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#93: Chloe Stevens: A guide to pelvic floor health, strength and recovery from a Women’s Health Physio
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In this episode, I chat with Chloe Stevens, a highly experienced Women's Health Physiotherapist and Nutritionist with over 14 years of expertise in women’s health to discuss all things pelvic floor.
Chloe discusses her journey from maternity support to specialised pelvic health care, highlighting how nutrition can play a critical role in pelvic floor rehabilitation. This conversation isn’t just about exercises – it’s about a holistic approach to pelvic health, where lifestyle, diet, and practical, everyday adjustments are central to a healthier pelvic floor.
We also explore Chloe’s insights into essential pelvic floor exercises, the challenges women face postnatally, and the widespread need for education on pelvic health at every stage of life. Chloe tackles common concerns like stress incontinence and prolapse, shares actionable tips on strengthening the pelvic floor, and offers advice on when it’s time to seek professional help. From postural changes to stress relief, this episode is full of with expert guidance for a healthier, empowered life.
Key Questions Discussed:
- What role does nutrition play in pelvic floor recovery, and what foods can help?
- Why is pelvic health education so important for women across all stages of life?
- How can women effectively manage common issues like stress incontinence and prolapse through exercises and lifestyle changes?
- What are the best pelvic floor exercises, and how can you incorporate them into your daily routine?
- How does menopause impact pelvic health, and what can be done to support it during this transition?
- Why are breathing techniques essential for pelvic floor support, and how do they work?
- What simple changes can help alleviate constipation, and how can posture and hydration make a difference?
Links & Resources:
- Connect with Chloe Stevens on Instagram here
If you enjoyed this episode, please subscribe, leave a review, and share it with friends who might benefit. For more health and fitness tips, follow me on Instagram and TikTok @katehamiltonhealth.
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Transcript
Introduction to Women's Health Podcast
00:00:10
Speaker
Hello everyone. And welcome back to another episode of the Kate Hamilton health podcast. So in today's episode, I chat about all Kings female health with women's health physiotherapist and nutritionist Chloe Stevens. Chloe is based in the UK, but she shares a lot of valuable information on her Instagram page. And she does see clients online as well to offer advice and support in relation to any.
00:00:38
Speaker
pelvic health issues that you may be experiencing.
Understanding Pelvic Health Concerns
00:00:41
Speaker
We have a really, really interesting conversation where I ask all the stupid questions. Well, they're not stupid there's no such thing as a stupid question. I asked all the burning questions that I had in relation to pelvic floor health and female health in general. And I really did learn a lot from this conversation.
00:00:58
Speaker
We chat about stress incontinence, urgent incontinence. We chat about prolapse. We chat about how pelvic health is really important from teenage years all the way up into your 80s, 90s. It's never too early to start looking after your pelvic health and it is never too late. And that was a really relieving thing to hear.
00:01:21
Speaker
She talks through exactly what exercises we should be doing every day to strengthen our pelvic floor. She tells us exactly how many sets and many reps of them to be doing. And it's there for you to use in the episode. So have a listen, give it a go.
Impact of Life Stages on Pelvic Health
00:01:38
Speaker
We talk about how our cycle affects.
00:01:41
Speaker
our pelvic health, we talk about how it changes during perimenopause and menopause. We talk a little bit but around gym work as well. So apart from pelvic floor specific exercises we should be doing, we also talk a lot around what type of exercises we should be incorporating into our gym programs and how to breathe properly, should I say, rather than bracing when doing heavy lifts like squats and deadlifts.
00:02:06
Speaker
and even slightly lighter lifts as well, how best to breathe through those. So this was a really, really empowering conversation, I would say, where it's left me feeling I can look after and take steps towards fixing my own pelvic floor health, which I think any of us in particular who have had children will it be experiencing some sort of difficulty there. And she does explain how this can get worse.
00:02:35
Speaker
as we enter into perimenopause. So dealing with the issues as soon as you notice any issues is the time to do so. She talks us through it all. And if you are through perimenopause and menopause or you're in the middle of it at the other side, it's never too late. And I think that's the most important message to take from this conversation is it's never too late to focus on your pelvic floor and your pelvic health. There is help out there and there are things you can do yourself as well, which is really, really empowering.
00:03:05
Speaker
So I hope you enjoy this as much as I did.
00:03:13
Speaker
Chloe, welcome to the podcast this morning with all our ups and downs trying to actually get connected here. I think the podcast platform's woken up or my computer hasn't woken up yet, but hopefully we're starting now. Well, it's woken also up at least. Just for anyone who doesn't know who you are, would you like to share a little bit about you and what it is that you do?
Chloe's Professional Journey and Insights
00:03:31
Speaker
Yeah, I'm Chloe. I'm a pelvic health physiotherapist and I have been doing that for about 10 years now. I work in the and NHS Monday to Friday i and I came from a background of working as a support worker in maternity. So I did that whilst I was training to be a physio and then kind of I loved women's health but I wanted to work in physiotherapy and women's health physiotherapy just brought the two together perfectly for me. So Alongside that, I've done qualifications in nutrition because I think that's a really important part of pelvic floor rehabilitation. and Then I am currently doing my Masters in Women's Health at UCL and my project is focusing specifically on prolapse, which we'll probably talk about at some point. and I run a small consultancy that helps to support businesses with women's health issues or their clients with women health issues. so that
00:04:23
Speaker
Kind of a very brief summary of the last 15 years of my life with regards to my career. Amazing. And to know of what I find absolutely fascinating about what you do, which is such an important job. I had my first child almost 15 years ago. I was 23 years old and you know didn't have a care in the world. I remember the midwife saying, ah an antenatal class, the midwife saying, now make sure you do your pelvic floor exercises. You'll thank me when you're 40. I had no idea
Postpartum Pelvic Health Support Gaps
00:04:50
Speaker
what pelvic floor exercises were.
00:04:52
Speaker
I didn't know that there was such thing as a pelvic health physio. That was the last I heard of it after that. It was just, you know, I had the baby, went home, just got on with my life. Never did any pelvic floor exercises because it wasn't shown to me. I wonder what it's like now for women. From my own experience, my oldest is 15. I have an 11 year old as well. And I have a seven ah seven-year-old and even with the seven year old, this isn't available to us in Ireland as part of our maternity care.
00:05:20
Speaker
I think it's a big problem and I think when you are newly postpartum you're kind of on your way out of the delivery suite with your new baby you're high on adrenaline probably quite stressed out trying to establish feeding and then someone on the way out of the door says oh do your pelvic floor exercises no new mum is going to remember that I think really the conversations around pelvic floor need to start ah a lot sooner and to natively and also need to be followed up post natively and unfortunately those services aren't in place in many places in the UK. It's a bit of a postcode lottery.
00:05:59
Speaker
And I think really that a lot of women don't really understand their pelvic floor until they have a problem with it. And it's not really talked about in like education, around women's health in schools. So I really think we need to do a better job of educating women about pelvic floor conditions throughout their entire lifetime and not just leaving the conversation till when you've had a baby.
00:06:21
Speaker
because these problems can be unfolding at any time in women's lives. A lot of young girls might have problems with pelvic floor too. So I really, really hope that in the future, we're having more conversations around pelvic floor at every stage in a woman's life, not just when she has a baby, when she's at school and when we're talking about periods and menstruation, you know, when you're going through your menstruating life, having conversations with the GP or in a GP setting about pelvic floor. And then of course, anti-natally, post-natally,
00:06:50
Speaker
but also it not just being this kind of really flippant conversation as you leave maternity wards, you know, having structure around it, teaching it in antenatal classes, and then potentially having really good post-natal checks with physios available on the NHS or the equivalent that you have in Ireland, because there are services within the UK, especially that are like more thorough postpartum checks with a physio, but they have to be paid for, and I think that should be able to be accessed by every woman.
00:07:20
Speaker
Yeah. And I think that's a huge barrier for people. So anyone even who is aware of what is available quite often can't afford it, especially at the state of life when you're starting a family or you usually have, you know, you've got high rent or you've got a mortgage to pay or other kids. That's not always an option. And it would just be so amazing to get that available to everybody. I suppose what exactly, if you were to kind of describe to anyone listening is your pelvic floor. So when we're talking muscles, what are we talking
Importance and Techniques of Pelvic Floor Exercises
00:07:49
Speaker
about? Yeah okay so your pelvic floor is a collection of 14 muscles that sit inside the bowl of your pelvis and it's double layered so we have like a deep layer and then we have a more superficial layer and the pelvic floor connects to your pubic bone at the front and all the way wraps back and connects to your tailbone at the back
00:08:10
Speaker
and it really has like four roles so those roles are to shut the sphincters so it shuts your urethra where your urine comes out and it shuts your back passage where your faeces comes out so it has a role in shutting the sphincters.
00:08:26
Speaker
It also has a role in holding everything up inside. So it's kind of like a support structure to all of the organs in your pelvis, your bladder, your vagina, your uterus and your bowel. So it kind of has a support structure there.
00:08:42
Speaker
It also has a role in sexual function. So an orgasm is like a contraction or a spasm of the pelvic floor muscles as well. And it also has a role in postural control. So it works with your diaphragm and your tummy muscles and your back muscles in a way to support your posture. Kind of that core cylinder is what people would call it. It's part of your core cylinder there. So it has loads of roles and that really is like the basics, the fundamentals of your pelvic floor. Brilliant. Well, 14 muscles. Yeah. A lot of us think we're just talking about a small little muscle that we're squeezing and releasing just in relation to having a weak pelvic floor. Let's say I give a little bit of kind of personal background on it just for context. So, you know, I've had three kids. So I found after I had my third kid,
00:09:32
Speaker
My other two kids had my 20s so probably didn't notice as much of my third child I had when I was 31 and my pelvic floor was very weak afterwards. This was but still before I got into fitness so I wasn't like heading back to the gym or anything. I wasn't really doing much. You know I was just surviving and raising three small kids. But I did notice then when I did, I started to get into fitness then. And I remember I wasn't able to like use a skipping rope without basically wetting myself or, you know, going onto the trampoline and playing with my younger kids. If I was jumping up and down, I would always wet myself. But then I started getting into a little bit of running and the same thing was happening. Then as I got into fitness, again, I still didn't do anything directly. It was kind of brushed off as, Oh, this is a normal thing. You know, all you've had three kids. So when I started getting into fitness, I suppose I started, you know, lifting weights. I started lifting barbells. My core got stronger. I was doing core work and it got better. So I could then use a skipping rope without, so it did get stronger. But to this day, I would still at times, depending on the time of my cycle, still struggle with a bit of that when it comes to running or like, I don't really, I'm not often on a trampoline, but I would imagine it's still the same issue on a trampoline. So sorry, that's a really long winded way of just giving you kind of a background of where I'm at with my pelvic floor health. It needs a lot of work. Is it too late? It's never, ever, ever too late. It's never too late. I really believe that we need to get this message across to every woman. It's never too late to start. It's never too late to build muscle. And that's effectively what we're doing if someone has a weak pelvic floor. It's never too late to get into fitness, to start working on your pelvic floor health. No, that's never too late.
00:11:11
Speaker
Okay, this is exactly what I wanted to hear. So with that in mind, I know you would recommend anyone with symptoms like mine, I would presume to visit a pelvic health physio. I think that is really, really important to kind of see where we're at, because there's kind of like, there's a degree of symptoms and the most common symptom is urinary incontinence. So urinary incontinence and stress incontinence particularly, which is what you were describing. So any increase in intra-abdominal pressure, whether that's running, skipping, jumping, laughing, coughing, sneezing, all of these things increase the pressure in your abdominal area and put loads down onto the pelvic floor. And that's what can cause this leaking to occur. So that's called stress incontinence. And that occurs in about one third of women or around 22%. If we're looking particularly at stress incontinence, so that's really common. Now, I think going to see a women's health physiotherapist would be fantastic to really ascertain where your pelvic floor is at specifically. However, as you notice, Kate, the fitter and stronger you got, the better it got as well. So I do really believe that a lot of pelvic floor issues can be really helped along by the strength and the condition of the the woman that you that has these issues.
00:12:25
Speaker
And if we look at the statistics, women who are fitter and stronger get better from pelvic floor dysfunction. So yes, I think going to see a pelvic health physio can be really useful to get a really in-depth look at what your pelvic floor is doing. But as we just said, you know those options aren't available to everyone, but actually working on your generalized strength and fitness can be really helpful too. Because actually, if we think about that pelvic floor,
00:12:52
Speaker
some of the muscles that attach into that pelvic floor are actually hip muscles, muscles that control our hip strength and power so i I'm always a massive advocate of this not just being about the pelvic floor in isolation but actually being about the whole strength and condition of that woman in front of me because actually there's a whole woman attached to that vulva. And I think we are very good at physios of just locking in into the thing that we're concerned about when actually, the generalized strength and condition of women can be a really helpful to help resolve or remedy those pelvic floor issues. So does everybody hear that there's another reason why we should all be strength training? yeah
00:13:34
Speaker
but with the bring another ring and to show you all joke aside this This is really, really good information. And for anyone listening who, you know, might not be in a position to go and get a screening and see exactly where they're at. Is there anything specific as well as obviously, you know, maybe going to the gyms, speaking with a personal trainer, getting a strength program going, being consistent with that. Are there specific exercises that I could be doing at home?
00:13:57
Speaker
Yes there are. There are pelvic floor exercises so I will take take take you through a round of pelvic floor exercises because that's the best way to teach it. So a pelvic floor exercise is like you're imagining you're trying to stop a wee and a fart at the same time. Imagine you had a really big curry last night and you're in a really crowded room and you don't want to fart in front of everyone is what I always say to my patients. So It's that kind of like feeling of lifting your vagina up inside you, almost like you've got a very thick milkshake and you're trying to suck it through a straw. So it's that squeeze up inside. So that's what it should feel like, that you're trying to stop a wee in a fart. So what we tend to do is two types of exercise. The first exercise is a slow hold. So this is where we imagine we're stopping that wee in a fart and we hold for up to 10 seconds. So 10 seconds is actually quite a long time. It is. but Yeah.
00:14:49
Speaker
Yeah. Two, three, four, five, six, seven, eight, nine, 10. Now that can feel quite challenging and that's okay. So a lot of women can't hold for that 10 seconds initially. So starting with like two or five or eight or whatever feels comfortable to you and then trying to build that up over time is ah is a good thing to do. The optimum is a 10 second hold 10 times.
00:15:17
Speaker
And then the short squeezes are quick pulses. So we squeeze and we relax down. We squeeze and we relax down. We squeeze and we relax down. And we also try to do 10 of those. With those exercises, one of the things I see a lot with women is they squeeze, but then they don't let it fully relax.
00:15:39
Speaker
and it's really important that we often we talk about pelvic floor strength a lot which is fantastic. Pelvic floor relaxation is vitally important too so really making sure with those quick pulses that you are letting it relax is so important because our pelvic floor should relax for us to go for a wee, for us to empty our bowels and for us to allow to have tentative sets. If it doesn't relax then we start to go into problems of it being non-relaxing and that can lead to problems like retaining urine, constipation, painful sex. So relaxing is as important as strengthening when it comes to your pelvic floor. Okay. and That's really interesting. So if we're doing these exercises, is one set of 10 second hold 10 times per day enough? If you have a dysfunction, we aim to do a 10 second hold 10 times or whatever you can hold at that time, 10 quick pulses, three times a day. So if you were to do that alongside your fitness routine, amazing. Especially if you have an issue, I would be aiming for that three times a day. And knowing that whenever you're doing your strengths training, your pelvic floor is working too.
00:16:49
Speaker
So, you know, if you're doing a back squat, your pelvic floor is loading in that back squat. If you're doing a dead lift, if you're doing a single leg squat, if you're doing hip abductions, your pelvic floor is working with you too there. So doing that alongside your strength training. Amazing. Perfect. Okay. Perfect. And should we be doing like the hold and the pulses?
00:17:09
Speaker
Yes. So the hold, 10 second hold, 10 times and then 10 pulses? Yes, that's right. Yeah. And I suppose probably ideally to do it maybe like before we stretch after a workout or I suppose to put it in where we can really, isn't it? What I find a lot is that women, because I appreciate how busy women are, is they're like, oh, I'm doing it. I do it when I'm at the traffic lights or I'm doing it whilst I'm washing up.
00:17:34
Speaker
Which is fine, but I do think when you initially are trying to get used to training your pelvic floor, actually doing it mindfully and fully concentrating on it is important initially. Once you learn the skill and you know exactly how it feels, then I think you can do it while you're doing other things. But I would say initially acquiring that skill, building that connection to those muscles with your brain, it really acquires a little bit of focus initially, and then you can start to do it throughout your day. Does it matter if we're sitting or lying down? Is there a preferred position? It depends on your ability. So if I'm lying down, it tends to be easier for me to squeeze my pelvic floor up and feel it because gravity isn't acting down on my pelvic floor. So I'm not working it against gravity.
00:18:18
Speaker
If I sit in a chair, I've got a little bit more gravity acting down on my pelvic floor. If I stand up, I've got even more gravity. So women who have dysfunction or issues, what we tend to use is their position to make the exercise harder. So if you're starting initially, you can do it lying down, you can do it sitting, you can do it standing, but remembering that all of those are more challenging for your pelvic floor because it's working against gravity.
00:18:42
Speaker
Okay. Thank you so much for this. I know that there's so many people listening that are like, okay, I'm doing this reminders in my phone. I'm going to work on this. Obviously is an exercise that anyone can do. Anyone who's listening who you know hasn't had children yet or hasn't had children. And I know this is something that's covered in post-natal fitness classes. So anyone who hasn't had children yet, or, you know, who might be pregnant listening to this, or, you know, are hoping to get pregnant. Like, I don't really believe in regrets because I think we learn from everything, but this is one of my regrets. I regret not being active through my pregnancies. I doing a post-natal class after any of my pregnancies as well. Like it is one of my regrets because now I am like, you know, I'm 38 now. I only really noticing the consequences of that now, particularly at, you know, the past so seven years I've embraced an active lifestyle and it's really become apparent to me how like how much of an issue it it actually is. And that's such an interesting statistic that you say,
00:19:48
Speaker
33%? Did you say but one about one third? If we look at pelvic floor dysfunction in general, which would embody stress incontinence, urge incontinence, fecal incontinence and prolapse, we're looking at about one third of the population of women having one of those issues.
00:20:06
Speaker
If we dig down into each specific condition with incontinence, as in stress, which is what we talked about with that increase in abdominal pressure, urge, which is this sudden urge to need to go to the toilet that you cannot control, you have to go straight away, we should be able to delay going to the toilet. That's a slightly different type of incontinence. We see about 22% of women do you have this type of incontinence. If we think about prolapse,
00:20:33
Speaker
Prolapse statistics are really interesting. So prolapse is where one of the pelvic organs descends into the vagina. So that might be a bulge or a heaviness or a dragging sensation that women feel in their vagina. And that can be the bladder has kind of slipped into the vagina, the uterus has kind of slipped down into the vagina, or the bowel has bulged into the vagina.
00:20:57
Speaker
And you might feel this kind of drugging heavy symptom in your vagina there. And we know that around 50% of women have a prolapse, which is a massive amount. Yes. However, I would caveat that with saying not 50% of women have symptoms. So you might be asymptomatic or not have symptoms. And about 8% of women will present to a GP with a symptom. So I don't want that to be like scaremongering, like 50% of women have a prolapse, because not all women have symptoms of it. But we do see some descent of the pelvic organs into the vagina. Now, again, to caveat this, if you're 18, your titties are up here, aren't they? And then as you get older, gravity has an effect and you don't expect them to be up there anymore. I mean, mine definitely aren't.
00:21:46
Speaker
It's the same in our vagina, right? There's a bit of descent of some of those organs, which would be classed as very normal. So I don't want people to go away thinking, oh my gosh, 50% of women have a prolapse because not everyone has symptoms from it. But the cystic is still high. You know, we do see changes. we Gravity acts down on our vagina as well. We do see some descent.
00:22:08
Speaker
then if we think about fecal incontinence, the statistics are a lot lower. I think it's about 10 to 13%, I think. I can't remember the statistic off the top of my head, but as you can see, those range of different pelvic floor dysfunctions are very common. And I'm always so excited when a coach or a fitness professional wants me to come and talk about this, because if you're coaching just women or like loads of the women you're coaching, you've got these issues and might not even want to talk about them because they're still so taboo.
00:22:38
Speaker
the amount of women that I speak to and there's very few women particularly who've had kids that haven't had some sort of issue in relation to their postnatal recovery. Do these symptoms sometimes like intertwine like if you suffer from one, do you often suffer from the other?
00:22:53
Speaker
yeah quite often. So quite often if a woman has a prolapse, she might have a degree of incontinence. And I think they often do intertwine, you know, if a woman has prolapse of her bowel, then maybe she might suffer from some constipation and that can have problems as well. So everything really does intertwine, as you said, and you know, it's quite often that we will, if we see kind of like prolapse symptoms, we're going to see some incontinence symptoms or some changes. and There's definitely an intertwine. What are the symptoms of prolapse?
00:23:24
Speaker
symptoms of prolapse are like a heavy dragging bulge into your vagina it almost feels like you know when you put your tampon in the wrong way and it kind of like is irritating and it feels like uncomfortable that's what a lot of women describe as a prolapse symptom that tends to be the main symptom of prolapse. There might be pain on penetration. It might be worse at the end of the day when gravity has been acting down, sometimes with loading. So strength-based training can kind of bring those symptoms on more or lifting. And so the the main symptom of prolapse is this heavy bulging sensation into a vagina.
00:24:00
Speaker
OK, and I know like another thing that can happen with pregnancy as well, particularly if the baby is quite low down is piles. Is that tied in with pelvic health issues as well? Yeah, yeah, yeah, definitely. So, yeah, piles are a pelvic health related issue. pelvic floor exercises, I'm not sure if there's any data that suggests that they improve piles, but management of piles and management of constipation is really, really a big part of our role as physiotherapists, because we know that chronic constipation can increase the prevalence of pelvic floor dysfunction, whether that be ah prolapse or incontinence. So actually, if we are managing constipation, that can help with piles. Now,
00:24:43
Speaker
Yes, as you said, baby acting down or putting pressure down can increase the risk of piles in pregnancy, but also because of the hormonal changes in pregnancy where progesterone is much higher, what we see is slower movement of food through the digestive tract and more risk of constipation. So a lot of pregnant women are then straining to open their bowels as well, which increases the risk of piles. So one of the biggest things to manage if you have piles, whether you're pregnant or not, is constipation. So thinking about the way that we manage constipation, hydration. I have this conversation every day in my clinic. If you're not hydrated, your stall is dehydrated, it's harder to pass.
00:25:27
Speaker
fiber. We know the vast majority of us across the UK and Ireland are not eating enough fiber. We tend to see that most people get around 10 grams. We want 30 grams, but you can't go from 10 to 30 because you're going to get constipated. So you have to kind of build your fiber intake up slowly. And that's looking at things like your fruits, your vegetables, your whole grains, your pulses, your legumes. We need that fiber. It's so important. Then thinking about exercise.
00:25:56
Speaker
Exercise is one of the best ways to manage constipation because actually if I'm up and I'm walking my hip flexors, the muscles at the front of my hips are rubbing across my bowel, the sigmoid of my bowel. So even getting walking, getting active can be so helpful for constipation.
00:26:15
Speaker
And then thinking about the way that we sit on the toilet. This sounds really strange but but we sit very upright on the toilet don't we? So we're sitting upright, our feet are down. That's not a natural way for us to open our bowels. Because if I'm sitting upright like this, my pelvic floor is actually choking my rectum.
00:26:34
Speaker
Now we want to think about kind of mimicking your squatting position to allow that pelvic floor to relax. So what we get women to do is put their feet on a stool and to lean forward. And if you imagine how we would used to have gone to the toilet when we didn't have toilets, we would be squatting, wouldn't we? And actually that mimicking that squat position by putting your feet on the stool and leaning forward helps the pelvic floor to relax and for you to open your bowels more effectively. So they can be really helpful.
00:27:03
Speaker
The other thing that we want to avoid is straining so straining to open your bowels really can put a lot of downward pressure on your pelvic floor and make piles worse so you want to think about taking a deep breath in and as you exhale trying to get your pelvic floor to relax and let that tension from your pelvic floor go to go to the toilet. Do you know this completely answers my next question which was going to be I was interested in the nutritionist qualification and nutrition and pelvic health because I was like, how is nutrition and pelvic health? I was really interested to know how this is intertwined, but it makes so much sense, fibre. And anyone that who's been listening to me a while on this podcast, I didn't tell her to say this, I promise. and knowrate Fitness professionals always talk a lot about protein. It's like, yo you need to get your protein up. And yes, a lot of us don't eat enough protein.
00:27:52
Speaker
And we need it for healthy muscles, bones, you know, like healthy cells. Everyone and now knows this, but the problem is what I see a lot of women doing then is upping their protein and not changing anything else. Often upping their protein with processed food, which is might be worse as well, digestively. So yeah, for me, I'm like, it's the magic trio. We've got to have protein, fiber and water. And that's going to help you feel fuller for longer. And the reason for the fiber in the water is literally exactly what you've just described.
00:28:21
Speaker
Exactly and if you up your fiber you need to up your water because some fiber sucks water in, some fiber gives water out so you really need to think about the two coming together so I love your magic three that is perfect for pelvic floor health. I would say the one other thing for pelvic floor health when it comes to nutrition is what you drink.
Role of Nutrition in Pelvic Health
00:28:40
Speaker
So if you are just suffering from stress or urge incontinence, a lot of things can very much irritate our bladder. Caffeine is a massive bladder irritant. Alcohol is a bladder irritant. For some people, foods that are citrus based can be a bladder irritant.
00:28:57
Speaker
busy drinks can bla irritate the bladder as well. And even but tomatoes are actually quite acidic. So acidic foods like tomato basings can be very irritable for some women. So, you know, I love a coffee and I would never say cut out all caffeine, but we do know that these things can be bladder irritants. So if you're someone who is leaking a lot and you're drinking a lot of caffeine and not a lot of water, it can be quite a low hanging fruit to just reduce your caffeine intake.
00:29:25
Speaker
and reduce your alcohol intake and think about getting those very acidic, citrusy-based foods out of your diet because that can be irritating your bladder lining. Interesting. But you wouldn't think that that would cause the, yes, it would cause dehydration, the capping and the alcohol. but It wouldn't think that it would cause, like make the issues worse. But yeah, it does make sense when you think about it. Yeah. In relation then to perimenopause and menopause. Someone once told me that so you know any pelvic floor issues that I'm having now if I don't deal with it now it could potentially get worse or be aggravated through menopause. Is that true? That is true. So
00:30:10
Speaker
Estrogen, it plays a big role in our pelvic floor health. Estrogen is one of our sex hormones and it is important for our ovarian function. And when we see that ovarian function slowly starting to reduce over time when we go towards perimenopause and menopause, that decrease in estrogen plays a fundamental role in pelvic floor symptoms. So we know that the peak age for pelvic floor symptoms is around 50s and this is where most women are hitting that perimenopause or menopause have gone through that stage. So what does estrogen do for the vulva and the vagina and the pelvic floor? So estrogen has kind of like a plumping effect to the vaginal walls
00:30:54
Speaker
so One of the things that we see in perimenopause menopause is this thinning, or we call it atrophy, but thinning of the vaginal walls, and that can lead to painful sex. so A lot of women in perimenopause menopause might start to have changes where they have very painful sex, and that can be because of the lack of estrogen, we've lost some of the plumpness of the vaginal walls. Also, estrogen has a lubricating effect to the vagina,
00:31:21
Speaker
And so we might see that women might experience more dryness around this time. So that can be a telltale sign that there's going to be changes in the pelvic floor. Now, estrogen to the pelvic floor itself has a role in helping it be strong and flexible. So reductions in estrogen in the pelvic floor these changes in the vaginal walls can mean that we start to see an increase in the prevalence of things like stress incontinence, urgent incontinence or prolapse. And that is because of those changes in estrogen. So yes, it is common that women will see an increase in symptoms or a new incidence of symptoms when they go through that stage of life, most definitely. Okay, so the answer then is doing the pelvic floor exercises that we described earlier.
00:32:05
Speaker
100% doing the pelvic floor exercises can be the first gateway into managing those symptoms. If you think about what an exercise does is it increases circulation to that area. We want to get circulation to those pelvic floor muscles and organs to help to promote blood supply to that area to keep everything nice and plump. Also having a chat with your GP because we know that things like topical oestrogen, so oestrogen cream that you put into your vagina can be a very helpful adjunct.
00:32:35
Speaker
If you don't want to go down the HRT route, there are things like vaginal moisturizers that can be really helpful too. So I would say yes, we want to manage conservatively with our pelvic floor but by doing the pelvic floor exercises, doing our strength training again, because we know that women lose muscle mass at this time of life and we want to retain that muscle mass as much as possible. But then also thinking about, you know, you might need support from your GP with HRT or estrogen, topical estrogen that we can put into the vagina. They can really help those symptoms and quite often we'll see women in clinic where the the first course of action will be pelvic floor physiotherapy, topical estrogen from the GP.
00:33:16
Speaker
Yeah, no, I think anything menopause related, anyone struggling in any type of symptom, but perhaps some people maybe mightn't have realized that this actually is, you know, something that can happen to you, and that you can really experience during menopause. People are often thinking about mood and energy levels and, and how flushes that this is something as well that you could be experiencing and go chat to your GP. And I've had different people on the podcast as well talking really about, you know, advocating for yourself and the GP as well, you know, really, you know,
00:33:45
Speaker
make sure you're listened to. And if you're dismissed when it comes to symptoms, go back, get a second opinion and make sure that you do get listened to and that you get help and support for anything that you are experiencing. Definitely, yeah. In relation to any women that are through the other side of menopause and are still dealing with pelvic health issues, is it possible to make these things better now if we're through the other side
Pelvic Health in Menopause and Beyond
00:34:10
Speaker
of menopause? Yes, most definitely. I see women in clinic in They're 60s who've gone through the other side, 70s who've gone through the other side, even women in their 80s. And really being diligent with your pelvic floor exercises can be so, so important and it can make a big difference whatever stage of life you're in. And I never just give women pelvic floor exercises. I will give women other exercises to really exercise their deep glute muscles, the muscles that turn your hip outwards, inwards, add up to your exercises. so
00:34:44
Speaker
It's never too late. And you know, starting with your pelvic floor exercises consistently, as you said, setting reminders on your phone or using an app like Squeezy to remind you can be really, really helpful. sorry have to actually there There's an app called Squeezy. There's an Apple Squeezy. It's the Squeezy app. yeah calless and And then, you know, I think one thing, you know, thinking about your exercise tolerance, getting more strong and fit and conditioned, you can do that at any age, really, really important, and should come alongside pelvic floor physiotherapy. So, you know, even if we think about, you know, even just starting with things like sit to stand, sit to stand is a great exercise for a lot of women. And I use it a lot with pelvic floor rehabilitation, especially for my clientele that might not want to visit the gym. So thinking about some sort of strength of fitness routine alongside your pelvic floor and then also thinking about things like your protein intake. I haven't seen any empirical evidence that links high protein to changes in pelvic floor function. However,
00:35:52
Speaker
We know that if we're trying to gain muscle, we need to eat a high protein diet, your pelvic floor is a muscle, so I truly believe that there must be some sort of link between increasing your protein alongside doing your pelvic floor exercises that is going to lead to a stronger, more robust pelvic floor muscle.
00:36:10
Speaker
Yeah, I couldn't agree more that, you know, if we're looking to yeah preserve the muscle we have, strengthen the muscle we have, build a little bit on the muscle we have, then protein is is essential to be able to do that alongside our fibre and our water and our meat. But in relation to the gym, but so if we're talking about the gym or you know i have a lot of ladies that do home workouts, what kind of exercises do you often recommend? you know gym but What kind of exercises do you often recommend gets included in people's strength and fitness programs to help with with these issues?
00:36:44
Speaker
I love any sort of like compound lift. So what that means is using multiple joints at the same time. So I will get women doing squats. I will get women doing single leg stuff. So step ups.
00:36:59
Speaker
split squats, Bulgarian split squats, lunges. I also love a single leg Romanian deadlift for pelvic floor dysfunction as well. I would say all of your lower limb exercises are going to be so helpful. I also think things like any sort of clam or external rotation, if you've got hip abductor machine. And then the other one that we we don't focus on enough, I think is adductor. So bringing the legs, that's when you bring the legs together, the inner thigh muscles, they can be really helpful. Having strong, resilient adductors can be really helpful. And a lot of the time I will get women who have stress incontinence, a lot of adductor work can be really helpful. Our hip muscles attach into our pelvic floor. Our pelvic floor shares attachments with our adductor muscles. So really thinking about getting really strong, resilient, robust hips,
00:37:53
Speaker
it's always gonna really help. So glutes, we're talking about glutes, we're talking about quadriceps, we're talking about adductors, we're talking about deep glutes, all of abdominals, all of these things are gonna help to build a more stronger resilient pelvic floor. One thing I would say is if you are struggling with pelvic floor at symptoms in the gym, it's different things that you can try that might be helpful. Now, there's so many different ways that you can breathe,
00:38:20
Speaker
when you're doing gym-based workouts. So it's really, I don't like to be too specific because I think it's a bit of trial and error, but there's lots of different breathing techniques that we can use to help support pelvic floor. Now ah the one I most commonly go to for women who are having issues with their pelvic floor when lifting is when you push through the movement or when you do the concentric part of the movement, for example, when you are pushing out of the bottom of a squat, the hardest part of the movement, breathing out. so What that would look like is if I was doing a barbell back squat, taking a deep breath in, going down into the bottom of the squat with that deep breath in, and then as I push out of the bottom of the squat coming up,
00:39:04
Speaker
breathing out. So I always remember that or help clients to remember that as blow to go. So you're blowing out on the hardest part of the movement. And that can help some women who are leaking in the bottom of a squat or women who are having prolapse related symptoms in a squat. So blow to go can be something to think about. Some women can really get a good brace. So that's holding a breath throughout the whole movement without putting pressure down on the pelvic floor and not leaking. So and then there can be a valsalva which is where we have a closed glottis so we take a deep breath in and then close the glottis and push the pressure out. With a valsalva if we're doing it correctly we're not actually putting pressure down on the pelvic floor so it's really like I don't want to be like oh really black and white about this because your breathing techniques really are unique to you and how you can manage pressure with them but I think
00:39:57
Speaker
probably for my women I go to most the exhaling on exertion because that can really help to take that pressure off that pelvic floor in the hardest part of the movements. Yeah and actually that was a question I was going to ask you because I was initially taught how to squat and deadlift by a man and was was very much taught that yeah you had the breathe in hold brace technique and I don't think that that helps with what I'm dealing with, you know, with a little bit of stress and contents. Yes. In a way I have gotten much stronger and it has gotten much better, but I was actually talking to the podcast to Emma Dowling and she, she does a lot of work around this and she was like, try and learn to exhale when you're coming out of that squat. So I'm trying to, it's really hard when you've trained yourself to do it. And what she was saying was, she's like, who cares if you're not deadlifting or squatting as much because you're exhaling. Like, you know, look after your pelvic health and look after, yeah, like look after your body and your body's going to get the same benefits from it. so
00:41:00
Speaker
Yeah, exactly. So but yeah, I think it's not really a one-size-fits-all. It's really like what what you feel best. And you know a brace can be really effective, especially when we're going for those really heavy lifts. And if you don't feel downward pressure on your pelvic floor with that, and you can maintain that intra-abdominal pressure without putting the load down on your pelvic floor, then that's fine. But I do think, as you said, for the most part, for most women, exhaling on that exertion can be a great way to manage downward pressure on your pelvic floor.
00:41:28
Speaker
Yeah, and especially if anyone listening is just kind of getting into strength training, definitely make sure. What was the the expression you said? Push. A blow to go. Sorry, blow to go. So yeah, the hardest part of the movement, one because it's different. If you say the bottom of the movement, it depends on the movement really. Exactly. Yeah, yeah exactly. So the part that's difficult to get out of, whether it's pushing the weights up over your head, whether you're pushing to come back up from a squat. That difficult part is where you want to be exhaling. Yeah, exactly. yeah Perfect. In relation to pelvic health issues, like I'm just using stress incontinence as an example for myself, but are they aggravated at different stages of your cycle?
Hormonal Impact on Pelvic Floor Dysfunction
00:42:10
Speaker
Yes, most definitely. So what we find is that symptoms of pelvic floor dysfunction, whether that be stress, urge, prolapse, fecal and quaternus tend to be worse when we are just before we're about to come on our period. So if we think about what progesterone and estrogen are doing at that point, when we are towards the end of our cycle, whatever that day is for you, because obviously the 28 day cycle is not averaged between 21 and 35 days as a normal cycle, but say we were going to take a 28-day cycle for for argument's sake at this point. When we are probably day 26 to 28, so just before our period starts, what we see is a sharp decrease in the amount of estrogen, and we talked about estrogen and its effect on the pelvic floor already,
00:42:57
Speaker
so As that oestrogen really goes low when we're about to go towards our cycle, what we find is that women will have increased symptoms, well, whether that's stress incontinence, urgent incontinence, or prolapse symptoms might increase because of that change in oestrogen. It might also be accompanied by like water retention around our cycle that's going to put more pressure on our pelvic organs, increased circulation because we're about to have our period around those pelvic organs, again, can put more pressure and need to increase in symptoms. So it is cyclical and I will see so many women in clinic and they'll feel really disheartened and they'll be like, oh, I was doing so well. I wasn't leaking or I didn't have these kind of bulging sensations with my prolapse. And then like, it just started again. And I, okay, well, where are you in your cycle? Oh, it just started my period. And like, okay.
00:43:47
Speaker
So it might be related to that. So as you said, you know, fluctuations in it, especially when we're just the few days before our mental cycle or period starts, you might have an increase in symptoms most definitely. That's really interesting to know. Yeah. Okay. Last question before we finish up.
Holistic View on Health and Accessing Support
00:44:03
Speaker
What does the word health mean to you? What does the word health mean to me? Wow. That's an amazing question.
00:44:10
Speaker
i to everyone and i yeah I'm learning so much from every single person. It's so interesting. I think health is so multifaceted and I think we often really look at it from like not having any diseases or illness, but actually if we think about you know especially in regards to women's health, there are so many factors that contribute to women's health that are often, I think, not talked about enough. So if we think about the fact that health is actually part of like our social well-being as well, so the environments are in our ah economic health as well, all of these things are, the health is very multifaceted, especially particularly related to women,
00:44:53
Speaker
I think one of the biggest problems with women's health is that people don't see that things like violence against women are huge factors in women's health. And that's something that I think we need to talk about more. And if we think about women's health globally, like the fact that a lot of women still have a lot of maternal mortality and things like that, and that's due to poor housing, poor healthcare systems. So I i think we have to look at health as a much broader thing. Yes of course it is to do with our not having disease or ailments or issues but also all of the factors in our life feed into our health, our social, our economic and our different situations like that have an impact on our health and I think
00:45:39
Speaker
women That's why I love women's health because it's so impacted by so many different things in our society. So I think when we're looking at health, we have to zoom out and think about all of the things that contribute to our health, not just our nutrition and our exercise, but actually our social environments, our housing, where our careers, all of these things are contributors to our health. So I think it's much broader than just health and fitness.
00:46:06
Speaker
Yeah, that's such an interesting perspective on it. And I suppose, you know, all of us listening here are in a fortunate position in where in the world we live, as much as we complain about we don have access to pelvic health and our health services, you know, at least we have access to health care. And there's a lot of women that still don't have access to like maternity care or contraception or safety. 100%. Yeah, that's so true. Yeah. Yeah. So I think, yeah, like you said, it's much broader than that. And, you know, we are so privileged in where we live with regards to our health. To look after it, I suppose as well. Yeah. Chloe, thank you so much. I have learned so much and I know that everyone else listening will have as well. It's been so interesting. And I think I've asked
00:46:49
Speaker
and be of my ah particularly kind of burning questions and I like to kind of ask all the obvious ones and they're they're quite genuine questions on my part it's not you know what I think other people need to hear it's like what I want to know as well so thank you so much if people want to reach out to you and connect with you is Instagram the best place to do so?
00:47:09
Speaker
Yeah, I think Instagram is a great case to do that. So my Instagram handle is at Chloe Stevens physio. So if you have any pelvic health or women's health related issues, please feel free to drop me a message on there. I mean, I can speak to you virtually as well. So I also have a website and that is Chloe Stevens women's health.co.uk. So you can always contact me through there as well. And I invite questions. I like to talk about these things. So if you want to discuss things, I'm more than happy for people to drop me a question and hopefully I can help them in whatever way I can over the internet. Yes, brilliant. Thank you so much Chloe. Thank you. Thank you.
00:47:49
Speaker
I just want to say thank you so much for listening to the podcast. It really means so much to me that there are people out there actually listening to what I have to say and to the conversations that I'm having with others. So thank you so much. If you are enjoying the podcast, could you please make sure that you are subscribed? And if not, if you could hit that subscribe button, it really does make that much of a difference. Also, if you would like to leave a review on any of the episodes that you listen to that you particularly enjoy. I would love to hear what you have to say. And also, if there's an episode that you've enjoyed, please do share it on your social media, in your WhatsApp groups, with your friends. If you're sharing it on your stories, please tag myself in it and whoever I'm interviewing, this it would be greatly appreciated.
00:48:30
Speaker
Also, if you're interested in working with me and my wonderful team, please do you contact me about applying for coaching. So you can contact me at KateHamiltonHealth at gmail dot.com or on Instagram, Facebook, TikTok, all Kate Hamilton Health, and you will be able to apply for coaching. We can organize to have a chat and see if it's a good fit for you and get you moving towards your goals.