S3E6: Pelvic Floor Health: A Vibrant Life After Pregnancy And Menopause With Amanda Rafferty

PTBE 6 | Pelvic Floor Health

Your pelvic health is the foundation of your well-being. You don’t have to settle for discomfort. In this episode, Clare Sente and Rachel Watson invite Pelvic Floor Physical Therapist Amanda Rafferty to talk about common changes that happen to a woman after delivering a baby, in perimenopause, and menopause. Mandy discusses the mysteries of the pelvic floor, a part of our body often overlooked but critical to our overall health and happiness. She shares the keys to strengthening and maintaining a resilient pelvic floor and addresses how the shame and the stigma surrounding the issue should be removed. Throughout the episode, Mandy emphasizes that no woman should need to put up with pelvic discomfort or dysfunction. Tune in now and be guided toward a life of comfort, confidence, and vitality.

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Pelvic Floor Health: A Vibrant Life After Pregnancy And Menopause With Amanda Rafferty

We’re in Season 3, Episode 6. If you’re new to the show, welcome. We’re so glad you’re here. If you’re one of our loyal readers, we are so happy that you are back again with us. One of the reasons that we wanted to expand our topics in season three was to look at more ways that might get in the way of a woman feeling confident and her best self. We used our origin stories for Rachel and I to look at what was going on in our lives that might have affected our view on sex and what a woman is capable of. That’s one thing.

For our topic, we have a guest, and her name is Mandy Rafferty, and she is a Physical Therapist. We wanted to talk about pelvic floor health because it’s something that’s pretty important. I’ll tell a little story later of how it affected me on my vacation in Greece, but let’s bring on Mandy and Rachel and get this party started.

Mandy, thank you so much for coming. We are excited about this topic. We chatted a little bit before we started, and we were saying that pelvic floor health affects women at every age, and there’s so much of it that we’re told to put up with. I love that you’re here to help us not to put up with things.

Thank you for having me and for bringing this subject to light because it’s something so many women do not talk about. The younger generation, the women in their 20s and 30s, are starting to talk about it more, which is wonderful, but it’s been a mission of mine to get the word out there. It’s something we need to think about and need to talk to our girlfriends, daughters, and our mothers about, and make it not so taboo. We don’t have to suffer through incontinence and pelvic pain. There are so many things that we’re told, “Go get a Poise pad or get some Depends. This is what you have to do, and this is going to be for the rest of your life.” That’s not the case. I’m so glad you two are getting the word out there. We need to continue to share.

Mandy is someone who lives closer to me. We were introduced through a mutual friend. She has quite a great background to be talking about pelvic floor health. She has both her Bachelor’s in Biomedical Sciences and a Master’s Degree in Physical Therapy, as well as a Doctorate in Physical Therapy. She has been practicing for several years with treating pelvic floor patients for many years. She cares a lot about women’s empowerment like us.

We’re going to dive into some of these topics that we’ve all talked about as taboo. We do not like taboo topics around our sexual health and feeling confident. Can you tell us, Mandy, how many women does this affect? Do you know the stats with it? I read that it’s 1 in 3 women will have issues with what’s called stress incontinence. What does that mean? It means that maybe when you’re sitting, you’re okay, but you might cough or jump or run, and all of a sudden, there is some bladder leakage. What are stats that you know?

For those women over 60, it’s more about 2 out of 3 women are having issues with incontinence, stress, or urge incontinence. Overall, if you looked at the general population of women, say, 16 up, it probably is about 1 in 3. We don’t think it tends to happen in younger women or women before they’ve had babies, but it does. There are girls in high school even that are having issues and they don’t want to talk about it, or their moms don’t know what to do about it. Overall, if you took every woman, teenage and up, it probably is about 1 in 3 on average.

2 out of 3.

Over 60, it starts moving up there. If we know about this younger, if we treat it younger and more aware of it, that number can start to decrease as we start to age as well. We have power over this.

One of the things that I know about bladder and stress is incontinent. We talk about how you have children and maybe, “We can’t go on a trampoline anymore because I’ve had kids, and I’m going to pee myself.” It’s very much, “I’ve had kids, so now I’m going to pee myself a little bit.” The other side of the coin, which I would love to make sure that we talk about, is the joke. It gets told in the hospital. There should be a survey done on how many men have made the joke, “The woman has just had a baby. She’s getting stitched up.”

The husband says or the partner says to the nurse, “Can you put an extra stitch in?” On the other side of that coin, when we’re looking at the health of the pelvic floor of our vaginas, is it good enough for pleasing my partner during sex? That’s why people my age are doing Kegels, and they’re buying these things that you insert and have gamified them. You can watch it on your phone. You do this game, and you squeeze.

Most people are not doing it in order to have a stronger pelvic floor. They’re doing it because they’re worried that their partners are going to be like, “This is baggy and saggy. I don’t like it anymore. It’s changed.” That’s heartbreaking. That’s why younger people are worried about their bodies and their ability to please other people and not look after them for themselves. Do you do you hear that, Mandy?

That’s something that’s talked about. I’m quickly doing an assessment of every woman I’ve seen at every age for several years. I almost think that is an older-generation thing, but you’re in your 30s. What’s being talked about in your circles? I’m a little bit older than you, but that is something that’s talked about. They’re usually scared after they’ve had a baby. If they have had to have stitches, “What is sex going to feel like the first time?” It’s not always wonderful, but if you’re married to him, or he’s an important person in your life, I’m going to go on my little soapbox. He needs to put up with you. You just had a baby, and he needs to be nice, patient, and kind.

That being said, can sex go back to being good after you’ve had a baby? It for sure can. There are things that can be done. Kegels can be important, but every person is different. I don’t love all those things that are out there that you can buy because it’s one-size-fits-all, and that’s not who we are. Every single person is different. Everybody’s birthing experiences are different. Did you have a very fast birth? Did you need forceps? Did you have a cesarean? All of those things are going to impact what your recovery is like and what your pelvic floor health is like after you’ve recovered if you’re having pain.

Sometimes, things aren’t loose down there after having the baby. You do have instances where, if you’ve been stitched up, there’s a lot of scar tissue there. That can be very painful. It all makes the difference, and that’s why I promote that every woman who is pregnant see a physical therapist while they’re pregnant. If you have pain or don’t, if you have any symptoms or you don’t, it’s good.

Even for one visit, have some education on what the process is like, especially if it’s your first pregnancy. Every woman should see a pelvic floor physical therapist after they’ve given birth so they know what the right things are to do to improve their body, feel more confident, and feel more comfortable with themselves and with their partner.

My daughter will be having her first child in February 2024, so I get to be a grandmother, and no one ever talked about seeing a pelvic floor specialist afterward. I agree with the benefit of seeing someone before so you know what to expect and seeing someone right after. Is there ever a point where it’s like a point of no return, Mandy? It’s like you’ve got too far out that you can’t make improvements or you’re probably going to tell me, “Anything with prevention. It’s a lot easier if we can catch it sooner?”

It’s going to be easier if you can prevent something from happening, like preventing a tear or a difficult labor. Prevention is key, but there’s no point of no return. I tell people it doesn’t matter if you had your baby 6 weeks ago, 16 years ago, or 30 years ago. You can always make improvements. Your pelvic floor muscles are like any other muscle in your body. If you don’t use it, you will lose it, and that doesn’t mean having intercourse or whatnot. That means focusing and being in tune with your body. That means making sure that you’re functioning in a way that helps your pelvic floor and doesn’t cause more problems for you later in life.

PTBE 6 | Pelvic Floor Health
Pelvic Floor Health: Really focus on being in tune with your body, making sure that you’re functioning in a way that helps your pelvic floor and doesn’t cause more problems for you later in life.

It’s like going to the gym when you’re 50 years old, 60 years old, or 70 years old, and you can get stronger. You can get your pelvic floor stronger. I see so many women in their 60s and 70s who say, “I’m weak. I had four babies. That’s what I was told. It happens. All my girlfriends are doing it. I can’t do anything.” I’m a big cheerleader. I’m like, “We can fix this. This can improve.”

My favorite story is I had a 90-year-old woman come in. This was years ago. She was so cute. She only spoke Polish, so her daughter came with her and translated for us. She was such a feisty, determined little lady. She had both ball and bladder incontinence. She said, “Can this help?” I said, “If you do what I’m telling you to do, we can help you,” then I crossed my fingers because if she knows what I’m telling her to do, we can get this better. Am I going to improve it completely? I don’t know.

As we age, we lose muscle integrity and connective tissue integrity. I said, “If you listen and work with me, I promise we’re going to make this better.” She got so much better, but she was determined. She put the work in for me. She was so fun to work with because it was so great to see that happening. I love to tell that story because it doesn’t matter how old you are, how long ago you had kids, or how long this has been going on. Improvement can always happen. Keep that in mind. If it’s something that’s been going on much longer, then it’s going to take longer to improve, but there’s always room for improvement.

It doesn't matter how old you are. It doesn't matter how long ago you had kids. It doesn't matter how long this has been going on. Improvement can always happen. Click To Tweet

I love that story. I love the idea of the daughter translating to the mom. The things you have to discuss. Let’s get an appointment. That leads me to my question, which I would love to ask. It’s a stupid question but I’m going to ask it for myself and on behalf of some readers. Please, Mandy, will you tell us what you mean by pelvic floor? What part of the body is included in the pelvic floor, please?

We should have started off with that. If you think of the muscles at the base of your pelvis, there are multiple muscles and muscle layers down there. They make like a bowl or a sling that holds all of our organs, our uterus, bladder, rectum, and bowel. Everything is supported by that pelvic floor. It’s a sling of muscles that’s at the base of our pelvis.

Those muscles do, though, work in conjunction with our abdominals, diaphragm, and glute muscles. I tell people, there’s so much talk about the core and core strengthening. Your pelvic floor is part of your core. When you’re doing core strengthening, you need to know what your pelvic floor is doing because, unfortunately, if we’re doing core work and we think we’re doing the right thing. Sometimes, we’re not. We need to know how we are breathing, what our diaphragm is doing, what our abdominals are doing, and whether the right abdominals are working. The pelvic floor is those muscles at the bottom of the pelvis, but they do work in conjunction with the abdominals, glutes, and diaphragm. They are muscles.

Having a strong pelvic floor is not to the same as having a tight vagina. Those are different things.

They are different. They go together, but they are different. Your vagina is an organ in your body, and you have a set resting tone of your vagina that is going to be a higher resting tone and tighter connective tissue. As we’re younger, as we have pregnancies and deliver babies through that area, that does loosen up in integrity like if you have a balloon and you blow it up big, then you deflate it. You blow it up again big, and you deflate it. The resiliency of that balloon does not always return back to normal. That’s a little bit of what happens with the vaginal wall after we’ve had multiple births.

Now can your pelvic floor muscles help support that? They for sure can because they are helping to support that area. If you have had a few children and you also are not using your pelvic floor muscles, we call them hypotonic. Those muscles aren’t working so well. They get a little smaller and then your vaginal area is going to feel like it’s a little more open and looser. That can cause problems with things like leakage and prolapse, where organs fall down into that opening.

If they are working properly, keep your public floor strong, and you’re using those muscles, then the muscles, like if you use any other muscle in your body, will hypertrophy. It will get bigger and work better. That helps not to make you feel like your organs are falling out. That might make sex better. Your partner might say, “Things feel better down there.” There are some differences, and what your muscles are doing can help make the vaginal opening have a better integrity than if we’re losing that integrity in the tissue, the connective tissue, and the integrity in the muscle.

Mandy, if we’re sitting, which a lot of us do, it turns off the glutes and the muscles down there. I do Thai massage. You had a Thai massage with me. You’re stretching, and I didn’t realize a lot of times that the stretching of the hips is also stretching the pelvic floor muscles a little bit. A woman is probably reading this, and she’s thinking, “Am I hypotonic down there? What’s going on?”

Let’s maybe jump to what are some things that a woman can do as well as we can find resources for a woman finding a pelvic floor specialist. What are some things? We are where we are. Is there anything we can do that someone reading can try without going to a pelvic floor specialist to get some exercises? Are there some general things that we could be on the lookout for and be doing?

You need to figure out if you are hypertonic or hypotonic. Sometimes, that’s hard to figure out on your own. Signs of hypertonicity are pain with the insertion of a tampon, with intercourse, difficulty with bowel movements, and difficulty starting a stream of urine. Those painful things are telling you that you’re hypertonic. The muscles are too tight.

Hypotonicity is more of that heavy feeling in the pelvis. You feel like, “I have to get to the bathroom. My bladder is full and it almost feels like it’s going to fall out.” Sometimes we have a lot of pelvic pressure if we’re lifting something or standing a lot during the day or very active on our feet lifting things. You might have leakage, all leakage, and bladder leakage. Those are going to point you more in the hypotonic direction.

Now you can be hypertonic and also have your urinary leakage. They can go hand-in-hand. It happens a lot in runners. You want to first figure out where I am and if you don’t know that’s okay, too. I love teaching people diaphragmatic breathing. I don’t know if you folks have ever talked about it on your show.

We just love breathing in general.

It’s so good. We all need to breathe. No one is breathing correctly. We’re breathing but barely. I pretty much teach everybody diaphragmatic breathing. I tell people to lie down in a quiet area, one hand on your chest and one hand on your belly. Take some slow deep breaths. If you have trouble doing that, a lot of people do. Try to count when you’re inhaling. I say count to four. Hold it for a couple of seconds. On your exhale, try to exhale to a count of eight. You want the exhale to be longer than the inhale. You want to feel that your belly is rising when you’re breathing as well.

A lot of people will only breathe with their upper respiratory area. That’s chest and shoulder breathing. You want that belly breathing because if that’s not happening, your diaphragm’s not moving, and your pelvic floor is not doing anything. I always tell people to start there. That is important to learn whether you’re hypertonic or hypotonic.

PTBE 6 | Pelvic Floor Health
Pelvic Floor Health: It really is important to learn whether you’re hypertonic or hypotonic.

Some things that are great for a hypertonic pelvic floor are the child’s pose. Child’s pose with deep breathing and a happy baby pose. These are common yoga poses that are pretty safe for everyone and are good hip openers. That helps us to learn to relax the pelvic floor. They also get you in tune with your body if you stop and spend the time to listen to your body. Many people I found have no idea what’s going on at their pelvic floor, their belly, and their butt.

You said, you’re sitting there and you’re not contracting your glutes, but many people sit all day at work and are contracting their abdominals and their glutes like nobody’s business. That can lead to a lot of problems down the road with your pelvic floor and with hip pain too. Start to connect with your body and pay attention.

I do tell people, especially those who are working at a computer for most of the day, “Try to check in with yourself. See what your body’s doing and what position you’re sitting in. Put a little sticky note on your computer. Between calls or Zoom meetings, stop and do a couple of deep breaths and check-in, ‘Are my legs crossed? Are my glutes tensing up? Are my abdominals tensing up?’ Check in with yourself.” Also, a nice time is at a red light because we’re in a busy city and driving can be a little stressful at times. People are trying to get places. Stop at the red light, take a couple of deep breaths, and check-in. Are you clenching? Are you clenching your teeth?

If you’re a teeth clencher or you have shoulder pain, I’m guessing you’re going to have a hypertonic pelvic floor because they go hand in hand. We carry a lot of stress in our pelvic floor. That’s another place. You think of tension and headaches. You think of TMJ, a lot of times, you’re tensing up the pelvic floor as well.

I had heard that the diaphragm and the pelvic floor move together. Is that what you’re leaning when you’re saying that diaphragmatic breathing that takes from the dome shape? When you inhale, it makes it flatten. That also is the same thing I heard with the pelvic floor. It extends it a little bit and you slowly let that eight count out. That’s wonderful that you could maybe even try connecting with your pelvic floor that way if you’re going to lie down and do that diaphragmatic breathing.

I love that you say you teach that to everyone and the massage. When I meet someone for the first time for a Thai massage, I always look to see how they’re breathing. As you said, 99% of people don’t know how to belly breathe. The ones that do are usually people who play a wind instrument, scuba divers, or something like that, where you are used to learning how to take these long breaths. The rest of us, we’re breathing from that top part of our body, that shallow breathing. I made a lot of people and myself included hand up for sure the clenching of the jaw and the tight shoulder.

That means I’m in that hypertonic category. The child’s pose to reiterate and the happy baby. You could google happy baby pose. It’s so great because that’s something I do for all my Thai massage clients. I’m like, “We’re putting you in happy baby. That means it looks like I’m going to change your diapers,” but it’s amazing that when someone does that stretch for you. You could relax. It’s amazing. They all go, “Wow. I got loose in my lower back or I feel that tightness in my hips.” They don’t usually say pelvic floor, but they’re like, “I’m tight down there.” That’s something someone can do every day, right, Mandy?

It’s great to do it at night before you go to bed because doing those poses with deep breathing calms down your nervous system as well. For those who wake up with hip pain or back pain in the morning, it’s good to start with those but gently. Don’t force anything, but if you have time. I have three kids so morning gets a little hectic.

If you have the time and you can take five minutes to yourself to do a little bit of belly breathing, child’s pose, happy baby, and cat-cow, it’s a nice set. It’s a nice way to start the day and starting to get in tune with your body. I tell people, especially with so many people working from home still, “If you get a break between calls, get down on your office floor. Hop up on your bed and do some of the structures during the day because we get into work mode and we’re not paying attention to what our bodies are doing.”

It’s so important to take those little move breaks or you could call them movement snacks during the day. You’re going to get more out of doing a little bit throughout the day than putting in a big 20 or 30-minute exercise routine for this. I try to make all of my home exercise programs manageable for people because I know being a busy mom, busy working mom. It doesn’t matter a mom or not a mom. We’re all busy. The more we can fit it into our daily routine, the better. The more we can start to tune into our bodies.

Even I notice I’ll be in the car and I’m trying to get somebody to practice and there’s traffic. I notice I’m tense and holding my breath. I’ll stop and say, “This doesn’t matter. Take a few deep breaths and relax your body. It’s not worth it in the long run.” It’s so important. I am doing so much teaching, especially in the beginning, trying to get women to recognize what’s going on in their body and what their body feels like because we ignore ourselves.

We’re so disconnected. I can’t tell you how many women, maybe there are men out there but I listened in the last several years to women, either for nutrition or for this. They’ll be like, “I’m a teacher. I’ve learned to hold my pee. I don’t go to the bathroom for ten hours a day because who has time? I’m a nurse or I’m a busy mom and I don’t have time to go the bathroom.” How can that be helpful for our pelvic floor and for our bladders?

Teachers and healthcare workers are the worst offenders, “I barely could drink. I barely had time to drink if I was working in the hospital or in a busy clinic and then to go to the bathroom. There’s no time for that.” Summers get very busy. All the teachers come in. We get very disconnected from ourselves or we have children. There’s never a moment to yourself with little children. “I’m just going to hold it.” It is trying to take that time for yourself again. Pay attention to yourself and to your body. I tell people it’s a restroom. Go in there and rest because things are not going to work properly if you’re not resting in the restroom and you’re trying to speed through that process.

I love the starting point for this. It’s like connecting with your body, relaxing, and doing some child’s pose. Whenever I’m at yoga class and we go into child’s pose, then the instructor will say, “Now we’re going to do this.” I’m like, “Let me stay on child support forever.” I have to adjust that a little bit. I’ve got a big belly so I have to open my knees even wider to let my belly but I do it. It feels so good. If you need to adjust it from what the pictures you see on the internet, you adjust it. That’s the perfect thing.

My question is then, being in the UK, accessing things is a little bit different. I’m fortunate that all of these services are free and available to me. Sometimes. you have to fight tooth and nail to get them and wait for a long time to get them. If I’m going to make generalizations that are backed up by years of experience, specifically, women’s health services are very difficult to access. Male doctors don’t care if you pee yourself. They don’t care about that stuff.

In the US, not everybody has health insurance. Not everybody can access all these services. At what point do I go to my doctor and say, “This is a concern and I am fighting for myself? I am advocating for myself. I need you to refer me.” Are there other things that a woman should just never ignore? Is that an okay question to ask?

You shouldn’t ignore any of it. If there is a tiny bit of leakage, you had a baby, and you want to go jump on that trampoline with your kiddo, you should not be leaking. If you are having pain putting a tampon in or with intercourse, that is not okay. It’s not normal. We do not need to put up with that. It’s never okay. You need help at that point. Don’t put up with it.

We try to get women to recognize what's going on in their body and what their body feels like because we ignore ourselves. Click To Tweet

Sometimes you have to fight for services in the US, too, unfortunately, and I could go on a big tangent about services for older adults even, but for women too, for young women for moms, that is not okay. It is not okay if you’re twenty and having intercourse for the first time for it to be painful. It’s not okay if you’re 70 and having intercourse and it’s painful. None of that is okay. You should have help for that, whether that’s going to your doctor and fighting to see, as you call it in the UK, a physiotherapist.

Fight. It’s you, your body, and your health. It is all tied in together. If we don’t want to have intercourse with our partner because it’s painful and/or we’re leaking. That’s pretty embarrassing too. We don’t feel good about ourselves and we’re only 35. How are we going to feel good about ourselves when we’re 55 or 65? It is so important no matter what age you are and where you’re at. We all deserve that.

The beautiful thing about the internet now and social media is that there is a lot of information out there. Watch where you’re getting your information from because there’s not always great information. I don’t have a big social media presence. I’m not good at that but there are some wonderful pelvic floor physical therapists out there that have a lot of great information. On Instagram alone, you can find.

Sometimes that’s a great starting point. I’m always open to a call or an email. I love to educate and give women the power to advocate for themselves. In your situation, say you’re pregnant and this is my second pregnancy. I had a rough time after my first pregnancy and you’re in the UK. I would start talking to my doctor. I would say, “Can I get some physical therapy now while I’m pregnant because X, Y, and Z happened after my last delivery? That was tough to recover from so can I see someone now for a couple of visits?”

Start to push for it then and then after you have the baby, “This is happening again. This is not normal. I want to see a physical therapist.” Don’t settle and don’t think, “I need to put up with this pain and/or I need to put up with peeing on myself every time I sneeze.” because that’s not okay. It’s common but it’s not normal. It can be changed. It’s so important to be an advocate for yourself, your friends, your mothers or daughters.

Mandy, you were talking about there are some ways that women can find on social media, perhaps some physical therapists and some information. I like following Dr. Janelle Howell. She was interviewed on another show and that’s how I found her. She has very interesting workshops every first Sunday of the month that you can pay for. I bought one for my daughter. You can get the replay which is getting ready for baby, getting your pelvic floor ready for birth when you’re pregnant and I thought, “That’s a perfect gift. I’m going to get her that,” for $35. That’s a good one. If you give us some that you would suggest so that we can have some resources for our readers.

The one you mentioned, she’s wonderful. She has a lot of good content out there for pregnancy, after pregnancy, health, and women’s health with the pelvic floor. She’s a great resource. Another one I love, her tagline is, “The Vagina Whisperer.” She’s out of New Orleans. She’s Dr. Sara Reardon. She has great stuff. She has a lot on Instagram and on her website as well.

She also has some classes that she has pre-reported. I believe they’re reasonable. There is a lot of good information. I would look for a pelvic floor physical therapist. There are a lot of great trainers out there and health coaches. To be on the safer side, especially with the pregnancy and postpartum, I would head toward a pelvic floor physical therapist as well. That’s the big one that’s popping up in my head, but I can send a couple of others. For menopause, a great doctor to follow is Mary Claire Haver. She’s out of Texas. She has lots of information. She’s an OB/GYN, but she is focused on menopause. She has a lot of great information as well.

In Chicago, I followed Dr. Lauren Streicher. That’s how I found like half of the great people that I follow. I’m like, “She interviewed her. That was very interesting.” It’s a journey so we’re probably going to wrap up a little bit here.

We could talk about this for about three hours.

I was like, “I don’t know how much you want to cover or what you want to focus on,” because I can go on.

It would be great to have some of our readers. We could end up having a Zoom where it’s a Q&A. It could even be something that they pay for or we could set something up. I’ve seen that done where you have a smaller group. It’s some women who can ask some questions because as Rachel said, we’re waiting to get in to see doctors. What can we do now? There might be some ways you’ve already helped us a lot. I love that you’re suggesting throughout the day to do the diaphragmatic breathing and to do those breaks in between the Zoom calls and in the morning with the stretching.

Can someone find a pelvic floor specialist? I know for the North American Menopause Society, NAMS, a woman who is in menopause can find through their directory some doctors that are in their area. Is there something that is helpful for a woman? That’s for the US. I don’t know for Rachel with the UK, how it works to find a specialist.

In the US, we have the American Physical Therapy Association, the APTA. If you go there, you can find the section on women’s health. There is a directory. You can put it in your state and you can find a pelvic floor physical therapist. Not every public floor physical therapist is on that site. Sometimes, you’re googling within your region. It is hard to find them in more rural locations and smaller cities, but I started doing this several years ago and there were not many of us.

Far and few between.

I’m hearing it is still hard to find one. It is hard to get in. There are waitlists a lot of times, even locally, at the clinics that I know of. I would do a Google search. You want to make sure when you’re looking for a physical therapist, too, that you are getting one-on-one time with the pelvic floor physical therapist. It is done in a private room and a private setting. You want to make sure that you’re going to get a full 45 minutes to 55 minutes with that provider because sometimes in a physical therapy clinic, it’s done in an outpatient setting and a big room. More for orthopedic issues or neurologic issues.

PTBE 6 | Pelvic Floor Health
Pelvic Floor Health: You want to make sure when you’re looking for the physical therapist too that you are getting one-on-one time with the pelvic floor physical therapist.

You want to make sure with your pelvic floor physical therapist that you are getting that one-on-one time in a private room with them. It’s okay to interview them as well because, like anything, we’re all different. We all have a different vibe. It’s something that’s pretty intimate sometimes with the exam. You want to feel comfortable with that person, so I say, “Don’t feel bad about calling the clinic or that provider up and asking to have a ten-minute chat with them and having some questions ready for them. See if you think you’re going to get along with them.”

You want to be able to feel comfortable with them and be able to work with them. This is something that’s already uncomfortable for a lot of women to talk about, so you don’t want to be uncomfortable. You want to feel good about who you’re seeing and feel like you can talk to them openly about things. Rachel, in the UK, I’m so sorry. I’m going to have to investigate for you.

I’ve had an investigation. There is an NHS service called the Pelvic Health Physiotherapy Service, which does stress incontinence. It’s all these things that we’ve talked about. They also have specific doctors for postnatal physiotherapy as it relates to pelvic health, bowel problems, and pelvic pain. They do cover it all. There are lots of private clinics. I googled around my area, and there were a lot of private practices that offered the same thing.

It looks like we are training, talking about it, and doing a lot more. It’s the case of advocating for yourself, going out, and getting it. Often, the first hurdle is not even going to the doctor. The first hurdle is believing in yourself enough to seek help. Let’s say I’ve connected with my body. This is not right, and I know it can be better, and I deserve the fuss that it will take to make it better. I love that when I asked what we shouldn’t put up with. You said, “Don’t put up with anything. You deserve to feel good. You don’t need to have these problems.”

If anybody reading is going, “Maybe I don’t need to put up with this or that.” You can go and advocate for yourself. Advocating for yourself is tough because it can be. Get a sister, a friend, your mom, or your partner. Get somebody to come and be on your team who’s going to help you advocate. I love that. Thank you so much.

The squeaky wheel gets the oil. I have become more squeaky as I’ve gotten older. I tell my daughter, “Learn from my mistakes. Be a squeaky wheel. It’s okay.” Rachel, if you want some help giving you a little push or you need an advocate buddy, I’m here for you.

Thank you, Mandy. It’s been a pleasure to have you with us. It’s so good. Clare, you have to tell us your story another time because we’re out of time. The readers want to tune back in, and I’ll make her tell the story next episode because it’s fun.

I want to hear it, too.

What a teaser. I love that, Rachel. You must be good in the bedroom with the teasing there.

Subtlety is not my forte.

Thank you so much, Mandy. It was a pleasure. We’ll see what other collaborations we can we can maybe put together for our readers. I learned something, and I’m going to do more of the child’s pose, the happy baby, and some diaphragmatic breathing. That sounds good.

Thank you so much. This has been so much fun. I enjoyed talking to you and spreading the word on pelvic health.

Thank you, dear readers, for hanging in. If you have any questions, you can send us any questions to EnchantingPodcast@Gmail.com, or you can send a private message to us on our Instagram, which is @Permission_Podcast.

Do get in touch. We would love to hear your questions. If you have questions specifically about your pelvic floor health, potentially, we can have Mandy back. We can host a Q&A with her. If you have some questions you would like her to answer, send them along, and we’ll see what we can do to get them answered. Thank you.

Thank you, and we’ll see you on the next episode. Thank you, Mandy. I love you, Rachel.

I love you, Clare.

Thanks, ladies.

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About Amanda Rafferty

PTBE 6 | Pelvic Floor HealthAmanda Rafferty is a seasoned physical therapist who specializes in women’s health physical therapy, with a focus on pelvic floor physical therapy. Her passion is addressing musculoskeletal movement disorders with relation to pelvic floor dysfunction. In her more than 20 years as a physical therapist, she has also worked extensively in orthopedic physical therapy. Her goal is always to educate and empower her patients to take control of their diagnosis so they feel prepared to manage their symptoms when they complete physical therapy.

Mandy received a Bachelor of Biomedical Sciences from Marquette University. She completed her Masters and Doctorate of Physical Therapy from Washington University in St. Louis, Missouri. She has taught continuing education courses to physical therapists on movement disorders and lectured to runners at Chicago Area Runners Association (CARA) meetings regarding injury prevention. She is a member of the American Physical Therapy Association (APTA), International Pelvic Pain Society, and Chicagoland Pelvic Floor Research.

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