Lindsey Vestal Talks Pelvic Floor Care Without Shame
Do you know where your pelvic floor is, and why should you care about it? That’s exactly what we dive into in today’s episode with Lindsey Vestal. Lindsey is an occupational therapist with a focus on pelvic health, and today she joins us (from Paris!) to talk about the pelvic floor, and how this structure supports our essential functions. This week, episode 34 of Poised & Powerful Podcast is sharing inside knowledge on pelvic floor care!
Do you find yourself needing extra time to recover from your weekend or time to prepare your mind and body for the week ahead? Join me for a restorative practice where we’ll release tension in our neck, back, and shoulders. Clear your mind so you’ll feel reset and re-energized for yourself and your family. Drop into my Sunday evening restorative group: https://poisedpowerfulparenthood.com/take-a-break
Lindsey Vestal is the founder of The Functional Pelvis, the first in-home pelvic health practice in New York City run by an Occupational Therapist. She has helped thousands of people overcome chronic pelvic health challenges like incontinence and pelvic pain. Her goal is to empower women and men to listen to the wisdom of their own bodies—without resorting to invasive surgeries or prescription drugs—so they can heal and get back to enjoying life again.
SHE TAKES A DIFFERENT APPROACH FROM OTHER PELVIC HEALTH EXPERTS. In fact, she doesn’t really take an “expert” approach at all. Instead, she relies on her clients to share their expertise about their own bodies. That way she can offer the personalized support they need to regain control of their basic bodily functions. She considers the whole person, not just outward physical symptoms. She doesn’t believe Kegels are a one-stop-shop for every pelvic floor dysfunction.
In this episode of Poised & Powerful Podcast, Lindsey and I discuss the following:
What a pelvic floor is, and where to get started exploring this part of your body so you’re not afraid of it.
How your daily activities - and bathroom habits - affect your pelvic floor.
How to find the right pelvic floor therapist for you, who takes the time to listen to you and understand your concerns.
How more muscle tone isn’t always better when it comes to the pelvic floor, and other pelvic floor myths debunked!
Whether you’ve given birth or not, your emotions and experiences affect your pelvic floor, and we want everyone to be empowered with this information. Especially if you’re dealing with leaking, “sneeze pee”, chronic constipation, painful sex, or other pelvic health challenges - we don’t want you to be too embarrassed to seek help. Take care of your pelvic floor and it will take care of you!
Do you have a favorite pelvic floor fact, exercise, or practice - post to your stories and tag us! And please rate and review - it helps new listeners find us!
Learn more about Poised & Powerful and Sarah at https://poisedpowerfulparenthood.com/interviews
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PPP Ep 34
SPEAKERS
Sarah Mayhan, Lindsey Greene Vestal
Lindsey Greene Vestal 00:00 {teaser clip}
At your six week checkup, they're not even checking your pelvic floor muscles. They're checking that your uterus is closed and they're checking that your perineum, you know, isn't infected. The muscles are between those two places, and they're not checking what's in between. If someone you know, just basically hand waves you off and says that this is normal, you've had a baby, you know, don't accept that. They probably just don't know. So don't be afraid to be an advocate for yourself, get multiple opinions, talk to other people and know that there are always alternatives and things that you can do to empower yourself.
Sarah Mayhan 00:33
Welcome to another episode of the Poised, Powerful Parenting podcast. I'm your host, Sarah Mayhan, I coach movement, alignment and the empowerment that comes from understanding how your body works. This podcast is all about helping regular people adapt to the physical and emotional challenges of new parenthood, and hearing some good stories from people getting the Crash Course.
So I am very excited to have here on the mic in Paris. Yes, yes, in Paris, Lindsey Vestal. She's the founder of The Functional Pelvis, the first in-home pelvic health practice in New York City run by an occupational therapist. She has helped 1000s of people overcome chronic pelvic health challenges like incontinence and pelvic pain. Her goal is to empower women and men to listen to the wisdom of their own bodies without resorting to invasive surgeries or prescription drugs, so they can heal and get back to enjoying life again. She takes a different approach from other pelvic health experts, an approach we hope is becoming more common. She wants you to be the expert of your own body. And she also trains OTs to work in this mode of empowering people, and empowering them to understand and not be afraid of their own pelvises. Welcome, Lindsey.
Lindsey Greene Vestal 02:11
I love that introduction. That was spot on. Sarah, I am so honored to be here. I'm a big fan of your podcast. I most recently listened to the one called Pelvic Floor Myths Vs. Facts. And I highly encourage anyone if they haven't heard that episode, check it out, because I think it's a nice foundation and background to what we'll be talking about today.
Sarah Mayhan 02:32
Oh, yes. I love that. That was the one with Pelvic Organ Party. So that's Denise Gittens. She's in Canada. And so she's helping people learn about the pelvic floor through art and make it approachable and less scary, which is kind of what we're going to be talking about today. Because we want people to be less afraid of their pelvic floors.
And I was just talking about this because I was teaching an Alexander Technique group for pregnant folks. And we're kind of getting to the last class, you know, people were asking all kinds of different questions about their changing bodies. It's a really exciting time, I mean, really, every part of your body changes, there's no system that isn't affected by a pregnancy, we get to the pelvic floor. And there's just like a little bit, people were like, “I want to know some things about my pelvic floor. But I'm a little scared, I'm a little overwhelmed.”
So let's get started. If you're just wanting to start approaching your pelvic floor, start making friends with your pelvic floor. What is the pelvic floor? And why do I not need to be afraid of it?
Lindsey Greene Vestal 03:41
Beautiful question. I also want to say that I think it's such a natural time in a birthing person's life to even ask that question at that point. You know, in Manhattan where my private practice was, for eight years, that was the majority of our clientele was pre and postnatal people. And it's just such a natural time to want to meet your pelvic floor, and to get to know it. So I applaud that. It's my favorite. It's my favorite community to work with. So your pelvic floor, I really love to think about it for how it serves us. So it's function and the three main jobs of the pelvic floor are elimination. So that's urinating and bowel movements. And guess what? It's keeping it in, and it's getting it out completely. The second big job is sexuality. So being able to participate in intimacy, being able to find it pleasurable and achieve orgasm. And the third big job is organ protection and support our pelvic floor is part of our core, our core being. Its job is to keep everything stable and support it and really have it be able to be the platform to which we do all of our movements from.
So it's three huge jobs. And I think it's jobs that happen behind closed doors. So jobs we don't really talk about, it's jobs we don't really know much about. And I joke that when we don't really think about the pelvic floor until it bothers us, or until there's something that we have questions about, totally natural. But guess what, once you start asking those questions and thinking about it, if you're like me, you become obsessed in the most beautiful way possible, because you recognize just how much it adds to quality of life, both from a birthing person perspective, and also, someone going through puberty, someone going through perimenopause, it's it's the whole thing. It's a lifelong pursuit, that once we do become friends with it, and you don't have to geek out as much as maybe you and I do, Sarah, as long as you can befriend it and understand it and treat it well. That's enough. And that's a perfect way to honor it and serve it.
Sarah Mayhan 05:53
Yes. And really important to know that like, you know, this is a part of your life, people of all genders have a pelvic floor, it is a supportive structure to you. And you know, take take care of your pelvic floor, it will take care of you. I read somewhere that the number one reason people are put in nursing homes is due to continence issues, at least in this country. Because it's just very difficult to care for someone with those needs, if they're ongoing. So, you know, it's not just about like, getting your body back, or anything like that.
Lindsey Greene Vestal 06:29
The burden of care really escalates tremendously when you have an incontinent person and actually, that exact stat Sarah, that you shared was when I was in grad school, going to NYU for occupational therapy school, that stat is exactly one of the things that started to draw me down the rabbit hole of wanting to know more and more. And so originally, my intention was that I wanted to serve the elderly population, I wanted to try to help them get out of nursing homes, age in place, stay where they were, as long as they could to really empower them.
And then when I started my family 10 years ago, as the universe has it, right, I just started, everything started to become around the birthing person. And then all of my referrals were coming in from that way. And then ever since then, like, that's been it, because I've sort of taken this proactive approach of I still would love to serve the, you know, the elderly population, but I'm thinking, if we could go back in a woman's life or a birthing person's life, and actually serve them and empower them while they're pregnant, before they're pregnant after they're pregnant, could that change and that it does change the trajectory of their life so that the nursing home thing maybe doesn't even happen? it's not even linked to an incontinence issue.
Sarah Mayhan 07:39
To do that, we do have to tackle talking about some of these issues. I know I grew up in an abstinence-only education era, me too. And I grew up in the South. So there was just a little bit more a reluctance to talk about things like sex. If you're above the elementary school age, there's a reluctance to talk about, you know, bodily functions, people are very embarrassed. If they're not continent. There are these little jokes about “sneeze-pee” and trampolines. But that's not the same as having a really good in depth conversation about it. So I think the more we talk, the better.
So maybe you could talk a little bit about your own story, because I think that would help people maybe get away and in terms of making friends with their pelvic floor, in terms of why you decided to be an OT in this specialty, you know, and where are you unlearn some things, and then you had children, you gave birth, and we can kind of know things intellectually, and then even as professionals, and we still have so much more to learn. So I would just love to hear about that.
Lindsey Greene Vestal 08:52
So for me, it was even before I got into grad school, I was really drawn to topics that were not common dinner table conversations. I really like making things that are esoteric and potentially kind of taboo, more natural and easy to talk about. I was a technical writer before I went to OT school, and so I really enjoy breaking down information into a really digestible format. And then I was always drawn to the body. I was a choreographer for a while, and a performer and so I always felt really aligned with the body and thought I would always go to PT school. Well, while I was applying to PT, school or physical therapy school, my father became incontinent because he ended up getting bladder cancer and prostate cancer down the road. And he's a very outgoing, gregarious person, one of the biggest extroverts I know and I saw my father go from being this outlandish person involved in every board in his community to being really socially withdrawn. I mean, his quality of life just plummeted within a matter of months. And so I remember thinking that There's muscles down there, right? There's muscles and Dad, you just went through a knee replacement and you aced it like a pro, maybe we can rehab the muscles there that are causing you to leak urine and causing you to pee every 15 minutes. And so I looked into it, and I found him a pelvic floor therapist, and I mean, voila, it was - it was amazing. I got my dad back. So this was really fundamentally shifting for me.
I was job shadowing at a PT clinic in California, while my husband was finishing up his degree. And that particular day, the physical therapist called in sick, and so the director of the center said, “Hey, listen, it's great for you to know other disciplines. I'm going to have you shadow with an occupational therapist today.” And I was like, “I have no idea what that is. But I'm game, that's cool.” And this particular day, the OT was working on memory with a client who had been through a stroke. And I was like, what, “what is this form of rehab that can address the mind?” And then later, we took the session into the gym, and we addressed the body, I was like, this is everything this is this is the whole kit and caboodle. And right then and there, I became obsessed with occupational therapy, our background is in mental wellness. So I thought, okay, if I am looking towards a therapy program, that's going to take care of a part of the body that is so intrinsically connected to our core being and to vulnerability and to a taboo conversation, I want that mental wellness aspect, so that I can really make my client feel comfortable. So I dropped my PT applications, I withdrew them, I applied to OT school.
And you know, here we are today, and I'm in a very privileged position where I am now helping other occupational therapists get into this field because you know, it's, it's still an emerging field of practice, I would say it's about 30, or 35 years old, which isn't that old. In the grand scheme of things. You know, OTs are really uniquely suited to do this profession. And so I love empowering OTS to realize it's even an option for us, and to let them know just how incredibly rewarding this field is, as well as continuing to educate the public, I have an online course called key goals that work that with the same name, www.KegelsThatwork.com - where I'm teaching the public how to identify if Kegels are right for them. We haven't segwayed into that, so forgive me for jumping ahead here.
But just in terms of empowering and myth-busting and trying to get the information out there, that our pelvic floors are part of our body and a system to be honored. Taking that into our own hands and recognizing that we actually can figure this out for ourselves in our own time. And it's actually the most beautiful way to do it. I mean, here I am a pelvic floor therapist telling you that you know, you can do this, but it's true. Actually, our whole philosophy is that the more you can do yourself and own this material, it's a little bit akin to me teaching you how to fish versus serving you a meal. And as an occupational therapist, we always want to teach you how to fish.
Sarah Mayhan 12:54
Mm hmm. I love that. I love that because I'm an Alexander Technique teacher, we come at the improving people's lives from a sort of similar vibe. I don't want to be the expert, where I'm in charge, and I'm doing everything to you. Right, I want to help you have some alignment and movement that feels more comfortable for you. So that you get to be the expert in your own body. And you get to be used to checking in with yourself and incorporating these things into your everyday life. A lot of people out there might no not know about OTS. I think the first time I learned about OTs - my sister is on the autism spectrum. OTs have a really wide scope of practice, in terms of helping people become more comfortable and doing a lot of their daily activities, you know, so if you're on the autism spectrum, you can have some coordination issues, but also just need that greater support of step by step, how to do an activity. And I think this is a really great place for us to talk about, you know, both of us, we love helping people do their daily activities a little bit more easily. So like, where could a person start in their everyday life? Maybe showing some love to their pelvic floor just as part of everyday living? Let's start there.
Lindsey Greene Vestal 14:18
Yeah, well, first of all, I have to say just how much I love the Alexander Technique. It's one of the ways we found each other, you have an amazing blog, and just the work that you do is incredible. And I've taken years of Alexander training and I feel very aligned to it. I think OTs and Alexander Technique go hand in hand beautifully. Again, bringing it back to that daily function, those activities of daily living.
So one of the ways that I think that without even you know getting too heavy or geeky about it, is we can simply be a little bit more mindful when it comes to going to the bathroom. So remember those three jobs that we talked about elimination, intimacy, and organ protection. I think the easiest, most approachable for most of us is just elimination. Right, so if we're not pregnant and we're not over 60, the optimal is to pee six to eight times in a 24-hour period. Okay, so some of us pee less, some of us pee more. And that's part of why you would go to a pelvic floor therapist, but the optimum is six to eight.
Where things can become a little bit non optimal would be if we are so present and conscientious around our decisions about, let's say, peeing. So living in New York City, like I did, for 12 years where my private practice was started before moving to Paris, it was very common for people to pee before they left the house. In New York City, it’s not the cleanest place to use the bathroom, if you even have the opportunity to access one. So very often, before you even had an urge, it was common just to pee before you left the house. This, again, is getting away from mindfulness because we are overriding that communication between the brain and the bladder, we're saying, hey, you know, I need to go now. And you know, the brain is so adaptable, it's got our back, it wants to support us. So while we might do that one or two, or even 15 times, that won't really affect us. But let's say that's our norm over the years, and it does, I have 1000s of clients that that is their norm, what happens is it rewires the brain to bladder communication, so that brain starts to go, okay, so instead of being able to accommodate 400 milliliters of fluid, Oh, you want me to alert you when I've only had 15, or 20 milliliters in there, right? A much smaller amount. And that's because you were starting to pee at those intervals when your bladder wasn't completely filled. And those stretch receptors had a chance to alert the brain to what was going on.
So we have these mindless habits, that out of convenience we give into. And that really does start to affect our quality of life and our pelvic floor's ability to support us, because now it's not able to get that signal as efficiently, it's not able to do its job of supporting that bladder, right. So now it's working less. And so which starts to change the whole system. And then sometimes people can become one of those people who may not take car rides, or maybe don't want to sit through a two hour movie because they're having to pee really often. So I would say just simply starting with mindfulness around an authentic urge is what I call it. So when you actually need to pee versus going out of convenience is a great way to start.
One other quick thing in case that doesn't resonate with your listeners would be: we should not require any effort to start our urine stream. So urination is actually an act of relaxation, as well as having a bowel movement, as well as actually believe it or not, from a pelvic floor standpoint, delivering a baby, which means our pelvic floor and our sphincters shouldn't be closing, they should actually be relaxing. And when we use effort to - we call it, like “power peeing” - pushing that pee out; starting that pee, if we do that, with effort, the pelvic floor is actually tightening and closing, which physiologically is the opposite of what we want to happen. So over time, again, that starts to rewire coordination, and our body and our abdominal muscles, which is part of our pelvic floor, part of that larger system of even our breath and our diaphragm, it starts to get rewired and coordination tends to get off, and then we start to see problems down the road. So if we could just start with being mindful with peeing, and those two examples I just gave, that would be amazing.
Sarah Mayhan 18:35
You've made me think of so many things. One is, you know, I think we both have a little bit of performance background. And I know that like right before the curtain was about to rise, you'd have people be like, “oh, I need to pee again, I'm so nervous!” Now I know what I would recommend in that situation is, okay, well, let's maybe pause, maybe find your feet on the ground, wiggle your toes, see if you can calm your breathing a little bit. But that tie of the pelvic floor to anxiety to that need to pee: those things are intertwined. So something to pay attention to. If you're finding, like, “Oh, I'm anxious, I need to pee.” We think of that as really normal. It is normal. I guess it's a responsive action. But I do think that's a place to bring some mindfulness.
Lindsey Greene Vestal 19:22
I love that example.
Sarah Mayhan 19:23
I think most of us relate. We talk a lot about in Alexander Technique - we talk a lot about what we're not doing and a lot about how we're not adding extra force. And it is really challenging either when you're, you know, say you're pregnant, and you've already got a toddler. They're in the bathroom, they're out the door, they’re “mommy I need a sandwich!” to not try to pee as quickly as possible. Or when you, you know you have this crying newborn. I know mine cried every time I sat him down. So you're trying to pee quickly, “baby I want to get back to you”. So this is not just muscles. There's some emotion here.
Lindsey Greene Vestal 20:01
And you can see why to approach the pelvic floor from a purely physical standpoint. If you go to a physical or an occupational therapist who says, You know what, we're going to do a bunch of clam shells, we're going to do a bunch of Kegels, maybe we'll do a little bit of core work, and they base it purely from a strength based protocol, I would caution you to get a little bit of curious around that. And to potentially go, I'm not so sure you're the right therapist for me, because we know that innately based on exactly what you're sharing, Sara, that there's so much of our core being, our nervous system response, that's intrinsically connected to pelvic floor function. And if we just assess it in that one dimensional way, from a physicality standpoint, we're really missing the mark. So we really want to go to someone who thinks a bit more big picture, a bit more holistic, and is thinking about everyday life and function, and not just taking a set of beautiful, you know, leg slides and saying, that's enough, because it just, it just isn't.
Sarah Mayhan 21:01
I mean, it's a very close relationship that you would have with a pelvic floor therapist, or an occupational therapist who does pelvic floor. And I think a lot of people think that because of this causes some people anxiety, there is some internal work. And people are anxious about that. But I think as well, just that emotional piece, you know, that understanding of your life, and you know, you're sharing this with somebody. How can people find the right therapist for them?
Lindsey Greene Vestal 21:30
So here's the thing, we don't have to do internal work. And in fact, the longer I'm in this work, to be honest with you, the less I find it necessary, especially if there's been a bit of trauma, or you know, anything like that there's so much external work we can do. And there's so much mindfulness and behavioral work that we can do, there's so much about habits and routines that are really intertwined with the pelvic floor, that education goes so far, and honestly, just being heard going to someone who really stops and listens to you, you know, in my private practice, we would spend 90 minutes with you for the balance 60 minutes for the treatment. I mean, we have time with you, we were available between appointments, and all of that goes so far, because you really feel understood. So many people are told, especially if they have pelvic pain, you know, intimacy issues, like oh, just go have another glass of wine, right, and that's dismissal at its finest. And so if we, if we're in a situation where we're giving eye contact, and we feel that therapeutic rapport building, sometimes internal work is not even necessary. So I would say that if you go to someone who thinks that's the only trick up their sleeve, you know - run away, because there's so, so many other more nuanced, and I want to say even sophisticated things that you can do, that don't involve internal work.
Now, let's say you do want internal work, or you feel like that's the next step in your process, it can be extremely helpful, because it does give us a real finesse or finessed understanding of the coordination of the muscles, there's actually 14 muscles in our pelvic floor. So some of them could be kind of overactive. Some of them could be underactive, so an internal exam really does give us an amazing view of what's happening. And I would say that you are the expert of your body, and you get to call the shots. So maybe you're at your fourth session, and your first three, you weren't ready, and you're ready at your fourth, speak up, let your therapist know. So you asked how to find the right therapist. And honestly, the right therapist is the one that's going to listen to you and that he sees you as the expert. So I would say that if there's no one else in your area, because sometimes people live in an area where maybe their closest one is two hours away, and they went to this person. And let's say it just was lackluster. Well, guess what? Through COVID, we've gotten really good at virtual services. I even do Alexander Technique virtually right now, because there's not anyone near me in Paris. So like you can pretty much you can do a lot virtually. I would say that you can go to a pelvic floor therapist, virtually someone that really can meet your needs and hears you.
Sarah Mayhan 24:07
There’s so so much in that, especially if person has a history of trauma - which sometimes that can be present with pelvic floor issues, sexual assault, sexual trauma, birth trauma -having that power, come back to you. Yes. Really super important. I also know that both me and my husband who had pelvic floor therapy, being taught how to do some of the internal work ourselves, that was really key, both for just being able to know what was going on. It is empowering. And I know..like, after birth, I had a tear. So doing that internal work myself. I do know it got me less afraid that my vagina was gonna rip in half. Which it's not going to do. It just feels like when you're coming back to sex after having a baby. Sometimes you have that feeling. Again, there's emotions, there's tensions, there's extra stuff coming along for the ride,
Lindsey Greene Vestal 25:08
I'm so glad your pelvic floor therapist included that extra component of being able to carry the work onward out on your own. A good pelvic floor therapist will invite the partner in, if you know that is, of course, what you as the client wants that to happen. And that way it can really be turned over to you guys as a family or as an individual. Because again, our whole inspiration is to have you own this material and really embody yourself and you do that not by being done to but being taught how to live in this body that you have. Because maybe you grew up in a place where abstinence was a sex education, maybe you grew up in a place where you just didn't talk about that part of the body. And you know, that's really common. With all of that, you know, you really do want to be able to own this material and feel at ease with it and comfortable with it.
Sarah Mayhan 25:54
Mm hmm. Yeah, safety is such a big part. I mean, it's so intertwined with a lot of pelvic floor stuff. Because, you know, I tell this to people all the time, like, of course, you can't just relax. People think that, oh, I should be able to just relax or relaxing is good - or sometimes, releasing tension doesn't feel safe. And sometimes having tension is sort of, you're trying to keep yourself safe. That's right. And so that's just really important to recognize now when it comes to birth.
Now, here's one thing just because you've talked about passage outward. I've heard people say they want a strong pelvic floor so they can push their baby out. Tell us, maybe that's not quite the thing.
Lindsey Greene Vestal 26:39
So here's the thing, the vagina does not push the baby out, the uterus pushes the baby out. So if you have an overactive, strong, tight, pelvic floor - remember how I talked about you know, when we urinate or have a bowel movement, the pelvic floor needs to be able to relax? Well, if you have one that likes to live in that tight place, that place where maybe it's not so buoyant and responsive, when the baby comes out, and there's a lot of feelings of vulnerability when you're giving birth to a baby. And there's a lot of things that could be happening in the environment that could be contributing to this. But if our pelvic floor doesn't know how to yield, if it's not something we've practiced or familiar with, you know, giving birth is not the most optimal time to practice this new skill.
Sarah Mayhan 27:25
Yeah, it's advanced level, yeah, totally, is always to work in application. Birth is kind of like an Olympic sport, however you do it, it is top level.
Lindsey Greene Vestal 27:36
Yes. So we actually gave birth in rehearsals, and in my private practice, where we would practice like the more optimal muscles to use. So you actually want the pelvic floor to relax, and you let your abdomen and your uterus do the job, so that the baby can come out with ease. It's this beautiful companionship of higher up, the baby being pushed out, and then the doors open and relaxed. And that means we're not only we're less likely to tear, we're less likely to have trauma. So I would say that working at full range of motion, working for coordination, buoyancy responsiveness are actually the vocabulary I would rather love to hear. When it comes to preparing for birth rather than “tight.”
I mean, tight is just you know, you can be tight and and weak. Because when you're tight - so, I want everyone who's listening to kind of like, make a bicep curl, right. So I've got my palm and my hand up at my ear. Let's say, I'm showing Sarah my beautiful bicep right now. So now I just want you to kind of contract like couple centimeters at a time. So you're not bringing your hand all the way down to your waist, you're just staying there. Okay? This is what you would be doing if you had a overactive or a tight pelvic floor every time you Kegeled, you would be moving in this short, tight range, meaning you're restricting blood flow further, and you're not going to change the tone, you're not going to change the aesthetic of that muscle. In fact, you're just going to bind it down more, right?
We really want a pelvic floor - and actually, every muscle in our body - one that can can tighten and can come up like a bicep curl, but can also relax, be able to be capable of all of those ranges of motion, you know, so when we step off a curb, you don't want a pelvic floor that's taut and overactive. Because you might leak urine in that moment, you want one that can kind of soften for a moment, collect itself and then come back up, right? And so that buoyancy and that responsiveness is really what we're after. And that would be optimal for birth, after birth, before birth, and anytime across the lifespan.
Sarah Mayhan 29:39
Here's a question from a listener, which is: “how do you know if your pelvic floor needs to be stronger, more relaxed, or both?” I think we know we need some or both.
Lindsey Greene Vestal 29:51
We definitely need some of both. You know it's not something I can really, you know, completely answer on an audio based you know, podcast but you know, I'm going to try it: doing your own exam. And this could be just external sorry to bring it back up again. But really that Kegels That Work class that I said earlier teaches you exactly how to do it, I give you internal and external ways. So basically, it's things like sitting on a couple yoga blocks and taking a strap that you wrap up so that it's, you know, kind of maybe just like the length of the length of a ruler. And so you're sitting with it lengthwise, almost like a bicycle seat on top of the yoga blocks. You can even do this on a couch if the couch is firm. And with that strap there, I want you to try to try to lift away from the strap. And then I want you to try to soften into the strap, almost like bulge into the strap. And you're paying attention to which is easier for you, which do you do with greater ease? And which are you kind of like: I'm not even sure.
And also, the more basic question beyond that is even can I tell which way I'm moving? Can I even tell what lifting away feels like from a strap that would be akin to a kegel? Can I tell what it feels like to even soften into the strap? That would be relaxation. So number one: can you sense that those are the two movements, one goes towards the head, one goes towards the feet? And then which is easier for you to do?
So this is a great starting place just to see and get a sense of whether you're overactive or underactive, and I think most people assume they're underactive, and they need to tighten. And the reality is, everyone's an individual, we don't really know. But I would actually tell you that in my private practice, the majority of our clients, even if they were leaking urine, even if they were peeing constantly, which we automatically just assume it means that we're underactive, and we need to tighten. The reality was once I did an evaluation with them, they were actually overactive. They were to quote unquote, tight, which meant they were actually weak, because they weren't capable, that full range of motion and that buoyancy. And that's not a strong muscle, that's not one that can fully support us, let's say in a functional task of, like, stepping off of a curb or something like that, where the muscle needs to be accommodating in that moment.
Sarah Mayhan 32:06
And also noted, the pelvic floor isn't just one muscle, it's multiple, we're not all exactly symmetrical. We're going to have some your resources linked in the comments. So I think just that first step is going to be to tune in. If you know, like me, you first learned to do Kegels at 19, from reading Cosmopolitan, maybe you can check out some of Lindsay's resources, and just be able to learn a little bit more to check in a little bit more clearly. You know, obviously, it’s great to see a professional.
Lindsey and I, we could nerd out all day on the pelvic floor. But she's a busy lady. I just wanted to thank you for your time. If you have anything else you wanted to add that we didn't get to touch on, feel free to share.
Lindsey Greene Vestal 32:54
I would say that - don't accept that intimacy should be painful. If it is, it means that it needs your attention. It's asking for your attention. So it's not quote unquote, “optimal” or, you know, “normal” to feel pain with intimacy. So don't accept that. Also don't accept that leaking is inevitable after you have a baby or at any point in your life. These are, again, are taboo topics that most of our you know, most respected practitioners, our general practitioner or OBGYN, our midwives, whomever you have served you well through many periods of your life, let's face it, this is not covered in their degrees, right, this is a very specialized area of practice, a urogynecologist - which is not a gynecologist, it's a combination of being a urologist, and a gynecologist - does have exposure to the muscles when they're in school, it's one of the only practices out there that do.
So if someone you know, just basically hand waves you off and says that this is normal, you've had a baby, you know, don't accept that, they probably just don't know. Because again, this is a pretty new and emerging field of practice. And we're really starting to understand it. And we're learning more and more all the time. So don't be afraid to be an advocate for yourself, get multiple opinions, talk to other people and know that there are always alternatives and things that you can do to empower yourself.
Sarah Mayhan 34:18
Oh, that's a strong point to end on. I think a lot of people think, especially if they do their six week postpartum checkup, that, “Oh, my doctor will tell me if there's something wrong with my pelvic floor.” That is not the case. You know, I just want to nudge you to not put it on somebody else to tell you that there's a problem that needs to be fixed. We should examine, you know, I think we valorize suffering for motherhood in our culture, which is American culture. And I just just want to just ask the question, you know, are there things you could be enjoying more you deserve to enjoy your life? Yes!
Lindsey Greene Vestal 34:56
That's so beautifully said. And I just want to add to that very quickly, that at your six week checkup, they're not even checking your pelvic floor muscles. They're checking that your uterus is closed and they're checking that your perineum, you know, isn't infected. The muscles are between those two places, those 14 Beautiful muscles that contribute to everything we've talked about today are between those two areas that they're checking, and they're not checking what's in between.
Sarah Mayhan 35:20
If you even come away with that takeaway, again, there's just so much we don't know, unless somebody tells us, but we hope that you're going to learn more and it's going to be as rewarding as we think it is. Lindsey, thank you so much for your time today. I really do appreciate it.
Lindsey Greene Vestal 35:37
Oh my gosh, oh, the pleasure is mine. Again, I love everything you're putting out there in the world. It's such beautifully empowering information for parents everywhere. I could talk about this with you all day. So thank you for giving me the opportunity to share this information.