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

Episode Date: April 5, 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/livymethodwinter2024Topics covered:Introducing Erin DegagneHow does pelvic health affect both men and women?What is pelvic health?How does pelvic health factor into weight loss?How to know if you have underlying pelvic health issues?How symptoms present in men and womenReasons you should seek a pelvic physiotherapistShould everyone be doing Kegels?How long should we be holding our urine?Bladder retrainingWhat happens at your pelvic physiotherapist appointment?What are some things that people can do to address their pelvic health?Tips for retraining your bladderHow your lifestyle can affect your pelvic healthThe difference between pelvic tension and weaknessHow diaphragmatic breathing can help your pelvic floorThe difference between regular breathing and diaphragmatic breathingThings you can do to help Nocturia (waking up in the night to urinate)Water and pelvic healthHow much of our day should we set aside for stretches and breath work @32:30How to do a proper Kegel @34:38The impact weight gain and weight loss have on your pelvic healthHow menopause can affect your pelvic healthBowel movements and your pelvic floorHow posture can affect your pelvic healthHow long should a bowel movement take?When should people seek out a pelvic health physiotherapist or doctorSeeing a pelvic health physiotherapist can be life-changing!What is a UROSPOT?Where to find Erin Degagne:https://pelvichealthsolutions.ca/ (Find a local pelvic physiotherapist)www.lakecountryphysio.com (Erin's clinic)Follow Erin on Instagram: @squats.and.margsTips for seeking out a physiotherapistTo 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,

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Visit Peloton at onepeloton.ca. behavior cycle can start changing. The last time I had this conversation with today's guest, I mean, I was blown away. It was probably our most popular conversation that we had. And we were talking pelvic health with Erin Degagne. Good morning. Welcome to the show. Hello. Hi, Tina. Thanks for having me. Okay, so let's get right into this pelvic health. First thing I want to talk about is, is this conversation just for women? Or does this include men as well? It definitely includes men as well. So it is more common in women, one in three women in Canada experience incontinence, one in nine men. For men, it's mostly triggered by an issue with their prostate. So either a chronic

prostatitis or their prostate has been removed because of cancer or something like that. But it's definitely a question for everybody. Men experience urgency and incontinence as well. Okay. So then let's break it down. What, what is public when we say we're talking pelvic health? What can people expect to hear today? Okay, so we're just going to do a general overview of a what your pelvic floor even is. I brought my pelvic model today. So I can kind of show you most people have no idea that pelvic physiotherapy is even a thing or what their pelvic floor is. So just to get a general idea of what it is, what we treat, how it can be helpful for you is a super helpful thing. So this is your pelvis. Your pubic bone is right at the front, your bladder is right behind that. For women, your uterus and your vaginal wall and rectum at

the back with these are your pelvic floor muscles. So it's a group of muscles that act as a sling in your pelvis to hold up your organs help with bowel and bladder function help with sexual function, support your surrounding muscles and bones. So your pelvis, your back, your hips, and they really contribute to a lot of our overall health and how we're functioning through the day. Okay, so you're familiar with the program, Aaron's done the program, we had this conversation last time. Why do you think it's an important conversation for our members who are trying to lose weight? How does this how does this conversation factor into that? So as we're increasing our water, so water is a big component

of the program. And I mean, just in general, most people are walking around dehydrated. And so oftentimes, increasing your water really does bring these other issues to the surface. So it can seem like, you know, oh, I started drinking water, because I'm doing this program. And now I have all these issues. But it's not increasing the water. That's the problem. Most people probably had some underlying things going on. And then just increasing your water intake now that you're not totally dehydrated, is really bringing these things to light. So it might seem like, you know, the water is the problem, but it's likely not not the problem. Okay, so how would someone know, though, is it is it that they're starting to drink

more water, because we've, we've, we've heard Dr. Pfeiffer talk about water here on the program. And you know, it's normal normal as you start drinking more water to find yourself going to the bathroom more often. But at some point, that should level out. You shouldn't be going as often. And so how do you know, what point do you know that there's an underlying, how would people know there's an underlying issue there? What is normal? What is not normal?

So a normal, let's say, quote, unquote, I hate to say normal, but amount of times to go to the bathroom, let's say five to eight times per day. So let's say you were going, you know, five times a day before you start the program, everything is fine, you increase going to the washroom, maybe a couple times. And then like you said, your body levels out, that doesn't really affect you very much, right. But if you're already peeing, you know, nine or 10 times a day, and then you increase your water, and now you're going 12 times a day, and you're up three times in the night, that's really disruptive to your life. So that's disruptive to your life. So that's disruptive to your life. So that stop every time I'm, you know, drive by a

bathroom or peeing before I leave, and I'm peeing when I get there. If it feels disruptive to your life, there's probably a problem. And then also, if you're having incontinence, like if you're having leakage with like a cough, a sneeze, jumping, or if you're having leakage with urgency, like you're rushing to the bathroom and you're losing urine on the way, that would kind of indicate that there's an issue going on there. Yeah, I just reading a comment. I went five to eight times last night, have to say it's probably the post game beers. Yeah, that happens too. You're like, good to go, you have some drinks. And the next thing you know, you're going all the time. But I know that's not what we're talking about today. So so let's talk about how we've normalized that we just pee

ourselves when we laugh. And when we jump, and we do those about, um, how we've normalized that we just pee ourselves when we laugh and when we jump and we do those things. Like I don't do a trampoline anymore. Cause for sure I'm going to pee my pants. Um, I was, uh, with the ladies away in the Bahamas and we had, we did something that was funny. I peed my, I literally peed my pants in front of everybody. And then I was just like, Oh my God, I'm peeing my pants. And that's normal because we've all done it. It's but it's not normal. Right? So it's common, right? It's very common. So that's why it seems normal, right? You hear from your mom, you hear from your aunt, your sister, your friend, you know, everyone's peeing

when they laugh when they cough when they sneeze. And so it seems like it's just something that happens. And women are a little more tolerant of these things than men, right. So the men that I see with incontinence are like, we need to fix this today. Like this is a problem. I can't live like this. But women are a little bit more accepting of incontinence. And it's our healthcare system, too, right? There's a little less emphasis on like research for women's health and education around women's health. So most people just think it's something that happens after you have kids, you're going to pee your pants when you go on a trampoline. But no, like, no, this is all fixable stuff. You should have no leakage, you should have no urgency, you should have no heaviness vaginally, like you shouldn't have any of this stuff. But it's very common, which is why it seems like a normal thing. Okay, do do men and women? Do they and I want to be inclusive, of course, in this conversation. But for the sake of simplifying,

is it do they do symptoms present differently? No, like it's the same. It's your pelvic floor is in a man and a woman is the same. There's just less likelihood that a man is going to have issues because they're not childbearing, they're not having their period every month, all of these things that can really increase tension in your pelvic floor, or lead to weakness, they're not dealing with menopause, which can also affect how your urinary tract is working. But it presents in the same way urgency, like if I'll have patients come in and they're like, my husband's up, you know, 10 times in the night peeing, what's going on? Once their prostate has been cleared, it could be that yeah, they have a lot

of tension in their pelvic floor, it needs to be released. And so these are just regular muscles, like muscles anywhere else in our body, but we kind of ignore them because our culture is really private. And you know, you don't want to, you don't want to look, you don't want to figure out what's going on there, right? Okay, so then what, what, what, what, what's the cause? You mentioned like, stressed or tight muscles, there's there's childbirth, there's, there's menopause, like what is what, what are all the causes? So it could be a combination of things. The reason to see a pelvic physio is because you don't know by looking at someone, do they have tension in these muscles? Or do they have weakness, right? We're kind of the misconception is that well, if you had babies, or if you're having urinary issues, that it's weakness, these muscles are weak, and you need to be strengthening them, you need to be

doing Kegels 100 times a day to really strengthen them. But that's often not the case. It's often tension that's created from a bunch of things, painful period. So endometriosis, other diseases, injuries, like if you have a hip injury or a back injury, that can increase tension in these muscles in the same way that like, if you had a shoulder injury, the muscles around your neck might be tight because you're compensating right? Stress, anxiety, those things, women especially tend to hold a lot of tension in their pelvic floor, past trauma, like childbirth, like we said, menopause can really affect things as well. And so it ends up being kind of this gradual increase of tension. And because the muscles are kind of bone bound in there, there's no way to stretch

them out, like you would stretch your neck, stretch your back. And so this tension just kind of builds and builds and builds until it causes an issue. It could also be weakness, like I see patients as well who have weakness, but the majority of people have tension here in the same way that the majority of people have tension in their neck. It's not a weak there. No one has weakness in their neck, right? They're holding tension. And that tension needs to be released so that the muscles can function the way that they need to. Wow. That's crazy. And even if it is, yeah, even if it is weakness, right, which does happen, there are are times when there's there's weakness there. Often, it's coupled with tension,

because the muscles are working so hard to try and either stop your urine or hold up your organs, that they're fatiguing, and then you end up with tension there. But it would be like if your arm all of a sudden got weak, like we would be very worried about that there would be either a neurological condition or there would be, you know, something pretty intense going on if muscles all of a sudden got weak. Oh, wow, that's so fascinating, because that you just think I have a weak bladder. I you know, that's what we just blow it off as I had a prolapse prolapse uterus whenever I once when I had one of my kids like what was supposed to be inside was on the outside after my last one and um I couldn't couldn't walk for like six months and I had to do the the option was to have one of those mesh things put inside uh and I know I I hear people talking about how they've had that done here as well. So I opted instead to do Kegels, but it was just like,

just do a million Kegels a day. And you're saying that's not necessarily, that's not necessarily what you do. Not necessarily. You know, we see the TV shows and everyone's like, yeah, I'm going to do your Kegels, sit on the ball, you know, or do Kegel, our Kegels, is that a one way to fit? Okay. let's, what do we do about it? To Kegel or not to Kegel? We want to go into the signs of it or just let's talk about Kegels specifically. Yeah, sure. We can talk about Kegels. So I would say unless you've had an internal exam from a professional, could be your doctor, could be a nurse practitioner, could be a nurse,

could be a physiotherapist. To assess what's happening with those muscles, you shouldn't be doing Kegels, like, just stop, you'd be better off to stop and wait until you see someone or just honestly just stop, then to be doing them and be doing more damage there, right? So if you already have tension, it would be like running every day, when you have a knee injury, right? Like that's what we're doing. Or if you had a lot of tension in your hamstring and you're working out every day trying to make it better, you could really be making things worse. And even if you think you're doing them properly, like 95% of people are not doing them properly. So you probably aren't helping yourself out much. And how is it working for you, right?

Like most women who have incontinence are doing Kegels, but they still have incontinence. Like it's not the answer, typically. Wow. Okay. What about like, what about is it from like holding our pee? Or is that a totally separate thing? It's a separate thing. It's not it's not ideal to be holding your pee for any length of time, like, But our bodies are pretty resilient, right? Unless you're holding it to a point where you're in a lot of pain, it's not the end of the world. The issue is almost more the opposite. Peeing when you don't need to pee, right? So you go pee right before you leave the house.

And then you pee when you're in Walmart. And you pee here. You pee there. And your body is trying to protect you. Because if you've had leakage in the past, it's an embarrassing thing, our body is there to protect us. And so it's really sending this signal that you have to pee before you actually do to protect you, but then it gets out of control. That's when you have people who are, you know, peeing 1215 times a day, peeing four times at night, right? We call that urinary urgency. So it's this involuntary contraction of your bladder before your bladder is actually full.

Yeah, because that a lot of a lot of people are afraid to leave their house because they're, they're going to have to go to the bathroom. And, you know, like, it's like, I think it's much of it's as much in your head, in your as in your body. So to pee or not to pee. So we talked about something called bladder retraining. So part of it is, I'll give you an example of how how the signals work between your brain and your bladder and your pelvic floor, the three work really closely together. So let's say your bladder fills up, like let's say normally, it would fill to 75% full, then send a message to your brain that says you have to pee. You look around, you know, you're sorry, you're just you're holding this red blob. Is that a bladder? This is your bladder? Yeah, it looks very small. It is not going to hold three liters of water it doesn't it can't all at once but

so what happens is let's say it fills some it's a bit bigger than this model but not not too far off so it fills to 75 full it sends a message to your brain that says it's time to pee it's kind of like how you talk about you know hunger isn't an immediate need for food like this signal that you're getting is not like you better pee right this second, or your bladder is going to explode, that would be a terrible signal for your body to send, right? So it sends it before you actually need to go, which is a safety thing, like you don't always have access to the bathroom, right? So it fills up to 75%. Well, let's say sends a message to your brain that says you have

to pee, you look around, you're out somewhere. No, I don't I don't want to pee here. So your brain would send a message to your pelvic floor muscles to contract. The two work in opposition, your bladder and your pelvic floor. So your pelvic floor contracts, and then your bladder can relax. And you just go pee when you get home. It's not a big deal. But if there's something happening with your pelvic floor muscles, so tension or weakness, that maybe they're already here. They can't send that signal to your bladder

that says, no, it's not the time. So your bladder thinks she's on the toilet. It starts to contract. That's when you're like, oh my gosh, why do I have to pee so bad? All of a sudden out of nowhere, right? If you haven't been holding it for four or five hours, like you shouldn't have to go that bad. So what happens is your bladder starts to contract,

it's just a big muscle. Luckily, you probably have decent pelvic floor strength, you stop that from happening, your bladder isn't just empty right there. But it's like rushing, you're rushing, rushing, rushing to get to the bathroom, you get there. And then what happens is your bladders and your body is like, well, that was really stressful, i almost peed my pants in walmart so it lowers that line so that it's now sending the signal when your bladder is only half full and often sending it much stronger so that's that urgency where you'd get to the bathroom and you're like oh there wasn't even that much there right like i didn't have to go that bad that's why and so a couple things that we can do for that are releasing tension in these muscles,

if they need to be released, need to be released, need to be released, need to be released, so that you're not getting sent the signal every single time that you know, your bladder is a quarter full. Okay, how do we do that? So releasing tension in your pelvic floor is what a pelvic physiotherapist does. So it is an internal exam. It's an internal release, right? So we're doing either vaginal or rectal treatment, which I know sounds really invasive. Sounds like something no one wants to do, right? It does.

Why would we want to do that? But then, like, it's really a fixable problem. Everyone, most people ask me at the assessment, like, why do you do this? Like, how is this your job? And like, it works, like, I wouldn't do it if it didn't help. And you can really get rid of the incontinence, like, it doesn't have to be a thing at all. And our, like I said, our culture is very private and very, you know, like, ooh, like, I can't believe we would do that. But these are just muscles. They're like muscles anywhere else in your body. And they are very tight, or they're weak, and we need to figure out what's going on there. And so releasing that tension often is super effective in just getting those muscles to

their proper length, so that they can function, they can send those proper signals to your bladder, they can support your organs, right? Like going to a massage therapist, or going to see a chiropractor or doing it's the same thing. Yeah, it's the exact same type of muscle. We just ignore it because of where it is. Right. So that's part number one. The second part is there's a lot of other things that you can be doing. I was really surprised last time because last time we did this talk, the feedback that we got people really having great results just based on the information and not because everyone that I see in the clinic, I'm doing physical like treatment

on right, so we're releasing this tension, and I'm giving them the information. And so I don't know what's what, like what's helping the most, but I was surprised how much just being aware of this bladder retraining of urge delay, which we'll talk about how much that made a difference in their peeing at night, peeing during the day, just being aware of it is so helpful. Yeah. Okay. So everyone's now into this conversation about what do we do? What do we do? What do we do? What do we do? So we might as well go down this rabbit hole. I know there's a lot of other things to talk about the difference between urgency, frequency, waking up at night to pee, but let's get let's get right into so they go see a physiotherapist like you, they help you release those muscles. What are some other things that people can do? So it wouldn't be a bad idea, everyone should do a bladder diary. So get a piece of paper right down, you know, 7am to 7am the following day. And just for one day, track how many times are you peeing and for how long?

So count, you sit down to pee, count how long it is in seconds, like 1, 1000, 2, 1000, 3, 1000, like that. If you're peeing less than six seconds, your bladder likely didn't have enough urine in it, like your line has lowered, right? Like you're, this line on your bladder is not't have enough urine in it like your line has lowered right like you're this line on your bladder is not where it should be and you're getting sent the signal that you have to pee before your bladder is really full so if you're going like three seconds at seven three seconds at eight three seconds at nine like those should kind of be amalgamated into one

pee but we just we get an urge and you just go you don't question it right but your body can really go into overdrive and be sending you signals that you have to pee when you really don't. So that would be to fill out this bladder diary, write down how long you're peeing, how many times so that you can kind of get an idea. You might be totally fine, right? Five to eight times a day, six seconds per pee-ish, like six to 10 or 12. Also, if you're going and it's like 25 seconds, like you're probably holding it too long. Right? Okay. Yeah.

Sometimes I'm like, checking my watch. I'm like, Okay, what is this gonna end? Yeah, that's normal, but probably a sign. That's not an indication of anything, probably just a sign that I missed a couple opportunities to go. Totally. And so yeah, so you can do that you can work on urge delay. So let's say you're getting this really strong urge, like we were talking about that you have to rush to get to the bathroom. The problem isn't going to the bathroom often, it's when you when you give into that urge, and you're rushing, rushing, rushing, that signals to your body that that was really stressful situation, we need to change something, we need to ramp this up even more. She's not listening to us,

he's not listening to us. Okay, so when you let's say, let's do an example, you're sitting at home, you stand up from your couch, all of a sudden, you have this insane urge to be Oh, my gosh, like all of a sudden, I have to pee so bad, your instinct is to run to the bathroom. But what I want you to do is stop, take a deep breath. We're trying to get that urge to calm down because it really shouldn't be that urgent. Like you haven't held your pee for five hours, your bladder is not about to explode. But that's what it feels like. So we're trying to get your central nervous system to calm down. So take a deep breath and then distract yourself. So think about you know, what am I going to have for lunch?

Like what should I be doing later on today? You can go on your phone, answer an email, count backwards from 100 by twos, like just distract your mind so that it realizes like this is not an emergency right now, right? Get the urge to calm down. Now, the goal here isn't to try and hold your pee as long as you can, right? We just don't want to be going more often than we should. And so the way that you know that so we get this urge to calm down. If you think you know, I've just went pee 10 minutes ago, then probably don't go. If but if you think you know, it's been an hour and a half, I had a coffee, I might have to actually go then slowly, calmly walk to the bathroom, pee and count. Oh, how long was it? Right? It's all just information. So maybe it's four seconds. Oh, I didn't really have to go. Now I know that, you know, if I wait, I could have waited a little

bit longer there, right? It's all just retraining your bladder to know how much it can hold, what's acceptable and what's like way too often to be going. What? Yeah. So that's kind of like when you got you on, you're in the car, and you got to pee, and I got to pee so bad. And then just you start just like breathing, like, okay. And then five minutes later, you're fine. You go from like, I'm gonna pee everywhere to I'm okay. Now is this you're talking about so retraining. So do we is this sort of is like, can this be a habit? Like we create a habit of going all the time. Also like at night when I'm lying there, it doesn't matter if I drank water, a whole bunch of water before bed or haven't drank any I'm in bed. Oh my God, I got to pee. So I get up cause I don't want to wake up. I want to sleep

and I pee and I'm just like, okay. And I come back 10 minutes later. I'm like, Oh God. Okay. I think I got to pee again. I don't want to like wake up in the middle of the night, which I'm going to be awake anyway. Is that like the same kind of thing? So yeah, it's an octorhea. Peeing more than once at night is too much. So one or zero times is what's normal. But yeah, our mind is really powerful. Sleep is really coveted, right? Like we want to have a good sleep, we don't want to wake up in the night. So your body is trying to protect you. It's sending these signals like, oh, you should pee again, pee again, maybe you won't have to go. And same thing with waking at night. You know, the first time you wake up to go pee, go, that's fine. You might actually have to go, that's fine. The second time, your body,

you could be waking up for a number of reasons, right? You could, your hip hurts, or you know, you, you didn't, you ate too close to bed, like all of these sleep hygiene things. So you wake up and you think, well, I might as well just go because I don't want to wake up again in an hour. And then I'm gonna have to pee. But no, like you shouldn't. And you are creating this habit. So then even if you're not waking up for any other reason, your body thinks, I don't know, she usually pees three times a night. So let's send the signal again. And she'll wake up, go pee again, right? So if you don't have an urge to pee, definitely don't go. Like if you're just thinking about it, I should pee, don't go. And if you wake up a second time, roll over, try and go back to sleep.

And that will correct itself. Like, unless there's any like an underlying issue, you shouldn't be going often, your body is just used to going that many times at night. And so yeah, you just roll over, try and go back to sleep. Now, if you roll over, and you're like laying there awake for more than five minutes thinking, Oh, I really have to go like, just get up and go. That's okay. Yeah. But like, see, see a public physiotherapist, you might have so much tension there that you're getting this like feeling like you need to go pee, right? When you don't. That tension thing is this do you think this is a lifestyle like our public health is more prevalent these days? Is this a lifestyle thing? I think our lifestyle doesn't help, right? We're rushing, rushing, rushing, stressed and anxious and doing too much not resting,

right? No one's stretching, myself included. I need to get better at that. But yeah, like we hold a lot of tension, right? There's not a lot of like rest, relaxation. That's why like mindfulness and meditation can be really helpful as well for an overactive bladder going to the washroom all the time because it just calms our central nervous system.

If we're always in this fight or flight mode, right? Your body is sending you all these signals all the time that don't really mean what they should. more than just diet and exercise. It can be about tackling genetics, hormones, metabolism. Felix gets it. They connect you with licensed healthcare practitioners online who'll create a personalized treatment plan that pairs your healthy lifestyle with a little help and a little extra support. Start your visit today at felix.ca. That's F-E-L-I-X dot C-A. Whether you're in your running era, Pilates era, or yoga era, dive into Peloton workouts that work with you. From meditating at your kid's game to mastering a strength program,

they've got everything you need to keep knocking down your goals. No pressure to be who you're not. Just workouts and classes to strengthen who you are. So no matter your era, make it your best with Peloton. Find your push. Find your power. Peloton. Visit Peloton at onepeloton.ca. Yeah. Okay. So you talked about going to see a physio, retraining your bladder, keeping a bladder diary. You mentioned stretching. So is there anything we can do at home that can help release the stress? How do you know the difference between if you got weakness,

or I guess you you want to go to see a therapist to know if you have weakness, or you need to strengthen? You do? Yeah, yeah. But there's ways to know if you have tension. I teach people all the time how to do self release. Again, some people feel comfortable with that. Some people don't. It just depends like your comfort level, you could have someone help you out in pregnancy, typically, someone will tell you, oh, you should try perineal, perineal massage. And that's just massaging that tissue, right? So I'll show you, I don't know, this is seems explicit for people. To me, this is just very normal. But anyways, between your vaginal opening and your rectum, all your pelvic floor muscles come together. So this is your perineal body. It's just where all those muscles come together.

And so often in pregnancy, we're trying to massage that tissue so that the tension is released to reduce tearing and that type of thing. Right. Um, but you can do the same thing. Like I teach people all the time, how to do self-release. And so I can, maybe I'll post a video or something of how to do it properly. Cause it's a bit of a process, but, um, it's not the same as masturbating. That's what you're trying to say. No, not at all. Like it would be the same way that you like, oh, like feel that you have tension in your neck and do a stretch, right? It's the same thing that you can feel the tension or if you're having like, so ways to know that you have tension and like, definitely don't do any strengthening. If you're having urgency,

you probably have tension. Like if it's like that rush, like feeling, if you're having pain, like hip pain, back pain, you probably have tension. If you're having pain with intercourse, same thing, like you probably have tension in your pelvic floor. And so those would be ways to know. But I mean, most people have tension in the same way that if you went for a massage, most people would have tension like in their neck, right? Like, it's common. Okay, so it's not like you can just like do like some, I don't know, like some side to side stretches and get deep in there. Like, is that a thing? That can be helpful. So stretching all the muscles around your pelvis muscles that attach. So there are muscles from your hip that attach into your pelvic floor. Yeah. And so stretching

those muscles can be helpful because then they're your pelvic floor isn't compensating when those muscles have weakness or when you know, you get to the end of a walk and they're fatigued, your pelvic floor is going to be trying to help out right. And so yeah, a side to side like adductor stretch for your inner thigh. I'll I'll print out like a good list of like general hip stretches that you can post if you want just for people to try and do that wouldn't be harmful at all. Yeah. And yeah, and so you want to, you want to keep everything kind of loosened up. But a lot of it is really like our, our like routines that we're doing all the time, you're just used to doing what you're doing. So you just kind of continue on that. You're not questioning anything.

Cool. Okay. Anything else? I see breathing here. So yeah, diaphragmatic breathing can be really helpful, because our diaphragm and our pelvic floor work together kind of as like a pump, right? So when your diet, when you take a deep breath in your diaphragm drops down, and it forces your pelvic floor down to relax. And so if you can get even like five to 10 deep diaphragmatic breaths in before bed, that can really help your pelvic floor to relax so that it's not tight, you know, for the rest of the night, and then you're starting the day with tension there. Okay, can you just explain the difference between just regular breathing and diaphragmatic. Diaphragmatic, yes.

So most of us, right, are doing this like upper chest shallow breathing because A, we're stressed. B, like we're not paying attention, right? Yeah. A deep diaphragmatic breath is like one hand, put one hand on your chest, put one hand on your belly. You want to take a deep breath in through your nose, your belly should expand, this bottom hand should rise, this top hand shouldn't move at all. Okay, so and then you breathe out through your mouth, that hand should drop down. Okay. So but most people are like lifting their chest opening up through here, right? Yeah. So you want to get a deep belly rising breath. That's all your abdominal contents coming down, forcing your pelvic

floor down to relax as well. Okay. All right. Other things that you can do for nocturia. So the waking at night to pee. So making sure that you're getting your water in early in the morning that can be helpful so that you're not you know, continuing to drink a lot before bed to try and get in a certain amount, right. But I wouldn't stop drinking at all. Like at 5pm or something like that, like you need to still hydrate your body, but just, you know, bulk most of it early in the day. And then you'll have like some leeway closer to the end of the night. Legs, if you lay on your back with your legs up the wall, about a half an hour to an hour before bed, that can really help your body process fluid

that's kind of just been sitting down in your legs, whether you have diabetes or most of us have more swelling in their legs by the end of the day. So that when you lay down to go to sleep, right, it's much easier for your body to be processing that fluid because it's not working against gravity. And then you're creating more urine, you're going to have to pee. So if you can do it before lay down like an hour before bed with your legs up the wall, even for five minutes, your body can really process that fluid, you go pee, and then it's not another time waking in the night. Okay, when we talk about drinking water,

obviously, we tell people not to drink more than a liter an hour, right? I mean, that's for a whole other reason not to overload your body. But what about what about your bladder then? Like what's your suggestion? Like get it in early, but obviously you still want to spread it out. How much is it sort of capable of like, what are you overloading? And if people who have issues, should they be more mindful of that? Like drink more, drink less more often or what? Any thoughts? Yeah, you'd be better off to be sipping like throughout the day versus like, you know, chugging a whole glass of water because yeah, your bladder can only hold so much at once. Some people don't have the ability to do that, right? Like they're working and they can't be drinking all the time. But yeah, you don't want to be drinking a ton all at once.

The liter an hour sounds great. Like no more than that, for sure. You can only handle so much and like your body will process it. But there's no point in putting undue stress right on your pelvic floor on your bladder. Like it's just a lot for it to process all of that at once. Yeah. Okay, so legs up the wall, doing some stretching, doing some breathing, how long? What are we? What are we taught? Like how, how much of our day should we set aside? Or how long should we do each one of those things? Like five minutes, legs up the wall, that's all you need to do. Do your breathing at the exact same time, right? Like you're laying there anyways, do some deep diaphragmatic breaths while you're there, you can get it all done in five minutes while your legs are up there. You can spread them out this way,

you'll get a good stretch in your inner thighs, like you can really do this within like five, you can even be doing other stretches, I'll do a, I gotta write this stuff down. But yeah, I'll do a series about legs up the wall, what you can do, you can do most of your hip stretches you could do while your legs are up, get it all done, like 5-10 minutes max, like this doesn't need to be a huge commitment. A lot of it is just like awareness of do I actually have to pee right now? What's happening with my bladder? Like, why does this urge feel so strong, those type of things. I mean, outside having like a prolapsed uterus or some sort of like structural, structural issues, do you find it's more of, is it more of the, how your, how your body's been trained and what's happening in your mind or more of the physical need, like the, the stretches that

are going to make more of a difference or are needed? I think it's a real combination. I thought it was before doing this talk the first time, honestly, I thought most of it was just tension. And like, we're helping with these other things, but like, they don't mean that much. But after doing the talk, and people having results, like even my mom was like, Oh, I'm not paying at night anymore. I'm like, what? Like, how did I guess I assume that most people kind of know these things. But the information and just being aware that like, oh, you don't have to listen to every single urge in the same way that like, you know, you have an urge for chocolate cake, you don't just automatically go and do it. Or like you said, you have an urge for hunger,

you don't need to eat right that second. helps because that can really go overboard. Our bodies are trying to protect us, but they often go way too far. Well, yeah, what you said about just like hunger, it's not an immediate need. Just like when you go pee, it shouldn't be an immediate need. Can we go back to Kegels in terms of like, can you can you take us through how to do a proper proper Kegel? Totally. So I will explain how to do this. I do not think that anybody should be doing like, here's the thing, these muscles, they don't need to be that strong, they need to be able to hold up your organs, they need to be able to stop your pee, like they don't need to be able to like a lift a truck. So you don't need to be doing like exercises to like hold balls up

inside of your vagina, or you don't need, you know, like, they don't, you don't need to be doing like exercises to like hold balls up inside of your vagina or you don't need, you know, like they don't, you don't need to do a hundred kegels at the light. Like that's not functional. You're never going to have to do that in real life. Right. It's good to know how to do a proper kegel because it's good to support. Like if you're going to go lift something heavy, you should probably do a bit of a contraction before that, right? Or just to know that these muscles are working properly. Like if you if you think you can do a Kegel, your strength is probably fine, honestly. Like if you feel nothing happening, then it might be time to see somebody about it. And there's things you can do for that, like just showing how to properly do one, but I'll explain

it right now. So you're sitting down, men can do this too. So you can for for women, it's a little easier most of the time to picture a ping pong ball at the opening of your vagina. Okay. And think about pulling that up inside yourself. Okay, nothing should happen from the outside. If anyone around you can see what you're doing, you're doing it wrong. You shouldn't be doing it. Yeah, no, you shouldn't be moving. And for men, if you picture a marble at the opening of your rectum, and picture pulling that up inside yourself, or picture like, we'll give an imagery for men, you know, you're walking into cold water, and you're trying to like, lift your testicles. Apparently, I can't relate. But apparently, this is a relatable thing for men,

trying to lift them up, like away from the cold, that's your pelvic floor contracting, right? Okay. And so that's how you would do a contraction. It's good to also do one so that you can relax those muscles in the same way that if you cut yourself with your shoulders up here, you'd be like, Oh, man, like, Oh, we need to relax those muscles. So if you do a contraction, it can help you locate the muscles so that you can totally relax them. Most people don't know that they're holding tension, you could be at the computer all day, and then you realize, oh, my goodness, why am I holding all of this tension, or if you're stressed, or you're anxious, right? So doing a contraction to locate those muscles so that you can relax them can can be helpful. Hey, interesting. What is the what is the impact on then weight gain and weight loss? Is that affecting pelvic health?

For sure. So I like to see that in the same way that if you had knee pain, and you had were carrying extra weight, that that would be more difficult, you know, to get rid of your knee pain, and you had were carrying extra weight, that that would be more difficult, you know, to get rid of your knee pain, but not impossible. So I wouldn't use it as a barrier. Like if you are overweight, you're carrying extra weight, I wouldn't say, well, I'm not going to get this fixed until I lose weight, because it's totally fixable. I see people every single day who are carrying extra weight, and it can still be fixed, right? But having extra weight in your abdomen is going to put extra pressure on your pelvic floor on your pelvic organs, right? And so it is more likely to have incontinence if you are carrying extra weight, but put it on your

why list, right? Like losing weight will also help with all of these things make it a little bit easier for your body to be holding up those organs if it doesn't have extra weight to be holding on to, right? Okay, and what about menopause and hormone issues? How do they factor into this? So menopause is a huge factor. We see a lot of women right after they go through menopause or as they're going through menopause, because that decrease in estrogen that your body experiences with going through menopause or as they're going through menopause, because that decrease in estrogen that your body experiences with going through menopause really affects the lining of your vaginal wall. So there's thinning of that wall and decreased lubrication. So often women are experiencing

either pain, painful intercourse or dryness, right? It also affects your lower urinary tract. So you're more likely to have leakage as well. But again, it's not like, oh, once you hit menopause, you're just going to have leakage. It's just kind of the last straw that broke the camel's back. People probably had issues before, then they go through menopause, and your body is just like, okay, I can't, you know, I can't stop this on my own anymore, because you already either have tension, or now you're having pain, all of these things are kind of compounding so that now it's become a bigger issue. Okay. And it's the same, like you dress it the same way. It's not like taking as is, you know, hormone therapy going to help with that? Is it or is it just like, is this just like a physio? do your breathing, stretching type of thing? So hormone replacement therapy orally hasn't been shown to decrease urinary incontinence.

But vaginal estrogen, so I see a lot of women who are using vaginal estrogen, that can really thicken the tissue locally, and can help with incontinence as well. And it does help with the dryness, like it can help just with lubrication of the tissue health of the tissue so that it's not irritated as easily that type of thing. But yeah, see a pelvic physio like it's hard to differentiate because the two present very similarly, right? If you have dryness and irritation in this tissue, and you're having pain with intercourse or just pain at rest, it could be that it's tension as well, right? So to deal with both, to figure out what is actually the problem is a good thing.

And the two often go hand in hand, right? Yeah, I just want to say right now, like, I love that you're taking time to educate us. And that is exactly what these conversations are about. They're not like prescriptive. And I love that you're sharing that there are things that we can do. But it's really about awareness, all these conversations, you know, this program specifically focuses on helping people lose weight. And with that getting healthier, and obviously, the pelvic health conversation comes into play as we're increasing more water, and people are starting to notice that they actually may have some underlying issues. So it really is suggested that if you really think that something is going on, definitely seek out a healthcare professional. We talked a lot about pee today, but what about

poo? Like what about constipation? Is it our bowel movements equally affected by our pelvic health? Yeah, for sure. So we see people with like Crohn's, IBS, colitis, constipation, it's a huge, huge one. So what happens with your rectum so your pelvic floor muscles are like here at the bottom right and so if there's tension there and you're not fully emptying your bowels because you know let's say there's quite a bit of tension here as your bowels fill there's enough pressure in there to push past the amount of tension that you have but you know maybe you halfway empty but there's too much now there's not enough pressure in there to fully empty your bowels. So then there's more stool sitting in there for longer, right? It gets harder, the water is excreted from there. It's

like a vicious cycle of constipation. So it could be releasing tension, it could also be muscle coordination. So the muscles aren't contracting at the right time, right, for you to properly empty. So working with a physiotherapist to do that is great. We work on toileting positions, like no one's going to the bathroom properly, you really should be using a squatty potty or a stool to put your feet up onto something with a bowel movement, even if you don't think you have issues, it really like we were originally like just squatting down in a deep squat to go to the bathroom, right? So it really changes that anal rectal angle to allow your bowel to empty properly. So it's not kind of trying to go on an angle when we're sitting up at

like 90 degrees, right? Yeah, my kid made us get a squatty potty. I'm not a kid anymore. And we have one in the bottom. And then all my upstairs bathrooms, the garbage cans have dents in them because she must like put the garbage can. Perfect. It's great. Okay. Seriously. Okay.

You're suggesting that that can be great. Not just if you're having issues going, but for pelvic health in general. Oh, for the squatty potty. Yeah. Because you know, any bearing down or pushing or holding your breath and bearing down can really affect prolapse like if you're feeling heaviness vaginally that can really be pushing everything down but it's a lot of stress on your pelvic floor too like don't sit on the toilet for hours with your phone like none of that is good for your pelvic floor

if you have an urge to go go and then don't sit there any longer than you need to. What about just like, like sitting in a chair all day? Like I get sitting not sitting on the toilet trying to go. But does posture play a role in it? For sure. So we see it a lot with tailbone pain. If people are having tailbone pain, often it's tension that's pulling on that tailbone, unless you've had like a specific injury. But yeah, when you're sitting, if you are allowing yourself to kind of slouch back in your chair like this, right, you're really pushing your pelvis forward and shortening through your pelvic floor. So it's just easier for you to build up tension there. So sitting up, making sure you're doing like some pelvic tilts back and forth to really make sure that those muscles are moving and they're not just stagnant in one position for a long period of

time can be helpful. Um, doing some deep breathing, like while you're at work, even like if you've been sitting, you're talking like, like, yeah, back and forth. Yes, exactly. Like you would do a cat and cow and yoga type. Perfect. Yes, exactly. Wow. Oh my gosh. Okay. There's a great question. How long should a bowel movement take? I mean, like if you're sitting on the toilet for more than like two a minute two minutes with nothing like get up go lay in your bed do some stretches like knees to chest to really try and get things moving you can get into like a deep squat hang on to something your kitchen counter or something get into a deep squat it's a great position do some deep breathing that too right

will help relax your pelvic floor so that things can kind of pass a little more easily. But just sitting there probably isn't going to help if it's not happening within, you know, an hour or two. Or an hour or two, a minute or two. And, you know, you want to make sure that when you're getting an urge to go, that you do go. Like we tend not to want to go in public. We tend not to want to go, you know, at work. But if you're ignoring that urge, you know, at work. But ignoring that urge, you know, you're really are leaving the stool in your mouth for way too long, right? It's going to

be water is going to be excreted from your bowels, they're going to be harder, it's going to be harder to pass. It's like a vicious cycle. Yeah, what's happening in your brain, just as important what's happening in your body. Okay, I'm just cognizant of time here. When we talked a lot about, but when should people go see their doctor or a physiotherapist or someone to help them with this? So if you're having any urinary or bowel issues, like even if you're having leakage with like a cough, sneeze, like you really should be telling all of this to your doctor. Um, it's good for them to know what's happening with you, right? Even if there's not like an immediate solution that they're going to give you, it's good to discuss

all of this stuff, because you do want to rule out, maybe there's something actually wrong with your bladder, maybe there's actually something wrong with your bowels, right? You want to make sure that you're taking all the steps to clear any of that before you're just like taking this on yourself and trying to fix the problem. But there's specific things like if all of a sudden you're losing control of your bowel and bladder out of nowhere, if you're having any blood in your urine, if you're having like pain with urination or bowel movements out of nowhere, like anything like that, I would for sure seek medical attention right away. But if any of this is happening, you should be talking to your primary healthcare physician about that. Okay, anything we missed today, Erin, that you think is worth noting?

I mean, we covered a lot. I'm trying to think. We had so many great questions. I'll try and answer a bunch of them today as well for people just because there's so many good ones. But yeah, let me see if there's anything. A lot of people asking about. Yeah, go ahead. Yeah. Can't say enough about seeing a pelvic floor physiotherapist during and post menopause gave my life back. Yeah, like, I really do see this every day. I know it sounds like a little bit crazy coming from someone who this is what I do for a living. But like, it can be so life changing. Like this is all fixable. There's so much hope.

It's not like you just have to live with this forever. Like you see, you know, nursing homes filled with people with like, depends on right, that doesn't need to happen. Like it's not an age thing. It's just the reason it's worse as you age is because it hasn't been dealt with ever. Right? Like they, it just gets worse and worse and worse over time because it's never dealt with. And they do a much better job of this in other countries. Like as soon as you have a baby in Europe, you just see a pelvic floor physiotherapist. It's just like a normal part of health and aging. But here we tend to be a little more private. We don't want to do these

things. Or we don't know that there's something available, right? Or you don't think it's fixable problem, but it's all really fixable. And the sooner you deal with it, the less likely it's going to just continue to be an issue, but it's not just inevitable. Drop the mic that we don't have to be wearing diapers when we're older okay um uh cognizant of time but people are asking about uh euro spot i don't even know okay so euro spot is like um a chair that you can sit on that is like involuntarily giving you pelvic floor contractions to strengthen those muscles and so it would be similar to like a Dr. Ho machine, if anyone's seen that, like, you know, I'm aging myself, but where they have like,

yeah, and they're like contracting your muscles to give you abs kind of thing, right? Yeah. The problem here is like, fourfold, I don't know. Unless so they're not all created equally, there are some places that have pelvic floor physiotherapists working for them that will do an internal exam beforehand to make sure that that's what you actually need. But you can go to a place like a med spa or something and just go and just sit on that. And it's doing like 10,000 kegels in a session or whatever, right? Yeah, way too much, in my opinion, like it's often not needed and the problem is even if you do have weakness and you need strengthening right um it costs like two to three thousand dollars and you could easily learn how to do a proper contraction a proper kegel from seeing a pelvic

physiotherapist like one or two times. And just the cost is so enormous. That, like, I mean, if it's something that you really wanted to do, I would make sure that you're going to a place that does do an internal exam first to make sure that you it's actually, it's actually what you should be doing. But the cost is pretty astronomical for Yeah, I don't know. I'm not a huge fan, but I only see people who it doesn't work for, right? Like, I'm sure there are people who it does end up helping. But for like $2,000, like, oh my gosh, we could have fixed that in, you know, a couple sessions. Yeah, here's someone I did the euro, euro spot cost me $2,500. It did nothing. Also, what we've learned today for a lot of people, it's not a weakness. That's the problem. It's actually

too much stress built up in there. And that's just going to, you know, not help. In fact, perhaps make it worse. So before you spend the money, make sure someone's saying Pilates, would Pilates help? I'm sure Pilates would help in terms of stretching. Yoga would help in terms of stretching. Any kind of body alignment, strengthening of your body, I think would be a benefit there as well. For sure. Okay, well, clearly, we can keep on going with this conversation. But we are out of time. I know people are going to ask where to find you. Okay. I work in Aurelia. So I'm in a smaller town. There is a website that's great to find a local pelvic floor physiotherapist who is great and

accredited. That's they have it up here now pelvichealthsolutions.ca. There's also tons of great resources and information there. If you are in the Aurelia area, I work at Lake Country Physiotherapy here in Aurelia. But I mean, you don't need to drive to come and see me. There's so many amazing pelvic floor physiotherapists that um, that can help you. And, but if anyone ever has questions, I'm so happy to help. So happy to answer any questions that you have. Send me a DM on, um, Instagram. Like I'm, I'm so happy to just give you the information that you need and help in any way, uh, that I can. Okay. Um, I'm just going to clarify for people because we're in like 55 different countries. So Erin is in Ontario, Canada, which is where I am. So any tips for people all over the world seeking out a physiotherapist? Anything you should do? Is it something you have a conversation? I mean, if they're going to be up inside your body, should you have a conversation with them first? Like anything to look for be mindful of? Yeah, so here, it's fairly strictly regulated in Canada, right? Like you'd have to be a registered physiotherapist who's taken like an

accredited training program. I'm not sure what the rules are in other countries. So yeah, it would be good to look into what are their accreditations? Are they a registered physiotherapist, like you should be going through all of your physiotherapy training first, then doing additional training on top of that to really specialize in like a pelvic pelvic physiotherapy. So it would be good to look into that. Because yeah, you know, the rules here are quite strict. So it would be difficult to be practicing without an accreditation. But I don't know what it's like everywhere else. So make sure that you are seeing someone who is has a good reputation has the proper training for sure. Amazing. Aaron Deganes, thank you so much. Like I said, this is a really eye opening conversation the first time we had it. And it seems like it's just as eye opening for many of our new and even our returning members. We're going to put your contact information in the post in the Facebook support group, and we're going to add it to our podcast as well. So people listening can find you. Thanks so much for joining me today. And thanks everyone for listening. No problem. Thanks. We'll see you're not. Just workouts and classes to strengthen who you are. So no matter your era, make it your best with Peloton. Find your push. Find your power. Peloton. Visit Peloton at

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