Search

How can I help you?

    120: Why You Should Care About Your Pelvic Health w/ Dr. Brianne Grogan

    Pelvic floor health can decline for women of all ages, whether they’ve had a pregnancy or not. Though severe issues are more common after giving birth, some degree of trouble happens as a woman grows older.Dr. Brianne Grogan is here to talk about the link between pelvic floor health and mental health and what we can do to prevent the decline.

     Or listen & subscribe for free on Apple Podcasts | Android

    Brianne had her own pelvic floor scare when she went for a run 3 weeks post-partum and felt something shift to where it wasn’t supposed to be. She was determined to regain her pelvic health and now teaches other women and men how to protect themselves. Because for so many people, mental health is linked to pelvic health, and women who experience pelvic issues often experience feelings of loneliness, as well.

    A women’s health physical therapist is a specialist who works exclusively with women to improve their pelvic floor health. If you’ve been experiencing issues, you should ask your doctor for a referral. Brianne explains what some of the symptoms of pelvic floor problems are and what you should look out for.

    She also shares some great advice about easy lifestyle changes you can make right away to start improving your pelvic health. From regularly walking and Kegel exercises to her favorite butterfly position, every little change can have a positive impact. But you also need to be careful that you’re not overexercising that area as this can actually have a negative impact on your pelvic health.

    Brianne talks about some of the less appealing topics of women’s health, but learning to use the toilet properly is so important for all of us. Make sure you’re never pushing your urine out and consider investing in a squatty potty. She also shares some tips on how we can prevent pelvic prolapse, which is a pretty scary experience for women.

    Do you regularly practice Kegel exercises? Are you aware of how much you’re pushing while using the toilet? Have you heard of a women’s health physical therapist?

     

    In This Episode:

    • How your pelvic floor health is linked to your mental health
    • What a women’s health physical therapist does
    • What some of the symptoms of pelvic floor problems are
    • What lifestyle changes you can make to start improving your pelvic floor health right now
    • How you can use the toilet properly
    • How to prevent pelvic prolapse

    Subscribe to Couch Talk w/ Dr. Anna Cabeca on Youtube

    Quotes:

    “There’s a lot of build-in shame around this personal area of our body, aside from the fact of prolapse and incontinence.” (12:25)

    “Now that she’s found a group of women who get her, who understand her, the loneliness is gone.” (36:19)

    “There is no age limit on good pelvic health!” (38:26)

     

    Links

    Join “Lift” Pelvic Organ Support Series

    Buy Lady Bits

    Find Dr. Brianne Grogan Online

    Find Dr. Brianne Grogan onFacebook |Instagram |Pinterest |YouTube

     

    Transcript

    Dr. Brianne:
    I am leading a group called Fem Squad, which is a group of women that have come together to get a little more one-on-one support from me, but they're also coming together because of community. And one thing that really stuck with me from this group that ties into our pelvic health and mental health theme today is she said that, now that she's found a group of women who get her, who understand what she's going through, she says, "The loneliness is gone." And some women have said, "I didn't even really know I was so lonely before having people that I could talk with about this stuff."

    Dr. Anna:
    Well, hello everyone and welcome to Couch Talk. This is an intimate place for intimate conversation, and I am your host, Dr. Anna Cabeca. My guest today is Dr. Bri, Brianne Grogan, who I've known for over a decade, I believe. And she is just a superstar in the pelvic health space. And today we're going to be talking about how our pelvic health is really tied into our mental health and some of the issues we struggle with as we get older, and how we can really reverse some of these changes that we're experiencing in our body. It doesn't have to be this way, ladies, and it's really important to know. It's not just ladies, it's men too. So Dr. Bri, let me tell you, she has over 10 million views on YouTube. She has been featured on mind-body green. She has a five-star reviewed book that I highly recommend, and she is a well-respected voice in the field of women's health, pelvic health, and wellness.

    Dr. Anna:
    She describes her YouTube channel as the home of core plus pelvic floor friendly fitness. She is just loved, as you will see, by so many people. She has her FemFusion Fitness programs and is just well-known and well-respected as a physical therapist, especially when it comes to pelvic health and pelvic rehab. Hey, Brianne, how are you?

    Dr. Brianne:
    I'm so good. Thank you for that beautiful introduction. I'm so glad to be here.

    Dr. Anna:
    I'm glad to have you here. And, you healed yourself from prolapse like 12 years ago. Let's talk about that, because that's also like you've had like, tens of thousands of views, like 30 40,000 views on that one. I don't know. A ton of views on that video, that YouTube video. I highly recommend everyone go watch that one too.

    Dr. Brianne:
    Thank you. Yeah, that's one of... It's funny, because my YouTube channel really just was nothing until I started talking about my own experiences and my own issues that I personally had and really started focusing on the pelvic floor. I'd always integrated it into my core fitness videos that I put on there, but I didn't really so specifically, so detailed talk about prolapse and incontinence and issues like that. And that is when people really started taking notice I guess. And because people were lonely and they were scared and they were researching on YouTube, as people do. And so that video that you're referring to where I talk about my pelvic floor journey and my prolapse journey is one of my more viewed videos. And in it, I talk about how I did develop a mild prolapse after my son. I went running.

    Dr. Brianne:
    I'm a physical therapist. I know better. I don't know what I was thinking except that I was slightly obsessed with running at the time. And I'd run through most of my pregnancy and I started running at three weeks-ish postpartum, and it was not good. So the results were not good. I immediately, as soon as I felt like a slip and something felt off in the pelvic region, I stopped and I went home and I took a look and I confirmed what I saw. Luckily it was mild, and luckily I was very early postpartum, as I said, and there was a lot of natural healing that does occur after you wean and as things go back to normal. But I'm glad to say that I'm, for the most part, symptom-free these days. I get a little heaviness sometimes when I'm close to my period or if I'm constipated, but other than that I'm good.

    Dr. Anna:
    And I think that's really important thing, like you said, that heaviness, right? As a gynecologist, we'd ask if people were feeling symptomatic. Sometimes it's pelvic pressure and it's a feeling of heaviness in the pelvic floor. This weighted kind of feeling in the pelvic floor more common at the end of the day. As you go on, you're on your feet, you're working nurses, teachers. I mean, if we're on our feet a lot, we sometimes we'll feel that more at the end of the day. And that's that relaxation of the pelvic walls and that means we need to strengthen them, right? Because muscle is the connective, attached to the connective tissue that really keeps everything tight and pulled up.

    Dr. Brianne:
    Absolutely. And that's why I'm a huge proponent of exercises. And also I'm a huge proponent of your Julva, Anna. I love it, the Julva cream, which I'm sure you've talked about before, but it's wonderful for just the tissue health and then the pelvic floor strengthening, and the lifestyle, that is absolutely huge is lifting correctly, and having good posture, and toileting correctly. There's a lot to think about there.

    Dr. Anna:
    Let's talk about toileting correctly because, you know, I can do a whole episode on how to use the bathroom.

    Dr. Brianne:
    Yes. I've actually done a whole series on YouTube called Things That Make You Go Poo. It goes with that song, "Things that make you go, ooh, ooh." You know that old song?

    Dr. Anna:
    I love it.

    Dr. Brianne:
    That was my intro, and I have a series, and yeah, it's actually a pretty watched series as well, just because again, people are interested in this stuff and they're having the issues and they want to know about it.

    Dr. Anna:
    Well, and I would say, as women, I think we are recognizing we have to take back the control of our own health. We have to take back the power over our bodies. We've given it away and in so many ways, to our physicians. Even like to me as a physician and a gynecologist, I want each and every individual to claim the power of their body, their power to heal itself. It's not in a pill or a potion, even a program. Right? There's a multitude of things we have to do on a daily basis, and it comes with ownership of our body and the power we have over our body to heal given the next right step one at a time.

    Dr. Anna:
    So let's talk about this as far as what we're experiencing to just the pelvic health tied into mental health issue. And then we'll talk more about the props and strategies to keep from experiencing prolapse or pelvic floor problems, incontinence, leaking bladder when you cough, sneeze, accidental urinary leaks, leaking after sex, all of those things that are troublesome and add to the mental health issue, add to disease, so to speak. So we definitely hit on these and give some really practical strategies to our listeners that they can be doing right now while they're listening, even to improve pelvic health. Till we die we have to take care of our core and our pelvic floor. So I'm with you on that, Brianne.

    Dr. Brianne:
    Absolutely. Well if you don't mind, I actually have... I'm terrible with statistics. They just fly right out of my head. So I actually took the time to write down a couple of things, and maybe I can just read them to you. Well, first of all, nearly half of women over age 50 report bladder leakage. Now these statistics about incontinence are actually all over. There's different ones for different age ranges but definitely one in three women kind of in general. That's a pretty well-known statistic for bladder leakage. And when we get into the older ages, so women over 50, about nearly half of those do report bladder leakage, and many of these say it's a major problem for them. And this aspect of this statistic makes me very sad is that two thirds of these women haven't actually spoken to a doctor about it, and many don't actively do anything about the issue. Instead, they just rely on pads and the thought that it's just a normal part of aging.

    Dr. Brianne:
    And one thing I want to say before I go on with that is though it's normal in that a lot of people have this, or I should say, excuse me, it's typical, but it's not necessarily normal. So it's not something that you just have to deal with in many cases, many, not all, but in many cases there is definitely something you can do about it. So a couple more stats, just a few is that there was a recent study done by MUTU System. Actually this is an exercise program, a foundational exercise program that I actually recommend to a lot of my FemFusion followers. I just think that it's a wonderful program. But they you did a big survey and found that 87% of women in their survey said that dealing with pelvic health issues had affected their mental health at some stage.

    Dr. Brianne:
    And also, women who are living with urinary incontinence, so bladder leakage, have been shown to have a significantly lower quality of life compared with those who are continent. And that's really sad to me. It breaks my heart. And when you add to this, this other stat, that approximately 68% of women with mental health problems are mothers, and then you're layering on facts that it's already a challenge and a struggle being a mom. Often, a new mom, it's hard. There are some issues there that some people deal with postpartum depression, and then you layer on top the burden of pelvic floor issues and the mental strain that that can cause, that just really exacerbates everything that you might be dealing with at that stage. And the last little stat here is that actually 50% of postpartum women, so women who've given birth, experience pelvic organ prolapse with symptoms of bladder and/or bowel dysfunction.

    Dr. Brianne:
    So again, it's not necessarily going to stink. Sometimes the prolapse symptoms can be reversed or be be lessened. But that's a pretty big number. So we've got a lot of women dealing with, and it does impact your mental health, how you feel about your life.

    Dr. Anna:
    It does. And it's not just that. It's the caregivers of elderly parents with incontinence. According to research, incontinence is the number one reason that caregivers put their loved one into a nursing home or other care facility. And that's heartbreaking to me. I was joking with Bri, it's like, I have four daughters and I've disciplined them greatly during their teenage years. I don't want to give them another excuse to tuck me away somewhere. They're not going to let that happen. But so pelvic floor health, at least continence is not going to be the reason they send me away.

    Dr. Brianne:
    Absolutely. Yeah, so I mean those are just some stats there. It is a big thing, and imagine then the mental, the impact of putting your loved one in a nursing home. So even for the loved one who has to go into a nursing home, they're probably not thrilled about it. And you're, as the loved one of them are probably not thrilled about it either. So it really is far reaching when you think about the ripple effect.

    Dr. Anna:
    Yeah. And from a mental health perspective too, having incontinence is so shameful, right? It's shameful. I mean, so many women in their 30s, 40s even, say, "You know, I stopped running because of incontinence. I had to wear a pad every time I run," or, "I leak through my yoga pants and I won't go to yoga anymore." You know what I mean? And that's like, "Okay, well we can fix this."

    Dr. Brianne:
    Totally. And let me just tell you something that might blow your mind here. But the word pudendum, which is a word for external genitalia, particularly female, comes from the Latin word pudēre, which I don't know if I'm saying that right. I don't speak Latin.

    Dr. Anna:
    Pudēre.

    Dr. Brianne:
    Pudēre, but it means shame. That just makes it seem like-

    Dr. Anna:
    I didn't know that.

    Dr. Brianne:
    Yes. It just gives me heart chills of emotion thinking that that is actually the root of the word pudendum, which there's a pudendal nerve that runs through that area. There's the pubic bone, although I'm not sure if that's the same root, but very fascinating that that is actually the root of pudendum. So yes, there's a lot of just builtin shame around the personal area of our body, aside from the fact of prolapse and incontinence.

    Dr. Anna:
    Well, let's talk about where the pudendum is because it's the same for men and women. We want to talk about the pudendal area as a female and a male word, which is nice to know because sometimes we just think it's associated with female, and other words that have a terrible-ridden origin like masturbation, right? Masturbate, in that I prefer self-pleasuring. That's just a nicer way to say it. And especially if you... I did a blog on this. I was like, "I do not like this word." And then hysterectomy, from hysteria. So let's talk about that too. But first let's talk about where the pudendum is.

    Dr. Brianne:
    We're going to be talking about the vulva, the entire vulva region, which is the whole external area of our private area.

    Dr. Anna:
    Clitoris to anus.

    Dr. Brianne:
    Yeah, clitoris to anus, exactly. That's our pudendum. And then deep to that we're talking about the pelvic floor muscles. And that's really what my focus is. My work is on the pelvic floor, and I do work with male pelvic floor muscles as well because we all have them, male and female. So yeah, that's the pudendum and-

    Dr. Anna:
    Critical for life. It's so important.

    Dr. Brianne:
    A whole lot.it's unfortunately that shame is tied to something that actually bursts human life.

    Dr. Anna:
    Again, underappreciated area of our body that needs to be taken well care of for our entire life. So let's start with that. What are some things that we can do to take care of the pelvic floor so that we don't experience or if we are experiencing continence, prolapse? How do you work with clients when they come in from the assessment through the plan?

    Dr. Brianne:
    Right now, my main work is actually online, so I'm not seeing clients one-on-one, but a physical therapist, women's health physical therapist, that's where I started in a clinic, as a women's health PT. So if people don't know that is a thing. You can go to a women's health physical therapist. I know you've had other folks on your show that have talked about this. This is a specialty that is absolutely wonderful. If your doctor doesn't know about it, and that's possible. A lot of physicians out there don't necessarily refer just because they don't know one in the area or maybe they don't even think about it as a specialty. But a women's health physical therapist will evaluate and assess the pelvic floor muscles and how able a person is to use those muscles, contract them, release them. That's really, really important is that you're able to have coordination, contraction and full, full release.

    Dr. Brianne:
    They'll make sure that there is... So again, coordination, strength, figure out what's going on there, and then they'll also assess the other muscles of the core as well, because the pelvic floor is just part of the core. We also have our hips and our glutes and our abs and our breathing diaphragm, so we need to really look at all of it. Also they'll assess your posture, they'll assess your breathing strategies, all sorts of things that are ultimately related to your pelvic health, and from there you'll get a treatment plan that's usually exercise-based. If you have more pelvic pain issues, there will be a little bit more manual therapy. Trigger point release, sometimes biofeedback is involved with both strengthening or pelvic floor weakness type issues, as well as overactivity or pelvic pain issues. So biofeedback is a way for you to see what your pelvic floor is doing, whether it's contracting, whether it's relaxing, and it's a really, really neat treatment modality.

    Dr. Brianne:
    But I definitely recommend seeking a women's health physical therapist if that is available in your area. First of all, step one, if you have some sort of issue, whether it's pelvic pain and tension, painful sex, bladder leakage, gas leakage, fecal leakage or feelings of heaviness and prolapse, then just know that this isn't normal. This isn't something that you necessarily just have to deal with. So step one would just be that awareness. And step two would be talking to your doctor. Step three, if your doctor, because unfortunately I have to give a slap on the hand to our fellows in the medical community. There are some folks, some doctors out there who have said to my followers who reach out to me and tell me their stories and they will say, "There's really nothing you can do about this. You're just going to have to live with it." Or the only option they'll give is surgery.

    Dr. Brianne:
    So unfortunately that's still floating around out there. So I would say when that happens, if that happens, know there are other options. Again, seek a women's health physical therapist if that's available to you, or go online and do some due diligence research of your own. I have information that I can share on.. Is it okay if I share my-

    Dr. Anna:
    Please, yeah.

    Dr. Brianne:
    Okay. I have a free series of videos. It's totally free. It's called Lift. It's my pelvic organ support series, and you can sign up for it at a bit.ly link. So it's just bit.ly/femlift, F-E-M-L-I-F-T. It's free. It's five weeks of exercises. They're real simple, and lifestyle tips. Again, those are huge. The posture, the breathing, the lifting, the pooping correctly, all of that is a part of it. So it's not medical treatment, but it is general information that unfortunately most of us, like 99% of us were not taught. And so, of course, you need to learn it somewhere.

    Dr. Anna:
    Yeah, that's great.

    Dr. Brianne:
    Yeah, so and I have my book too, which my book, Lady Bits.

    Dr. Anna:
    I love that book. I love that book. So that is great. That is a must-read for every woman with lady bits. It really is.

    Dr. Brianne:
    Yeah, with lady bits, exactly. And so, I mean a lot of it is really just self-education and learning those basic strategies. And I'd be happy to give some exercises that maybe I'll let you pop in in-

    Dr. Anna:
    Yeah, no, let's do... Well, first talk about using the bathroom properly because I promised my audience that. So let's talk about using the toilet properly and then another exercise that we can do to maintain the pelvic floor.

    Dr. Brianne:
    Sure. Okay, so first of all with urination, so for going pee, we want to make sure that we're not pushing to pee, which is so common to actually push to get it all out. So you're in a hurry and you're like, I don't have time to go to the bathroom and you are bearing down to make everything come out faster, or you're trying to multitask and you're blowing your nose and doing all that while you're going pee. That also puts a lot of strain and pressure on your pelvic floor. And so when you sit down to urinate, just sit down and also don't hover, because when you hover above the toilet seat on a regular basis, that can potentially lead to retention of urine because you're really having to activate all of your muscles to stay hovering above the toilet seat. You're not really able to completely relax and let go.

    Dr. Brianne:
    Urination is a time to let go, ladies. It's a time for self-care, so just sit all the way down on the toilet seat, let it all go. Take your time, don't push, and let it all come out, and then when you're done you can move forward. But that's just a really basic tip that some people have never really thought about.

    Dr. Anna:
    And then that's a good one because sometimes we're in such a hurry, we're like... Especially my teachers, doctors, nurses, right? It's like go, two seconds, and out of there. Right? You're never completely emptying, not relaxing, not taking a moment, and especially if you're using public restrooms as a good part of your day, you're hovering. One thing I would also say from an energetic standpoint, as part of my journey around the world and speaking with healers, bladder issues are often that fear of letting go.

    Dr. Brianne:
    Yes, absolutely.

    Dr. Anna:
    Fear of letting go.

    Dr. Brianne:
    Absolutely. Bladder issues and pelvic floor hyperactivity as well. Fear of letting go, fear of just wanting to keep it all in. That can happen. Yeah, that's a great point, what you just said there. Actually, I believe that incontinence and bladder issues are that fear of letting go. Also feelings of urgency and busyness and overwhelm can definitely lead to anxiety, which triggers sensitivity and bladder issues as well. So it's definitely all wrapped together. I also liken prolapse to too much pressure and not enough support. And that can-

    Dr. Anna:
    That's a life analogy right there.

    Dr. Brianne:
    Exactly. And it's for... I mean literally that's what's happening in your body is there's too much downward pressure and not enough support to keep your pelvic organs in place. But from an emotional perspective as well, when we're just rushing and rushing and moving through life and we're just trying to hurry and get stuff done, and so we're pushing to pee and then we're constipated because we're anxious and so we're pushing to poop. And don't have help around the house and we're young mothers maybe or in any age, but I'm just thinking of maybe new moms and they're lifting their babies and they don't have support and they don't have help. That contributes to prolapse. So big emotional tie there.

    Dr. Brianne:
    But, so another last thing about toileting is going to have a bowel movement is, I definitely recommend... Are you a fan of the Squatty Potty?

    Dr. Anna:
    Of course. Billions of people around the world squat to use the restroom, right?

    Dr. Brianne:
    Yes, they do. And I love that Squatty Potty came up with a design that brings the squat to your toilet. Essentially it allows you to simulate that squat position. But it isn't... One thing I do want to always tell people is to make sure that when you're using it, so your feet are elevated, your knees are up, but just make sure that you're not really, really roundy hunchy with your back because that can compress everything and it's just not contributing to what we're trying to do.

    Dr. Brianne:
    We're trying to get that nice squat position with a long spine, and that helps straighten out the anorectal angle and allows the bowel movement to pass through. And it's also not going to compress your pelvic organs the same way as it would when you're really rounding and curled over.

    Dr. Anna:
    Very, very true.

    Dr. Brianne:
    Yeah. Also expand your belly when you're having a bowel movement. And it can be helpful for some people to make kind of a low, like a low sound with their voice, even. There's the glottis is actually tied to your pelvic floor as far as the way they work. So making a low sound like that can be helpful with letting the bowel movement out.

    Dr. Anna:
    How interesting. So just a low vibrating sound. Do you have a particular word?

    Dr. Brianne:
    [inaudible 00:23:33].

    Dr. Anna:
    Okay, I can do that.

    Dr. Brianne:
    You could try that.

    Dr. Anna:
    Already got it.

    Dr. Brianne:
    And you can open your mouth and just everything just relaxes. So try it. This is actually a fun little trick. Some of this is from Susan Clinton who's a wonderful physical therapist who does a lot with this, but she has you do [inaudible 00:23:52] and then try going [inaudible 00:23:53] and go really high with your voice. And everyone should try it right now at home. And you'll feel when you do the [inaudible 00:24:00] you feel a release of the pelvic floor, and when you do that [inaudible 00:24:04], your glottis is tightening up, your diaphragm is lifting and your pelvic floor lifts as well. So it all lifts with the high and then relaxes and opens.

    Dr. Anna:
    I love it. Okay, so that deep vibrational sound, but also definitely, I have to emphasize that deep breath. Deep belly breath and relax, because we're busy, we're working still in the bathroom sometimes on our phone or whatever way. Take that time to just really relax, take that deep breath, those deep belly breaths, right? That helps ourselves, our bodies, our nervous system shift from the sympathetic into the parasympathetic. And so that stimulates the vagus nerve and so we're able to relax and then we know, "Okay, this is the time. It's safe." You can have a bowel movement. This is a good time, a safe time. So just those deep belly breaths are powerful too. And other thing, many women in obstetrics to postpartum, and with prolapse, the question I would ask as a gynecologist, do you ever have to put two fingers in the vagina to have a bowel movement because of constipation?

    Dr. Anna:
    Sometimes constipation is a result of prolapse, but it's usually prolapse more a result of chronic constipation. So I want to emphasize that point. But if we're doing that, if we are doing that, that is a sign that maybe there's a break in that fascia or the musculature, but still we can go a long way to heal it. So certainly Julva, vaginal hormones like testosterone and DHEA, using the pelvic floor exercises can really help that. And then probiotics, mighty maca grains, right? Regular bowel movements, lots of fiber, lots of dark green leafy vegetables, lots of good natural plant fiber, fresh ground flax seeds, things that really help us have regular bowel movements on a daily basis. Soften that stool. So we have that banana shape brown stool. And that makes it different.

    Dr. Anna:
    Nothing to be shameful of. If we're doing that, you're doing that. There's nothing to be ashamed of, right? This is just part of nature is telling your body, "There's something that we have to deal with. Let's come around dealing with it. Let's handle it. Let's fix it." And we get to the root cause of that. Often many reasons, that's why it's never just one thing. So, Brianne, just go ahead and let's talk about some pelvic floor exercises that you highly recommend each and every one of us do.

    Dr. Brianne:
    Yeah. Well, so the problem with blanket statements, as you know, is that [crosstalk 00:26:39]-

    Dr. Anna:
    Call me on it.

    Dr. Brianne:
    You set me up for that.

    Dr. Anna:
    I did.

    Dr. Brianne:
    And so I'm going to give some general ideas, but I'll give, there's a couple that I just love. But just know that some people really need to be careful because they can have too much tension, too much activity in their pelvic floor.

    Dr. Anna:
    Right, it's that hypertonic, just that overtense muscular spasm.

    Dr. Brianne:
    And it's actually surprisingly common. I would say that so many people who reach out to me are dealing with this issue and rather than underactive, they're having pain, they're having spasms, they're having tension, their Kegel exercises that they try make things worse. So that could be because either they're doing their Kegel exercises wrong, which is very common. Or it could be that they are just overly tense already. And the last thing they need to do is be tightening things up using various things that are out there, devices, et cetera, to exercise the pelvic floor, which they can have their place, but not for everybody. So that's my little soapbox there.

    Dr. Brianne:
    But I'll say in general, I like this. I'm all about the middle road and balance. So one exercise that I really like to wake up the pelvic floor and fire up the core is if you're lying down on your back and you have your knees bent and your feet are on the floor, so you're in a just a basic on your back position with your knees bent and your feet on the floor, let your knees flop apart. So it's like a butterfly position. Some people who might know me might know my butterfly bridge, which I love, which is where you lift your butt up off the floor. But this, you don't even do that. All you're doing is moving your knees together and then flopping them apart. So you bring your knees together and then you flop them out and apart.

    Dr. Brianne:
    And what you want to start doing is incorporating your breathing with this and tuning in to the muscles of the deep core, so the pelvic floor in the deep abs. So when you let your knees flop apart, like that butterfly, you're relaxed and you're released, and you inhale and you just let your belly expand. And then when you bring your knees together, your inner thigh muscles, your adductors are going to have to help work to make that happen. And they actually help activate your pelvic floor. So there's a lot going on in your inner thigh muscles, in your pelvic floor as you bring those legs together. And then if you also exhale during that part, that activates... If you pull your belly inward a little bit as you exhale, that activates your deep abs and it helps lift the pelvic floor because the breathing diaphragm is lifting as well.

    Dr. Brianne:
    So I know I just said a lot right there, but suffice it to say, when your knees flop apart, everything releases. When your knees come together and you breathe out, everything lifts in and up and you feel that activation of your pelvic floor, your inner thighs, your deep abs, and it feels amazing. So that's just, I call it fire up the core or butterfly, and you can just do that for a minute or two and it's a wonderful way to both release and also activate without really focusing on a Kegel per se. 

    Dr. Anna:
    I love that. I'm definitely going to start doing that because that sounds like a great morning exercise to open up also your hip flexors, right? Also your hips, because so many of us, especially as we're getting older, we risk those hip replacements, broken hips, all those things, and that, a lot of times it's because there is fibrous tissues, there are adhesions around the hip socket. So just this fact of opening, extending, because often we're sitting legs crossed. It's always an internal rotation versus an external rotation. There's my little exercises right here.

    Dr. Brianne:
    Those are pretty good [crosstalk 00:30:30].

    Dr. Anna:
    Good exercise.

    Dr. Brianne:
    Those are good.

    Dr. Anna:
    So we want to do that, so knees together, knees out. And then that's a great way to open up and so we're going to inhale as we exhale. I mean, inhale as our knees go out and [crosstalk 00:30:45] as they lock because we want that extra pressure, that kind of relaxation. We just want them to flop. No tension. So inhale and then exhale. And then as we're exhaling, we can imagine the whole diaphragm is lifting up, lifting up the pelvic floor with it, up and tight just in a very passive way and how therapeutic that can be. So I love it. Inhale, exhale.

    Dr. Brianne:
    You got it. You got it.

    Dr. Anna:
    We've got it.

    Dr. Brianne:
    And if someone is really tight and stiff and maybe even painful in their hips, they can have yoga blocks or pillows on the outside of their hips so that their knees don't have to feel like they're dangling in mid-air and uncomfortable. They can feel supported in this. The idea is the open and the opening inhale and then the close together and exhale and lift that pelvic floor. I always describe it as zipping up, like you're zipping up a tight pair of high-waisted skinny jeans. So it's like you're starting way down low at the pelvic floor and your zipping up.

    Dr. Anna:
    Yep. That's a great, great analogy. And that's also clitoris to anus, all that zip it up. And I'm glad you mentioned the pillows because one of the things I do, I have really tight hip joints, right? They're really, really tight. And so having the pillows around if I'm doing a relaxation yoga pose and in that butterfly position laying down like you described, relaxing, that way I'll relax more with those pillows around me.

    Dr. Brianne:
    Absolutely. Absolutely. You'll get so much more out of it if you support yourself. It seems like you're cheating by using props, but you are not.

    Dr. Anna:
    Yes. Yeah, great. I'm glad we did that. So what do you call that one?

    Dr. Brianne:
    I call it butterfly or sometimes I've called it fire up the core.

    Dr. Anna:
    Fire up the core.

    Dr. Brianne:
    Fire up the core.

    Dr. Anna:
    I like fire up the butterfly.

    Dr. Brianne:
    Fire up the butterfly. There you go. That's a good one.

    Dr. Anna:
    We'll rename it.

    Dr. Brianne:
    You can always do basic Kegel as well, a squeeze and lift of the pelvic floor and then a full and complete release. But again, those are not always for everyone. And sometimes they're a little boring so it can be fun to try something new.

    Dr. Anna:
    You know, Brianne, one the things I was consulting for our practice in St. Pete and one of the clients came to visit me and she traveled all around looking for pelvic therapy because she had the hypertonic, she was a runner, she had to stop running, but she still had this hypertonic bladder floor. And one of the things that I did, and this is why a pelvic floor physical therapist is so critical, or osteopathic gynecologists like I am, or an osteopathic physician that knows pelvic floor therapy. And because like with those spasms, and this is a segment of the population that's usually ignored or told the wrong thing. Right? And so it can go on. Like she wasn't able... She had difficulty having sex for a decade with her husband. And you know, just again, mental health, pelvic health. Right? What am I doing? What am I doing wrong?

    Dr. Anna:
    But even in just like with the pelvic floor therapy, the muscles that are through the vagina, and again thinking about the psoas muscles, being able to do that trigger point release, that pressure onto the pelvic floor and allow those muscles to relax and release, teaching her husband to do that as part of foreplay, as part of their open, honest, loving communication. And as they did this as an exercise, as a loving attention to each other, she had been able to completely heal from that condition without anymore doctor's visits, injections and everything else along the way. So I thought, I think it's really important to know that it's not very common, but there's a lot of women that are experiencing it.

    Dr. Brianne:
    A lot, women and men. I'm actually working on a project for men coming up that's about that exact condition as well that men are dealing with too. It is big, and the sexual impact is huge. I remember one of my early clients that had severe pelvic pain, she actually came back to me a year later with her baby and she was so... I mean because she hadn't been able to have sex at all. She'd gotten married, they'd not been able to have sexual intimacy, penetrative intimacy because of her condition. And then she went through therapy, things got better quite quickly and she got pregnant almost immediately. So that was an amazing success story.

    Dr. Anna:
    Yeah. And so if someone's dealing with that too, again, just it's not in your head. As Brianne said, it's like, "Okay, we got to address this issue. We have to address the issue." And don't deal with it. And if you're not getting an answer, if you're not getting help, you got to keep looking. You got to keep looking. And your book, Lady Bits goes into this. So again, I recommend your book. I recommend your teachings, I recommend your lifts. So that's bit.ly/femlift, F-E-M-L-I-F-T, and they can get your free series. Thank you so much for sharing that with us, Brianne. Now what final parting words would you like to say to our audience of listeners?

    Dr. Brianne:
    I would just want to say, I am leading a group called Fem Squad, which is a group of women that have come together to get a little more one-on-one support from me, but they're also coming together because of community. And one thing that really stuck with me from this group that ties into our pelvic health and mental health theme today is she said that, now that she's found a group of women who get her, who understand what she's going through, she says, "The loneliness is gone." And again, it gave me heart shivers thinking that she had been so lonely, and some women have said, "I didn't even really know I was so lonely before having people that I could talk with about this stuff. Because before I just didn't talk about it. But now I know that I can."

    Dr. Brianne:
    And so, I guess my last word would be to know that you're not alone and know that there are groups out there, not just mine, but there's other places you can go, and at the very least just go to my YouTube channel and other great YouTube channels out there that are growing and popping up or social media accounts that are talking about pelvic health, because this is becoming a much more open topic, thank God. And it's wonderful. It's wonderful to know that you're not alone. So make that loneliness go away, if maybe you didn't even know you had it. But yeah, it can go away.

    Dr. Anna:
    It can absolutely go away. So pelvic floor exercises till we die, right? Bri, thank you so much for joining us, and I encourage our listeners, I want to do a quick product spotlight for Julva, my anti-aging cream for the vulva, because I was looking on our testimonials. We have over 800 five-star testimonials on at dranna.com for Julva and thousands and thousands of users. But this one is from Joan and she is a 70-year-old woman and she wrote in a five-star review at dranna.com. You can read it here, and she said, "The vaginal dryness I've experienced for many years has been steadily decreasing over the past month. Years ago I tried Premarin but stop quickly because of the risks and how it made me feel. Julva felt good from day one. I am over 70 years old and I'm very happy with the results. I'm also inspired to more regularly do my Kegel exercises. For the first time in years, I am enjoying pleasurable sexual activity."

    Dr. Brianne:
    That's wonderful.

    Dr. Anna:
    I know, right? Isn't that beautiful?

    Dr. Brianne:
    Yes, that's the great one. Yes.

    Dr. Anna:
    So, so good. There is no age limit on good pelvic health, right? There is no age limit.

    Dr. Brianne:
    Definitely not.

    Dr. Anna:
    Well, thank you. Thank you so much for being with us today. I encourage our listeners with a bunch of gratitude to really love your pelvic floor, right? We say Couch Talk is shameless, guiltless conversation, and this is exactly where I want you to embrace your body, whatever condition you're in now, however old you are. And if you're not getting help, get help. Definitely get Dr. Brianne Grogan's book, Lady Bits, because it's a great read and it's easy and it's designed for you to start working and helping yourself. And just again, having the words, the verbiage that we need to really make some changes and make some improvements.

    Dr. Anna:
    So we honor our pelvic floor. It is not just for passage of babies, it is not just for sex and passage of sperm, right? It is a hugely important pelvic organ that is necessary for the rest of our life, our pelvis and our core, the strength. We do it till we die. We just do these exercises and love on our pelvic floor, nourish it and good diet, good exercise and good habits, all of that promote a healthy pelvic floor.

    Dr. Anna:
    So I want to thank all of you for listening today, thanking our guest, Dr. Bri, Just again for being here with us. And I want to thank all of you too for your reviews. Your reviews on our podcast, your reviews on my products, that makes a big difference because each and every one of you help spread the word and the love of what we're doing here. My goal is to educate, inspire, and somewhat entertain, right? Give you hope that there is something that you can be doing today and tomorrow that is going to give you a better tomorrow. So thank you all for being here.

    Dr. Anna Cabeca

    Dr. Anna Cabeca

    Dr. Anna is a Triple Board Certified OB/GYN, Anti-Aging Medicine expert, and author of the best selling book, The Hormone Fix.

    Dr. Anna helps women heal the 9 most dreadful symptoms of menopause with natural, safe solutions. Follow her for content on hormonal imbalances, vaginal dryness, menopause (and more) that are medically backed, and created to empower women — not just treat them.