[00:00:00] Speaker A: Hey, thanks so much for listening to this message. My name is Jason and I'm one of the ministers here at the Madison Church of Christ. It's our hope and prayer that the teaching you hear today will bless your life and draw you closer to God. If you're ever in the Madison area, we'd love for you to stop by and study the Bible with us on Sundays at 05:00 p.m. Or Wednesdays at 07:00 p.m. If you have questions about the Bible or want to know more about the Madison church, you can find us
[email protected] dot. Be sure to subscribe to this podcast as well as our Sermons podcast Madison Church of Christ Sermons. Thanks again for stopping by. I hope this study is a blessing to you.
[00:00:37] Speaker B: I am Julie Lively. I have been coming to Madison since 2015 and we have Jared is my husband and we have two little boys, five year old Luke and two year old Jordan. And I got into pelvic floor physical therapy. I've been a pt now for just about ten years, and I got into it because my first job here in town, my coworker, was getting into the pelvic health stuff late in her career. I think she ended up retiring within five years of starting, but she kind of sparked it. But I wasn't quite ready to get into any specialty yet. But then I had kids and that kind of changed things for me.
My first one ended up being a c section, and then with Jordan, Lord help him, he caused a fourth degree tear. So with that, that really gave me empathy for all my patients.
But it also sparked into how our pelvic floor really is tied into our mental health.
And for me, it became painful to have intercourse for probably ten months. I wouldn't even let him touch me for four.
So bless jared for that. But yeah, so this topic will be on all the different issues that we have as women with our pelvic floor. Men and children also have issues as well. So if you have any questions at all throughout it, or I'm not clear on something, or you just are curious about something, raise your hand and I'll either answer it or Trina's back there in the audience and she'll field some questions, too.
But I am a PT with results physiotherapy right up the street next to Jack's and then that just love coffee shopping center and have been doing pelvic floor for about five years now.
I treat men, women and children with all kinds of pelvic floor dysfunction. So I'm gonna kinda get into what is pelvic health therapy.
So it's a specialized training that you get post doctorate program, and it focuses on the pelvic floor musculature, your deep core, your breathing, hip and spine. So kind of anything here. All right. With a global focus. Overall, we, not all of us are comfortable with treating males or children, but there are some that do and that's even extra special training on top of just the pelvic floor.
We treat any, and this is just a small list, but it's probably the most common stuff. But constipation, and that's mostly what we deal with with children. So if you have a delayed potty trainer or a kid that's had bedwetting issues throughout their, I guess, even up into teenage years, that's likely due to a constipation issue. And that can be treated with physical therapy, urine and fecal leakage, pelvic organ prolapse, which is probably what you've heard a lot from obs or from other ladies, low back, hip, or pelvic pain. And that is a lot of different diagnoses, but painful intercourse or penetration. So pain is not supposed to be a part of sex or speculum exams. If you go to a gynecologist, things should not be painful. They can be like a little uncomfortable or you just don't love it. None of us love it, but it should not be painful. And if it is, that is a sign that you need help.
And you are probably going to have to advocate for yourself.
Majority of my patients have had to ask for PT for help for this post surgical conditions, whether it's like a hysterectomy or if you've had any other pelvic surgery and postpartum recovery. We also treat pregnancy, and that's oftentimes if you're having back pain or like a, what they call lightning crotch, where you're having pubic symphysis, pain in the front. During pregnancy, a lot of times the providers are just like, you can get therapy later or once you're done having kids, then we'll talk about sending you. No, advocate for yourself. And if your ob or gyn won't send you, go to your primary care and they will send you for therapy.
Okay, so what is your pelvic floor? It is made up of three different layers of muscle, all in that pelvis. Okay. So it's more of like a bowl shape than the floor of something. So it wraps up and inside that pelvis, and it's just like it's skeletal muscle, just like your bicep or your hamstring or any other muscle in your limbs.
The I wish I had a little laser pointer. So this picture, I'm just going to walk over here. This muscle right here is your big glute muscle. So we all know, like our big booty muscle, okay? So diving deeper than that, who's heard of the piriformis muscle?
Okay, that is one of the walls of your pelvic floor. And there's a muscle right underneath that called the coccygeus that attaches to your true tailbone, your coccyx, okay? In childbirth, I think that's like one in four fracture this.
So you can end up with issues with guarding and tension in that muscle, causing pain with sitting or any sorts of things like defecation, those kinds of things. But your sciatic nerve could come out right between those two muscles. So if you've got dysfunction there, you could end up with more of a sciatica.
This group of muscles right here, those are referred to as your levator ani, as a kind of group of muscles. Those are really important in the support of your pelvic organs. So if you feel heaviness or feel like you're sitting on an egg sometimes, you probably have an issue with the strength of those muscles. Then more superficially, you've got. So that's the deepest third layer, this layer that goes kind of there.
We can separate the pelvis into urogenital triangle and anal rectal triangle. So the urogenital triangle up in the front, that will help. That second layer has your external urethral sphincter, which is really important for us if we're peeing on ourselves.
It is not normal to pee on yourself when you're coughing, sneezing, laughing, jumping, whatever, lifting. It is very common, but it is not normal. And you should seek help if that is happening to you or if you know of somebody, get them into some pt.
Then the first layer, the most important part about that is this external anal sphincter.
But it's also that layer is hugely important for our satisfaction with intercourse. So that is the pelvic floor in a nutshell. Any questions so far?
All right, functions of the pelvic floor, these are, there's only like seven ish, but support for the pelvic organs. So it's like a bowl shape. And there's all this kind of stuff in that bowl from our bladder and our uterus and our rectum are the biggest parts in there. And they're helping they're supported by some fascial layers. I like to think of that as, like, the saran wrap of our body. It kind of helps hold things in, but those muscles help support those organs from just falling out down below.
It helps in bowel and bladder control.
So those sphincters, that anal sphincter for bowel and that urethral sphincter for pee really helps to control those for us. And it also, in reverse of that, it helps us pass urine and feces. Okay, so if you struggle with constipation or hemorrhoids or you have delayed, like, it takes you too long to urinate or takes you too long to poop, those can be signs of pelvic floor dysfunction as well, that you aren't relaxing it enough to let those things come out. It's important. Our pelvic floor muscles support sexual function, breathing. So your pelvic floor is kind of like a sump pump with your diaphragm. Your diaphragm is a muscle that sits like this, and when you take a deep breath in, it goes down because your lungs expand with air. If your diaphragm comes down, it's squashing everything here. So our pelvic floor really needs to lengthen and relax with that. And so they work together, pregnancy and childbirth. So we're all familiar with that.
But kegels or pelvic floor contractions have no place in the delivery room. You do not have to have a strong pelvic floor to deliver a baby. Isn't that good news? Right? You actually need to have relaxed pelvic floor in order to not have significant tearing.
There are lots of things, other reasons why you might have tearing, but tightness in that pelvic floor is one of them.
It's also helpful in lymphatics.
The contraction and relaxation of those muscles helps to move fluid out of the pelvis and around the body. So on the right hand side of the screen, a healthy pelvic floor can both squeeze and lift as well as open and lower.
So if you can't do one or the other, you will have some kind of pelvic floor dysfunction. If you have trouble with squeezing and lifting, you're probably in the camp of pelvic organ prolapse or urine or fecal incontinence.
And then if you can't open and lower, you probably have more of pelvic, pelvic pain, constipation, hemorrhoids, those kinds of things. Okay, that would be like gross generalization, but we treat those differently. So I can't just go out and prescribe all of you, let's do 1000 kegels, and you're going to be all better, because that might be the exact opposite thing that you need. So getting a professional opinion on what's going on with you is really the best way to go about it. And there are all kinds of things that can be done. So, good news, there's hope.
So how common is this about one in three women will have some kind of pelvic floor dysfunction in their lifetime.
Some report that it's one in four, but that study was really just focused on urinary incontinence, fecal incontinence, or pelvic organ prolapse. And there's lots of other things involved in pelvic floor dysfunction that probably make it more prevalent.
About 16% of men. So not as common in younger men. But if your male or dad or granddad has had any prostate issues, they've probably dealt with some pelvic floor dysfunction, especially if they've had the prostate removed, because that shortens the urethra. And a lot of times, at least in the past, there's not. They weren't so great at sparing the nerves down there, now they're better at it. But about 40% of women will present with just one problem. So say some stress incontinence that I pee on myself when I jump or when I cough. Okay. But 17% might have two problems, so they might have some stress incontinence and some pelvic organ prolapse. Then six might have three different problems and then 2% have four. So it kind of goes down in that prevalence of how many conditions that you have.
But the real reason why becky brought me in for today is that pelvic floor dysfunction plays a huge role in our mental health.
Women who have pelvic floor dysfunction also have high levels of depression and anxiety. Those are probably the main problems that you'll see, but they experience low mood and emotional distress and it impacts their quality of life. So if you're.
This is why it doesn't get talked about very much, because it's kind of a private matter. If you pee on yourself all the time and you're wearing just like, a liner, well, that liner is going to turn into a pad, that pad's going to turn into a bigger pad. That bigger pad is going to turn into a diaper throughout your lifespan. If you don't get things taken care of, think about the financial burden of having to wear one of those devices we call them assistive devices, just like a cane or a walker would be.
You're needing that assist throughout your lifetime, and that is a huge money drain.
And not only that, but if you start getting more and more incontinence, then you think you either are or you think that you're peeing on yourself during intercourse. So then you stop having intercourse, and then your relationship with your husband goes down, and then you start to separate, so it just kind of snowballs. Okay.
So really getting these things fixed early on is going to help save a lot of problems down the road.
So about you're three times higher to have anxiety and depression when you've got a pelvic floor dysfunction. You can have increased stress and low self esteem, isolation and relationships. It can disturb your sleep if you're constantly getting up to go to the bathroom.
Let me pull the audience.
If you are premenopausal, how many times is it appropriate for you to get up and go pee?
Zero to one? Yes, zero to one. So if you're pregnant, you get a pass. Okay? But for premenopausal, yes. Zero to one. If you're postmenopausal, one, no more than two. If you're getting up more than two times a night, your sleep is significantly disturbed. And at that point, the rate of your body being able to heal itself goes down. And if you don't get in a good rim cycle, you actually don't stop producing urine at the same rate as you do during the day. So REM cycles help shut our kidneys down or bring down that level so that they don't produce as much urine during the night, which is why you're able to hold it for eight plus hours, maybe. Who gets 8 hours? Who gets 8 hours? Okay.
But you're able to hold it longer than you would during the day, and that's because of that slower production, provided you're actually getting REM cycle sleep.
You can also have body image issues.
This particularly constipation can lead to bloating, which just leads to some body image issues you can have, like, I mean, pelvic pain can really impact your kind of self worth.
I had a lady who was one year into her marriage, and she had never been able to consummate that marriage. Okay?
Imagine the strain on that relationship. I mean, her husband was great and very supportive. She had some trauma in her background, and she had dealt with a lot of that psychologically, and she was very much ready to deal with that aspect of it. With her pelvic floor, she did not realize it took us about two rounds of physical therapy for her to really unlock all of that trauma that was still in her pelvis.
Your body. There's a good book out there called the body keep score. Okay. This is. To be honest, I haven't gotten to read it yet, but Becky will tell you that hers is very marked up from reading. But that is a great book and highly recommended on how trauma impacts and gets kept in your body and stored in your body. And who's heard of somatic exercises? Okay, those are all geared towards releasing that trauma from your body.
There's lots of those that you can do that I've seen floating around Instagram or YouTube, but that trauma in her body was finally getting released, and then she moved to Florida. And I haven't checked in with her lately to see how things are going, but she very much wanted to have intercourse, so it was not a lack of desire, but it was her body's trauma that was blocking that from being successful for her.
So we spent a lot of time. She's one that did not need kegels. She needed a lot of what we call down training. So nervous system regulation and improving that ability for her to, like, open up her pelvis because it was kind of like she would describe it as a brick wall when trying to have penetration. So.
But that can lead to a lot of issues. All right, so this is kind of my last, like, true slide, but finding a specialist. So both Trina and I deal with pelvic floor cases here in town. I'm obviously in Madison, right down the road, and she works in Huntsville part time with Nissan physical therapy. There's also a couple of these QR codes, and I'll just leave that up there.
But there are two other ways for you to find practitioners. If you've got a loved one in a different state that you think could benefit, those two sites can really help gear you towards finding a practitioner in that area. It's not all inclusive. Like, I don't. I'm not on the APTa one because I don't have a subscription to that licensing body, but I should be on the pelvicrehab.com one, but yeah. All right, I'm going to open it up to questions, and then we'll kind of take it from there.
Anybody got anything personal or not personal?
Okay.
[00:21:15] Speaker C: I just wanted to advocate.
I've had pelvic floor therapy, and I didn't. I didn't know anything about it.
I didn't know that it was an option. I didn't know that I really needed it until there was the whole backstory. But I do. I mean, I recommend it, obviously, even if you weren't here, I would recommend it. Felt, you know, kind of awkward in general, but definitely worth it.
Hugely beneficial in my experience. And, I mean, no shame, you know, even if it's. It's uncomfortable. You know, it's part of your body. It's a muscle. And it was great. It really helped me. Again, I wish more people knew about this and it was more widely talked about.
I don't know why it's, you know.
[00:22:06] Speaker B: I guess because it's part of the body.
[00:22:08] Speaker C: But anyways, anybody's welcome to talk to me about it if you have any questions.
[00:22:12] Speaker B: Yeah. It's a part of the body that we don't. We're basically told to not think about until we're married. Right. And then you're told to.
It should just be fun. Everything should be fine. It's not always fun. It's not always fine. And especially after having kids, it's not always fine. Yes. Okay, so this might go into her, like, it being uncomfortable question. And I know you already said there are multiple, like, you can't just give everybody the same, like, you do this, everybody do this. But, like, what do you do? Yeah. Okay. All right, cool. All right, sure. Fair question. Okay. So based on your diagnosis, that will largely gear me towards whether I want to try to have an internal assessment or not. I will never force, and no physical therapist trained in this will ever force you to have an internal assessment. Okay. I can treat internal vaginal or internal rectal. Um, and based on your issue, you might need one or the other or both. Um, but if all we ever did was external clothes, you would get benefit. Okay. I might not have the complete picture, and I've got one right now that she's 17 and we have not gotten there yet. And it's probably about six to eight, but we're getting there. She's getting comfortable enough to where we can look at that.
But if you've got, let's just take stress incontinence, because that's probably the most widely prevalent. So stress incontinence is when you leak a little bit, like, little drops here and there with a cough, sneeze, laugh, jump, carrying, walking upstairs. Really any kind of movement.
That's the stress part. Heart, not, I'm stressed and I'm peeing on myself. Okay.
So it's the body stress, and it's more of a pressure balance. So you could have a perfectly fine pelvic floor, and you could have really terrible breathing, and that could be the reason why you are having that incontinence, because there's too much pressure from above. Remember how I said the diaphragm and the pelvic floor work together? They really do need to work together to not have too much intra abdominal pressure. So one of the biggest, the highest level of intra abdominal pressure that we do is a sit to stand. How many times do we sit and stand every day? A lot. Okay. And particularly if you've got a full bladder and you go to stand up, that might be a cause for leakage. So with stress incontinence, that more than likely you're going to be in the up training camp of needing to do those kegels. So, externally fully closed, I can do an assessment, but all I'm getting is kind of a global sensation of what things are doing. Kind of like, if I look at you doing a hamstring curl like this, you're kicking your butt. I can kind of look at that, but if I can really feel, I can kind of tell you there's three different hamstrings. So I can tell you where you might be having issues. If I can't feel each layer, I might not know where we need to work specifically. It's also more valuable for cueing purposes to do an internal assessment. So if a little lab time, everybody sit on their hands. Okay. And I want your hands to be inside the bone that you sit on. Okay.
All right?
Okay.
Now I want you to do what you think is a kegel. Okay.
How many of you just squeezed your butt?
Okay. You should not be squeezing that glute muscle. Okay. That glute muscle should stay relaxed. Okay. So you want to work the muscles in between your fingers. And what if I give you. Oops, stay on your hands. Stay on your hands. We're going to see if they get better.
Okay? So I want you to think about your urethra. Okay. The p hole. Okay. Being a straw. Okay. So it's a regular sized straw, right? Now I want you to make it into a coffee straw. Narrow that down.
Try to.
Okay, try to stop your flow of p. Or narrow that urethra down.
Did that change your contraction?
Okay. Now, all right, so that's the urogenital triangle. Okay. That's important, but let's try a different cue. Okay, I want you to imagine that you're sitting on a blueberry. Okay. I want you to pick that blueberry up and pull it up towards your belly button.
Did that change anything? Okay. That might not have worked for some people. Okay, so now you're gonna imagine that you've got a tampon inside side. Okay. And I'm going to come by and I'm going to try to pull that out.
Try not to let me pull that out.
Can you hold that up and in? Pull it higher. Pull it higher. I'm pulling hard.
Okay. Did that change anybody's?
Okay, so that's the more of that third layer, that deep, supportive layer. Now I want you to try to hold back gas.
You're about to toot. You gotta hold it in, but you can't squeeze your butt muscles. You can't squeeze your butt muscles. What are you gonna do? And you can't cross your legs.
You have to just squeeze that external anal sphincter. Okay.
And hold that in. All right, so these are three different types of contractions. Okay. So those are the types of things that we can really cue better if we can feel things or get an internal assessment. But as you just saw, like, I can coach you through something without ever touching you. It would take my assessment of you and your problem to know whether that would be appropriate or not. But I can do it without ever touching you.
Would you be touching then, while the person is doing whatever thing is they're doing? Typically, if you're comfortable with it, sometimes kids are not.
And with kids, it's sometimes needed to do.
If I were to work on a balloon catheter with them, they would have to have an internal assessment, but it's not going to be their first time somebody's had that done.
But with them, I always, I keep them clothed and usually I will have you sit on my hands and I can feel stuff.
Provided you're not wearing, like, starched jeans. I can probably feel what's going on, but I'm feeling for. So, okay, the original assessment. You come in, I'm talking to you. I find out what's going on, how long you've had this problem, and we get into the assessment portion. I'm first going to look at your back. I'm going to have you bend over and touch your toes. I'm going to have you bend backwards and side bend each way and turn. I'm going to see, are your hips moving well? Is your back moving well? Because that's going to impact the pelvic floor.
The nerves that help us pee and poop are s two, three and four. That's found in the sacrum here. But we also have a lumbar plexus. And that sciatic nerve that I talked about going through the, it can go above, below, or through the piriformis muscle. If it goes below, then it's between the coccygeus muscle and the piriformis, so heavily impacted by the pelvic floor. And I won't know that. Even if you had an MRI, I wouldn't know that. So no need for imaging there.
And that's another thing. We don't need imaging. You do not need to spend $1,000 to get an MRI before you come to therapy. They won't help you.
So if that's the case, what was I even talking about? I'm looking at hip, and I will lay you down on the table. We'll look at hip strength.
I will look at your hip mobility if you are restricted in a certain range, particularly with more rotational things. But can you go in and out with your knee from the hip, not from the knee. And then I'm going to look at breathing. And if you have a diastasis recti, which is a separation of your abdominal muscles, it's really more of a laxity than a true, like, separation common in pregnancies. If you've had particularly more than one or you've carried multiples.
It also happens in men, particularly those men who carry all their weight in the front.
It's just a separation here where we test for that in like a little crunch. And you can feel for belly button, and it's depth and width are the important factors there. And then we'll do above belly button and below. And that will largely impact how we can treat you because that's going to impact your deep core system. I'll circle back to that. Remind me to talk about the soda can because I'll forget.
But after I've assessed your breathing and all that, then we get to the pelvic floor. Okay, so I look at lumbar hips and kind of abdomen first before I ever look at pelvic floor. And then we've got three options. We have external clothed, we have external visual. So you can take underwear off and I can just look at things and feel for things a little bit better.
Or we can do an extra. Or an internal vaginal or internal rectal exam. Single finger, no speculums with Lube. Lube's your friend, by the way.
Any lifespan age, lube's your friend.
Yeah. Any other questions? Okay, so the internal exam, what would that be?
Okay, so when you're at the gynecologist, they have you scoot all the way down. Right. Your feet are in stirrups. I don't have stirrups. I have a bed.
You sit on that bed. I sit to the side of you. Sometimes somebody might sit at the bottom of the bed. I've just found it's easier for me to assess your abdomen while you're doing things, if I'm by your side. Plus, you can see where everything's at. You can see my other hand. You can. It's just more comfortable for me and probably for you, too. But single finger, and I'm looking at left and right side of your pelvic floor. So I'm feeling for layer by layer, that first layer, then the second layer, and then the deep third layer and into the pelvic wall where the hip muscle, the obturator internus, and the piriformis are, and kind of get to the coccygeus through the vaginal canal. But it's a little harder. My finger's not that long.
That's a more of a rectal approach.
We can do lots of different mobilizations there, but if you don't have great breathing patterns, then I'm going to start there with teaching you how to do a great diaphragmatic breath, because that's what I'm going to need to be able to coach you through a bunch of things. Once I'm internal, we can treat the same thing as. You might have a massage out on your arm, particularly like a therapeutic massage, not a feel good kind of massage.
We can do the same thing with the pelvic floor muscles because they're skeletal muscle. Right. We can use contract relax, where you actually contract a muscle and then try to release it. And we can do some, lots of breathing things to help reduce tone and pain, and oftentimes get your pain down. If you came in with a six out of ten pain with me touching something, I can get it down to one or zero with just you breathing. It's kind of cool.
Then after that, you would dress, we would talk about what was going on, and, yeah, I would do an assessment of strength there, too. So there's two types of contractions with endurance and then, like, coordination.
And so it tests the difference between that and then develop a program that's appropriate for you.
Yep. You said that part of the issues were the muscles and the sacrum and the. The lower back.
If you've had surgery in that area, can it be a reason why you might be having pelvic floor trouble? Have you had a prolapse surgery? No.
Okay. Mesh oftentimes gets attached to the sacrum. If you've had a pelvic organ prolapse surgery or something else, they oftentimes attach that, and so you end up with a lot of low back pain or sacral pain from that.
If you've had a hysterectomy and they've taken your cervix, they've actually removed a whole layer of fascia and a lot of attachments.
So you lose some stability through that from that procedure. So if they can leave the cervix, it's best if they do.
I was speaking more like back, but yes, back. Okay, so back surgery. Yes.
So, a lot of times, you lose some mobility through there. Your hips can impact your pelvis, and your pelvis, your back, the arm bones, connected to the. You know that song. Yeah, everything's connected.
You have about 400 miles of nerves in your body, and they're all connected.
So I had a pregnant lady.
Well, no, she wasn't. She was postpartum. 15 months postpartum. She had already had surgery and all sorts of different kinds of things, but we ended up finding out that her pain was sitting and ability to wear, even, like, underwear, was uncomfortable to wear, and she was just wearing loose fitting clothing, couldn't walk for very long, and was caring for a little baby who had some hearing loss, too. So lots of doctor's appointments and that kind of stuff, but hers was actually, like, more of a traction kind of injury from being pregnant. So her nerves in your thoracic spine. So up here, right there, those nerves, there's a few nerves there that wrap around through here and down and through the front part of your pelvis. So we treat thoracic spine a lot with pelvic floor stuff, but I did a lot of nerve based things with her, and she's just fine now.
But, yes. So all kinds of spine things? To answer your question, yes. If you've had back surgery, then it. Okay, 75% of people with a low back pain have pelvic floor dysfunction.
Okay. All right, that's a good segue into the soda can. Okay, so everybody knows what the soda can looks like. Your diaphragm is the top part of that soda can. Your pelvic floor is the bottom of that soda can. Then the walls are kind of made up of deep layer abdominal muscles called your transverse abdominis. It's actually like a corset, starts back here and wraps all the way around, and it kind of tightens us, stiffens us, and then some small little muscles they're almost like Christmas trees coming out back here called multifidi.
And all of those need to work together in order to benefit your stability of your back and be able to help you move in different positions without pain. So chances are if you've had to have a back surgery, you already had pelvic floor dysfunction, and that might be missed by an orthopedic therapist.
We're getting better, but we're not all there yet. Yes. How frequent and then for how long.
[00:39:07] Speaker C: Is your typical treatment?
[00:39:10] Speaker B: Very variable. However, I tend to deal with painful conditions on a three times a week basis. Then as you're getting better with the pain and that's come down and we're just strengthening, I move you to two times. And then when we're getting into more functional things, I have you do a lot more at home and we'll just do one time a week, and then if you feel like you're not quite ready to be discharged yet, we'll do every other week or something like that. But I firmly believe that you're going to get out of it what you put into it. So if you just can't, for whatever reason, you're a stay at home mom with four kids at home and you just don't have anybody to watch them, but maybe one time a week, your husband's home on Friday every other week. You come to see me Friday every other week and we'll see what we can do. Something's better than nothing. But the more frequently you can come and stay on top of it, the faster you'll get better. Did you mention that a position's referral is required?
Lovely state of Alabama. We're behind the curve. So that's called direct access and we do not have direct access in this state. Please talk to senator, senators for that and House representatives there.
You do have to have a referral. We do offer screens. So I've got a, we offer free screens for urinary incontinence or postpartum. If you've had a baby, you're postpartum. It doesn't matter if you're 80 years old. Okay, cool.
So we offer complimentary screens, but they are not available for those with federal insurances. So Tricare, Medicare, those they tightly regulate, you have to have a referral.
It's best to just go ahead and get the referral first because the most that I could do is talk to you and assess you and kind of figure out what's going on. But I can't treat you and I can't give you. I should not give you exercises, we'll put it that way. I might give you some food for thought or something to go look up, but I should not prescribe you any exercises without having a referral.
How many months does it usually take to get things going in the right direction? It could be a few visits or it could be many months. Kind of depends. Constipation stuff tends to be a slower kids. You're talking months to years.
It didn't all happen in one day. And depending on kind of how many issues you've got or how long something's been going on, it can take a while. Sometimes it's how quickly can you connect your brain to your pelvic floor?
There's something called the homunculus in the brain. So we have slices of our brain here, and you've got a motor cortex, and in that motor cortex is kind of a body map, and you have parts of that that might get smudged if you just don't really think about it or you don't use a body part for a while.
If you've ever broken a body part and not been able to use it, then you're kind of like, what is this? Or after childbirth, you're kind of like, what is that down there?
That it's just. Your body's just kind of getting used to everything. But there's. Your brain is very plastic, and we can change things so we can sharpen those lines, and it can come from, like, a very blurry picture of what is the pelvic floor to a very sharpened picture. And that timeline can be highly variable on people. I've had light bulbs kick on like that, and they're instantly, wow, I could carry my kid without a problem today, or it might take months to be like, I still don't know what you're talking about.
Yes. So assuming you have unhealthy pelvic floor and everything, but you're wanting to get pregnant or the pregnancy, are there certain, like, therapies or physical things you can do to both prepare for pregnancy and for birthday? 100% yes. So I will treat pregnancy and postpartum. Even if you don't have an issue, it's great, particularly if you want to do a natural labor and delivery. We can kind of coach you into what things you need to do at what different stages of your pregnancy and what's safe during different timeframes, and then how you can relax and lengthen that pelvic floor and other tips like soft tissue techniques so that you can reduce your risk of tearing? Yep.
Anybody else?
Yeah. If you're struggling with potty training, is there, like, a rib that may be.
That would tip you that this is the problem? As opposed to constipation is probably the problem.
If they hide to poop or they've ever had a hard poop or something hurt to come out while on the toilet, they will revert back to holding it in, and then that just starts to cycle. So Luke, bless his heart, it took months, and that's really when I really started to get into the kids stuff.
But it can be as easy as dietary changes or just adding some. Some osmotic laxatives into their drinks to really kind of help. Or it could be, like, behavioral changes.
Maybe they're just, like, not going pee or. I don't know.
Typically, if they're three, we can start working on them until they're three. Don't really worry about it if they're struggling, but you do want to just make sure that they're pooping regularly and that it's not, like, dry and hard.
Any other questions? I know the bells have gone. I could talk all night, so anybody else?
All right, if y'all have any other questions, I'm here. I've got my card and screening cards up here if you want to grab one.
But, yeah, thanks for your time.
