Help, I'm Leaking! Why Your Pelvic Floor Physical Therapist is Better Than a Plumber
"It's just part of aging" might be the biggest myth about leaking when you laugh, sneeze, or exercise. That unexpected wetness isn't your body betraying you - it's sending an SOS you can actually answer. In this candid conversation, Dr. Kerry Winge and Nathaniel dive into the taboo world of pelvic floor dysfunction, where "queefing," unexpected leaks, and the sensation something's falling out of place aren't just embarrassing moments but treatable conditions. You'll discover why stressed breathing sabotages your internal foundation, why men need pelvic floor therapy too, and why Kegels might actually worsen your symptoms if your muscles are already too tight. Stop planning your life around bathroom locations or avoiding activities you love - your plumbing system deserves better than just extra pads and compromise. This might be the maintenance upgrade you never knew was possible.
Transcript
Dr. Kerry Winge: [0:00] Hi everyone, welcome back to the Bottoms Up Podcast. Today's episode is called, "Help, I'm Leaking! Why Your Pelvic Floor Physical Therapist is Better Than a Plumber." And yes, you heard that right. We're diving into pelvic floor health, literally and figuratively. Because when it comes to leaks, your body might need more than a wrench and some duct tape. Today, we're gonna talk about why pelvic floor issues are super common, but often misunderstood, and how pelvic floor therapy can be the real solution, not just extra pads or avoiding your favorite exercise class.
Nathaniel DeSantis: [0:39] So let's start with the basics. Simple question, maybe not so simple answer. We'll see. But can you walk us through what's really happening in the pelvic floor? How do the muscles and the ligaments work together to support things like the bladder, the bowel and reproductive organs?
Dr. Kerry Winge: [0:58] Yes. So let's break down what the pelvic floor actually is. I want you to picture a hammock or a trampoline stretch across the bottom of your pelvis. That's your pelvic floor. It's made up of layers of muscles and ligaments that actually act like a supportive sling. And this sling holds up some very VIPs. Your bladder, your bowel, and for people with a uterus, your reproductive organs too. Think of it like a basket holding water balloons. So if the basket gets weak or the strings actually get too tight, stuff starts to leak or shift in ways that we really don't want it to.
Nathaniel DeSantis: [1:42] So immediately the first thing that comes to my mind, the first question that I have based off of this is when I think of a trampoline, when I'm done using a trampoline, I don't then like take the trampoline apart and put it away. And so I guess what I'm wondering is, is the pelvic floor kind of the same? Does it ever get rest or is it always kind of active and in use, ready to go, being pressed upon, whatever it might be?
Dr. Kerry Winge: [2:03] No, not really. They are not always working at full force, but they do have a state of continuous resting tension. So they help control when you go to the bathroom and they support your organs when you cough or lift things. And they really play a huge role in sexual function.
Nathaniel DeSantis: [2:24] Okay, so basically they hold in a sneeze, gas, or a full bladder during a meeting.
Dr. Kerry Winge: [2:30] So that's your pelvic floor doing its thing. And if that system isn't balanced, you can experience like leaks or pain or pressure.
Nathaniel DeSantis: [2:39] Okay, so bottom line, pun intended, the pelvic floor is your body's built-in support system, pressure regulator, and gatekeeper all rolled into one.
Dr. Kerry Winge: [2:52] Right.
Nathaniel DeSantis: [2:53] Something that I think gets repeated a lot online, on social media, and just pop culture, for whatever reason, is a lot of people think leaking is just from childbirth. Is that true?
Dr. Kerry Winge: [3:04] Not at all. While childbirth can be a big factor, you do not have to have kids to leak. So we often see urinary incontinence in athletes and people who lift heavy weights, and even those with poor pelvic floor coordination, and I'll explain that a little bit later. But sometimes the muscles are overactive or they don't contract and relax when they actually should, and that can lead to leakage even if they aren't necessarily weak.
Nathaniel DeSantis: [3:37] Okay, got it. So could you explain common dysfunctions of the pelvic floor?
Dr. Kerry Winge: [3:41] Yeah. So basically, we talk about that pelvic floor again. It is just like that trampoline at the bottom of your pelvis. But remember, the actual muscles have to have a certain pelvic floor resting tension. And if it's too tight, that tension is too tight or it's too loose, then we end up having those problems again: the urinary incontinence, the pelvic pain, the prolapse, and that sexual dysfunction.
Nathaniel DeSantis: [4:12] Okay, interesting. So anecdote, maybe not an anecdote, but fun fact, I had a family friend who actually had to go to the bathroom at the same time every day, like multiple hours. She was like 8 p.m., 8 a.m. Afternoon because she couldn't feel the urges to use the restroom or go to the bathroom. That's a pelvic floor problem, right?
Dr. Kerry Winge: [4:35] It is. And that's when we use a technique called timed voiding. So you have nerves that go from your lower back to your pelvic floor and then nerves that go from the lower back to the brain. And those nerves, the pelvic floor and the brain, they weren't all coordinating. And that's why she did not have the urge to go. And we, in physical therapy, we use that technique called timed voiding. And so we have people go to the bathroom every two hours, basically, you know, set a timer on your iPhone so that we can reconnect those muscles. So the body gets used to the bladder filling.
Dr. Kerry Winge: [5:18] And then releasing, filling and releasing. And often, you know, we'll have people go to the bathroom and sit down, even if they feel that they don't have to go, because it can take a while to really connect that muscle memory to the brain. And we might have them think about a waterfall, or actually turn the water on in the bathroom. It will help to relax their system and allow their system to connect to that bladder function and say, okay, it's time to go. And then eventually they will end up going on their own and it will be just natural for that to happen. And we only have them do the time voiding during the day because of our circadian rhythm. Like you don't want to get up all night and pee all the time, right? That's going to interrupt your sleep. But it's just like what we call adult potty training. No different than what we do with a child.
Nathaniel DeSantis: [6:10] Okay. Well, that's a, you know, I think that's something people don't consider often that that's something that could happen is you don't feel the urge to go to the bathroom. And I could only imagine how disruptive that would be to my life. But it's a reality some people have to deal with. So that's interesting with the timing and everything, how that works.
Dr. Kerry Winge: [6:29] It is. And it has happened pretty often after childbirth because there's a nerve that as the baby exits the canal, it stretches in your pelvis. And it can also be as a result of a surgical problem where that nerve might get nicked. Or you can have a neurological disorder, like multiple sclerosis would be one or Parkinson's would be another. So there's a lot of different reasons for it.
Nathaniel DeSantis: [6:57] Well, very interesting. So a little tangent. Sorry about that, audience.
Dr. Kerry Winge: [7:01] That's all right. Hey, I think it's important for the listeners to really know everything about this.
Nathaniel DeSantis: [7:04] It is important.
Dr. Kerry Winge: [7:05] That's why we're doing the podcast.
Nathaniel DeSantis: [7:07] Exactly. Yeah. And these things exist and it's, you know, it's a reality for some people so I'm sure they'll find that to be comforting they're not alone. But let's jump into some questions that maybe people are a little bit more embarrassed to ask, that they may not really want to ask online or on a Reddit forum or to their friends, but listeners want to know. I'll jump into it. Listeners want to know about other leaking, but not pee, air. Air down there. So why don't we explain that?
Dr. Kerry Winge: [7:37] You mean queefing?
Nathaniel DeSantis: [7:39] Yes, exactly. You took the words right out of my mouth.
Dr. Kerry Winge: [7:42] Okay.
Nathaniel DeSantis: [7:42] You took them right out of my mouth.
Dr. Kerry Winge: [7:43] I'll say it for you. Vaginal air that escapes when you really don't want it to. Queefing, it's simply air that gets trapped inside the vaginal canal, and then it releases, making a noise that's similar to passing gas. But unlike rectal gas, though, this isn't actually caused by digestion. It's just air movement. It's very common. It's completely normal, especially during activities like exercise or sex, stretching, or even certain yoga poses.
Nathaniel DeSantis: [8:13] Interesting. Did not know that about yoga poses. Now, is that the medically accurate term, queefing? Is that if I go to a doctor and obviously I wouldn't be in that situation.
Dr. Kerry Winge: [8:20] You mean like Dr. Google?
Nathaniel DeSantis: [8:22] Exactly. With Dr. Google. Is that medically? Is that what we call it?
Dr. Kerry Winge: [8:27] Yes. That is what we call it.
Nathaniel DeSantis: [8:30] I did not know that. See, even I'm learning something new every day.
Dr. Kerry Winge: [8:33] Longer and say the leaking of vaginal gas.
Nathaniel DeSantis: [8:37] It's too boring.
Dr. Kerry Winge: [8:38] Queefing is so much easier.
Nathaniel DeSantis: [8:39] When you say that.
Dr. Kerry Winge: [8:40] Everybody knows what you're talking about.
Nathaniel DeSantis: [8:42] Yeah. Straight to the point. So then why does it happen in the first place?
Dr. Kerry Winge: [8:46] So the vagina is a muscular tube. And just like any tube, it can trap air when there's pressure or movement. So things like squats, you know, you're going down, pelvic tilts, intercourse, or inverted positions in yoga like downward dog or hip bridges. These actually create shifts in pressure that allows air to get pulled in and then push back out. But in some cases, you know, vaginal tone or pelvic floor function also plays a role. So if your pelvic floor muscles, again, are either too relaxed or overly tight and uncoordinated, it can actually create more space for the air to be drawn in.
Nathaniel DeSantis: [9:32] I want to pick apart. You said uncoordinated. Now, when I think of uncoordinated, I think of myself because I am very uncoordinated as an individual. What does that mean muscularly, though, to be uncoordinated? Does it mean your muscles aren't in sync or is this something that you can do to work on?
Dr. Kerry Winge: [9:48] That is exactly what it means, that the muscles are not in sync. So some muscles that are supposed to be tight or loose, the ones that are loose are tight, so they're not working themselves within that coordination. And if all the muscles are working together in that hammock to support your organs and you have one side that's not functioning properly, then we give you exercises and we do a couple of different treatments. One is actually called electrical muscle stimulation. You can use it in other parts of your body. People have understood about e-stim, say, on their shoulder, if they had a shoulder operation or they've seen it for a total knee replacement to get the quad muscle to kind of get back into sync.
Dr. Kerry Winge: [10:35] And I use the electrical muscle stimulation as a probe that actually goes in your vagina for a female or the rectum for a male, or depending on what the issue is, either party could use it rectally. And it gets those muscles to contract in the correct timing. And then I have the patient actually work with the machine so that it re-coordinates with the brain so that after the patient leaves the office that their muscles kind of have an idea of what they're supposed to do. And then we rebuild on that by retraining the brain and we level the exercises to the ones that they are able to do at this point in time. And it's different than a regular exercise when you're doing neurological re-education because if you're learning a new skill, you only have to do a couple of reps, but you want to do that a lot of times during the day. And that is because you need that neurological reinforcement of the new pattern or the brain wants to go back to the old pattern. And it's a very successful treatment.
Nathaniel DeSantis: [11:46] Interesting. My sister used a STIM kit. She got hit by a car not that long ago. Yeah. And so she actually got one in the mail. It's crazy because she, when I was in high school, we were in a car accident on my birthday. Happy birthday. And yeah, I know right, and it's actually a little bit, it's not my fault, I didn't cause it, but I wanted Starbucks to celebrate my birthday and if we didn't go to Starbucks it wouldn't have been in that accident. It wasn't a terrible accident, but you have PTSD.
Dr. Kerry Winge: [12:12] With Starbucks now.
Nathaniel DeSantis: [12:14] You would think so but actually she was at one point like a gold member so I clearly didn't bother her too much. But she had a winged scapula as a result, which is interesting that that's even a thing that can cause from an accident, and they used a STIM kit back then and I remember at the time how big these things were and it was really bulky. And now she got a new one for this accident getting hit by a car and they shipped it in the mail and when she opened it up I was like, "Where's the rest of it?" and there was no rest of it, that was it. These things are really incredible these days. I mean technologies, the medical technology has advanced so much. But I do have a question related to the queefing and I think we have a few more questions that we're going to cover with this, but something that I'm, you know, you mentioned what's causing it and it usually seems like it's an air problem, it always seems like it's an air problem, all the muscular uncoordination as well can be a... Does, and this might be a silly question, how does diet influence queefing? Is that something where let's say you eat too many beans and it's an excess of air? I mean they're not in the same tube. So I don't think it would cause it.
Dr. Kerry Winge: [13:20] Correct.
Nathaniel DeSantis: [13:20] Right. Okay.
Dr. Kerry Winge: [13:21] It has, it has no correlation whatsoever. No correlation whatsoever.
Nathaniel DeSantis: [13:26] That's what I've thought. Yeah.
Dr. Kerry Winge: [13:27] So if you want to think about queefing, I don't know if you were a kid, did you ever do like the underarm farts?
Nathaniel DeSantis: [13:32] Oh yeah. Oh yeah.
Dr. Kerry Winge: [13:33] Like that, right?
Nathaniel DeSantis: [13:34] Yeah.
Dr. Kerry Winge: [13:34] I might be idea.
Nathaniel DeSantis: [13:36] Yeah. I might still do it to this day. I'm a kid at heart.
Dr. Kerry Winge: [13:40] My brother could do it. I think it was my sister. Maybe it was my sister. She could do it with her hands up underneath her knees.
Nathaniel DeSantis: [13:54] Yeah, she should. Hey, if she was born a little bit later in life she would have been huge on TikTok for that.
Dr. Kerry Winge: [13:59] Yes, she'd be famous. She probably still could. That my family can do is they can balance spoons on their nose. Really? Yeah, just get a little bit of heat breath on that and you put it and then you have to figure out, you know, who can hold it the longest.
Nathaniel DeSantis: [14:12] If I am uncoordinated, then there's no definition that exists for how the rest of my family is. 'Cause like, I'm the most coordinated in my family, which is saying something. The most athletic of my family, which is saying something. The fact that I went skiing a few weeks ago, I was like, oh, he's done something. No DeSantis has ever done skiing. But I get back to queefing.
Dr. Kerry Winge: [14:31] You're like the prodigal son then.
Nathaniel DeSantis: [14:33] Yeah, exactly. Like, I run for like five feet. They're like, yeah, it could be in the Olympics. But bringing it back into queefing, is it a sign that something is wrong?
Dr. Kerry Winge: [14:47] Something's wrong? No, it's definitely not a vaginal emergency. Definitely not. But if it's happening frequently, like with daily movements or you're feeling pelvic heaviness with it or pressure or other pelvic floor dysfunction symptoms, then I really think that it's worth having a pelvic floor specialist assess you. Because sometimes a mild prolapse, which is a weakening in one of the walls or a laxity can actually contribute to the queefing. But for most people, the occasional queefing is just part of being human. So especially for people who are active or if they're postpartum, they just had a baby and there's been a shift in your hormones, and that can increase the laxity as well.
Nathaniel DeSantis: [15:30] Okay. Is there anything people can do to prevent or reduce it? And we've talked a little bit about the uncoordinated aspect of it. What about the rest of it?
Dr. Kerry Winge: [15:41] So strengthening and coordinating the pelvic floor muscles can really help create better control and reduce how easily that air is pulled in. Things like pelvic floor exercises, I'm sure you've heard the term Kegels. Kegels actually done correctly, which is one of my big wheelhouses here. The "correct" is the word that has to be used because you have to make sure that you are lifting and exhaling at the same time. Breathing, breathing coordination and working on your posture during exercise can all make a difference in this. But I just want to tell the audience, please don't be embarrassed by it. So it happens all the time in a clinical setting, especially with me. I'm always looking at people's bottoms. That is my job. So even during pelvic floor physical therapy, it happens and we just usually laugh it off. You know, it's a trapped air doing its thing. But I actually prefer it to a fart considering that that air doesn't smell what your gas does. So...
Nathaniel DeSantis: [16:42] Fair. Yeah.
Dr. Kerry Winge: [16:43] Yeah. Yeah.
Nathaniel DeSantis: [16:44] It's very fair. Well, so and that's interesting about the Kegel thing. And I know that is a unisex exercise. Men can do Kegels, too.
Dr. Kerry Winge: [16:55] It sure is. Anyone with a pelvic floor.
Nathaniel DeSantis: [16:57] And so is that the same thing? Does the technique change whether you're a man or a woman? I don't know why it would.
Dr. Kerry Winge: [17:02] It does not. It does not. The only thing that changes if you're a man or a woman is the actual instructions that I give you because the men, their muscles are more on the outside, easily accessible, where the women, we have ours on the inside, but they're the same group of muscles and they function the exact same way.
Nathaniel DeSantis: [17:27] Okay. Got it. So that was a little brief discussion about queefing. So, but we're going to move on to other things because leaking can go beyond just air and gas. So how about when things are falling out? Like, let's say someone comes in and they say, I feel something falling out of my body. Is it prolapse? You know, what's that all about?
Dr. Kerry Winge: [17:51] The best way to explain prolapse is think of your pelvic floor like the foundation of a house. So your pelvis is actually the framework, kind of like the structure of the house itself. So inside that framework, you have your pelvic floor muscles, which act like the floor or the foundation of the house, and they hold everything up. And then you have four walls inside this space. So the front wall of the pelvic floor is going to be supporting your bladder. And the back wall supports the rectum. And the top wall or the roof, that actually helps to support and hold up the uterus. Or if you've had a hysterectomy, it's called the vaginal cuff. And the side walls help hold everything together, keeping the organs in their normal position. Now, if you have these muscles and the tissues that weaken, whether it's from childbirth or heavy lifting, chronic constipation can cause that too because of all the pressure from the top. Or even just natural aging with a shift in your hormones. It's like the foundation that starts to soften or sink.
Dr. Kerry Winge: [19:05] And if the front wall weakens, the bladder might come down and press into that vaginal wall. And if the doctor can see that, we call this a cystocele. If the back wall weakens, then the rectum might push forward into the vagina, and we call this a rectocele. If the roof actually weakens, then the uterus can descend, and we call that uterine prolapse. So when people actually say something is falling out, what's really happening is that one of these organs is shifting lower and it's pressing into those vaginal walls. But in more severe cases, you might actually see the tissue or the bulge near or out of the vaginal opening, which can be scary.
Nathaniel DeSantis: [19:57] Okay, so let's say I am coming into you and I say, Kerry... I have prolapse. How much can that be improved? Can we fix prolapse or leakage? Or is it kind of one of those things where it's like, Kerry, I have prolapse. It's like, okay, let's figure out how you can manage this the rest of your life. Or is it, okay, here's the silver lining. Here are the steps we need to take to make it better. What is that recovery? How does that look like though for someone trying to fix prolapse?
Dr. Kerry Winge: [20:27] Well, great question. So the amount of improvement and what a pelvic floor physical therapist can do to help you really depends on several factors. Like the grade of the prolapse. And the grade, we actually measure it, how far that tissue has come down. And for prolapse, we grade it from a grade one to a grade four. One is mild, barely detectable. Just feel something's a little off. Grade two means that the organ itself is closer to the vaginal opening, but it doesn't exit.
Dr. Kerry Winge: [21:02] And grade three may partially bulge out of the vaginal opening, usually when you stand up, because gravity, if something's weak, it's going to come down. And grade four is when the organ is completely outside of your body. So if you have grade one or two prolapse, we can manage those symptoms pretty effectively with pelvic PT, exercises, some lifestyle changes. But higher grades still can benefit from PT, but also may require additional interventions, like a pessary or surgery, depending on the individual's goals. But prolapse itself is also something that is not dangerous. It's uncomfortable. I mean, people could live the rest of their lives with that. If their bladder does fall out, it's actually the bladder wall that you see and the bladder that's behind it. Sometimes you can just kind of push it, push it back in. So it's not life threatening, but really, really irritating.
Nathaniel DeSantis: [22:01] Got it. The benefit of having someone like me on this podcast is that I do not know much about medicine. So I'm going to ask the question. A lot of people probably were just wondering, what is pessary?
Dr. Kerry Winge: [22:12] Okay. A pessary is like a brace. Okay.
Nathaniel DeSantis: [22:16] Got it. Okay. Never heard that word until today.
Dr. Kerry Winge: [22:19] We have a brace for your vagina. And depending on the type of prolapse that you have, this pessary comes in a lot of different shapes in order to hold up the wall that is required further support.
Nathaniel DeSantis: [22:34] Got it. Good to know. There we go. The word of the day, pessary. I'll start using it more. It's funny how medical terms are becoming a part of my life more. So my girlfriend, Kerry, I was just telling you this, Emily, broke her fourth metatarsal. And 28 years, never heard the word metatarsal, never uttered the word metatarsal. Now it's like a common part of my vocabulary. I wake up, I say metatarsal. You know, it's one of those things.
Dr. Kerry Winge: [22:59] How is your metatarsal?
Nathaniel DeSantis: [23:01] Yeah, is your metatarsal good today?
Dr. Kerry Winge: [23:03] You didn't think you'd be saying that to your girlfriend. So how is your metatarsal?
Nathaniel DeSantis: [23:08] Life takes you on a very fun journey sometimes.
Dr. Kerry Winge: [23:11] Yes.
Nathaniel DeSantis: [23:11] We can do a whole episode, "Help, My Metatarsal's Broken from Wearing High Heels." Probably a really...
Dr. Kerry Winge: [23:19] Good story behind that. How the heck did she break her metatarsal?
Nathaniel DeSantis: [23:23] She was running in high heels towards my car and one thing led to another and she just collapsed on her foot and she was hobbling home the rest of the night. It was really tough. We almost took her to the emergency room that night but we were like, well, if it's broken there's not anything that's going to change tonight or tomorrow. So she slept it off.
Dr. Kerry Winge: [23:43] Yeah, I didn't sleep though. That's miserable.
Nathaniel DeSantis: [23:45] It was tough. Yeah. But good tangent on metatarsals, but let's bring this back. Let's bring this back to prolapse. So genuine question, because I've never experienced this, but how can someone tell if they have pelvic organ prolapse?
Dr. Kerry Winge: [24:02] Well, some people might feel a heaviness or pressure in their pelvis, like there's something sitting low or they may feel a fullness, but others might notice a bulge or feel something at the vaginal opening when they're wiping or during any physical activities. Some people even feel like they're sitting on a small ball or they may feel it's almost like a tampon that won't stay in place. And you can notice symptoms will get worse after standing or lifting for long periods of time. And usually with the history, you know, the patient will come in and say, you know, but I feel a lot better when I'm lying down or if I put my legs up the wall or a pillow under my knees.
Nathaniel DeSantis: [24:45] By all accounts, this seems like something where if this were happening to me, I'd probably be freaking out.
Dr. Kerry Winge: [24:51] Yeah.
Nathaniel DeSantis: [24:52] So is this dangerous? Can it be fixed? Like, can we help maybe those people experiencing prolapse listening right now, you know, what's that look like? Is it dangerous? Can it be fixed? How does that look?
Dr. Kerry Winge: [25:05] So it's usually not dangerous, but if you have a supportive disorder and we're talking about the bladder itself and the bladder is not in the right position, people may have a hard time emptying their bladder. And that's extremely important because, you know, those are your toxins leaving your body. And if they're left in your bladder for too long or they don't empty properly, then you can have some bacteria grow and maybe end up with a urinary tract infection. So it can be serious but not dangerous. But it's more about discomfort overall and how it's affecting your daily life. So mild to moderate prolapse can often be managed really well without surgery. And that's how we talk about when we assess the patient, level one through level four. And we use the pelvic floor physical therapy to actually strengthen that foundation of the house and the walls and reinforcing the house's structure. So we teach people how to recruit and coordinate their pelvic floor muscles and adjust their posture, work with their breathing patterns, and avoid habits like straining on the toilet. Because if you have weakened walls and you're pushing down, you're going to continue to make things worse.
Dr. Kerry Winge: [26:24] And then we always talked about the fact that a pessary may or may not be a candidate for a pessary, but that definitely supports you internally and helps to hold everything in place, like a brace. But surgery is typically a last resort, and it just really depends on the severity of the prolapse and then somebody's personal goals. So you may have a runner running a marathon who has a level two prolapse. And when you're running, you're constantly pounding on your body and there's nothing you can do about it because gravity is going to take over. That prolapse is not going to get any better if you're running mile upon mile upon mile. So even with a mild to moderate case, a runner might say, look, I'm not giving up my lifestyle. This is what I want to do. So I really do want to have surgery because I don't want to have to think about it.
Nathaniel DeSantis: [27:18] Right. And I'm sure continuing to run might even take it to that grade three or four stage, right?
Dr. Kerry Winge: [27:24] Yep. Sure could. Okay.
Nathaniel DeSantis: [27:26] These are serious medical issues we're talking about. Prolapse. It's never fun for anyone to deal with. It's never fun to have a diagnosis or have to deal with that. So I think it's important that we kind of dig to the root of what's going on. So how do people end up with a weakened foundation in the first place?
Dr. Kerry Winge: [27:43] Well, it can be from a lot of things. Vaginal childbirth is a big one, especially if there was tearing or prolonged pushing, but repeated heavy lifting, high-impact sports like we talked about, the running.
Dr. Kerry Winge: [27:59] Chronic coughing also because you're increasing that pressure every time you cough in the pelvic floor, straining from constipation, and menopause due to the natural drop in the estrogen. When you have a drop in estrogen, then it decreases the elasticity of the tissue. So all of these can weaken that support system over a period of time. But one of the biggest thing is disordered breathing and chronic tension, stress, and anxiety because people are always holding their breath and they're bearing down subconsciously. And what they don't realize is, you know, you're stressed during the day. So we talked about this in a couple of the other episodes where you take a breath in, but you don't actually exhale. And then you take another breath in, but you don't completely exhale. And that builds up that pressurization. Think about a pressurization tube over a period of time. And what happens is, you know, that pelvic floor can only take so much. So you're always pushing down on it. So stress and anxiety, holding your breath, bearing down, pressuring, you know, clenching your jaw, things like that, that can lead to prolapse issues. It can also lead to constipation because it can slow everything down in your belly. And it comes from the top down in this situation, not the bottom up.
Nathaniel DeSantis: [29:24] That's so interesting how I had no idea stress could do that. And you mentioned this, but we do have episodes that we did earlier on on stress and we have breathing techniques in there that you can do. So go listen to that if you want to avoid prolapse from stress. Yeah.
Dr. Kerry Winge: [29:41] Also, I teach a class. I take a cohort of a max of eight people on a six week rotational basis. And it's called neuroregulation. And I teach the people in the class based on where their level of readiness is, how to rewire the brain and calm their nervous system down so that they can live their best life. And they really become aware of what their habitual patterns are in order to really make a lasting lifestyle change.
Dr. Kerry Winge: [30:14] My classes of people do fantastic. And it really makes a difference in their life. So if anyone is interested in signing up for my class, you can do that on my website and contact my billing specialist. Her number is right in there. And either the billing specialist or the receptionist will give you all the information that you need. But just know that it is an hour class. It is over Google Meet. And we work in a group of between four and eight people maximum for the six-week cohort. And once you start, you have to finish the six weeks. And you can't jump in in the middle because it is a leveled class and everybody works together. So anyway, that is another solution of... Process that I really, it's kind of like my baby because I know that if I help out one person and they relax their nervous system and they're a happier individual, they are touching the lives of everyone else around them. And so it's personally fulfilling for me to be able to help people.
Nathaniel DeSantis: [31:24] Incredible. We'll have the links for Kerry's website in the description, so go check it out there. So here's a question from a listener. They say, I have two kids and now I pee when I sneeze. Is this just my new normal?
Dr. Kerry Winge: [31:39] No, it's common, but it's not normal. So pelvic floor therapy can retrain those muscles and improve your coordination and help you sneeze without the puddle.
Nathaniel DeSantis: [31:50] It's one of those things actually, like, you know, discussing this with you, it's kind of, we'll ask this question actually in a second, but it kind of seems a little bit skewed towards women because obviously I'm not giving birth. So less likely for me to happen. But I guess that is a really good question to lead into this. Do only women need pelvic floor therapy?
Dr. Kerry Winge: [32:11] Absolutely not. We treat men in our clinic every day because men have pelvic floors too. And they can experience things like post-prostatectomy incontinence or pelvic pain. So remember the segment that we did with Dr. Shakuri Rad in the beginning? Anybody that has questions about male pelvic pain or prostate issues, please refer back to our previous segments. There's a lot of good information. However, if you have further questions, just write them down here, shoot me a DM and we'll make sure that your questions are addressed.
Nathaniel DeSantis: [32:53] Maybe a juxtaposition is we're talking about prolapse and pelvic floor. And it kind of seems like in order for that to happen, you need kind of a loose pelvic floor, right? To go back to the hammock and trampoline analogy. But it seems like what you're saying is that when you're stressed, you tighten up. And that seems like a juxtaposition of what we're saying. So what is it about a tight pelvic floor that's bad? I thought tight is good. Like we want to hold it in. You know, we don't want things escaping the trampoline, so to speak.
Dr. Kerry Winge: [33:25] Right. You definitely want to be in the middle and you want to have a normal resting tension. So think of your pelvic floor like any other muscle. If it's too tight, it can't function well. Higher than normal resting tone in your pelvic floor can lead to pain, your constipation, and even leaking. Think about a gymnast. Everything is high and tight. I treat a lot of patients that are current or former gymnasts because they feel that everything always has to be lifted at the end of their gymnastics. They're always lifting up their chest and squeezing up their pelvic floor, but they forget to relax and let everything go. And that becomes one of those habitual patterns that we talked about that needs to be broken, that's where the in-coordination disorder comes into play.
Nathaniel DeSantis: [34:18] Got it. Good to know. I'll make sure when I'm doing my gymnastics.
Dr. Kerry Winge: [34:23] With all your coordination.
Nathaniel DeSantis: [34:26] Exactly.
Dr. Kerry Winge: [34:27] Hey, I won't be out there either. I won't. Okay. Yeah.
Nathaniel DeSantis: [34:29] Yeah. For a second, I thought this was just the, let's make fun of Nathaniel's unathleticism episode. I'm glad you're not out there with me either.
Dr. Kerry Winge: [34:37] I got it.
Nathaniel DeSantis: [34:38] So, okay. Let's say I'm averse to surgery. I really don't want to get a surgery. And that's just not what I want to do. So last scenario for me, can pelvic floor exercises replace surgeries?
Dr. Kerry Winge: [34:51] Sometimes, yes. From mild to moderate cases of prolapse or incontinence, pelvic floor therapy absolutely can significantly reduce or completely resolve the symptoms. What I tell my patients is that based on what we find, pelvic floor PT can decrease your prolapse symptoms by one grade. And that is usually enough so that they will not feel it. So if your pelvic floor is functioning fine, you're pooping, you're peeing, you don't have excess gas, you're not noticing any discomfort, pelvic heaviness, you're able to lift and it's functioning, it's okay if you still have a level one prolapse. Level one prolapse is very on the low normal range and it's not an issue. And if we can get you back to that where you don't notice it and it's not affecting your life, then you're absolutely fine. There's no issues at that point in time anymore.
Nathaniel DeSantis: [35:52] Okay. Good summary of everything right there. And I think it's time us to go on to myth versus fact, which was so well received last episode that we're continuing.
Dr. Kerry Winge: [36:05] I like this game. It's awesome.
Nathaniel DeSantis: [36:06] Okay. Myth or fact. Kegels are the answer to all pelvic floor problems.
Dr. Kerry Winge: [36:13] False. Kegels are helpful, but only if prescribed correctly. So some people shouldn't be doing them at all. So if your pelvic floor is too tight, Kegels are the last thing that you should be doing.
Nathaniel DeSantis: [36:25] Yes. And we learned why just a second ago. So I hope you're paying attention. Myth or fact. Pelvic floor therapy is only for postpartum women.
Dr. Kerry Winge: [36:38] Okay. Back at you. You get to answer this one.
Nathaniel DeSantis: [36:40] I'm going to go with false. It's a myth.
Dr. Kerry Winge: [36:43] Yes.
Nathaniel DeSantis: [36:44] We just talked about that, but just to reiterate, it can happen to anyone. And that's the first thing when you were saying some of the symptoms or some of the causes of it, you said lifting. So that was the first thing that made me think like, oh, I got to be careful with my lifts to make sure I'm not causing any prolapse right there.
Dr. Kerry Winge: [37:02] Yes, and actually, you know, with men that do a lot of heavy lifting or CrossFitters, 99% of the time they are lifting incorrectly. And I have to retrain their bodies on how to do it so that you're coordinating your entire system, your breath and your pelvic floor and your lower back. A lot of times they're taught to tuck their pelvis forward and tighten up. Worst thing that you can do. You want a quick way to cause a hemorrhoid? There you go. Once you have them, it's too late. Hemorrhoids do not go away. They may decrease in size, but they never completely leave.
Nathaniel DeSantis: [37:40] Interesting. I also was reading you can get a hemorrhoid from sitting on the toilet for too long.
Dr. Kerry Winge: [37:44] Sure can.
Nathaniel DeSantis: [37:45] Yeah.
Dr. Kerry Winge: [37:46] Well, it's all about gravity and blood flow and it is a vein that pulls away from the wall, right? Yeah. So you don't want that to happen. You are messing with your foundation.
Nathaniel DeSantis: [37:56] Yeah.
Dr. Kerry Winge: [37:57] Don't mess with your foundation.
Nathaniel DeSantis: [37:58] Bad, bad. Don't mess with foundation.
Dr. Kerry Winge: [38:01] Okay.
Nathaniel DeSantis: [38:03] Another myth or fact. If I don't leak when I sneeze or cough, my pelvic floor is fine.
Dr. Kerry Winge: [38:08] Not necessarily. So you may still have dysfunction like pelvic pain, heaviness, or sexual discomfort. And we're actually going to discuss sexual pain in the next few episodes. That's going to be probably a couple episodes deep because it is a very complicated topic. But it's important to understand that the muscles of the pelvic floor actually need to coordinate together. We talked about it. It's like a symphony. So when everyone plays their part in the right timing, beautiful music is made. But when they don't, it's easy to detect the instrument or instruments that are actually not in tune. Like a human with pelvic floor dysfunction, the reason why they have pelvic floor dysfunction is usually multifactorial. So it may be how the breath actually enters that instrument. It could be the person's posture, how they're playing the notes, or the instrument might actually need a tune-up from an expert, which is where I come in.
Nathaniel DeSantis: [39:11] Let's go really quickly. We're towards the end of the episode. We always like to wrap it up with quick tips, things to do for your pelvic floor and things not to do. Let's hit it, Kerry. It's all you.
Dr. Kerry Winge: [39:24] Okay. Let's keep this simple. So practice your diaphragmatic breathing, your belly breathing. Remember, when you breathe in, your belly should come into your hand and expand like a balloon. And when you exhale through your mouth, you leave your hand where it is and you pull your belly button toward your spine without moving your pelvis. That's diaphragmatic breathing. Nothing should happen in the upper portion of your chest. It should always be from the rib cage to the top of the pubic bone. Nice and easy to relax that system.
Nathaniel DeSantis: [39:59] We got diaphragmatic belly breathing. What else can we do?
Dr. Kerry Winge: [40:03] Stay hydrated. So half your body weight in water. Eat enough fiber. Go ahead and refer back to that constipation episode that we did is all the ins and outs of fiber for an hour. Learn to fully relax and fully engage your pelvic floor. So that's all about that breathing, but also the mind-body coordination and kind of asking yourself, you know, where am I right now? And how do I feel? And where's the stress located in my body? And can I just breathe and be in the now? Empty your bladder every two to three hours during waking hours. We talked about that. And consult a pelvic floor PT if you have symptoms.
Nathaniel DeSantis: [40:44] Great tips on things to do for your pelvic floor. What about things not to do?
Dr. Kerry Winge: [40:50] Don't constantly clench or hold your pelvic floor muscles all day. Don't clench your jaw. If you clench your jaw, you're automatically clenching your pelvic floor. And sometimes people will realize it's really common that they will say, Hey, I've noticed that I squeeze my butt cheeks together all the time and I push my pelvis forward and I clench my jaw and my shoulders are forward when I'm doing, you know, working from home or if I'm in a stressful meeting or I have to, you know, talk publicly. Public speaking is a big one. So be aware of where your patterns are and try to change them. Don't strain or push during your bowel movements. Don't assume that it's normal to leak, even a little. And please, please do not self-diagnose yourself from the internet. I want you to get assessed by a professional. Remember, plumbers fix pipes. Pelvic floor physical therapists help you stop leaking at the source. And if you're dealing with water or gas leaks or pelvic heaviness, don't just grab a roll of paper towels. Get yourself evaluated.
Nathaniel DeSantis: [42:00] And don't be embarrassed. Pelvic floor dysfunction, it's super common and treatable. But just to reiterate, we talked about this with Dr. Shikori Rad about problems with men's urological health. And a lot of the times people don't come in because they're embarrassed or they don't want to face the reality. But that's what doctors like Kerry are here for is to make you feel comfortable and to get you through it. So don't feel embarrassed. It's common. It's treatable. It's not the end of the world. Go see Dr. Kerry. Go see your local pelvic floor therapist and get some help.
Dr. Kerry Winge: [42:35] Absolutely. We will catch you next time. And remember, your body deserves better than just patchwork solutions.