WEBVTT 00:00:01.660 --> 00:00:03.980 Women are not talking about this because it does 00:00:03.980 --> 00:00:06.379 feel embarrassing, shameful. A leak is a leak, 00:00:06.400 --> 00:00:09.080 regardless of how big or small that is. In fact, 00:00:09.119 --> 00:00:11.939 it's common and not normal. C -sections are only 00:00:11.939 --> 00:00:13.859 protected until the age of 50. One of those things 00:00:13.859 --> 00:00:16.440 that women joke about, and that is being unable 00:00:16.440 --> 00:00:18.239 to sneeze in public just in case you piss your 00:00:18.239 --> 00:00:20.940 pants. 95 % of women that present with persistent 00:00:20.940 --> 00:00:24.600 back or pelvic pain. have underlying pelvic floor 00:00:24.600 --> 00:00:26.899 changes. Fucking hell. Are you saying that's 00:00:26.899 --> 00:00:29.780 the number one non -pregnancy related cause of 00:00:29.780 --> 00:00:31.480 women's pelvic floor disorders? It's Australian 00:00:31.480 --> 00:00:34.039 constipation. The number of women who don't know 00:00:34.039 --> 00:00:37.299 how to poo well, it's diabolical. Today's episode 00:00:37.299 --> 00:00:39.700 is one every woman in her 40s secretly needs 00:00:39.700 --> 00:00:41.759 to hear because we're talking about something 00:00:41.759 --> 00:00:44.500 most of us experience, hardly any of us understand, 00:00:44.579 --> 00:00:47.759 and almost none of us ever bring up, pelvic health. 00:00:47.979 --> 00:00:49.740 You know that moment when you laugh a little 00:00:49.740 --> 00:00:52.100 bit too hard? Cough at the wrong time or feel 00:00:52.100 --> 00:00:54.179 a sneeze coming on and suddenly you're clenching, 00:00:54.280 --> 00:00:56.259 crossing your legs, hoping for the best? For 00:00:56.259 --> 00:00:58.320 so many women, that becomes the new normal in 00:00:58.320 --> 00:01:00.640 midlife. But is it actually normal or just something 00:01:00.640 --> 00:01:02.659 we've learned to put up with? Today's guest is 00:01:02.659 --> 00:01:04.680 here to break up the silence, clear the confusion 00:01:04.680 --> 00:01:06.540 and help us make sense of what's really going 00:01:06.540 --> 00:01:08.540 on with our bodies as we move through perimenopause 00:01:08.540 --> 00:01:11.120 and beyond. And before we get stuck in, if this 00:01:11.120 --> 00:01:13.480 episode makes you think, oh, wow, that's me, 00:01:13.640 --> 00:01:16.879 do us a favor. Hit follow, send it to a friend 00:01:16.879 --> 00:01:18.980 because no woman should be crossing her legs 00:01:18.980 --> 00:01:23.810 alone. Hi Preet, welcome to the 40s Formula. 00:01:24.329 --> 00:01:26.549 Hi, thank you for having me. We're so excited 00:01:26.549 --> 00:01:28.629 to be here. Oh yeah, we're so excited to have 00:01:28.629 --> 00:01:32.549 you. Took you long enough, but anyway. Right, 00:01:32.629 --> 00:01:34.530 so Preet, today we really want to talk about 00:01:34.530 --> 00:01:36.590 one of those things that women joke about and 00:01:36.590 --> 00:01:39.090 that is being unable to sneeze in public just 00:01:39.090 --> 00:01:42.290 in case you piss your pants. Now, is that a new 00:01:42.290 --> 00:01:43.930 normal? Is that something that we need to live 00:01:43.930 --> 00:01:46.590 with? Look, the short answer is no, it's not 00:01:46.590 --> 00:01:48.590 something that you need to live with. But I feel 00:01:48.590 --> 00:01:51.599 like... And historically, we're not having these 00:01:51.599 --> 00:01:54.060 frank conversations like we do about skincare. 00:01:54.180 --> 00:01:56.920 We're discussing serums. We're discussing Botox. 00:01:56.939 --> 00:01:59.760 But like, why not pelvic health? It's one of 00:01:59.760 --> 00:02:03.099 the reasons why women pull back from life. You 00:02:03.099 --> 00:02:05.079 know, have you got that friend that may be saying, 00:02:05.159 --> 00:02:06.819 you know what, I'm not going to go out because 00:02:06.819 --> 00:02:09.039 I need to go to the toilet every 10 minutes. 00:02:09.789 --> 00:02:12.210 for instance, or perhaps you have a significant 00:02:12.210 --> 00:02:15.129 loved one like a parent or a grandparent that 00:02:15.129 --> 00:02:17.210 needs to be put into elder care because they 00:02:17.210 --> 00:02:19.349 can't manage their continence piece. And that 00:02:19.349 --> 00:02:22.830 is a number one reason behind why older parents 00:02:22.830 --> 00:02:27.530 are put into assisted living in their older age. 00:02:27.689 --> 00:02:30.810 So why aren't we having the conversation around 00:02:30.810 --> 00:02:34.449 pelvic health sooner? And why isn't it more commonplace? 00:02:35.039 --> 00:02:36.500 It's interesting, isn't it? Because I remember 00:02:36.500 --> 00:02:38.639 having a conversation with a friend who was worried 00:02:38.639 --> 00:02:40.840 about a kid's birthday party being at bounce 00:02:40.840 --> 00:02:44.020 because it's like jumping on a trampoline. Absolutely. 00:02:44.539 --> 00:02:48.759 Absolutely. I have a client, bless, she's incontinent 00:02:48.759 --> 00:02:52.520 in both areas, as it were. And she was at a swim 00:02:52.520 --> 00:02:55.860 lesson with her little one. And she had to pretend 00:02:55.860 --> 00:02:58.139 that her little one had an accident. But it was 00:02:58.139 --> 00:03:00.759 hers. And it was so embarrassing, deeply embarrassing 00:03:00.759 --> 00:03:03.550 for her. And women are not talking about this 00:03:03.550 --> 00:03:06.210 because it does feel embarrassing, shameful. 00:03:06.389 --> 00:03:11.669 Why can't I fix this problem myself? Why? Exactly. 00:03:11.669 --> 00:03:18.469 Look, I think generationally, mothers aren't 00:03:18.469 --> 00:03:20.389 having conversations with their daughters. Daughters 00:03:20.389 --> 00:03:22.449 aren't having conversations with their friends. 00:03:22.729 --> 00:03:25.930 And it creates this taboo and shame. It actually 00:03:25.930 --> 00:03:28.629 perpetuates this shame around pelvic health. 00:03:28.750 --> 00:03:31.080 But what we need to realize is that You don't 00:03:31.080 --> 00:03:33.840 have to do it alone. Help and care is available. 00:03:34.099 --> 00:03:36.199 And just because it's been normalised through 00:03:36.199 --> 00:03:38.319 the generations or perhaps it's even normalised 00:03:38.319 --> 00:03:39.879 through healthcare providers that haven't had 00:03:39.879 --> 00:03:42.379 adequate knowledge, training and skills to manage 00:03:42.379 --> 00:03:44.939 that, it doesn't have to be the way forward. 00:03:45.219 --> 00:03:47.360 Look, I'm not here to say that everyone who leaks 00:03:47.360 --> 00:03:50.439 is going to be dry. There's people that are really 00:03:50.439 --> 00:03:52.719 worse off and there's women that are manageable, 00:03:53.039 --> 00:03:55.259 right? Like a scale. That's the word I'm looking 00:03:55.259 --> 00:03:58.759 for. There's a scale of symptoms, right? Women 00:03:58.759 --> 00:04:02.710 who have mild symptoms, may achieve dryness through 00:04:02.710 --> 00:04:05.569 conservative management, right? Versus women 00:04:05.569 --> 00:04:08.229 who have significant impacts in their urethral 00:04:08.229 --> 00:04:11.889 function, they may need more invasive management. 00:04:12.030 --> 00:04:15.169 That may look like surgery for some, or it might 00:04:15.169 --> 00:04:17.970 be something as easy as a pessary, which is still 00:04:17.970 --> 00:04:20.589 considered conservative management at the end 00:04:20.589 --> 00:04:22.850 of the day. So I think a lot of people come into 00:04:22.850 --> 00:04:26.829 perhaps this misconception that a... Kegels are 00:04:26.829 --> 00:04:29.670 going to fix it all, which we know it's not the 00:04:29.670 --> 00:04:32.730 case. We have to treat the whole body at the 00:04:32.730 --> 00:04:36.490 end of the day. But also there is a continuum 00:04:36.490 --> 00:04:39.550 of care that can be provided to women to help 00:04:39.550 --> 00:04:41.730 them address their concerns. And you brought 00:04:41.730 --> 00:04:43.949 up Kegels, which made me think of the exercise 00:04:43.949 --> 00:04:47.029 side of incontinence, right? And the normalization 00:04:47.029 --> 00:04:49.589 of, oh. It's squats, it's deadlifts, so I'm wearing 00:04:49.589 --> 00:04:52.149 black pants. Yeah. Because I'm going to pee myself 00:04:52.149 --> 00:04:54.769 is the subtext there. And it's like that to me 00:04:54.769 --> 00:04:57.990 is astounding. There's memes around it. There's 00:04:57.990 --> 00:05:00.290 cultures around it. It's a black pants day, you 00:05:00.290 --> 00:05:02.410 know, and I'm like this is absurd, isn't it? 00:05:02.449 --> 00:05:04.769 Yeah, like in the CrossFit industry, if you don't 00:05:04.769 --> 00:05:06.410 leak when you're doing a double under, are you 00:05:06.410 --> 00:05:08.449 really a CrossFitter, right? And I think there's 00:05:08.449 --> 00:05:11.709 this YouTube clip of an obstetrician glorifying 00:05:11.709 --> 00:05:13.930 women leaking on double unders. Fucking hell. 00:05:14.389 --> 00:05:17.889 And it was a cultural thing, right? just you 00:05:17.889 --> 00:05:20.149 know there is a point where your body is going 00:05:20.149 --> 00:05:23.730 to fail you let's be honest okay um but that 00:05:23.730 --> 00:05:27.149 doesn't mean you normalize yeah everyone's incontinence 00:05:27.149 --> 00:05:29.829 experience no matter how big or small it is at 00:05:29.829 --> 00:05:31.730 the end of the day and just because you leak 00:05:31.730 --> 00:05:35.449 a little doesn't mean it's not a leak a leak 00:05:35.449 --> 00:05:37.850 is a leak regardless of how big or small that 00:05:37.850 --> 00:05:39.370 is at the end of the day and that's your body 00:05:39.370 --> 00:05:41.310 telling you that hey perhaps something's not 00:05:41.310 --> 00:05:46.100 quite right and to listen And go seek help. But 00:05:46.100 --> 00:05:48.139 I also feel like a lot of women don't quite know 00:05:48.139 --> 00:05:52.480 where to go for help either. And we want to encourage 00:05:52.480 --> 00:05:54.660 women to reach out to their pelvic health or 00:05:54.660 --> 00:05:57.199 women's health physiotherapist for that further 00:05:57.199 --> 00:05:59.779 guidance and care because we can really act as 00:05:59.779 --> 00:06:02.579 a caseworker for you and refer you to the right 00:06:02.579 --> 00:06:04.540 people at the end of the day because it does 00:06:04.540 --> 00:06:06.740 take a village, as corny as it sounds. We talk 00:06:06.740 --> 00:06:08.759 about villages when women give birth, right? 00:06:08.819 --> 00:06:11.699 But women in perimenopause and menopause need 00:06:11.699 --> 00:06:14.310 a village as well. One clinician. is not going 00:06:14.310 --> 00:06:17.050 to have all the answers for you at the end of 00:06:17.050 --> 00:06:19.250 the day. You're absolutely right. And I think, 00:06:19.250 --> 00:06:21.910 you know, normalizing, like you said, is one 00:06:21.910 --> 00:06:25.230 part of it. But connecting with resources. This 00:06:25.230 --> 00:06:27.769 is a dumb question, potentially. We'll find out. 00:06:27.790 --> 00:06:30.269 Is there a centralized, like, so say I'm someone 00:06:30.269 --> 00:06:32.569 experiencing incontinence. Is there something 00:06:32.569 --> 00:06:35.129 I could search for? Is there a bank of practitioners? 00:06:35.250 --> 00:06:38.509 Is there a organization of people like yourself 00:06:38.509 --> 00:06:42.189 that I would turn to? Yeah, great question. Unified 00:06:42.189 --> 00:06:46.509 in Singapore? No. And that's the harsh reality. 00:06:47.980 --> 00:06:50.000 We're working on it. We've got a special interest 00:06:50.000 --> 00:06:51.660 group, particularly when it comes to the pelvic 00:06:51.660 --> 00:06:54.160 health physios. We're coming together to create 00:06:54.160 --> 00:06:57.920 a bit more of a consolidated approach to care 00:06:57.920 --> 00:07:00.180 in terms of having a bank of clinicians that 00:07:00.180 --> 00:07:02.339 are recognised and certified that can provide 00:07:02.339 --> 00:07:07.319 care. But as it stands, unfortunately for Singapore, 00:07:07.399 --> 00:07:09.879 no. We do see this in other countries. I think 00:07:09.879 --> 00:07:11.759 it's just a matter of time having the right... 00:07:12.589 --> 00:07:16.110 women championing for that uh to be put forward 00:07:16.110 --> 00:07:18.350 in the future can we just get back a little bit 00:07:18.350 --> 00:07:20.250 yeah and we've obviously mentioned pelvic health 00:07:20.250 --> 00:07:22.870 what i want to understand is what does pelvic 00:07:22.870 --> 00:07:26.430 health actually cover like is it just like the 00:07:26.430 --> 00:07:30.750 vaginal area is it you know the whole thing yeah 00:07:30.750 --> 00:07:34.069 is there is it what does it not cover oh okay 00:07:34.069 --> 00:07:38.529 look at the end of the day we're familiar with 00:07:38.529 --> 00:07:41.639 the term core yeah okay Now, a lot of women who 00:07:41.639 --> 00:07:43.819 we see at the clinic think the core is just your 00:07:43.819 --> 00:07:46.639 abs. But the reality, the core is a system, right, 00:07:46.699 --> 00:07:49.259 made up of your diaphragm, your pelvic floor, 00:07:49.459 --> 00:07:52.259 your deep abs, and to a lesser extent, the back 00:07:52.259 --> 00:07:55.779 stabilizers. So what we're looking at is that 00:07:55.779 --> 00:07:59.420 the pelvic floor and pelvic health is a part 00:07:59.420 --> 00:08:02.300 of a bigger system, okay? And hence, when we're 00:08:02.300 --> 00:08:04.459 helping women overcome their pelvic health challenges, 00:08:04.560 --> 00:08:06.060 we're not just looking at pelvic floor, we're 00:08:06.060 --> 00:08:08.649 looking above. We're looking in front, we're 00:08:08.649 --> 00:08:10.689 looking behind, but also we're looking beyond 00:08:10.689 --> 00:08:12.569 the pelvis as well. We're looking at, is there 00:08:12.569 --> 00:08:14.850 something happening at your feet? Maybe you sprained 00:08:14.850 --> 00:08:16.629 your ankle, you broke your foot like 10 years 00:08:16.629 --> 00:08:18.470 ago, and that might be playing into why your 00:08:18.470 --> 00:08:20.029 pelvic floor is gripping and holding tension. 00:08:20.699 --> 00:08:22.600 Or, hey, are you someone that has persistent 00:08:22.600 --> 00:08:24.980 neck and jaw pain because you're gripping all 00:08:24.980 --> 00:08:26.759 the time through your jaw for whatever reason 00:08:26.759 --> 00:08:29.079 that may be? And that might also be impacting 00:08:29.079 --> 00:08:31.579 your pelvic health. Fucking hell. That is so 00:08:31.579 --> 00:08:33.960 interesting. Like literally head to toe. Absolutely, 00:08:34.120 --> 00:08:35.980 head to toe, right? And that's what I mean by 00:08:35.980 --> 00:08:38.440 what does it not cover, right? A skilled clinician 00:08:38.440 --> 00:08:41.059 has to be able to look beyond the pelvis for 00:08:41.059 --> 00:08:43.539 answers at the end of the day. And to that point 00:08:43.539 --> 00:08:46.600 about Kegels being the solution, it is a starting 00:08:46.600 --> 00:08:49.980 point. It is not your end point. And I guarantee 00:08:49.980 --> 00:08:53.679 you, you'll be doing more than just Kegels, whether 00:08:53.679 --> 00:08:55.620 you're trying to address prolapse, whether you're 00:08:55.620 --> 00:08:57.360 trying to address incontinence, whether you're 00:08:57.360 --> 00:08:59.840 trying to address menstrual pain, because you 00:08:59.840 --> 00:09:02.720 might have a diagnosis of endometriosis or adenomyosis. 00:09:02.940 --> 00:09:05.360 You might be someone that's got persistent lower 00:09:05.360 --> 00:09:07.700 back pain. We've got some great research that 00:09:07.700 --> 00:09:10.659 says 95 % of women that present with persistent 00:09:10.659 --> 00:09:14.289 back or pelvic pain. have underlying pelvic floor 00:09:14.289 --> 00:09:17.929 changes 95 of women okay and people you know 00:09:17.929 --> 00:09:19.850 if you've got back pain and you're going to a 00:09:19.850 --> 00:09:22.330 physio osteochiro unless they're trained in pelvic 00:09:22.330 --> 00:09:23.870 health they're not actually asking the questions 00:09:23.870 --> 00:09:26.350 like so just by the way i just want to double 00:09:26.350 --> 00:09:28.320 check do you happen to have any pelvic floor 00:09:28.320 --> 00:09:31.139 issues while you're at it? It's such a simple 00:09:31.139 --> 00:09:33.320 question. It's such a simple question, but people 00:09:33.320 --> 00:09:35.460 don't have the tools, don't have the confidence 00:09:35.460 --> 00:09:38.580 or the knowledge to actually ask those questions 00:09:38.580 --> 00:09:41.179 because that could be such an easy starting point 00:09:41.179 --> 00:09:43.480 for some women who have been obviously dealing 00:09:43.480 --> 00:09:47.120 with persistent pain but might also have an underlying 00:09:47.120 --> 00:09:50.309 pelvic health challenge that has gone. unrecognized. 00:09:50.330 --> 00:09:54.549 And 70 % of women don't volunteer their pelvic 00:09:54.549 --> 00:09:57.190 health concerns unless asked. And so if health 00:09:57.190 --> 00:09:59.690 practitioners are not asking those questions, 00:09:59.909 --> 00:10:05.529 we're creating a society of women that have no 00:10:05.529 --> 00:10:08.070 idea that what they might be experiencing, in 00:10:08.070 --> 00:10:11.409 fact, is common and not normal and help is available. 00:10:11.929 --> 00:10:13.950 And that builds that shame as well. Absolutely. 00:10:13.970 --> 00:10:15.570 Because it's like, if I'm not being asked about 00:10:15.570 --> 00:10:17.549 it by my practitioner, then maybe I should hide 00:10:17.549 --> 00:10:19.649 it, right? Exactly. Maybe it's not a thing, right? 00:10:19.690 --> 00:10:21.429 It wouldn't be relevant. If it was relevant, 00:10:21.590 --> 00:10:24.950 they'd ask me. Exactly. Wow. Exactly. So I was 00:10:24.950 --> 00:10:27.779 actually going to ask, oh, is it? Does this only 00:10:27.779 --> 00:10:30.620 happen after having a baby? Doesn't sound like 00:10:30.620 --> 00:10:34.179 it. No, it does not. I mean, when we look at 00:10:34.179 --> 00:10:35.779 the research, let's just take, for instance, 00:10:36.000 --> 00:10:38.639 stress urinary incontinence. So that leak that 00:10:38.639 --> 00:10:40.639 happens with your cough or your sneeze or when 00:10:40.639 --> 00:10:43.840 you're at bounce or when you're in the gym. The 00:10:43.840 --> 00:10:47.379 lifespan incidence of urinary incontinence is 00:10:47.379 --> 00:10:51.879 33%. They've got research in elite female athletes 00:10:51.879 --> 00:10:55.850 who have never been pregnant. OK, they're leaking 00:10:55.850 --> 00:10:57.850 at the same rate as women who have given birth 00:10:57.850 --> 00:11:01.509 or are menopausal. OK, so what we're seeing is 00:11:01.509 --> 00:11:03.429 that pelvic health challenges actually do start 00:11:03.429 --> 00:11:06.129 quite early. And in particular, with this study 00:11:06.129 --> 00:11:09.730 that I'm referring to, these girls were typically 00:11:09.730 --> 00:11:14.669 volleyballers. netballers trampolines okay ballerinas 00:11:14.669 --> 00:11:18.129 gymnasts so all these impact related sports um 00:11:18.129 --> 00:11:20.629 that are bringing on these symptoms but again 00:11:20.629 --> 00:11:22.850 no one's educating these poor young girls right 00:11:22.850 --> 00:11:27.350 on that you know this leaking is not normal okay 00:11:27.350 --> 00:11:29.110 you don't have to put up with it but i think 00:11:29.110 --> 00:11:32.250 we need more funding in those spaces we need 00:11:32.250 --> 00:11:35.789 more skilled clinicians to really push that agenda 00:11:35.789 --> 00:11:40.169 in educating women um on what's common what's 00:11:41.440 --> 00:11:45.179 and how these concerns can be managed. So then 00:11:45.179 --> 00:11:47.519 that then brings me to someone who turns around 00:11:47.519 --> 00:11:49.779 and says, oh, I had a C -section. I don't have 00:11:49.779 --> 00:11:51.820 to worry about my pelvic floor. I've heard that 00:11:51.820 --> 00:11:53.820 so many times. So many times. Heard that so many 00:11:53.820 --> 00:11:56.159 times. Yeah, look, and this leads to the conversation 00:11:56.159 --> 00:11:58.460 about what are the pelvic floor risk factors. 00:11:58.519 --> 00:12:00.580 So when we have clients in the clinic and we're 00:12:00.580 --> 00:12:03.080 trying to build a picture around the why behind 00:12:03.080 --> 00:12:06.059 their symptoms, we're screening for risk factors. 00:12:06.139 --> 00:12:11.200 So when we look at... obstetric versus non -obstetric 00:12:11.200 --> 00:12:14.500 risk factors okay obstetric risk factors being 00:12:14.500 --> 00:12:17.879 pregnant so regardless of mode of delivery being 00:12:17.879 --> 00:12:19.940 pregnant and being pregnant more than once is 00:12:19.940 --> 00:12:25.580 a risk factor i mean i hear you okay c -sections 00:12:25.580 --> 00:12:28.899 are only protective till the age of 50. oh that's 00:12:28.899 --> 00:12:30.860 interesting can you clarify what you mean by 00:12:30.860 --> 00:12:35.570 that because hormones level us all out Well, 00:12:35.629 --> 00:12:37.169 I think I was going to say seven years. Or rather 00:12:37.169 --> 00:12:40.970 lack of hormones. Seven good years. Nope. Yeah, 00:12:41.049 --> 00:12:44.029 hormones level us all out. Yeah, so you may not 00:12:44.029 --> 00:12:47.929 have symptoms until peri or menopause because 00:12:47.929 --> 00:12:50.750 the hormonal fluctuations that drive those pelvic 00:12:50.750 --> 00:12:54.210 floor challenges. So we've got pregnancy as an 00:12:54.210 --> 00:12:56.309 independent risk factor. Then we look at vaginal 00:12:56.309 --> 00:12:58.389 delivery, the way you birth. So for women that 00:12:58.389 --> 00:13:00.330 birth vaginally, if your baby weighed more than 00:13:00.330 --> 00:13:04.230 four kilos. if there's been a prolonged labor, 00:13:04.269 --> 00:13:07.110 so more than 90 minutes of pushing, but also 00:13:07.110 --> 00:13:10.830 too quick, less than 15 minutes of pushing. So 00:13:10.830 --> 00:13:12.870 we always hear about long labors being a problem. 00:13:12.950 --> 00:13:15.169 I'm here to tell you, girlfriend, short labors 00:13:15.169 --> 00:13:17.389 are a problem too because that's a quick stretch 00:13:17.389 --> 00:13:20.429 on your connective tissue. Okay, so I fell in 00:13:20.429 --> 00:13:22.950 the range, I feel. I think it was an hour with 00:13:22.950 --> 00:13:25.330 my first and like 45 with my second. So I feel 00:13:25.330 --> 00:13:30.059 like what you just told me is a revelation. Can 00:13:30.059 --> 00:13:32.279 we talk about how no one prepares you for how 00:13:32.279 --> 00:13:34.940 your skin changes in your 40s? Honestly, one 00:13:34.940 --> 00:13:38.279 day it's fine. The next it's dull, dry and showing 00:13:38.279 --> 00:13:40.879 every single emotion you've ever felt. That's 00:13:40.879 --> 00:13:43.120 why I've actually been loving Love Indus. 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Plus, they ship free to Singapore, 00:14:17.139 --> 00:14:19.299 which seems like a very rare little treat. And 00:14:19.299 --> 00:14:21.440 yes, we earn commission when you use our code. 00:14:21.519 --> 00:14:24.279 So don't forget to support the show by using 00:14:24.279 --> 00:14:27.759 code TFF. And then we have instrumental deliveries, 00:14:27.960 --> 00:14:30.059 forceps and vacuums. That increases your risk 00:14:30.059 --> 00:14:33.399 of an oasis injury or a levator ani defect, for 00:14:33.399 --> 00:14:35.559 instance. What's that, sorry? Levator ani defect 00:14:35.559 --> 00:14:37.860 is something that's not so commonly talked about. 00:14:37.919 --> 00:14:40.460 It's actually where the attachment of the pelvic 00:14:40.460 --> 00:14:44.019 floor and the pubic bone becomes impacted. So 00:14:44.019 --> 00:14:45.740 there can be a partial tear at the attachment 00:14:45.740 --> 00:14:48.360 or it can be a complete tear. It could be unilateral. 00:14:48.379 --> 00:14:50.519 It could be bilateral. Is that what leads to 00:14:50.519 --> 00:14:53.480 a prolapse? One of the reasons is a higher risk 00:14:53.480 --> 00:14:55.679 of a prolapse. It's not the only risk. reason 00:14:55.679 --> 00:14:59.139 why you would get prolapse. Does episiotomy affect 00:14:59.139 --> 00:15:03.720 any sort of pelvic floor function? It can. Look, 00:15:03.759 --> 00:15:07.080 so episiotomies are commonly related to or correlated 00:15:07.080 --> 00:15:10.659 with ongoing perineal pain. Okay. But also the 00:15:10.659 --> 00:15:14.220 reason why episiotomies came about was to actually 00:15:14.220 --> 00:15:16.259 protect women from having those third or fourth 00:15:16.259 --> 00:15:18.759 degree tears. Okay. That is what my doc said 00:15:18.759 --> 00:15:21.080 when she did mine. Yeah. She's like, I'm here 00:15:21.080 --> 00:15:22.399 to help you. And I was like, all right, girl, 00:15:22.580 --> 00:15:26.019 I trust you. The problem with episiotomies, I'm 00:15:26.019 --> 00:15:28.200 afraid to say, is that some people have just 00:15:28.200 --> 00:15:31.419 dished them out routinely. Okay. So without, 00:15:31.580 --> 00:15:33.500 you know, without the actual risk being there, 00:15:33.559 --> 00:15:36.179 they'll just do it for just in case. Correct. 00:15:36.259 --> 00:15:38.539 Oh, my God. Yeah. I have heard that before. Like, 00:15:38.580 --> 00:15:40.340 it was like, you know, you'd only been in labor 00:15:40.340 --> 00:15:41.820 for a few hours, and she's like, okay, let's 00:15:41.820 --> 00:15:43.659 get this on the road. Yeah. You know, whereas, 00:15:43.820 --> 00:15:47.100 yeah. When mine, I remember she came up to my 00:15:47.100 --> 00:15:50.000 bedside and held my hand. Yeah. And she was like, 00:15:50.139 --> 00:15:52.720 we need a little bit of help at this point. Because 00:15:52.720 --> 00:15:54.759 it was, this was my first vaginal delivery. And 00:15:54.759 --> 00:15:58.120 it had been. A while. A while. Okay. And I think 00:15:58.120 --> 00:15:59.879 exactly what you're saying is, I think the two, 00:15:59.960 --> 00:16:01.700 she was worried about edging into the too long 00:16:01.700 --> 00:16:04.279 situation. After hours and hours, and she was 00:16:04.279 --> 00:16:06.409 like. we might have. And I was like, because 00:16:06.409 --> 00:16:08.309 the one thing in my birth plan, literally like 00:16:08.309 --> 00:16:10.389 a one sentence birth plan. Yeah. And it was like, 00:16:10.409 --> 00:16:16.279 please, no. Anyway, we all survived. Going on, 00:16:16.340 --> 00:16:18.659 obstetric risk factors. Yeah, so they're the 00:16:18.659 --> 00:16:21.980 four key ones around vaginal delivery. So pushing 00:16:21.980 --> 00:16:24.720 for too long, not pushing long enough, baby weighing 00:16:24.720 --> 00:16:27.580 more than four kilos and the use of instruments. 00:16:27.940 --> 00:16:29.919 Okay, so these are obstetric risk factors and 00:16:29.919 --> 00:16:32.100 we look at the non -obstetric risk factors. Okay, 00:16:32.259 --> 00:16:35.059 so again, regardless of whether you've had a 00:16:35.059 --> 00:16:37.620 baby or not. Genetics, if your mum or grandma 00:16:37.620 --> 00:16:39.259 suffer from incontinence or prolapse, you're 00:16:39.259 --> 00:16:42.769 highly likely. Really? Yeah. Are you hypermobile? 00:16:42.809 --> 00:16:44.990 Have you been diagnosed with a connective tissue 00:16:44.990 --> 00:16:47.809 disorder such as like an Ehlers -Danlos syndrome? 00:16:48.149 --> 00:16:50.309 What that tells us is that your connective tissue 00:16:50.309 --> 00:16:52.570 is just too stretchy and not supportive enough. 00:16:52.629 --> 00:16:55.649 That puts you at higher risk of things like prolapse, 00:16:55.669 --> 00:16:58.669 okay, for instance. And those girls are often 00:16:58.669 --> 00:17:00.610 the ones that are doing your gymnastics and your 00:17:00.610 --> 00:17:03.289 ballet. I was thinking Cirque du Soleil, but 00:17:03.289 --> 00:17:05.910 also gymnastics. I mean, it's kind of the same. 00:17:05.930 --> 00:17:08.829 You follow the same. It's a continuum. That's 00:17:08.829 --> 00:17:10.750 the word I was looking for earlier, continuum. 00:17:11.150 --> 00:17:14.630 Oh, my God. Anyway, I digress. Then we move on 00:17:14.630 --> 00:17:23.029 to things like, fuck me, brain fart. Let me just. 00:17:23.440 --> 00:17:26.940 rewind a bit so we've got things like genetics 00:17:26.940 --> 00:17:30.460 we've got things like uh connective tissue disorders 00:17:30.460 --> 00:17:35.099 we've got things like hormones that's the word 00:17:35.099 --> 00:17:37.539 i was looking for so you know whether you're 00:17:37.539 --> 00:17:39.579 postpartum and you've got a decline in estrogen 00:17:39.579 --> 00:17:42.440 whether you're in peri and you've got your progesterone 00:17:42.440 --> 00:17:45.299 declining and then you've got your estrogen tapering 00:17:45.299 --> 00:17:46.839 off and then menopause you've got your estrogen 00:17:46.839 --> 00:17:49.640 you know our vulva vaginal tissues are very much 00:17:49.640 --> 00:17:52.180 estrogen dependent they need estrogen at the 00:17:52.180 --> 00:17:54.299 end and it's not typically the oral type it's 00:17:54.299 --> 00:17:56.240 more the vaginal estrogen just for clarification 00:17:56.240 --> 00:17:58.400 there and we can elaborate on that a bit later 00:17:59.369 --> 00:18:06.990 And then we move on to things like BMI. BMI greater 00:18:06.990 --> 00:18:11.369 than 25. Greater than 25? So just in the overweight 00:18:11.369 --> 00:18:13.730 category. That is lower than I expected you to 00:18:13.730 --> 00:18:17.089 say. To be honest, we could harp on about how 00:18:17.089 --> 00:18:19.869 crap BMI is as a measure because it doesn't accurately 00:18:19.869 --> 00:18:22.049 tell us body composition and all the rest of 00:18:22.049 --> 00:18:24.069 that, but I'm just going to leave it at 25 because 00:18:24.069 --> 00:18:27.299 that's what the research tells us. Things like, 00:18:27.319 --> 00:18:28.880 are you in an occupation where you're constantly 00:18:28.880 --> 00:18:35.039 lifting Herbie? Yes. Yes, I am, doctor. Can you 00:18:35.039 --> 00:18:39.099 tell me more? But I'm sure your form and pressure 00:18:39.099 --> 00:18:41.400 maintenance is good. I mean, they're pretty good. 00:18:42.579 --> 00:18:45.059 And things like, you know, do you suffer from 00:18:45.059 --> 00:18:47.160 a respiratory illness, like an asthma that's 00:18:47.160 --> 00:18:49.460 poorly managed? So you're constantly coughing, 00:18:49.660 --> 00:18:53.500 coughing, coughing. Pressure, pressure, pressure. 00:18:53.660 --> 00:18:57.579 So it's literally the repetitive pressure. I 00:18:57.579 --> 00:19:00.940 would never have connected that. Wow. And the 00:19:00.940 --> 00:19:03.440 big one is constipation and straining. The number 00:19:03.440 --> 00:19:05.160 of women who don't know how to poo well, it's 00:19:05.160 --> 00:19:07.680 diabolical. And the problem with like if you're 00:19:07.680 --> 00:19:10.140 not pooing well and you're not completely evacuating 00:19:10.140 --> 00:19:13.839 and you're pushing every time you're pooing, 00:19:13.880 --> 00:19:15.900 you're just weakening the connective tissue, 00:19:16.019 --> 00:19:19.019 right? And beyond that, estrogen gets created 00:19:19.019 --> 00:19:21.869 through our faeces. And so if you're not going 00:19:21.869 --> 00:19:23.630 to the toilet and regularly evacuating, that 00:19:23.630 --> 00:19:25.390 estrogen gets reabsorbed by your body, right? 00:19:26.089 --> 00:19:29.470 And so that might be impacting your periods. 00:19:29.710 --> 00:19:32.309 Are you saying that's the number one non -pregnancy 00:19:32.309 --> 00:19:34.230 related cause of women's pelvic floor disorders? 00:19:35.130 --> 00:19:38.210 Constipation. Australian constipation. I have 00:19:38.210 --> 00:19:40.549 never, ever heard that. And I've been also in 00:19:40.549 --> 00:19:42.730 this field for a while. That is stunning. Yeah, 00:19:42.769 --> 00:19:44.710 absolutely. So yeah, regardless of whether you 00:19:44.710 --> 00:19:47.049 had babies or not, if you don't know how to poo 00:19:47.049 --> 00:19:50.000 and you don't know how to poo well, you might 00:19:50.000 --> 00:19:53.940 have issues wow yeah that is scary yeah that's 00:19:53.940 --> 00:19:56.200 my bread and butter in the clinic like screening 00:19:56.200 --> 00:19:58.960 for bowel health talking about poo that's my 00:19:58.960 --> 00:20:00.880 bread and butter no but i think and that relates 00:20:00.880 --> 00:20:02.980 back to us you know in the nutrition field as 00:20:02.980 --> 00:20:06.180 well because constipation is a super commonly 00:20:06.180 --> 00:20:08.380 reported symptom so you guys are looking at from 00:20:08.380 --> 00:20:10.440 it From a nutrition perspective. I'm looking 00:20:10.440 --> 00:20:12.220 at it from a biomechanical perspective. Like 00:20:12.220 --> 00:20:14.619 how do you poo? Do you actually relax your pelvic 00:20:14.619 --> 00:20:16.900 floor muscles? Are you straining and pushing 00:20:16.900 --> 00:20:19.140 every time you're doing a poo? Let me teach you 00:20:19.140 --> 00:20:21.779 how to poo without pushing and straining. Let 00:20:21.779 --> 00:20:23.039 me put you in a bowel routine. I need to know 00:20:23.039 --> 00:20:26.099 how you'll be teaching people to poo. Do you 00:20:26.099 --> 00:20:28.740 give them a handout? I do have a handout. I can 00:20:28.740 --> 00:20:30.440 share it with you later. I can also go through 00:20:30.440 --> 00:20:33.160 it right now and teach you how to poo. I think 00:20:33.160 --> 00:20:35.359 that would be quite handy for our audience. So 00:20:35.359 --> 00:20:37.950 look, the easiest, look. Let me put it like this. 00:20:38.009 --> 00:20:41.150 The toilet is the most horrible invention for 00:20:41.150 --> 00:20:43.730 our pelvic floors ever. Because of the weird, 00:20:44.190 --> 00:20:45.750 okay. Yeah, because you're not in the correct 00:20:45.750 --> 00:20:48.410 position. Correct. So when we're pooping, right, 00:20:48.470 --> 00:20:52.269 we want to think about being relaxed. Defecation 00:20:52.269 --> 00:20:55.470 requires the pelvic floor to relax and let go, 00:20:55.670 --> 00:21:00.710 okay? If you're straining, so for instance, I'll 00:21:00.710 --> 00:21:03.150 pretend you're my client. Pretend that seat that 00:21:03.150 --> 00:21:04.470 you're sitting on is your toilet. How would you 00:21:04.470 --> 00:21:07.460 position yourself to poop? I kind of go, I'm 00:21:07.460 --> 00:21:10.740 kind of leaning forward a little bit. Yeah, I 00:21:10.740 --> 00:21:13.079 think that's like a general half lean. Half lean, 00:21:13.079 --> 00:21:16.339 yeah. Do you use a squatty potty or a stool? 00:21:16.400 --> 00:21:18.500 I don't, not sure. My toilet is actually quite 00:21:18.500 --> 00:21:20.640 low because I've got little legs. Yes. In England, 00:21:20.759 --> 00:21:23.740 I do have to use, I laugh and I joke, my family 00:21:23.740 --> 00:21:26.900 laugh at me, but I have to use the stool because 00:21:26.900 --> 00:21:29.319 otherwise I can't, my feet won't rest on the 00:21:29.319 --> 00:21:32.829 ground. I come like a little kid swinging. And 00:21:32.829 --> 00:21:34.450 talking about kids swinging, make sure your kids 00:21:34.450 --> 00:21:36.549 don't swing when they poop and pee. Feet firmly 00:21:36.549 --> 00:21:39.670 planted. So if they're swinging mid -air, no. 00:21:40.269 --> 00:21:43.390 Wow. Are you saying because that will instill 00:21:43.390 --> 00:21:47.089 the incorrect pooping posture? Yeah. Absolutely. 00:21:48.250 --> 00:21:50.890 So, yeah, that's how you poop, right? So what 00:21:50.890 --> 00:21:53.009 I'd be looking at is looking at the relationship 00:21:53.009 --> 00:21:55.750 of your knees to your hips. Are your knees higher? 00:21:56.299 --> 00:21:58.480 Or lower. And they should be higher, right? Higher. 00:21:58.599 --> 00:22:00.359 Okay. Because if you think of a squat, right? 00:22:00.460 --> 00:22:02.960 Yeah. Knees are very much higher. That doesn't 00:22:02.960 --> 00:22:04.640 have to be all the way up into your chest. What 00:22:04.640 --> 00:22:06.440 you're saying is I should not have renovated 00:22:06.440 --> 00:22:09.740 my bathroom in my 1977 Singapore house from a 00:22:09.740 --> 00:22:12.160 squat toilet. Because when we moved in, it was 00:22:12.160 --> 00:22:14.240 two squat toilets and one bowl. And now it's 00:22:14.240 --> 00:22:16.480 three bowls. So I've done a disservice to my 00:22:16.480 --> 00:22:18.660 family. The previous owners must have had amazing 00:22:18.660 --> 00:22:20.680 health. Amazing health. That's true. Absolutely. 00:22:20.799 --> 00:22:24.220 I'm going to have to get in touch. So, yeah, 00:22:24.279 --> 00:22:25.500 we're looking at the relationship of the knees 00:22:25.500 --> 00:22:26.940 to the hips. We're looking for whether you're 00:22:26.940 --> 00:22:30.480 leaning forward, body weight supporter. Then 00:22:30.480 --> 00:22:31.680 I'm looking at what you're doing with your bum 00:22:31.680 --> 00:22:36.440 and your belly. Are you sucking it in and pushing? 00:22:36.859 --> 00:22:41.319 Are you Valsalva -ing? We don't want to Valsalva 00:22:41.319 --> 00:22:43.619 when we poo. And again, for a few reasons, because 00:22:43.619 --> 00:22:45.599 we also don't want to poo when we're Valsalva 00:22:45.599 --> 00:22:48.440 -ing. There's that worse in both directions. 00:22:48.700 --> 00:22:51.440 Absolutely. Things like, you know, what are your 00:22:51.440 --> 00:22:54.960 shoulders doing? Are you breathing out? Are you 00:22:54.960 --> 00:22:57.740 sucking your belly in? Fundamentally, these are 00:22:57.740 --> 00:23:00.259 the things that we'd be looking for when pooping. 00:23:00.259 --> 00:23:03.059 But if you wanted to make a simple change to 00:23:03.059 --> 00:23:06.220 the way you poo to minimize your risk of straining, 00:23:06.359 --> 00:23:11.180 get a squatty potty. And then go see a physio 00:23:11.180 --> 00:23:12.799 and understand whether you're pooping well or 00:23:12.799 --> 00:23:15.140 not. Okay, business idea for you because your 00:23:15.140 --> 00:23:18.230 voice is so calming and lovely. can you record 00:23:18.230 --> 00:23:20.809 a poo track? Like a 20 second poo track. Kind 00:23:20.809 --> 00:23:22.710 of like 90 breath work, right? Can you report 00:23:22.710 --> 00:23:25.190 a poo track, a calming background? I'm going 00:23:25.190 --> 00:23:28.210 to just give a shout out to a wonderful physiotherapist 00:23:28.210 --> 00:23:29.789 by the name of - Who's done this? Who's done 00:23:29.789 --> 00:23:33.210 this? Yeah, Shelly Prosko. It's the toilet meditation. 00:23:33.769 --> 00:23:36.549 It's called the airbags analogy. You can YouTube 00:23:36.549 --> 00:23:38.509 it. I give it to everyone that comes to my clinic. 00:23:38.589 --> 00:23:41.450 You meditate your poop out. I love it. We are 00:23:41.450 --> 00:23:43.329 putting that in the show notes. Absolutely. We 00:23:43.329 --> 00:23:45.829 are putting toilet meditations. That is fantastic. 00:23:46.519 --> 00:23:48.519 Ask me to remember what the acronym stands for 00:23:48.519 --> 00:23:49.839 because I don't remember off the top of my head. 00:23:49.960 --> 00:23:52.039 But, yeah, it's all about, like, meditating your 00:23:52.039 --> 00:23:56.759 poop. Because we are – we're busy. We don't have 00:23:56.759 --> 00:23:59.920 time to shit. Simple matter of fact, you know. 00:24:00.900 --> 00:24:03.359 You know, you're a teacher and I think – I'm 00:24:03.359 --> 00:24:05.480 so sorry, teachers. I really feel for you. You're 00:24:05.480 --> 00:24:07.500 rushing between classes, right? You might be 00:24:07.500 --> 00:24:09.359 an office worker rushing between meetings. You're 00:24:09.359 --> 00:24:12.059 not prioritising your pelvic health, you know. 00:24:12.079 --> 00:24:14.519 You're holding on as long as you can hold on, 00:24:14.579 --> 00:24:17.579 right? at the end of the day, trying to get through 00:24:17.579 --> 00:24:20.859 all your competing priorities. But please, just 00:24:20.859 --> 00:24:25.319 when you need to poop, poop. Don't miss the boat, 00:24:25.380 --> 00:24:27.799 okay, at the end of the day. Is holding your 00:24:27.799 --> 00:24:30.259 pee bad for your pelvic floor? Great question. 00:24:30.339 --> 00:24:33.720 Look, there's a saying in pelvic health, you 00:24:33.720 --> 00:24:36.859 know, the bladder makes for a great sailor, not 00:24:36.859 --> 00:24:39.819 a great captain, okay? So it can be trained, 00:24:40.119 --> 00:24:44.039 okay? We have a lot of women going just in case, 00:24:44.099 --> 00:24:46.950 you know. I don't know if there's going to be 00:24:46.950 --> 00:24:51.470 a toilet there. I may as well go now. Okay. And 00:24:51.470 --> 00:24:53.549 we see that in like our kids when we're like, 00:24:53.609 --> 00:24:54.730 okay, we're about to leave the house. Can you 00:24:54.730 --> 00:24:56.269 please go do a wee because I don't have to stop. 00:24:56.450 --> 00:25:01.390 Yeah. I do it. Oh, no. I do it. Guilty. I do 00:25:01.390 --> 00:25:03.250 it as well. I do it too. Yeah, don't worry. Yeah. 00:25:04.009 --> 00:25:06.970 No shame in admitting that, okay. But what we're 00:25:06.970 --> 00:25:09.490 doing is we're setting these kids up for future 00:25:09.490 --> 00:25:12.950 toilet habits that we're not going to serve them 00:25:12.950 --> 00:25:17.250 well, right? You know. Do a wee when the urge 00:25:17.250 --> 00:25:20.089 is moderate or strong, okay? You don't want to 00:25:20.089 --> 00:25:23.170 go in there and just a little trickle. The problem 00:25:23.170 --> 00:25:25.990 with my kids is they tell me they need a wee 00:25:25.990 --> 00:25:31.390 when the urge is too far gone. That sounds about 00:25:31.390 --> 00:25:35.569 right. Yeah, kids, they're frustrating. And you've 00:25:35.569 --> 00:25:37.890 got three of them as well, right? Actually, we 00:25:37.890 --> 00:25:39.450 all have three kids here, don't we? A lot of 00:25:39.450 --> 00:25:42.990 kids. A lot of experience in this room. And so, 00:25:43.109 --> 00:25:47.130 yeah, look. People are not just only pushing 00:25:47.130 --> 00:25:50.170 or straining to do a poo, but we're also power 00:25:50.170 --> 00:25:54.509 peeing as well, right? And straining in general 00:25:54.509 --> 00:25:58.240 is a pelvic floor no -no. okay so we want to 00:25:58.240 --> 00:26:00.000 be able to poop well and pooping is not just 00:26:00.000 --> 00:26:01.779 about what you're putting in your body it's how 00:26:01.779 --> 00:26:04.180 it comes out of your body so we refer to as defecation 00:26:04.180 --> 00:26:06.420 dynamics and that's what we would coach and guide 00:26:06.420 --> 00:26:08.299 our patients through in the clinic on how to 00:26:08.299 --> 00:26:10.539 optimize that where we feel like there's a large 00:26:10.539 --> 00:26:12.539 dietary component that needs to be managed we 00:26:12.539 --> 00:26:14.420 would refer them out like go speak to someone 00:26:14.420 --> 00:26:16.799 that can help you with your guts and what you're 00:26:16.799 --> 00:26:18.019 eating and making sure you're getting adequate 00:26:18.019 --> 00:26:21.079 fiber right the number of us that aren't eating 00:26:21.079 --> 00:26:24.799 enough fiber is ridiculous as well right at the 00:26:24.799 --> 00:26:28.009 end of the day and so So to my point earlier 00:26:28.009 --> 00:26:30.990 about it takes a village, right? It's not just 00:26:30.990 --> 00:26:32.930 one clinician. I'd love to be able to just see 00:26:32.930 --> 00:26:35.049 one person that can solve all my problems, but 00:26:35.049 --> 00:26:37.329 the reality is we all have our strengths, we 00:26:37.329 --> 00:26:39.930 all have our weaknesses, we all have our training 00:26:39.930 --> 00:26:42.890 and skills, and we need to stick within that. 00:26:43.009 --> 00:26:45.089 And you are going to need to see more than one 00:26:45.089 --> 00:26:47.769 person to navigate these pelvic health challenges, 00:26:47.849 --> 00:26:51.220 guaranteed. And I think this leads really nicely 00:26:51.220 --> 00:26:54.460 into our Fuel Your 40s by The Meat Club. And 00:26:54.460 --> 00:26:56.240 they actually have a specific question for you. 00:26:56.380 --> 00:26:59.539 And the question they have for you is, we talk 00:26:59.539 --> 00:27:03.259 a lot about fueling our bodies. And from your 00:27:03.259 --> 00:27:07.140 perspective, how does food impact your pelvic 00:27:07.140 --> 00:27:10.640 health? Look, whether it's a muscle you can see 00:27:10.640 --> 00:27:14.000 or not see, it's muscle at the end of the day. 00:27:14.039 --> 00:27:17.619 So those biceps and triceps and quads and hamstrings 00:27:17.619 --> 00:27:19.980 you're trying to build through, strength training 00:27:19.980 --> 00:27:23.859 and eating adequate protein that all needs to 00:27:23.859 --> 00:27:25.819 go to your pelvic floor too at the end of the 00:27:25.819 --> 00:27:28.339 day because it is a muscle it's not just muscle 00:27:28.339 --> 00:27:30.799 it's connective tissue as well it's ligaments 00:27:30.799 --> 00:27:34.680 okay it's nerves it's blood supply as well so 00:27:34.680 --> 00:27:36.720 regardless of whether it's a muscle you see or 00:27:36.720 --> 00:27:39.359 don't see you need your protein you need your 00:27:39.359 --> 00:27:43.980 collagen you need to be hydrated it applies across 00:27:43.980 --> 00:27:47.519 the whole body We completely agree. And that's 00:27:47.519 --> 00:27:49.579 why we love the Meat Club as our sponsors, because 00:27:49.579 --> 00:27:52.240 that's a place where you can get fresh Australia, 00:27:52.319 --> 00:27:54.640 New Zealand produce and protein straight to your 00:27:54.640 --> 00:27:58.380 doorstep with $20 off with our promo code TFF20. 00:27:59.019 --> 00:28:00.799 And I think that's the thing. A lot of people 00:28:00.799 --> 00:28:04.759 think about what they're eating and muscle. And 00:28:04.759 --> 00:28:07.789 I think all they're thinking of is biceps. booty 00:28:07.789 --> 00:28:13.089 yeah exactly but you know it's not just about 00:28:13.089 --> 00:28:15.549 that it's about making sure that the whole body 00:28:15.549 --> 00:28:20.130 is fueled yes yeah exactly i feel like obviously 00:28:20.130 --> 00:28:23.170 we've spoken a lot about shitting obviously a 00:28:23.170 --> 00:28:26.730 lot about pissing yeah now what about hormones 00:28:26.730 --> 00:28:29.450 obviously you've touched upon it yeah and you 00:28:29.450 --> 00:28:32.589 said that if the childbirth and childbearing 00:28:32.589 --> 00:28:35.420 doesn't get you your hormones will Please tell 00:28:35.420 --> 00:28:39.140 us what can us women in our 40s expect during 00:28:39.140 --> 00:28:41.940 this time and what can we do about it? When you're 00:28:41.940 --> 00:28:45.000 in your 40s, right, what starts to decline is 00:28:45.000 --> 00:28:47.940 your ratio of progesterone and estrogen, right? 00:28:48.039 --> 00:28:50.420 That's what we're commonly seeing. And so it 00:28:50.420 --> 00:28:53.259 starts with your progesterone declining, okay? 00:28:54.220 --> 00:28:57.460 The way I like to explain it to people is your 00:28:57.460 --> 00:29:00.460 progesterone is a lawnmower. And your estrogen 00:29:00.460 --> 00:29:04.420 is the grass. Okay. I like that. Okay. And so 00:29:04.420 --> 00:29:08.519 the lawnmower keeps the grass in check. Okay. 00:29:08.619 --> 00:29:11.559 So as your progesterone starts to decline, you 00:29:11.559 --> 00:29:14.880 get more estrogen in comparison, right? In that 00:29:14.880 --> 00:29:17.880 ratio. And so what you might start to notice 00:29:17.880 --> 00:29:22.259 is changes to your menses cycle. Okay. Heavier 00:29:22.259 --> 00:29:27.200 periods. For instance, irregular periods. You're 00:29:27.200 --> 00:29:29.519 more PMS -y. Do you feel like you want to kill 00:29:29.519 --> 00:29:31.680 your husband? Oh, yeah. I mean, yes, but that's 00:29:31.680 --> 00:29:36.539 28 days per month. You're starting to get a lot 00:29:36.539 --> 00:29:39.519 of those emotional side effects as well, right? 00:29:40.099 --> 00:29:43.279 And then we look at things like what's happening 00:29:43.279 --> 00:29:46.099 with the rest of the body. You might get generalized 00:29:46.099 --> 00:29:48.640 joint aches and pains. You're starting to see 00:29:48.640 --> 00:29:51.700 that loss in your lean muscle mass. If you've 00:29:51.700 --> 00:29:54.160 been getting follow -up for bone mineral density, 00:29:54.299 --> 00:29:56.519 you might start seeing a loss in your bone mineral 00:29:56.519 --> 00:29:59.799 density. What about things like, you know, that 00:29:59.799 --> 00:30:03.319 sudden frozen shoulder that you got and you're 00:30:03.319 --> 00:30:07.339 in your 40s? Okay. Or that plantar fasciopathy 00:30:07.339 --> 00:30:09.119 when you wake up in the morning and you feel 00:30:09.119 --> 00:30:12.500 like you're walking on glass. Okay. Or more of 00:30:12.500 --> 00:30:15.859 that lateral hip glute pain. You know, these 00:30:15.859 --> 00:30:19.339 are really common hallmarks of this transition. 00:30:20.349 --> 00:30:22.609 Typically when people experience those symptoms, 00:30:22.769 --> 00:30:24.950 they're going to be going to a physio, osteo, 00:30:24.950 --> 00:30:27.390 chiro, get in management. But actually there's 00:30:27.390 --> 00:30:30.410 probably a hormonal component driving that as 00:30:30.410 --> 00:30:34.829 well. And so if you've gone and got physio, osteo 00:30:34.829 --> 00:30:37.289 or chiro and it's not getting better, that's 00:30:37.289 --> 00:30:41.369 a sign for you to perhaps go to the GP and understand 00:30:41.369 --> 00:30:43.730 what your hormones are doing. Absolutely. And 00:30:43.730 --> 00:30:46.430 I think you're absolutely right that it's confounded 00:30:46.430 --> 00:30:48.470 with I have a physical problem, I need to see 00:30:48.470 --> 00:30:51.680 a physio, osteo. Also, it's aging. Yes. This 00:30:51.680 --> 00:30:54.500 is aging. And it is meaning you don't, you don't 00:30:54.500 --> 00:30:56.700 reach this level of kind of hormonal reshuffling 00:30:56.700 --> 00:30:59.299 until you age. Absolutely. For many of us. But 00:30:59.299 --> 00:31:01.519 the point is like, yeah, it's aging, but it's 00:31:01.519 --> 00:31:03.799 specific to something that we can intervene. 00:31:04.200 --> 00:31:06.640 And I think that when people say it's aging, 00:31:06.759 --> 00:31:08.339 it's just like when people say it's genetics, 00:31:08.539 --> 00:31:10.859 it's like, it's this untouchable force that no 00:31:10.859 --> 00:31:12.400 one could ever, you know, but it's like, but 00:31:12.400 --> 00:31:14.859 a lot of times it's menopause or hormones and 00:31:14.859 --> 00:31:17.119 it's epigenetics. So it's two things that you 00:31:17.119 --> 00:31:21.279 can control. Yeah, absolutely. I think perhaps 00:31:21.279 --> 00:31:25.640 that served people well historically. We didn't 00:31:25.640 --> 00:31:27.160 have the knowledge. We didn't have the resources. 00:31:27.480 --> 00:31:30.240 But that doesn't serve us well anymore. We're 00:31:30.240 --> 00:31:32.539 more proactive when it comes to healthcare, right? 00:31:32.660 --> 00:31:35.819 And we have more means to address and access 00:31:35.819 --> 00:31:40.269 these things. And why not? Yeah. So then we're 00:31:40.269 --> 00:31:41.890 looking at things like what's happening to your 00:31:41.890 --> 00:31:44.930 bladder as a result of these hormonal fluctuations, 00:31:45.490 --> 00:31:48.309 right? The bladder becomes less elastic. It feels 00:31:48.309 --> 00:31:50.670 like my bladder has shrunk. Why do I have to 00:31:50.670 --> 00:31:52.650 keep going to the toilet even though I just went? 00:31:52.910 --> 00:31:58.750 You might be experiencing urgency, like suddenly 00:31:58.750 --> 00:32:00.970 have to go to the toilet that you can't defer. 00:32:01.470 --> 00:32:04.279 Is that because of the lack of... Yes, so the 00:32:04.279 --> 00:32:07.339 bladder compliance can reduce. So your bladder 00:32:07.339 --> 00:32:10.400 capacity reduces, but also reduce, I'm sorry, 00:32:10.460 --> 00:32:12.740 the lining of the bladder is estrogen sensitive. 00:32:13.160 --> 00:32:15.440 Okay, so when there's less estrogen, it makes 00:32:15.440 --> 00:32:17.240 it more sensitive. So those nerve endings are 00:32:17.240 --> 00:32:19.339 more exposed and they're always triggering. So 00:32:19.339 --> 00:32:21.559 that's the, you know, the 3am wake up when you 00:32:21.559 --> 00:32:23.220 need to, when you should be sleeping, you're 00:32:23.220 --> 00:32:24.819 waking up to go for a wee. Yeah, potentially, 00:32:24.980 --> 00:32:28.099 look. Wake up once at night is considered still 00:32:28.099 --> 00:32:31.000 quite normal. If you're having to go more than 00:32:31.000 --> 00:32:32.880 two times a night, we would refer to that as 00:32:32.880 --> 00:32:35.000 nocturia and we would want to understand why 00:32:35.000 --> 00:32:37.599 are you waking up so often? Is it something related 00:32:37.599 --> 00:32:42.000 to like your diabetes or is it that you're, it's 00:32:42.000 --> 00:32:44.420 a habit, like you just have a habit of making 00:32:44.420 --> 00:32:46.599 up for the lack of water you've had through the 00:32:46.599 --> 00:32:49.480 day and you're chugging it down after 9pm at 00:32:49.480 --> 00:32:51.769 night. It could also then, I guess, be like a 00:32:51.769 --> 00:32:54.549 sleep apnea type thing. Absolutely. Yep. Okay. 00:32:54.549 --> 00:32:58.069 It could be a variety of different things at 00:32:58.069 --> 00:33:02.109 the end of the day. For instance, you might feel 00:33:02.109 --> 00:33:05.009 like you're getting UTIs all the time because 00:33:05.009 --> 00:33:08.390 the lack of estrogen is creating this unhealthy 00:33:08.390 --> 00:33:11.230 environment for bacteria to thrive. Wow. Okay. 00:33:11.390 --> 00:33:13.950 Or if you're in a habit of going to the toilet 00:33:13.950 --> 00:33:17.349 quite often. frequency you might find that you're 00:33:17.349 --> 00:33:18.890 not completely emptying your bladder and that 00:33:18.890 --> 00:33:21.230 might be leaving a little bit of wee in the bladder 00:33:21.230 --> 00:33:22.769 and that might be irritating the lighting as 00:33:22.769 --> 00:33:26.089 well that might be giving you a UTI and you would 00:33:26.089 --> 00:33:30.069 want that confirmed on a urine culture or genuinely 00:33:30.069 --> 00:33:33.589 it just might be That you've got reduced bladder 00:33:33.589 --> 00:33:37.150 compliance and you also might have pelvic floor 00:33:37.150 --> 00:33:38.589 dysfunction where your muscles are stiff and 00:33:38.589 --> 00:33:42.069 tight that give you this impression of a UTI 00:33:42.069 --> 00:33:44.549 -like symptom. But it just might be your pelvic 00:33:44.549 --> 00:33:47.509 floor not relaxing enough. To like empty out 00:33:47.509 --> 00:33:49.710 the wee. Yeah, absolutely. And you might be getting 00:33:49.710 --> 00:33:51.710 these phantom UTIs, which is just more of the 00:33:51.710 --> 00:33:53.450 pelvic floor being switched on tight and off. 00:33:53.569 --> 00:33:56.029 Because like every other muscle, it needs estrogen. 00:33:56.150 --> 00:33:58.369 And when it doesn't have estrogen, it undergoes 00:33:58.369 --> 00:34:01.380 atrophy. becomes so stiff is vaginal estrogen 00:34:01.380 --> 00:34:04.359 the answer yeah it is so if someone presents 00:34:04.359 --> 00:34:08.639 menopausally um with a pelvic floor complaint 00:34:08.639 --> 00:34:11.699 the american menopause guidelines actually recommend 00:34:11.699 --> 00:34:14.019 vaginal estrogen as a first line of manager for 00:34:14.019 --> 00:34:17.840 these women it's good to know yeah yep so not 00:34:17.840 --> 00:34:21.780 oral okay does oral do anything like no it needs 00:34:21.780 --> 00:34:25.699 to be locally does you know the wow so it literally 00:34:25.699 --> 00:34:27.860 has to be vaginal to address the symptoms you 00:34:27.860 --> 00:34:30.199 are referring to specifically see i don't think 00:34:30.199 --> 00:34:32.139 that is very clear yeah no because i think you 00:34:32.139 --> 00:34:34.039 just think oh i'll just take the cream or whatever 00:34:34.039 --> 00:34:37.119 it is and it will stop my symptoms but if it's 00:34:37.119 --> 00:34:39.460 not stopping the symptoms then clearly it might 00:34:39.460 --> 00:34:43.280 not be the right type of estrogen wow yeah that 00:34:43.280 --> 00:34:46.239 is good to know now sort of switching up a little 00:34:46.239 --> 00:34:49.400 bit one of the other things i think women always 00:34:49.400 --> 00:34:51.659 sort of talk about is aesthetics and the way 00:34:51.659 --> 00:34:54.650 they look and we tend to get women who Might 00:34:54.650 --> 00:34:57.869 be slim all over, but then they've got this protruding 00:34:57.869 --> 00:35:00.309 belly. Yep. And they want to say, I just want 00:35:00.309 --> 00:35:02.969 to lose weight here. Is that weight or is that 00:35:02.969 --> 00:35:05.809 something else? You guys are the experts in this 00:35:05.809 --> 00:35:08.969 space. Come on. I mean, I kind of, I kind of. 00:35:11.210 --> 00:35:16.309 Look, you know, it's hormonal. It's connective 00:35:16.309 --> 00:35:19.460 tissue quality. It's. Postural. Subcutaneous 00:35:19.460 --> 00:35:23.679 fat. It's postural. It's a lack of muscle, right? 00:35:24.440 --> 00:35:26.260 How many of us are in occupations where we're 00:35:26.260 --> 00:35:28.840 sitting all day every day? There you go. You 00:35:28.840 --> 00:35:31.199 know, we're hunched over, okay? What's happening 00:35:31.199 --> 00:35:33.099 to your diaphragm? It's getting compressed, right? 00:35:33.539 --> 00:35:35.920 And what's happening to your muscle length and 00:35:35.920 --> 00:35:37.599 tension relationships? They're getting a bit 00:35:37.599 --> 00:35:40.320 stiffer and tighter as well, right? You know, 00:35:40.380 --> 00:35:43.400 back to the point about the core, you have to 00:35:43.400 --> 00:35:46.380 address the whole system, right? You know, it's 00:35:46.380 --> 00:35:48.780 not going to be as easy as, yeah, I'm just going 00:35:48.780 --> 00:35:51.219 to do a shit ton of crunches and be gone belly. 00:35:52.119 --> 00:35:53.699 We've got to look at the whole system. We've 00:35:53.699 --> 00:35:55.440 got to look at your lifestyle. What's your stress 00:35:55.440 --> 00:35:57.300 like? What's your sleep like? What's your nutrition 00:35:57.300 --> 00:36:00.920 and hydration status? So unfortunately, yes, 00:36:00.980 --> 00:36:03.860 it's a common hallmark for women as they transition 00:36:03.860 --> 00:36:06.980 through many perimenopause and menopause, but 00:36:06.980 --> 00:36:09.360 it's not just hormonally mediated. We've got 00:36:09.360 --> 00:36:11.199 to look at the whole picture at the end of the 00:36:11.199 --> 00:36:13.219 day. Yeah, all those, I mean, and again, it's 00:36:13.219 --> 00:36:15.539 a marketing tool, right? Oh, do you suffer from 00:36:15.539 --> 00:36:18.239 hormone belly? You know, and it's like - Menobelly. 00:36:18.659 --> 00:36:20.539 Menobelly, yeah, all these things. And it's like, 00:36:20.559 --> 00:36:23.360 yeah, but like - you suffer from not sleeping 00:36:23.360 --> 00:36:26.719 and exactly zero water and not exercise there's 00:36:26.719 --> 00:36:28.440 so many things and like what's your alcohol intake 00:36:28.440 --> 00:36:30.900 like yeah there you go what's your intake like 00:36:30.900 --> 00:36:33.519 yeah well and you know this is back to the aging 00:36:33.519 --> 00:36:34.820 thing right where it's like blaming everything 00:36:34.820 --> 00:36:37.340 on aging but but here's where aging does step 00:36:37.340 --> 00:36:39.619 in where it's like yeah why didn't i have this 00:36:39.619 --> 00:36:44.940 in my 20s well the accumulation of bad or forgotten 00:36:44.940 --> 00:36:47.809 habits over 20 years is going to hit you when 00:36:47.809 --> 00:36:49.110 you're 40. It's not going to hit you when you're 00:36:49.110 --> 00:36:51.469 20. So that's where the aging thing is very real. 00:36:51.570 --> 00:36:54.730 Very real. The big wheel keeps on turning. Proud 00:36:54.730 --> 00:36:56.429 Mary keeps on burning and it ends up in your 00:36:56.429 --> 00:36:59.750 stomach. Unfortunately. Some things you can't 00:36:59.750 --> 00:37:01.869 outrun. You cannot. You've got to call a spade 00:37:01.869 --> 00:37:03.789 a spade at the end of the day. I feel like when 00:37:03.789 --> 00:37:05.969 I – I know this is not 40s necessarily, or it 00:37:05.969 --> 00:37:08.519 could be because we do see women having – children 00:37:08.519 --> 00:37:10.840 later and i think that often confuses diagnosis 00:37:10.840 --> 00:37:15.139 as well like is this postpartum or is this depression 00:37:15.139 --> 00:37:18.800 or is this peri because we are having families 00:37:18.800 --> 00:37:22.119 later which can delay diagnosis so mandy you 00:37:22.119 --> 00:37:23.579 know how i've been on this journey about improving 00:37:23.579 --> 00:37:25.579 my sleep oh you have been obsessed about it lately 00:37:26.199 --> 00:37:29.840 Well, I have found something that has been incredible. 00:37:30.760 --> 00:37:33.380 Cozy earth bed sheets. That's saying a lot because 00:37:33.380 --> 00:37:35.300 you are really picky about your sleep setup. 00:37:35.539 --> 00:37:38.019 Exactly. These sheets are made from bamboo viscose. 00:37:38.039 --> 00:37:41.739 They are naturally breathable and I get the perfect 00:37:41.739 --> 00:37:45.159 night's sleep. They keep me cool all night. Oh, 00:37:45.219 --> 00:37:47.239 and I've been eyeing the pajamas too. They are 00:37:47.239 --> 00:37:50.500 so chic and super cozy. It's a total game changer 00:37:50.500 --> 00:37:53.460 and so relaxing for the evenings. And what's 00:37:53.460 --> 00:37:56.000 crazy is that Cozy Earth actually ships to Singapore, 00:37:56.199 --> 00:38:00.280 orders over $560 ship free, and in the US orders 00:38:00.280 --> 00:38:02.760 over $50 ship free. And did you know you can 00:38:02.760 --> 00:38:06.860 get your biggest ever discount, 41 % if you use 00:38:06.860 --> 00:38:11.099 code TFF today. So head over to CozyEarth .com 00:38:11.099 --> 00:38:14.929 and use that code TFF today. Moving on. We're 00:38:14.929 --> 00:38:16.489 going to do a little segment called Hot or Hype. 00:38:16.489 --> 00:38:20.250 And this is fast paced. Just whatever comes. 00:38:20.889 --> 00:38:22.409 You know, you tell me whether you think it's 00:38:22.409 --> 00:38:23.849 hot or hype. I'm going to ask you a few questions. 00:38:23.889 --> 00:38:25.190 Some of them you've already answered, but we'll 00:38:25.190 --> 00:38:27.190 just get your quick take on it. Everyone should 00:38:27.190 --> 00:38:31.150 be doing Kegels every day. Hype. Is there a place 00:38:31.150 --> 00:38:33.269 for Kegels though? Like, is it one of the things? 00:38:33.809 --> 00:38:37.110 Yes. Okay. Okay. Leaking a little bit when you 00:38:37.110 --> 00:38:43.820 laugh. I hope you're not leaking that. This is 00:38:43.820 --> 00:38:49.260 my confident leaking laugh. I'm hype. Strong 00:38:49.260 --> 00:38:53.320 glutes equals a strong pelvic floor. Hot. Ooh, 00:38:53.519 --> 00:38:55.699 can you expand? Glutes save everyone, correct? 00:38:55.840 --> 00:38:58.400 Absolutely. Okay. Absolutely. Glute strength, 00:38:58.460 --> 00:39:00.400 hip strength. I'm just putting them together. 00:39:00.659 --> 00:39:02.300 Look, they've done research and I'm going to 00:39:02.300 --> 00:39:06.159 specifically focus on outcomes for stress urinary 00:39:06.159 --> 00:39:07.719 incontinence. So women who leak with a cough, 00:39:07.760 --> 00:39:10.239 sneeze, run, jump kind of stuff. They looked 00:39:10.239 --> 00:39:12.889 at, Two groups of women, women who leaked and 00:39:12.889 --> 00:39:15.690 women who didn't leak. And they did studies on 00:39:15.690 --> 00:39:20.909 pelvic floor strength, tone, and then they also 00:39:20.909 --> 00:39:24.250 analyzed glute and hip strength. What was the 00:39:24.250 --> 00:39:25.849 difference between the two groups? Can you guess? 00:39:26.070 --> 00:39:29.750 Bigger booties. Stronger hip and glutes. Does 00:39:29.750 --> 00:39:31.880 not surprise me. Because when you were saying 00:39:31.880 --> 00:39:34.460 about what muscles make up the core, I include 00:39:34.460 --> 00:39:36.699 glutes. I include glutes because I do feel like 00:39:36.699 --> 00:39:40.300 glutes are the backside, keeping the front side 00:39:40.300 --> 00:39:43.980 where it needs to be. I refer to it like an onion. 00:39:44.059 --> 00:39:46.739 There's layers of muscle and layers of support. 00:39:47.500 --> 00:39:50.659 And to my earlier point, your pelvic health challenge 00:39:50.659 --> 00:39:53.480 isn't just about what's happening in the pelvis. 00:39:53.500 --> 00:39:56.440 We've got to look head to toe and what's driving 00:39:56.440 --> 00:39:59.769 that at the end of the day. Pelvic health physio 00:39:59.769 --> 00:40:08.949 is only for new mums. Right. You can't lift weights 00:40:08.949 --> 00:40:14.869 after 40 safely. Are you sure about that? I am 00:40:14.869 --> 00:40:17.429 only kidding. And perimenopause makes pelvic 00:40:17.429 --> 00:40:21.519 issues inevitable. Look. inevitable look it's 00:40:21.519 --> 00:40:23.800 going to happen but there's so many modifiable 00:40:23.800 --> 00:40:27.179 risk factors we can work on yes that can help 00:40:27.179 --> 00:40:31.179 improve your outcomes so basically it's not just 00:40:31.179 --> 00:40:34.739 one little section it's going to be your whole 00:40:34.739 --> 00:40:38.760 body your whole life so women sort it out yeah 00:40:38.760 --> 00:40:42.119 yeah look sooner rather than later yeah so you 00:40:42.119 --> 00:40:46.090 can just get on with life yeah okay and On that 00:40:46.090 --> 00:40:48.210 point, like it's never too late. So for those 00:40:48.210 --> 00:40:50.429 that feel like, oh, they've missed the boat because 00:40:50.429 --> 00:40:53.510 they didn't come in after they gave birth. If 00:40:53.510 --> 00:40:55.630 now you have the bandwidth and the time and the 00:40:55.630 --> 00:40:58.150 resources, that's like 15, 20, 30 years down 00:40:58.150 --> 00:41:00.250 the track, it's still okay. There's still something 00:41:00.250 --> 00:41:01.909 you can do about it. Because it's a muscle at 00:41:01.909 --> 00:41:03.530 the end of the day and you can always train muscles. 00:41:03.809 --> 00:41:06.250 But also to the point, it's not just a muscular 00:41:06.250 --> 00:41:08.070 problem when it comes to pelvic health challenges. 00:41:08.110 --> 00:41:10.480 It could be. a connective tissue problem. It 00:41:10.480 --> 00:41:12.599 could be a neuro problem. It could be a glute 00:41:12.599 --> 00:41:15.360 problem. It could be a diaphragm problem. It 00:41:15.360 --> 00:41:18.039 could be a foot problem. So it's not just about 00:41:18.039 --> 00:41:20.079 muscles at the end of the day when it comes to 00:41:20.079 --> 00:41:22.079 optimizing pelvic health outcomes. Can I ask 00:41:22.079 --> 00:41:23.940 a quick question? Yeah. Because I think this 00:41:23.940 --> 00:41:26.619 is something when I refer my own clients to pelvic 00:41:26.619 --> 00:41:29.659 floor physios, sometimes, and now this also makes 00:41:29.659 --> 00:41:32.119 me think, do they really go? Sometimes they come 00:41:32.119 --> 00:41:34.440 back and say, yeah, she did a quick assessment 00:41:34.440 --> 00:41:36.480 and it was all good. And I said, did she see 00:41:36.480 --> 00:41:39.480 you internally? And they're like, no, no, it 00:41:39.480 --> 00:41:41.039 was just like an external palpitation. And I 00:41:41.039 --> 00:41:42.519 was like, I don't think that's a pelvic floor 00:41:42.519 --> 00:41:45.539 exam. Can you just walk us through what a pelvic 00:41:45.539 --> 00:41:48.360 floor exam or assessment might look like? Yeah, 00:41:48.360 --> 00:41:51.900 sure. So look, the gold standard of pelvic floor 00:41:51.900 --> 00:41:55.860 integrity assessment is a internal vaginal examination. 00:41:56.539 --> 00:41:59.059 So finger up the vagina. There you go. Okay. 00:41:59.119 --> 00:42:02.139 I had a wand. Is that, am I a fancy? Was that 00:42:02.139 --> 00:42:06.059 like a ultrasound wand? Yes. Okay. Yeah, different. 00:42:06.519 --> 00:42:07.619 I think they're probably looking at something 00:42:07.619 --> 00:42:10.059 else there, like your ovaries and your uterus 00:42:10.059 --> 00:42:13.480 and stuff like that. But anyway, so pelvic floor 00:42:13.480 --> 00:42:15.739 examination, gold standard, vaginal examination, 00:42:16.000 --> 00:42:17.699 fingers into the vagina. What are we looking 00:42:17.699 --> 00:42:21.800 at? We're looking at muscle tone. We're looking 00:42:21.800 --> 00:42:23.860 at muscle strength. And you can feel that. You 00:42:23.860 --> 00:42:26.400 know what a good muscle tone should feel like. 00:42:27.119 --> 00:42:29.320 Yeah, I've done a lot of pelvic floor assessments. 00:42:33.380 --> 00:42:37.920 We're looking at vaginal wall integrity. So how 00:42:37.920 --> 00:42:41.219 stiff or loose the walls of your vagina are because 00:42:41.219 --> 00:42:43.559 that might indicate presence or absence of prolapse, 00:42:43.559 --> 00:42:46.699 for instance. So they want to be stiff or loose? 00:42:47.179 --> 00:42:50.849 Stiff. Okay. Well, stiff might give the wrong 00:42:50.849 --> 00:42:54.309 connotation. You want them to be firm. Firm, 00:42:54.389 --> 00:42:57.510 tender, like a good steak. Sure, we can talk 00:42:57.510 --> 00:43:02.869 about steak. Then we're looking at things like... 00:43:04.000 --> 00:43:06.820 is there a presence or absence of like tender 00:43:06.820 --> 00:43:09.480 points or bits in the muscles that might be contributing 00:43:09.480 --> 00:43:12.199 to some referred pain or pain that you might 00:43:12.199 --> 00:43:14.619 get during sex or pain that you get with your 00:43:14.619 --> 00:43:17.179 menses cycle, for instance, whether it's ovulatory 00:43:17.179 --> 00:43:18.800 or whether it's when you're on your period, for 00:43:18.800 --> 00:43:22.159 instance. We're looking at proprioception. Can 00:43:22.159 --> 00:43:24.199 you feel if I'm on the left of your pelvic floor 00:43:24.199 --> 00:43:25.840 and the right of the pelvic floor? We're then 00:43:25.840 --> 00:43:28.340 relating that to what's also happening at your 00:43:28.340 --> 00:43:30.820 obturator internus, which is a common hip pelvic 00:43:30.820 --> 00:43:32.909 floor muscle that connects. pelvic floor to your 00:43:32.909 --> 00:43:35.869 hip which is very much critical for good functioning 00:43:35.869 --> 00:43:39.110 pelvic floor um yeah throughout the lifespan 00:43:39.110 --> 00:43:41.989 so these are some of the assessments we'd be 00:43:41.989 --> 00:43:45.969 looking at the reality is when you're doing a 00:43:45.969 --> 00:43:48.150 pelvic floor exam you're getting a full picture 00:43:48.150 --> 00:43:51.210 okay a pelvic floor exam may not be appropriate 00:43:51.210 --> 00:43:53.829 for everyone they we may not be given the consent 00:43:53.829 --> 00:43:56.130 to do a pelvic floor exam or it might be contraindicated 00:43:56.639 --> 00:43:59.219 Okay. So what are our options in those scenarios 00:43:59.219 --> 00:44:02.900 and situations? We might recommend a real -time 00:44:02.900 --> 00:44:04.860 ultrasound exam. So similar to when you go to 00:44:04.860 --> 00:44:07.139 the gyne to look for a baby, we would be looking 00:44:07.139 --> 00:44:09.280 at your pelvic floor and more specifically how 00:44:09.280 --> 00:44:11.840 the pelvic floor changes the way your bladder 00:44:11.840 --> 00:44:14.300 looks and moves on a screen. What we're not going 00:44:14.300 --> 00:44:17.539 to be able to elicit from a 2D image is strength 00:44:17.539 --> 00:44:21.380 tone. What we're going to be able to see is when 00:44:21.380 --> 00:44:24.500 you do a pelvic floor contraction, is it switching 00:44:24.500 --> 00:44:28.690 on? Is it switching off? Is it relaxing? Is it 00:44:28.690 --> 00:44:32.530 stretching? Can you poo well? So we can train 00:44:32.530 --> 00:44:35.570 these things using the real -time ultrasound, 00:44:35.769 --> 00:44:38.090 but we're missing some critical information that 00:44:38.090 --> 00:44:39.929 gives us a comprehensive understanding around 00:44:39.929 --> 00:44:43.050 your pelvic health. And in those scenarios, we 00:44:43.050 --> 00:44:44.610 might even get patients like, no, I don't even 00:44:44.610 --> 00:44:46.550 want an ultrasound. So what are we left with? 00:44:46.630 --> 00:44:48.610 Then it's external palpation. And so we might 00:44:48.610 --> 00:44:50.550 have someone inside lying and we're palpating 00:44:50.550 --> 00:44:52.550 along their butt crack, just trying to get a 00:44:52.550 --> 00:44:55.630 picture or understanding. But it's relative really 00:44:55.630 --> 00:44:59.010 then to the patient preference. Preference, what 00:44:59.010 --> 00:45:01.150 are their concerns? Honestly speaking, vast majority 00:45:01.150 --> 00:45:04.269 of our clients, 90%, come in with the mindset 00:45:04.269 --> 00:45:06.130 they're coming in for a pelvic floor check at 00:45:06.130 --> 00:45:07.969 the clinic, unless there's a contraindication 00:45:07.969 --> 00:45:11.409 or perhaps they haven't given consent. So to 00:45:11.409 --> 00:45:13.989 your point about checking abs to understand pelvic 00:45:13.989 --> 00:45:18.989 floor integrity and functioning, no. That's good 00:45:18.989 --> 00:45:22.050 to know. Okay, so then what are the sort of treatment 00:45:22.050 --> 00:45:25.409 options out there? We hear about Kegels all the 00:45:25.409 --> 00:45:26.409 time. Everyone always tells you when you're pregnant, 00:45:26.489 --> 00:45:28.250 you do your Kegels. Yeah, we've now learned about 00:45:28.250 --> 00:45:30.369 vaginal estrogen for hormonal -related symptoms. 00:45:30.469 --> 00:45:33.150 What are some other treatments? There's loads. 00:45:33.369 --> 00:45:35.670 Oh, my gosh. Like, just strength training stuff, 00:45:35.829 --> 00:45:37.369 right? Head to toe. You know, we spoke about 00:45:37.369 --> 00:45:42.150 strong glutes, strong hips. Okay? Yeah. Other 00:45:42.150 --> 00:45:44.150 treatments from a physio perspective would be 00:45:44.150 --> 00:45:46.360 like... What are your bladder habits like? What 00:45:46.360 --> 00:45:48.320 are your bowel habits like? We spoke about how 00:45:48.320 --> 00:45:50.739 to poo. For instance, we might be looking at 00:45:50.739 --> 00:45:52.920 things like breath work, diaphragm mobility work, 00:45:53.059 --> 00:45:57.199 thoracic mobility work, stress management strategies. 00:45:57.980 --> 00:46:00.880 Poo meditation. Poo meditation, absolutely, absolutely. 00:46:01.380 --> 00:46:04.659 Pelvic floor meditations to downtrain sore, tight, 00:46:04.679 --> 00:46:07.619 painful pelvic floors. Do those exist? Are we 00:46:07.619 --> 00:46:09.800 talking about meditation tracks that you can 00:46:09.800 --> 00:46:12.400 listen to? So there's an app called Insight Timer. 00:46:12.639 --> 00:46:14.840 And they've got pelvic floor meditation tracks 00:46:14.840 --> 00:46:17.059 on there that we might recommend our clients 00:46:17.059 --> 00:46:19.579 who might be suffering from pelvic pain, for 00:46:19.579 --> 00:46:22.260 instance. Wow. Yeah. That's so interesting. So 00:46:22.260 --> 00:46:25.480 basically, not a lot, but some women who suffer 00:46:25.480 --> 00:46:27.619 from pelvic pain might just be because they're 00:46:27.619 --> 00:46:30.360 stressed out and they're just not able to relax. 00:46:30.440 --> 00:46:32.440 So, you know, in a situation where they're trying 00:46:32.440 --> 00:46:34.769 to have intercourse, they can't because... It's 00:46:34.769 --> 00:46:38.590 just all too tense. Look, that might be an oversimplification, 00:46:38.590 --> 00:46:43.429 but yes. Okay. You know, I think culture and 00:46:43.429 --> 00:46:45.730 intimacy and sex is a bit like, you know, we're 00:46:45.730 --> 00:46:47.469 all in a rush, right? We just want to get it 00:46:47.469 --> 00:46:49.550 done, put a tick in a box, right? It takes anywhere 00:46:49.550 --> 00:46:51.949 between 17 minutes to 40 minutes for a woman 00:46:51.949 --> 00:46:55.929 to be sufficiently aroused. Wow. Okay. You might 00:46:55.929 --> 00:46:59.289 be aroused objectively, i .e. you might be wet, 00:46:59.510 --> 00:47:01.590 you might be feeling it down there, but if you're 00:47:01.590 --> 00:47:04.030 not aroused subjectively. it ain't going to happen. 00:47:04.170 --> 00:47:06.769 Yeah. Okay. And it's not going to happen comfortably. 00:47:07.670 --> 00:47:10.750 Absolutely. So, I mean, that might not be the 00:47:10.750 --> 00:47:12.969 case for everyone, but I'm just like considering 00:47:12.969 --> 00:47:15.570 the audience, you know, we have lots of highly 00:47:15.570 --> 00:47:18.090 functioning women who are busy, busy, busy and 00:47:18.090 --> 00:47:19.849 don't have time for things and they just need 00:47:19.849 --> 00:47:22.409 to get it done, but maybe not be setting the 00:47:22.409 --> 00:47:25.230 environment and the context to allow for that 00:47:25.230 --> 00:47:27.230 to organically happen in a comfortable manner. 00:47:27.809 --> 00:47:29.630 But also like if you're someone that's lacking 00:47:29.630 --> 00:47:32.889 estrogen, you've got reduced lubrication. muscular 00:47:32.889 --> 00:47:36.690 muscular atrophy sex is going to be uncomfortable 00:47:36.690 --> 00:47:40.570 yeah in that menopausal period yeah and it may 00:47:40.570 --> 00:47:42.889 even start in perimenopause for some as well 00:47:42.889 --> 00:47:45.210 just depending on how much of a fluctuation there 00:47:45.210 --> 00:47:49.309 is in their estrogen status wow so much to think 00:47:49.309 --> 00:47:51.309 about and i just here i was thinking we're going 00:47:51.309 --> 00:47:52.769 to be talking about you know how did you get 00:47:52.769 --> 00:47:56.309 exactly and done yeah or this is only for an 00:47:56.309 --> 00:47:58.869 episode for women who've had babies no this is 00:47:58.869 --> 00:48:02.019 for everybody yeah i think Yeah, if it's one 00:48:02.019 --> 00:48:05.440 thing I could really get women to think about 00:48:05.440 --> 00:48:10.199 is, or just remember that just because you've 00:48:10.199 --> 00:48:13.360 had a baby, just because you haven't had a baby, 00:48:13.519 --> 00:48:15.639 just because you're old, just because you're 00:48:15.639 --> 00:48:17.739 young, it doesn't mean you're going to be immune 00:48:17.739 --> 00:48:19.619 to pelvic health challenges at the end of the 00:48:19.619 --> 00:48:22.199 day. Because there are some risk factors that 00:48:22.199 --> 00:48:24.940 exist that dictate the functioning of your, the 00:48:24.940 --> 00:48:27.440 optimal functioning of your pelvic health. And 00:48:27.440 --> 00:48:29.690 it's never too late. But it's always better to 00:48:29.690 --> 00:48:31.449 seek help sooner rather than later just so you 00:48:31.449 --> 00:48:34.570 just can get clarity and get a plan in place. 00:48:34.769 --> 00:48:38.110 And like with most things around lifestyle management, 00:48:38.309 --> 00:48:41.829 it takes time. It's not going to be like you 00:48:41.829 --> 00:48:43.989 go in for a session and you get taught how to 00:48:43.989 --> 00:48:47.010 do Kegels and that's going to fix that and poverty. 00:48:47.409 --> 00:48:51.190 It takes time because, you know, humans are intricate 00:48:51.190 --> 00:48:54.269 beasts at the end of the day and it's not clear 00:48:54.269 --> 00:48:58.789 cut. And it does take... A team to address concerns. 00:48:59.710 --> 00:49:02.289 Wow. I feel like you've given us so much to think 00:49:02.289 --> 00:49:04.849 about. And, you know, everything you've told 00:49:04.849 --> 00:49:08.849 us is so relevant to our audience. You know, 00:49:08.869 --> 00:49:10.690 whether they, like you said, had kids, haven't 00:49:10.690 --> 00:49:12.710 had kids. You know, the ones who are approaching 00:49:12.710 --> 00:49:15.489 40, the ones who have passed 40. But before we 00:49:15.489 --> 00:49:17.369 go, we do have one final question we would like 00:49:17.369 --> 00:49:20.590 to ask you. And that is, what's your 40s formula? 00:49:20.809 --> 00:49:24.730 What advice, mantra, or just tips would you like 00:49:24.730 --> 00:49:27.300 to share? with women who are in their 40s that 00:49:27.300 --> 00:49:31.980 are listening in today? You want my honest? Yes. 00:49:32.139 --> 00:49:34.500 And this is you. This is Preet. This doesn't 00:49:34.500 --> 00:49:38.460 have to be rep and physio. I just don't give 00:49:38.460 --> 00:49:43.460 a fuck. Yes. I sat there thinking about it. I'm 00:49:43.460 --> 00:49:45.739 like, you know what? This is what feels authentic 00:49:45.739 --> 00:49:49.099 to me. I just don't care as much as I used to 00:49:49.099 --> 00:49:52.659 anymore, right? Yeah, I value my time. I value 00:49:52.659 --> 00:49:56.400 my energy and I value my people. You don't exist 00:49:56.400 --> 00:49:59.460 within that realm for me. I'm sorry. It's nothing 00:49:59.460 --> 00:50:02.719 personal. It's just it is what it is. I only 00:50:02.719 --> 00:50:05.079 have so much capacity at the end of the day. 00:50:05.159 --> 00:50:08.400 And by nature of the work I do as a pelvic health 00:50:08.400 --> 00:50:11.300 clinician, like a lot of my energy gets zapped. 00:50:11.619 --> 00:50:15.039 And so that leaves very little for everyone else, 00:50:15.039 --> 00:50:18.380 I think, at the end of the day. So respectfully, 00:50:18.719 --> 00:50:21.920 just. not giving a fuck that's it girl and I 00:50:21.920 --> 00:50:23.199 think that's the big thing isn't it it's the 00:50:23.199 --> 00:50:27.280 capacity that we have as 40 year olds and mothers 00:50:27.280 --> 00:50:31.780 and women who are working and just whatever is 00:50:31.780 --> 00:50:34.260 going on in the world there's just so much information 00:50:34.260 --> 00:50:36.579 so much stuff going on and you're right if you 00:50:36.579 --> 00:50:40.139 don't fit within what our boundaries are it's 00:50:40.139 --> 00:50:43.780 just too much and you can be left to feel perpetually 00:50:43.780 --> 00:50:47.239 inadequate yeah Because, yeah, we are surrounded 00:50:47.239 --> 00:50:52.070 by information and, you know. this whole push 00:50:52.070 --> 00:50:55.610 to age well live well you know are you getting 00:50:55.610 --> 00:50:57.449 enough exercise are you getting enough protein 00:50:57.449 --> 00:50:59.469 are you eating your collagen are you doing your 00:50:59.469 --> 00:51:02.130 pelvic floor exercises are you doing xyz like 00:51:02.130 --> 00:51:05.630 you start to realize that self -care list really 00:51:05.630 --> 00:51:08.909 builds up it's getting longer and longer I feel 00:51:08.909 --> 00:51:12.949 like every year and so we are at risk of actually 00:51:12.949 --> 00:51:15.769 overwhelming ourselves as well trying to keep 00:51:15.769 --> 00:51:20.409 up with this and so I do worry um and I think 00:51:20.409 --> 00:51:23.869 it's can be quite challenging for women to take 00:51:23.869 --> 00:51:28.829 away what they need and prioritize but given 00:51:28.829 --> 00:51:31.030 zero fucks to the things that don't matter it's 00:51:31.030 --> 00:51:35.769 definitely hard cuts yeah absolutely well thank 00:51:35.769 --> 00:51:38.530 you so much for being here pre we've really really 00:51:38.530 --> 00:51:40.309 enjoyed this conversation and honestly you've 00:51:40.309 --> 00:51:42.469 given us so much to think about things i didn't 00:51:42.469 --> 00:51:44.610 even think about yeah absolutely you you've brought 00:51:44.610 --> 00:51:46.449 new information to the table which is always 00:51:46.449 --> 00:51:48.110 why we're here so thank you so much thank you 00:51:48.110 --> 00:52:19.920 for having me thank you Thank you. Because the 00:52:19.920 --> 00:52:21.599 way the teleprompter works, sometimes there's 00:52:21.599 --> 00:52:23.440 a gap, so we just stop. Yeah, until the next 00:52:23.440 --> 00:52:25.639 paragraph. Yeah. You know, like as it's running. 00:52:25.780 --> 00:52:27.519 Yeah. And sometimes our editors don't catch it. 00:52:27.780 --> 00:52:29.780 So we have to always, they'll be like, today's 00:52:29.780 --> 00:52:32.920 episode is about something that we all, and then, 00:52:32.920 --> 00:52:34.119 you know, it's like, no, but you've got to tighten 00:52:34.119 --> 00:52:36.460 that up. Yeah, it's like, we can't have that 00:52:36.460 --> 00:52:36.860 like that.