Part 1 of 2: Pelvic Floor Physical Therapy- It’s for Everyone! with Dr. Aakriti Agrawal

[00:00:02] What you want, when you want it, where you want it. This is The MESH. Hey everybody and welcome to part one of our podcast with Dr. Acrete. We went everywhere with this one. So let's jump into part one and I'll see you back for part two.

[00:00:23] Hey everybody and welcome back to another episode of Healthy AF. I am so actually excited. You know, we've been doing these smaller little snippet podcasts which has been fabulous and I have loved it. But if you didn't know Healthy AF is healthy, Amy and friends.

[00:00:43] And I've had no friends and that's a big part of our healthy living. And so I'm so excited today to have a friend on. It's Dr. Acrete from Hickory, North Carolina. Dr. Acrete, thank you so much for being here. Yeah, thanks for having me. I'm excited.

[00:01:00] Me too. When I first started stalking you on social media and looking through all of your reels, actually, you've got some really great information on there. I was excited and also like a little intimidated, not going to lie.

[00:01:21] I was like, oh, this girl is like she's kind of going on there. So I'm super excited to dive in. I want to give our listeners a heads up so they know what this podcast or where this podcast might go.

[00:01:36] Can you just describe for me really quick, sort of what your professional title is, what you do in a nutshell? Yeah, so I am a doctorate of physical therapy with a specialization in the pelvic floor.

[00:01:56] Okay, yeah. And God bless you because I've talked about it before on the podcast. I love my pelvic floor. I've done a lot of pelvic floor work. It was really, really life changing for me and not everybody talks about it.

[00:02:15] And so people still don't know. I mean, I started physical therapy for my pelvic floor in 2016. So, you know, it's been eight years, but still people do not know. And we don't know as women what's normal and what is not normal.

[00:02:30] And so I am super excited just to have you in the world. Thank you. You know, for just being so forward and straight about something that's really important. Someone has to be.

[00:02:44] No one else, no one will know what is okay, what's not okay, what's normal, what's not normal. Unless someone's not afraid to talk about it out in the open. Yes, yes, it's so true. I actually just, side note, I did a program for my church's youth group.

[00:03:07] And it was an exercise program because you know that's my jam. And I was telling, you know, when you're going to exercise, you need to check in with your body. Like did you get enough sleep? Have you eaten? And I just spilled it right out there purposefully.

[00:03:19] To our middle school and young high schoolers, are you getting ready to start your period? Because we've got to start talking about, it's not sexual health. It's our sexual health and it's important.

[00:03:36] And then you got all the urinary and all the hip and all the low back and all the, you know, that kind of function too. So before I get ahead because I get so, I really am so excited to have you here.

[00:03:50] I'm just going to ask you, tell us your story, Brene Brownstile. Okay. All right. So my story can go many different directions, but basically what brought me here is I am an immigrant from India. I grew up in Cary, North Carolina.

[00:04:12] And I had my whole health journey myself with chronic pain, low back pain, anxiety, mental health struggles, all of that. And I found movement and fitness and moving my body as a way of healing. And that's what got me into looking into physical therapy as a profession,

[00:04:36] because I loved the chronic pain aspect of pelvic health and physical therapy, actually physical therapy before pelvic health. And then in college, I was a sex educator and I got a grant from Trojan.

[00:04:52] I got like 500 condoms shipped to me and I would like pass out condoms and be like, all right, let's talk about safe sex and make sure you protect yourself. And I told that story in a PT school interview and they were like,

[00:05:06] have you heard of pelvic health and woman's health? I don't love the term woman's health because everyone has a pelvis. So I like to say pelvic health instead. And I was like, no, tell me more. And as I started learning about this, everything clicked and fell into place.

[00:05:24] I was like, oh, it makes sense. What I was learning made sense. It was a missing piece in my life because I harbored a lot of anger, resentment, and just like rage about how women were treated in our society, in our culture, and in our world.

[00:05:44] And it just made me so mad, but I didn't have an outlet. And then I found pelvic health and I'm like, oh, so we don't need to suffer. We don't need to be in pain all our lives. We don't need to pee our pants.

[00:05:56] Pregnancy and birthing and postpartum can be actually a wonderful experience if you know how to work with a body. And I basically channeled my rage into education and becoming into this profession. And I love it. Oh, wow. That's just so much. Okay.

[00:06:18] Let me, let me, I don't even know where I started. I still, I feel like I'm a kid. Like tell me more. So you went from sexual health educator, which is great. And then right into women's health, pelvic health, you know, and really discovered where you had that.

[00:06:39] I wonder, I'm just thinking about rage and anger. Yeah. And how it can really, I just heard this past week that when we listen to it, it can push us into some new discoveries about what is not okay with us.

[00:06:59] Usually there's a spot in our lives that something is not okay. And we haven't taken care of that. We're tolerating it. So tell me what about, how do I want to say this? What about pelvic health and our societies is not okay with you? Oh man, everything.

[00:07:29] Well, let's go on a tangent on that topic. It's how we shame women's bodies when we have a pregnancy, when we give birth, when we're postpartum. It's how we gaslight women's pain. Like, oh, like it's just your period. Oh, you're just pregnant. Like, oh, you just gave birth.

[00:07:48] You're supposed to not feel okay. You're supposed to be in pain. So, oh, like you're in pain. Of course it's not like something life-threatening or like endometriosis. It's just, you know, you're supposed to have pain under cycles. Like no, one in 10 women or, excuse me,

[00:08:04] people with a pelvis have endometriosis. Like that is your pain. And it's not something that's normal. So I think it's all the things we normalize about what women go through that makes me so mad. It's like the amount of women who like laugh or jump

[00:08:25] and are like, oh, LOL, I just like peed a little bit. And I'm like, no, you don't need to. That's like, you don't have to do that. Like you don't have to pee your pants. And so I think it's just like the normalization

[00:08:38] of all the things that are not normal that make me really, really mad. Yeah, they send you through the roof. Okay, so let's, maybe it would be fun if we played this game where we toss back and forth some situations

[00:08:53] that we hear our clients because A, I've lived it and B, you know, I coach around it around things that society tells us are normal. Yeah, is it okay if I interrupt one second? Free range, free range. Okay. Let's go. To clarify when I say women,

[00:09:16] I am talking about people with a uterus because not everyone with a uterus will identify as a woman, but with our conversation, I just want to make that distinction because it's just a little bit easier in our conversation to say a woman, man.

[00:09:31] But what I really mean is someone with a uterus. Okay, I love that. And so just for clarity sake, when we use the word woman, we're talking about uterus carrying people. Yes. Lajona CEO. No uterus carrying people. Yes. Okay, cool. All right, just for ease.

[00:09:53] Thank you for that clarification. Okay, so yeah, we'll say, can I go first because you're going to know more than I will. You might have to do two for each of my one. Okay, so I'll just start with like,

[00:10:06] yeah, it's normal to dribble a little bit when I laugh, sneeze or jump. No, it's not true at all. Not true. It's normal to have pain the first time you have sex. It is not. Not true. No. It's normal as I age that I can't trust a fart.

[00:10:36] It's normal as you progress through your pregnancy to have like low back pain, SI joint pain, like abdominal pain. It's not. I like to say that when you're experiencing pain with pregnancy, it's your baby trying to tell you something

[00:10:51] that there's some restriction in the body that it wants to be addressed. Oh, I love that. Okay, so I'll say, oh, I had a good one. Oh, it's normal to have to be in the bed for a couple days with your period. No. Gosh. Gosh.

[00:11:15] That helps her so much. It's normal to feel like something's falling out of your vagina when you lift something heavy. Yeah, yeah, that's a good one. Here's one. It's normal to always tear with pregnancy and with labor. Nope, nope, nope. Let's see.

[00:11:41] It's normal to have tailbone pain when you sit down. Yeah. Okay, this is the last one I think I can come up with. But if you're peeing in your pants, you can just do kegels. Oh God, no. I'm wondering how that would get you. Stop doing those kegels.

[00:12:05] Especially half the people don't do it right. But also it's not necessary. It's normal to whenever you get a slight urge to pee, you have to rush to the bathroom. Oh girl. No. I love it. I love it.

[00:12:23] Okay, so we've just done a really nice job of saying all the stuff that as uterus carrying people we hear all the time. And as non-uterus carrying people, I think sometimes we hear that too. Like I know a lot of my boyfriends, you can't trust fart.

[00:12:46] Well, there's something we maybe could do about that. Yeah, I got really excited when I went to one of my guy friend's house and he had a squatty potty. I was like, I'm so proud of you. Yes.

[00:13:02] In fact, I have one in my house and I have two bathrooms. And my daughter, my oldest daughter just moved back in with me. And she's like, one day I found the squatty potty in her room.

[00:13:14] And I'm like, you better bring that back because your mama does not poop with that. And even in public bathrooms, you think I won't find a trash can to put my feet on? Oh, you bet your sweet Fanny I will.

[00:13:25] A trash can, a baseboard, a toilet, a scrubber holder. This girl will be putting her feet up. Exactly. It's the worst when you're traveling. First of all, when you travel, your bowel movements get a little weird anyways because of the change in schedule.

[00:13:43] And then all these hotel and Airbnb toilets are so high. I am five foot tall, barely. My legs are dangling on a toilet. I'm like, oh my God, it's so bad. I love that. I'm five four. And I've noticed that the potties are tall.

[00:14:03] Like everything just kind of got bigger. If you go into a house with original fixtures built in like 58, it's perfect for a person my size. Yeah. Mine's 59, in fact 1959 and the toilets are almost just right. Yes, almost. Okay. I love that.

[00:14:20] So out of all those things that we listed that are common misconceptions, what are maybe the top two or three that you cannot leave this podcast without us talking about bringing awareness to talking about treatments for diagnostic stuff? Where do you want to go? Pick three. Yeah.

[00:14:46] So the most common that I hear like that almost every single one of my clients have is definitely their urinary urgency. Having to go to the bathroom all the time. And then another one is just like peeing your pants a little bit with exercise

[00:15:04] or with cough sneeze jump laugh. And then the third thing is pain with sex. Yeah, those are the biggest things. I also like to practice that I do treat all genders and all ages, even though we're kind of talking about a specific population right now,

[00:15:22] I'll see children who have bedwetting issues or constipation. I'll see men who like people with penises who have had a prostatectomy and they're peeing their pants or they're having like a lot of urinary issues and they'll be young and have testicular penile pain.

[00:15:41] So I do like to say like pelvic health is very all-inclusive. I love that. I've never thought about clearly there's a reason why I've never thought about testicular pain. I never thought about that. I actually have a lot of clients who struggle with penile and testicular pain. Really?

[00:16:02] Okay, so I'm just going to jump over there. Okay, because that's so shocking to me. I've never even thought about that. What are the common causes for testicular and penile pain? Yeah, so one of the things I see often is like, hey, maybe you have a fall,

[00:16:23] like an injury, right? Falling, playing sports or falling off a ladder. And there may have been some compression, something happening because there's a lot of blood vessels, nerves, fascia in that area and nerves that innervate the penile, base of the penis and testicles, all of that.

[00:16:39] And so that can happen. Another thing is they may genuinely had an infection like prostatitis, epididymitis. But infection may have gone away, but they're still having that pain because those pelvic floor muscles are still heightened and they're still active and too tight.

[00:16:59] And so those are the two main things and main reasons. I see a couple other things could be like diet or food. Maybe they'll have some bladder irritants as well. That can be a cause. Chronic low back pain can definitely spread into the pelvic floor area

[00:17:21] because a lot of people who have low back pain also have some sort of pelvic floor dysfunction involved with it. Okay, so I'm just itching a little bit to tell you my story. I don't know if you've ever heard of it. No, I haven't.

[00:17:36] So I would love to hear. Okay, so this is the reason I'm passionate about pelvic floor. Okay? And if you've ever taken, you haven't because I would know if you had taken a CrossFit class with me. But if you've ever taken a CrossFit class with me,

[00:17:50] a lot of times I talk about like doing some work that helps support our pelvic health, you know, whether it's that breathing, you know, it's very common for me to lay my people out on the floor and say, oh, I'm going to do this.

[00:18:05] Lay my people out on the floor and say, okay, we're going to do our abdominal breathing. We're going to do our external oblique opener. We're going to, you know, all these things that are good for our pelvis.

[00:18:15] So in 2010, I was dead lifting a very lightweight on a warm up and hurt a pop and started the low back pain journey. Right? It took me a couple years to be diagnosed properly that my I had an anteriorly rotated pelvis

[00:18:35] and I needed to do physical therapy for that. So I started doing physical therapy for that. Solved the low back pain pretty much, but it was always sort of like in the gym, out of the gym three weeks on two weeks out,

[00:18:48] you know, like this constant catching up and I was constantly having to readjust that pelvis. Right? Like with the active, I think it's called active release. Is that right? Anyway, so I'm doing that. I'm doing all kinds of things for my back,

[00:19:07] which said, you know, bulging disc L4, L5. And then finally in 2016, I went to a weight lifting certification and it just happened to be that some physical therapists were taking it. And we had all been yucking it up about me peeing

[00:19:26] in my pants and telling stories and you know, that's so funny. And then I said to one of them, hey, can you just pull my leg because I can tell my pelvis is rotated and I just, can you just help me? And they said, have you ever thought

[00:19:41] that you have pelvic floor dysfunction? And I said, nope, because I don't know what that is. Wow. Six years later too. And I can't tell you, I had the time, I was a stay at home mom. So I had, I had my daytime.

[00:19:59] Now I didn't have morning time, morning time and after three is like a little long, but you know, like midday I had time. I had the time and at the time I had the income to spend a lot of money and a lot of time.

[00:20:14] And frankly, I was in a lot of pain. So I had the stimulus to be very consistent on acupuncture, massage, physical therapy, chiropractic care, like this girl did it, right? And it took six years. And so then I started going to Asheville two

[00:20:35] to three times a week because there was nobody in Hickory. Oh my goodness. That's why some time and some money. And I stopped lifting. I stopped basically everything in the CrossFit for a while, while I just focused in on this.

[00:20:52] And the most beautiful thing was that when I got up there, pre that I had been in Hickory at a doctor's office, at the only doctor that would treat anything like this. And they did the feedback where they stuck a probe

[00:21:07] in my vagina and a probe in my anus and like had me clamp down and what I know, clamp down and watch that muscular contraction and the fatigue and like I get all that. It did not help my pain.

[00:21:20] Now, at this time, I had noticed, you know, double unders where the rope goes under your feet twice when you jump. There were some places in the gym that I would typically leak. I typically did not leak when I was jumping on a box

[00:21:38] when I was jumping anything other than like double unders. And with double unders to get the coordination to do the double under, I had to relax. Well, what I found is I used to maybe lose a little bit of control like maybe 20.

[00:21:57] But then it got to where I lost a little bit of control at 12, but by 20, it was just running down my legs. And I was just letting it because, you know, at that point I was like, you know, I'm going to head straight home for a shower

[00:22:13] unless I'm going to the store after my workout. I'm just going to pee. It's not a big deal. That's where I was. And then one day I was teaching a class and I had demonstrated some pull-ups and I dropped down off the bar

[00:22:30] and just that little inch of a drop, I peed myself. And I was like, okay, this is not okay. So I had that going on with my urinary and I had that other going on with my low back and my pelvis.

[00:22:46] Did not know that the two were in cahoots, right? And didn't know that pelvic floor physical therapy could help me solve all of that. So the first thing they taught me up in Asheville is how to sit down on the toilet and pee.

[00:23:08] They told me to stop all this preemptive peeing. Now I was, you know, Asheville to Hickory, it took me about an hour and 15 minutes to get from. And I used to stop on the in-between. Yeah, just in case. Yep. It almost gets me teared up thinking about it

[00:23:30] because you do all these things to take care of this irritation, inconvenience and you don't even know how much of your life and energy and stress you're putting on managing this incontinence and or pain. Constant, it's constantly in the back of your mind

[00:23:57] and never leaves and it's running your life and you basically have lost your freedom and your autonomy. Yeah, I mean, when you're still, it was handy, I knew what all the rest stops for. So the first thing they told me was like,

[00:24:15] hey, you know, when you go into the CrossFit gym and you go pee and then you warm up and then you go pee and then you've got to work out again. So you go pee get just in case. They're like, no, no,

[00:24:28] you're teaching your bladder never to hold anything. You know, you've never, you know, you're never practicing. And when they told me, they actually told me, you know, I should be peeing for a certain amount of time to start timing my peas. Wow, life changing.

[00:24:44] When they taught me how to sit on the potty and how to relax. And I'll tell you what, this is one that always amazes me. She said, okay, at the end of your pee, just give yourself a big, ah. And every time I do that,

[00:25:04] I have a little more come out, you know, it's like, I just have to relax. And from the life I was living and the go-go-go and the, you know, I didn't ever relax and pee half the time. And especially as my background as a nurse at the hospital,

[00:25:22] you don't sit down and have a pee. You sit down and force that pee out as fast as you can because you've got some other people waiting on you. No, no, we need to stop this. Right? And so just down to that, when I started learning

[00:25:37] how to not pee, just, you know, preemptive, just in case pee, to breathe while I was sitting on the toilet, to sit on the toilet properly, you know, squatty potty style. So many of my incontinence issues disappeared. And after doing about six months of physical therapy

[00:26:00] with my Pellis practitioners up in Asheville, I could do 50 double unders, completely dry. I could sneeze and cough without moving to the side, without doing the little, you know, inconspicuous lean. No, I could stand fully straight up and I could sneeze and not dribble.

[00:26:22] And I'll tell you what had me spend the time, money and energy on that. It was that I'd heard, and you can tell me if this is right or not, I had heard a statistic that said like, out of so many people who have urinary incontinence,

[00:26:38] there are those people, good percent, who as they age also have fecal incontinence. And I said, thank you, no. I will be working on this at 45 so that at 75 I'm not farting myself and having an accident because nobody wants that. And it is not normal.

[00:26:57] It is not normal. Nope. Yeah, so that's where I come from. And that's why I'm so excited that you're here. And I think that what you're going to say, and I've had three natural births by the way, and I did tear every single time, but it's okay.

[00:27:16] And I think that what you're going to say is that my story is a common story that you hear all the time. Every single, almost every single one of my clients, 100%. And I really appreciate you being vulnerable and sharing that story because the more times

[00:27:35] people like you will share their story, someone else will hear that and think, oh, I don't have to live like this. It takes all of us sharing our story so other people can learn and hear. And no, they're not alone because every single one of my clients

[00:27:54] who have such a similar story as you, they think they're crazy. They do. They think I must be the only one dealing with this. I am so embarrassed. I can't believe I'm even sharing this and I have to tell them you are not alone. Hold on.

[00:28:14] So much information. We decided to cut this podcast in two because I don't want to fire hose you. This is such good stuff Dr. Crete is giving us. So join in for part two. Like, subscribe, share. Subscribing really helps the show.

[00:28:33] Give yourself some grace and we'll see you on part two talking about pelvic health with Dr. Crete. Visit myhealthylifed.coach and don't forget to hit the subscribe button so that each new healthy AF episode will be sent directly to you. Let's take you from where you are

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