The Livy Method Podcast - Let's Talk Pelvic Health with Registered Physiotherapist Erin Degagne - Fall 2024

Episode Date: October 30, 2024

In this Guest Expert episode, Gina talks pelvic health with Registered Physiotherapist Erin DeGagne.You can find the full video hosted at:https://www.facebook.com/groups/livymethodfall2024Topics covered:Are all those trips to the washroom about more than just the water you’re drinking?Why is pelvic health so important? What is the pelvic floor and what does it do for us?What are the signs of issues with your pelvic floor?Two types of incontinence that can be treated - and Kegels aren’t always the answerUrinary urgency/frequency - what causes it and how can we manage it?Nighttime trips to the washroom - how many are too many and how can we limit them?What does pelvic health have to do with losing weight?The benefits of recording in a Bladder DiaryWhy do we sometimes feel like our bladder isn’t empty after we’ve peed?Is it normal to pee every hour?Does gaining and/or losing weight affect pelvic health?How does pelvic health look different for men and women?Pelvic health and its effect on bowel movements Hormones and the role they play in pelvic healthKegels - should we be doing them? Organ prolapse - what is it and what do we do about it?How do we release tension in our pelvic floor? Overview of what we can do to support our pelvic health and relax our pelvic floorThe value of practicing urge delayThe importance of overall strength training - if you’re losing strength everywhere else, you’re losing strength in your pelvic floor tooHow do we access a pelvic health physiotherapist?Where to find Erin - lakecountryphysio.com IG: @squats.and.coffee www.pelvichealthsolutions.caIf you feel there's an issue, take control of your pelvic health and advocate for yourselfTo learn more about The Livy Method, visit www.ginalivy.com. Hosted on Acast. See acast.com/privacy for more information.

I'm Gina Livy and welcome to the Livy Method podcast. This is where you'll have access to all of the live streams from my 91 day weight loss program. With a combination of daily lives, guest expert interviews and member stories, there is something new almost every day. Miss the morning live? Want to re-listen to one of our amazing guest experts? Well, this is the place. This podcast is hosted on Acast, but it's available on all podcast platforms, including the one you're listening to right now, Spotify, Apple,

and Amazon Music. This is an opportunity to become curious. And then some things, how do we help you feel less overwhelmed so you can continue on your journey? Keep believing in yourself and keep trusting the process. Just be patient. Maybe all those trips to the bathroom while you're trying to lose weight aren't actually about all the water that you're drinking. And maybe there's something more to it. I've been having this conversation with our guest today, Erin Degagne, for, oh my gosh, I think probably over a year now.

We've had this conversation quite a few times, and it never ceases to surprise me that it's such a big, massive, huge conversation. Today, we're talking pelvic health. Hi, Erin. Hello. Hi, Tina. How are you? Good. You know, excited about this conversation. I know you are too, because this is something that you are super passionate about. Let's start off with why is pelvic health important? So I think it's something that just kind of really gets lost in the conversation especially when we're talking about bladder issues it kind of especially for women but for men as well it kind of gets passed on something just happens automatically as you get older you're going to have leakage and that's just something that you have to live with and so it's kind of this

misconception that there's nothing you can do about it so a lot of people don't know that there is something that you can do about it and it doesn lot of people don't know that there is something that you can do about it. And it doesn't have to be that way. Well, and I love that you pointed out this conversation is for men and women. When we think pelvic health issues, we think women who've had babies, prolapsed uterus, all of that. Just do your Kegels and you're good. And in fact, that's like that's I mean, OK, it's part of the conversation, but it's not the whole conversation. So this conversation is important for everyone. Where should we start this conversation? So I'll give maybe just a brief understanding. So people kind

of have my pelvis here. Maybe I can just show people what your pelvic floor is. Cause again, a lot of people don't have a lot of information about their own body and kind of what's happening. So this is your pelvis. your pubic bone is right at the front, and then your bladder sits right behind that. So if we take that out, then you have if you're a female, your uterus and your vaginal wall, and then your rectum is at the back. So if we take all of that out, then you can see that you have all of these muscles that attach from your pubic bone to your tailbone. And they really help to do so many things in our body. So they're supporting these organs, they're helping with bowel and bladder function, sexual function. They also help to pump fluid out of your pelvis.

And they're just really important for other things and stabilizing your pelvis, they work with your hip muscles and your core muscles. And so as a pelvic physiotherapist, we take a look at these muscles and see what's happening with them is there weakness in these muscles is there tension in these muscles so that we know how to properly go forward and treat treat these muscles how would somebody know that they have some pelvic health issues going on like what are the signs of that how how would they try to figure that out even to begin with good yeah so there's a lot of different signs and a lot of things, again, that we kind of consider normal or you attribute even in the program, right? As, oh, I'm drinking more water. So this is just from that, right? So if you are going pee

more than six to eight times a day, so if you're up all the time or you're constantly thinking about when you're going to pee next, where's the bathroom, if you're like, we call it toilet mapping, if you know where every bathroom is in the city that you live in, then you know, that's a sign that you know, you probably shouldn't be thinking about going to the bathroom that often. If you're having urgency where you need to like run to get to the bathroom on time, like, if you if you don't go immediately, when you get the signal, then you're you know, having an accident, if you're definitely if you're having any leakage, so urinary stool leakage, pelvic pain, heaviness. There's just so many things. Even low back pain and hip pain can be a real sign of pelvic tension if it's not being addressed.

If you're seeking treatment and it's not improving, sometimes pelvic tension can be a huge part of that as well. Okay. And what about when we're, if we're laughing and we're sneezing or we're jumping on a trampoline that. So any urine leakage. So there's two different kinds of incontinence that we mainly treat. Stress incontinence is when, yeah, you're coughing, sneezing, jumping, laughing, and you lose some urine there. And then urge incontinence would be like when you're rushing to the bathroom and then maybe you have some leakage on the way there. So yeah, we can treat both these types of incontinence.

And I think in the past it was kind of assumed that, well, you just should be doing Kegels because these muscles, they must be so weak if they can't stop your urine. Right. Unfortunately, that's almost never the case. We've talked about this before, but we really shouldn't be giving people Kegels or doing strength training for these muscles without properly assessing them. So there are there are instances where there is weakness and these muscles need to be strengthened. But a lot of the time, there's just a ton of tension in these muscles. So it would be like, you know, you have all this tension in your muscle and you're trying to use it, but it's already at its max capacity. So you cough or you sneeze and it's either a timing issue and it can't contract quickly enough to stop your urine from coming out,

or it's just at its max capacity, it can't contract strongly enough to stop your urine, but it's not really a strength issue. Once we get it to its normal length, then it can contract fine and stop your urine with like a cough, sneeze, jump, laugh, whatever's happening there. Yeah. It's so true because we associate it with weak muscles when what you're saying is actually can be, you know, too much stress being held in the muscles. I do want to also say when it comes to this conversation, and again, if you missed it, this is for men and for women, but I think, especially for women, we are taught that that's just how it's going to be it's just how it is it's part of aging just deal with it it comes with being a woman you know um i i noticed

like the the depends section adult depends section is just growing and growing and growing and growing and getting bigger over a year or year over year why do you think that is well i think the population is aging, right? But there's still there's just not enough information out there for people. It's really not something that just has to happen. Obviously, going through menopause, and then, you know, as you go on in your life, if you have this tension, that just kind of builds up over time, it seems like, oh, it's getting worse as I age. So that's just normal. But what's happening is no more things have happened as you age, and you've had this tension for longer if it is a tension issue, which again, most commonly

it is. So let's say you had kids, then you had a hip surgery, you had a really stressful event in your life, you had, you know, some bladder infection, something like that, all of these things, you have your prostate removed as a man, all of these things will increase tension in your pelvic floor, but because they're kind of bound by these bones in your pelvis, you can't stretch them like you would stretch a normal muscle. So this tension just kind of builds and builds. So it seems like, oh, I'm just getting older and this is what's happening. But no, I see people in their eighties and nineties all the time. And it's a fixable problem. Like it's not something that you just have to live with. Well, I noticed that you mentioned menopause because hormones are a really hot topic. And I know a lot of people are

not aware that your hormones play a major role as your estrogen levels start to drop in your hormones. I know we're going to get into that conversation in a few minutes, but let's start with the basics. Where should we start with? Um um like urinating urgency frequency let's let's start there what what's going on there and what can we do about it okay so urinating urgency is again a common thing that happens it can either develop really quickly after something specific or it can kind of slowly get worse over time and people just assume oh i have a small bladder or you know i go to the bathroom all the time, which I mean, is typically not the case. So your bladder, we'll talk about urgency for a second.

It's often associated with a lot of tension in your pelvic floor muscles. So I'll tell you what normally happens. Your bladder would typically fill up to like, let's say 75% full. And then your body would send you a message to your brain that says, you know, it's time to pee. Maybe think about looking for a bathroom. It doesn't mean that your bladder is going to explode. It doesn't mean you need to pee right now. It just means maybe you should think about going to the bathroom. So that message gets sent to your brain. And then you look around and you think, do I have access to a bathroom? Is this convenient time for me? If it's not, then your brain would send a message back down to your pelvic floor muscles, like we showed you, they would contract.

And then that would send a signal back to your bladder that says like, not the time your bladder relaxes and you pee like when you get home. But if your pelvic floor muscles are either really, really tight, which is probably the case, or they're weak, then they can't send that signal to your bladder. So your bladder is thinking, oh, we sent the signal, we didn't get anything back. She has to go to the bathroom. She's probably on the toilet. So it starts to contract. It's just a big muscle. And that's when you're like, Oh my gosh, like why all of a sudden do I have to pee so bad? It's because your pelvic floor or your bladder is trying to pee. Luckily you probably

have good pelvic floor strength because you're, it's quickly stopped that from happening. It's like, Oh my gosh, I'm in Walmart. Like, don't do that. Right? Then you're running, running, running, running to get to the bathroom. Maybe you make it there. And oh my gosh, that was a close call. Or Oh, you have some leakage on the way. Either way, your body sees that as a really stressful situation. And its whole job is to protect you from these situations. So what happens is, it lowers that fill line. So now it's sending you the signal that you have to pee when like your bladder is half full, and it feels the same as it would if your bladder was very full. So the feeling is very real, but it's just no longer a clear

indication of what's in your bladder. And then that continues on and on and on. And that's what leads to this urinary frequency where you're peeing all the time. And then you get there and it's like a little dribble. It's because your bladder is not really full, but your body has kind of gone overboard trying to protect you. So it's almost like your body has become trained and its threshold is lower. So would it be fair to say that people say, oh, I have a small bladder that don't necessarily have a small bladder. It's just their, their bladder has learned to have a lower threshold. Yeah. Your, your central nervous system is just trying to protect you from an embarrassing, like incontinence can be very embarrassing. You don't want to pee your pants when you're out with

in public with people. And so your body's hyper aware of that. Okay, oh, there's a bathroom here, go pee there. And then you're emptying your bladder more often than you should. So I would suggest like, unless you have an urge to pee, definitely don't go. Because if you're emptying it every time it's a quarter full, it's going to start to think that's when you need to empty it, right? So if you're peeing before you leave, and then you pee right when you get somewhere like you haven't drank anything, your bladder is not full. Does it help when we pee before we leave? Like, does that actually Oh, you should probably pee now because I'm going to be in the car for a couple of hours. Like, is that actually doing us harm? Is it okay every now and then? Yeah, it's okay every now and then.

If you're going to go on a long trip, like, yeah, go pee before you go. So you're not stopping, you know, a hundred times. But if you're feeling really anxious about where there's going to be a bathroom or when you're going to be able to go to the washroom, that is an indication that something else is going on. Either you have this tension in your pelvic floor that needs to be released, or maybe there's something actually going on with your bladder itself. But you know, there's, there are times when you should see your family physician about this. But I mean, it's a super common issue and often is just related to pelvic tension. Well, one of the, one of the things that I found really interesting in our conversations with you

is how much your brain is connected to your body in the sense that, for example, you know, you're in the car and you have to like pee really badly, but then all of a sudden, like you literally think you're going to pee your pants. And then all of a sudden you can't get to the bathroom. So, oh, you're fine. Like we've, we've almost taught our brains that, okay, I got to go now. We're almost stressing. We're same thing at night where I'm just lying there and I'm like, oh my God, if I don't go pee right now, do I have to go? Do I not have to go? If I don't go pee right now, then I'm not going to get to sleep. So then I create this habit of getting up and peeing. Can you just talk a little bit more about that? Yeah, for sure. Our mind is super powerful, right? and our body's whole goal is to protect us

so it really can go overboard and like you said at night so that's called nocturia if you're peeing more than once at night that's too much okay so uh if you're getting up more than once i'm going to give you some urge delay techniques to try and get that under control there's things you can do but if you have all of this tension it really does probably need to be addressed um by a pelvic physiotherapist. But there's other things that you can do to because some of it is just like you said, a habit that you've created, right? So you wake up the first time when you wake up at night to go pee, go pee, that's okay. Once is normal. Zero would be great. But once is normal.

If you wake up a second time, I would try and roll over and go back to sleep because there's a lot of reasons why you might just be like waking up cause your shoulder hurts or, you know, you're in detox and you're awake at 2 AM kind of thing. Right. So you might not necessarily need to pee. You just wake up and you think, well, I might as well pee now because then I want to be able to sleep. Like sleep is really precious to us. So you just think, Oh, I'll just go anyways. And then I won't have to wake up later, but you shouldn't have to wake up later. You should only be going once a night. Well, we've learned this from our sleep experts to talk about how you sleep in different stages and sleeping is not just like you're dead to sleep at night all night. You do wake up. And

so you wake up a little bit and if you've got it on your mind that, Oh my gosh, I'm going to have to go to the bathroom. And then you create a habit of when you do kind of wake from those sleep cycles to go to the bathroom. And then you're almost training your body that you need to go to the bathroom. Yeah, it can become a very stressful situation that truly is messing with our sleep. Yeah. So it's a thing that you can, we've trained ourselves to do, but you can untrain it too. So, you know, it just takes a little bit of work and it takes a little bit of time so that if you do wake up the second time, roll over, try and go back to sleep. If you're laying there for more than five minutes, like, oh, my gosh, I really have to go, then like, get up and go. Don't stay up all night,

like trying to hold your pee. That's not helpful either. And you might have some issues. Like at that point, I would see somebody because it is quite easy to fix that, like releasing tension in your pelvic floor almost always gets rid of that nighttime waking unless there's another issue but there's other things you can do for the nighttime stuff too you want um like laying on your back with your legs up the wall um about 30 minutes before bed can really drain a lot of the fluid from your legs that kind of accumulates through the day so that your body can process that and then convert it to urine and you can pee before you go to bed so that because once you lay flat it's much easier for your body can process that and then convert it to urine and you can pee before you go to bed so that because once you lay flat it's much easier for your body to process that fluid and so you are creating more urine um if you're taking medications that are a diuretic if you can

ask your pharmacist if you can switch them to an earlier time in the day sometimes that can be helpful so it's not right before bed or uh compression stockings can help if you are having a lot of of swelling in your legs and then just dealing with other sleep hygiene things, right? So that you are having a deep sleep and it's not waking you up for other reasons. Yeah. I mean, this is a big conversation. People might be thinking, well, what does this have to do with, you know, weight loss? Again, you have to be healthy in order to lose weight. It's got a few things, especially when you're drinking a lot of water and you're blaming that on the fact that you're drinking a lot of water or what that might be, how

it interrupts your sleep and just how it interrupts not just your physical health, but your mental health as well. Can we just talk about how long we're supposed to pee for? Like, is there a certain length? How much pee? Like, you know, like I was at the menopause show on the weekend and the ladies were like, you must need to pee. I'm like, I can't pee.

I can't break that seal. Because once I start peeing, I'm just going to keep peeing. Is that real? Is that in my mind? Like what's happening there? Well, I think part of it is probably mental. But it's a real thing, right? And I mean, especially if you are having alcohol, that's typically a comment that kind of goes with that as well. But yeah, it can, it's a diuretic and you know, things,

you know, I don't know. I don't think there's a lot of research on breaking the seal, but, but yeah, you, you should only be peeing. So I'm going to, I'm going to post a bladder diary. I think we sent it over so that you can post it in the notes. But it would be a great idea for everyone to just do a bladder diary because most people have no idea how many times they're peeing a day, for how long. You just get an urge to pee and you go, right? It's just a normal thing that you do. So you just do it.

But it just will have you record every time you take a pee pee count how long it is in seconds so like one one thousand two one thousand three one thousand if it's less than six seconds really like your bladder's not full you didn't need to pee your this line has dropped down so far that like it's sending you the signal when it's like three seconds of pee in there right yeah so that's a good indication and then also how many times you're peeing. So yeah, six, five, six to eight times a day is considered normal. Okay. I find though with people on Gina, I've seen so many livid livid losers since being on here for pelvic physio, but that because we are so well hydrated, like a lot of these numbers are geared around people who aren't hydrated at all. Right. So six seconds is a win. But if you're drinking a lot of water,

sometimes those numbers can be higher. It doesn't mean that there's not an issue. If you have urgency, if you're rushing to get to the bathroom, or if you're peeing all day long, like it doesn't matter how much you're drinking, that still shouldn't be that high. Okay. There is an adjustment period when you do start drinking your water, but there is like at this point in, if you've been consistently drinking your water and you still find you're going to the bathroom, an obscene amount, um, that could be problematic. What about when we go to the, what about when we go to the bathroom and then like literally we stand up and then we're like, I got what I got to go back. Like, I feel like I didn't really go, go. Okay. So there's a couple of things happening there. Again, it's likely

pelvic tension. I know I sound like a broken record, but it's there's a couple things happening there. Again, it's likely pelvic tension. I know I sound like a broken record, but it's just such a common thing, because there's so many different things that can cause this pelvic tension. So most of us have it right in the same way that most of us have neck tension. It's just can be stress, anxiety, pain, you know, childbearing, surgeries, abdominal surgeries, all of these things. So what happens is when your bladder is full, so your urethra comes down like this, and your pelvic floor muscles are here, like around your urethra. And so if they're tight, it when your bladder is full, there's enough pressure in your bladder to push past that tension. But as it decreases, you get maybe you know, to here,

there's not that much pressure left in your bladder, so it can't push past the tension. So it just stops. So that's that feeling like, like like i'm done peeing but i know that there's still some there and so what happens is if you stand up and sit back down often that will help your pelvic floor to relax and then you should be able to empty out the rest of that the other thing that you could do is once you're stopped peeing you could do a pelvic floor contraction and relax those muscles, which I'll tell you how to do in a second. And then that would might get the muscles to contract, relax, and then that will allow your bladder to fully empty, which helps because then if your bladder is only emptying, you know, to a quarter full and then only fills to halfway, like you're emptying

this middle portion of urine all day long and you're never really fully emptying your bladder. All right, Erin, I'm just, thank you for that. I'm just, I'm just reading this. What about every hour, 4.5 liters of water a day, I can pee between 30 minutes and an hour. So first off, you're drinking that much. You really do want to spread it, spread it out throughout the day. And there is something to be said. We learned this from Dr. Pfeiffer. If you're just like guzzling your water, just drinking, drinking, drinking, drinking, drinking. So what do you have to say about that? So I would say, yeah, every hour is way too often. Like that's so disruptive to your life. If it feels disruptive, it's a problem really. Yeah. Um, I've been doing this

program for over a year and drinking that much water and I'm not peeing every hour. Right. So it should be able to get it to a point. And if it's not adjusting, then there's probably another issue going on. But, yeah, drinking all of the water at the same time, your body can't really absorb that. Right. So it kind of just goes right through you. You can look into something like the. Oh, I take it every single day. Can't even think about it. The salts like in your water. Yes. Trace minerals. Thank you. Something like that to just help better absorb the water. But I mean, yeah, if you're going pee every half an hour, there's something

else going on in there. Speaking of the living method, does losing weight affect, I mean, does gaining and losing weight affect your pelvic health? Yeah, so it really can. So gaining weight, especially around your abdominal area can put a lot of pressure on all of your pelvic organs and on your bladder, just and on your pelvic floor, right? Holding up more weight. And so it really can affect your ability to stop the flow of urine with prolapse as well, right? Heaviness, if those organs are falling further down into your pelvis, it can affect that. I just like to be careful because I think our healthcare system tends to kind of brush things off. Everything is just a weight problem. Oh, you just need to lose weight and then this will go away, which isn't necessarily true, right? It's a piece of

the puzzle and losing weight will probably help. But I see people all the time who are extremely thin, who have pelvic floor issues, right? So, and it doesn't mean, and I see a lot of people all the time who are really overweight and we can still fix their pelvic floor issues. So it's a piece of the problem, but it's not the whole thing. Okay. Is there differences between the signs that women get versus the signs that men have when it comes to pelvic health? So men have the same pelvic floor as women. So all of these things that we're talking about, the urgency and the frequency, waking at night, are across the board, right? So I'm sure some of the ladies listening and some of the men listening can relate. I have tons of patients who tell me, oh, my husband wakes up at night and pees more than I do, right?

And so you want to make sure that you're checking prostate, right? So that you know that you rule that out first to make sure that it're checking prostate, right? So that you know that you rule that out first to make sure that it's not a prostate issue. But if you've had your prostate clear, it's likely that you have pelvic tension. And it could be from a multitude of things, right? It could be from back pain, it could be from stress, it can be from a previous injury. And so yeah, but it's very similar. Sometimes men will describe it more as like they feel like they're sitting on a ball or there's all of this like pulling kind of right around like their testicles. There can be testicular pain, whereas for women, obviously the pain area is different, but it's fairly similar, honestly, the things that we're hearing. Yes.

So that's why I'm just listening to the comments and Dave Stewart talking how he's probably not going to do a PP journal. So, but you might want to, if you have some other things going on, Dave, you're going to start that PP journal. Um, it can be really important to your health. Okay. Um, let's talk about what's happening with our bowel movements. Is there anything happening when our bowel movements that could be affecting what's going on with our pelvic health? Is there any signs there? Constipation, a lot of loose bowel movements happening in the program, obviously when people are losing weight. Also constipation, what's normal, what's not? How do we know that's an issue? So constipation is something that we see all the time,

and it is connected to pelvic tension. If you can think of your rectum here, I'm very, very comfortable. Asules do help. If you have tension, like right around your rectum, this is where your pelvic floor would be, then it's a lot more difficult to fully empty your bowel, right? So maybe this tension kind of builds up, all of your stool builds up, and then you can have a bowel movement, but you're only half emptying because there's all of this tension here. And then that's staying in your rectum longer, it's getting harder, it's getting more difficult. So it can kind of perpetuate that constipation. And then loose stool is typically not an issue with like your pelvic floor directly. But what happens is often is people who are experiencing a lot of loose stool,

it becomes more apparent that they have a pelvic floor issue because they're having stool incontinence, right? It's a lot harder to stop loose stool than it is like a harder, firmer stool. So if you're having stool leakage, for sure, that's a sign. It's not just because you're having loose stool, you should be able to control it. But if your pelvic floor is a little weak or a little tight, it's a lot harder to stop that. But yeah, we see people with bowel issues all the time. We see people with Crohn's and colitis, like all of these issues, like all of that pain that that creates in your abdomen too, really does create a lot of tension in your pelvic floor. And then the tension creates pain. So it becomes difficult to determine what the pain is from.

Is it from the colitis? Does it come from the interstitial cystitis, which is a bladder issue? Or is it now that this pelvic tension is contributing to the pain as well? Okay, wow. Let's talk about hormones. Because there's so much conversation out there on menopause. Obviously, it's been a huge conversation, but hormones can affect your pelvic health as well. They really, really can. So there's a couple of

different times for women that hormones can really affect what's happening in your pelvic floor. So one is postpartum. So it's when your estrogen is decreased. So especially if you're breastfeeding postpartum, your estrogen has decreased and then in menopause, the same thing. And what that does, so your vaginal wall is this nice thick tissue that really does help hold up the other organs. So your uterus is at the top, your bladder is here, and your rectum is here, and they kind of sit on your vaginal wall. And so over time, as your estrogen is decreasing, what happens is the thickness of

that vaginal wall really thins. And so it's less of a shelf for those organs to be sitting on. So it's more likely to have a prolapse or heaviness. But also, as your estrogen decreases, your lower urinary tract, so your external urethral sphincter, at the end of your urethra, all of that tissue is also affected. So it just makes it way more common to have urgency, frequency, like we were talking about, and urinary incontinence. It doesn't mean that, oh, you just have to give up. It just means that you probably had this like low level issue before. And then menopause often just like pushes it over the edge and you really notice this difference and they just blame it. Oh, well, you're in menopause,

right? But there's often other issues along with it. Okay. No, I asked Aaron this behind the scenes before we got started. And you know, there, there is, you know, obviously the big conversation with HRT and what you can do there, not a lot of research done in this area, but with, you were saying with estrogen creams that can sort of thicken the tissue, which can be beneficial. Yeah. So, um So they haven't been in a lot of studies that show that HRT really makes its way to your pelvic floor to make a impactful difference. But again, there hasn't been that much research, so it's getting better. It's becoming a really big conversation. I feel like in the past, it was kind of put to the side. There was a bit of a controversial study that was done

that, you know, wasn't really that effective in telling us what what was safe and not safe about HRT and so that kind of put that on the back burner but now that it's back we have this conversation every day with patients and so there's not a lot of research to show that it helps directly but what does really help directly and we we have patients who use this every single day it's completely safe it's's just absorbed locally. You have to have a prescription from your family physician. But it's just a vaginal estrogen cream that does help with thickening up that tissue. It helps with dryness and irritation as well, because the tissue becomes very like irritable, as well as you go through menopause. So that it can help with that. But it

also helps with urinary issues, because it's right in the same area as your urethra it does affect that lower urinary tract as well and can help with incontinence and that type of thing so you could always ask your family physician for that um yeah okay i want to talk about kegels because they talk about controversial should we do them should we do them should men be doing kegels okay so i'm gonna say going to say something. Yeah, probably controversial. I think that unless you've had an internal exam by either your family physician, nurse practitioner, OB-GYN or pelvic physiotherapist, like you should not be doing Kegels at all. Like you just don't know what's happening in there, right? It would be like me calling you on the phone and giving you a specific exercises for your knee when I've never seen your knee.

I have no idea what's happening in there. And just blanket statement giving this exercise to everybody. Go ahead. What were you going to say? No, that's really interesting that you say that. I mean, I guess we assume there are certain exercises. I know like at the menopause show, they were, they were selling those vagina balls, those balls or whatever, those things that you shove up there and then you hold on to and, you

know, so no, definitely not. Do not get those. I'm official at all. Do we want to be strengthening those muscles? Like, I don't know. I think like, what about for like, you know, intercourse, which what a weird word, by the way, to say out loud, is it helpful at all for any of that? It's not helping.

Like if you have weakness, it is helping. Right. But you don't know if you have a weakness or not. And really, if you can hold those balls up inside of you, you do not have weakness. Like it's just, it's not functional, right? I see it as like, do you ever really need to do that in real life? Like, no, these muscles are holding up your organs all day. So they're working all the time, right? They're stopping your urine all the time. So by doing all of these extra things, you're just fatiguing them so that they can't do their regular job. Right. Oh, so unless you're making them stronger or making them stronger, which can also be a problem, too. Right. Stronger isn't the problem, really, but they're probably as strong as they need to be.

Like you don't need to be able to like crush something with your vagina. Right. Like they're as strong as they need to be unless you do have weakness, which is, I mean, possible for sure. But if you don't know, you're probably doing more harm than good because really most people have tension. So just because maybe you are peeing a bit when you laugh or when you jump doesn't necessarily mean you need to be doing Kegels. No, no, no, definitely not. And even if you do need to be doing them, like, how do you know how to do one? Right. Like no one's assessed it. You could be doing anything. Right. You might not even be doing them, like, how do you know how to do one, right? Like, no one's assessed it. You could be doing anything, right?

You might not even be doing a Kegel. It's just this random word that we have out there that, you know, we've said, okay, do Kegels. But what does that even mean? And are you doing it properly, right? Most people, like, I can tell you, I assess this every single day. Most people are not doing anything right. Like, it's not a Kegel at all.

And so it's not even really effective. And then you've created all this tension around the other muscles in your body and it's just not great. So Kegels are just old news. Kegels are old news. Is there a time and place for Kegels? Like who would know Kegels? Of course. Yeah. So I give people Kegels all the time. Typically it's after we've released tension and then we've noticed that, oh, there still is a little bit of weakness or a timing issue, right? These muscles need to contract right before you cough, right before you sneeze. But I'm never giving someone like a hundred Kegels when you're sitting at the stoplight or like every single time you, you know, do this, like 25 Kegels. That's not how your pelvic floor works and that's not really how it needs to be working. Okay, what about prolapsed bladder prolapse? So bladder prolapse, uterine prolapse, rectal prolapse, all super common. And unfortunately, there's not a lot of information

out there. And so people kind of feel alone. And it really does affect their ability to do activity, they don't want to go out and do anything, because the more you're on your feet, the more heaviness you feel. Right. And so what it is, it's not that your bladder is falling out of your body or you're just falling out of your body. It's falling into your vaginal wall. So if you see something externally like a bulge, it's the inside of your vaginal wall. It's not a medical emergency. I mean, you want to see a family physician if you notice this, but people get really freaked out and scared, right? Yeah. I've shared this with you after I had my last child. Um, that's how I knew I was done is I looked down there and I was like, wow, what is that? And, uh, I couldn't really walk for months afterwards because the heaviness would literally feel like my insides were coming out my vagina. Yes, it was very unnerving. Eventually, they went back in. At the time, thank goodness,

I was presented with the uterine mesh. I think that they now discontinued because that caused a lot of problems with women. And I went at the time more of a Kegel route, but I was taught how to do those Kegels properly. Um, and there was a lot more to it then. Okay. Yeah. And we give people that all the time, right? So once we've addressed the tension issue, because these muscles, right, they've been trying to hold up these organs and failing all the time. So you can imagine the tension that would be in there. So we released the tension and then we can teach them how to properly strengthen these muscles and I can hold everything up. But there's a lot of things you can be doing at home, too.

Like our culture is very go, go, go. If you're like on your feet all day running, you never lay down, you never stop. Right. Then these organs are way more likely to be falling into your pelvis lower, especially if your pelvic floor isn't supporting them the way that it should be. So even just taking five minutes in the middle of your day to lay down, put your legs up, allow these organs to kind of come back up into your pelvis where they should be and give your pelvic floor like a couple seconds of a break, right? That can be helpful. Well, I'm thinking like hairdressers, hairstylists, healthcare workers constantly on their feet. I mean, really anyone who's just constantly on their feet all day long. You don't want to live a sedentary lifestyle either,

but there is something to be said that we do tend to overdo it. Okay. You keep talking about, um, you keep talking about releasing these. How do you, How do we do that? So typically, with the pelvic floor assessment, we do an internal exam, which is a barrier, right? Like people are really uncomfortable with this. Most people who come in to see me are like nervous, and they're uncomfortable. And initially, and they don't really want to be there, right? We do either a vaginal or a rectal exam, depending. So for women, we do a vaginal exam. For men, we do a rectal exam to see what's happening with these muscles. And it's very obvious. Oh, yeah, that feels like you would know. Oh, yeah, that feels like a tight muscle like anywhere else in my body. Or no,

that feels fine. And we can assess strength. And we can assess where these organs are sitting if you do have a prolapse. But honestly, I think we do a worse job here. Like in Europe, it's just a normal thing. You have a baby or you have in Europe, it's just a normal thing. You have a baby or you have a surgery, you just see a pelvic floor physiotherapist. We're a little precious here about like privacy, which is understandable. But most people who leave say, you know, that wasn't as bad at all as what I thought. Like it's way more comfortable. And some people are worried about pain, especially if they are having pain, like pain with intercourse or pelvic pain in general. It's not as painful as like a pap or, you know,

getting your IUD put in things like that. I think that there's not a lot of care taken, unfortunately, in women's health. And it's easy to make it so that it's not a painful experience. And then it's not like an embarrassing experience or something that you have to be worried about. So there's that if you if you have the means to see a pelvic floor physiotherapist, it is not covered by OHIP, which is unfortunate, but it is covered under pelvic floor physiotherapy benefits. Outside of that, there's a lot of other things that you can do at home. So stretching through your hips and pelvis, I'm going to post, we're going to post some hip stretches that you can be doing that can affect muscles that attach into your pelvis. Great. Yeah, go ahead. No, no, this is good because I'm glad that you're getting into this

because I'm like, I mean, also mammograms and PAPs are uncomfortable. And if you're in a lot of pain and you're peeing your pants every five seconds, as uncomfortable as it may be to go and seek treatment for this, because it doesn't sound good. Jamming anything up, both of those areas with having someone else do it and all of that, I mean, doesn't sound good. But I'm sure it could be a game changer for a lot of people. So as uncomfortable as that is, I'm sure the benefits outweighs that, that those few moments of uncomfortableness. But I love that you're sharing with us. What can we do outside of waiting until we need that? Because there is something to be said about maintaining bladder health as we age and pelvic health as we age. So I love that you're talking about what we can do

about this. So, sorry, can you just go through like a bit of an overview of what we can do? So seeing, so we talked about, what did we just say? Oh, making sure that you are drinking enough water. It's a big part of it as well. Like when your urine is really concentrated, that's a real irritant to your bladder. And so that can be signaling that like, oh, you have to pee, get this out of here, right? Okay. Hip stretching, low back stretching, some sort of yoga, a deep breath, like breath work or meditation, we really hold a lot of tension in our pelvic floor when we're stressed or anxious. And so being able to release that at the end of the day, so you're not going to bed with all of this tension can be really, really helpful. You want to address things like a chronic

cough, I see tons of people who are like, oh, I was doing so great. And then I got sick and I'm coughing, coughing, coughing. It's because every time you cough, your pelvic floor muscles contract as hard as they can. And then that, you know, once or twice, not a big deal. But if you're coughing for a week, it's so much work on those muscles that this tension kind of builds up and then they can't function the way that they need to. So if you do have a chronic cough, you know, kind of builds up and then they can't function the way that they need to. So if you do have, you know, kind of dealing with that, um, diaphragmatic breathing is a real game changer for your pelvic floor. The two really work together. So your diaphragm right at the base

of your lungs, when you take a deep breath in has to drop down to allow room for your lungs to fill with air. And in doing that, it forces your pelvic floor down to relax as well. And so most of us are kind of doing this upper chest breathing all of the time. And we're never really fully relaxing, we're never taking a full deep breath to fill our lungs. And so your pelvic floor is just tight all day long, like in this tense mode, right? Another great thing to do is a reverse Kegel. So we can, if we want to do it now, we have if we have a second to do a proper Kegel and then show how to relax those muscles, because again, most people have no idea where they even are, but if you're holding tension in your neck, like if you find yourself doing this, your pelvic floor is probably also doing

the same thing. Okay. So if you're sitting seated, get comfortable, you can be laying down, it doesn't matter. So for women, you want to picture a ping pong ball at your vaginal opening. For men, you want to picture a marble at your rectal opening. And then you want to think about pulling that up inside yourself. No one around you should be able to see what you're doing. You want to keep breathing. And then you want to relax those muscles out of the opposite of the contraction is really what we want right that will help to relax those muscles so that they're not just being held tight so if you're having an anxious moment or you're just having a day to put just put a little reminder for yourself like okay do a contraction and then relax those

muscles so that you're not just holding on to all of this tension all the time okay so that's more of a like uh you're pulling it in focus on that with your breathing along with it. And then you're relaxing it out is the, the, you know, equally important. So you're not just doing this. No, like No. Good. No, I was just going to say that makes makes sense i get the coughing thing because i have a back injury and when it's really bad and i cough i feel like my whole body is tightening up to try to protect okay that's very that's actually very relaxing that makes sense if you're squishing your shoulders you're squishing you're tensing everywhere so okay that's a good one what else you got um urge delay can be really helpful So the bladder diary will kind of help give you

an indication of like, how often you're peeing. But if you want to try some urge delay, so let's say there's often specific triggers that different people have. So it could be you know, you're washing your hands, and then oh my gosh, I have to pee or you're doing dishes, it could be water or often it's like, you pull into your house. And then oh my gosh, all of a sudden you have to pee or you're doing dishes. It could be water or often it's like you pull into your house and then, oh my gosh, all of a sudden you have to pee and you're like sprinting to get in. And you're like, I can't unlock the door. Like all this stress, right? Yes. Like there's a bathroom in there. So it's just like, oh, go pee now. Like it's, it really heightens that. So we want to work in those situations to get that to calm down because it's not the peeing all the time that's the problem it's the running there that really signals to your body that like oh this is

a problem that we need to fix so now let's lower that fill line and send you that signal more strongly and more often okay got it wow so let's say you pull into your driveway oh my gosh like i'm gonna pee my pants i can't get the. I have to like run to the bathroom. Stop. Don't run to the bathroom. Take a deep breath. Your bladder's not about to explode. Like unless you've put this off for four hours, you have to tell yourself like this is your bladder can hold a lot of urine.

Like you're probably going on all night without peeing or, you know, half the night without peeing. It doesn't need to go every 10 minutes. So there's enough room in there. It's okay. So you're going to do, you can do a couple of deep breaths, a pelvic floor contraction, like I just had you do, and then relax those muscles. And then you want to distract yourself.

Go on your phone, put in your information for the living method, love your water, whatever. What are you going to make for lunch? Like think about something else. You can count backwards from 100 by twos. Like there's all of these different things that you can do and that's like what you were saying before when you're distracted you don't even realize you had to pee or it goes away because you're doing something else right so you distract yourself and then get the urge to calm down once it's calm then it's not a matter of like oh just hold it forever get it to calm down and then if it hasn't been like 10

minutes since you peed last, then just calmly get up, walk inside, go to the bathroom. But it's the rushing that really reinforces that this is a big problem and your body needs to do something about it. Yeah, I can see how that works. Because again, that's like being in the car where you're like, oh my God,

I'm going to piss my pants so bad. But then you're just like, you're like, okay, let me just deep breathe. Let me take my mind off of it. I'm okay. And the next thing it goes away or why I can sit there for six hours and not go to the bathroom at the show because I'm being distracted. But I can also see how we've trained ourselves, especially if you,

if you do deal with issues and you are known to kind of dribble a little bit, that can cause a lot of like insecurity and stress you and, oh my i'm not gonna make it and then it just kind of like that's that's the trigger that's the association that's what like you're thinking so when you think it your body reacts to it and so you've almost trained it to be all stressed out about going to the bathroom and so this is sort of like taking a minute to be in the moment and assessing your situation or calming the body down first and being like okay yeah we're fine here let's just take a minute and then so that's kind of untraining or rewiring it's a lot of what we're doing here is rewiring how your body has come to function and right we're like rewiring it back so it functions uh in the way that works better for our lives okay amazing um okay anything else

um yeah if anyone has questions, there's so much, like we could literally talk about this forever. There's so many different things that we treat. But yeah, there's a lot of things that you can be doing at home. We'll post a couple of things to help with all of that. The legs up the wall before bed is a game changer. The stretching and like getting things moving in there, strengthening your body in general, like general strength training as you age can really help. Like if you're losing muscle mass everywhere else, you're also losing muscle mass in your pelvic floor. So interesting. So you want to be keeping your body strong and flexible in the same way that you would do for any other muscle, like it's the same thing. But you just it doesn't need to be so specific. Like your pelvic floor is working when you're doing a squat, your pelvic floor is

working when you're lifting weights. It just, it doesn't need to be like individually lifting the little balls. Got it. Got it. Loud and clear. Okay. So, um, if someone wants to come and see you, uh, we're going to put your contact up there, up there in a second. But do we need to go to our doctors first to get a referral to see you. Yeah. It just depends on your, on your insurance provider. If you don't have insurance, it doesn't even matter. You don't need a note from your doctor. We often send notes off to your doctor if that's what you want, just so that they're kind of in the loop and they know what's happening. But otherwise, no, we don't need a referral. I do want to get into, yes, definitely finding a public health physiotherapist that you're comfortable with is important. I would imagine you could just go and have a conversation.

I'm looking for some of the comments where people basically said it was a game changer. It was honestly a game changer for them and that the uncomfortableness of it all was well worth it, was well worth the outcome of it. How do people reach you? How do they, if they're local and they're around, How do people reach you? How do how do they? If they're local, and they're around? How do they find you? Where are you at? So I work at Lake Country Physiotherapy in Orillia. And if you live in this area, I'm happy to see you if you don't live in this area, though, like there's so many amazing pelvic physiotherapists across Ontario, across Canada. And you can find the ones in Ontario at pelvichealthsolutions.ca.

The website is up there. It's a good resource for a lot of other research, like books and videos. There's a lot of great resources there, information. So that's where I would start to find someone in your area. Okay. I love that pelvichealthsolutions.ca. And then I love if you're local, lakecountryphysio.com. I mean, that sounds really nice. Sounds lovely. If I may, Erin's also on Instagram. Squats and Coffee is her handle.

And she shares some amazing recipes, some great health and wellness tips. You should come on and do some recipes for us and cook some fun stuff for some great health and wellness tips. I got it. You should come on and do some recipes for us and cook some fun stuff for us. That'd be fun. I will be trying to do that. Yeah. Okay. Well, we'll talk about that behind the scenes for now.

Thanks everyone who joined in on the conversation live or who's listening after the fact. It's a good one, right? It's something that we don't talk enough about and a lot of people struggle with. So hopefully you found this conversation to be of value. I just want to thank Erin for joining us again. The conversation never gets old. Final words to our members listening. What do you want to say about pelvic health? I would just say, you know, take control of your health.

You really have to advocate for yourself. Don't just take whatever is said to you at face value. If someone says like, oh, this is just what it is, or, you know, your pain isn't really valid. Unfortunately, in our healthcare system, women's pain isn't really taken that seriously. And so if you think there's a problem, there's probably a problem. And so just keep looking until you find someone who will listen to you. And there's just so much that can be done. Like none of this stuff is just something that you have to deal with and live with forever. It's just, it isn't, it's not true. And there's a lot that you can do yourself

and with the help of a professional, yeah. I love it. Erin Agonyé, thank you so much. I appreciate you. You're welcome. Thank you.