The Pelvic Floor: (W)hole Health

Rachel Gelman: Hey everyone, welcome to the first episode ⁓ of Not Enough Information. I am Dr. Rachel Gelman and I'm joined with my dear friend and colleague Dr. Britt Van Hees. And we are here because we often hear people talk and say TMI, too much information. When in reality, we feel like most people don't have enough information. And so we are here ⁓ in a time when I think people desperately need medically accurate factual information to

Britt (she/her): That's true.

Rachel Gelman: tell people things that they should know and things that they do not have enough information about and we're gonna kick it off by talking about one of our favorite topics the pelvic floor

Britt (she/her): yeah.

Rachel Gelman: yeah I think you and I both agree that most people don't know enough if anything

Britt (she/her): Yes.

Rachel Gelman: about the pelvic floor.

Britt (she/her): Yeah.

Rachel Gelman: What would you say people should know about the pelvic floor?

Britt (she/her): well, hello everyone. Did a good intro. I'm a pelvic floor physiotherapist and a doctor of physiotherapy. And I think that what people need to know about the pelvic floor is that there are. two to three holes generally when we're talking about the pelvic floor that go through it. If you have a penis, there are two holes. And if you have a vagina, there are three holes. They're also for the vagina people, there are some holes for glands, but we'll just sidestep that for right now. Yes, thank you. That's a beautiful penis model. So.

Rachel Gelman: I'm sitting here looking at my desk in disarray and it's just like, I actually do have a penis here and a vulva and

Britt (she/her): That's awesome.

Rachel Gelman: all sorts of stuff laying around my desk. I guess I could show people, but I'm sorry to interrupt you, my friend.

Britt (she/her): That's okay. I was looking for a tiny model, a tiny pelvic floor model. I wasn't successful. I was like, maybe that'd be a cool thing. But anyway, so there are these holes and these holes have things going in and or out of them. So there's a pee hole, the urethra, and pee comes out of that hole. And also if there's a person with a a penis ejaculate comes out of that hole. That's one hole. Then there's another hole. that poop comes out of, or sometimes things go in it as well. So that's a, depending on where you go, you can be an in and out hole, but that's your anus. And then for people with a vagina, there's a third hole and that's the vagina. And so anything to do with those holes has to do with your pelvic floor. Anything. You're gonna think of anything to do with those holes. I'm not saying the pelvic floor is definitely involved, but there's a high likelihood it is. because the pelvic floor is a group of muscles that has these three holes going through it. That's how I feel like just to start with so people can kind of expanding or thinking about possibilities.

Rachel Gelman: feel like that's I've never thought about explaining it that way and that's a much more efficient way than I have and also when you're talking about the anus and how things can go come out or go in I feel like I just immediately wanted to talk to you about heated rivalry but I feel like that will have to be a whole separate episode

Britt (she/her): Yeah, you'll have to make me hip to the know-how.

Rachel Gelman: gonna say I'm like I don't know if you've watched it yet but now you have time to watch it we can have a whole episode about heated rivalry I'm

Britt (she/her): No. I feel, it's exciting. Okay.

Rachel Gelman: very excited but yeah I think people are not aware of the fact that there is this whole bowl or hammock of muscles

Britt (she/her): Yeah.

Rachel Gelman: inside the body inside the pelvis and because you can't see them it's very easy to not these muscles and all the amazing things that they can do because they're holding all of the internal organs. So you know we have the the bladder, the rectum, and either the prostate or the uterus. And so they're working all the time to hold those organs up and then you know they're moving in tandem with the diaphragm. So when people are breathing these muscles are going to be moving So they're also involved with like core stability. It's the reason we're upright, not, you know, jellyfish. So they do so many things. And I think that's why it sometimes blows people's minds when we talk about how is pelvic floor therapists, the things we do. I think so many times people come in and talk to us or hear what we do and they're like, you're seeing people who are pregnant. And

Britt (she/her): Mm-hmm.

Rachel Gelman: it's kind of like, yeah, that's definitely, you pregnancy, I think is one of those life events that has such a huge impact on the pelvic floor for obvious reasons. But when you start talking about what all these muscles do and when we start talking about like, yeah, like at least for me, I think you as well, like so many of our patients have a penis. So

Britt (she/her): Mm-hmm.

Rachel Gelman: they can't get pregnant.

Britt (she/her): Yeah. Mm. Mm-hmm.

Rachel Gelman: when people are able to kind of get a better sense of where these muscles are and what they do, it then becomes apparent how

Britt (she/her): Yeah.

Rachel Gelman: their symptoms can be presenting or why they might be having symptoms and that there, know, so many people I think also feel like they're going crazy because they go to the doctor who's looking at a specific organ, like let's say the bladder and the bladder looks okay. But when you realize that there's a muscle that's wrapping around the urethra, these muscles are supporting the bladder and they're in spasm, then it kind of helps people realize like, I'm not going crazy. These muscles are what's causing me to have this sensation that I have a UTI or the sensation that I need to pee all the time. So I think it's just kind of interesting that this huge group of muscles isn't talked about more because it can explain so much for people.

Britt (she/her): Yeah, I think you hit so many good points there. I was like, I remember to say something about that and say something about that. So the last thing you said was that like, that the bladder is supported by these muscles. So if there's a problem, possible past history, a problem with the bladder, or you can have these, you can have these muscles respond in a way that's spasmodic, which is supposed to happen. But then these muscles can also create symptoms like urgency or UTI like symptoms. And I say that what's so interesting about the pelvic floor too is as pelvic floor physios, we see patients symptoms in a lot different light than people who only specialize in the bladder or only like doctors who only special like urologists or here in the Netherlands, they say proctologist. Well, not for urologists before like, you know, rectal issues. But anyway, going back, I'm quite a circuitous talker for the listeners. Yeah, yes. But

Rachel Gelman: I enjoy it. I'm with you.

Britt (she/her): how when a patient comes in and they say, yeah, I had a UTI. And then it was like it was bad UTI. And then after that, I've been having like UTIs all the time. And sometimes they're positive. Sometimes I get positive bacterial infection and sometimes I don't. And then I also notice that now it's like hard to have penetrative vaginal sex. And to them, it's two separate things. But to us, we're like, well, of course you would. Those muscles are right next door to each other. I mean, the urethra is like on top of the vagina. Like it just, and it comes out of the, it comes out of the vulva. So it's like, why wouldn't you? Of course, I mean, I'm more surprised when people only have dysfunction in one section. Usually that's a red flag for me. If people only have either only a bladder issue, only a pooping issue, or only a sex issue, I'm kind of like, okay, keep that. in my head because usually because the muscles are so close to each other they're going to affect the other system.

Rachel Gelman: think that they are coming in soon. I'm like, we're probably catching it or getting them in soon, which is great.

Britt (she/her): Yeah, yeah, yeah. Yeah. Yeah, that's true, actually, I think, because we've seen so many people like who've experienced things for multiple years before. Yeah.

Rachel Gelman: But as you, I know you lived in the States, because that's how we know each other, that to get into a doctor here, to get in with a specialist takes so long, seven, eight, nine months. So people are waiting, waiting, and by that point, symptoms continue to progress. And sometimes it takes a couple of years before people come into pelvic floor therapy or get a better, or get the correct diagnosis. So it is, sometimes I feel like unusual. in our line of work to see people who only have one symptom or one thing going on. Because often like you kind of described, I see so many people who, you know, felt like they had a UTI, maybe they got a culture done, maybe they didn't. They take antibiotics, symptoms persist. So then they're given a stronger dose or another round or a different type of antibiotic. And maybe they've done that three, four, five times and they still have symptoms. And now, because of all the antibiotics, maybe their gut got all out of whack. And also they've been so, you know, for obvious reasons, stressed and scared about these symptoms. So the muscles are probably guarding even more. then like you said, they're, having pain with penetrative sex or not even able to have penetrative sex or maybe they can't even like insert a tampon or wear tight clothing. And it just kind of continues to progress and like snowball until they're maybe having pain all the time. And

Britt (she/her): Yeah.

Rachel Gelman: you know, like I'm kind of circling back to the whole point of this conversation is like these muscles that are wrapping around the urethra or the vaginal opening or the anus or attaching at the base of the penis are just so interconnected that if one starts to guard or tense, they all get pulled in. And

Britt (she/her): Yeah. Yeah.

Rachel Gelman: it's pretty, it's pretty, I don't even know what the right word is, wild and interesting how,

Britt (she/her): Yeah. Yeah.

Rachel Gelman: you know, all of these areas can overlap when they feel like they shouldn't or they feel like they're not related at all.

Britt (she/her): Yeah. And that's why when I explain what the pelvic floor does, I often will talk about the holes because I've done so many different types of education about it that I will do the whole thing. And then several sessions later, someone will say, can this affect my pooping? And I'm like, what have you been doing this whole time? You know, I'm like, didn't we do the spiel? So now if

Rachel Gelman: Yeah.

Britt (she/her): I say that and I really am explicit about it, it it helps people connect things a lot quicker. And then when they come back like, I've also had this and I didn't even know, you

Rachel Gelman: Yeah, no, like I said, I feel like that's a I've never thought of explaining it that way. And I think it makes sense. And it's a good visual because people know about holes. Holes a hole.

Britt (she/her): Yeah, I mean a hole is a hole. Hashtag a hole is a hole.

Rachel Gelman: That is a great hashtag that we will be sure to use

Britt (she/her): You

Rachel Gelman: for this episode and probably future episodes because I know we're going to be talking about a lot of holes.

Britt (she/her): yeah, you can say whatever hole you want, we'll chat about it. Yeah.

Rachel Gelman: and the pubic bone. So sometimes we're seeing people who also have a history of hip pain or

Britt (she/her): Yeah.

Rachel Gelman: back pain, groin pain, things that people kind of are like, this probably has nothing to do. with my bladder symptoms or my sexual dysfunction or my constipation. And it's always interesting, or I always like when I see patients kind of like light bulb moment when I'm maybe working on their pelvic floor and I palpate, you know, that hip muscle internally and they're like, that's my back pain.

Britt (she/her): Mm-hmm.

Rachel Gelman: And you're like, yeah, like this muscle has a big role in

Britt (she/her): Yeah, that would be another good topic for us to talk about. Yeah.

Rachel Gelman: Yeah, for sure. We will dive a lot deeper into a lot of these topics going forward. But hopefully this has given you a taste of what to expect in future episodes. The fun

Britt (she/her): Yeah, and the fun you will have.

Rachel Gelman: we will have talking about all the information that we feel like you do not have enough of and that there is no such thing as TMI.

Britt (she/her): Yeah.

Rachel Gelman: There is definitely, I think it's not enough information.