Transcript
Dr. Becky Allen: I cannot even tell you the amount of times women have been in my office and they have told me sometimes even in tears that they were just told that this is normal. This is how it is now. Try Kegel exercises, just relax. Like these are very common things that women are being told that frankly are not working and sometimes making it worse.
Grace Gerke: Welcome to the Skills for Moms podcast, where we equip you with tools for wholehearted living. I know so many moms in particular who cannot live wholehearted due to pelvic floor issues that they often don't even feel comfortable talking about because of the shame. Today, we're going to cover pelvic health across the lifespan, from toilet training all the way to perimenopause, and bust some common myths about pelvic floor physical therapy.
Grace Gerke: I am so thrilled to welcome my own pelvic floor physical therapist, Becky Allen, to the show. Thanks for being here today.
Dr. Becky Allen: Yay. I am seriously so excited about this, Grace. Thank you so much for inviting me.
Grace Gerke: Yes, you have helped me through two pregnancies and two postpartum times and have opened my eyes to pelvic floor. PT is not just about down there and healing scar tissue.
Grace Gerke: There was one after one birth, you were helping me with my diaphragm that needed releasing and breathing techniques.
Dr. Becky Allen: yeah
Grace Gerke: And so I just want to open up the can of worms that pelvic PT is not just for women who just had a baby and it isn't just about down there.
Dr. Becky Allen: Right.
Grace Gerke: It's like our whole bodies are connected and you show that so well.
Dr. Becky Allen: Oh my gosh. Music to my ears. I'm so glad you learned something from your time with me. No, just kidding. But I love it.
Grace Gerke: Yeah.
Dr. Becky Allen: you you You hit it though. You hit the nail in the head. it is way It's way more than your pelvic floor. Pelvic floor function is more than your pelvic floor.
Grace Gerke: Yeah. Yeah. Well, I just want to give our audience a brief background on you because you are so knowledgeable. You're a thought leader, really influencing people around the globe through your online platforms. And so I just want to give them a background of who you are.
Grace Gerke: So Becky founded Genesis Pelvic Foundation. and therapy or sorry, physical therapy and wellness with a bold vision to transform the way pelvic floor therapy is delivered, understood and experienced. You are passionate about whole body healing, not just focusing on one area, but realizing how we're all interconnected.
Grace Gerke: And you have now have five branches in Dallas area, as well as virtual appointments all across the globe and really impact people through your social media accounts, through your physical therapist and occupational therapist training opportunities. And you really stand by your philosophy that um you have to treat the whole person. You can't just focus on isolated symptoms. You've got to look at the whole person. And so I'm just so thrilled to have you on today. I feel so flattered and honored that you would come on my podcast. So thank you for being here, Becky.
Dr. Becky Allen: Oh my gosh. Any opportunity to just educate the world to stop doing Kegels. You know what I'm saying? Yeah.
Grace Gerke: And I mean, just that might sound like a no brainer to some people, but I think for some, they're like, what are you talking about? That's the only thing I've ever heard that you're supposed to do.
Dr. Becky Allen: Yeah.
Grace Gerke: Could you elaborate a little bit more on that one?
Dr. Becky Allen: Yeah, I would love nothing more than to elaborate. So Kegels are kind of well known as the go-to pelvic floor strengthening exercise. And it it stems back from actually the 1940s. There's a man named Dr. Kegel, that was his last name. And he technically didn't invent the Kegel, but he named the Kegel after himself and kind of deemed this exercise as the end-all be-all to strengthen improve, whatever you want to call it, your pelvic floor function.
Dr. Becky Allen: And it still it started from women, females.
Grace Gerke: Sure.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: But all a Kegel is, is it's literally just a squeeze or a clench of your pelvic floor muscles, kind of like you're stopping your flow of urine midstream.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And that's all it is.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And so...
Grace Gerke: hamed
Dr. Becky Allen: For so long, that one little movement or exercise, quote unquote, if we want i want to call it an exercise, is what women have been told to do to fix all of their pelvic floor problems, you know, even if they're told and anything at all, to be frank.
Grace Gerke: Yeah.
Dr. Becky Allen: But
Grace Gerke: Mm-hmm.
Dr. Becky Allen: You know, what we've come to know now is that the pelvic floor muscles are typically the victim of something, something somewhere else.
Grace Gerke: Yeah.
Dr. Becky Allen: It could be nervous system. It could be gut dysfunction. It could be hip dysfunction. It could be you're wearing bad shoes and your feet aren't moving.
Grace Gerke: here
Dr. Becky Allen: It could be your diaphragm.
Grace Gerke: yeah
Dr. Becky Allen: You know, there's so many causes. And so this idea of just do Kegel exercises to, quote, strengthen your pelvic floor muscles, is just very, very incomplete.
Dr. Becky Allen: And it's doing everyone, women included, ah across the world a disservice whenever we tell them that.
Grace Gerke: Mm-hmm.
Grace Gerke: Yeah, yeah, that makes a lot of sense. Like I remember going to pelvic PT before you for the first time, kind of not knowing what it was or what I was getting into.
Dr. Becky Allen: Mm-hmm.
Grace Gerke: And I found out I actually had really tight pelvic tone, like I'm background running. And so a lot of my exercises had nothing to do with tightening. It was about actually learning to fully lengthen and relax those muscles.
Dr. Becky Allen: Mm-hmm.
Grace Gerke: And I know for other people, sometimes it's a coordination, like it's like,
Dr. Becky Allen: A hundred percent.
Grace Gerke: the timing of things. So that was a huge aha of like, oh, maybe it's that I don't need to be do more tensing. Maybe I need to learn how to relax these muscles. Yeah.
Dr. Becky Allen: Yes. Yeah. If you think back to before you or just anyone started having pelvic floor symptoms, you never thought about your pelvic floor, right? You were never thinking, huh, okay, let me tighten it.
Dr. Becky Allen: Okay, let me let it go. You just lived your life. You just used the bathroom or...
Grace Gerke: Sure.
Dr. Becky Allen: jumped on a trampoline or went for a run or chased your kid or sneezed or laughed, whatever it is, you just did it and your pelvic floor did its job without you ever thinking about it.
Grace Gerke: Mm-hmm. Mm-hmm.
Dr. Becky Allen: And so that's ah that's a big disconnect that bothers me is I'm like, so why do we say then that now that it's that there are symptoms that we now suddenly for the rest of our lives have to do these exercises, these Kegels, think about our pelvic floor all the time,
Grace Gerke: Mm-hmm.
Dr. Becky Allen: When what we really should be doing as licensed PTs and OTs is restoring the function of the pelvic floor itself. And you said it perfectly.
Dr. Becky Allen: Any muscle in the whole body needs to be able to lengthen. You know, we don't just want to walk around with our elbows clenched and bent.
Grace Gerke: Yes.
Grace Gerke: Yeah.
Dr. Becky Allen: Then our bicep is just tight all the time.
Grace Gerke: Mm-hmm. Yes.
Dr. Becky Allen: That needs to be able to lengthen as well. It's the same with your pelvic floor.
Grace Gerke: Mm-hmm. Yeah. And I mean, that's good word for me because I just finished doing pelvic PT after my fifth baby. And I sometimes I get, yes, right.
Dr. Becky Allen: All the babies.
Grace Gerke: I have these guilt trips of like, oh my goodness, I haven't done my PT exercises in a while. But then I realized, oh, I'm lifting heavy kids. I'm moving into a new home. I'm doing all these things.
Grace Gerke: with my pelvic floor in mind.
Dr. Becky Allen: Yeah.
Grace Gerke: So I am strengthening and doing those things without always doing the the exercises, if you will.
Dr. Becky Allen: Right. Well, and that's, yeah, that's, that's exactly kind of
Grace Gerke: Like they were like a tool to get to where I'm at, if that makes sense.
Dr. Becky Allen: what your phase of rehab should look like is there is a time and a place for connecting with your core muscles, your pelvic floor, and just understanding what does that even mean?
Grace Gerke: Yeah.
Dr. Becky Allen: How does it all work together? How does it contract? How does it relax? That is an early piece of the puzzle. And then we move into more of the, you know, traditional, what you think of when you think of PT, right?
Dr. Becky Allen: There's exercises, there's manual therapy, there's all that. We do all of that. Just like if you came for low back pain, you know We would progress through certain exercises to make you more mobile, stronger, all of these things, and then you would progress into your normal life.
Grace Gerke: Sure.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: we would we would How do we integrate that into your normal life so that you're no longer, if we're going with the low back pain example, I don't want you thinking about your back all the time for the rest of your life.
Grace Gerke: ahead
Dr. Becky Allen: I want to actually restore the functions so you can go live your life with all this newfound mobility and strength so that your back doesn't hurt for the rest of time.
Grace Gerke: ah Yeah. Yeah.
Grace Gerke: Yeah. And I mean, it seems like sometimes pregnancy or it could be close to menopause for women. Why, why would you say there's certain periods of a woman's life where all of a sudden they realize, oh, I just sneezed and leaked and it never happened before.
Dr. Becky Allen: Yeah.
Grace Gerke: Why are there certain periods that it seems to become aware, Hey, something's not right.
Dr. Becky Allen: Yeah. Yeah. Yeah. So you, you named it pregnancy, postpartum, kind of around menopause, perimenopause time. Those are three huge periods in a female's life where we are more vulnerable to pelvic floor symptoms like leaking, um pelvic pain, prognosis.
Dr. Becky Allen: pressure and heaviness type symptoms from prolapse. There's, you know, there's a, there's a handful of things that the symptoms wise that we can experience. And there's a few different kind of common reasons that they kind of quote flare up during these times.
Grace Gerke: then
Dr. Becky Allen: But the similarity between all of them is that usually the pregnancy or the postpartum or the menopause perimenopause time is kind of the straw that breaks the camel's back.
Grace Gerke: yeah
Dr. Becky Allen: It's kind of like, The one more thing that your body is like, oh, okay, this one is too much. I can no longer compensate um for maybe what's been happening already for years because our bodies are master compensators.
Grace Gerke: Yeah. Yeah.
Dr. Becky Allen: They're great. We don't have to have perfect bodies. um We're made not to be perfect. We're, you know, in human bodies, we're aging, we're you know, all the things. But at a point, there's going to come a time where our pelvic floor is like, Ooh, hold on a second.
Dr. Becky Allen: I can't keep doing it all actually, you know?
Grace Gerke: yeah
Dr. Becky Allen: And so that's kind of what happens. Like take pregnancy. We are, um, we have some hormonal changes. So that's changing kind of the actual bones of the pelvis and the stability there.
Grace Gerke: The pressure,
Dr. Becky Allen: We have a growing belly. So there's a weight component as well as, what's called like a center of gravity shift component. And all that means is kind of your balance changes.
Dr. Becky Allen: So as the belly grows bigger and forward, it kind of pulls you there.
Grace Gerke: yeah.
Grace Gerke: ah Yeah.
Dr. Becky Allen: That actually tips your pelvis and puts more pressure on your bladder.
Grace Gerke: Yeah.
Dr. Becky Allen: And so that's just kind of and ah one example.
Grace Gerke: Yeah.
Dr. Becky Allen: Perimenopause would be there's hormonal changes that happen that and that affect the integrity of the muscle tissue.
Grace Gerke: Yes.
Dr. Becky Allen: And so it's like, what is the thing during these time periods that made our pelvic floor go, okay I can no longer continue doing everything for everyone.
Grace Gerke: Yes.
Dr. Becky Allen: i'm having symptoms now. Someone please help me <unk>
Grace Gerke: yeah Yes. Yeah. And it's kind of like as women, um I don't remember anyone when I was starting my period saying, hey, there's these certain times in your life.
Grace Gerke: You need to like really baby yourself. You need to give yourself some extra TLC. Don't go on that run when you just had a baby.
Dr. Becky Allen: me.
Grace Gerke: Don't go do this crazy thing. And no one ever told me that, you know, I'm kind of copy paste.
Dr. Becky Allen: Yeah.
Grace Gerke: Like I should do the same thing every day.
Dr. Becky Allen: Yeah.
Grace Gerke: Like a guy does. And it sounds like for women, that's just not, we may be able to do everything, but not everything at once or at the at a certain time.
Dr. Becky Allen: Yeah.
Dr. Becky Allen: who
Dr. Becky Allen: yeah
Grace Gerke: Right.
Dr. Becky Allen: A million percent. Yeah. Our hormones are like a roller coaster. Guys are more like a straight line. And so it's not that we necessarily need to like watch our cycles like a hawk and proactively make changes.
Grace Gerke: Yes.
Dr. Becky Allen: But what I, what I advocate for is I want women to actually learn how to tune into your own body and
Grace Gerke: hamman
Dr. Becky Allen: recognize, Hey, I feel off today. I feel fatigued.
Grace Gerke: Yeah.
Dr. Becky Allen: Um, you know, and, and maybe, maybe then you look at your charting and you know that, Oh, that makes sense. I'm in this part of my cycle and you know, maybe I'm, maybe I'm going to do a yoga today instead of lift heavy, but I want it to be based off of how you feel.
Grace Gerke: Sure.
Dr. Becky Allen: Um, not necessarily only by the chart, you know?
Grace Gerke: Yeah.
Grace Gerke: Yeah. Yeah, that makes a lot of sense. um Kind of tracking back a little bit. You know, I know our pelvic floor, it even starts with our kids.
Grace Gerke: Like, you know, some of us are just trying to potty train a kid or navigating things like that.
Dr. Becky Allen: Yeah.
Grace Gerke: And some of those habits we have, you know, push peeing.
Dr. Becky Allen: Mm-hmm.
Grace Gerke: I know you cued me in on not push peeing.
Dr. Becky Allen: Oh. Yeah. ah
Grace Gerke: But could you just want to highlight how some of those maybe habits we had as a kid that we didn't realize, like bowel bladder stuff, then can play into, you
Dr. Becky Allen: Yeah.
Grace Gerke: making that a you know a bad cycle when we do get postpartum or or in a point of life that's trickier public floor wise
Dr. Becky Allen: Mm-hmm.
Dr. Becky Allen: Mm-hmm. Yeah. The two main kiddo habits that I see kind of compounding and and leading up to this adult pelvic floor dysfunction is constipation or withholding stool. And so a lot, I mean, anyone who has kids knows that whether you're just potty training or even, you know, into the elementary years, like kids, for whatever reason, they don't want to stop.
Dr. Becky Allen: They don't want to go poop. They don't want to take the five minutes.
Grace Gerke: Yeah.
Dr. Becky Allen: You know, they don't want to go in the public place.
Grace Gerke: Uh-huh.
Dr. Becky Allen: They don't want school. And so constipation is a big one because what happens as a kiddo is if, if they hold stool and remain constipated, which by the way, we need to be going at least one time a day.
Grace Gerke: Mm-hmm. Yes.
Dr. Becky Allen: so if your kiddo does not go at least once a day, don't panic, but just know that there's resources you can, you know, call us and we'll help you and your kiddo. Um, but a constipated kiddo, especially over like months and years of their early life that actually stretches out their rectum and lends itself to constipation as an adult.
Grace Gerke: Wow. Wow.
Dr. Becky Allen: And when we're constipated, there's that poop fills up in our pelvis and pushes on your bladder in front of it.
Grace Gerke: Wow. Yeah.
Grace Gerke: Wow.
Dr. Becky Allen: And so that can lead to bladder problems and and a whole host of other things, pelvic pain, painful intimacy.
Grace Gerke: yeah
Dr. Becky Allen: So constipation in childhood is a huge, huge, huge one that you want to address. The second thing in kiddos, moms, I'm not shaming you, but if you do this thing, I'm just gently asking you to stop. And that is having our kiddos pee every time before we leave the house.
Grace Gerke: yeah
Dr. Becky Allen: And that comes down to our bladders are very trainable. So they if if if we train our bladders, whether we're a kid or an adult, this happens in adults too, but it's common in kiddos.
Dr. Becky Allen: If we train our bladders to empty before it's fully full, right? Because we know we're about to go to the grocery store or you know on a road trip or whatever. And so every time before we leave the house, we're going and we're emptying our bladder.
Dr. Becky Allen: Our bladder starts to think that we don't want it to fill up all the way. And so it changes its signaling to us.
Grace Gerke: him
Dr. Becky Allen: And so then it's going to tell your kiddo or you, whoever it is experiencing this more often that you need to go empty your bladder.
Grace Gerke: Yeah.
Dr. Becky Allen: And it just kind of becomes this cycle. And so I talk about this in the kiddos because I'm guilty of this. I have done this where I'm like, just please go to the bathroom before we go to soccer practice or whatever it is.
Grace Gerke: Yeah.
Grace Gerke: Yes.
Dr. Becky Allen: Cause I'm like, I know you haven't gone in an hour or two.
Grace Gerke: Uh-huh.
Dr. Becky Allen: But the reality is, is we need to be teaching our kiddos how to listen to their own bodies. And it might be annoying to have to pause in middle of soccer practice and run them to the public bathroom, but it's better for them to have that awareness.
Grace Gerke: Yeah.
Grace Gerke: Yeah.
Dr. Becky Allen: And then it's better for their pelvic health in the long run.
Grace Gerke: Yeah. Yeah. I, I can relate to that. I mean, it makes me think of hunger fullness with kids. You know, if you're like forcing them to eat, then you might end up with an obese kid, you know, but with our, one of our kids that we potty trained on the earlier side, i was so nervous of about him having accidents.
Grace Gerke: I would have him go more often than normal, you know, needed.
Dr. Becky Allen: Yeah.
Grace Gerke: And then even as like, you know, six, seven year old, we're having to kind of retrain like, oh no, you can go two to three hours, you know, or for myself, like, you know, when you're pregnant, you do have to get up at night to go the bathroom.
Dr. Becky Allen: Yeah.
Grace Gerke: That's pretty expected.
Dr. Becky Allen: Sure.
Grace Gerke: But then you have to kind of undo that habit afterwards.
Dr. Becky Allen: We do. Sure.
Grace Gerke: Otherwise you'll like forever be going pee in the middle of the night.
Dr. Becky Allen: You will.
Grace Gerke: Yeah.
Dr. Becky Allen: And that's a big one is even in postpartum when you're up with baby, do your best to make it to at least four in the morning before you go pee.
Grace Gerke: um
Grace Gerke: wednesday
Dr. Becky Allen: Now it's different if you're in like a marathon nursing session at 11 or midnight and you chugged a huge thing of water, you might have to go pee.
Grace Gerke: Yeah.
Dr. Becky Allen: But in general, if you can make it to at least 4 a.m., that's a pretty great physiologic timeline to be you know signaling and training your bladder again of like, hey, we need to be making it through the night.
Grace Gerke: yeah
Dr. Becky Allen: Okay. Yeah.
Grace Gerke: Yeah, yeah, no, that's good. Yeah, I think this was my first time postpartum, I did like a bladder diary for a bit, because I was just like, I'm pretty sure I'm like peeing more than I need to.
Dr. Becky Allen: Yeah.
Grace Gerke: But then once I saw, hey, I can go five hour, you know, four hours, then it was like, all right, it's fine. And it kind of went back to normal. So yeah,
Dr. Becky Allen: Yeah, data is so, so, so helpful because so many times I ask my own patients, you know, maybe I'm in an eval, I'm, you know, and doing their first session and I'll say, how often do you go pee? And they're like, oh, you know, like a normal amount. And I'm like, you know, is it every 30 minutes, every hour, every five hours? And a lot of them are saying probably every hour.
Dr. Becky Allen: And so I educate them. We really want to be in kind of that two to four to five hour at the most range.
Grace Gerke: eleven
Dr. Becky Allen: And you're not going to kill yourself if you have a day where you go eight hours.
Grace Gerke: Yeah.
Dr. Becky Allen: My nurses, my teachers, I see you, you know, and it's like, I know y'all have teacher bladder and nurse bladder, just do your best to at least go like at lunch or something.
Grace Gerke: Yes. Yeah. So getting back to the the constipation thing with kids, like what are some little pearls? It sounds like, you know, coming to you guys, seeing a, you know, your pediatrician to make sure there's not something going on, but what are some little pearls to help a mom who maybe is struggling, has a kid struggling with constipation?
Dr. Becky Allen: Yeah. So full stop kiddos with pelvic floor dysfunction, even if you don't know it's constipation, it usually is constipation. That's usually the main driver of like bedwetting at night, urinary urgency and frequency, UTIs, and especially little girls.
Grace Gerke: Yeah.
Dr. Becky Allen: Um, so it's a big, big, big thing. So I just wanted to like hone in on that again, that we got to get these kids pooping and to help them do that.
Grace Gerke: First. Yeah.
Dr. Becky Allen: Um, a big thing that if, if you're a mom and you come or a dad, if you bring your kiddo in and you're like, I know this child's constipated, you know, they've, they go days and days and days between poops. Then first and foremost, I do want you to go to your pediatrician and get a KUB x-ray.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: That's actually going to tell us the diameter of your rectum.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And that's really, really important because like I mentioned earlier, sometimes that rectum is stretched out.
Grace Gerke: Yeah.
Dr. Becky Allen: And when it's stretched out, it doesn't signal your kiddo.
Grace Gerke: Wow. Wow.
Dr. Becky Allen: So I'm pre over here preaching.
Grace Gerke: Wow.
Dr. Becky Allen: I'm like, let your kid listen to their body. But if it's stretched out, it's not signaling in time. So there is an intervention that we need to get to in that earlier stage, but we don't know that if we don't know that.
Grace Gerke: well
Dr. Becky Allen: So KUB x-ray is what it's called. You could just ask your pediatrician for that, for the diameter of the rectum, and then tell that to your pediatric pelvic PT, right? um So that way we know what's going on.
Dr. Becky Allen: So that's little perk number one, tip number one.
Grace Gerke: Yeah.
Dr. Becky Allen: But at home, very simple things like increasing fiber intake is a huge one. Like just I know kids are picky, but whatever you can find that they'll eat, even if you sneak it in and a cookie or something like make a sweet potato cookie, I don't know.
Grace Gerke: Yeah.
Grace Gerke: Yes.
Dr. Becky Allen: You know, it's like just sneak that fiber in somehow, and that will make a huge difference.
Grace Gerke: The fiber. Mm-hmm.
Dr. Becky Allen: And then a lot of times um they'll do really well with a magnesium supplement. And they make these little gummies.
Grace Gerke: Yeah.
Dr. Becky Allen: It's called Calm.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: My kids take that. They take one in the evenings. And it's the certain type of magnesium that promotes bowel regularity, but without giving diarrhea.
Grace Gerke: Yes.
Dr. Becky Allen: Now, if you take too many of them, you're going diarrhea.
Grace Gerke: Yes.
Dr. Becky Allen: But if, you know, if you just give them one, that's going to be
Grace Gerke: Is that the magnesium citrate?
Dr. Becky Allen: Uh-huh, uh-huh. Yeah, that one's a train.
Grace Gerke: Because magnesium is glyconate. That's more for like calming and sleep.
Dr. Becky Allen: okay
Grace Gerke: Is that correct?
Dr. Becky Allen: ye Yep.
Grace Gerke: Okay.
Dr. Becky Allen: Yep. Yep. That helps, that helps you, um, your muscles kind of calm down and there's glycinate also, which helps your nervous system calm down.
Grace Gerke: Yes. Yes.
Dr. Becky Allen: So, but yeah, so fiber, a magnesium supplement, and then it's so underrated, but toilet posture, get your kids a stool to put their feet on because, you know, even adults need the squatty potty.
Grace Gerke: union Yes.
Dr. Becky Allen: People giggle at that, but it really helps.
Grace Gerke: Yes.
Dr. Becky Allen: And the reason it helps when you have a stool under a stool under your feet for your stool to come out, right?
Grace Gerke: Yeah. Right.
Dr. Becky Allen: Is it changes the angle of your pelvis in a way that relaxes the pelvic floor muscles on the back half.
Grace Gerke: Yes.
Dr. Becky Allen: So it no longer kinks off kind of that rectum.
Grace Gerke: said you
Dr. Becky Allen: And so the poop just gets to like shoot right out. And so toilet posture is huge, huge, huge, huge.
Grace Gerke: yes
Dr. Becky Allen: So just put a stool and what you want to look for is you want their knees to be just slightly higher and slightly wider than their hips. That's kind of the, that's how you know that the stool is high enough basically.
Grace Gerke: Yeah. Yes.
Dr. Becky Allen: Okay. And so those three things, plus teaching your kiddo to listen to their body and helping them overcome, you know, their fear of pooping.
Grace Gerke: Yeah.
Grace Gerke: Mm-hmm. Mm-hmm.
Dr. Becky Allen: Maybe they had a history, maybe they were constipated and it hurt one time, right?
Grace Gerke: Yeah.
Dr. Becky Allen: Working through a lot of that.
Grace Gerke: ya
Dr. Becky Allen: We do a lot of coaching with parents on how to coach their kids through that.
Grace Gerke: yes
Grace Gerke: madam here
Dr. Becky Allen: um But, you know, there's fear when we're afraid our pelvic floor clenches and poop is not going to come out of a clenched pelvic floor. So, you know, there's a lot of nervous system retraining we have to do sometimes too.
Grace Gerke: yeah
Grace Gerke: And also, would you say like not the breath holding bearing down that they want to like blow it out kind thing?
Dr. Becky Allen: Oh my gosh. Yes. Yes. Look at you. You just know all things. I love it. I love it. Yes. So, you know,
Grace Gerke: Well, working through that with one of my kids, so. Yeah.
Dr. Becky Allen: Yeah. Yeah. Yeah. So, I mean, even adults do this too, where we kind of like, like hold our breath and we want to push or whatever.
Grace Gerke: Yeah.
Dr. Becky Allen: So kids do the same thing, especially when the stool is like hard or larger, which can happen with the enlarged rectum, um, or lack of water and all that, all that stuff. Um, so yes, we definitely want to, for the kiddos to teach to exhale, just kind of like you're blowing bubbles or, um, you know, sometimes you can put a little like pinwheel in front of them or have them hold a pinwheel and blow the pinwheel and And that way, what that does is it kind of changes the pressures in your abdomen.
Grace Gerke: yeah
Grace Gerke: yeah yeah thank you that is so helpful and i think that's going to be
Dr. Becky Allen: So that way it makes it easier to push the poop out.
Dr. Becky Allen: Yeah.
Grace Gerke: a big help to a lot of our young moms with young kids.
Dr. Becky Allen: Yeah.
Grace Gerke: Cause that is a hard thing. i mean, toilet training is not fun for anyone, but yeah.
Dr. Becky Allen: No. No.
Grace Gerke: And then once you kind of had it going, maybe not the best its it is hard. You know, I get that to like change.
Dr. Becky Allen: It is hard to backtrack.
Grace Gerke: things
Dr. Becky Allen: Yeah. There's habits form quickly in kiddos and, and, you know, you, we can totally overcome it, but it is harder if you're already farther down the road, for sure.
Grace Gerke: Yeah. And going now more towards like that puberty time, like I know you probably have a lot of patients, you know, perimenopause and postpartum, but like, how do you talk about some of these pelvic floor issues with like a girl who's maybe about to start her period or just with sports?
Grace Gerke: How do we be cognizant of that for that age?
Dr. Becky Allen: Yeah. Mm-hmm. Mm-hmm.
Grace Gerke: Like I've heard of a couple girls, you know, these are teenagers who are, had pee episodes, you know, where they're working too hard and then they peed themselves, you know?
Dr. Becky Allen: and
Grace Gerke: So it's like, they're obviously having some pelvic floor dysfunction, even at a young age.
Dr. Becky Allen: her Yeah. Yeah. Yeah. The biggest thing with this population is to reduce shame around it because they want to keep it a secret, especially depending on their relationship with their own mom, right?
Grace Gerke: Yeah.
Dr. Becky Allen: That's, that's going to have a big factor in all of this. But, um, let's say they even have a great relationship with their mom. They still feel like, Oh my gosh, I can't believe I peed my pants or I can't believe like,
Grace Gerke: Yeah.
Dr. Becky Allen: my period's so heavy or they have all this pain around their period maybe.
Grace Gerke: Yeah.
Grace Gerke: yeah
Dr. Becky Allen: And they just think that's normal because no one's ever told them. And so I think just doing our best to educate in an effort to reduce shame.
Dr. Becky Allen: Like it's, there's nothing shameful about it. This is just, it's just like if your shoulder's hurting, it's just, you know, if my shoulder's hurting, there's something causing that.
Grace Gerke: Yeah.
Grace Gerke: Yeah. Yeah.
Dr. Becky Allen: If your pelvic floor is not functioning well, there's something causing that and we can do something about it. um But the shame is a big piece because that prohibits them from even telling their moms or their doctors or whoever.
Grace Gerke: Yeah. And could you, segwaying from that, tell us a little bit more about what to expect for someone who's never been to a pelvic PT and now they're like, you know what, I think I maybe should get checked, you know, and I know a lot of people have had a traumatizing experience with the pelvic exam and the speculum and the pap smear.
Dr. Becky Allen: Sure.
Grace Gerke: So just, could you, you know, give us a little bit of information about that?
Dr. Becky Allen: Mm-hmm.
Dr. Becky Allen: Yeah. The pelvic floor exam with a pelvic floor PT or OT is nothing like at your gynecologist or your OBGYN. So um obviously, if you've had a bad experience there, naturally, you're going to have some thoughts and questions and potentially
Grace Gerke: Yeah.
Dr. Becky Allen: around what the heck are we actually going to do But I always like to say like, we don't have a speculum. We're not actually, you know, the speculum opens up so they can see your cervix.
Grace Gerke: Yeah.
Dr. Becky Allen: We don't need to visualize your cervix.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: We as ATs and OTs, we're assessing musculature.
Grace Gerke: Yeah.
Dr. Becky Allen: We're assessing muscle tone and strength. We're assessing mobility of the joints. Just like if you were coming for your shoulder, I would look at all of those same things. These muscles just happen to be inside your pelvis.
Dr. Becky Allen: And so At a typical evaluation or assessment, we're going to start, i'm going to ask you a billion questions. And at Genesis, at least, our evaluation is an hour and a half long when you come in person.
Grace Gerke: name
Dr. Becky Allen: And it's precisely for this reason, because i think the answers lie in the patient's story.
Grace Gerke: Yeah.
Dr. Becky Allen: And so what we strive to do is ask so many great questions to have a really great hypothesis going into the assessing, the exam, all of that stuff.
Grace Gerke: Yeah.
Grace Gerke: Yeah.
Dr. Becky Allen: So that way that stuff just becomes confirmation, rule it in, rule it out, and then move on with treatment.
Grace Gerke: yeah
Grace Gerke: Yes.
Grace Gerke: Yes.
Dr. Becky Allen: And so bunch of questions.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: It's great. We're going to get ah we're going to get to know each other super quick. And then from there, i do like a quote, normal PT assessment.
Grace Gerke: Uh-huh.
Dr. Becky Allen: I'll look at how you move, how you walk. I'll look at your hips.
Grace Gerke: Yeah.
Dr. Becky Allen: I'll look at, um you know, mobility. i am going to check how you breathe.
Grace Gerke: Yeah.
Dr. Becky Allen: So we're going to look a lot at breathing patterns and rib cage mobility.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And then if A, we have time, if B, I think it's indicated, and if C, you have said, yeah sure, let's do a pelvic floor exam, that that is something that we tend to do at pelvic floor therapy.
Dr. Becky Allen: And so that includes kind of externally looking at the tissues, feeling feeling the tissues.
Grace Gerke: Yes.
Dr. Becky Allen: And then internally, there's one gloved finger that goes in and we just work our way through the pelvic floor muscles super gently. The point is not to cause pain. The point is for us to just gather information and pain is information.
Grace Gerke: Yeah.
Dr. Becky Allen: So if you have that, we, we have our techniques and our tactics to be able to reduce that for you and to be less invasive. Um, and we'll kind of grade that patient by patient.
Dr. Becky Allen: So we do that and then that part's over and then we go into treatment. So we might do some manual treatment that day.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: I'm probably going to give you a couple exercises to get you started. I'm going to educate you on what I found, how it's connected to your symptoms and what the heck we're going to do about it.
Grace Gerke: Yeah.
Dr. Becky Allen: you ah but Then we're off to the races. And so that's kind of, you know, in a magic wand, perfect scenario, that's kind of what my first visit with someone would look like.
Grace Gerke: yeah
Grace Gerke: Yeah. Yeah. And I mean, I just want to give a little personal um story about that. Like, i i think after maybe my second or third kid, I guess had some tension, you know, down there. And I i didn't even realize it. You know, I wasn't having any pain that I noticed. But then again, with When I was getting the internal exam, there was some tender spots.
Grace Gerke: And so just by me, deep breathing and the pelvic floor PT, putting gentle pressure on that area, we were able to release those kind of trigger points.
Dr. Becky Allen: Yeah.
Dr. Becky Allen: one
Grace Gerke: And then the next time we you know came to them, there may be a little bit sensitive, but not the way they had been the first side. And it was kind of all connected.
Grace Gerke: Like, I think it was on the left side and then, you know, I like left. you know, body stuff going on.
Dr. Becky Allen: Yeah.
Grace Gerke: And so it was like, oh, once I work on this, you know, body stuff, then it's going to help the pelvic floor, how we're all connected.
Dr. Becky Allen: Totally.
Grace Gerke: So yeah, I just, um I don't know, manual therapy.
Dr. Becky Allen: Totally. Yeah.
Grace Gerke: I'm like, wait, what does that mean? You know, some people, again, if you've never been, it's like, yeah.
Dr. Becky Allen: Yeah.
Dr. Becky Allen: Yeah. Yeah. It's just a fancy way to say hands-on treatment. You know, a massage is manual therapy. um Stretching a joint is manual therapy. Doing trigger point releases manual.
Dr. Becky Allen: There's a lot of different kinds, but it's just a fancy way to say, i got my hands on you and I'm doing something.
Grace Gerke: Yeah. Yeah. And I, I love how you guys treat each person individually. Like I've had friends who. you know, pay for some online course, which is great. You can learn a lot from an online course, but it's so important to also have someone that you trust like Genesis PT to lay hands on you and help you see how that information translates to your body and the whole, like, maybe you have too much tone or maybe you're lacking coordination or what are your issues that you need to fix?
Dr. Becky Allen: Sure. Yeah.
Dr. Becky Allen: and
Grace Gerke: They could be different than your friends, you know, or what Instagram says.
Dr. Becky Allen: Yeah.
Grace Gerke: Um,
Dr. Becky Allen: Yeah. And you're right. I mean, there's great courses out there, but nothing beats the individualized assessment and treatment, especially if you've tried the courses or the handouts or the Googles or the whatever, and it hasn't helped.
Grace Gerke: Yeah. Yes. Yes.
Dr. Becky Allen: um
Grace Gerke: Yeah.
Dr. Becky Allen: Just do this for yourself, you know?
Grace Gerke: Yeah. Yeah. And it seems like to me, postpartum in particular is such a key time to pay the extra money, do what you need to do to get seen by someone.
Grace Gerke: Because if you were having something like a prolapse or a condition going on, that's maybe, you know, beyond the naked eye, like that could really impact the rest of your life.
Grace Gerke: Right. If you don't get it checked.
Dr. Becky Allen: Very much so.
Grace Gerke: So could you share a little more about like postpartum, like what things might pop up or, you know, the importance of getting checked kind of during that timeframe?
Dr. Becky Allen: Very much so.
Dr. Becky Allen: Yeah. Yeah. So having a baby is very, very natural. We are made to do this as women. um of course there's sometimes it ends up being a surgical intervention and that's, you know, technically not natural, but that's, that's not the majority of births.
Grace Gerke: Yeah.
Dr. Becky Allen: And if you have that, that a million percent warrants rehab, first of all, every postpartum mom, whether it's vaginal or C-section needs rehab,
Grace Gerke: Yeah.
Grace Gerke: Yes.
Grace Gerke: Yes. Mm-hmm.
Dr. Becky Allen: but especially the C-section moms. I just wanted to put that out there that it's like you had a major abdominal surgery.
Grace Gerke: Yes.
Dr. Becky Allen: You need to advocate for yourself and go get rehab so that you could live your best life for the rest of time.
Grace Gerke: Yeah.
Grace Gerke: Yeah.
Grace Gerke: That's what, yeah.
Dr. Becky Allen: But, you know, let's say that you have a vaginal birth with, you know, it went normally and minimal complications and all the things you might be thinking, well, I'm made to do this and maybe I don't need specialized rehab.
Grace Gerke: Yes. Mm-hmm.
Dr. Becky Allen: And you are made to do that and know better, do better.
Grace Gerke: Yeah.
Dr. Becky Allen: Right. And so Now that we know that in a vaginal birth, your pelvic floor muscles stretch to three times their normal length, no other muscle in the human body can do that.
Grace Gerke: Wow.
Dr. Becky Allen: So it is made to do that.
Grace Gerke: Wow. Yeah.
Dr. Becky Allen: And we know that after vaginal birth, women are more likely to experience things like leaking pain and prolapse symptoms.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And so because we know that, and And now we have information and data on how to treat that and what interventions work best, aka not Kegels. Now that we know that, that should be the standard of care for every single female.
Grace Gerke: Yes.
Grace Gerke: Yeah.
Dr. Becky Allen: In in France, over, you know, across the pond, it actually is. You actually get 12 sessions automatically postpartum to help your body recover.
Grace Gerke: Wow. That's amazing. Wow.
Dr. Becky Allen: And it's like with anything else, early intervention is best.
Grace Gerke: Wow.
Dr. Becky Allen: I mean, literally there is no part of the medical world that would argue that early intervention is not ideal, right?
Grace Gerke: Yes.
Grace Gerke: Yeah.
Dr. Becky Allen: It's not that it's never too late, but early intervention is always going to be the best option.
Grace Gerke: Yeah.
Dr. Becky Allen: And so when you are healing postpartum, your tissues, they want to heal.
Grace Gerke: Yeah.
Dr. Becky Allen: Your body wants to get back to what it was doing.
Grace Gerke: Yeah.
Dr. Becky Allen: So if you add good pelvic floor rehab, it's It's just going to make it like a million times better, faster. You're going feel your best. You're going back in the gym or on the trail quicker. You're going to be much less likely to have symptoms down the road. It's just going to be so good.
Grace Gerke: yeah yeah that's So good to hear. So it's never too late. So even if you're 70 and having issues, get seen, get checked, get help, but don't wait till you're 70.
Dr. Becky Allen: Yeah.
Grace Gerke: I know our mom's generation that's now like in menopause, you know, retirement age, you know, they were basically told you're fine.
Dr. Becky Allen: Yeah.
Grace Gerke: You don't need anything after birth. But then some women in that group have had pelvic floor issues, probably worse than necessary because they didn't get that rehab postpartum.
Grace Gerke: Is that right?
Dr. Becky Allen: Mm-hmm. That's a hundred percent right. And that's that generation, our mom's generation, I feel so bad for them because that's exactly what they were told. You know, they were, they were told, Oh, you're fine.
Dr. Becky Allen: Just go on back to, to life, to work, to whatever.
Grace Gerke: Sure, yeah.
Dr. Becky Allen: And there was nothing, nothing about pelvic floor rehab or anything like that. And so I think probably the data, I think less of them talk about it than is what's really happening.
Grace Gerke: Yeah.
Dr. Becky Allen: you know, like, because they just assumed, oh, I guess this is just part of my life.
Grace Gerke: Yeah.
Dr. Becky Allen: And so they didn't even think to bring it up over the years because because they just assumed that this was what they were stuck with.
Grace Gerke: Yeah.
Dr. Becky Allen: So I think the numbers are probably way higher in that generation of what they're dealing with.
Grace Gerke: Yeah.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And it's probably a ah whole host of various things.
Grace Gerke: Yeah.
Dr. Becky Allen: But I think the numbers are probably pretty high. if If we were to honestly ask every single one of them and they answered honestly, i think we would be we would be looking at 70, 75% have symptoms.
Grace Gerke: Yeah. And what would you say if, say, someone thinks they're having a pelvic floor issue, maybe a prolapse, or maybe they just don't know what's going on. They go to their OB and they're either told you're fine, or they may recommend an OB might just say, oh, let's just do a hysterectomy. I'll fix your problems.
Grace Gerke: What should someone do if they're either told they're fine and they're like, I really feel like I'm not fine, or hey, let's rush to remove your uterus. That's a very intense thing to do
Dr. Becky Allen: Yeah.
Grace Gerke: what Where could they go from there if
Dr. Becky Allen: Yeah. Okay.
Grace Gerke: Yes. Her.
Dr. Becky Allen: I love it. I love it Okay. so I'm go to start with the first part, which is the you're fine. So I will say OBGYNs and gynecologists, unless they have done the extra intentional work to learn about functional pelvic floor rehab, which most of them have it, and it's not their fault.
Grace Gerke: Yes.
Grace Gerke: Yes.
Dr. Becky Allen: It's just, you need to see a pelvic floor PT, not your gynecologist for your pelvic floor problems.
Grace Gerke: her and yes
Dr. Becky Allen: Right. And so it's like, they're not trying to dismiss you most of the time. I'm sure that there's the handful that are actually really bad doctors of people, but that's not the majority of them. The majority of them are doing the best with what they were taught in school, which was probably one lecture about Kegels.
Grace Gerke: Yes.
Dr. Becky Allen: Okay. And so if you get that answer, try your best, even though it's frustrating, you can be frustrated, but they're probably not just trying to screw you over. They probably just don't know.
Dr. Becky Allen: So you can advocate for yourself. You can ask for a referral. um Most PTs and OTs anywhere, actually you don't need a referral anymore.
Grace Gerke: Yeah.
Dr. Becky Allen: You can just come see us before that.
Grace Gerke: Yeah.
Dr. Becky Allen: So that's a big thing that people don't realize is you can just call me up and say, hey, I want to see Genesis.
Grace Gerke: yeah
Grace Gerke: yeah
Dr. Becky Allen: And we're going to say come on, girl.
Grace Gerke: Yeah.
Dr. Becky Allen: And so you can advocate for yourself because if you don't advocate for yourself, who else is going to?
Grace Gerke: Yeah.
Dr. Becky Allen: And so that's the first piece of it.
Grace Gerke: Yes.
Dr. Becky Allen: The second piece is if they jump right to surgery, hysterectomy, bladder sling, whatever it is, um I want to shout from the rooftops that evidence, we have so much research and evidence that has proven over the recent years that pelvic floor therapy
Grace Gerke: Mm-hmm.
Dr. Becky Allen: has a grade of a which is the best that you can get in research, as the first line and the best line of defense for pelvic organ prolapse, no matter what grade it is, whether, because there's some grades to it of severity.
Grace Gerke: Yeah. Wow.
Grace Gerke: Yeah. Yeah. Yeah.
Dr. Becky Allen: And so I just want to educate that,
Grace Gerke: her
Dr. Becky Allen: This intervention of pelvic floor therapy is the most effective and the best choice that you can make if you have prolapse, just hands down. Surgery, I'm not saying is never necessary.
Grace Gerke: yeah
Dr. Becky Allen: I'm saying it's probably necessary 1% of the time, frankly.
Grace Gerke: yeah
Dr. Becky Allen: And um so if your doctor recommends that, just don't panic. Get a second opinion. Call up your pelvic floor PT.
Grace Gerke: Yes.
Dr. Becky Allen: Come get an eval. We will tell you.
Grace Gerke: Yes.
Dr. Becky Allen: If we say you need surgery, you need surgery.
Grace Gerke: Yeah.
Dr. Becky Allen: But if I'm like, girl, no, we're just going to do some rehab and you're going to be great.
Grace Gerke: Yeah.
Grace Gerke: Yeah. Uh-huh.
Dr. Becky Allen: You know?
Grace Gerke: Yeah.
Dr. Becky Allen: Um, so it's just, you have to be your own advocate.
Grace Gerke: Yes.
Dr. Becky Allen: Um, and that, that's, that's why I want to educate the world is because you can't be your own advocate if you don't know what to advocate for.
Grace Gerke: Yeah. Yes.
Dr. Becky Allen: But once you know, then it's like, you just, you got to do it. You got to ask for the flow. You got to take initiative. You got to get a second opinion, all the things.
Grace Gerke: Yes.
Grace Gerke: Yeah. Yeah. And if you're not in Dallas, um, Genesis does awful offer virtual consultations. Um, and they also probably have a network where you could maybe do a virtual with you guys, and then y'all might be able to get them hooked up with someone in Houston or wherever they're at.
Dr. Becky Allen: Totally.
Grace Gerke: Um, cause I would, to give you guys a plug, like when, after one of my kids, I had insurance covering like a traditional pelvic PT you would find at a hospital. And so I went and
Dr. Becky Allen: Sure.
Grace Gerke: And they basically said everything was perfect. So I went for the exam and I was like, I feel like I could have some improvements in my life, you know, but they were like, nope, basically, unless you're like, again, your uterus is falling out.
Dr. Becky Allen: Yeah.
Dr. Becky Allen: Yeah.
Grace Gerke: It's almost like they don't care.
Dr. Becky Allen: Yeah.
Grace Gerke: And again, I'm not, I'm not saying every government PT, you know, what someone played through insurance is like that, but there is like probably less incentive to really provide that wellness based model.
Dr. Becky Allen: Yeah. No.
Dr. Becky Allen: Mm-hmm. Mm-hmm. Mm-hmm.
Dr. Becky Allen: Yeah.
Grace Gerke: Right. When it's, yeah.
Dr. Becky Allen: Yeah. it's It's really sad because insurance, the PTs, they want to help you. But if they take insurance, their hands are tied because unless you're going to, you know, flub on your documentation and lie or make things sound worse than they are on the test, quote unquote, you're
Grace Gerke: Yeah.
Grace Gerke: Yeah. Yeah.
Dr. Becky Allen: The insurance is not going to pay for it. So if you're in an insurance-based clinic and if I do your exam and you are at least 80% of your, what's called like your prior level of function.
Grace Gerke: yeah
Dr. Becky Allen: So what you report to me that before these symptoms...
Grace Gerke: Mm-hmm.
Dr. Becky Allen: if If you're at least 80% to that, insurance doesn't want to continue paying for it.
Grace Gerke: Wow. Because it's wellness.
Dr. Becky Allen: And so they're they're okay.
Grace Gerke: Yeah.
Dr. Becky Allen: Yes. Yeah. That becomes wellness, maintenance, all of that stuff. They're okay with you not not getting quite back to what you used to be.
Grace Gerke: Yeah. Wow.
Grace Gerke: Wow.
Dr. Becky Allen: They're okay with you being just good enough. And so the PTs want to help you. They just can't, you know, unless they truly find something that they can report on your documentation and send it off to insurance to get it reimbursed, there's there's nothing that they can really do.
Grace Gerke: Yeah. Yeah. It's an example of kind of our broken medical system, but you know, from my own life, I'm just finding it's worth it.
Dr. Becky Allen: yeah
Grace Gerke: You know, you pay for it one side or the other. So would you rather pay, you know, now for like the care that's going to get you back to your, your life that you loved, or are you going to like wait and put it off and then like continue to like have worse health?
Dr. Becky Allen: Sure.
Grace Gerke: You know, it's kind of like you get to choose. Um,
Dr. Becky Allen: Yep.
Grace Gerke: And what would be, i guess, just some signs with someone who's pregnant or postpartum, like these are high alert symptoms.
Dr. Becky Allen: Mm-hmm.
Grace Gerke: You need to like get checked, you know, cause there may be people who are just like, Oh, I think I can manage.
Dr. Becky Allen: Yeah.
Grace Gerke: I'll do some online stuff. But what are those like, you need to get checked. This isn't normal stuff.
Dr. Becky Allen: Yeah. Yeah. Yeah. um I would say feeling like things are falling out is a big one.
Grace Gerke: Okay.
Dr. Becky Allen: um And that's, that can be very common.
Grace Gerke: Yeah.
Dr. Becky Allen: It doesn't mean that it's going, it doesn't mean that it's super, super bad and everything's terrible and your organs are never going to be the same, but it does mean that you need good rehab.
Grace Gerke: Yes. Yeah.
Dr. Becky Allen: And so, you know, if you feel like, and and sometimes they'll say that it feels like there's a tampon in there, but there's not, or it feels heavy and like something's dragging or, so or sometimes it really is like they can feel like there's like a ball in there.
Grace Gerke: Yeah.
Grace Gerke: Mm-hmm.
Grace Gerke: Okay.
Dr. Becky Allen: It's like my bladder and I feel it coming down.
Grace Gerke: Yeah.
Dr. Becky Allen: So that would be a big one postpartum that again, not to scare you guys, but just
Grace Gerke: Yeah.
Grace Gerke: Yes.
Dr. Becky Allen: come to rehab and we can help you with that and get back to normal and symptom-free and everything like that.
Grace Gerke: Yeah.
Dr. Becky Allen: That, if you're having those significant symptoms, that probably won't get all the way better on its own. And then significant bladder changes. So leaking, urgency or frequency.
Grace Gerke: Okay.
Dr. Becky Allen: So like you feel like you're just like a you know, chain to a bathroom. You're going every 30 minutes or like when the urge hits to pee, it hits and you got it.
Grace Gerke: Yeah.
Dr. Becky Allen: You better get there or you're going to leak.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: Um, That would be a big one. Or if you had a tear with or without a repair, if you had ah a vaginal tear in birth and you know you're noticing that it's just like real tender still and it hurts to sit on it, or you tried to resume intimacy and it just is hurting.
Grace Gerke: Yes.
Grace Gerke: Yeah.
Dr. Becky Allen: Or of course, there's like the the medical red flags of like a foul odor discharge.
Grace Gerke: Yes.
Grace Gerke: Yeah. Yes.
Dr. Becky Allen: I'll just throw that in there because that's important to be aware of also.
Grace Gerke: Yeah.
Dr. Becky Allen: Um, that would be for your OBGYN though, to check.
Grace Gerke: Yes.
Dr. Becky Allen: Um, but it's just significant pain at the, at the tear or repair site.
Grace Gerke: know
Dr. Becky Allen: And then of course C-section I'm like, well, for like everyone postpartum should be coming, but you know, C-section mamas, like, please come.
Grace Gerke: yes
Dr. Becky Allen: We need to be helping the scar to heal. we need to be retraining your abdominal muscles that were cut through. we need to be re-coordinating those muscles with the pelvic floor. There's just so many things.
Dr. Becky Allen: There's so many things. Yeah.
Grace Gerke: that's, I, yeah, I have not personally had a C-section, but in my mind, it's like, oh, you're a C-section.
Dr. Becky Allen: Right.
Grace Gerke: You're good. You didn't have the baby stretching out down there.
Dr. Becky Allen: Right.
Grace Gerke: But what you're saying is it's kind of the opposite.
Dr. Becky Allen: Yeah.
Grace Gerke: Like there's more rehab necessary.
Dr. Becky Allen: Yes. Yes.
Grace Gerke: Is that correct? If you've had a C-section.
Dr. Becky Allen: That's a hundred percent correct because, you know, not to beat a dead horse, but a vaginal birth is, is how we're meant to birth a baby.
Grace Gerke: Okay.
Dr. Becky Allen: And so, yes, it was stretched out, but it was meant to do that, you know? And of course there can be complications there, but a C-section, you there are multiple layers of skin, fat, connective tissue, multiple muscles that are cut through to be able to get the baby out, which so thankful we have this intervention.
Grace Gerke: me
Dr. Becky Allen: It has saved, know, you know, countless lives, both mom and baby, and it is a major surgery.
Grace Gerke: Yes. Yeah.
Dr. Becky Allen: And it bugs me so much because that exact statement that you said, well, you know, it didn't actually come out of my pelvic floor.
Grace Gerke: Yeah.
Dr. Becky Allen: So I don't, my pelvic floor is fine.
Grace Gerke: Yeah.
Dr. Becky Allen: You have so much connective tissue. That is where that scar is.
Grace Gerke: and
Dr. Becky Allen: That actually connects to your pelvic floor. It connects to your bladder.
Grace Gerke: Yeah.
Dr. Becky Allen: Um, Not to mention the function of the abdominal muscles themselves. They are best used with the pelvic floor muscles.
Grace Gerke: Yeah.
Dr. Becky Allen: So if one of them was cut through, the other one is going to be impacted as well.
Grace Gerke: Uh huh.
Grace Gerke: Yeah. And would you talk a little bit about the people probably have heard of it, diastasis recti or the mommy pooch, like, you know, is that just like a thing that's just going to happen after you have a baby or what can that be done about that?
Dr. Becky Allen: Mm-hmm. Yeah. So diastasis recti, um, is essentially an overstretching of your six, your six pack muscles, right? So like picture, you know, the six pack muscles, I'm not saying we all have to have them because that's whole other story.
Grace Gerke: They're covered by skin and stuff.
Dr. Becky Allen: There you go. And that's very normal, but like, we all know what they look like on some people's bodies, right? So like picture your six pack muscles, they run up and down on each side of your belly button.
Grace Gerke: Yes.
Dr. Becky Allen: Okay. And so what diastasis recti is, is there's a, a connective tissue, a ligament that connects those muscles in the midline.
Grace Gerke: and
Dr. Becky Allen: And when we're pregnant and 100% of pregnant women, no matter what, that tissue gets stretched because it needs to because there's baby in there and we need to be able to stretch the belly to get there.
Grace Gerke: Yeah.
Grace Gerke: That's right. yeah Yeah. Yes.
Dr. Becky Allen: And so that's very normal.
Grace Gerke: Yep.
Dr. Becky Allen: That is diastasis recti. That is ah diastasis of the rectus abdominis.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: Diastasis means a stretching or an opening
Grace Gerke: Yep. Separation. Mm-hmm.
Dr. Becky Allen: And then recti means the rectus abdominis.
Grace Gerke: Yep. Yeah.
Dr. Becky Allen: Okay. And so when it becomes a problem is when it hasn't healed after about six to eight weeks. And we have an assessment that we do for that.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: We can check for it super, super easily.
Grace Gerke: Yep. Mm-hmm.
Dr. Becky Allen: There's kind of some norm, normal values that we look for, um, both on the width of the healing of the diastasis recti, but also the depth of how deep it goes.
Grace Gerke: Uh-huh. Yeah. Mm-hmm.
Dr. Becky Allen: And then kind of the integrity of the tissues at the bottom of the gap. Okay. if that makes sense.
Grace Gerke: ah Yeah.
Dr. Becky Allen: So it's kind of like a three-dimensional assessment throughout that line.
Grace Gerke: Yeah. Uh-huh. Sure. Yeah.
Dr. Becky Allen: And so what we look for is, you know, when you come in for your six or eight week assessment with us, um yeah, we're going to be checking for that.
Grace Gerke: Postpartum. Uh-huh.
Dr. Becky Allen: And if it hasn't healed on its own by then, we will be initiating rehab specific to that because we we want our abdominals to be able to come back together. We want them to be able to, that's a huge part of pressure management.
Dr. Becky Allen: So that helps with leaking prolapse pain, back pain.
Grace Gerke: mean
Dr. Becky Allen: um So we'll definitely be addressing that. But I would say in the in the vast majority, 60 to 70% of women, it'll be healed by about six to eight weeks.
Grace Gerke: And if for some reason you weren't in that large majority, it heals naturally. There are still physical therapy exercises you can do to typically help it heal without needing a surgery or something.
Dr. Becky Allen: Totally. Oh my gosh.
Grace Gerke: All right.
Dr. Becky Allen: Yes, yes, yes, yes, yes.
Grace Gerke: Yeah.
Dr. Becky Allen: The only time you need a surgery for that, if there's actual hernias, which a hernia is an actual tear.
Grace Gerke: Yeah.
Dr. Becky Allen: So that's a tear in the tissue. And that can happen in a few different places throughout the abdomen and kind of groin area. But um just the diastasis recti, the stretching of it, that can heal on its own with rehab.
Dr. Becky Allen: um Now, women have different connective tissue integrities, right?
Grace Gerke: Yeah.
Grace Gerke: Yeah.
Dr. Becky Allen: So, you know, all humans are different.
Grace Gerke: Yes.
Dr. Becky Allen: Some people are more stretchy and some are less stretchy.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And so, you know, I've had a mom come in who had ah very, very wide one. It was a an eight finger. So that means like both hands whenever I assess the width of it.
Grace Gerke: Wow. Oh my goodness.
Dr. Becky Allen: Yeah.
Grace Gerke: Yeah.
Dr. Becky Allen: So it was really, really wide and really, really deep.
Grace Gerke: Yes.
Dr. Becky Allen: She's great. You know, it takes time. You have to do the exercises. You have to, you know, do what I say, but it's totally possible because it's just a game of moving pressures.
Grace Gerke: Yes.
Dr. Becky Allen: And it's one of my favorite games to play It's just like, how do we get the pressure to stop pushing out onto your belly and move it and displace it elsewhere?
Grace Gerke: Yeah.
Grace Gerke: Yeah. I think, were you the one who gave me the analogy of our abdominal diaphragm and pelvic floor being kind of like a soda can and the managing pressures?
Dr. Becky Allen: Totally.
Grace Gerke: Do you want to just talk a little bit about that?
Dr. Becky Allen: Yeah.
Grace Gerke: Just, you know, it's not just about our pelvic floor, it's all so connected.
Dr. Becky Allen: Yeah. Yeah. Yeah.
Grace Gerke: Yeah.
Dr. Becky Allen: Yeah. So our, you know, our abdomen, right? Our core, if you will, is shaped kind of like a can of Coke.
Grace Gerke: Yes.
Dr. Becky Allen: Okay. So the, the lid or the upper portion of it is your diaphragm muscle. is shaped like a dome or like an umbrella.
Grace Gerke: yes
Dr. Becky Allen: And then we have the cylinder of the Coke, right? So the front wall is your abdominal muscles. The sidewall is your oblique.
Grace Gerke: Yeah.
Dr. Becky Allen: muscles. And then the back wall is kind of your back muscles, your fascia, connective tissue back there.
Grace Gerke: alpha
Grace Gerke: Uh-huh.
Dr. Becky Allen: So that kind of forms this cylinder, if you can picture a Coke can.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: And then the bottom of the can of Coke is your pelvic floor. And so all of those things together form this Coke can shape and they form your true core muscles.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: So they all have to work together.
Grace Gerke: Yeah.
Dr. Becky Allen: Now, in a can of Coke that we haven't opened yet, right, it's pressurized. It's, you know, you can't squeeze it.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: It's, you know, there's, it's made up of the liquid and then the air in there and it's very pressurized, right?
Grace Gerke: Yeah.
Dr. Becky Allen: Right. If I were to take a knife and stab the front of it, that coat is going to, it's going to spew out the front.
Grace Gerke: Yeah.
Grace Gerke: Yep.
Dr. Becky Allen: Okay. So that's, that's kind of the example for diastasis recti is like, that's pretty graphic, but it's like, you just have a, you know, you have ah a weakness right there in the front wall of your coat can.
Grace Gerke: Mm-hmm.
Grace Gerke: Yeah.
Grace Gerke: Yes. Yeah.
Dr. Becky Allen: And so because there's a weakness there, the pressure kind of goes there. The pressure is always going to go to to the least resistant spot.
Grace Gerke: Yeah.
Grace Gerke: Yeah. Sure.
Dr. Becky Allen: And so it's going to go there. And then that becomes a self-perpetuating cycle because the pressure keeps pushing forward onto this lengthened, weakened tissue.
Grace Gerke: Yeah.
Dr. Becky Allen: And so it just kind of perpetuates itself unless you do the things to to reverse the pressure, move the pressure, strengthen the wall.
Grace Gerke: yeah
Grace Gerke: Yeah. And some of that is our, again, you've mentioned breath. Like if you are doing strenuous activities while breath holding, you're going to be putting extra pressure right on your pelvic floor, the diastasis, if it was healing your diaphragm, is that correct?
Dr. Becky Allen: Mm-hmm.
Dr. Becky Allen: everyone
Dr. Becky Allen: Totally. That's a hundred percent correct. Yeah. Anytime we hold our breath and move, lift, twist, get up from the floor, even just that little, like that technically increases the pressure inside our abdomen.
Grace Gerke: Yeah.
Dr. Becky Allen: And I don't want you guys to like fear this, like don't panic and be like, oh my gosh, I'm never going to, like hold my breath again, you know, but it's like, it does increase the interdominal pressure.
Grace Gerke: Yeah. Yeah. Yeah.
Dr. Becky Allen: Now there are times where that's helpful. This is for my power lifters out there who are doing like one, two, three rep max lifts.
Grace Gerke: Uh-huh.
Dr. Becky Allen: Like we need to have some stiffness and some pressure there, um, to support your spine, but that is not most people, right?
Grace Gerke: Yes. Yeah.
Grace Gerke: Mm-hmm.
Dr. Becky Allen: Most people, we don't need that much stiffness in our core and um and for our spine, we actually need more fluidity and mobility.
Grace Gerke: Yes.
Grace Gerke: Yeah.
Dr. Becky Allen: And so that's where I always say blow before you go.
Grace Gerke: time
Dr. Becky Allen: So before you get up off the floor with your baby, just right before you go and stand up, if you're going exercise, blow out with the harder part of the lift.
Grace Gerke: Yep.
Grace Gerke: awesome Yes.
Grace Gerke: Yes.
Dr. Becky Allen: Um, yeah, those are just some easy hacks.
Grace Gerke: Yeah. The blowout with exertion.
Dr. Becky Allen: Mm-hmm.
Grace Gerke: And yeah, as women, it's like our pelvic floor, because it has more openings and intricacies than a guy.
Dr. Becky Allen: Mm-hmm.
Grace Gerke: It's just, that's kind of in a way our weakest link. Like you hear more, I feel like about guys, oh, I got a hernia or, oh, I got a slipped disc, but I don't hear as many women talking about, you know, again, we could still have the Coke can analogy, a weakness somewhere on the Coke can, but most likely it's going to be on the pelvic floor if
Dr. Becky Allen: Totally.
Dr. Becky Allen: Yeah.
Dr. Becky Allen: Yeah.
Dr. Becky Allen: Yeah. Mm-hmm.
Dr. Becky Allen: Totally.
Grace Gerke: Especially if you had several births.
Dr. Becky Allen: Yeah. That's where the quote hole. Yeah. That's where the hole got poked in the can of Coke, right? Is at the bottom.
Grace Gerke: Yeah.
Dr. Becky Allen: And that's why we leak or we have pressure or heaviness or pain, even pain, even with a tight pelvic floor, usually it's still some level of excess downward pressure onto it.
Dr. Becky Allen: And so your pelvic floor is like guarding against it. You know, it's like, oh, i well, I don't want the organs to fall out.
Grace Gerke: Yeah.
Dr. Becky Allen: So I'm just going to squeeze. And and then it just becomes this chronic tension. It's still usually is some version of excess pressure that it's, that it's fighting against really.
Dr. Becky Allen: And so it is, it's all a pressure game. Just move the pressure around.
Grace Gerke: Yeah. And what would happen with someone who is like, I have the tight pelvic floor. I'm a horseback rider. I'm a runner, yoga instructor. Like over time, what's going to happen with that tight pelvic floor?
Grace Gerke: Yeah.
Dr. Becky Allen: Yeah. So if, if we have a tight or a tense muscle, I always like to say anywhere in the body, because people can conceptualize like your leg muscle more than your pelvic floor, like any muscle that stays tightened and shortened for a longer period of time, it loses mobility and functionality because muscles need to be able to lengthen their full amount and shorten their full amount, no matter where they are in the body.
Grace Gerke: Yeah. Yes. yes
Grace Gerke: Yeah. Yeah.
Grace Gerke: Yeah.
Dr. Becky Allen: And so when a muscle kind of gets short, tight, tense, and stays that way for, you know, weeks, months, years, decades, right, it loses its functionality.
Grace Gerke: yeah
Grace Gerke: yeah
Dr. Becky Allen: It's no longer, it doesn't absorb force as well. It doesn't have as much mobility and rotation.
Grace Gerke: yeah
Dr. Becky Allen: And and also it it does lose strength. People think, well, a tight pelvic floor must be a strong pelvic floor, but that's not true. Because a strong pelvic floor is one that can go through its full range of motion strongly.
Dr. Becky Allen: And so if a muscle is just tight and tense all the time and it's never lengthening, it still becomes weak even though it's short and tight.
Grace Gerke: Yeah.
Dr. Becky Allen: And so that lends itself so whole that that lends itself to symptoms, you know?
Grace Gerke: Yeah, man, that's so good. Well, I've just loved having you on today, Becky, just a few like closing questions. What would you say is like just one of your key takeaways or things you want like every woman out there to know either for herself or her kid, you know, for someone who's listening today?
Dr. Becky Allen: I think I want you guys to know that If you are having pelvic floor symptoms, they don't have to be bad enough to do something about them.
Dr. Becky Allen: You know, even if you're not having symptoms and you're like, I just want to know a baseline of how my pelvic floor is functioning. I want to be proactive. Like, I want you to know that it is okay to do that for yourself.
Grace Gerke: Yeah.
Dr. Becky Allen: And and you should, you should advocate for yourself. Cause when we take care of ourselves, right. You can't pour from an empty cup is the saying, but it's like, it's true.
Grace Gerke: Yes.
Dr. Becky Allen: Like if we don't take care of ourselves, we're how are we going to be expected to to be able to show up for our kids, for our spouses, for, you know, our teams at work? And, you know, so it it really is that important.
Grace Gerke: Yeah.
Dr. Becky Allen: So I just want to encourage everyone to do that for yourself and stop putting yourself on the back burner because you're not going to be there for your kids and family as well as you could if you just take care of yourself and just advocate for yourself.
Grace Gerke: Yes. Yes.
Grace Gerke: Yeah.
Grace Gerke: Yeah.
Dr. Becky Allen: So I just, that's what I want to put out there is like, Go treat yourself to a newly functional pelvic floor.
Grace Gerke: Yes. No, that's so good. You know, and I think especially as women, but in general, we can compensate, like you said, for so long, but then you don't want to get to menopause or, you know, these special points in your life and then just be crumbling train wreck because you were trying to compensate for so long and you just can't, you know, um,
Dr. Becky Allen: Yeah. Yeah. 100%.
Grace Gerke: Because it's like, you don't want to just like make it to the finish line, whatever age God has for us.
Dr. Becky Allen: right yeah oh yeah
Grace Gerke: It's like, I want to be thriving. I want to be the, my, my Nana's 90 about to be 90 and she's still doing Pilates and just like doing amazing. And it's like, that's how I want to be when I'm 90.
Grace Gerke: I want to be thriving and, you know, living a full life.
Dr. Becky Allen: totally yes gosh yes yeah yeah
Grace Gerke: So that's so good to hear Becky. Yeah, well, um what are the ways that our guests today could just connect with you, those who are listening, the audience?
Dr. Becky Allen: Sure. Sure. Yeah. So we post a lot of education, um on our Instagram account. If you're on Instagram, it's at Genesis PT wellness. So that's our Instagram.
Dr. Becky Allen: Then of course our website, Genesis PT wellness.com. We have blogs, we have free resources. We have some things you can download some guides and all of that stuff.
Dr. Becky Allen: Um, and of course, if you're like, i don't about you, but I need to book this appointment. Like you can do that on our website.
Grace Gerke: Yes.
Dr. Becky Allen: Um, So those are kind of the two best places to just get to know us and and learn more about your pelvic floor function. And then I also am going to share with your listeners our leak-free movement reset.
Dr. Becky Allen: And so it's basically four videos that I put together.
Grace Gerke: So great.
Dr. Becky Allen: They're each about between 10 and 12 minutes long, follow along little flows that you can do.
Grace Gerke: Awesome.
Grace Gerke: Yeah.
Dr. Becky Allen: And the four of them together are designed, like you can just do, you know, a couple of week here and there, maybe before bed, you pick the nervous system reset.
Grace Gerke: Yeah.
Dr. Becky Allen: it will get you ready for bed. Maybe before your workout, you do the, the hip mobility flow, but you can kind of just pick and choose and just do them.
Grace Gerke: Yes.
Dr. Becky Allen: But they're designed to really begin to restore the normal natural function of your pelvic floor muscles without having to do endless Kegels for the rest of time to manage your symptoms.
Grace Gerke: Yes.
Grace Gerke: yes
Dr. Becky Allen: So that is my gift to everyone listening today.
Grace Gerke: yes
Grace Gerke: Thank you so much, Becky. And what about for our listeners who maybe have a background in medicine or in therapy?
Dr. Becky Allen: Sure.
Dr. Becky Allen: Yeah. Yeah.
Grace Gerke: What kind of resources do you have for, you know, some of those medical therapy professionals who are looking for more?
Dr. Becky Allen: love
Grace Gerke: They maybe, maybe they're an OB and they're like, man, I want to like learn more.
Dr. Becky Allen: yeah Yeah. Oh, I love that question. So I have my other professional Instagram, which is Dr. Becky Pelvic PT. And that's kind of my my page where I post a lot of stuff geared towards the clinician, the doctor, the coach, the movement professional.
Dr. Becky Allen: um And so I do a lot of education on there. And then beyond that, I have my own podcast called From the Ground Up. So that is geared towards clinicians who are wanting to take a more zoomed out approach to treatment like we do at Genesis.
Dr. Becky Allen: And then I also have a course and I run a clinical mastermind. And so all of that stuff, you can get get to it through my Instagram, DrBeckyPelvicET, if you're a professional.
Grace Gerke: Okay, awesome.
Dr. Becky Allen: I mean, anyone's welcome to follow me over there for sure.
Grace Gerke: Yes.
Dr. Becky Allen: But that a lot of those resources, they're going to be more for the professional who treats this stuff. Whereas on the Genesis side, that's more for the the person dealing with this stuff.
Grace Gerke: Yes.
Grace Gerke: Yeah. Well, thank you. You are just such a great person to be connected with. And we've just loved having you on the show today. So thank you for being here.
Dr. Becky Allen: Yay. Thank you so much. It was so fun.
Grace Gerke: Yeah. Yeah.
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