281 - Mary Alice Vetter

Mary Alice: [00:00:00] I just think they probably have been told over time and time again that that's normal maybe to some when they've brought it up in the past, and maybe that's where maybe a little fear is coming with too, is 'cause they've brought, maybe they've tried in the past and they were just like, "It's normal. It's age.

You're getting o- you know, you had a, you had a kid." I mean, your usual. I, I call them the usuals because patients get told that a lot unfortunately.

Elizabeth: Welcome to the Done with Dieting Total Health for Women over 40 podcast, the podcast for women who are done with the start over cycle and ready for a way of taking care of themselves that actually works.

Hey there. Welcome back to the podcast. I am your host, Elizabeth Sherman, and I am really glad that you are here today. So, I wanna start out with a quick question. When was the last time someone asked you how your pelvic floor was doing? Right, never. And yet, if you are a woman over 40, there is a very good [00:01:00] chance that your pelvic floor has something to say.

Today, I am talking with Dr. Mary Alice Vetter. She is a doctor of physical therapy who specializes in pelvic floor care, and she also runs Cornerstone Pelvic Health, a virtual coaching practice where she works with women on everything, from incontinence to prolapse, to the pelvic floor changes that come with perimenopause and menopause.

So she came to me through a client of mine who had surgery for a prolapsed bladder and felt, well, to her- used her words, a lot of shame about it. Working with Mary Alice changed all that. And so when she offered to come on the show, I said yes immediately. Pelvic floor is one of those topics that we hear about but we are still really quiet about, even when we talk to our doctors.

And that silence can cost us because most of [00:02:00] what women experience in this area is not something that you just have to live with. It's actually treatable, often without surgery, often starting with things that you can do right now in your own home. Here's what you're going to walk away with from today's conversation.

First, you will know how to actually recognize pelvic floor dysfunction, what it looks like, what it feels like, including symptoms that you're probably brushing off as something else entirely. Second, you'll understand what prolapse is, the different types, and how to know when something warrants a conversation with a specialist versus when a conservative approach can do a lot of work.

And then third, you'll hear something that I think is genuinely important, that pelvic floor health is directly connected to what's happening with your hormones in midlife and [00:03:00] why. So Mary Alice is one of those people who doesn't make you feel like you should already have known this already, and like it's totally okay that you don't.

So she's clear, she's warm, and she doesn't make any of this feel like it's something to be embarrassed about. And I think that that tone really matters in this conversation with women our age. So let's get started

Elizabeth: okay. So Mary Alice, welcome to the show. Tell us, who are you? What do you do? Who do you help? And let's get into it.

Mary Alice: Well, thank you for having me. I'm honored to be here. My name is Mary Alice.

I am a pelvic floor physical therapist. I have my doctorate in physical therapy, and I generally help all populations, all people, but I do specialize in pelvic floor care, including anything from [00:04:00] pregnancy, postpartum, menopause, incontinence, really the whole realm of pelvic floor

Elizabeth: health. Okay. So you mentioned that you deal with...

Y- you- you've, uh, dealt with your own pelvic floor issues. How much of that personal experience has shaped what you do professionally, and how did it change how you talk to your patients about it?

Mary Alice: Yeah. So, I didn't initially think anything of pelvic floor PT when I first started my practice. In school they go over it, but nothing like...

they mention it. They- they don't go over it in detail or anything. And so I didn't really have a drive to even go down that avenue of special- uh, specialization. And I, truly shortly after PT school, actually studying for boards, very stressful time in life, and I started to have some pelvic floor symptoms, and I didn't really think much of it at the [00:05:00] time.

I was just focused on one thing, and that was studying for boards. So I didn't really think much of that. But afterwards and when I really got out and started treating patients, I didn't really end up coming back to it until I saw it in practice more. Mm. I would have a patient that would come in with low back pain or this hip tightness that their imaging was fine, MRIs were fi- they couldn't really figure it out and they just kind of gave a broad diagnosis of, hip bursitis.

Mm. And we started treating, and I'm asking some questions. We're not making too much progress, and then I start asking other questions and, we trace it back to the pelvic floor. And I started seeing that more and more, and then I just started asking pelvic floor questions right off the bat, and it was more prevalent than I thought it was.

It did take me asking patients really to get them discussing about it, but I found it was way more common, in the clinic [00:06:00] than, you know- What patients' diagnosis these were, w- to come, like why they were coming in to see me. So I really started getting interested in my own pelvic floor issues and I'm like, "Oh, I, mm, I have some of these things."

And I started basically treating myself and wanting to treat myself and helping my patients more. And really, I started to go down the specialty avenue doing that because I feel like I need to serve my patients, so I wanna be educated to do that. So I started going down the specialty road a little bit more.

Elizabeth: Yeah. So I realized after I asked you the question- Mm-hmm ... that we haven't really defined what pelvic floor is, and I think that for many women- Mm-hmm ... we hear the term. Mm-hmm. What... And maybe for a lot of women my age- Mm-hmm ... like in their mid-50s, we've heard the term- Mm-hmm ... but we don't really know exactly what it means [00:07:00] or- Mm-hmm

what it's all about. Could you- Yeah ... could we back up a little bit and talk about that?

Mary Alice: Yeah, absolutely. So pelvic floor is the muscles, our abdominal area muscles, our reproductive organ muscles, the ligaments. That whole area we consider pelvic floor. That includes, again, reproductive organs our abdom- some abdominal tissue.

Mm-hmm. That really includes that whole entire area. Mm-hmm. It has different functions for us that are, not just reproduction, but you know, stability really. So that's generally what we consider pelvic floor. Mm-hmm. Now, s- diagnoses associated with that would be like urine incontinence urgency, frequent urina- frequent urgency, frequent urination, um, bowel/bladder leakage.

That includes prolapse, pregnancy and any [00:08:00] of those symptoms that you might see postpartum or into men- menopause as well. But yeah, that is what we consider pelvic floor. Now, pelvic floor in and of itself can refer to different areas of the body as well. So- Mm ... I made the example of, someone with hip bursitis came through the door, and we're assessing and we fit some of that hip bursitis, categories, but not quite.

And we're not, we're getting some progress, but not a ton. So then we kind of step back and reassess, and then we go down a different avenue. So pelvic floor can refer pain to the hip, the low back the knees. Our pelvic floor is greatly associated with jaw, our upper back, and our feet even. So- Really?

there's a lot of referral patterns. There's a lot of- Fascial visceral connections to our pelvic floor.

Elizabeth: It's very- Okay ... And so do men have a pe- pelvic floor? [00:09:00]

Mary Alice: Absolutely. We all ha- yes, everyone has a pelvic floor. Mm-hmm. Okay. But we don't hear about it in men. Very true. Very true, we really don't. As infrequent, I would say, that it seems like women want to come forward and come to pelvic floor PT, I would say it's incredibly less frequent with men, with male pelvic floor.

Elizabeth: Mm-hmm. Is that just because of education and knowledge, or is it just because men typically don't use, like, their insurance and they typically don't- Mm ... I don't want to say that they don't care about their health. Th- Obviously they do, but- But yeah,

Mary Alice: I would say more it's definitely a combination of both.

I would say more often than not, they don't see that as an issue or a problem. Got it. I- I feel like more commonly I will see like prostate issues- Yeah ... in males when, we work, do all external stuff, but we... I would, I would say that's probably what I see most often due to them being referred [00:10:00] by the, a urologist or something like that.

They're never like coming in direct access, meaning that they called PT and said, "Hey, I'm having some issues. I'd like to be seen by a physical therapist." Yeah. Yeah ... that's more, that's more the women that will, that will do that.

Elizabeth: Mm-hmm. Okay. Okay. Thank you for clearing that up. Yeah. Yeah. Thanks. So, you mentioned that you actually thought pelvic floor work was not for you when you were in school.

Yeah. So what changed your mind, and what was it like to realize that you were working through your own issues within that same time?

Mary Alice: Yeah. I have a problem, I would say, in the clinic of, you see patients in the clinic and, you form a lot of connections with your patients 'cause I don't know if you've ever been to physical therapy, but it's...

You see your physical therapist for a while, especially if you're post-op or, chronic pain, and, so you're seeing your physical therapist often. Mm-hmm. And I joke that I would see my patients more than I saw my husband [00:11:00] sometimes, 'cause I, I see him all the time, and- Uh-huh

we're, working. But I would find myself, coming home and like... or, on my drive home, at the time I had a long drive, and I would just be thinking about my patients and thinking about like, "Oh, man, why didn't that... why aren't they getting better?" And, kind of going over their like past medical history, like, "Oh, am I missing something?"

Mm-hmm. And kind of back to what I said earlier, I just felt like there was like a missing piece that I wasn't educated on, that I was like, "Okay, I'm seeing this as a common-" issue in the clinic. Um, oh, I have incontinence or oh, man, I- I'm getting up four times in the middle of the night to go to the bathroom.

I'm, I'm hearing the same thing, similar symptoms. I feel really heavy down there, and I'm hearing this, and I felt like I had no mode of treatment. I did, but not, like, well enough where I felt confident in what I was... in, in my treatment. So I [00:12:00] wanted to, again, fill the, fill the void and, serve my patients better and serve the community better.

So I was like, "Okay, I'm gonna, I'm gonna go down this avenue a little bit more." And again, I kinda knew I had my own pelvic floor issues once I started to, like, really get into that nitty-gritty. I'm like, "Oh, well I have that. Oh, well this makes sense for me." Mm-hmm. Um, yeah, yeah.

Elizabeth: That's- And so, like, you're actually...

You're very young, um, and yet you were experiencing pelvic floor also. So this is not related specifically to midlife perimenopause menopause.

Mary Alice: Correct. Correct. Um, I think that is a common misconception. I think the thing I hear the most is, "Oh, well, I've never had kids, so I don't, I don't have any... I wouldn't be a candidate for pelvic floor."

Mm-hmm. And, um, common myth I would say, not, I've... Not everyone that's had kids, does have pelvic floor issues. Not everyone that does, does. Mm-hmm. I've had plenty of patients that have come in for the clinic, and they've never had children, and they've had... they're having pelvic floor issues.

So it's definitely not, just because you had kids, um, or just because you had a C-section [00:13:00] doesn't mean you don't need pelvic floor therapy afterwards. That doesn't, like, negate the fact that you grew a child inside you. The pelvic floor is still doing stuff. Um- Mm-hmm ... but yeah, any age range.

Um, actually, we do have pediatric pelvic floor as well. That is a specialty prac- I do not do pediatrics, but that is a specialty practice as well. Um, babies that are having a hard time with their, poopin', they can't go poop, or they're having... They're really gassy, and they're holding onto it, and they're just crying 'cause they don't know what to do, mm-hmm. Yeah. So there's a lot of different, um... really any age range and male or female. Mm-hmm. So

Elizabeth: we talked, um, a few weeks ago, and one of the things that we were talking about was how we talk about these issues as we... Well, I guess the, the statement is how you notice that women of different age ranges talk about pelvic floor when they come [00:14:00] in.

Mm-hmm. How willing they're able to talk about it, how willing they're able to admit that there's a problem. Mm-hmm.

Mary Alice: And

Elizabeth: so let's talk about that a little bit first.

Mary Alice: Yeah, absolutely. I would say- When it comes to who's willing to have the discussion, I, I would say most women are willing, if we're talking about women specifically, most women are very willing to have the discussion.

Mm-hmm. It's more of am I driving conversation or are they? So if I'm getting somebody that comes in, let's just again use my hip bursitis patient, um, I might put the, the thought into her head like, oh, oh, is this a... like, is this an issue? Like, I didn't... oh, I didn't realize this was not normal, or I didn't realize this could be part of what I'm experiencing- Mm-hmm

in regards to her hip pain. Like, so I, kind of being the dot connector a little bit for patients. Um, so sometimes I'm actually starting that conversation with them. Uh, not always, but I, I'm... will definitely always bring it up and say, "Hey, this could be related. [00:15:00] Let's do some stuff for this too."

But, um, and I would say most of the time my younger, I would say maybe 45 and under, are- Mm-hmm ... more proactive about it. Like, they're the ones calling and saying, "Hey, uh, can I see a pelvic floor PT for," whatever. Um, and I don't know if that's... I wanna say a part of that might be social media driven because- Mm

just, uh, being in the world of it, I do think social media is helpful for getting information out there. And, once you see one thing, of course our algorithm. So I do think that's helpful for that younger, I feel like the younger generation. I feel like that might be why they're a little more proactive about it because you'll see everywhere, see a pelvic floor PT, take care of your pelvic floor.

And, um, so I definitely think that has something to do with it. Yeah. And on the same breath though, I do think there's a maybe a little bit of fear of the unknown when it comes to pelvic floor a little bit. Um- Okay ... because I was thinking about that [00:16:00] question when we talked about it last, 'cause we talked about, like, there's maybe some embarrassment or maybe some shame even involved in that, um, because it is such a taboo topic.

And I was really thinking about it. I'm like, honestly, I think there might be a little fear too with some people because it is a sensitive area, and maybe they don't wanna know what might be happening down there. Maybe they don't wanna know. Maybe they know something's wrong or don't wanna get help for it 'cause they, they fear the worst or, I don't know.

But, um, I think that could be a part of it too, and I do think sometimes social media can kind of do a little... we kind of fear base a little bit too in the sense of like, oh, you, you have, you have to go get this done, or you have to go get hel- or, and I think sometimes we make it sound a little fearful, um, which isn't helpful sometimes.

I definitely think that. Uh, I mean, even just like, even just you saying that, I had just had a patient the other day, I mean, a- again, it was... She got referred to from, to physical therapy a- and, um, from her OB. And so, [00:17:00] she knew what she was coming for. I... she had no idea really anything about it, which is fine.

That's what I'm there for, to fill in the blanks. But, um, I think, she wou- you know, she'd start hushing her, hushing her words, and it was just me and her in an empty, in a, in the room. It was... It's just, um, and I, I wanted people to feel relaxed, but it, I think there is a little, like, embarrassment even just talking, one-on-one with somebody about it.

And you can tell with body language and conversation, they'll hu- they kind of hush their voice a little bit or, they... I get very specific sometimes in my questioning and I say, "This might be, you don't have to answer, but..." And then, I get specific in my questioning 'cause it helps drive treatment and assessment for me.

So I think that, I can kind of tell sometimes when it's like, "Oh, oh, we're asking about that?" And then it's funny too to even see the light bulb go on a little bit, like, "Oh, yeah. Oh, I did ex- oh, you know about this?" Or, "Oh, that is a symptom 'cause I have that," so it's, it, it is one of those things that I think pe- the women are very [00:18:00] open to this conversation.

I just think they probably have been told over time and time again that that's normal maybe to some when they've brought it up in the past, and maybe that's where maybe a little fear is coming with too, is 'cause they've brought, maybe they've tried in the past and they were just like, "It's normal. It's age.

You're getting o- you know, you had a, you had a kid." I mean, your usual. I, I call them the usuals because patients get told that a lot unfortunately.

Elizabeth: So I'm wondering if... Like, you were talking about the hushed voices when talking about this issue, and I'm wondering how much of that is generational and women not feeling comfortable talking about their body and their body functions and all of that stuff.

Mary Alice: Yeah. Yeah, I definitely think that plays a part, and the way I can relate to that in my practice would be even just, like, even just with, like, with when we [00:19:00] start doing physical therapy, I mean, it's a physical, physical work, right? We're doing physical work, right? We're doing PT, so it's physical therapy. But, um, and when people come in, I sometimes think they don't quite grasp what that might entail, so sometimes when I am working with my older m- uh, women population, we start doing stuff and, or they'll... I'll get a comment that they'll say, "Oh, I've never been the one to... I don't, like, lift or work out," or, "I've never ex- I don't, like, really exercise," it just wasn't, it wasn't expressed, I guess that... Or, hmm, bad words there. it was never a thing for women. Men, men work out and did s- and did sports and, that was not s- as common, I guess.

But, so we'll start working out, and we'll start doing stuff, and they'll say they don't, they just don't know what that, any of that entails. So then I'm the first one introducing some stuff like this to them, and educating on just- moving their body and loading their body properly and what good it can do for, for [00:20:00] us in so many different ways.

Pelvic floor, osteoporosis, so many good things for movement. Mm-hmm. And it is kind of interesting, I would say. Like, I love my f- one of my favorite things is we'll be doing, like I'll say, "Okay, hey, we're gonna lift that. We're gonna lift that," and they'll be like, "What are you talking about? I'm not, I'm not lifting.

I'm not, I've never lifted more than..." And then we're doing an exercise and, all of a sudden I have them. I'm like, "Okay, now just, like, I want you to do the same movement. I just want you to, like, hold this. Just, casually. Can you just hold this?" And then we're doing it. I'm like, "Look at you, you're lifting."

It's just, they're like, "Oh my gosh, you're right," the- Yeah ... the realization that they're stronger than they think they are, or they can do things that they think that they can't, and that's like, I love that part. Yeah.

Elizabeth: That's one of my favorites. Well, meanwhile, they're carrying around a purse that's like 35 pounds.

Right ... exactly.

Mary Alice: Oh, totally, yeah. Making it relatable, I'll say, "This is... A gallon of milk is about eight pound, a little, little less than eight pound. Let's carry our [00:21:00] gallon of milk or let's carry our laundry basket." Right. So yeah. Carry a baby. Right. Yeah, yeah. So making it, making it relatable- A toddler

is always good. I'm like, "This is about what this would weigh,"

Elizabeth: exactly. Yeah. Yeah. Yeah. Love that. Yeah. Okay. So the way that Mary Alice and I met was through a client of mine who had prolapse. Mm-hmm. So let's talk a little bit about prolapse, because my client really felt a lot of shame around her prolapse- Mm-hmm

and did not hear a lot about it on social media, knowing what it is. And- Mm ... so, um, anyway, let's talk about what prolapse is and- Mm-hmm ... how, like, what are some of the symptoms? And- Yeah ... yeah, let's move into that.

Mary Alice: Yeah, yeah. So prolapse is where basically some pelvic and/or abdominal organs will start [00:22:00] to kind of descend through the vaginal wall, through the vaginal canal.

So it can be very shameful and scary because, you have some organs kind of falling out of places that we never thought that that was a... that could happen. Mm-hmm. So it is definitely, I would say, even more taboo than just, oh, I, I have a hard time holding, holding my urine in when I'm trying to get to the bathroom, and I have leakage.

It's, it's... I am... So there are th- uh, probably like three main types that I see. Um, one would be uterine prolapse- So the uterus is falling down. Mm-hmm. The bladder prolapse, same thing, or and then bowel prolapse. Those are probably, like, the main ones that I see. Okay. Um, the d- different symptoms associated with bladder prolapse, a lot of times ladies will say, "I'm [00:23:00] having to go a lot.

I'm having to go to the restroom quite a bit," like, more than usual. Um, or they're having, like, really sudden, all of a sudden urge. Sometimes they don't always make it to the bathroom, um, in time and they're having a little leakage. Um, but the increased frequency is a big one for that, um, during the day and at night.

Elizabeth: Okay.

Mary Alice: Bowel, uh, bowel prolapse, um, a big one associated with that is, being, having constipation. Hmm. But, but bowel prolapse, a lot of times, like, we feel a lot of straining. We have a real, we have a hard time having a bowel movement. Sometimes we're even having to help have a bowel movement, maybe using- Mm-hmm

a hand to help. Um, or we feel like we have to get in a different position in order to, for that to happen. Um, that's a lot of, I would say, like, movements associated or, uh, symptoms associated with bowel prolapse. And then uterine prolapse, um, I would say very similar to, similar to bladder prolapse, a lot of them, they, you al- most of the [00:24:00] time have some feeling of, like, pressure, increased pressure down there, or heaviness feeling.

Um, a lot of times it does radiate to the hips, like feel a lot of just, like, hips always feel stiff. Um, that's a big one. Um, maybe some low back pain or stiffness as well, um, when you get some of those symptoms, especially if it's kind of a bad stage of prolapse. The stages of prolapse, go into that. Stages of prolapse, um, uh, the first degree or grade one, very common.

It's just we have a little bit of a descent into the vaginal, um, opening. Um, very common though. Most of the time, most of the time I would say symptoms are pretty mild. Might still have symptoms even though it's a grade one, but symptoms are generally pretty mild. Grade two is where p- take your pick on the organ that's descending, but, um, the organ is about one centimeter either above the vaginal [00:25:00] opening or one centimeter has crossed the vaginal opening.

Okay. And then grade three is we have over one centimeter of distension, and then a grade four is that majority of the organ is outside of the vagina.

Elizabeth: So- It's outside? Mm-hmm. Mm-hmm. Wow. Mm-hmm. Okay Yeah And so all of this has to do with muscle structure inside the body that we don't even, like, lift weights for, right?

Mary Alice: Yeah, so, um, one huge, huge, huge component of our reproductive organ's job, our pelvic floor's job I should say, yes, reproduction, childbirth, and, to be able to create life, but is to... is stability. A big, big component of our pelvic floor is stability. A lot of our base of support, we always talk about core.

If my core is strong, I feel stable, but encompassing with that, our core and hips, but our [00:26:00] pelvic floor is right in the middle of both of those. Mm-hmm. So, and it's a muscle just like anything else, so we should treat it that way. Right? So, um, it's a combination of our muscles, our ligaments, really coordinating them together to basically help them do their job better.

Mm-hmm. And honestly, a lot of it is a coordination issue and pressure control issue, I would say, especially with prolapse. Um, definitely is just coordination. That's a lot of what we're working on, is working on coordination with the pelvic floor and the rest of the body, and talking to that pelvic floor for better coordination.

And then working on pressure control with everyday movements. Yeah, those are kind of the big, I would say, things that we look at when we're looking at treating prolapse in the clinic.

Elizabeth: Okay. And so how much of that can be fixed through going to the- Mm-hmm ... um, physical therapist? [00:27:00]

Mary Alice: Yeah. So, um, I would say generally a grade one and two we see really great results with.

Um, I would say the grade three getting into grade four can still see good results with. Um, that, like, grade four and beyond, it depends, I would say, in the sense of, like, how ma- how much results we're seeing in the sense of, like, symptom management. But there's a lot of other conservative treatments that can help coincide with PT to help with grade fours, or, three or fours I would really say.

So the... we have pessaries. People can get fit for pessaries, which is a device that you can, you can get fi- fitted for specifically, for- depending on the organ that you're wanting that is prolapsing, um, you can go to your OB, your gyne- your OBGYN. Sometimes PTs are certified, and they can do that as well, but it's just a devi- Pessary is the word?

Mm-hmm. It's called a pessary. Mm-hmm. And what is it? P-E-S-S-A-R-Y. It's... There's so many [00:28:00] different kinds and shapes honestly, but it basically its job is to, you insert into the vaginal canal, and, um, you position it in a certain position, and it basically kind of s- helps support what the pelvic floor isn't doing.

It's like an extra support. I al- almost think of it kind of like a brace for the pelvic floor. It's like that extra little idea of support, I guess, um- Okay ... for the pelvic floor. Mm-hmm. So they can... you can wear that, um, throughout the day. Y- you can wear it all the time. Generally, we teach people how to put it in, take it out.

Mm-hmm. Um, but that's another conservative way to help support prolapse. Um, there's, uh... I mean estrogen, HRT, there's other things that help with symptoms, I should say, of prolapse. Um, however, if we're not getting good symptom management and function, we're not getting function that the patient wants back, um, then sur- surgery might be a good option for, [00:29:00] for them.

Okay. Mm-hmm. I would say more often than not, the grade, the, the bad grade threes and then the grade fours are the ones more so looking into surgery if they're not getting any symptom relief or function back.

Elizabeth: So y- the, the symptoms that women will have that they might ignore, that you already said- Mm-hmm

just to reiterate then, like, if a woman's thinking, like, "How do I know if I have this?" It's, um, for the uterine, it would be just pressure around her hips and- Mm-hmm ... like, her just general, like-

Mary Alice: Yeah ...

Elizabeth: pelvic area?

Mary Alice: Yeah. So, um, you can have that pressure or heaviness feeling with really any type of prolapse, and- Okay

really a lot of times the- bowel and bladder and uterine prolapse, I mean, there- when we have a certain degree of prolapse even, [00:30:00] a lot of times the structures surrounding are trying to help. So that can sometimes be why we're feeling it when we feel a lot of hip tightness, we feel a lot of low back tightness, maybe even, maybe even abdominal tightness a little, or, just pain even.

'Cause when we're constantly tight trying to help the pelvic floor do its job- Mm-hmm ... when we're s- too tight we get, that can drive pain. Too loose can drive pain. But, um, a lot of times that can be cause for, for pain when it's really maybe the prolapse that's actually, like, what's, the problem.

Okay. Which is an- another way to word it too is, like, when a, a patient comes in for treatment I get asked a ton, like, "Oh, can I... this be reversed? Can this be- Mm ... fixed?" Right. And, um, I- we kind of change maybe verbiage there a little bit 'cause, um, grades one and two we might not see that functionally.

Like, functionally with doing stuff maybe we're not having prolapse while we're doing stuff. Maybe the pelvic [00:31:00] floor's doing its job functionally, we're just seeing that we have some prolapse when we're doing internal work and I ask them to bear down and it's like, oh yeah, no, we have some, we have some signs of prolapse.

Um, but the grade three, fours were not... 'Cause those are the during are the people that are like, "Well, but can this get better? Can this reverse?" Yeah. "Can it be a... go from a grade four to three or a grade-

Elizabeth: Mm-hmm.

Mary Alice: Not necessarily. Mm-hmm. Um, most of the time you might see better change in the actual position with the grades one or two.

Um, I would say less in positional change for grade three, four- Mm ... but we're there more to... or I, I guess educate more to help drive when it comes to, like, symptom management versus what, what the actual structure is doing. Um, it's less of a fix, more to help symptoms and function. So, um, I've had a grade one patient that was having severe heaviness, um, a lot of leakage issues, whereas a grade two, [00:32:00] considerably worse, right, than grade one, that, they were having mild symptoms if, if any.

So it, it... the stage doesn't always coincide with severity of symptoms. Interesting. Okay. That's a driving point, too.

Elizabeth: Yeah. Okay. Yeah. And so the woman who's listening right now and she's thinking, "I do Kegels," or, "I don't do Kegels- Mm-hmm ... should I be doing Kegels?" Mm-hmm. Like, what is helpful? What can she be doing right now if she thinks that- She's having some issues with her pelvic floor, and does it matter whether we're talking about prolapse or some other issues?

Mary Alice: Yeah. So the number one thing I think that no matter what kind of pelvic floor issue you're dealing with that I would generally prescribe for people is some form of deep diaphragm breathing. Um, that's generally the number one thing I will give to everybody- Mm-hmm ... whether they have prolapse or not, um, or some form of deep 360 [00:33:00] diaphragm breath.

Um, breath can help a lot with the pelvic floor, a ton with pressure control. So and a, and a lot of times if anyone carries stress, a lot of times we're breathing up here and not necessarily down here with our diaphragm, which is actually our main muscle of inhalation. So- Mm-hmm ... and we underutilize it, so then the re- you know, that affects pelvic floor a lot.

So- Mm-hmm ... breath work, um, body scanning, body relaxation stuff is awesome. I normally prescribe that day one for most, um, just because they don't pe- you know, we don't... We, we know we have to breathe, right? We know we should take time and breathe and take time for ourselves, but we don't, most... We don't do it.

We know we need to. So I generally do prescribe that because, I'm like, "This is homework. Like, we're, we gotta do this, like, you're

Elizabeth: gonna be breathing anyway. This is kind of home- Why not do it?

Mary Alice: Right. So we generally, I, I would say that is really, really helpful. Um, there's plenty of ways to do [00:34:00] that.

Um, but some form of deep breathing where you feel like you're breathing into the belly and into the ribs-

Elizabeth: Mm-hmm ...

Mary Alice: um, is what I would give everybody. Now, the Kegel conversation, um, love-hate relationship with that because as, um, as a muscle group, the pelvic floor generally works very passively. So there's really never a time functionally where we need to do a Kegel.

Okay. Um, the pelvic floor mainly works as a passive muscle, just like our deep core, our lumbar stabilizers do. When we go to lift something, those guys should be turning on, right? Whether we are sitting there thinking about it or not, they, they do, they turn on, and that's how the pelvic floor should be working too.

Um, even if we go to lift a pencil, we're, it's... Or lift, my cup of water or whatever, it should be turning on to a degree because the core, the lumbar stabilizers, our pelvic floor, it's gonna meet the demands that you're asking of [00:35:00] it most of the time. And most of the time that's in a passive way.

It's not us having to sit there and be like, "Okay, I need to Kegel before I do this or that." Now, that- is the case sometimes when we're talking about coordination and retraining. Um, we, Kegels are good. There, there are, there is a time and a place for them. I would say generally if you're sitting there doing like 100, 100 Kegels a day or, um, I think somebody was, "Do the, do your Kegels when you're at a stoplight," or, I...

That's a big one. Or I would say maybe stop doing that, um, especially if you feel like you're not getting any symptom relief. Um, but Kegels probably aren't gonna be the answer. Kegels can sometimes make symptoms worse, um, especially if you have something, some form of incontinence. But, um, yeah, Kegels can make things worse sometimes.

With prolapse, it's a little more helpful to do a Kegel, but it's more the coordination of Kegel and breath that's gonna be really helpful. I say all this to really say go see a pelvic floor PT because- Hmm ... they are, um, the [00:36:00] experts in this. Mm-hmm. They're the experts in the functionality part of everything.

You can go to your doc and OB and, they might talk to you about the structures themselves, and they might give estrogen, right, for, for menopause. And, when we are in menopause, our estrogen drops, tissue is thinning. We have, that, the tissue thinning, estrogen dropping, that can weaken muscles.

Um, it can, um, cause dryness down there. It causes a lot of different things. So they're gonna take care of that s- that part of it, right? They can prescribe estrogen and stuff. But when it comes to functionality, what we deal with day in, day out, right, that's gonna be where pelvic floor PT can really come into play, or a pelvic floor coach.

Um- Okay ... yeah.

Elizabeth: And so it, there is connection between menopause and pelvic floor issues. Is that what I'm hearing you say right now?

Mary Alice: Def- definitely. Mm-hmm. Okay.

Elizabeth: Mm.

Mary Alice: Um,

Elizabeth: the- And that's because of the drop in estrogen?

Mary Alice: I mean, our hormones are kind of going crazy, kind of figuring out what's going [00:37:00] on when we- Mm-hmm

as we age. Yeah. And, um, estrogen dropping is, I would say, a big one when it comes to driving symptoms that we might experience. Mm-hmm. Um, like I said, the vaginal dryness, the brain fog. I woke up and I'm, like, in a sweat at night, that's a, that's a big one. Um, uh, energy, decrease in energy, fatigue, a lot of fatigue.

Um- Yeah ... a lot of these things we don't always associate maybe with menopause or being symptoms of menopause. Um, but they really, they really are. Um, when estrogen drops, like I said, we have a decrease in actually, like, muscle, or in... I'm sorry, an increase in muscle mass loss. Um- And we have an increase in fracture risk.

I would say a lot of times when I'm seeing a patient that might have just gotten a diagnosis of menopause or s- we're also working on, or subsequently they also just got a bone density exam as well, and we might be working on some osteopenia or osteoporosis too- Yeah ... um, because they're, they're [00:38:00] linked.

Um, but estrogen, uh, its job is to help protect or help support joints, ligaments, um, other connective tissues, muscles, um, helps collagen, right? Which does the same thing for us. So we're naturally not having as much of that as we age, but there are plenty of things that we can do to help still support those structures.

Elizabeth: And so is there ever a point where addressing it becomes more difficult or you can't or, um- Yeah ... yeah, is it ever too late?

Mary Alice: Um,

Elizabeth: I'm,

Mary Alice: I know I'm biased, so I always think PT is worth a sh- worth a go. Um, even if, and I've done this, I've had this, even if it's just for like education purposes, like you come in and you just, again, just got the diagnosis, maybe doc didn't have time to really explain it, um, or yourself wanted to come in.

You're like, "I think I have something going on, but I don't know. Help me," so- Mm-hmm ... um, and we, and [00:39:00] we talk about it. Um, even if it's just for that, in my mind that's helpful. We actually research, research does show that even just having education and bringing awareness to the pelvic floor can actually already help symptoms.

Education alone, like having education can actually help pelvic floor symptoms. The awareness, really being aware can already help pelvic floor symptoms, which is another big thing we actually work on is body awareness. But, um, so I think it's always a good go-around 'cause I think in my mind, knowledge is power.

The more you know is helpful. And, even if there's no symptom improvement, like, like we do ... we try PT, we do PT, there's no symptom improvement, a lot of times it's good prep for that next step anyway. So, um, there's been plenty of times where I've, I, I have a, had a patient that they said that they're like, "I'm, I'm set up for surgery already.

I just wanted to like cover my bases," or, "I know I have a grade four and I think I'm gonna have surgery. What do you think?" And [00:40:00] we'll talk about it. Um, but it's good prep for surgery, um, again, and, and for after 'cause just 'cause we had surgery- Doesn't necessarily mean that the body's not gonna kind of go right back to its old habits, uh, when it comes to pressure management and coordination, right?

Yeah. Structurally we're better- Right ... but if these guys didn't learn anything from that- Right ... it's very easy to still have symptoms of after surgery. So, um, in my mind, even if it is a bad grade or we are still electing to have surgery, which is absolutely fine, I think it's a good go anyway. You can gain so much from going to a pelvic floor physical therapist or coach, um, just by knowledge alone.

Um, I think patients can get a lot out of it. Yeah. Awesome. Again- Is there

Elizabeth: anything else that you think that my listeners need to know?

Mary Alice: Um, I'll say it again, knowledge is power. I think the more you know and the more you're aware, the more you'll find [00:41:00] that you don't know and you can get addressed how, uh, how you need to get addressed.

Um, so do your research. Um, gonna plug PT again or coaching, because, we are research-based and we do have the knowledge, we have the experience, and then we can make referrals and screen. If we think something else is going on, we can make that referral elsewhere. So we can sometimes be a nice first step if you don't really know what's happening, 'cause then we can kind of help guide you in the right direction.

Um, there's also so many good books out there, especially like for menopause and pelvic floor, 'cause there's not... I mean, we're still coming out with research and it's still happening, but there's not a lot out there.

Elizabeth: Yeah. Yeah. And so I think that probably the listeners are thinking that they need to go to someone locally, but you actually work with people virtually.

Mary Alice: Yes. Yes. So, um, I do pelvic floor coaching, um, virtually because, um, again, it was almost like I felt like a need that wasn't being met in the community, because [00:42:00] I see people in the clinic, but I really didn't see a ton of people in the clinic. And I'm like, "Well, I know that there's plenty of people that deal with this that might just- Not have the time, um, then it definitely, like pregnancy postpartum moms, sometimes time is hard.

So, um, or they just are nervous. Again, uh, it can be kind of a taboo topic. But, um, so virtual is a great option I think. Um, even if you just wanna talk through what that might entail, um, definitely check me out. I'd be- Awesome ... happy to help. And where do they find you? Um, you can find me on Instagram at Cornerstone Public Health, and We'll have a link in the show notes

the comments. That'd be great, yeah. Um- For what? So I can see, again, anything from postpartum to perimenopause, menopause, and any symptoms in between can fit into that category, so don't be afraid to even reach out and just ask.

Elizabeth: Okay. Yeah. Great. So thank you for being here. Mm-hmm. This has [00:43:00] been amazing. I really

Mary Alice: appreciate it. Yeah. Yeah, I appreciate you asking me. I feel honored.

Elizabeth: All right, so that was Dr. Mary Alice Vetter, and I hope this conversation did for you what it did for me, which is make a topic that has been weirdly off limits feel like something that we can just talk about. Because here's what I took from today: A lot of what women experience in their pelvic floor, the leaking, the pressure, the urgency, the pain, the things that they've been told are just normal parts of aging, just part of getting older, just what happens after you have kids, a lot of that is treatable, and some of it is reversible as well.

And even when it isn't reversible, there is so much that can be done to help you function the way that you want to function. You don't have to just manage around it. If today's episode opened something up for you or if you have a friend or someone that you care [00:44:00] about who's been quietly dealing with any of what Mary Alice described, please share this episode with her.

You can find it wherever you listen to podcasts, and you can always find it on my website at elizabethsherman.com. I've linked to Mary Alice's Instagram in the show notes @cornerstonepelvichealth. And she works virtually, so geography is not a barrier. And if what you're noticing right now is that there's a bigger pattern going on with your health, not just the pelvic floor piece, but applying what you know that you should be doing for your health, that's exactly what I work with on with my clients.

Take a three-minute quiz to find out what's getting in your particular way. So head over to elizabethsherman.com/quiz. It takes a few minutes, and it'll show you pretty clearly where your particular version of the start over cycle is breaking down. So thank you for spending your time with me today. I will talk to [00:45:00] you next week.

Have an amazing day. I'll talk to you later. Bye bye.

Hey, before you go, if you are someone who says, "I know exactly what I should be doing, I just don't do it," hey, if that's you, I made something for you. It's a free three-minute quiz that gets underneath that exact problem, not to give you more information, but to show you the specific reasons your follow-through keeps breaking down, because it's not the same for everyone.

And once you can see your pattern clearly, everything else seems to change. Head to elizabethsherman.com/quiz. It's free, it's fast, and it's honest