Ask the Expert with Melia Perrizo - Pelvic Floor Health, part 2
Learn how your respiratory system is an integral part of your pelvic floor health.
Elaine: Hi, good afternoon, everyone. I'm really excited today to welcome Melia Perrizo. She is a physical therapist and she specializes in pelvic floor. She was on last September and we had so many awesome questions. She is a physical therapist and we were talking about pelvic floor. So let me just give you the proper introduction. You're a physical therapist, specializing in orthopedics and pelvic floor dysfunction. You combine these two specialties for your main passion of returning postpartum women to fitness and activities safely. You use a one-on-one approach to address body mechanics, pelvic floor breathing, and posture, to help with urinary incontinence, pelvic pain, low back pain, diastasis recti, and pre and postnatal care. That's a lot of things. Melia: It is a lot of things. It's a lot of things that women need help with though as well. Elaine: It is. And so you are kicking off my, what I'm calling our self-love week here at Elaine Wellness because I think too many women in our culture neglect themselves and put their own needs off to the side. And I know as being Pilates instructor for the last 16 years, I see a lot of pelvic floor dysfunction and I'll think a lot of women are too embarrassed to ask for help or even know that someone like you is out there in the world to help women. So tell us, just get us up to speed again. What is the pelvic floor and why is it so important? Melia: Right. So we discussed last time, a little bit about pelvic floor. So I brought my model again. What I like to also say is that it's really not just a pelvic floor, but it's a pelvic bowl. I f I were to kind of give you the example of this is the pelvis looking from the front. So this is the pubic bone. This is the spine pelvis is here. The legs would be here and then dip down inside. This is all pelvic floor and pelvic floor is made up of soft tissue muscle, tendon, ligament, but it has to be really dynamic in order to hold all of those organs and support all of those organs, the pelvic organs, the abdominal organs to support. And then it also has to be really dynamic in, in the sense that it needs to relax and let urine past feces pass parts of sexual function. So if you were to look from below the parts, the bony structures are really only our sit bones here and the rest of this is all soft tissue. So all of that is that muscle tissue that really needs to be supportive for all of those structures to occur to happen. So again, pelvic floor is really a pelvic bowl. It really has this nice hammock to help support all of those organs. And those organs in particular, bladder holds urine. Uterus can hold baby and colon would hold our poop in it. And all three of those sit inside that bowl in that midline right inside. Elaine: Right. So pregnancy obviously puts a big demand on those muscles. And if you deliver naturally that also places a really big demand, what are some of the other situations that can put a lot of demand on our pelvic floor? Melia: Yeah. So even just as we hormonally change, so as different hormones are coming through our body pregnancy obviously is a big part of that. But then even as you start to hit perimenopause age or menopause postmenopause, those hormonal changes can make some differences in the ability to have the same stability of these organs. So these organs are all held in space by ligaments. And if we know that ligaments can start to be affected by hormones, which means they can start to have a little more movement in them, which is what happens in pregnancy. Right. But can also start to happen with some of the menopausal changes. So if there's estrogen changes and that type of thing, then you can start to have some movement in these organs, which then can start to typically with gravity, we'll start to come down towards that pelvic floor, which then means the pelvic floor has to do a lot more work to help support that. Elaine: Right. Right. So one of the common symptoms we hear is urinary incontinence, right? If you laugh, cough, sneeze, jump, go running, you may leak urine. So are there, are there some other symptoms as well that can be caused by pelvic floor issues? Melia: So, similar to what I was just saying is so you said stress incontinence, which is urinary incontinence leaking. You can also have people incontinence, so you can have staining of feces or passing gas without trying to you can't hold it in. You can have prolapse, which is when the organs actually start to slip down through the vaginal canal. You could have some pain with intercourse with that, with some of the prolapse symptoms. Elaine: That's okay. Well, I think you can also like low back pain, which I was low. Last time you talked about low back pain can actually be referred sort of from pelvic floor dysfunction. Is that right? Melia: Right. So if you're pelvic floor, isn't being dynamic and it's part of our deep core system, Melia: Then it can lead to some of the issues that you'll see with even hip pain, low back pain, because it's not doing its job as a, as a stabilizer, the pelvic floor floor is meant to stabilize us and stabilize our core in particular. Right. And so if that muscle truly isn't doing its job, then other muscles of the back or hips will start to take over. And so then that's when you'll see some of the low back pain or the hip pain. And another one with that is some of we talked about a bit of the diastasis, recti so the separation of the abdominals, and really that's the idea of that core system not working as well. And so if it's not creating enough tension for you, again, some of the low back pain can come up because you're just not utilizing that system as efficiently as possible. Elaine: Right? So these are all issues we're talking about of a pelvic floor. That's I'm guessing is too slack that's that has weakness. But when we talked last September, I was really surprised to hear you say, a lot of women are actually too tight in their pelvic floor. And why is that? Melia: Right? So the pelvic floor, our body's amazing in it's gonna find a way to, to make things work, right? And so the pelvic floor tends to be a muscle that says, oh no, something's wrong. I'm gonna go into overdrive and help everything. And so, because it has to hold up. So many of those organs, it tends to go into a, a hyper tone or a shortened position to create that sense of stability for us. So if for some reason, even with pregnancy or with low back pain, if things aren't working correctly, the pelvic floor goes, I got this, I'll take care of it. And so it, it goes into this sense of shortening almost where it creates a false sense of stability. And that false sense of stability is really those muscles going into a higher and tight position. And so a lot of times what I'm doing is down training that muscle tissue so that you can get better strength out of it. So I kind of talked about it, like the length of my bicep. If I was gonna contract my full length of my bicep, I have this full range of motion. If I have this pelvic floor that's sitting high and tight, I'm only getting this much contraction and strength out of it. Right. So a lot of times I'm teaching, you have to fully relax in order to get a full contraction. Right. Right. So the same thing with jumping or running is a lot of my ladies will come in with, I can't control when I cough or sneeze. And it's because this is all the strength that they're getting out of the pelvic floor. So in order to get that full ability, it's you gotta have that full relaxation to that full contraction. Elaine: Got it. So I hope everyone understands right. Muscles that are short and tight are often they're lacking strength. Yeah. So I pulled a quote because I think we were all really surprised in the conversation myself included last time you said, I always start with breathwork because the pelvic floor is part of our respiratory system. So help us understand that. Melia: Right. And so the core system, the kind of the deep core, truly the pelvic floor responds to respiration where when the diaphragm sitting underneath our rib cage comes in on an inhale, it pulls air into the lungs on that inhale and contracts. And it basically tells everything below it to get out of the way. So the lungs can fill with air. And so what responds is the pelvic floor relaxes in order for that to happen, the abdominals actually relax as well. So on inhale that pelvic floor drops down into that a little bit of a relaxation or a recoil, and then on exhale, the pelvic floor contracts and helps push the air back out through the lungs. So they work in conjunction together. When you have somebody who has a impaired respiration these are my ladies who have either high anxiety or even from pregnancy diaphrams have been pushed up. Now we start to chest breathe. Yep. And we are constantly up through here that pelvic floor never gets that same recoil of full elongation to full contraction. And so now the diaphragm isn't giving that input. And so we stay in this shortened state all the time. Right. So starting with this true diaphragmatic breath is so important. So you can start to get that full range of motion back. Elaine: Right. And so I know we live in a culture where everyone's sort of in a fight or flight. People are breathing up in their neck muscles, these very shallow breaths. Now more and more people are trying to meditate there's books coming out about the importance of breathing. It seems so simple, but can you give us some cues and some tools for how can people start to get that deeper breath and let that pelvic floor relax. Melia: Right. So important. And that's where I think I can give you a lot of cues but having somebody watch you or watching yourself in the mirror, because when I tell somebody to take a deep breath, it's instantly it goes into the chest and we try to the shoulders go up. Yes, exactly. Yeah. And so really trying to picture what the diaphragm is doing and the diaphragm, as it sits under the ribcage is truly contracting and coming down. So on the right side, your liver is there on the left side, the stomach and the pancreas. And so sometimes I I'll tell patients really think about that. You're massaging those organs down towards the floor. And so one hand on your chest, one hand on your belly, can you get the belly hand to start to move a little bit more than the chest hand so that, that diaphragm is truly coming down into the abdomen and the abdomen can get out of the way. So it's not that you're pushing the abdomen out. It's really that, that diaphragm is telling everything to get out of the way. You can also place two fingers right at that perineum. So right between vaginal opening and rectum two fingers there, you can get a little bit of feedback. So when you sit down standing anything, and you sit with your fingers there and you take that inhale, you should feel that pelvic floor recoil down into your fingers on inhale. And then you should feel that gentle contraction on exhale. And so if you aren't feeling that that breath is probably still staying up into the chest a little bit more. And so we're trying to get a little bit more of that. Almost neural control where right. We probably have it, but it's just getting it to come back. And so a little bit of tactile queuing with fingers there. You can even put both hands underneath at that perineum to get a little bit of that as well, and really focusing on that. Elaine: Yeah. I know. I, I did a prenatal class for Pilates and they had us do a lot of work sitting on a gym ball, which that has give and flexibility. So do you think, is that another thing people could do is to sit on a gym ball and you can actually feel your pelvic floor muscles engaged. Would that be a good way for feedback? Melia: That's a great way for feedback. Yes. So the same idea, you should be able to feel kind of that gym ball has nice flexibility to it. You can sit on that and you can feel that inhale as it kind of comes into the ball, and then that exhale as it comes away from the ball, sometimes even sitting on a towel roll, you can roll a towel up underneath that perineum as well, and you get that same feedback. And so you should be able to feel that relaxation and then that contraction. Elaine: I love this. So this is also a way then in essence, to practice getting in the rhythm of engaging pelvic floor, letting it relax. Melia: Yes. Would you stay definitely. Yeah. And really, I, what I like to tell patients is three times a day, check into your breath. So a cycle of 10 inhale, exhale, inhale, exhale cycle of 10 of those, and it can be sitting, standing, lying down doing the dishes, but just so that you're getting that full inhale, exhale with a diaphragmatic breath as opposed. Elaine: Exactly. Well, and I think also a lot of women are so trained to wanna hold their belly in. Do you find that, especially here we're, we're both in Southern California. Melia: That's a big, that is a, one of my hardest things to retrain is, we're so used to sucking in everything. Yeah. And again, if I'm starting with a shortened abdominal wall too, and I'm only getting this much contraction, I have a lot of high level CrossFitters who, if they are sucking it in the entire time, this is their range of motion for their core string. Right. To get them to be able to fully release that and then contract it's a tough sell, but then yeah. They come back and they go, I'm so much stronger now that I can use my full range of motion and my full strength. Elaine: Right. Right. So the benefits are gonna be obviously if you're athletic at all. Yes. Since we're in the week, before Valentine's day, it's also gonna help you in the bedroom. Melia: Yes, yes. Right. Absolutely. So even for orgasm too, the pelvic floor needs to be able to go into full contraction. Right. And so you have to have the ability to relax, to allow penetration, and then you have to be able to allow contraction. And so if you can pair that with that exhale breath and turn that whole pelvic floor on that contraction can be so much better. Elaine: Right. Well, and I would say even breathing during sex, right? Yes. That'll make a huge difference for your orgasms. Melia: Yes. It increases circulation. It improves. Yes. It can be so helpful. Absolutely. Elaine: Absolutely. So I'm loving the comments here. If anyone has any questions, we don't want this to just be a conversation between me and Melia. So jump in, don't be shy. She's here to answer anybody's questions. So as women age, what are the important factors for keeping pelvic floor healthy? If as you get through menopause and you still wanna have a great sex life and you still wanna be able to be active, what are some tips that you would have? Melia: Right. And I love that as you were saying that I was just thinking I wanted to touch on foreplay, especially because that tends, we tend to, if we start to get busy and it's, it's like, let's just get this done and be over with foreplay actually has a big portion for us with the pelvic floor stuff. So when we're stimulated, what happens is the, let grab my model here is so this is uterus. Cervix is at the bottom here. The cervix actually with, with foreplay will tent up and almost get out of the way. So some of my women will complain about they have pain with intercourse and it feels like they're hitting something or something's being hit inside. And it tends to be, if you're not creating that time before intercourse when you are when you have foreplay in, in involved, it allows the cervix to move up and out of the way. So it tends to create more space. Okay. And the other part is lubrication. So when we are aroused, more lubrication occurs as we get older, we start to lose lubrication. And so multiple reasons for us to use that arousal time, that stimulation prior to intercourse, so that we can have less pain during intercourse as we start to age. Elaine: Right. And I've heard, you know, I've read things, foreplay should be up to like 20 minutes. Melia: Yes, yes. 20 minutes is yes. 20 minutes is how long it takes our brain chemicals to really start to trigger all of those changes. Elaine: Right. And creates blood flow. Right. Absolutely. Can you speak to how important, just like men get an erection from blood flow women in essence needed too, right? Melia: Yes, absolutely. So we have lots of vessels down there, not just blood flow, but nervous tissue and the nerve endings down there. And so the more blood flow that's down there, the more feeling you're going to get and the more pleasurable it will be as well. And so that 20 minutes, it can start in the kitchen with, you know, just a brush of, you know, your back or something. It doesn't have to be 20 minutes in the bedroom, but that thought process starts to make those chemical changes within you so that you can start to get that arousal and that blood flow. Elaine: Right. So, so important. And I think you know, for a lot of women, we're busy, we're juggling a lot of different things and it's really important to find sort of that transition space, I think, where you're not going from being at the computer to just rushing, to get it done, as you say. And I think sometimes we have to tell partners that, you know, I need some time mentally because sex is so much in your head. Yes. In essence that I need some time or I need to take a bath or I need something to help me switch gears. And I think it's, it can only benefit both of you. Melia: Absolutely. I would definitely agree. And that's, it's the, that's the tough challenge is making sure that your partner knows too and having that conversation before you get to that spot, I think. Elaine: Right, right. We had a question come in. How, and when should we do those? I think Kegels. Right. So talk a little bit about kegels. A lot of us have a certain generation have grown up reading Cosmopolitan and all these magazines that we're like Kegel, Kegel, Kegel, just do your keels all day long. Melia: Right. And so kegels is really the pelvic floor contraction. So right. Your body naturally is doing that for you all day, where with that breath, normal breath pattern, there is a slight kegel happening, right? So that activation of the pelvic floor is ideally something that needs to be very dynamic. So if I were to pick up a coffee cup of, you know, a couple pounds versus 50 pounds, my pelvic floor needs to do to match that tension to task. So if you do a thousand kegels only at 10 outta 10 max contraction, your pelvic floor, isn't dynamic enough for all your activities in life. So ideally you are matching that tension to task with your daily life. So you go to push a heavy door open, you're creating that kegel right then and there, as you're exhaling, pushing that door open, you're going to pick up your laundry basket. You're pulling that Kegel on. So ideally you're doing it with your daily activities which makes it that much more dynamic versus here's a thousand kegels to do. Similar to, if you came into me for a shoulder problem, I wouldn't give you a hundred bicep or a thousand bicep curls. Right, right. I'm not gonna fix the shoulder issue. So the same thing with kegels, I would prefer you to do it dynamically throughout the day, right. With an exhale breath so that I know it's dynamic so that when you go to coffer sneeze, it turns on the appropriate amount of time. Or you go to push something, you have that appropriate kegel. Elaine: Right. So I'm hearing you say, it's, we need to practice this with breathing. It's no longer the days of like sitting at the light in your car, you were supposed to just like Kegel like a mad woman or something. Melia: Yes. Yes. So, yes. Ideally you're practicing this throughout your day. Not just, you know, thousands of kegels. And really, again, the focus is can you fully relax it and fully contract it when you're doing it? And so that's why the breathwork comes really into play is that I know on that inhale, you're gonna do a relaxation and then on exhale, you're gonna do a contraction versus starting here and just kegel going. Elaine: Right, right. And I also, I wanna go back to what you were saying, how you know, the, I believe you were saying the diaphragm sits on top of the liver and the kidneys. And I know last time we had talked about we, we got a little over into visceral manipulation, which I love and I have done. And just talking about how this breath can help the organs as well. I think people maybe aren't as aware of that. Melia: Right. And so visceral mobilization visceral means organ. And it really is mobilizing that organ system. When that diaphragm say, you go into that fight or flight that high anxiety, that diaphragm doesn't start to come down into the abdomen. Well, all those organs below it are meant to get this nice range of motion all day long with our normal breath pattern. And if things are sitting high and tight, those organs below it, aren't giving that normal movement pattern. And so you, I think about the organs, having this nice sliminess to them, it keeps them mobile and moving and keeps all of the even for the digestive tract, all of the food moving well through there. And if that diaphragm, which is our main driver of keeping things, kind of slimy, isn't doing its job, then those things start to not move as well either. And then they can't do their job as well. Elaine: Right. Right. So I think our entire conversation today is circling back to breath. Yes. And how, you know, breathing seems so simple, but it's really the foundation to pelvic floor health, having great sex, keeping our organs juicy and, and mobilized. Does anybody else have any questions don't be shy out there? We appreciate you joining, so drop them in the comment if if you have any questions or if any of this is helpful. Karen says we love the foundational simplicity. Well, good. I, I hope I hope we can make it so that it's understandable. You added a question to the question box. I might not have seen it. Can you drop it in here? And we will answer it unless, let me see. Oh, would you recommend using a roller around the sacrum if there's pain around that area? So talk to us, a lot of people have SI joint dysfunction, sacrum pain, maybe tell us where the sacrum is. Melia: Right. And so turning that pelvis around the sacrum is that triangular bone in the back that attaches to the spine that's there. And a lot of times people will have that SI pain, which is the sacral iliac joint, which is, this is the ileum that attaches to the sacrum. And so rolling can be great through here. You can use a ball. It just helps with some of the soft tissue. The biggest thing is why are you having SI pain is really what we wanna dive into which is typically what's happening around it. So the muscles around it, the spinal muscles, and then on the inside the pelvic floor. So is there a dysfunction where one of those muscle groups is working harder than the other? And what you'll typically see is some type of hip weakness where, whether it's in the hip rotators or glutes that the pelvic floor then makes up for that hip weakness and going into that, that kind of shortened high and tight position. Really the rolling can be helpful, but it's not gonna take care of the why. And so figuring out why is the big deal right. The, and that's kind of the, the go see somebody go see a pelvic floor PT to help with the SI stuff, because they really will figure out why the pelvic floor is doing what it's doing, why it's creating this tension or torsion in that SI joint. Elaine: Right. And talk to us a little bit. I think we touched on this last time. Yeah. She's saying from lots of sitting and of course we live in a culture where we're all sitting hunched over computers or on phones or commuting. So talk to us about too much sitting and what happens with pelvic floor. And is there anything we can do? Melia: Right. So sitting is really a big a big problem for our poor pelvis, because ideally we should be sitting on the bony structure. So the bony structure, again, is those small little sit bones here. And the rest of this again is soft tissue. So when we sit in a reclined position and that slouch position we are really sitting on soft tissue. And so that soft tissue is now getting compressed, where we should be sitting on those bony structures, which is more of an upright position here. So every time we go back into that slouch, we sit on all that soft tissue. So ideally in this position, in that upright position, actually all of our pelvic organs are now supported by this bony Ridge, which is the pubic bone. They get support there. There's a nice little ledge for them to sit on. Elaine: Right, right. Versus when we're sitting here now our pelvic organs start to slip down into that space. So ideally we should be sitting in an upright position, same thing for toileting. The colon is I pull it out here. If it was, if you're sitting upright, it goes here. If you're sitting here, you have to go across a curve and you have to push a lot harder when you're in that slouch position. So same with the Squatty potty. Is it puts you in that upright position. So things can just slide out versus having to push against that curvature. Elaine: Wow. Okay. I learned something today as I sit here sort of like slouch down in my office chair. Melia: Yeah. So it is sitting can be a big problem, you know? Right. Especially as our bucket seats for our cars as well. We start to sit into this posture as well. So the pelvic floor just is not in its optimal position to help support all of those organs. Elaine: Right. So I think today we learned, we need to walk more, right? Yes. Melia: Walk and, and breathe, which causes you to breathe to get your cardio going to get your diaphragm going. Elaine: So who drop in the comments who is gonna go either sit on a gym ball or put your fingers on your perinium and see what your breathing pattern is when it comes to your pelvic floor? I think this is super important. I think it's a really simple takeaway that I hope everyone will use as just a little act of self love and self care towards yourself. So Melia, this has been as always, I learned something from you every time and you put it in a way that I think we all can understand it, which is phenomenal. So how can we find you? How can we get ahold of you? Do you do virtual con consults? Melia: I do virtual consults. Melia's website Melia's Instagram Disclaimer: The conversation between Melia Perrizo and Elaine Morrison is for educational purposes only. This is not medical advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional, or delay in seeking it because of something you have read on this website or watched in the video.