time management, sleep, nutrition, all those things play a role, and having enough support. You know, training for races with a baby, you need someone to watch your baby. When you're resting, you need to be able to ask somebody for help so that you can rest. So through that experience, I realized that in my practice I wanted to help postpartum runners. And I also noticed a little bit more clearly, like the older women I was treating in the clinic, they would have been in their 70s and 80s and have these problems that stemmed from when they had their children 40 years ago. And I'd ask, oh, what happened back in the '70s? Like, oh, I've, you know, been constipated since the '70s. Okay. Like you had your children then. Okay. You've been leaking since then and they didn't know they could get help. So a different generation, but also sometimes I see this is pretty common. A lot of moms will think that taking care of themselves needs to go to the back burner. So there's little things that may have not been a small problem, not been a big problem when it first happened, but then you waited 30 years and it's a little harder.

Wow. Yeah.

So yeah, there's a window for when you're young and motivated to build resiliency in your body. And then if you were a runner and you love doing what you love running like myself and Chris, you know, like there are ways to get back into it. Um, but it'll look different than what you did before.

Interesting that you, that you say that it, it might look a little different cuz you also have a new human, right?

Yes.

But tell us about how, um, cuz when I, when I first reached out to you, I was like, you know, I don't know if this is a good topic because, um, it's really only geared towards women. And you said Men have pelvic floors too.

They do. They do. Every human has a pelvic floor. Everybody has a pelvic floor. I specialize in female athletes, but for sure, pelvic floor issues. I would say if women are underserved and they don't talk about it or it gets brushed under the rug, for men specifically, it's like it's harder for them to get help because they will think they're more likely to think there's like like a cancer. And there definitely could be cancer, right? Prostate cancer is real, right? I would say for the issues most people would notice after surgery for prostate cancer, particularly if they're active— even if they're not active, actually— they'll have, um, they'll have issues with leakage. Okay. But people think it's a women's problem, but it's not.

It's not. Okay, so let's go back to some of these common issues. You've already mentioned leakage. So if we're piddling in our pants, I should say, I don't know what's— we've got all the jokes. So you could tell us the more scientific approach to this. Oh yeah.

Like tiny bladder syndrome. Yeah. Runner's bladder.

Tell us the common things that you'll see and maybe some of the signals that should indicate to us like, oh, maybe this is not just low back pain or maybe this is, not just normal for you to be leaking, or— yeah, so, so tell us about some of those issues.

Yeah, so leakage with exertion is what they call stress incontinence. Um, so if you're leaking when you sneeze, you cough, you're running, jumping, getting surprised, um, yeah, that's accidental leakage. So that would be a check-in signal to get help. It's very common. 30% of female athletes who have never had children have stress incontinence. And so this is with like impact sports like gymnastics, running, any sport where you're landing forcefully and you're hitting the ground. There's urge incontinence, that's when you have to go and you're not quite getting to the bathroom in time. Some people have a combination of two, of the two. There's also accidental leakage of bowel movements or accidental leakage of gas. So they would fall into the category of anal incontinence. So for triathletes, stress incontinence and anal incontinence tend to be the more popular things that pop up. And particularly with like, it's, you have to put a lot of training in and the impact with running tends to put them at risk for incontinence.

Okay. So, so it can apply to everybody whether you've had a baby or not.

Yes.

Yes.

And it's— yeah, I would say it's good to know that you are not alone. Oftentimes the, the runners I've treated who are not pregnant, they have a hard time getting help for it. But when they find out that, yeah, like, this is really, really common, you can relax, you can get help. There's hope for you.

Okay, I like that. There's hope for us. So if we're, if we're experiencing some of these things, do we go— would we come sign up with you? And, and then, and then what happens?

Yeah, I absolutely think it's, um, the collaborative approach is important. So it's good to talk, have a conversation with your doctor. Um, I love it when people reach out to me directly Some providers, even though they mean well, they might tell women that just to deal with it and put a pad on. But that, when someone's asking for help, I feel like that's really discounting, right? So you can get help for a problem if it's meaningful, that issue is really interfering with your life. Quality of life is important. And I think everybody deserves, if they want help, to get help. So I love to chat with people before they book in and just one, you know you're not alone, and two, you can get help.

I, I always find a lot of women who are like, so I will never buy any pair of pants other than black for this reason, right? So like, let's get a little color in your life, ladies and gentlemen, perhaps.

Yeah, absolutely. You know, you think about like quality of life. We have the different dimensions of health. So there's physical health, there's mental health. There's emotional health, there's spiritual health. And I think it's a really— when someone is telling someone just to put a pad on and deal with it, but it's really ruining their ability to be social with their friends, pick up their kids, maybe they're changing their clothes multiple times a day, or they're planning their race routes or their training routes about where the toilets are, that interferes with their mental health because they can't express their bodies in the way they want.

Yeah, certainly. Um, and we'll see this from the nutrition— nutritional perspective, like, oh well, this must be because I'm eating too much fiber, or, you know, what, what are they? And so same thing, I appreciate the collaborative approach of the mental health and, you know, physical health and all that kind of stuff. Okay, great, I love that. Um, so we're in your office Now, what is there, like, a specific way of, like, a specific intake, or what's, what's an exam look like in pelvic floor health? We're walking us through all of it. Yeah.

So I have a sports background. So a lot of what I do, people are surprised. They're like, oh, you want to see what my pelvic floor does when I squat and, like, what's happening when I jump and run? So I take a full body approach. We always start with talking. And figuring out what's meaningful for you. So like if you are leaking with sneezing, you're leaking with running, let's talk about like, okay, what your goals are. And then we go through how we can start doing meaningful activity towards that. So with the sports background, I think it's really important. Like I do have people do crunches and we're checking squats and jumping, jumping on a trampoline. All of those things give me information about your pelvic floor. So for some people, we do a pelvic floor assessment. And that's, you know, we— I'll talk about if that's appropriate and let them know exactly what's happening. Because just like with sprinters, you will train for like sprinting. Your endurance runners will train for endurance. Your pelvic floor muscles have those different fibers too. So what I do for the pelvic floor assessment is different than your OB. I'm looking at your muscle performance, like your speed, your endurance, your power, like all those things. It's fun. Yeah. And then also like physically, like what else is your body doing? Because you are more than your pelvic floor. Like you walked in here.

So like, yeah, yeah, exactly. Okay, cool. So it's, it's a muscle just like any other muscle. Yes.

Or it works with other muscles.

Yeah. Coordinated. So let's talk about that, the coordinated approach of Because when you say pelvic floor, I'm like, hey, let's all be doing our Kegels, right? Is that something that's appropriate for everyone? Yeah. So, and perhaps tying that into like, does like coordinating— is it me just sitting in my car like doing my Kegels or something else?

Yeah, that's a really great question. And so with that, just like you wouldn't just train your feet muscles for running, you train your whole body. And so I look at a holistic approach and I love the umbrella of pelvic health. So like, what are the dimensions of the factors that influence your pelvic health? So we talk about your habits, like, do you drink water? Are you restricting water? Are you overdoing it with coffee? So some coffee is good, some coffee is not ideal depending on your situation. Kegel is just the name of the muscle contraction. So, but some people need to work on doing the opposite of contracting, right? So if you're always tense and tight, we might incorporate things to help your pelvic floor muscles not be that way.

Tell me a little bit about the coordinating process. Like, is this are we going to a Pilates class in our pelvic floor PT? Or are we— are you going to like— are we going to be patting our heads and rubbing our bellies? And like, so yeah, tell me about that.

Okay, so, so your question is like, what does coordinating pelvic floor—

well, perhaps using an example, like, you know, let's say somebody who comes in for some of these typical things that are coming in for runners, perhaps it's the stress incontinence that you talked about or urge incontinence. And let's say they recently— they're postpartum. Do you typically see too strong, not strong enough? And what would be sort of a case study or something along those lines of What am I just coming in for an exam and then am I going to be, you know, jumping up on a trampoline like tomorrow or, you know, how do I get— what are the steps that I need to get there? How long does it take? And I'm sure it varies by person, but maybe walk us through some examples that you've had in your office.

Yeah, that's a great, great clarification. So yeah, I have a superstar client who was leaking after her twins. Every time she tried to run. Right. And then she had a single birth after twins again, like leaked every time she ran or tried to run. Right. So this is like you got cleared to exercise. She had a tummy tuck the year after she was done having kids, you know, had a lot of loose skin and that was like gasoline onto the fire. So before she came to see me, she was changing her clothes multiple times a day. She was working from home, so she had the safety of having her closet like 30 seconds away. She was leaking when picking up her kids. She wasn't able to play with them. And one of her goals was try to be active and healthy again, but the bladder issues were a problem. So with, for her, she had, after working with working together, we started with the basics with looking at, okay, like, can your pelvic floor move in both directions? And then building blocks of like abdominal, like, what are you doing with your breathing? Like, what specific meaningful activities to her. Lifting her kids without leakage was important. Running was important. And so we gradually added those things in and she went from like leaking with picking up her kid to playing tennis. So like tennis was another issue where like the impact of hitting the racket, she would leak. So but she was able to get back to tennis, jumping up and down, doing jumping jacks with the trainer. She signed up at a for a 5K at her kids' school, ran the whole thing. And so it's when people ask like, how long will it take? It's always important to know, well, how long have you had the problem? And then what are your tendencies before the problem happened? Because quite often there's a baseline, like you can have something going on with your pelvic floor and be fine and not know it. But then maybe a hormonal transition, a surgery comes up, and then you look back and realize, oh, you've been like going to the bathroom every hour and just ignoring the fact that your life has been rearranged by your bladder habits. So a lot of people, sometimes it sneaks up on them. They don't realize it maybe got to that point until they have an embarrassing episode in public.

Interesting. Yeah. Okay. Yeah, that was a great example of somebody's transition. So it sounds like if you have any sort of, at least from an incontinence perspective, like don't wait because the longer this issue goes on, the harder it is to treat. Is that an accurate statement?

I would say so. And if you think about it from like muscle physiology, as we age, we do lose some muscle mass. And so like when you're younger, like your 20s and 30s is like the ideal time to build that muscle resiliency. So So you can get help later down the road. For some people, right after having their babies is just— it's a chaotic time and they don't have the margin to be able to dedicate time for themselves for showing up to appointments. Totally respect that. But I think the truth is, is like there's, there's wisdom in understanding how to take care of your body and, you know, wanting to like make it to your 80 rolling around with your grandkids and being able to get to the bathroom when you have— when you feel that urge when you're old. Because when I was working with the elderly, I don't see them on my population. We still need to work on balance and speed. And like when you feel that urge to go to the bathroom, can you get there, change your clothes without falling? Right. And thinking— but I think oftentimes we think about, oh, right now it's not that bad right now. Yeah, I'm young. It'll be like, it'll— I'll be fine. Maybe it'll go away on its own. But the truth is, like, we're getting older and, you know, taking care of our bodies now, I think our older selves will be grateful for that.

Appreciate that. As you were saying, the balance when you have to go reminds me of a half marathon I was in where I did have to go and was like, where's the closest porta potty? And doing the awkward dance when you're in, you're like, your heart rate's up and then you're in the porta john trying to like, how am I supposed to navigate this small space? In here and oh my God, the toilet paper's out. I just sat down. Now I have to get back up. Oh goodness.

Yeah.

So it's not just the old, right? It can apply to the runners too.

Yeah. And particularly on race day, like you said, adrenaline is high, cortisol levels, you have so many other hormonal factors playing a role into that. Yeah. And I think that's a good point to see that our— what was happening in our hormonal status and our outside world also affects our pelvic floor because a well-organized race will have a lot of porta-potties. Yeah. Or at the start line and at the finish line. Right. So because people's nervous systems are a bit amped up on race day.

Yeah. So, so yeah, we got a little— there's that mental health part of things, you know, that— so that's interesting that you mentioned that. Again, same thing. People come to me because they're like, as a dietitian saying, oh, it must be my nutrition that is making it, giving me the urge to go, or, you know, whether it be a bowel movement or their bladder. So it's, you know, nutrition is part of it, certainly, but so is pelvic floor health.

Absolutely. And with that, you know, I always let my patients know that the pelvic floor muscles are emotional muscles. So they've actually done studies where they put sensors on people's upper traps and their pelvic floor muscles. and they showed women a violent film. Well, there was activation in those pelvic floor muscles and upper trap muscles. So even just that threat around them, even though they were like, they're just watching a film, there was muscle activation. So there is something to be said for recognizing that our brain, like what's between our ears, is important in addition to like what's going on with the muscles in between your legs. And so when people see that connection, they tend to like pick it up much quicker and see the results they're looking for.

Wow, that's, that's fascinating. And that in, in my mind, as you're saying, like, oh, something stressful, breathing is what comes to mind for me. So I perhaps this is going back to coordination. Are there exercises that you do to coordinate pelvic floor with breath?

Absolutely.

Like, give us an example.

Yeah, that's— I always start with breathwork because the diaphragm, which is a muscle that lives underneath our ribs, it coordinates with the pelvic floor. So there's a million ways to breathe, and there may be a way that someone's not good at. So we practice a way that helps them to relax their diaphragm, relax their breathing. Like the 4-count breathing is like a simple way to start. So you inhale for 4, exhale for 4. And then some people do well to progress to like a 4 and 6. But particularly with running too, being able to control your breath and relax your upper body when you're running will really impact your pelvic floor. Because if you think about just running— sorry, I guess they can't see me. If you tighten everything up and like don't move the middle of your body, like there's just not much range of motion. Your diaphragm can't do what it needs, your ribs, and just not as much expansion. So you're right on point with the breathing. Your breath is always with you. So it can be a really, really powerful tool.

I like that example you just gave. And granted, those who are listening can't see what you just did, but basically, like, you know, pulling your shoulders to your ears and like bringing your fists up to like your face, which I feel like is every runner. If you took a picture at like in like a half marathon, like mile 12, right before the end, everybody's got this like hunch. They're all stressed out and they're, oh, get me to the finish line, or, you know, mile 21 of a marathon or something like that. So that's interesting, the association of other muscles in conjunction with pelvic floor and breathing and all that kind of stuff.

Wow.

So cool. Yeah.

And, you know, even with that, I like— so, you know, humans are not like cars, but the car analogy is helpful. So if there is like a check engine light, it doesn't mean you're going to blow, but it just might mean, like, take a look at what's going on underneath the hood. Like, usually when you take care of something sooner, then there's like less other problems. So sometimes, like, looking at like a pelvic floor issue, we might look at, okay, well, what else is going on in the system? It just may be a clue that I need to talk to someone, I need to get help. And with the integrative approach, you know, you mentioned like people think sometimes it's their nutrition. A lot of like female runners may not be tracking their periods because they're on birth control and like understanding your cycle or lack of cycle can give valuable information because the risk of like stress incontinence does increase if you are not getting— if your hormones are imbalanced.

So fascinating. Does this tie into like menopause as well?

Yes.

Yeah. Yeah. Tell us about that. Like, is there a higher likelihood of having some sort of level of incontinence like in like perimenopause, menopause versus like— or is it similar to postpartum? Or are those perhaps related?

Yeah, it's the hormonal transition. So like pregnancy is a huge— pregnancy and postpartum are huge hormonal transitions. And then in menopause you have, you know, changes in your estrogen level. There's estrogen in your pelvic floor. So some individuals who may have been fine during pregnancy and postpartum will start to experience, whether it's like stress incontinence or pain with sex, like penetrative intercourse. During the menopausal perimenopausal transition because of those hormonal transitions. So like getting help from a qualified physical therapist can help in addition to other things to modulate your hormones. I think people really underestimate the role of stress.

Oh my gosh.

Yeah, but so like stress, there are hormones with when you're like stressed all the time that can influence your periods, implement your hormone cycles. All of that will influence your pelvic floor.

Yeah. And, and here we are trying to go for a run to reduce our stress.

Yes.

But then we have to go to the bathroom right before we go out. We're picking the black clothes. We're picking the route that, like, that's stressful, you know, isn't it? Isn't it so much less stressful to be like, you know what, I'm going to throw those gray shorts on that I have. And oops, I forgot to go pee before I left. Like, Okay, cool. So you're saying this— there is hope that we can one day do that?

Absolutely. That's an example. Is one of my clients who she just wanted one less thing to worry about, right? So like having to plan her workout clothes or work clothes, all those things, it was really interrupting her life. But after working together, she was able to find like she has her regular life problems, but her body, her pelvic floor is not one. You know, she's able to worry about what's for dinner rather than like, oh, I need to run to the bathroom as soon as I get home from work. So, but for sure, like, you know, life is— our modern lifestyle is like busy, right? But there are definitely ways we can turn the dial down on that intensity of the stress so that the body can be in a more balanced mode.

I love it. Very cool. So, Bong, how do people get a hold of you if they either want to work with you or they have questions or or they're curious whether— because we didn't really even get into low back pain.

Yes.

So maybe let's, let's rewind, erase what I just said. Let's talk about low back pain real quick and then we'll see how people can get a hold of you.

Yeah. So low back pain, there's actually a recent study that showed about like 90% of women with low back pain have some sort of pelvic floor issue. And I think it's about 50% of them also have a that maybe pelvic floor muscles are too tense rather than weak. So it's super important to get a customized approach rather than troubleshoot it yourself, because if you're trying to just do Kegels for your back pain, that may not be what you need.

You mean Dr. Google doesn't have all the answers?

Right? I know Dr. Google is so full of misinformation, unfortunately. Although I know we live in a digital age, so people tend to like ask on the Google or post anonymously in Facebook groups.

Yeah, yeah, yeah. I feel like this is, this is a good issue to get some one-on-one attention.

Absolutely. Just like our fingerprints are individual, like our body's needs have different needs. So, and I think sometimes people will get caught up in like, oh, well, I just, I don't, I don't have time for this, but you always have time to take care of yourself.

Yes, I'm glad that you mentioned that. What a— what a— okay, yes. So let's, let's put a bow on that, uh, thought. I love that. Um, so before we can get a hold of you, if you were to summarize and have people take away, um, maybe 1 or 2 or 3 things that they could walk away with after our discussion that we just had, what would inspirational things? Because we try to really empower people with this podcast. So what would those couple of things be? You know, quotable moments featuring Bong Henry. Yeah.

So the big point— we'll start with you're not alone if you're dealing with pelvic pain or leakage. It's so common. And particularly if you're an athlete and you love it, like you don't have to you don't have to wait till you're on fire to get help. So like, if there's something that's not working for you, reach out for support. And then with like the postpartum and pregnancy, what you love before you got pregnant is not going to change. So you're still going to be you, your interests. So if your interest is running or exercising or like jumping on a trampoline, those things don't die. So I think it's really important to recognize that like what you love and what you, you value, there's ways to incorporate that. And build back, you know, as you're learning how to care for a new human and just lots of grace and self-compassion because learning how to care for a human who's figuring out how to be human is a lot of work. So you're learning something new. You're both learning something new.

I love it. That's— those are great tips. So, Bong, how do people get a hold of you and perhaps even make an appointment with you?

Yeah, they can reach out on the Radiance Physical Therapy, RadiancePT.com website. And I always chat with folks before they book and we do a strategy call. We talk about where they are right now, where they want to go, and then we come up with a plan to get them to where they want to go. And it's really good just to like just chat and hear what people's goals are, because if you, if you're not pointed towards somewhere, it's hard to figure out where you want to go.

I love that. Awesome. Bong Henry from Radiance PT, thank you so much for joining us.

You're welcome. Thank you so much for having me. This is so much fun.

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