Part 2 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 welcome back for part two of my podcast with Dr. Freeti.

[00:00:13] So much information coming your way. If you're popping into part two and you haven't listened to part one, I think it's okay. But just know that there's a treasure trove of information in part one and part two. Thanks and enjoy.

[00:00:27] Not one bit. And you know what by the way at the time right before I did all this, I think between the L4 L5 bulging disc incident, which now I know I probably had that bulging disc. You know that bulging disc was probably not the result.

[00:00:46] I mean not the cause of my pain but I'm that's another whole podcast. Another story. 100%. But those little things had come out. They weren't urinary pads. They were the insertables. It almost was like a toy. Poison placer.

[00:01:07] Yeah. Yes. And all of us in the gym, all of us in the CrossFit gym who were all you know 40s, you know multiple kids had those and we'd like, oh it was like middle school tampon girls.

[00:01:21] Like you got a tampon. No, you got I call it scaffolding. You got any scaffolding in your. I did. I did. And we used those all the time. You know and then the like just when I did my physical therapy and my urinary incontinence just went away.

[00:01:42] I was like yeah. Did not know. And there I was with a nursing background and clearly thank you for acknowledging my vulnerability. And some of us are less private than others. I don't have a lot of private bones in my body. Okay.

[00:02:04] I was telling everybody about it all the time. It wasn't like I wasn't saying to health care practitioners and or friends and or coaches and or mentors you know like I'm peeing in my pants. You know I was very vocal about it and it still took me.

[00:02:21] A decade almost. Oh yeah. Yeah. Yeah. Isn't it wild like that lot of it was just lifestyle modifications and breathing techniques and learning how to regulate your nervous system calm down in your day. And that can fix your incontinence. Like I had someone come to me last week.

[00:02:43] I've been working with her for three four visits just you know it's only been like a month and a half working with her.

[00:02:50] And she was like I can't believe she's the one who would like leak all the time making the bathroom cough sneeze and it'll be a wet pool under her pants.

[00:02:59] And she was like I can't believe they just like little things like decreasing caffeine counting my pee not just in case peeing doing couple of like pelvic and core like. Strengthening exercises. I'm not peeing at all anymore.

[00:03:16] Not once and you did not even do an internal examination on me. I didn't do my yeah you do not need to get that biofeedback you don't. Internal exam is never ever necessary or mandatory for you to get better.

[00:03:35] Now OK so how do I want to know about this. I did get trained with my physical therapist on how to use that internal wand thing. I did a couple of things that made me as a. I don't know married middle aged woman. Little bit uncomfortable.

[00:03:54] I got those little balls that you can put into your vagina that are the weighted balls. And I practice I'd put those up there and I practice doing double unders with those.

[00:04:05] And and feel you know how that felt to sort of have to hold that ricocheting ball inside my vaginal canal. And I also did a wand you know so for if you're listening it looks like a little lightning bolt. Like a little. Nation.

[00:04:29] Yeah plastic hard plastic and my physical therapist drew out a map for me. Of my innards and said OK this is where you're going to hit a bone don't hit a bone that's not going to feel good.

[00:04:42] You know and look for those knots she said you can work the knots out of your hips and pelvis from the internal side. Just like you can phone roll them from the outside.

[00:04:54] So how do you feel about all that and what are you what are your thoughts on internal work. Yeah that's a great question and some people may not agree with me on this because my stances it's never necessary to the internal work.

[00:05:10] Some for some clients and maybe but majority of the clients know because a lot of people have a history of trauma. Or like there's a lot of stuff that's happened to my clients and doing anything internal will re trigger them.

[00:05:26] Or even doing it to themselves may trigger them so for majority of my clients we don't even need to do internal work and you don't even need to like internally release a pelvic floor muscle because.

[00:05:40] The pelvic floor it's reactionary I like to think of it as a scapegoat. Okay why is that muscle tight and you can keep releasing and releasing it but it's gonna come back right coming back because.

[00:05:55] Why is it tight why is it coming back what is it telling you what's outside of the pelvis or what's other muscles connecting to the pelvis that's making the pelvic floor so tight. And we need to address that and the tightness will melt away automatically.

[00:06:13] I love it you said that because you mentioned a lot on your reels and whatnot your like nervous nervous nervous system and your stress level and all that stuff and also.

[00:06:26] I'm a big believer in energies yes in energy work getting stuck spots in your body and when you hear when when you say the pelvic floor as a scapegoat.

[00:06:39] And we know that there's a lot of people who have had trauma a lot of people who have had trauma. What are your thoughts on that whole energy thing. Oh 100% I believe I get acupuncture work done myself it's changed my life like i've done.

[00:06:59] Some recall healing stuff with a friend of mine who's certified in that i've done like body code like i'm very familiar. it's so interesting and fascinating and it works, I mean I come from an Indian background with.

[00:07:13] My grandmother she will like you know if there's too much like negative or evil energy at me like on me, she will do a thing to like get rid of my nether we call it in Hindi is like she gets rid of my nether like that energy and so i'm a firm believer in energy work but.

[00:07:31] Like think of the pelvic floor like if it's holding on so tight like why is it holding on so tight what else are you holding on in your life that you're not letting right.

[00:07:43] What are you holding on to what are you not releasing so you can't release your peer poop. yeah.

[00:07:50] I just love that and what and to be clear, what I love is that I do not love holding on to negative stressful scared energy in my pelvic floor I do not love being constipated. I love that we are saying this out loud for people to hear. yeah.

[00:08:13] yeah i've had a client who I. taught her how to first breathe into her posterior rib cage because no one can breathe in that area.

[00:08:25] Because the right like our lungs are 360 or diaphragm is 360 or rib cage is 360 we focus too much on our chest and diaphragm and nothing in our back body.

[00:08:33] And then we taught her how to set boundaries in her life, why is she like extending herself, why is she not doing anything that brings her joy pelvic pain disappeared we didn't like do internal work. Oh, I did. earn a work.

[00:08:50] It just wasn't that kind of internal work. Right exactly like internal emotional work. Like it also helps her pelvic floor like there was a study I can't remember the exact one where they put like they put people in front of like.

[00:09:07] A movie where they see a traumatic car accident and see where they hold on to that tightness in their body and right we always think our traps right or neck and upper traps that time, but so did that pelvic bowl. That also holds on to. That energy.

[00:09:25] Is that where we get that expression, so I always say and I know I heard it somewhere like I didn't make this up, but I always say like oh that's got my butthole up in a squanch.

[00:09:37] Oh wow oh my God not a people, I have to tell to let go of your booty hole or just bring you into your booty hole is probably on a daily basis, I need a sticker that says breathe into your booty hole.

[00:09:51] That's making that sticker I would love that. We are clenching there so. All the time. All the time, but also like I'm clenching now I realize like wait why am I clenching and then also as women we also suck in our belly suck in that abdomen.

[00:10:09] Stop sucking in stop clenching your butt booty hole in your abdomen let it go and your pelvic floor will thank you.

[00:10:17] yeah yeah they did tell me they were like Amy your pelvic floor is all and especially like you said that trauma of I never know when i'm going to pay so my always just trying to hold as hard as she never.

[00:10:33] Relax except with orgasm you know and then that was another thing that I read when I was very first learning about my pelvic floor health was all those hormones that are released when we orgasm so good. Or stopping our urinary incontinence.

[00:10:55] Oh I've given people like an orgasm a day keeps the doctor away so I'll tell that just like work on arousal work on like orgasms like.

[00:11:05] Work on like self pleasure it can be so lovely for your pelvic floor but when we think about like that holding on because you don't want to leak right. Think of the if you're familiar with the length tension relationship in our body and our muscles right.

[00:11:19] Now i'm not going to say it again well so kind of but tell us say about that place. yeah or the length tension right so our muscle it shortens it also lengthens when we hold it in a tight shortened position.

[00:11:36] And we have like a sneeze cough or pressure it's not able to have that reaction of tightening and like keeping it there because it's already too short.

[00:11:48] It needs to have that like nice stable lengthened position to engage to stop that p&p so if we're always holding is so tight. there's no reference like it can't hold on the opposite thing you want to do.

[00:12:04] yeah that was somebody demonstrated that with me some one time they like took my arm and like held it here and they pulled against it and I couldn't hold it.

[00:12:13] But I could pull it up, it was it was a weird it's like if your bar if your muscle is at like a 50% tension i'm making this up, but, for example, say a 50% tension state all the time. That when it needs to go to 100 it can't go to 100.

[00:12:30] It is you can't get there, but if it but if it flows between like oh i'm totally relaxed and lengthened at a zero and then I can go to 100.

[00:12:39] And then I can go to a 50 and then I go back to 100 then I go to a zero but it's got to be in that flowy state and so many times with the stress level and then you're really stressed because you've peed in your pants and you don't want to pee again and you're terrified.

[00:12:52] Then that little pelvic floor just is always like on the on guard state and it can't really come to the rescue. yeah but also your pelvic floor by your abs your booty hole your job your whole body is becoming really, really.

[00:13:06] Yes, and you can't react to anything because you're so stiff like think if you were like.

[00:13:12] Your john clenching your biceps and someone throw a ball at you you're not going to be able to catch it, but if you are in that flow state like relax oh cool I can catch it like I see it coming right. yeah.

[00:13:24] I just heard a soft total side note we went to the batting cage for the first time.

[00:13:29] The other day we've been saying that we want to go this batting cage for like months and we went to the batting cage and I haven't hit a softball since I was probably 17 so it's been quite some time.

[00:13:39] And I did all right, but you know I got in there and I was like like. wound up like holding it right here, so I could like slip and then this other woman comes in she's 28 and she clearly has a lot of softball experience right.

[00:13:56] And I hear her talking to the little kids because my my oldest and I were doing this and she's like yeah mom it's pretty the same as it always is it's just me you bunch of little kids and the professionals. yeah.

[00:14:12] But we hear her talking to this little kid and she's saying yeah you don't want to be tight while you're waiting for the ball, you want to be loose.

[00:14:22] And just like that's that's a newness for me that's a learning for me so I've been thinking about that all week like huh so you want to be in the batter's box ready but loose.

[00:14:39] And now here we are talking about you need your pelvic floor your abs your booty hole, you know your clenched jaw your big old traps to be in that ready state but not turned on. You got it. Oh gosh well. Well.

[00:14:58] hmm and then there's the practice of undoing all the conditioning that we have and all of. And that's where you come in isn't it.

[00:15:09] Exactly because everyone needs I like to say, like so I have a problem with a lot of Western medicine and how doctors practice in the US because we just tell tell tell.

[00:15:22] And force force force and that's not how the body works, so I believe when i'm with a client there are two nervous systems in the room.

[00:15:33] Mine and the clients if they don't feel comfortable with me I don't feel comfortable with them or there's something off with their energies they're not going to heal.

[00:15:43] So i'm always a meeting meet your clients where they're at never tell them to do anything but ask ask questions and figure out where they are in their life because. I am more of a coach and a guide.

[00:15:58] My clients know more about their own bodies right more than I would ever know about their bodies right because you're your person right your mind body spirit your everything not just the muscles and pelvis is on like assessing. Your whole. Just the pelvis.

[00:16:18] Like I tell people hey like where I do public floor work but i'm looking at your job looking at your rib cage and looking at your feet we're looking at everything.

[00:16:26] But I am a guide and a coach like I can help you through this journey you're in because people need accountability they need education like.

[00:16:39] Like maybe an exercise program but that can change like as you go through the months of working together, but in those months of working together it's a two person thing right.

[00:16:51] My hundred percent is only 50% of the relationship and vice versa like I need the input from my clients, I need to see where they're at in life and adjust as we go and.

[00:17:02] When I like had to have my own like physical therapist I can't heal myself I need someone looking at me with an objective lens. To see what what am I doing how am I moving like all of that so I feel like everyone needs like.

[00:17:17] Like all of that, so I feel like everyone needs like someone else looking at them objectively.

[00:17:23] Now I love that I was gonna say yeah because the the job for me when i'm coaching like same thing I know that you are the expert and for all that I know about all that I know about all my life experiences about.

[00:17:40] Trauma about marriages and divorces and pregnancies and childbirth and CrossFit and nursing and like i've got a boatload of knowledge and really it doesn't.

[00:17:52] Stand Center stage if anything it's way back in the wings, because my best job is helping show an objectivity that then you the client can receive and interpret with all your knowledge. Because that's where the juice is okay it's not over here with me.

[00:18:13] No, I'm just the question the mirror the you know i'm just the one who's digging. You got what we're digging up and decide what to do with it. Exactly I love that analogy yeah.

[00:18:27] yeah yeah you can tell when when I talk to people who do the same thing that I do in the same sort of theoretical underpinning.

[00:18:37] it's an interesting conversation because it's a good paradox to live in right like it's totally who I am and also it has nothing to do with me. is all. yeah fun isn't it. Okay, so we talked about.

[00:18:55] The the peeing in your pants when when I said to you, what are the three things. wanna make sure we talk about you said the urgency frequency. The dribbling and you think and you said the. pain.

[00:19:14] So let's talk about that a minute because we haven't really talked about that.

[00:19:18] yeah so and i've and i've never experienced that that's probably why I say that to last, so this is a new thing i'm helping hoping you can shed some light on when that happens why that happens what can we do about that how would people know you know how people know and how who would they decide to go to.

[00:19:39] yeah that's great and I mean this can be a whole nother topic of conversation as well, I think the whole hour long so i'll try my best to kind of summarize it a little bit but.

[00:19:50] pain with sex, it can be many different things, it could be like back or hip pain with sex in different positions, it could be.

[00:19:58] Like vulvar clitoral pain me there's something burning in that area would touch so that's actually called a vulva denia or a vulvar pain there's also clitoridinia like a more like clitoris pain, there can be pain with any sort of insertion.

[00:20:16] And that could be many different things, it could be the glands in that area, it could be the pelvic floor muscles in that area.

[00:20:27] And it could it could also be deeper pain so like with the sex if it's like too deep like you can have pain deeper I have some people say they have a lot of like abdominal. With sex.

[00:20:39] Because, like those muscles are all connected abdomen pelvic floor everything, so it could like encompass like all that could be pain with arousal pain with um orgasms.

[00:20:50] Just not having any pleasure with sex that could be something as well, and lots of different things can cause it, it could be past this year of trauma, it could be shame and guilt. It could be our upbringing on how we view sex, it can be.

[00:21:09] An injury right could be a back injury injury hip injury it could be a laboral tear it could be like you know all of that it could be.

[00:21:16] I gotta I gotta I giggle because my children tell this one story that my oldest was climbing up on the tree house that we had in the house. And it was that. yellow nylon rope grid you know.

[00:21:34] And I was at the minivan at the top of the hill at the backyard and I saw her cold crawl I mean just straddle that nylon rope, I mean she hit it so hard. And I ran down the hill and you know nurse rip those britches down.

[00:21:56] Just opened up that vagina.

[00:21:59] Like i'm and she had a good you know red mark there, but but she was fine, but she the way she tells it is just so funny the way she's like remember that time you ran down hill right down my pants when I fell off.

[00:22:13] Yes, yes, I do because. Trouble has happened. And I probably did that because i'll tell this story to when I was about 10 I was on my bike and you know how when you're 10 you just have these.

[00:22:28] These like well I wonder how that would work moments so I was like I wonder how blind people ride bikes well.

[00:22:35] May not ride bikes this way, so I close my eyes and I ride my bike right into the wall beside the garage and what happens, but I slam off that banana seat and you know 1982.

[00:22:48] And I can remember like I don't remember I remember hurting and I can remember my mama looking at it and telling my granddaddy about it.

[00:22:58] It not in a traumatic way you know just like it was a big thing for me, but I remember it was a big thing for me. You know apparently so maybe that's why I flew down that hill so fast and ripped off her drawers but.

[00:23:11] But it happens, it happens and it can happen at any age. You got it yeah I have clients who. The first time they've had sex is after marriage and they and it's so painful and because.

[00:23:28] It could be you know their perception of sex, but it can they all I don't know if they're all in love with each other. After marriage and they and it's so painful and.

[00:23:44] Because it could be you know their perception of sex, but it can they all I also ask questions like do you have pain with pap smears do you have pain with like did you have pain putting a tampon in because those are early signs. Of pelvic floor dysfunction.

[00:24:01] Huh really. As early as like not being able to put a tampon in that sign of pelvic floor tightness like yeah.

[00:24:09] Okay, so I love this and you can dispel this myth so when when I first lost my virginity didn't hurt at all when I first needed a tampon didn't hurt at all.

[00:24:20] I always ascribed it to because my parents were very much like sex isn't a bad thing, but don't do it until you're married right yeah which clearly didn't happen, but that's okay too.

[00:24:34] But I also grew up a dancer so I spent a lot of time in my body and I spent a lot of time.

[00:24:43] Legs spread wide it wasn't a gross thing it was a very normal thing for me very flexible very limber and so I think I have this misconception in my head that well if i'm limber.

[00:24:56] It's not going to hurt when I have sex maybe when another girl has sex it hurts her because she's just not as flexible that's not true is it.

[00:25:06] No, no amount of people I work with myself included who are hyper mobile or they have like a connective tissue disorder things like that, like they have.

[00:25:16] I've seen so many people have so much pain like in their pelvic floor and with sex like i've worked with dancers like you're over stretching sometimes. And then the public floor is taking the brunt of that oh yeah thank you for sharing that.

[00:25:33] yeah okay so if you're having pain with sex it can be all kinds of different locations of pain it can be different timings of pain it can have different causes yes what can we do to treat and where should they go.

[00:25:51] yeah I mean number one is always public for physical therapy that's number one another thing is. I highly recommend like a. Sex counselor and if it's more of like pain with sex and like a marriage or something like that.

[00:26:10] Or if there's a lot of guilt and shame around sex so I highly recommend like sex counseling and don't really have this in hickory but I used to live in Nashville Tennessee, and they had a place where I used to send a lot of my clients who had more of a.

[00:26:25] Like so more of a high end like the nerves in that area overactive, so I can do a lot with public for physical therapy but was nice to have like.

[00:26:36] A nurse or a medical doctor that like stuff that's out of my scope to some people to because they are were into Institute of. Sexual wellness so they couldn't prescribe like maybe like a topical or like.

[00:26:50] Some other medication so like help calm down that nervous system and the overactive nerves so they can improve with physical therapy even more, and so that was an option clients in Nashville. But yeah those three are probably the.

[00:27:07] What I would suggest the most public for physical therapy sex counseling and a medical professional who has experience working with sexual health disorders. So there's hope oh my gosh there is hope you do not have to live with pain with sex no.

[00:27:27] And you don't have to live with never having orgasms and you don't have to live with peeing in your pants or pooping in your pants or being afraid to pee in your pants.

[00:27:37] Or not doing any running jumping sneezing without the side twist yep you don't have to ride your bicycle blind nope. There are so many things you don't have to do there's really hope there is hope yeah anything else you want to share before we wrap.

[00:27:55] We covered a lot of it um I I was like to iterate say it or a saying don't make a healthcare professional do something you're not comfortable with doing.

[00:28:06] If you're not comfortable with the procedures are doing or the topics they're asking you about you have the right to deny that.

[00:28:14] I always even like to tell my clients like hey like before we get started if we're doing anything or i'm asking something or we're we may do some testing if you're not comfortable with any of that raise your hand just like say something and we do not have to do it, you are in control.

[00:28:27] Of your own body so I was like to read that I love that and thank you for being that for people you know we need to know that we are not only in control and empowered but also responsible. For our own health care journey in our own bodies.

[00:28:43] Exactly you have to get better yeah yeah you have to want it and you have to yeah to be in the driver's seat it's sometimes it sucks sometimes it'd be nice if somebody just said like no eat this way exercise this way sleep this way that is not the way it works.

[00:29:00] Not how the way it works. Not how the way it works. It's not the way it works so okay so Lastly, I'd love for you to just share with our listeners.

[00:29:10] Where they can find you how they can find out more and we'll of course put that in the show notes too.

[00:29:17] yeah so the best way to get in contact with me and kind of find out more about what I do is through my instagram it's no pelvis left behind.

[00:29:26] And you can always send me an email at info at no pelvis left behind calm, I have a new office in hickory it's the address is 201 government avenue southwest suite 303 hickory and see 28602.

[00:29:46] So that's where many offices located I do virtual work all around the world, you do not have to be local and you don't have to be seen in person to get better yeah.

[00:29:58] I love that awesome so for those of you who are listening to this and going like oh wait that's me.

[00:30:07] Now you have a place to empower yourself and take responsibility for your own health hit up Dr. Crete you're going to have all her contact information in the show notes.

[00:30:19] And if you love this podcast episode please like subscribe share it share it share it you know good and well that some of your people are struggling and this might just be the information they needed.

[00:30:33] And lastly always give yourself some grace because you're still growing and you're still learning and you don't have to be right all the time and thanks for joining us on healthy AF.

[00:30:48] Thank you so much for listening to this episode of the healthy AF podcast I hope that it has helped you create a new possibility for your health and sets you into action to go get it.

[00:31:00] If you want more information or if you want to connect with me visit my website at my health life.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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