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S1 E26: Pelvic Floor Health & Fertility with Dr. Ryan Bailey

podcast Jan 08, 2022

Listen on Apple Podcasts

Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.

Amanda: In this episode, we're discussing pelvic floor health and how much of an impact this can have on fertility. I'm joined by Dr. Ryan Bailey. Ryan is a women's pelvic health physical therapist, mom of two, and owner of Expecting Pelvic Health. And she has been helping women for over 12 years reconnect to their body, heal injury, and restore function. Her philosophy is to use every moment in your day as a way to be mindful of your movement, posture, fitness, and overall health. Bringing this thinking into practice by nurturing a balance between efficiency and functionality in day-to-day tasks, exercise, body work, and self-care to promote long term pelvic health benefits. Dr. Bailey earned her doctorate of physical therapy degree from the University of New England becoming a board-certified women's health physical therapist and prenatal and postpartum exercise specialist with training in pilates. Dr. Bailey's passion is to help women harness their fullest pelvic health potential to achieve their motherhood dreams of conceiving, feeling amazing in pregnancy, having a positive birth experience, and transitioning into motherhood feeling empowered and strong in your amazing body.

And that is why Ryan is here today, because I just love her philosophy. I love how she teaches and educates women, very gentle and empowering. And that's what I'm all about here. So really the goal with this episode is to raise awareness about the pelvic floor. We're going to go through a lot of the basics, and then hopefully just help women gain a better understanding of how they can support their own pelvic floor health. So thank you so much for being here, Ryan here.

Ryan: You’re welcome, thank you so much for having me. This is a treat.

Amanda: I know, Ryan did a guest experts class for my membership so anyone that's listening from the membership will recognize your voice. Great breakdown. So nice with visuals, we don't have any visuals today, but I promise you're going to get a lot out of this podcast. So Ryan, why don't you start with telling us a little bit more about your own, like, health and healing journey and what got you so interested in pelvic floor health specifically for conception?

Ryan: For a lot of healthcare professionals, we kind of get into it because of our own journeys. And getting into physical therapy wasn't my own health journey. But it was unexpected change in my life where my father passed away when I was in college. And so I decided that I wanted to get into the medical field. I'm a very hands-on person. So physical therapy was what really looked like it was what I wanted to sink my teeth into. The women's health piece of it didn't come until I was several years into school. It was at my first internship, and at this internship—it was at an orthopedic outpatient clinic—and I had two patients who were ortho but were in with that women's health realm. One was a new mom and she had nerve damage and she couldn't, she could barely walk, she could barely lift up her son. And so helping her achieve her goals of being able to walk the hills out in California and be able to lift and play with her son was an incredible experience. And then the second woman who I saw she had bilateral hip dysplasia, she had had lateral hip surgery for replacements. And she was newly married and so she was really nervous about intimacy and what she and her husband were going to be capable of doing because of her hip replacements. And so that's not really something that we get taught in school. So I had to do a lot more research and dive into it a little bit more and it just really piqued my interest while in school. And then from there I, a local physical therapist came into some of my classes and she just kind of solidified my interest in helping women achieve this deeper understanding around pelvic health.

And that helped then my own journey, because I had a really difficult time conceiving. A lot of stress, being in school, graduating, become, you know, new professional, and then a lot of physical issues around conception and kind of the mechanical piece that I didn't realize were there and were, and really interfering with my menstrual cycle. And so I did a lot of body work on my own—body rolling, very specific exercises, changed my diet and lifestyle piece over this two year window, so that I could conceive my daughter. I then applied a lot of what I learned about my own experience into my care with my patients. And that's really when I started getting interested in working with women for conception.

And really, then, these past, I would say eight years since having my daughter, it's really then shaped my relationship with my patients as I've become a new mom, and my experiences through my own pregnancies, and my births, and my postpartum. And my own healing journey from having home births, and from having diastasis recti abdominis and healing that, and then making sure that didn't get worse than my second pregnancy, healing my own pelvic pain through both pregnancies and in my postpartum… And just really being able to learn a lot more about what women and what my patients go through during those times. As well as academically learning a lot more so that I could understand what was going on with myself and then apply that, again, with my patients. And it's just brought so much more depth and really broadened my view of how I can help. And the gap that is there in our, in our medical fields for women during this time, and just wanting to be able to bring as much as I possibly can to them.

Amanda: Well, and you've been doing this for so long. But how you said specifically, like, after you had your own children it really shaped how you worked with your patients and thought about everything. I think when you go through it yourself, it just changes things—it gives you a new perspective. I don't think we have to go through every single thing to help people with it, but I think having some experience like that it's just different, you know. When it comes to pelvic floor health, I feel like women don't address this until there's an issue. When it comes to things like fertility, I don't even think this is discussed at all. I've never heard a client bring up, that's been struggling with fertility, bring up pelvic floor health unless they also have endometriosis, but it's still not linked to their fertility. It is a separate, they're two separate things, right. So we're going to dig into that a lot more. But I want to start with talking about why, like, what our pelvic floor is and why women should care about it before it becomes an issue.

Ryan: Yeah, so our pelvic floor is the base of our pelvis. So if we're all sitting when we're listening right now, we are all sitting on our pelvic floor. And it is a set of muscles and connective tissue and ligaments and fat that makes up the, the bottom and the closure of our bony structure of our pelvis. It holds up our pelvic organs which include our bladder and our uterus and vagina and our colon and our anus. It really functions as the, the in and the out of our body, kind of sometimes gets a bad rap about not being functional or just kind of not being, kind of being forgotten about or kind of being taboo to talk about. There's also the other end of kind of a lot of discussion about okay, well, let's always do our kegels.

Our pelvic floor is super important to think about prior to conception because of the role that it plays in our bodies. And this role is important for men as well, but we are going to be really focusing on, on the female aspect of the pelvic floor. It controls what happens with our bladder, it controls sexual function, it controls our bowel function, as well as it has a huge structural support function for our pelvis and for our spine and to me our entire body.

If we are able to have an idea of what's going on in our pelvic floor, muscle, mostly muscular wise…of course, it's important to make sure that there's no infection because our pelvic floor is involved with UTIs and yeast infections and that type of thing, but muscular wise, we want to know what our baseline is prior to conception so that we know if we have any tension or pain to deal with. Maybe it's actually interfering with, with conception because of pain or endometriosis which we will get back into. Or maybe it's weak and you didn't even realize it. But you want to then start to work on that prior to becoming pregnant so that you don't have an increased risk of incontinence or peeing your pants or prolapse, which is when our organs drop out of the position where they're supposed to be and/or structural support issues that can lead to pelvic pain. Which is no fun I will tell you during pregnancy and afterwards as well as diastasis recti problems. This separation is completely normal, it's when it becomes a problem and you have symptoms around it, that the pelvic floor can really help out with the situation. So that would be the biggest reason why we want to know about our pelvic floor prior to conception is to know if there's anything going on that we want to take care of beforehand and then know what our baseline is. So that if nothing is going on, if something does happen, you know that it's not normal. And then you can do something about it.

Amanda: I think, too, when I think of home birth… we're gonna do home birth, and so a really big part of preparing for that is my pelvic floor and making sure that in a good place. Because having too tight of a pelvic floor can make natural birth very difficult. So there's so many important aspects. I think even just the health aspect of how it does impact other areas. It's not just our pelvis, it's, it's, like, it impacts our bladder, it impacts our bowel movements, so many other things. So it's, like, we should all care about this. And the more I learned about it, especially now being pregnant, I'm like, oh, my gosh, I wish I knew all of these things so much sooner. Especially as far as, like, strength training goes and, like, doing breathwork with the strength training, I'm like, okay, this could have changed my life and probably avoided a lot of issues. So it's just one of those things where I'm like, I know that a lot of women can be, like, I'm not pregnant yet, maybe they don't even want to have kids, but I'm like, we still want to learn about this. So it still really matters. And I think a lot of the techniques that we're going to talk about are helpful for everyone. It's not just for those wanting to conceive.

Ryan: Absolutely. This information is for everyone, literally. I work with teenagers and being able to have them have this knowledge about their body well before so many other people, it's incredible to be able to provide that for them. So it is definitely for everyone, regardless of if you want to conceive or not, because we all have pelvic floors. And it can be impacted by everything throughout our day. And we really just want to make sure it's going to be the most efficient and least impacted by our day-to-day lives as possible so that we can stay as functional might not have to worry about peeing our pants or having pain.

Amanda: Especially, like, I think long term, like, pain during sex. And, like, as you transition to the season of peri and post-menopause. Like, we don't want to wait until things get really bad. I, to me now, especially everything I've learned about pelvic floor health, I’m like this is, like, an essential part of women's health care. That's just, it's unfortunately, usually not brought up until there's an issue. What would you say that some of the biggest mistakes you see women make when it comes to their pelvic floor health?

Ryan: Yeah, so one of the really, the biggest ones, there's always doing kegels, always. So our pelvic floor, as I said, is kind of the gatekeeper of our pelvis and it keeps things in. But it also is meant to let things out. The muscles and the tissues of our pelvic floor are meant to contract to keep our pee and our poop in our farts and everything and baby and if we're pregnant and to help stabilize, but it's also meant to lengthen and relax so that we can pee and we can poop and we can let baby out naturally. And so if we are always doing kegels, which only actually targets a small portion of the pelvic floor by the way, you're only focusing on the contraction portion of the pelvic floor. And that in the long term can actually cause more problems than it can help. So that's one of the biggest, biggest things that I see as a mistake.

Another mistake is thinking that it's “normal” for a lot of symptoms that that people have. And that's unfortunately, because of kind of our societal norms and how it, you know, the taboo speak around, you know, the functions of the pelvic floor, especially the sex piece and the pain. And then, or laughing off oh, yeah, I pee when I laugh or, or that sort of thing. And just making it normalized when it's, it shouldn't be. Yes, it's extremely common, and it's only common because we don't take initiative to teach women that this isn't normal. And this isn't, this can be treated and you don't have to deal with this. And so those are two big, big mistakes that I see in general.

Amanda: When I think about, previous to everything I learned in the last, like, few years about pelvic floor health, I would say when I think of pelvic floor, I think of kegels, right? That's what most women I think are naturally going to think of and, like, do them at the stoplight, right. Do them when you're, like, driving, like, that's, like, what I think of, like terrible advice like that. And while some women, kegels do help them if they have a specific issue, I think for most women, it's probably the opposite end. Like you said, like, we have a harder time with tightness, lengthening, that sort of thing. So can you talk about, like, what is pelvic core breathing? And how would someone do it?

Ryan: Yeah, absolutely. So this is the most fundamental thing that I teach all of my patients. And I love teaching, because this is where it comes into play of just that every day practice. So pelvic core breathing, to give a little bit more of an anatomy lesson, right? We're all sitting. So if you're not sitting, go ahead and sit. And we're sitting on our pelvic floor. Our respiratory diaphragm is a buddy of our pelvic floor. And for those who don't know, our pelvic floor is also a diaphragm, because it's musculature that closes off the cavity of our body. And so these two diaphragms work together, they like to play well. And if they're not playing well, then we can have some problems with our pressure system within our trunk. What I teach is to get these, these two muscle groups to coordinate and to work the way they are meant to work together.

So what is physiologically supposed to happen is when we inhale, our respiratory diaphragm contracts and pulls downwards, okay, even though our ribs are, are pulling kind of up and out, our diaphragm pulls down. And so at the same time, that displaces our organs downward as long as we're not doing a really big belly breath, which is good for some things, like relaxation, but is not the way we're, we should be breathing all the time. Our, and so our pelvic floor lengthens as well in a downward fashion to create space for the downward placed organs. And this is, like, millimeters, it's not a huge movement of the pelvic floor. So when we're breathing on a regular basis, you're not going to feel it. But if you are very intentional about it, you can feel this movement. So on inhale, our respiratory diaphragm pulls down, our pelvic floor lengthens and moves down.

And something that I really like to do with our hands, again, for a visual for those who want to try this, you can put your hands kind of stacked on top of each other, like, it's your pelvic floor and your, your respiratory diaphragm. And when you inhale, you move them downwards, so you're getting that visual of down. Then when you exhale, our respiratory diaphragm relaxes and pulls back up. So then the pelvic floor can also move back up into its normal space or normal length position. This is then a great time to actually contract the pelvic floor, if that is your intent. If we're, if you're not wanting to strengthen the pelvic floor, don't necessarily need to, or are working on relaxation, then you don't need to contract it. But because the pelvic floor is already shortening during that exhale, that is then when you can do this great close and lift in contraction of the pelvic floor at whatever intensity feels right to you. So with those hands, they drop down on inhale and they move up on exhale. And so that is pelvic core breathing, in a nutshell. And then that can be applied throughout the day, to help with your lifting, coughing, sneezing, laughing, anything that you feel like you need extra support around the pelvis, especially as a new mom to reinforce that on demand control of that drawing in on exhale is a great way to start.

Amanda: When I first started doing this, I was like, I don't think I relaxed my pelvic floor that much. Because that, when you're breathing in and you're relaxing, when…this is very graphic, but a friend of mine has this way that she explains it to people before they do strength training, and it really helps, like, relax your butthole is, like, kind of her way to be like…because I mean, it's like what does it mean really, like, when you're breathing in and lengthening? What does that mean? And if you actually really do relax, it's like, okay, how often are you getting that? You know, I was kind of like, I don't think I'm getting this very much. So it was definitely very eye opening. And then to also apply that whenever I lift, like, I do that all the time now. And I'm like, okay, this makes a really big difference with pain, with stability, even, like, with my hips and stuff. I used to have some hip flexor issues and I was like, wow, I think that really made a big difference. And it just shows you, and something that you taught us in our membership class was how connected the pelvic floor is to other areas of the body.

Ryan: Yes, yeah. And if you're able to coordinate that breathing with exercise and not just the pelvic floor and the respiratory diaphragm, but the other deep core muscles, it makes then your other muscle groups, like, your hip flexors be able to focus on their true function. Where if you aren't bringing in that deep core or if your body isn't capable of doing it, it has to find ways to stabilize around your spine and around your pelvis so that your limbs can move. And that's where other tension and tightness and pain can, can become involved with your movement.

Amanda: Yeah, and I just think back to, like, years of lifting and CrossFit and I mean, I was always under tension, you know. There was never any relaxation. I did breathe during the lifts and they do teach you that. Especially with, like, Olympic weightlifting, you know, like, they're very specific with breathing patterns. I just wish that they went one step further and brought in the pelvic floor, both for men and for women, you know, definitely not just for women. But I was like, wow, if only I had this sooner, but I think the pelvic core breathing is something everyone can start with, like, even after listening to this podcast. And if you need a visual, Ryan has a million reels, guys. We were talking about this before we started the episode. I was like, Ryan, like, how do you make all these reels, but I'll put her Instagram in the show notes so you guys can check it out. Lots of instructional videos, which I think is great. But even just that concept of like breathing in, relaxing, and then breathing out, up, and in, and, you know, it's simple. I do it for, like, five-ish minutes before I do any sort of workouts. I do it every day, just because it feels good and I'm trying to relax my pelvic floor more, but it's something that we can all kind of start with.

So let's talk about body rolling. Because this is the other thing that you introduced in the class that we did and I was like, I've never heard of this before, you know, not even close. Like, pelvic core breathing, yeah, like, I understand the concept. I've heard something similar, but like, body rolling was very new for me. Can you kind of describe, like, what is body rolling, and who is it helpful for?

Ryan: Yeah, so this was something that I got more into for myself and took courses on and have found it so, so beneficial for my patients. So essentially body rolling is using a tool—like a foam roller or a ball, those are the two big tools—to roll out or massage or even just lay over specific points in the body and specific muscles in the body. And what that does, if you are, it can either just massage out a sore muscle, which can be helpful for athletes, and then that type of thing just as a kind of a routine part of their workout. But it can also be used in a very intentional way to actually change the collagen within our connective tissue and our muscles. And that can, can provide a much longer lasting change. Body rolling can be used throughout the entire body. I use it a lot in and around the abdominals and the waist and the back and the pelvis and through the legs. And essentially using either the foam roller or various size balls to stretch with a pressure and then time to get this, these tissues to soften and melt and relax so that they can then, again just like with the pelvic floor, go through their full range of tension.

Because just, just like the pelvic floor, we want muscles to be able to lengthen and be flexible as well as shorten and contract. And if there is any restrictions from scarring or adhesions or just past tension that creates bound up muscles, that, your body isn't going to be able to function well because of that. And then what that can lead to is reduced circulation, your lymphatic system is going to be blocked, your nerves are going to be kind of restricted and compounded and so they're not going to be able to communicate as well. And so that's also where this kind of overlaps into other areas of health in terms of at least what I do, because I do a lot of the body rolling with my patients for their home program, because I do a lot of what's called myofascial release manual therapy. And so it's a great way to have them be able to bring it home with them. And so for those who are dealing with infertility or pain or congestion and even gut issues, right, they may be having some of those other physical pieces that are reducing the ability of their body to bring the nutrients to where they need to be. We're getting rid of the excess hormones, or getting rid of the excess inflammation from a workout or an injury, and so body rolling not only works on the musculature but it then helps with these other systems so that you can bring a much more balanced state to the body.

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Amanda: I feel like people would resonate with being, like, I've seen people use a foam roller and stuff like that, but, like, you actually have videos of using different size balls and on your abdominal, and I think that's the biggest difference. And when you talk about how it impacts the lymphatic system, because we have, we have lymph nodes down in, within our pelvis area. And so I just think that's so interesting. And it just makes you wonder, like, women that struggle, maybe they have amenorrhea, like, they're not having a period, women with PCOS… It's like, how much congestion is going on down there. And then of course, like, the next thing we'll talk about is endometriosis, but when it comes to, like, rolling out specifically to try to create more blood flow and improve that, what type of ball are you using?

Ryan: I really like a very specific ball. It's from the, it's Yamuna. And they have made very specific body rolling balls. And they have courses and videos and things like that. And they come in, in various sizes from, like, four-inch diameter to 10-inch diameter, and they have varying thicknesses of the rubber. Those are my favorite for body rolling. However, there are other balls that are out there that are, can be just as effective. But those are my favorite. And I like having varying sizes because, like, sometimes you can't handle a small ball in a certain area and you need a larger ball or you need a smaller ball to get into a certain area. So having a variety of sizes, as well as a variety of densities can also be really helpful as well. Though for most people, I like ones that are firm but squishy, not as stiff as like a tennis ball. Definitely not a lacrosse ball—those are just too much on the body.

Amanda: And I think that especially for that, like, pelvis area, it's, like, obviously that would probably be painful. But using, like, those softer balls and boosting that blood flow and lymphatic, like, actual limb movement that can be really helpful. It sounds like for just overall period pain, which we're going to talk about. Which I think is so interesting how it can help a period pain, endometriosis, fertility, and just, like, improving congestion, especially for those women that maybe aren't having a regular cycle.

Ryan: Absolutely. It's, it is such a great tool, like I said, I used it for myself. The changes that I had from when I did my body rolling and continue to do it, because it's a really nice maintenance tool as well, it's incredible.

Amanda: So what kind of pelvic floor issues do you typically see with women with endometriosis? I'm assuming you probably see quite a few in your practice.

Ryan: Typically, as a physical therapist, I can't actually treat endo, but what I treat are the kind of the side effects of it and how the body responds to it. And what is typically seen in the pelvic floor is high and tight. The pelvic floor is guarding, guarding, guarding against that pain and so it is completely restricted. That's a very common thing that we see. And then depending on where the adhesions are, they may reach down into the pelvic floor and so there may be more restrictions beyond just the musculature that play a role in how we need to release, release the area. But, so typically, it's pain, so pain with sex pain, pain with any form of penetration. So you know, like trying to use a tampon or cup or going and having an exam…anything that is inserted vaginally or rectally can be painful. It can also just be painful just without having anything inserted and just having vaginal or vulvar pain. And gut, gut pain as well so abdominal pelvic, that kind of that anterior pain.

If I see after, you know, an endometriosis excision, everything's cleaned out but there's still that muscular tension that is not then addressed, that's in the pelvic floor that's in the abdominal wall. I do a lot of manual therapy for that, I provide them the education about the body rolling for that. And then it's a lot of education around how to use their muscles again in a safe way that they feel comfortable with. Because their bodies are so used to being tense and guarding that they have to learn how to relax again and lengthen and then contract in a comfortable manner, just with regular movement. That's typically what I see is just the upper high with the pelvic floor.

Amanda: Yeah, it's, it doesn't surprise me, because the, you know, chronic pain is such an issue for those women. And I just think about the clients that I work with. And, you know, usually their hair tests, like, you can see stress all over it. It can be so surprising for some, because they're like, I really don't feel, like, that stressed anymore. A lot of women learn how to deal with the chronic pain. And I'm like, your body's been in fight or flight, for, like, however long you've been dealing with this, usually it's 10 plus years. And sometimes it's 20 plus years, and I'm like, it's, it's gonna take time, like, their nervous system is usually shot. So I'm not surprised that it's, like, the higher tighter kind of reaction in their pelvic floor.

Ryan: You know, a piece of a connection with the rest of the body that I also help them through is thoracic mobility—again, getting to that diaphragm—so that the pelvic floor and the respiratory diaphragm can play well together, you know. But that also gets into that fight or flight through our thoracic spine. Helping them with the mobility through there with body rolling and exercises and manual therapy can be, can really help their bodies get out of that chronic stress mode.

Amanda: Obviously, if there's someone that was listening, and they were, like, listening to you describe the pelvic core breathing, and they're like, I would definitely be interested in this…would you say for most women with endo, most likely, unless they know that it's, tightness is not an issue, that when they're doing the end, like they don't necessarily need to contract?

Ryan: And it may be really, really challenging for them to feel any type of movement in the pelvic floor or even in the ribs, because when we're guarding our ribs lock down to it may be really challenging to even try to even attempt the pelvic core breathing. And so that's where body rolling can help out and the manual therapy and other mobility exercises can help you actually even just achieve that pelvic floor breathing.

Amanda: So, like, they might not actually be able to feel that lengthening. I'd be so curious, if anyone tries it and you have endometriosis, let us know. Send me a message on Instagram and let me know. And to me endometriosis, it's such a difficult condition to treat, because you really need a team of people, you know. Like, you need to have typically specialists, a surgeon that's a specialist in endometriosis that can do the excision and not cause further damage, you need to have some sort of nutrition expert that's going to be supporting them or have them go through like a course or something. And they need to have gut health experience because the gut health is usually huge. They need someone that they can see in person for in my opinion for pelvic floor therapy.

Ryan: Absolutely. The team approach is so the way to go.

Amanda: My clients with endo, they do often get pelvic floor referrals pretty easily, which I'm like, thank God because something needs to come easily for them, you know.

Ryan: If the person is aware of it, asks for it, great. It's when they're not aware of it and, and the doctors doesn't bring it.

Amanda: They're just so used to the pain or they have, like, excision surgery so they're like, I'm fine. But it's, like, so there's so much happens in the body after that. It's like it can be so helpful, but then I still see women experiencing symptoms or everything goes away and then it starts to come back. It, not even the lesions just the symptoms.

I feel like the mental health is probably the other one that I missed is, like, some sort of mental health support, nervous system support, someone that is educated around that. And I mean, that's like a four-person team, you know, and I hope one day, I hope one day that is the approach for endometriosis or that women can like… I mean, there are a lot of free resources out there, but it's a lot of work to kind of piece that together on your own.

Ryan: Yeah and you shouldn't have to.

Amanda: Exactly. So this kind of relates to the whole period pain piece, because obviously women with endometriosis that is, like, one of their top symptoms. Not for all of them, but I would say for most. You have, I think it was a blog post on period pain and I was like, wait, what? How does working on pelvic floor health, how can that reduce your period cramps?

Ryan: So there's the, kind of the two ways: mechanical, in terms of the tight musculature around the uterus and then the circulation. Taking away any of the tightness and the tension around the uterus just allows for better flow through the pelvis. And so balancing out the pelvic floor musculature, the abdominal musculature, the back musculature. And then that then plays into the circulation in terms of allowing proper oxygenation to the uterus. And then also on the hormonal piece, allowing the hormones to get where they need to get as well as flushing out the excess. And then of course, the congestion piece and allowing the lymphatics to be able to remove any extra stuff that's in the area so it doesn't bind up, cause bloating, and potentially cause pain in the area. So for some people, you know, their pain is, is very hormonally-driven, but for a lot of women, especially if it's chronic, it's going to also be involved, your muscles are also going to be involved from guarding. Being able to remove that can reduce the period pain.

Amanda: It makes so much sense when you say it. Like, even for endometriosis it's, like, you know, like, their muscles are literally guarding and trying to protect them. Can you talk a little bit more about the congestion that can occur, because I don't think people realize, like, the lymph nodes that we have there and, like, how those can become congested over time.

Ryan: So yes, we have different areas in the body that have lymph nodes, and our pelvis has a lot through the area as well as ducts that go through the area. This also plays into pregnancy and postpartum congestion, too, with the change in the blood volume and the hormonal change in the, in the pelvis. Essentially, things can kind of become stagnant and it doesn't move. And so our lymph nodes need a kind of movement around it to get them to actually open and close. So they need, they're tethered to our skin, they're tethered to the connective tissue, and so they need that to move to actually open to receive and then to close to pump out.

And so for a lot of women during their period, congestion can increase because of the increased blood volume, but also because of gut changes during that time, right. A lot of people have gut changes because of the hormone piece. And then with the decreased estrogen, our muscles actually become a little more loosey. They're not as structurally sound with the, with the decrease in estrogen during our period. So again, we're not allowing or providing that kind of pumping action through the muscles. Things become a little bit more stagnant and then can become more congested. It's almost like a highway, right, where we've got these on ramps and off ramps, and it's five o'clock rush time and nothing is moving and it's just stuck and stays. And so then everything from the legs that are trying to get up into our larger vessels can't and then just gets, again, more stuck in the pelvis until we clear it out.

Amanda: That's so interesting. And so for people that maybe they have pain during their period, cramping…would you say, like, the body rolling is probably one of the best ways?

Ryan: It's a great way. I mean, if you can't, if you literally can't get in to see anyone, body rolling is a great place to start so that you can, like I said, clear out the restrictions and the tension from the area. So you can open up the flow. And that's what I teach my patients in their home program.

Amanda: Like, I feel like this also has, relates a lot to conception, fertility, right, that congestion piece… How does our pelvic floor health, like, how does that directly impact our ability to conceive? And what would someone, like, how would they, like, bring that up? Because I feel like not all pelvic floor therapist… Well, not all physical therapist are pelvic floor experts, number one, and then, like, when you're talking to someone it's like, I feel like that's not as well known that it could actually be a mechanical issue.

Ryan: Yeah, so that gets into, again, the same adhesions, restrictions, muscle tension in that area. And so for those who may be having pain with sex, that in itself may be the mechanical issue of being able to conceive. Because it's just too, too painful to have sex and so you're not gonna be able to conceive because of that. But it also plays a role of just kind of restricting around the organs. And so we want to make sure that, again, there's this nice flow through the pelvis. One, so that the egg can get where it needs to get as well as the sperm can get to where it needs to get, but also for the hormones to get where they need to be and to allow with that the balanced hormones. So that, right, you've got good levels of progesterone in your in your luteal phase, and so you're building up that really great environment in the uterus. But if you don't have good circulation to that area, it's going to be really hard for your uterus to build up a really nice fluffy bed for that follicle.

And so doing manual therapy and body rolling and specific exercises opening, like yin yoga and, and those are great for, for removing those barriers around the organs. And the pelvic floor is a part of that. So that then you're taking away kind of that physical mechanical piece of egg can't get where it needs to get, pelvis, or sperm can't get where it needs to get blood, you know, hormones can't get where they need to get…removing that so that everything has an open space to be able to get where they need to be.

Amanda: That's really interesting. Do you happen to know if our pelvic floor health can impact our ability to make cervical mucus?

Ryan: I believe it can, because of the circulation aspect of it. If our pelvic floor is tight and restricted, it is actually going to probably feel drier because of all of the glands in the area and those being kind of shut off almost. So absolutely, I think it impacts cervical fluid as well as just natural arousal fluid as well, that things are just going to be drier. And again around the restrictions around the, the uterus and ovaries and everything. If you're not, if your hormones aren't balanced because of those restrictions, or it's impacting your hormone balance in terms of trying to get where they need to get, that is going to impact cervical mucus.

Amanda: It's definitely, I feel like there's a mechanical piece to it. And then of course, like, you need cervical mucus for the sperm to thrive. So in order to have everything actually work together and have that implantation occur, I could totally see how there's a mechanical piece as well.

Ryan: A lot of people wouldn't know that this is something that could be a problem from that for them. Unless, like I said, they've had pain or they've had a surgery in the past or they, you know, have PCOS or endo. I really think that anyone who has been an athlete or a dancer or, you know, have been active in their life, or not active, you know, have the potential for some type of restriction in the gut and in the pelvis. Because even the smallest things from being a child, so many of us have landed on our butts, right. I mean, just this past month, my son has slipped and sat on his butt hard twice, that I literally worked on his pelvis because I was like, oh, your poor little tailbone. And didn't want anything to happen long term for him. So, you know, so many of us have done that. And that then layers on.

So with the guarding something that happens in our body is we, we contract to guard and to protect, but then what doesn't happen a lot of times is the letting go piece, is, is the kind of the shaking it off. We've kind of forgotten that because of, of our bombardment of stress and, and on the go all the time. And we don't focus on the down training and relaxation. It's kind of a, it's just not promoted in our, in our society. And so you know, from childhood, even from infancy and in utero, things layer on in our body that may not necessarily present in typical symptoms, but can then if added with dietary problems, and other, you know, mental health issues…like, those can cause that subfertility that you may not even realize is there because it's all of those little things adding up.

Amanda: Yeah, I also, I mean, we were talking about this before we even got on to record this episode, but just how we do, we don't really live in a world that we're prioritizing that rest and digest, that parasympathetic relaxation state. When I mean in reality, we were supposed to be living in that state the majority of the time. That's how our bodies are designed to live, and then, you know, get into that fight or flight and respond to the stress when it comes up. But it's not supposed to be all day long, every single day, 24/7, 365 days a year, right? It shouldn't be that much. And I think that's, but it is, and I think that's why so many people have a hard time and feel very uncomfortable with the act of slowing down and not doing anything, just being.

And even, you know, I just think about myself, like, I have a really hard time slowing down. It's something that I feel like I have to practice every single day, or it's really easy for me to get into that go, go, go mode and not want to slow down. Because the more that you're out of that mode, the less comfortable it is when you slow down to get in it. I feel like it definitely has to be that constant practice. So I could totally, I feel like that guarding thing makes total sense.

Ryan: Pelvic floor therapy should be almost like the dentist, where you have your, kind of your yearly check-ins to see what's going on and make sure everything is just working the way it should be working.

Amanda: It's also one of those things where I feel like if you can relate to this, and not in that act of having a hard time slowing down. And maybe, maybe you've been trying to conceive and you're not sure if it's a mechanical issue or if there's something deeper going on. All your labs might look normal, but you're so, you're not really getting the answers you want. I feel like it is worth looking into that mechanical piece, especially if you have any sort of, like, history with exercise, or lack thereof honestly, like you said, it could go either way. Endometriosis, I feel like it's going to be more common if, you're probably going to look deeper if you have that. But honestly, anything, because it's just one of those things where, like you said, like it should be, like, pelvic floor care should be like the dentist, you know, women should be learning about this regularly. So it's something that is 100% worth looking into.

I know that, I mean, I didn't see a pelvic floor therapist until I got pregnant. And I was like, I really wish that I did this sooner, because it would be a lot less that you have to work on while you're pregnant. But you know, the goal is to just set myself up the best that I can. I'm hoping that everything will work out, we can do a home birth, and be okay. But if not, like, I would definitely understand why, because I did wait to work on the pelvic floor health. But yeah, there, you just got to do the best you can with what you have.

It really makes you wonder since women are not getting this care. And even if they're pregnant, I mean, you have to seek this out, it's not just gonna come to you whether you're pregnant or are postpartum. Unfortunately, it's not really part of that standard of care yet. But imagine just how many things could be avoided, or like, you know, symptoms that are not normal but are really common that women don't necessarily have to deal with. But they, they're so normalized in our society, and they're not seen as like a medical issue. All those things could be avoided.

And can you, I know you have that assessment, can you tell me a little bit more about that assessment, because I do think that's probably going to be like the best place for people to get started after listening.

Ryan: You know, I can't see everyone of course. And so I created this self-assessment so that for those who either can't get to pelvic floor PT—or OT, there's some OTs out there—in person or just aren't feeling ready for it yet. They can do a self-assessment and it's essentially checking out your pelvic floor on your own and seeing, visually seeing, using a mirror, ladies, to see what it looks like down there, right? If you don't know what it looks like, you don't know then what your normal is—because let me tell you, there are a ton of normal—so that if you do have a baby, you know what your normal looks like afterwards, and you don't freak out when you're, like, I don't think that's what it looked like. Well now you will know. As well as then physically feeling with your hands, what's going on? Can you contract the muscles, can you relax? I talk about anatomy and just how to have a better understanding of what you physically are capable of and look like and feel like in your pelvic floor. So that is all in there and I have some visuals and things so that you either have a better idea of what information to bring, say your doctor or your PT or, or that type of thing. Or just for your own, you know, well-being, knowing okay, this is my baseline, this is where I'm at so that if anything changes, you know a little bit on the faster side.

Amanda: That is such an awesome free resource that you created. I love that, because, you know, you can't work with everyone, but at least you can give women something where they can get some direction and build that familiarity. So that link is gonna be in our show notes. It's just “grab your free guide to pelvic floor self-assessment” and I also link to Ryan's website, her Instagram. She has a pelvic floor quiz that I put in there, and we've talked about a few blogs and stuff on here.

I know we didn't get to that tearing during, how to avoid like tearing during birth question, but we'll definitely, we're going to do an Instagram live answering your questions about pelvic floor health. I'll make sure I selfishly ask you that one since I want to get as much information as I can before this baby comes.

But overall, I'm, I love this episode, I think that you did a great job presenting the information. And I, I know for myself, the more that I've learned about my pelvic floor and the more connected I've gotten to it, the more empowered I feel. And I, and this is something that I really do hope for and want for all women. So I hope everyone takes advantage of all your amazing resources and that self-assessment and starts digging into all this stuff. Maybe they start with some pelvic core breathing. But yeah, I just really appreciate everything you shared. And thank you so much for being here, Ryan.

Ryan: You're welcome. Thank you for having me.

Thank you for listening to the Are You Menstrual? podcast. If you enjoyed today's episode, please consider leaving us a review and sharing the podcast with someone you think it will help. If you are new here, we can't recommend enough to start with our mineral imbalance quiz. This is going to give you an idea if you are at low, moderate, or high risk for mineral imbalances. And then of course, make sure you follow us on Instagram @hormonehealingrd. And consider signing up for our newsletter if you like nerding out and you're just loving these podcasts but maybe you're a little bit more visual and you want to see things too. We go into a ton of detail in our weekly newsletter. So we would love to have you join us there. Alright, thank you and we will see you in the next episode.



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