Episode 5: Is your pelvic floor causing your pain?
In this episode, Sam Lindsay-German sits down with women’s health physiotherapist Brooke Dobó to explore the connection between your pelvic floor and chronic pain.
If you’ve ever wondered whether your pelvic floor might be contributing to your discomfort, this conversation is a must-listen.
Brooke brings her expertise to the table, explaining how the pelvic floor muscles can become tense and contribute to pain, particularly in response to stress, anxiety, or trauma.
She also shares practical strategies for identifying and addressing pelvic floor tension, offering hope and empowerment to women dealing with chronic pelvic pain.
🎧 Tune in now to discover:
🍃 The role of the pelvic floor: How these muscles work and why they might be causing your pain.
🍃 Pelvic pain triggers: Understanding how stress, anxiety, and trauma can lead to pelvic floor tension and discomfort.
🍃 Practical strategies for relief: Learn techniques like belly breathing, pelvic floor relaxation, and gentle movement to help alleviate pain and support your pelvic health.
🍃 Empowering insights: Why being aware of your body, especially your pelvic floor, is crucial for managing and overcoming chronic pain.
Whether you’re dealing with chronic pain, are newly curious about pelvic health, or just want to learn more about your body, this episode is packed with insights to help you feel informed, empowered, and ready to take control of your health.
More about Brooke Dobó:
Brooke is an experienced women’s and pelvic health physiotherapist who is passionate about delivering holistic and evidence-based care to her patients.
She has completed a Bachelor of Biomedical Science with First Class Honours, followed by a Master of Physiotherapy Studies with further post-graduate studies in pelvic floor rehabilitation and women’s health and a Master of Pelvic Floor Physiotherapy through The University of Melbourne.
Click here for more about Brooke and her expertise.
Additional resources:
Healing Pelvic Pain by Dr. Peta Wright – A comprehensive guide on managing pelvic pain.
Article on effective pelvic health physiotherapy via telehealth.
If you’re in South East Queensland, click here to find out more about our next Healing Pelvic Pain Workshop.
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Episode transcript:
Ep 5 – Pelvic Floor Health with Brooke Dobo
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Welcome everyone [00:01:00] to our next wonderful episode of Women of the Well. This week I'm very excited to be introducing you all to Brooke Dobo, who is here as our very experienced Women's Health and Pelvic Floor Physiotherapist at Vera. So I'm just gonna just read a little bit about Brooke just so you can know who she is.
Brooke is an incredibly passionate woman, who is incredibly passionate mostly about delivering holistic and evidence-based care to all of her patients. She has just recently, very excitingly, completed a Masters of Pelvic Health and Physiotherapy. You're going to spend more time with us here on the sofa, discussing things about the pelvic floor and other things to do with women's health, um, related to physiotherapy and pelvises particularly.
But today, we're going to focus on on the [00:02:00] question, is your pelvic floor causing your pain?
I'm sure you guys have covered this already and if not it will be covered extensively. Pain is very complex and there are many potential You know, inputs and contexts and facets of pain and the pain experience and every experience of pain is different.
So when, and when we're talking about pelvic pain specifically, obviously I have a potentially biased lens being a pelvic floor physiotherapist and I know about the muscles within the pelvis, but certainly the muscles can contribute. To a pain experience. I think, you know, even if you consider Anywhere in the body we have we have muscles everywhere in the body and we have you know, specifically What we'd say skeletal muscles, which means we can Control [00:03:00] them semantically like from our body Brain and our central nervous system.
And one of the main roles of muscles, gluteal muscles in our body is to, is protection is to protect us. So if there has been threat in the area, whether the threat is there right now, or whether it's been there in the past, what our muscles are really good at doing. One of the main functions is to tense up and go into protection mode.
And that's what happens in the pelvic floor. Okay. Um, very, very commonly, I think, and I am very passionate about this because I feel like again, a biased opinion, but I feel like we should be educating young women and girls, at least around the age of menarche when they're first getting their period. So, you know, around twins, early teens, yeah, that there are muscles in our pelvis because [00:04:00] The thing is, you know, I say this a lot, we don't know what we don't know.
If you're never told that you have muscles within the pelvis that you can control or should be able to control, you never know they're there. And I think that, you know, especially when girls and young women get their first period and it's painful and, and that really scared, that's scary, right? Cause I've never experienced this pain before.
A lot of the time, subconsciously, the muscles. In the pelvis will go into that protection mode and do you mean they'll go into it because of the pain? Mm hmm. Yeah the signal of pain. Yeah causes the contraction. Yes. Yeah, so I mean Every month, again, I'm sure you'll, you guys will speak to this a lot. We have, yeah, recently, but maybe this is good anyway, because I like this sort of idea of the pelvic floor and how it's responding to the pain.
Yeah. Yeah, absolutely. [00:05:00] And so, um, I heard this rather recently, um, surprisingly in it, but it made so much sense to me that, maybe you tell me this Sam, I learned so many lessons from you, um, but when, when I'll, um, like, The lining of the uterus sheds when we're, um, menstruating and we bleed essentially what is happening when we have that bleed is, um, the muscle of the uterus, which we can't control inadvertently, like it's a smooth muscle.
So it's an auto autonomic, we would say, um, part of the nervous system. So we can't control the muscle, but it's still tensors and cramps like a muscle. So our amazing bodies, um, somehow work out that. You know, it's time to shed. Um, and it's almost like practice for labor because essentially it's the same muscles that contract during childbirth, which, yeah, I was like, Oh yeah, it makes sense, like, Yes, [00:06:00] it's like we get a practice run.
Yeah. Yeah. Every month. We're trained. Yeah. Yeah. And so, essentially, we will experience those cramps in our body. But if we haven't been told from a young age that that's what's to expect, that's what's normal and you will feel this sensation in your body, um, then feeling those cramps can be really.
Disconcerting for, you know, a 12 13 year old girl. I mean, especially, thankfully, it's changing. We're in the era of knowledge and, you know, um, education. Sadly, TikTok knowledge. TikTok knowledge, yes. It can be a little bit misleading. It can, yeah. But I think it's better than no knowledge. And it's better than, I think, um, secrecy and shame around these topics.
Yeah. I feel like this is something and more and more, the more I've learned about it, it makes sense to me that that fear. So [00:07:00] it's not just, it's not just the muscles sort of reacting to, Oh, what's this, what is this threat in this area and going into protection mode themselves. And then the main question of this morning is can the muscles cause the pain?
They can't help it fall cause the pain. Yes. They can contribute to the pain themselves, but it's also, The fear and the anxiety around that we know that when we're anxious We are tense. I mean in the whole body, but particularly in the pelvic floor Particularly as women we know that when we are fearful when we're uncertain when we're anxious When we're depressed and we've got studies on this to show the resting tone of our pelvic floor is higher and so if this goes on for years and years and On top of not even realizing those muscles there, that protective, you know, tension or tone of the muscles can, um, [00:08:00] increase and lead to, um, more issues.
Uh, just because this is the first time you've been on here and I think it's one of those questions that some people might have but not really know, you know, not really thought to ask anyone. But can you, could you just do a very simple, and I know you brought some models with you which might be able to help.
Could you do, could you do, um, sort of simple introduction to what the pelvic floor actually is? We'll just show us where it is and yeah, and sort of how it works. Yeah. Absolutely. So yeah, bring my model everywhere with me. Is that a pelvis in my bag again? Yes. And I appreciate that a lot of people listening to the podcast might not have visual.
Um, so I'll try and be as descriptive as possible, but essentially, essentially these muscles line the base of the pelvis. So if these, this is our pelvic bones here. So if you're watching. You can sort of see, um, where that sort of sits. We've got [00:09:00] the two bones coming together. And then right at the bottom of the pelvis, we have kind of like a hammock of muscles, if you may.
And so, and they attach to the pubic bone at the front, run all the way around to the tailbone at the back, and then connect to the sides with connective tissue. And so the main roles in that is to support our pelvic organs. So bowel in the back, Um, and if you have a uterus sitting on top, um, and then also a really important role of keeping us continent and what that means is, um, Um, stopping us from pooping and peeing without control.
So with that in mind, um, generally I explain the pelvic floor because I often use analogies because it helps my brain and I think it helps to explain it. Um, if the pelvic floor can go from ground floor, so relaxed, [00:10:00] to pelvic floor. Level 10, say, in terms of how contracted the muscle can be or how much tension it's holding.
So, um, for those that can see if this was a bicep, you know, my arm is out straight, that's level zero. And if it was fully contracted, my elbows all the way in, that would be level 10. So let's say the pelvic floor can do that. So right now, sitting on this very comfortable couch, I would say in theory that our, the tone of our pelvic floor, an appropriate Level of resting tone would maybe be at like level one or two.
So it's enough to hold everything up and in and enough that we're not just sitting here leaking urine, for example. If I was to jump up, do a big star jump or some double unders or something where pressure is coming down on the pelvic floor. Again, in theory, what should happen is the muscles squeeze up to withstand that pressure coming [00:11:00] down.
So that I don't link and things don't drop down and then come back down to that baseline. So that's usually how that's sort of my spiel and how I explain the pelvic floor. And then I guess in relation to what we're talking about today, what we've just spoken about is that, and this is what we see a lot of the time when someone's experiencing pelvic pain for whatever reason.
Whether it's all the time, or whether it's just with periods, or it might be with intercourse, um, or random pains. 9 times out of 10, if we assess a pelvic floor, it's not sitting at a 1 or a 2 out of 10 in a rested state. It's 7, 8, 9, sometimes 10 out of 10. So it's sort of, It has a high level of arousal instead of being at resting.
Absolutely. Yeah. And, and this is sort of the, the terminology that I use is that it's in protection mode. And I also, I'll take this opportunity to say, Don't [00:12:00] call that pelvic floor dysfunction. Medical journals will, but I believe that it's actually a very functional thing for our pelvic floor to do when there's been reason to.
Yeah. Um, in another episode, we've talked a bit about the nervous system and how, um, the nervous system responds to that sort of reptilian brain, the fight and flight. In that instance, what is the pelvic floor trying to do? It's so. It's just holding it everything. Mm-Hmm. . So why has it gone into that state?
What's it trying to do? Well, I mean, first of all, if we think about what does our breath do when we're in right or flat, how do we, yeah. We breathe up into our chest. And this is something I've come to really notice, which, and I find it fascinating, I have found it fascinating that if I am doing a pelvic floor exam and.
And we work on breath work. If someone is breathing up into their chest, I feel the muscles tighten. [00:13:00] And then if we can then get that breath going down into it, what we would say a diaphragmatic breath or like a deep belly breath, which is how we breathe when we're not in the front of five, it's the opposite of that in our rest and digest, the pelvic floor muscles let go.
So I think that's a huge part of it is just, you know, if we're in that ready to run, ready to fight. Ready to fly, we're breathing up in our chest and to do that, we're, we're tense down here. Our abdomen is tense in our pelvic floor muscles are tense. Um, but also think that also speaks to the fact, another analogy I use, you probably heard this before is when a dog is in trouble and they, yeah, what do they do?
They curl their tail under and that's, we have a tail, let's call it our tailbone, which all the pelvic floor muscles are attached to and That's exactly what happens when we're in that mood, you know, and potentially even that's a freeze mode, isn't it? Um, yeah, it is. And I just, as you were saying that I feel like, and I can think of times [00:14:00] in my life when I've just been walking around with fear of that, I might be in trouble.
Do you know what I mean? Like that kind of sense of, am I safe here? Is this, Space that i'm working in a safe environment. Am I about to have someone say something, you know, even Even just if I think back to my teenage years working as a waitress. Am I going to drop a plate? That's a real, you know They're worrying anxiety inducing things when you're not used to doing it So yeah, I can completely understand and that's that you can feel it in you 100 percent watching Like a thriller movie, which I don't do much these days.
I'm like this enough to in this world that put me in front of life, but in the past, yeah, watching thriller movie or even like action movies, I feel it in my pelvic floor. I feel my pelvic floor contract up and maybe it's, I'm more aware of what's happening down there, but yeah, you literally can feel it.
Or if I. [00:15:00] If I see something gory, my pelvic floor goes, you know what I mean? Like, Oh, just anything that makes you go, your pelvic floor contracts. So when you were talking about, you know, that a lot of time we should be getting back to explaining to the young girls about. You know, what exactly is happening to them at this stage in life and how they can actually be working with really having knowledge of their pelvic floor muscles, these muscles.
One of the things that occurred to me is just how hard it is having two teenage girls, like, well, they're not one of them, sort of teenager anymore, but I've gone through trying to help them in using tampons. And that's what came to my mind immediately that I remember trying to explain to them that. Then you can't do it unless you're relaxed.
And just how counter intuitive it is to tell your body to relax whilst you're trying to stick a foreign object into, you know, your vagina, it's super hard. And we [00:16:00] just do that and we kind of, you know, do it with gritted teeth. Um, anyway, that just came to me about that whole thing of pain. Absolutely.
Absolutely. So that's a big. Yeah, that would really help girls to understand that, wouldn't it? Definitely. I'm, um, earlier on in the journey with two very young girls, um, and I mean, I only recently got my cycles back after being pregnant and breastfeeding, so they hadn't ever really experienced mum having a period, but I'm, as you can imagine, very open about it because I don't want there to be any secrecy or any shame.
And I've recently discovered, I mean there's so many great products out now because I didn't have my period for like a big part of the last sort of six years with yeah, pregnancy and breastfeeding. And in that time there's all these amazing things like period undies and menstrual cups and menstrual discs.
So I've recently discovered a menstrual disc, which I am in [00:17:00] love with. I love it so much. And I mean, like, like anything it, like you just said, for the first time you're doing it. Myself, a pelvic health physio, found it a bit confronting. Like, how do I even, okay, let's, but like after a few practices, I love it so much.
And, um, my girls know exactly what it is. The first time they ever saw me changing it in the shower, cause you know, it's our house, we've have an open door. They were like, Whoa, but I was really mindful not to like, be like, Go away. Like, you know, I didn't wanna say No, no, no, don't look. I was like, yeah, I'm bleeding and I've got my period.
And, and I, in the first cycle they were like, can we see it? It's amazing. . Um, and now I just like, I did it the other night and they were like, yeah, whatever. Like, it's just, they're not, they don't even care anymore. They're like, it's just so normal. So hopefully by the time they come to that age, I mean, I'm sure there'll be even more amazing things out there.
Hopefully they won't have that fear and anxiety about, [00:18:00] you know, that. I agree. And I think that's a lot of change that is occurring where people are a lot more open about sharing their periods with their daughters and sons. And, um, and that does make a difference because quite rightly, we're not so scared immediately when we, when we get our first Bleed, which is a scary time if you're not used to seeing it and have never seen it, which I think for many of us, certainly my generation, I can talk to a lot of women who that was the case.
I certainly wasn't something I saw. So it was very much hidden. So it's a big thing from that. And I guess that that on this subject that we're on, If that's the case, and it was hidden when you first got your bleed, therefore you naturally went into fear. That's going to add to the likelihood of experiencing more pain.
Which leads me nicely on to ask you that question. So, what would you say are the main symptoms and [00:19:00] causes? I know we've listed it through a few, but what, where do you, what do you see as being the main symptoms and causes? Okay. Yeah, I guess the main symptom is, like I said, everyone's pain experience is always going to be different.
Um, but generally it's like crampy, deep pain. I mean, the descriptors often are stabbing, sharp. Deep throbbing that would relate usually to like the deep pelvic floor muscles that really sort of support underneath the organs. But sometimes it can be more at the entrance of the vagina and sort of more the superficial muscles.
And you know, that can be lots of different descriptions for pain. Um, if it is around the more of the back, I heard this term a few months ago. called lightning bum. That's been a description. Yeah. And like I said before, it can be, it can be provoked by period, but yet muscles sort of reacting to that. Like we said, the inner vertical is [00:20:00] normal crabs, um, inflammation that come with a menstrual cycle and just.
Being super on alert, and this is like, I guess I'm talking about the physical, right? It's the physical muscular reaction to this, but undoubtedly the other massive facet, one of the other massive inputs to pain, um, or modulators of pain is the actual. It's receptors. So like the nerve endings and same deal, like when the nervous system, um, and nerves like physical nerves have been experiencing what they think is a threat, they will then be more open to like looking out more on alert for a threat.
So it's like a car alarm system, you know, it should go off when a burglar is breaking in, but it's starting to fire off when a leaf is falling on the roof. So, you know, and what that means is. It, there shouldn't actually be a particular threat that's causing this pain, but they've become so hyper aroused that they are.
And so [00:21:00] things like inflammatory markers, prostaglandins, they can trigger off like massive pain signals. Yeah, I guess that's how, you know, people describe it. It can come mid cycle as well. Same deal with things around like ovulation. Exactly. Yeah. Okay. Um, and that can manifest as bloating as well, which comes with similar sort of abdominal pelvic discomforts and, and then potentially muscular reaction to that.
Do you see that people who have, I often think about this just from my own journey, but those of us that were sort of trained to hold our tummies in. You know, to be thin. Oh yeah. I don't mean like thin, I mean like flat, tummy, tummy thin so you could wear the skinniest jeans. Do you feel like that has an influence?
Oh yeah. And can we talk about that and one of my other hot subjects, which is yoga leggings. Yeah. Does that, you know what I mean? Like, not that the ones that are particularly, not the ones that are, um, the second [00:22:00] skin that can be a bit more loose, but I'm always trying to be able to get one size up. Yes.
And they've got all these others. Can we talk about that tight clothing, the desire to have a flat tummy? This The bane of my existence. Absolutely. And do you know, I'm actually listening to Burnout. Okay. Oh yeah. Amelia and Emily Nagoski sisters. And literally today, the, the chapter I was listening to was on this, they call it the, um, is it the bikini?
complex that we live in. And I actually found this really interesting. I've always said some likely dude along the way decided that we need to have a flat stomach to be desirable. Whereas not that long ago, like a couple of hundred years ago, what was desirable in inverted commas was round hips, you know, a big soft belly that can hold [00:23:00] children cause you're fertile.
And, and interestingly, um, that I just found out in this book, the chapter talks about in the industrial revolution, it was seen as like, what's the word I'm looking for? Like amazing. The, like the goal that you wanted as a man was to work for your family, have this like delicate week. wife that you had to provide for.
And so, I mean, I'm sure this is one theory, but I found it really fascinating of where did this whole flat stomach thing come from? Like, why do we all want that? Um, and that was seen as. you know, societal goals. To have this like, um, weak wife that couldn't possibly work, so you work. So it really, it's a symbol of like, control over wife.
Rather than seeing that she was actually the one running the household. And indeed. Strength and. Yeah, that's right. Yeah. The one that was actually fully in charge of. Yes. [00:24:00] Of the children. Yes. The home, the village. Mm hmm. And so, look, I do always bring up. Patriarchy and the patriarchal society we live in.
But I, I have to say something really funny that my mum bless her. In the last podcast I was on, I brought it up as I always do. And I guess what she was trying to say is like, when we use the word patriarchy, we, I think we have to be really careful, right? Yeah. You know what I'm trying to say? Because it's not like we're blaming all the men in our lives for all our problems.
It's not that at all. But. Really, it, it is the way that our culture has molded itself from these patriarchal kind of ideals, I suppose. Yeah. And I, it's, yeah, and it's good to sort of see that we can put a, a sort of place on that, where it's come into relation as a, of us looking a certain way. And I'm, I'm with you.
I don't, don't [00:25:00] particularly go out on the sort of going down on the patriarchy because one of my things is. We are the mothers of the patriarchy. Yeah. So it's up to us. This is what we're doing now. We're trying to communicate, spread the word, so that actually we can educate our sons to have an understanding of pelvic floors.
Yes. And why they don't want their mothers. Sisters, girlfriends, future wives to wear really tight clothes and have a fat stomach because they want them not to live a life of pain. Yes. And so we, by not just behaving like you're behaving with your girls in the shower, but like I behaved at home with my boys, want to be open about our bodily experiences.
Absolutely. Yep. So they can understand that. Absolutely. And if you look at, like, it's alarming the statistics, um, that they've brought out recently on, um, girls as young as six years old worrying about what they look like and having a flat [00:26:00] stomach. And that frightens me so much. So because to have a flat tummy, let's just be clear, if we, if you were going to tell someone, and I was just thinking about this.
The only time, or I remember ever being educated about until I came to see you, because I had an amazing appointment with Brooke, about this year? Um, yeah, I think it was, yeah. Because I'm always telling people to go and see Brooke, I decided I needed to go and see her so I could have experience to having, um, my pelvic floor checked.
And I thought it was good. I turned 50 this year, so I went for a kind of pelvic floor checkup and it was awesome. I really recommend doing it. It's just really good to get that, that level of feedback actually. And I found it really, really helpful. But anyway, I was thinking the only other time that I've really fully been able to contemplate the pelvic floor the first time was after having a child or during my pregnancy when, I don't know, some midwife would have said to me, you need to work on your pelvic floor.
Yeah. And then they would have [00:27:00] said, so simply just stop yourself urinating, you know, nine to 15 times a day or something. Yeah. And that was it. That, that was literally my education. And, um, then after I actually at the time didn't get any education, I didn't get any support after my children, but I know things are very different now.
Um, yeah. So what I was thinking was, how do Yeah, how do you tell people that they are going to put the pelvic floor into action and release the pelvic floor? If you do that, that will explain what happens when you pull your tummy in and hold it in. Yeah, absolutely. Um, and when this is the thing, right, I mean, they weren't all wrong saying, yes, squeezy pelvic floor, squeezy pelvic floor.
It's really important to have a strong pelvic floor, but I guess what we haven't realized until more recent years and a tiny bit of research is that it's just as important to know how to release your pelvic floor, especially within the earth world. A hundred [00:28:00] percent. Yes. And this is what we've come to realize in very recent years is that, yeah, well there was a study showing, um, That when if you just lined up a bunch of women and said, bear down, you know, like, like you're gonna maybe push a baby out, um, one out of three actually contracted their pelvic floor and, and simply because, yeah, we just don't really have that awareness.
Like I said, we don't know what we don't know. So, yes, I think in the later stages of pregnancy, it's more important to work on pelvic floor muscle relaxation than it is strength. I mean, both are important, right? But yeah, um, it's a really good point. But if we'd have been doing that all of our lives, if we'd actually been thinking about that from the beginning.
the get go then that wouldn't be something we had to relearn. I don't think so. And yet we're kind of doing the opposite and training ourselves to have active pelvic floor. Absolutely. By wearing the tight trousers. Yep. And wearing the very tight skinny leggings. [00:29:00] Sucking it in. Yep. Because doing that is contracting the pelvic floor.
It sure is. Absolutely. Yep. Yep. So Yes, I mean, uh, anyone who's heard me speak on this says, you know, if you're going to follow a hashtag, did you know you can follow hashtags? One of my favorite ones is hashtag, stop sucking it in. It's a great movement and it's, yeah, it's a good one to follow. And again, with my girls, you know, make a solid effort, like, cause I read all of this and I get so excited.
I get really worried about, yeah, the state of the world and how it's going to impact their body image and their health. Really, that's what it comes down to. And I pray that my input has enough of a percentage impact on them that I make an effort to, You know, our favorite song to sing is love my shoulders.
I love my belly. And we really like round the belly and give it a rub. And we're like, I love my head. Love my vulva. [00:30:00] I love my knees. And that's how I sing that. But just to get them, yeah, just loving all the parts of their body. And when, when I say, well, you know, what's your favorite part of your body? I'll always say, I love my belly.
beautiful big belly because it grew you guys, you know, and, and I, a little side note on that. I actually saw, um, because I, you know, I follow all these body positive things on Instagram. I like to think this is the same as everyone's algorithm, but this is mine. And one comment made, and it was a really good point is that someone said the same thing.
I'm like, yeah, cool. That's what I say to my girls. I love my belly because it grew you. And then a few people have commented, well, I've never had children and I still have a belly. So what do I say to that? And I'm like, Absolutely. Like, totally. We need to be thinking about that. That's not the only reason I love my belly.
If I didn't have children, would I still love my belly? Totally. Yes. Yes. And it makes you question the ingrained. That's the ingrained ideal of, yeah, am I [00:31:00] attractive? With a full belly. Yes. I actually love that whole concept of well, you actually have a round belly because you have a uterus yes, and so it's actually understanding that that's you need the space for the uterus and Yeah, and that was a real big moment for me of going Yeah, obviously like why we thought that we don't want to have a space for our internal organs It's totally ridiculous, isn't it?
So yeah, I'm Yeah. It's just all wonderful. I like to think that the tables are slowly turning. I think obviously there's more awareness about it, but I think we just have to be so cognizant about capitalism and how the world, and, you know, I like, this helps me, I visualize like, A boardroom of like middle aged white men making all this money off us believing we need to look a certain way.
And that makes me so angry. And I say, actually, no, no, I don't need [00:32:00] to inject things into myself. I don't need to suck it in. So I'm rebelling. Yes, we are big rebellers. Now what we want to get. Back to you. And really the most, um, probably the most important thing that we want to close with today is What are the treatment options that we have available to support us, um, with pelvic floor instigated pain or pain that we could say might be led from the pelvic floor?
Yep. Amazing. Well, overarching all of this absolutely is the context that you live in. The environment that you live in and the state of your nervous system. We know that, right? And I'm sure, I'm sure we'll speak more about that. We've got a whole episode sort of talking about pain and the nervous system and we're going to do more on that because that's going to be an endless conversation.
Not in a bad way, in a really positive way. We need to understand more and more about how our nervous system impacts us. Amazing. Yeah. But [00:33:00] yeah, for the purpose of honing in on the local, like I say, like the actual muscular physical aspect, which really is like responding to the state of the nervous system.
That's why I think, you know, I'll run through some really lovely tangible strategies, but if you only focus on that, which is really how I was trained in the early days as a physiotherapist, uh, you're only going to go so far, right? That's what I talk about. That's outside. Sort of from the outside pushing it into the body rather than healing from the inside out.
Yeah, and you were talking about we actually need to think inside out and the environment that we're living in, in the way we're living, and if we're happy or not in our lives. Yes. It's going to impact that. Absolutely, one of my favorite little quotes that Peter has put up in presentations and I've saved it is you can try and like pry open the pelvic floor, [00:34:00] you know, trying to, um, get it to release.
You can address the state of the nervous system, calm the nervous system and watch the muscles unfurl. Yeah. That's everything, isn't it? Yeah. Yeah. And look, there's the main strategies that I have for pelvic floor muscle relaxation. Funnily enough, I also do actually target calming the nervous system as well.
And so the first thing always, number one, that I will, um, assess and then address is breath pattern. And it's just something, you know, we often don't, again, think about. We just like, I can breathe. Yes, I'm getting oxygen into my body, but am I breathing up in my chest and am I tight down here? Because I'm thinking about, you know, picking up.
The girls from school, this stuff, you know, my, you know, here, I'm not present. I'm not grounded. Yeah. So breath, the breath is, you must start with the breath. So teaching, and it's not [00:35:00] easy. No, this is what I say. Like this is probably, it's one of the hardest strategies, which sounds weird. Like it's breathing, but you know, so many times when I'll get people in all different positions, right.
To like, come on, let's get it out. Usually in a four point meal or a forward lane. Uh, with consent, with a hand on the belly is a good way to help that belly let go. But I had this beautiful woman a few weeks ago, we, um, actually like turned our yoga space into a little like safe haven, put all the blinds down, it was amazing.
And we did that and she finally got it and she let go and she started crying. And she was like, that feels so foreign to me, but she got it, it clicked and her abdominal Muscles in her pelvic floor. I hadn't even assessed her pelvic floor like let's just go external things first And she was like wow, and there was all that emotional release as well And so this is the thing once you can master the belly breath.[00:36:00]
It is the most effective way at immediate, probably formal release. And, you know, I've had several women come in and say, maybe like at a subsequent appointment, and I've taught them that. And sometimes that's all I send people home with. I remember one who said I was coming up the driveway and I was feeling a little bit anxious about today and I felt the pain come on.
Um, and then I just took a moment and I did a few belly breaths and it just dissipated. So she came in like laughing. She's like, I just breathed my pain away. You know, like, yeah, like it sounds crazy. Sounds like witchcraft, but it's a, it's, that's it. So that, yeah, it really can be so effective. So can you just.
Take it through how do we belly breathe? Yeah, how do we do it? So any position I think you know, you try and be as relaxed as possible. Generally, I teach it by Just a bit of an awareness Exercise first of all. So, [00:37:00] um, I invite one hand up on the chest and then the other hand right down on the lower belly.
At least when we're first doing this, eventually you could go two hands down on the belly. And then I'll ask you to take a big breath, like take a deep breath and then notice what muscles are being used when you take this breath. Nine times out of ten, it's up in the chest. And then This whole awareness is, okay, so this top hand is here to sort of speak to all these accessory muscles that, you know, we actually don't need these muscles to help us breathe right now because we are calm and we're feeling safe and grounded.
So we're going to invite the diaphragm to breathe, which is the main muscle that's meant to work when we're in a rested state. Which also helps to massage the bowel and get more energy to our gut. So we're now rest and digest. And then we aim to, and you know, often people don't get this [00:38:00] straight up. And this is, this is why I send it home for the main exercise.
We aim to then. Breathe into our lower belly. Now you don't want to force it or push it. Uh, one nice visualization is literally blowing up the balloon in your lower belly, and you can even think of that bowl of the pelvic floor and expanding that. With that inhale another visualization. I heard recently that resonated with me is like a frog mouth You know how it goes Like it expands out that visualization in your lower belly and your pelvis with that Inhale and then thinking about just softening everything on the exhale now I feel like This is my number one hack to my nervous system.
So I use it, used it recently when I had the girls in the back and I was driving and someone pulled out in front of me and you know, like initial reaction, I probably said a swear word, but, and then I [00:39:00] thought like the old me probably would have been stuck in that survival mode for the next at least five minutes, you know, tense heart rate, breathing up in my chest.
But now that I have mastered this breath, I literally just straight away thought everyone's fine We're safe, and I didn't want to be like road ragey so I had this I use the strategy and I Breathe into my belly immediately and went and I actually got chills because I could feel my nervous system. Just go And we're back and we're okay.
And the first time I did that, I was like, Whoa, this is beautiful. Cause this is a demonstration of, um, basically emotional resilience. This is a wonderful demonstration of bagel tone, which we kind of slightly cover in a different podcast, but we'll go into more and that's because you're practiced. Yes. So it's not to say that anyone would just be able to do that.
That takes time. Oh, I reckon 10 years to practice that. Yeah, absolutely. And I totally understand. Yeah, because I, [00:40:00] yeah, obviously working with this breath is a big thing that I do, but I think that is a beautiful reminder. Yes. Um, but yeah, we shouldn't feel bad if we can't do that immediately, but also, gosh, yeah, just the simple act of, so the first, our first place to go is, When we get pain and we want to do something to self help, I mean obviously we're going to come and see you, but um, to have things checked, but then it would be to work on that belly breath.
Would be number one. Yeah. Yep. And I believe there is highly validated research paper coming out soon to show the effect of actually squeezing the pelvic floor and then releasing the pelvic floor. So I'd call that contract relax, um, which is so effective, but often hard to get straight up, especially if you've never really thought about where your pelvic floor is or even how to contract it.
And so the step before that would [00:41:00] be The fancy physio word would be biofeedback, which is just a fancy way of saying connecting your brain to that part of your body. Um, and we got to be creative in how we do it, do that. And that's how public floor physios, that's where we come in. Um, but the most simple strategy, this comes with complexities and can be confronting for some, for many different reasons, but it is getting a mirror to your vulva.
And doing what you think is a contraction and seeing if you can see any movement, even just getting familiar with that part of your body. Right. A lot of people. Yeah. I mean, new generations are better. Like when I asked the younger generation, they do it. I was told to do that by one of my teachers at school.
She would have been way ahead of the game. We still. Don't spend enough time really understanding this amazing part of our body, even if we have had children. Yeah. Um, yeah, especially seeing, you know, do we know what it was like before and do [00:42:00] we know what it was like after? Yeah. So yeah, it's wonderful really.
That's a great, yeah, just being familiar. Yes. Something I mentioned at the beginning. Our recent healing pelvic pain day that I had also recently heard, again, hadn't really thought of before, but makes so much sense is, you know, anyone who owns male anatomy as their body, they are touching themselves, their genitalia, like several times a day, right?
To urinate, um, and other things, which is normalized in our society, which is fine and great, but it needs to be the same for women, whereas not the case for females, right? And for us to Yeah, like look or feel, you know, that is a foreign concept to many. And so even, even more so, we're getting or even less sensory information from that part of our body, which further means we're not connected to that part of the body.
So, yeah, the way that we feel shame around touching ourselves or looking at ourselves or, yes, [00:43:00] and certainly we wouldn't put our hands around our vulvas in public. Yeah. I mean, it would be really, really, really, really, Weirdly looked at absolutely and yeah, yeah, which is a funny funny really that the part of our body needs to be such a shrouded Heart, anyway, we could talk for hours So we've got belly breathing yes, we've got getting familiar.
Yes. And so however that is that would be with a mirror maybe touching Yep. Yeah, and we've got I mean, um as physiotherapists, we've got many weird and wonderful Devices external and internal that we can use. We've got ultrasound on the belly to help visualize So we've got lots of different ways to help Perceive, first of all, where are the muscles on the scale that we spoke about?
And second of all, how do I squeeze them and how do I release them? Like a lot of people are actually okay at squeezing. But they don't know how to release, and that's what we need to work on. And then, you [00:44:00] know, movement. I was just about to say, can we talk about, I was like, when are you going to talk about dance?
Yes. Yes. I should have said that first. Yeah. Um, yeah. Any, uh, any desirable, joyful movement, which, again, is so important. People, um, you know, you know I'm big on children movement. Taking the time to stop, be present, listen to your body, hello, body, or even hello pelvic floor. How are you? What do you need? In this moment, you are in pain.
Okay? You know, like, like you would a little baby, a baby's crying. What do you need? Are you hungry? Are you, do you just need a cuddle? Do you need food? Do you need, you know? I don't, you know what I mean? Yeah. And responding to that. And really, I mean, if our body's hungry, we eat, um, but if there's tension, if there's tension, Tight spots.
If there's pain, usually it's your body [00:45:00] saying, Hey, I'm stuck. Like, can you help me? Can you move? You know? And so any, um, movement, and this is why I love music and dance because I really believe that music, especially music that gets you going, like it's gonna be different for everybody, right? It might be.
Yeah. Death metal, or it might be yoga. Yeah. Whatever. Whatever moves you that really you love. And I don't think anyone could ever say that there's a music that that doesn't get them going. Right. It's the language of the stuff that just gets your hips going. Yeah. Yeah. When you hear it and you're like, I can't sit still.
Yes. Yeah. Yeah. And then that rhythm is just moving the rhythms and the waves of the body. Yeah. Which, yeah. And if you can add a little hum or singing, yeah, exactly. Any of those as we sometimes do, then, yeah, so good. And yeah, I mean, yeah. Um, [00:46:00] It would be rude of me not to say yoga. Yeah. Yoga. Yoga. Yoga, yoga, yoga.
Like, you know. I can say this with beautiful research papers behind me. One of my professional projects for my masters was looking into, specifically, yoga for pelvic pain. And we've got the evidence. We've got pretty good evidence to show. And I mean, honestly, I know if I am feeling really antsy or. Yeah, maybe not have a period.
That's very good. Or I get migraines if I'm getting migraines. I stop and reflect and usually it's because I haven't been doing yoga or dancing or singing. It's kind of like, they're like my outcome measures. If I'm singing in the shower, I'm like, I'm good. Like I'm in a good mental state. And I mean, before I met you beautiful Sam and did yoga every week.
Unfortunately, being a busy working mom, usually the first priority to fall off our list is exercise or movement or our own relaxation. Self care and yoga was definitely my thing. And at a point in [00:47:00] time there, uh, you know, I had so much going on and yeah, I just wasn't doing yoga and I realized, wow, I need that back in my life, but because it, it ticks so many boxes.
It, it's a time to just, you know, Stop. Connect to your body. Listen to your body. Respond to your body. Move. Breathe. Meditate. Yeah. Well, I feel like that was a very rich conversation. So if you are looking to see a pelvic floor physio and you're in the area of Brisbane, then please come and see Brooke or any of the other physios that are here at Vera.
And if you need recommendations for people, do we have like a list of other people that we know? Yeah, we have the Collective online. I presented a webinar last year for the APA, the Australian Physiotherapy Association, on recent evidence for telehealth, specifically for pelvic floor physiotherapy. Which a lot of [00:48:00] people would think that wouldn't work, but in reality it works.
Yeah. Because a lot of what we do is talking and more and more I much prefer to teach people how to connect to their own bodies. I would much prefer someone to look at their own vulva if they never have before I do. So I think that's a really powerful tool. So do you do those here? Yeah, we do telehealth as well.
That's brilliant. Yeah, so you can see people anywhere. All over the world. Love it. Thank you very much for joining us. If you want to know more about anything that we've discussed, please head over to the website, the Vera Wellness website. Thank you very much and we'll see you again.
DISCLAIMER:
This podcast is for information and educational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment.
