353: Do You Pee When You Laugh?



Katie Tredo And Ashley James

We hear “pelvic rehabilitation,” and we think “women giving birth.” Hold that thought. Katie Tredo, a physical therapist specializing in pelvic health, explains how pelvic rehab can benefit men and women, adults and kids alike.

 

[00:00:03] Ashley James: Welcome to the Learn True Health podcast. I’m your host, Ashley James. This is Episode 353.

Hello, true health seeker, and welcome to another exciting episode of Learn True Health podcast. I’m excited to bring you today’s interview because the information is so life-changing for those who need it.

Even if you don’t have pelvic floor issues, you’ll want to listen to today’s episode because she also teaches preventive measures to help us sustain a healthy pelvic floor. Every woman knows someone who has pelvic issues. This is a big deal, and a lot of people don’t know that there is help.

Today you’re going to learn about the natural and effective ways to create a healthy pelvic floor. For some people, it will be life-changing information, so I’m very excited to bring this to you today.

Please visit learntruehealth.com because in the show notes of today’s podcast, there are some free resources that have been provided for us. Also, while you’re at learntruehealth.com, I want to let you know about a few other resources I have created for you. We have a 7-day workshop that’s delivered by naturopathic physicians to teach you the foundations of health. You should apply for that. It’s free.

Just go to learntruehealth.com and put in your email, and every day you’ll be given a video by one of the naturopaths that I’ve worked with. Also, on the website, in the menu bar in the upper right-hand corner, if you’re on a desktop, or click on the little menu bar if you’re on your phone, there’s ‘Ashley Recommends.’ That takes you to a part of Amazon where I have picked out all the things that either past guests have talked about being helpful or I have in my home that is helpful for me–kitchen gadgets, and all kinds of wonderful health goodies, including my absolute favorite replacement for the microwave, if you are like me and you don’t use the microwave because you know of the unhealthy effects that microwaves can create. If you’ve never heard of that and you’re going, “Oh, my gosh, wait! I use the microwave every day. What’s going on? I put my plastic container in the microwave. What do you mean that that’s unsafe?”

Yes, absolutely. We’ve talked about it in past episodes. I wouldn’t get into details here, but there’s a replacement for the microwave that is safe and healthy. I have it in the kitchen section. Just go to learntruehealth.com and click on ‘Ashley Recommends.’ From there, you will see my absolute favorite health gadgets and wonderful goodies.

There are lots of resources on Learn True Health website, including most recently we’ve started to transcribe all of the interviews that we’re posting. You can go to the most recent interviews at learntruehealth.com. You can read what the guest has said, which is so helpful. The feedback listeners have given me is that they listen to episodes sometimes two or three times while taking notes because of how valuable the information is that’s been delivered by the experts I have on the show. Now, it’s going to be a lot easier for you to be able to go through that information because we’re transcribing the interviews!

Thank you so much for being a listener. I know you’re going to share this episode with those you love because, ladies, if we pee when we laugh, that means we have pelvic floor dysfunction. We can correct it. Men can have pelvic floor issues as well.

If we have a pelvic floor issue, we can have pain, incontinence, pain during intercourse. For children, they can have problems potty training or wetting the bed. This is not just a female issue, but it’s very common for women after giving birth to have a pelvic floor dysfunction. The most common thing we hear from women after we have had a few children is that we pee when we laugh. Guess what? There’s a way to correct that. You’re going to learn it right now.

We are in for such a treat today. We have with us Katie Tredo. She’s an amazing physical therapist who specializes in pelvic health.

Is it only for women–the pelvic rehabilitation?

 

[00:04:45] Katie Tredo: No. I treat men, women, and children.

 

[00:04:48] Ashley James: This is cool. I know before we record, we were talking about postpartum health. When I think of pelvic rehabilitation, I think of women after giving birth, and how messed up we are in that area. That’s interesting that what you do can help everyone.

 

[00:05:09] Katie Tredo: I see a lot of women who have never given birth, too.

 

[00:05:12] Ashley James: Interesting. Just yesterday morning, I was with a girlfriend. I said something funny, and we both keeled over laughing. She said, “Stop it. You’re going to make me pee.” Of course, I was already peeing. I didn’t know that this was such a common problem that women can develop after having children. I was told that I should see a pelvic rehabilitation practitioner because there are exercises and things we can do to restore a pelvic floor, so we don’t have these accidents every time we sneeze, cough or laugh. That piqued my interest in hearing what you have to do, but you do so much more than that.

We’re going to get into your story, and what is pelvic rehabilitation, how do you know that you need a pelvic rehabilitation. But before we get into all that, I want to let listeners know that Katie is actively in our listener Facebook group, the Learn True Health Facebook group. She’s going to do a giveaway for the listeners.

After you hear this episode, please come into the Facebook group and join the giveaway. It’s a little bit unrelated to pelvic health. However, it is linked to Katie’s story.

She sells a healthy sunscreen. We’re coming into summer here in the northern hemisphere. I keep seeing articles about how sunscreen enters the bloodstream. It’s scary that this toxic sunscreen sold in the stores have carcinogens, endocrine disruptors, and they enter our bloodstream. We think that they’re protecting us from skin cancer, but they end up damaging us in a different way.

Katie, can you talk a little bit about the natural sunscreen that you sell and that you’re going to be giving away to a listener in the Facebook group.

 

[00:07:23] Katie Tredo: Yes. I partnered with a company about a year and a half ago called, Beautycounter, that’s based on Santa Monica, California. Years back, my husband and I were dealing with unexplained infertility. At the time, we started researching what we are eating, what was in the products we were using, and I was blown away when I learned how many hormone disruptors are in our products that we were using.

At that time, I switched to things I thought were safer, but later learned, as I joined Beautycounter, about different things, that there’s a loophole in the United States, that a company can claim to be paraben-free or phthalate-free and have fragrance on their label. That allows them to put any number of chemicals without disclosing what they are. It kind of undoes the claim on their label. It’s something that exists in the US.

Of course, I’m so curious, going back and looking at what I’m using. Everything in my bathroom had fragrance in it, so that’s a little bit disheartening. I started using Beautycounter with my family and getting more passionate about educating people on what I have learned because, in the U.S., there are only 30 ingredients banned from our personal care products. FDA has virtually no control or regulation over the industry.

By joining Beautycounter, I’ve been able to educate people, as well as advocate at the government level for change in the regulation. It’s been so much fun. Like pelvic health, it’s kind of once you know it, you can’t unknow it.

One of my favorite products with Beautycounter is the Beautycounter Countersun Face Stick. It’s a safe mineral-based sunscreen that I love for both myself and my kids. One of your listeners will get that. It uses non-nano zinc oxide, so it doesn’t absorb through the bloodstream. It’s unlike those chemical sunscreens that are getting a lot of press right now for showing up in the bloodstream. This is not absorbed.

Besides our health, sunscreen also impacts our environment quite a bit. This year, Key West joined Hawaii in banning chemical sunscreen. They do not sell chemical sunscreens anymore because it was killing the coral reef in those areas.

 

[00:09:40] Ashley James: Yeah. I heard that. I heard somewhere in Australia that they also ban it because it was killing coral reefs.

 

[00:09:47] Katie Tredo: Yeah, that could be. I’m not sure.

 

[00:09:50] Ashley James: You mentioned 30 chemicals are banned from our products. Do you know how many are banned in Europe? I’ve heard the number is way higher.

 

[00:09:59] Katie Tredo: Canada has 600 ingredients banned. They’re slightly ahead of us. Beautycounter is in the United States and Canada. Some of our leaders in Canada were just up there lobbying for better regulation in Canada in Parliament this past week. I saw the pictures.

Europe bans over 1400 ingredients. There are 1400 things in Europe that have been found to cause adverse health reactions, and in the US, we only recognize 30 of these. We still have formaldehyde in our products.

 

[00:10:30] Ashley James: No. Not in the products that you sell, but in America.

 

[00:10:35] Katie Tredo: No, not in ours. Beautycounter goes above and beyond. It has over 1500 that they have found that can either absorb in the bloodstream or cause an adverse health effect. They go by the theory that something has to be proven innocent before it’s used in a product.

We don’t wait to find out bad research about the ingredients we’re using. We make sure they’re safe before putting them in. They partnered with Tufts Medical School this year to provide medical research on all the ingredients we’re using.

 

[00:11:08] Ashley James: Cool. Early this morning, I was at Home Depot. I was like, “I ran out of my all-natural household cleaner.” I’m looking through other cleaners. Can I find a safe one? Then there’s this one. It’s called “green” something–I don’t remember the name, but it has the word green in it, so you think, “This must be their biodegradable, non-toxic, all natural one.”?

I flipped over the other side. It has that big warning: “In California, ingredients have been known to cause cancer.” I don’t trust this entire company because they call themselves green in the name. It’s frustrating that company’s try to be “green,” and then they’re using things that are known carcinogens. They’re poisoning their customers because it probably profits them to do so.

So just a recap, in Europe, 1400 chemicals are banned from their products versus our 30.

 

[00:12:13] Katie Tredo: Correct. What’s even more alarming is the last time we had a major law passed on the personal care industry was in 1938.

There is one right now on the Senate floor, The Personal Care Product Safety Act. Beautycounter was largely involved in getting that introduced in the Senate, and now we’re asking people to support that. I like to talk about this because it makes people understand why there is a need for better regulation.

 

[00:12:49] Ashley James: It reminds me of the Wild West where I could start a company tomorrow that sold some face cream or some cosmetic. I can put almost whatever I want in there as long as it didn’t have those 30 chemicals that are banned here, but I can put whatever I want in it.

 

[00:13:10] Katie Tredo: You can take it to another level. The FDA can’t even inspect where you’re making this product. It never has to be tested for safety before it’s sold.

 

[00:13:22] Ashley James: Wow.

 

[00:13:23] Katie Tredo: Right? Alarming.

 

[00:13:24] Ashley James: It is alarming. Learning about our clothing, when we buy new clothing, you always try to buy organic cotton as much as possible. When we buy clothing, the clothing is infused with formaldehyde because otherwise the clothing, when it’s a textile before it’s made into a garment, it could get moldy. They spray it with all kinds of chemicals. People don’t know to wash their clothing after they buy it, and it’s in direct contact with our skin.

My husband got a pair of jeans once from a well-known jeans manufacturer. He just put them on right away. I always wash stuff, but he’s like, “Oh, whatever! I’m in a rush.” He got a full rash from his belt down to his ankles. Our naturopath said, “Absolutely, it’s the chemicals they’re putting in our clothing now. It’s just getting worse and worse.”

We are the ones that advocate. This is me and my soapbox. The Learn True Health podcast helps us all to understand through wonderful guests like you that we need to be the experts in a sense that we need to do a little bit of research before we buy things.

 

[00:14:43] Katie Tredo: Right. Every dollar you spend is putting a vote towards what you believe in.

 

[00:14:48] Ashley James: Absolutely. I love that you advocate for a healthy sunscreen. We’re coming into summer. We all should have a healthy one. There’s nothing wrong with getting sun every day on bare skin. That’s great. But if you do buy sunscreen, buy a non-toxic one, obviously, one that doesn’t have the 1400 chemicals that are banned in Europe in our sunscreen.

All right. That has nothing to do directly with pelvic health, but it does have to do with health in general. It does have to do with your story. Let’s dive into your story, Katie. Please share with us, what had you want to become a doctor of physical therapy and specialize in pelvic health and pelvic rehabilitation?

 

[00:15:36] Katie Tredo: I can admit right now that when I was in PT school, I remember someone coming in. At the time I was in school, we didn’t talk about pelvic health that much, but someone introduced the topic to us. I remember specifically saying in my head, “Who would ever specialize in that?” Here I am. But it’s been a model for everything. Whenever I say I’m not into something, it happens.

I was one of those people who knew what they want to do from a very young age. When I was in eighth grade, I had met a family in my hometown that had a child with cerebral palsy, and I began babysitting. They were such an awesome family. I had an interest in working with children with special needs. They let me go to all the PT appointments. I traveled with them for a surgery their child had. It piqued my interest.

I know from that point on, I wanted to go into physical therapy. I was 100% certain that I would end up in Pediatrics. My first job was a cross between pediatrics and spinal cord injury. I was very fortunate in one of my internships to work with a physician that was working with Christopher Reeves in St. Louis at that time with spinal cord injury.

At the time, he had been asked by John Hopkins to come out to Kennedy Krieger Institute in Maryland and start this international spinal cord center. I happened to be graduating at that time. I was able to jump on and be part of that process, which was an amazing opportunity.

 

[00:17:12] Ashley James: That’s so cool.

 

[00:17:13] Katie Tredo: After about two years, I felt between pediatrics and spinal cord injury, that I was becoming so specialized in an area that if I have to leave Baltimore, which I plan to do someday, where would I ever find a job that would compare to this clinic? We had patients from all over the world flying in.

I met my husband. He had been doing travel physical therapy and was hoping to stop doing that, but I was very convincing. We left Baltimore and started traveling around the country doing different contract jobs. I got a taste of what working in different environments was like. Maybe 15 weeks, I did an outpatient orthopedic practice. Maybe another three months at a nursing home. Seeing the different areas that you could work in as a PT.

I found that I missed working with these major quality-of-life issues. The thing that drew me to pediatrics and spinal cord injury was that you weren’t only treating someone for something like an ankle sprain or an injury that might impact their life, but also you were changing their world. You were helping them to change their world and providing this education to get them beyond that point in their life.

That’s what I’m passionate about within PT. It’s not that I don’t think these small injuries need rehabilitation. Of course, they do. I like working on these big issues.

We were living in Hawaii for a year. I don’t know what it was about pelvic health, but I kept reading more and more about it. I found a pelvic health practitioner in Hawaii. I met with her and made her gave me a list of what classes do I need to do; where do you think I should start; how do I do this.

My husband and I were getting ready to move back from Hawaii, and when I have something in my head, I have to do it right away. On our transition to moving to Boulder, Colorado, I had a four-day layover in Seattle and took my first pelvic health class. I then landed in Denver to interview for a job to start a pelvic health clinic, which was courageous at that time. I wanted to learn as much as I could, so the next several years, I spent flying around taking different seminars and courses, learning as much about the topic as I could.

The type of people that come in my clinic, I know you’ve said like postpartum is what you think of. That is definitely a part of my practice, but the kind of issues that I’m dealing with patients are a few have come in that have such severe pain that’s preventing them from having intercourse with their partner. They can’t tolerate sitting at a meal with their family, sitting at an airplane or a bus to travel. They can’t engage in social activities. Patients have leaked urine and feces, and it can be anywhere from laughing with a friend and having a little bit of leakage to people who feel so isolated that they are afraid to leave their house because they are embarrassed to leak.

And then I work with children. Some of these kids are kids that don’t go to sleepovers because they’re scared they’re going to have bedwetting. They’re nervous about playing sports or be involved in things at school because they’re scared they’re going to wet their pants, and they are beyond the age that that should be happening.

 

[00:20:50] Ashley James: Very interesting. So, it can be anyone. You are saying either it’s a pain or discomfort or that they’re having incontinence in some way. Are there any other symptoms?

 

[00:21:03] Katie Tredo: Yes. I treat people with prolapse. I treat a lot of men as well. My patients with pain can be both male and female. I do see a lot of men who have had prostate cancer and are having incontinence after surgery.

 

[00:21:21] Ashley James: Any other male issues, like erectile dysfunction, or any other issues that are common for men to see you?

 

[00:21:30] Katie Tredo: Sure. Usually, they present with either incontinence or pelvic pain. But along with the pain especially or with incontinence actually, they can have erectile dysfunction as an issue with that. I’m working closely with urologists, so sometimes they’re testing different medications, those kinds of things. But when there is a dysfunction in the pelvic floor, it can impact the blood flow to the area and those sorts of things, so a lot of times men report that their erections improve after doing pelvic floor therapy.

 

[00:22:03] Ashley James: What about women’s sexual issues? Do women find that they have an improvement in sensation with their partner?

 

[00:22:18] Katie Tredo: 100%.

 

[00:22:19] Ashley James: very interesting.

 

[00:22:21] Katie Tredo: I advocate taking a holistic approach with these things. I do work with a lot of patients with sexual dysfunction. While the physical part is part of my job, I like to be in a network of whether it’s a sex therapist or psychotherapist. They can also help these individuals or couples work through some of these issues from more the emotional aspect as well.

 

[00:22:46] Ashley James: Right. Because we beat ourselves up and we feel anxious about it. Maybe we’ve had trauma in our past. We often have emotional issues either around not being able to perform in that area or not feeling good about ourselves in that area. I can see that there are emotions that can come up.

But if someone doesn’t have any emotional issues and then they end up not realizing that there’s not optimal health in their pelvic floor that can lead to sexual dysfunctions, like incontinence and pain and these other things. You can develop emotional issues because you have something physical.

 

[00:23:39] Katie Tredo: 100%. I was looking up some stuff recently about incontinence in particular which surprise me because I thought I’d see more of these with pain which is very isolating and there’s a lot of psychosocial stuff that comes about after realizing that you’re in pain. But for bowel and bladder, which when you maybe leak a little when you laugh, you don’t think this could be that serious, but bowel and bladder incontinence are highly linked to suicidal tendencies.

In one study I read, 70% of people interviewed felt that experiencing incontinence would be worse than death. In the United States, it is one of the top reasons for nursing home admissions. Fecal incontinence is the second reason why a person would put an elderly family member in a nursing home.

 

[00:24:27] Ashley James: Wow! Our society is so different from other cultures. Some cultures would never dream of putting their parents in a home. They take care of them no matter what. But in our society, we want to be very clean and sanitized, kill 99.9% of bacteria with hand soap. We want to be clean. We want everything sterile.

Tell me about this pain that people experience. What is causing pelvic pain?

 

[00:25:07] Katie Tredo: Pelvic pain is a huge area. There are so many different causes and different pain conditions that it’s hard to see in the research what the true incidence of this is because there are so many different names. As a medical community, it hasn’t been standardized.

There can be very different reasons people have pain. There can be nerve pain in the area from the pudendal nerve. Sometimes a hormone disruption will cause pelvic pain or changes in the pelvic floor or the vestibule area, which is like the entrance to the vaginal canal. Another fairly common thing is vaginismus, which is a condition where the pelvic floor is spasmodic. It’s painful. It’s the contraction of the vagina in response to physical contact or pressure and often intercourse.

This is one condition I see a lot of. Often, patients if they have primary vaginismus, maybe as a teenager they tried to use a tampon, and it was very painful, so they just stopped doing it. They avoided medical exams there. Then they go on later, and they’re in a relationship. They have sex for the first time, and they feel like there’s a wall blocking them. Someone descri bed to me that it feels like knives are stabbing them. They think they’re broken. It can destroy relationships. This is truly a problem of the pelvic floor.

Through physical therapy, they can learn relaxation techniques and be educated on their pelvic floor. We do a lot of in-clinic techniques and a lot of education between sessions, the patient working either by themselves or with a partner to relax these muscles.

It’s a terrible condition to have, so I hate when someone walks in and have this. But it’s one of my favorite conditions to treat because someone comes in scared to tell anyone that they have this problem, and they haven’t admitted it to most people in their lives. They feel like their husband has married someone defective. I hear all these horrible self-deprecating stories.

You can sit down with someone and say, “I see people with these all the time, and there are things we can do to get you past this.” One of my favorite success stories was a patient in Maryland. At that time, I had a cash-based practice. For her and her husband, their insurance didn’t have good reimbursement, and it wasn’t feasible to come often. They were both dedicated. I would teach them ways they could work on this at home.

I’d see her kind of spaced out, and then she was getting a litter better–more and more spaced out. Then I stopped seeing her. You always wonder what happens to these people that you’re not seeing. I got an email months later from her, and she said, “Things have been crazy. I never got time to thank you, but I also wanted to let you know that because I was never able to have intercourse or even a pelvic exam, I never in my life thought about preventing pregnancy, and I want you to know that we’re happily expecting our daughter in September.”

It made my day, because here is a couple who had never been able to have intercourse, and they’re growing a family and having pain-free intercourse.

 

[00:28:38] Ashley James: Oh, my gosh! I love it. That’s amazing. One of my midwives or my doula told me, because I was doing Kegel exercise to correct the peeing after laughing from birth, and one of them said, “Wait, don’t do Kegels because sometimes the problem is having the wrong muscles too tight and other muscles too loose.” She’s trying to explain that pelvic floor health is so much more than doing Kegels. Can you talk a bit about that?

 

[00:29:16] Katie Tredo: Yes, 100%. I want to make a side comment too that I love these people you’re talking to because your friend that you’re talking to that recommended pelvic floor therapy and this doula you’re talking to, it’s not common. I can’t tell you how many times I’m in a conversation with women and they laugh that they are leaking urine. Their doctors have told them, “Oh, it’s just part of having kids.” I sound like a broken record in my clinic because I’m constantly telling people, “This is common, but not normal.” It is something you need to work on. It’s something that goes beyond just that little bit of leakage. It’s part of your anticipatory core muscles. It changes the way you move, being injury prone, and all that. I am very excited that you’re having these conversations.

As far as your question, that’s 100% accurate. That is probably the thing I get most–people calling, friends that live in different areas that can’t come in, asking me, “Should I do Kegels?” It is very hard to answer that question because if someone has pelvic floor weakness which is very common, especially after having a child, they can present with incontinence, prolapse, musculoskeletal dysfunctions, back pain. They indeed need to strengthen their pelvic floor, making sure they’re contracting the correct muscles is important, and making sure they’re able to relax their muscles.

I have, on the other side, patients that maybe are experiencing frequent urination and overactive bladder symptoms. They may think that they need to do Kegels as well, but they might have a hypertonic pelvic floor, so the muscles are incapable of relaxing. On those patients, the last thing I’d want to tell them to do is to go home and do 20 Kegels.

It depends on an exam. Whenever I see someone for the first time, I explain that it can be anywhere on that spectrum. Through examination, we can determine where’s a good place to start and an appropriate plan of care.

 

[00:31:29] Ashley James: How do you examine the pelvic floor? I’m imagining it’s like getting a pap smear. In my mind, how else would you examine the pelvic floor?

 

[00:31:40] Katie Tredo: It’s less scary than a pap smear, in my opinion. It’s an internal pelvic exam. There are no stirrups involved. You are lying with your knees bent on the table. I don’t use a speculum or a device like that. It’s using a lubricated, gloved finger palpating the muscle starting very external working through the three layers of pelvic floor muscles. I’m looking for things like tight trigger points or painful spots that may cause pain there or referred pain. Sometimes, they’ll tell me it gives them an urge to urinate, or I might find laxity in the pelvic floor.

Different muscles can be tight, and different ones that can be lax. Then I’ll have someone do a contraction and try to do a Kegel. I see all sorts of things from squeezing just their glutes to squeezing their inner thighs. Sometimes you see one half of the pelvic floor, the right side or the left side, contract better than the other side, and that could be a recruitment issue. Sometimes women tear their pelvic floor muscles, and it’s left undiagnosed. A lot of times we picked up on that when we see you actually cannot elicit a contraction on those muscles.

 

[00:32:50] Ashley James: You’re saying ‘see,’ but what you mean is ‘feel’ because you’re not looking.

 

[00:32:54] Katie Tredo: We need to look at the skin quality and all that, but yes, ‘feel.’

 

[00:32:59] Ashley James: That’s how you would do with an adult female. How would you do it for a male? How would you do it for children?

 

[00:33:09] Katie Tredo: Good question. For a male patient, I usually have them lying in the same position. I start with an external exam, starting right at the groin and sinking into the pelvic floor muscles. I always check externally with the female as well because you get different information.

For a male, you can feel if the muscles are tight and painful there. Are they lax? I’ll have someone contract and relax. Sometimes you can barely clearly feel, and sometimes you can. Depending on the case, we may do a rectal exam, having someone contract that way and relax and feeling. If a male is coming in with pelvic pain, a rectal exam is the best way to relieve these trigger points and teach them how to do self-trigger point release at home.

 

[00:33:59] Ashley James: Interesting. I went to massage therapy college in Canada, which is very different from the States. It’s like a 3,000-hour program. What I learned about trigger points is that–correct me if this is the same thing or something different–it’s a small taut band of muscles that usually where the point of innervation is by the nerve, and that it is cutting off circulation which is creating referred pain. Is that what you mean by trigger point?

 

[00:34:43] Katie Tredo: Yes, 100%.

 

 

[00:34:44] Ashley James: Okay. You can teach people to release their trigger points from the pelvic muscles at home.

 

[00:34:50] Katie Tredo: Yeah. We do a lot of that work in the clinic. I do use a technique called trigger point dry needling in some cases as well, but a lot of people can use devices called vaginal dilators, or there are devices specifically made for the rectum that can be inserted. They’re kind of curved plastic devices that can help you target these trigger points.

They have massage tools like that, too. You’re putting pressure on different points. I have people think of their pelvic floor as a clock, and they go around that clock, and find where are their trigger points, and do these trigger point releases on them.

 

[00:35:32] Ashley James: So interesting. In Canada, in some of our provinces, you can be licensed. We call them registered massage therapist, not licensed. But we can be registered or licensed to do a vaginal massage, and you have to go for more training for it, but there’s so much stigma around it. Yet getting that right before or during labor prevents tearing. What I was so amazed by is that while I was in labor, my OB did vaginal massage. She’s like, “Hey, I’m here. We’ve got time. Can I do it for you?” I am like, “Yes!” I was so excited.

It’s not like sitting down in the spa to get a massage, but I’m so excited that she had the extra training and that she was knowledgeable. Our OB happened to be on vacation when the baby finally came, so I got a different one, and I have not met her before, but she was perfect. She was perfect. She sat down and said, “Can I do vaginal massage on you?” It was awesome.

I think we have a lot of stigma in our society. We’re afraid still. In some ways, as women, we look at how we’re dressing and how we’re acting in society, and we’re not prude in some ways.

But then, in others, what is going on? We’re still stuck in 1930 when it comes to talking about our pelvic floor health. We’re so closeted. The idea of having a vaginal massage for health or vaginal PT for health–this is not sexual. This is health. It’s done by a practitioner who’s trained and safe. Releasing that stigma, I think, is important.

 

[00:37:50] Katie Tredo: 100%. It’s sad to me that this stigma exists within the female culture. Some of it is just historical. Pelvic floor PT is becoming more popular because women are finally talking about these things. You’ll see more things on the news. Cosmopolitan last year had a big article on childbirth injuries bringing awareness that this stuff happens.

This isn’t to throw any physician under the bus, but unfortunately, pelvic PT wasn’t taught, or a lot of doula stuff was never taught in medical school for a lot of the doctors practicing now.

For me, and later on I’ll talk a little bit about the postpartum culture in our society, but I was blown away because here I had been practicing pelvic health for years before I had my children. I moved to Wisconsin. I was pregnant with my twins when I was here. I was going from doctor’s office to doctor’s office introducing myself, marketing what I do and getting very discouraged when OBs weren’t sending their patients into me. I thought maybe they don’t have faith in what I’m doing or whatever.

Then I had my kids. I had a twin pregnancy and twin vaginal delivery. I also was heavily trying to market to my physician. I went to my postpartum eval showing ready to tell her, “I’ve done a self-exam. This is what I think is going on with myself. I don’t have a diastasis. I think I have this.” We never even got to that part in the conversation. I was blown away. I realized doctors are not recommending pelvic PT because they don’t believe in it.

They’re not even checking for the things that we see people for. Again that’s not their training, so I shifted in my focus with marketing to educating physicians and why they should consider sending patients to us saying, “Not only you have to examine them for this, but if a patient mention this, that’s a reason to send them to our office.”

They’re checking for things at the postpartum visits like, “Are you still bleeding? Do you have any signs of infection?” They’re looking for major medical things.

More often if you have incontinence, which by six weeks postpartum is not normal–that should resolve before four weeks postpartum– they’re not necessarily checking if you have a prolapse or if you have a painful scar. I left feeling, “Wow! I’ve been practicing for years in this specialty, and I know what I have, and I know who to see for it. What if I didn’t know that and for years wondered what is going on with me?”

That’s what I see. Often, people that I’m treating for postpartum issues aren’t coming in six weeks or six months after having a baby, sometimes its years or decades after they’ve had a child.

 

[00:41:04] Ashley James: I have a friend who’s had five. She’s probably listening to this. Hello! Can a woman who has given birth to multiple children even years later go to a pelvic rehabilitation practitioner and see success?

 

[00:41:24] Katie Tredo: 100%. Sometimes I’ve had patients that have big problems for their first baby, no problems after their second or third. It varies, and there are always things you can work on. Something with moms, and I recently did an Instagram post about this, is our postures and our muscles change while we’re pregnant. Often, we have these compensatory movements or different movement strategies because our transabdominals are stretched out, our pelvic floor has gone through trauma, our diaphragm is not able to descend as it’s supposed to.

All of a sudden we’re not pregnant anymore, but our bodies are stuck in these positions, and we keep on reinforcing those movement patterns, and we never take the time to rehab those muscles that need to be part of the pelvic floor, diaphragm, and the transabdominals. These are anticipatory muscles that before we move, they fire.

They’ve shown these in healthy subjects that helps stabilize us, that helps keep us continent. It helps keep our breathing normal. A lot of time I do see people years later, and they can do great. I always advocate for earlier intervention, but I think it’s never too late. I’ve had people in their 80s and 90s even come in with incontinence that has gotten completely better.

 

[00:42:50] Ashley James: That’s exciting. To complete our conversation about the exams and sort of what to expect when someone comes in to see you or another pelvic rehabilitation practitioner. For children, how do you do that examination?

 

[00:43:10] Katie Tredo: With children, it is not invasive at all. Honestly, with children, education is the biggest thing. It’s a lot of education for their parents. A lot of these things someone could work on.

Anyone listening who has a child who’s having problems with bed wetting or incontinence, start paying attention if your child is constipated. It makes everything, and when I say everything like my adults with constipation have worse bladder leakage. They have worse pelvic pain. All of these conditions are compounded with constipation.

The biggest piece of advice to parents is to make sure your child has a regular bowel movement, having enough water, having enough fiber, having enough physical activity. That’s the biggest things for parents.

A lot of these kids go to school, and they dehydrate themselves all day long. They never want to take a drink of water because they’re afraid that they are going to leak, or they’re so distracted and busy at school that they are not doing that.

One thing I see, a lot of teachers and a lot of students are not allowed to go to the bathroom at a lot of schools during their class which can cause some problems for kids that really need to go.

A lot of it are basic things as far as making sure your hydrated and not constipated. When children come in, I have some children’s books that have pictures of how the body works, and how food and urine go through your body.

We do things like toileting positions. The child can be fully clothed, but we’re working on, “Can you contract your muscles to stop pee?” Then things to get the pelvic floor to relax so that they can void or have a bowel movement. We’ll do a lot of things like blowing bubbles with it or learning these breathing patterns, doing it through play.

 

[00:45:05] Ashley James: I love it.

 

 

[00:45:07] Katie Tredo: Sometimes we’ll check the perineum and the skin because we do need to check that the child isn’t having this red, irritated– physical therapists at most states now have direct access, and so if I see something that potentially could be an infection, I need to send them out to a physician who can treat that.

Then I’ll press along the groin, if I have the child’s and the parent’s permission, as the child contracts and relaxes, to see if any spots on their body are painful.

 

[00:45:41] Ashley James: That is very interesting. Do you have any advice? I know it’s hard because we don’t know what’s going on. You don’t tell everyone to Kegels because that could be the exact opposite of what they might need. So we can’t tell all children that are having incontinence, “Imagine you’re pulling everything up into you,” or try to give them some imagery because we don’t know if those are the right muscle groups for them to be exercising.

 

[00:46:18] Katie Tredo: We are very far from this in our culture. Nobody knows about the pelvic floor, that it exists until there’s a problem or until they’re having a baby. I think it would be great if we could teach children that there are muscles in their pelvis, and that if they have to go to the bathroom, and they have to hold it, to squeeze those muscles that are holding that urine and feel what that feels like, and then for these muscles also to be able to relax for them to be able to void or to have a bowel movement.

The good thing with the child knowing that they have muscles that control this is when there is a problem, they know it. I see a lot of adults who never know it was an issue or that it was something they could help.

When girls get to puberty too, they’re more prone to musculoskeletal injuries and different things just because of our development and hormonal factors and structural factors in our body, but we’re never taught that.

 

[00:47:22] Ashley James: Between the ages of 15 and 18, once every three months, I was twisting my ankle, falling down. I didn’t understand, and now I understand what was going on. My body was changing so fast that I didn’t know where the center of my gravity was. I just thought I was a klutz. Thinking back, I haven’t tripped or had any of those problems in years and years. It was only because our body is changing so much during our teenage years that we can be prone to accidents because everything is changing, and we don’t know where we are in gravity.

 

[00:48:05] Katie Tredo: This happens again in menopause actually, so be prepared. I think what happens is there are often changes on the pelvic floor whether because of hormonal changes and things. Sometimes people can develop secondary va ginismus, like that pain I’ve described before, but its due maybe to hormonal changes or menopause, or they can develop incontinence as part of that as well that they get vaginal atrophy.

At the same time, you see people losing their balance and having morefalls. One thing that I try to talk to other PTs about that treat orthopedics and want nothing to do with the pelvic floor is that those are not separate issues.

Back pain—it’s not a separate issue. If there’s a problem with the pelvic floor muscles, you’re going to present with another problem. So I encourage PTs on their screening form and probably any practitioner to have, “Do you leak urine?”—just a very simple question.

If someone’s coming back and they’ve had back pain over and over, or hip pain, neck pain, jaw pain, and you’re not getting anywhere with the techniques you know, and you noticed that they have written that they’re also leaking urine. There is a problem in those anticipatory muscles, and their core is not intact. That needs to be treated as part of the problem.

 

[00:49:32] Ashley James: In someone who’s walking, can you see in their gait that they have issues on their pelvic floor? Does it affect the body so overtly?

 

[00:49:40] Katie Tredo: That’s an interesting question. You can definitely in their posture. People move differently when they have a problem with their pelvic floor. You can sometimes tell from how someone is standing. I always look at posture when I’m looking at a patient because oftentimes someone stands in that posture, a pelvic tilt, with their tail bone kind of tucked under.

If anyone listening right now goes into that position and they try to contract their pelvic floor, what you’ll feel is maybe a little bit of a contraction on the anus, but a lot of gluteal muscles contracting.

If you come to a better seated or standing posture with more of a neutral spine, restoring that lumbar curve, you try to contract, and you can feel that that contraction moves anteriorly. You’re getting your pelvic floor muscles. Often, positionally, even with gait or just static standing or sitting, we can change the body’s ability to recruit these muscles.

 

[00:50:36] Ashley James: That’s so cool. I had a question pop on my mind. I’m not quite sure how to form it. More people than we are aware of have suffered from sexual assault. It’s one of those topics that is still not completely open. Unfortunately, the victims are left to feel that it’s their fault, and they’re ashamed of it. Some victims even have it in childhood.

Have you ever had patients who’ve come to you with pelvic issues, and in the discovery, you found out that they were sexually assaulted? Does the sexual assault injure the pelvic floor, or the emotions around it cause them to use their muscles in a different way, so it creates an injury?

 

[00:51:43] Katie Tredo: Yes, 100%. Traumatic events like that can cause people to develop these holding patterns, that clenching on the pelvic floor. People clench their jaws or those upper trapezius muscles. Trigger points on the pelvic floor are no different. Often, if someone has been sexually assaulted, they have been holding that pelvic floor tight and trying to protect themselves. They do develop pain. They also have a lot of psychological damage done from that. I have seen this in my clinic probably more often than you know. I’m glad they come in, but it’s sad.

What I do with these patients is I always tell them that you do not have to do internal work if you’re not comfortable with it. I say that to anyone whether they are traumatized or not. I explained that for me to get the most information from this exam, an internal exam is what is best, but if someone is not comfortable, that’s not best for them then.

A lot of these patients, I explain to them, “Let’s start with working on diaphragmatic breathing because you probably had never breath into your belly ever” or “Let’s work on some of the stretches.” Happy baby pose in yoga is one of my favorite for opening the pelvic floor. Sometimes having their feelings validated, someone willing to work at their comfort level. I make sure that they have seen a psychologist or know of one or get a referral for one. I explain to them that that is not my specialty. I am there to walk them through this and to work with them, but it will be beneficial for them also to see someone.

These patients do great because you can give them the tool they need. If it’s something like, “You need to work on this on your own at home,” if that’s what they’re most comfortable, sure they come back less frequently, you progress their exercise program, and you answer their questions. Often these patients end up becoming more comfortable in allowing an internal exam and internal work.

What I work out in those exams, we don’t do it for very long. It will be a very limited treatment there. I make sure the patient stays present with me. One thing I’ve noticed in my patients, and I’ve one that’s particular in my mind, always I see her eyes go up, and it was like she wasn’t paying attention anymore. I could tell when she’s dissociating from what is happening in her body.

It had been a technique that she had learned because she had to. She had been abused for so long. I try to keep people present with me. “Is this painful if I move your leg this way or if you contract or relax?” or “If we add pressure here, does that decrease the pain?” I keep this conversation going up. “What makes the pain better?” “What makes it worse?” “Let’s find a technique together and try to breathe into that spot.”

Sometimes you can only do that for a couple of minutes before the person is gone, but they continue to improve in that. I think getting back in their bodies and working with the psychologist on that is important as well. That can be beneficial for them because they’ve spent so long just tightening up and blocking people and blocking themselves from feeling anything.

 

[00:54:59] Ashley James: Have any of those patients shared with you that they were surprised that the pelvic physical therapy was cathartic, was a healing process for them emotionally?

 

[00:55:13] Katie Tredo: Yes. I have had several patients that I don’t even think they were even sad. It’s just like these tears would just come out. More so like, “I can’t believe I don’t have pain right there.” Do you what I mean as they were getting better and doing that?

I’ve had experience in a patient who didn’t know that she had been sexually traumatized until very recently. She had been by a priest. She blocked that out of her head, and she thought because it wasn’t sex, that she hadn’t been molested. When recent news had come out, and people were talking about it, “All of a sudden, she had this breakdown because she had been molested in her childhood, but had made excuses for it and blocked it out of her head.

She happened to be seeing me at that time. We took a break from physical therapy completely for her to do more talk therapy, working with her body, and ways with a psychotherapist. Then, she came back and did fantastically, but she was coming in for bowel and bladder symptoms, and it wasn’t what she was expecting was related to it.

 

[00:56:26] Ashley James: So were the problems because she was holding herself tight for so long?

 

[00:56:30] Katie Tredo: I think so. I think that played into it. She has also had a couple of children at the time. I think for her, it was a lot of urinary frequency and difficulty fully emptying her bladder — a lot of things that go along with having a tight pelvic floor.

 

[00:56:46] Ashley James: You see these commercials, like the Depends, the adult diaper commercials. They make it sound like this is something to expect, especially for women when they’re in their golden years.

You’ve said that you’ve had even women in their 80s come in, but the marketing is making it sound like when women are older, they’re supposed to pee themselves.

What you are saying is that it’s common, but it’s not normal or healthy. If 50% of the people walk with a limp, we would say it’s common, but that doesn’t mean it’s normal. It’s not supposed to be that way. It’s like people are walking around with an injury, and we’re being told by all the marketing that this is normal. It’s just part of aging, or it’s just part of having kids, or it’s just part of life. But it’s an injury, an imbalance we’re walking around with. It is not optimal health.

 

[00:57:52] Katie Tredo: Yes. We see this in every industry, but people are making billions of dollars off of these, so why would they want you to know that you could get better? But 100%, it is common, but not normal. We kind of put in our heads, it’s either after a baby or as we’re getting older, and that’s when it’s normal to experience this. It’s not normal in either of those cases.

 

[00:58:19] Ashley James: I haven’t yet gone to a pelvic rehabilitation practitioner. As I’m thinking about it, I’ve been putting it off, because it’s not that big of a deal. “So what? I pee a little when I laugh — no big deal. I’m busy. I’m a mom. I’m an entrepreneur. I’m putting my business and everything else.”

I’m just seeing this. I’m looking at my thinking. I’m thinking like how many women do this? We’re putting everyone else first, and we’re putting our health on the back burner. I keep saying myself, “I’m going to one eventually. In the future, when I have some free time, I’ll make time for my health.” How many of us do that? Now that my listeners know about pelvic rehabilitation, don’t be like me and put it off for years.

What you are saying is that the incontinence is a symptom and that the problem can be far greater, even though that’s the only thing you’re seeing. Maybe you’re not having discomfort or pain, but maybe you’re just seeing that you pee a little when you laugh, but that is actually causing more damage. Can you talk more about that? What’s the damage of continuing life with this imbalance?

 

[00:59:39] Katie Tredo: It can vary. Obviously, incontinence can become worse. I like to describe the course as a soda can. If you imagine you’ve had the respiratory diaphragm on top, the pelvic floor on the bottom, and the transverse abdominals coming around, and the multifidus on the back—those four muscles make up your canister, your core. These muscles should contract first, and they should stabilize and allow you to move from there to prevent injury anywhere in your body. They keep us continent. They keep us breathing well.

Like a soda can, if you imagine, pop open that can—whether its diastasis recti and you have lost your abdominal tone, you have this bulging herniation at your abdominals or pelvic floor weakness—how easy is that can to crash? You have no stability there anymore. It’s a balance of pressures on our body that’s there.

There was an article in the Medical Research, and I’m just going to read the title of it because it’s my best article to bring to a physician’s office and say, “Look at this. It changes what you think.” They found that disorders of breathing and continence, the diaphragm and the pelvic floor, have a stronger association with back pain than obesity and physical activity.

So what do we tell people when they have pain in their body? “You need to lose weight. You need to exercise.” But these disorders of the diaphragm and the pelvic floor are more associated with back pain than any of those things which are important as well. So it’s a huge problem.

One other thing, as far as how you said you don’t get help for it and how our culture feeds into this, it’s a little off that path, but I think with postpartum women, we are constantly marketed to how fast you can lose your baby weight and how great you can look right after you have a baby. If you’re on Facebook or Instagram or any of those, how many times a day are you marketed, “Join me and lose all this weight.” They’re these hard exercises that people are doing, and a lot of these women have never rehab their pelvic floor or their transverse abdominals.

I’m someone that believes that people can get back to everything after having a baby. I think after most of these that if you rehab correctly and you improve your movement patterns, the goal is to get back to all these. I would never want to tell one of my patients that they have to stop running or they have to stop doing anything.

When I was working in Maryland, I was asked to talk at a CrossFit gym, and I was a little taken back because at first, I didn’t know how this would go. I would see some of these women in these CrossFit gyms doing exercises that I knew they probably shouldn’t be doing.

One thing I was asked in Maryland was from an owner of a CrossFit gym to come in and talked about peeing while you exercise. I don’t know how to approach it exactly because I knew a lot of these women were peeing while they’re exercising because they have never rehab themselves properly to be able to do the type of activities they were doing.

I said, “That’s not normal. I’d love to talk about it.” She said, “Really, it’s not normal? You’ve got to see this YouTube videos,” and she sent them to me.

It was these interviews of someone at these CrossFit competitions going up to people and going, “Do you have the workout pees?” or “Do you pee while you exercise?” All these women like, “Yeah, I lift all these weights. I do all these hard exercises. I pee in my pants. I’m wearing a diaper right now.” I’m thinking, “What are we promoting in our culture that makes this seem like it’s a good thing or normal?”

It took a lot to get these women to step back. I said, “This isn’t that you’re never going to do these exercises, but you need to step back and learn how to move better before you can get back into these exercises.” There were people that came up to me and said, “I’m not going to see you if you tell me I have to take a break from this.” Of course, they never came to see me.

I do challenge people to think about it. We think about the pelvic floor so different than other parts of our bodies. If you strained your hamstring and you were playing a sport, you would rest. You’d work n stretches and strengthening. You’d ice. You’d do all of these things to rehab. You’d gradually get back into your exercise or your sport as you could tolerate because your hamstring was your weakest link. You wouldn’t push past and further injure yourself.

If we think of the pelvic floor as the weakest link in these situations, exercise to your weakest link. Maybe you can do a certain amount of reps or a certain amount of weight and stay continent, and you gradually increase that. But the second you train your body, “I’m going to keep jumping 800 times in a row,” or “I need to lift these weight that’s so heavy, and I completely lose bladder control,” you’re not training your body to move better.

They do want to help people. We have to look at the system. It was 1910, around there, the Flexner Report was created.

People can go on Wiki and see this but Carnegie—maybe he was the richest, I don’t know—who was one of the richest people in the United States at the time owned a pharmaceutical company. He wanted to influence the marketplace. He had a man go throughout the United States and create the Flexner report, which is, at that time, a list of all the doctors who are practicing allopathic medicine, which is a pharmaceutical-based medicine. At that time in history, we have to imagine what we know is not what the world was like back then.

Back then, you could see a chiropractor, osteopath, you could go to an herbalist or a homeopathy practitioner, and everything was an even playing field. You could become any of these different types of therapists. You could become a student of them at any of these universities or these colleges. Everything was an even playing field.

Then Carnegie invested millions of dollars. He put colleges out of business. He told the colleges and universities that he gave his money to that they had to stop teaching anything that had to do with types of therapy that competed against pharmaceutical medicine. He was able to change, and he created what we know now.

Everyone goes to an M.D., and everyone is put on a drug. Seventy percent of adults in America are on at least one prescription medication. We grow up in a system, and we didn’t realize that we think it’s normal. You go to an M.D.; you get a drug.

But back in 1910, right around then, it’s when Carnegie was influencing all the schools. The schools were influenced to teach a certain curriculum that he agreed to, which would then teach doctors to push the drugs and not natural therapies. So, if you have a bunch of people who are peeing themselves when they get older, then you can sell them a drug that might prevent peeing or sell them diapers or whatever.

 

 

[01:04:47] Ashley James: Interesting. I’ve worked with trainers before, and they always start with the core. Before we do anything, we’re going to strengthen your core because there is no point in having you do deadlifts or whatever when you have a weak core.

Everyone thinks when you say core muscles—what are your core muscles? My abs and my back. Everyone thinks abs. Let’s work on your core—your abs and your back or maybe your butt. But no one thinks about the pelvic floor as being part of their core.

That’s interesting because when it was described to me by Jennifer who’s been on the show before. She’s a 20+ years’ Pilates instructor. She says that the pelvic floor, imagine it’s a big salad bowl that’s sitting in your pelvis holding everything up. It’s holding your bladder and your bowels. It’s holding your uterus for women. It’s holding everything up, and it’s a big salad bowl.

She helps people to understand that they’re walking around with their salad bowl spilling out because their salad bowl is tipped forward or tipped to the side. Looking at and respecting the pelvic muscles are just as important as a part of our core. It’s there a bit subtler. You’re not going to do crunches.

 

[01:06:19] Katie Tredo: Right. The thing that people don’t realize is that the rectus abdominals are not part of our core. They’re very external muscles, and yet everyone wants them because it can do a six pack, but that’s not part of our core. If you just work on your rectus abdominals, you’re not strengthening your core.

 

[01:06:36] Ashley James: Your core is needed for stability, and so you’re saying that those with weak core end up injuring themselves more. As they get older though, they’re more prone to falling and injuring themselves.

 

[01:06:49] Katie Tredo: It can go the opposite way, too. We talked about fixation or immobility. We need our pelvic floors to be mobile and stable. It is this constant kind of balance because we need our muscles to be very mobile. We need them to expand to have babies and to have bowel movements, urination, and all of that. We need its stability to move and do all those things.

We end up at one side of the spectrum or the other, whether it is a very weak, stretched pelvic floor or if it’s a very hypertonic and painful pelvic floor. We’re going to have problems involved in those situations.

 

[01:07:31] Ashley James: Is this kind of physical therapy fairly new, or can you see when looking back in history that there are types of therapy, or there are cultures that focus on pelvic floor health throughout time?

 

[01:07:52] Katie Tredo: I don’t know when pelvic floor therapy started in the U.S. I know I’ve been doing it for ten years, and there have been therapists doing it way longer than that here.

There are definitely techniques taken from other cultures that we’ve learned about. I think some midwives in other cultures have been doing some rehab for the pelvic floor.

This isn’t really to speak to the historical aspect of it, but one thing I’m blown away by is I used to work outside of Washington D.C., and I had the luxury of working with people from all over the world because their jobs took them there or their partner’s jobs or whatever. It was eye-opening to me because I had a lot of patients from places like France and Germany that would come right after their postpartum check-up.

I’d say, “What brings you in today? What’s the problem?” They say, “You tell me. I’m here for my postpartum check-up.” It was refreshing. Some of these patients needed ongoing PT for a little while. Some of them, I gave them tips. We worked on their posture, made sure things were moving well, and I said, “Call me if you’re having any of these problems in eight weeks or whatever.” It was ingrained to them that having a baby is a physical event, and you need rehabilitation after. You’re going to go because why wouldn’t you take care of yourself after an event like that.

It’s just not the way it works in the U.S. We don’t support preventative medicine. We don’t necessarily take care of our moms after they have a child. We’re looking at getting people back into the workforce as soon as possible, losing your baby weight as soon as possible.

I think that’s damaging to women. I think more and more people are talking about it now, and there’s a huge demand for this type of therapy.

I encourage any physical therapist who is at all interested in working on this to take some training, even a course or two under your belt. It’s enough to help the most basic things and know enough to refer someone to someone more specialized later because there are just so many people not getting help.

 

[01:10:04] Ashley James: Absolutely. I’ve talked about this before on the show with other practitioners. Looking at the history of modern medicine—I wouldn’t get into it too deep, but it’s a very interesting topic to dive into to understand what’s influencing our modern-day practitioners.

We go to an M.D. or your OB, and we’re expecting them to know about other resources. If we tell them we’re peeing when we laugh, they should know to tell us to go for pelvic rehabilitation.

I’m not vilifying M.D.’s or any doctor. I think there are individuals who get into medicine because they do want to help people. We have to look at the system. It was 1910, around there, the Flexner Report was created.

People can go on Wiki and see this but Carnegie—maybe he was the richest, I don’t know—who was one of the richest people in the United States at the time owned a pharmaceutical company. He wanted to influence the marketplace. He had a man go throughout the United States and create the Flexner report, which is, at that time, a list of all the doctors who are practicing allopathic medicine, which is a pharmaceutical-based medicine. At that time in history, we have to imagine what we know is not what the world was like back then.

Back then, you could see a chiropractor, osteopath, you could go to an herbalist or a homeopathy practitioner, and everything was an even playing field. You could become any of these different types of therapists. You could become a student of them at any of these universities or these colleges. Everything was an even playing field.

Then Carnegie invested millions of dollars. He put colleges out of business. He told the colleges and universities that he gave his money to that they had to stop teaching anything that had to do with types of therapy that competed against pharmaceutical medicine. He was able to change, and he created what we know now.

Everyone goes to an M.D., and everyone is put on a drug. Seventy percent of adults in America are on at least one prescription medication. We grow up in a system, and we didn’t realize that we think it’s normal. You go to an M.D.; you get a drug.

But back in 1910, right around then, it’s when Carnegie was influencing all the schools. The schools were influenced to teach a certain curriculum that he agreed to, which would then teach doctors to push the drugs and not natural therapies. So, if you have a bunch of people who are peeing themselves when they get older, then you can sell them a drug that might prevent peeing or sell them diapers or whatever.

 

[01:13:32] Katie Tredo: Or surgery,

 

[01:13:35] Ashley James: Thank you. I’m getting to that. Surgery is another thing that they can sell you. Again, I’m not vilifying any individual doctor. Maybe listeners have gone to their doctor and told them that they pee themselves. The doctor said, “We have a drug or have diapers,” or “This is just normal,” or “Here’s a surgery.”

This is what medical schools teach because it would harm profits. Think about it–if doctors learned how to cure people, so they no longer needed drugs or surgery, then it would put industries out of business. The whole system is set up in a way to keep people stuck.

I think there are a lot of good people in the system. I think a lot of people are breaking out. I’ve interviewed a lot of M.D.’s that have broken out of the system and gone, “Wait a second. There’s way more than just drugs and surgery. What am I doing?”

At the same time, I love that drugs and surgeries are available should I need them. We want it, but it’s only one tool. It’s not “the” only tool. It’s one tool in our tool belt, and there are a hundred other tools, like what you do, which is get to the root cause and help people heal at the root level.

I want all the doctors listening, and all the patients listening. Let’s educate our doctors and let them know that there is a better way; that we don’t have to get on a drug or get surgery for peeing ourselves. If we have pelvic pain, there’s a viable therapy that gets to the root cause.

 

 

[01:15:13] Katie Tredo: I have had experience of working with absolutely fantastic doctors and learning from them too, and being able to observe some of their surgeries, and coming in for their exams, and having these discussions. I think more and more doctors are learning about this. To their credit, as you said, they did not learn about a lot of these in medical school.

My entire practice up until this past August was in private practice. For the first time, I’m working as a pelvic floor therapist in a hospital system. It has been wonderful to work with physicians, to start programs, and talk to doctors about how we may able to help each other.

One thing with surgery, for a long time with prolapse, for patients that was their option. That’s it—do a surgery. Depending on the doctor you go to, a lot more are saying, “Try physical therapy first.” A couple of my favorite surgeons in this area are huge supporters of pelvic floor therapists. It makes sense because if you only do surgery in the people that need that surgery, you’ll going to have better outcomes yourself as well.

One thing I’m working on educating both patients and physicians right now is the idea of pre-op surgery. Prolapse, for instance, I’m not going to say that everyone that walks in my door, I cure their prolapse. I don’t even take credit like that. I teach them to do things. I have some patients whose symptoms are 100% resolved, and they never need to have surgery. I have some patients who are borderline—”We’ll see how you do in therapy.”

I’ve had patients coming off the street into my clinic. I have them bear down, and their bladder is physically coming out of their vagina. I say, “I have a name of a great surgeon I’m going to send you to, and I think you should strengthen your pelvic floor as part of your rehab.”

It’s knowing each other’s specialties, who you can help and who you can’t help. I tried to educate my patients that if you go to somebody—my favorite thing is when a doctor says, “I don’t know. Let me find someone that does,” or “I don’t know. Let me look that up.”

Whether you’re going to a PT or a chiropractor or a doctor, if they think they know everything, that’s frightening to me. I’d much rather have a doctor say, “You know what, that’s not my specialty. Let me give you the name of somebody who it is.” I would much rather hear that.
Unfortunately, a lot of doctors still when they don’t know something, they dismiss the patient’s complaint. One thing that breaks my heart that I hear over and over still is a patient will go into her OB or her primary care doctor and say, “I’m having painful intercourse.”

When you say that, you’ve become vulnerable. You’re opening up to a very private part of your life. I can’t tell you how many times a patient comes in my door, either recently or years earlier their doctor’s advice to them was, “You just need to have a glass of wine and relax before you have sex with your husband.” It’s 2019. If someone’s willing to open up with that, find someone that can help them. Even if you think it is in their head, send them to a psychologist. But there are physical reasons for this pain.

I’m never under the belief that everyone will get better with what I do. I do need to refer out to other practitioners a lot. I think that working together is something that our medical field needs to do more of.

 

[01:18:57] Ashley James: As a patient, we should have the idea in mind that we are creating a team of holistic experts or a team of experts to surround us — hopefully, a lot of them holistic, but a team of experts. We want them to talk to each other. We want this team to inform us and help us to make the best choices, and we ultimately are the final deciders in the therapies that we’re going to participate in.

A doctor is not to put up in a pedestal. If your doctor has hubris or an ego, then fire him and get one that can step down from their ego and say, “You know what, I don’t know the answer. Let’s get the information. Let’s go find out.”

 

[01:19:42] Katie Tredo: Right. There is a lot of dangerous stuff by Googling stuff. One positive thing is if you can’t find the doctors, then get a physical therapy evaluation. A lot of times, most states don’t require a physician’s referral. If your particular insurance does, call your primary care doctor, any doctor you know, any nurse practitioner, and have them write a script for physical therapy. It’s rare that someone would say no. When you go to that specialist, whether it’s a pelvic PT or whoever you’re working with, and you have a problem, they probably have a physician to recommend for you because there are a lot of fantastic doctors out there.

 

[01:20:19] Ashley James: Absolutely. You’re just reminding me of Kristen Bowen. I don’t know if you’ve listened to her episodes. She’s the magnesium soak lady.

 

[01:20:27] Katie Tredo: Yeah, I’ve heard a little bit of it.

 

[01:20:32] Ashley James: She told her sisters—she had given birth to, I think, three children at that point—she started peeing after laughing, that kind of thing. Her sister went, “It’s time for you to go get the surgery.” She went to the doctor, and the doctor was like, “No problem. Let’s do the surgery.” They took a tissue from a cadaver, made a little hammock, put her bladder in it, and then use titanium screws to screw that little dead tissue hammock to the bones on her pelvis.

When she woke, she started having 30 seizures a day for two or three years, and she got down to 70 pounds. Then they finally convince the doctor/surgeon to take it out, to remove it. Most of her seizure went away. She got down to three seizures a day. She thinks she had an autoimmune response to the titanium, and also the tissue that was used. It turns out that they think that it was black market tissue because it was not tattooed with the code on it which it was supposed to.

She was not given any choices. She wasn’t told, “Let’s get examined by a physical therapist that specializes in pelvic rehabilitation,” or “Let’s give it a few months of exercises and see if that improves.” It was just immediate, “Oh yeah, you’re peeing when you laugh. It’s time to get the surgery.”

I understand that prolapse, if the bladder is coming through the vagina, then maybe it’s so far gone that PT wouldn’t help that person get back to where they need to be, but that they can use the physical therapy as rehabilitation.

Surgery should always be, unless its life-threatening surgery, should always be a choice you make after we’ve tried other options, like try a few months of physical therapy. It should be mandatory—if it’s a surgery that isn’t life-threatening, it should be mandatory that we at least try a few months of physical therapy first to see if we could make headway or see if we could prevent the surgeries because surgery is dangerous and life-altering, life-changing.

 

[01:23:10] Katie Tredo: That whole idea of having physical therapy first—I try to tell my patients, and that’s something I’m working on that I didn’t get to do much. When you tell someone that this might be able to prevent you from having surgery, I always tell my patients worst case scenario, you still need the surgery, but you’re rehabbing your pelvic floor, and you’re learning new movement patterns. You are learning how to properly void and not strain when you have a bowel movement.

All of these things you’re doing are going to optimize the results of your surgery. You’re changing the things that are contributing to you prolapse in the first place, so when you have that surgery, you’re not going to need it redone right after because you’re going to know how to move.

It just gets me when I get someone that’s post-surgical, and they have been straining their entire life. How did someone have surgery for prolapse and had not been taught how to toilet without straining? That’s just contributing to the issues.

I feel like pre-operative physical therapy cannot only do that but in men with prostate surgery, if these men came in for one visit pre-operatively, I think we could cut back the number of PT sessions they have after. By the time they come to me, they’ve developed very poor bladder habits.

It’s things a lot of people do anyway, but if they know not to do these things, and they know how to do a proper Kegel, when that catheter is pulled, they can start strengthening right away. They would be less frustrated, more educated, and prevent the secondary problems that they can cause with their habits.

 

[01:24:50] Ashley James: What about hernias? Can pelvic rehabilitation help with preventing or healing hernias?

 

[01:25:02] Katie Tredo: I treat a lot of patients for diastasis recti. If someone has a true hernia or umbilical hernia, they’re also seeing a surgeon depending on how severe it is. I’m not sure the answer to that question actually.

 

[01:25:19] Ashley James: For those who don’t know and I know because I have it, can you explain what diastasis recti is?

 

[01:25:27] Katie Tredo: Diastasis recti is a split in the rectus abdominal muscles. Sometimes during pregnancy or men with beer bellies or women with beer bellies, it’s not just pregnancy that can cause tearing in the linea alba or that white fascia when you see a picture of the muscular system between the abdominal muscles. When that splits, you see a bulge there, or you can usually sink a few fingers in between. That’s how it’s measured actually, so it can disrupt how you’re moving and how load transfers through your body.

 

[01:26:04] Ashley James: You can help people to heal it?

 

[01:26:07] Katie Tredo: Yeah.

 

[01:26:08] Ashley James: Very cool. How about inguinal hernias?

 

[01:26:11] Katie Tredo: The patients I see with hernias, either had a hernia repair, or they were sent to me with a questionable hernia. By working on the pelvic floor and the core, their symptoms went away. I’m not sure that they ever had a hernia.

 

[01:26:26] Ashley James: Thank you. That’s what I was getting at.

 

[01:26:28] Katie Tredo: I think it’s more of a misdiagnosis.

 

[01:26:30] Ashley James: Yes, I was misdiagnosed with a hernia, and it was diastasis. How do you say it?

 

[01:26:38] Katie Tredo: Diastasis recti.

 

[01:26:40] Ashley James: Thank you. Diastasis recti which is common for people to have or having some symptoms in their pelvic floor because it’s out of balance and its appearing like it’s a hernia. You do the work, and then the symptoms go away. So, we don’t need to know if it was a hernia or not because you’ve strengthened whatever was weak.

 

[01:26:58] Katie Tredo: Right.

 

[01:26:58] Ashley James: Very cool. This has been wonderful. I like it when practitioners share tips or exercises, but I’m getting the feeling that it’s personalized. You can’t tell us all to do Kegels because that could be making it worse for some people, but making it better for others. Is there any kind of advice, very general, applying to 100% of the population—exercises or advice that you can give us?

 

[01:27:25] Katie Tredo: First thing I keep talking about how with constipation that people strain and can’t have a bowel movement, so if anyone listening is sitting, I’m a huge fan of those squatty potties. Have you seen those?

 

[01:27:44] Ashley James: Yes. Every toilet in my house has a squatty potty.

 

[01:27:46] Katie Tredo: Same with mine. That’s great. You want your knees above your hips. You want your pelvic floor to be able to relax.

If everyone listening tries to do a Valsalva or pushing or bearing down motion, try doing that, and you’re probably holding your breath. As you do that, you’re holding your breath, what is your pelvic floor doing? When you’re doing that, you should feel like the pelvic floor is contracting and lifting up.

That’s not allowing for a bowel movement. Now if you sit and you let your abdominal relax, your pelvic floor relaxed, and I want you to blow out as you bear down like you’re blowing bubbles. Not a forceful air but just [blows].

Do you feel your pelvic floor dropping down and widening? How simple is that? I mean that is something I work with patients coming in from GI doctors, surgeons, and different people.

You’re an adult, and I had you pretend to blow bubbles, and we’ve just fixed your constipation problem. That’s a big thing—this breath holding pattern—that reflexive tightening of the pelvic floor. That’s one thing I like to tell people.

Another thing is—because it’s such a common issue—bladder issues. Some very simple things that a lot of us have been taught wrong when we were children is stay hydrated. The general recommendation is drinking half your body weight in ounces. I think this varies a little bit between people but in that fluid. That doesn’t mean drink half your body weight in soda. It means you want at least two-thirds of your fluids to be plain, flat water, so no carbonation.

Then you can have some things that have bladder irritants, but if you’re having a problem watching those bladder irritants–everything good like caffeine, carbonation, sweeteners, acidic foods, tomato products, some spicy foods. Some of these things can irritate our bladder and want the bladder to contract sooner and empty.

Pay attention. Some people don’t have a problem with that, but if it is contributing to your issues, make sure you’re at least diluting those irritants by having a good amount of water.

A big thing I hear—I had just someone come into my clinic, and I was like, “Oh, no. Go home and tell your daughter you didn’t mean that.” She was like, “I always teach my daughter never to sit on a public toilet.”

What we’re training to do, it’s very different than in third world countries where they have this deep squat that relaxes the pelvic floor. When you’re hovering over a toilet seat, you are in a contraction, and you’re teaching your bladder that it’s okay to contract or relax.

She said, “But she could get all those diseases on the toilet seat.” I laugh because I’ve never heard of anyone catching a disease from a toilet seat. I want to make a public service announcement that the toilets will be a lot cleaner if everyone just sat down and stop peeing on the seat. Maybe that could be the takeaway.

Then no going just in case. I have to catch myself saying this to my children, but every time you leave the house going, maybe you’ll be going half an hour, you’re going to go just in case because you’d hate to have to void half an hour into your shopping trip.

What you’re training your bladder what’s normal is that the bladder fills to a certain capacity. It’s only half full, but you’re letting it empty every time it gets to that point or way sooner than you’re even getting that first initial signal that you need to go, you’re now training your bladder that when it’s at that capacity, it needs to contract and empty.

People come in saying, “I’ve always had a small bladder. I’ve always known all the time.” They’ve trained their bladder to do this. What’s normal is three to four hours, so if you’re getting it within that time, you need to go and void. If half an hour, you’re getting this message, see if you can distract yourself. Do a few quick pelvic floor contractions. Give yourself positive affirmation. See if you can even stretch it 15 more minutes. You’re gradually training your bladder to get back to that normal bladder interval that can hugely prevent a ton of problems with urinary frequency.

Those are my everybody could learn from those. Moms and dads, stop telling your children to keep going just in case and never sit on toilet seats.

 

[01:32:29] Ashley James: I laugh there because in my mind you just made the bladder like a lithium-ion battery, where you want to wait till it’s fully empty and then fully recharge it, not just plug it in every time it is 75%. You don’t go pee when you have 25% full bladder. You should wait till the bladder is full, and then pee because it helps tonify and stretch the bladder.

 

[01:32:55] Katie Tredo: Right.

 

[01:32:56] Ashley James: That’s some pretty good advice right there. I have been doing a little bit with our son who’s four because I don’t know when he was going to need to go pee. Sometimes he goes like hours without needing to go. I’m like, “It’s been all afternoon, and you haven’t needed to go. You should go right now.” He’s like, “I don’t need to.” And I’m like, “You should. You haven’t gone enough.”

 

[01:33:14] Katie Tredo: Kids sometimes have a holding pattern. That’s important, too. It is tough with kids. I have three kids. I’m not going to lie. When we have to stop, and one of them has to go potty, it is extremely inconvenient and very challenging to have all three of them in a stall. Sometimes, I don’t follow my advice, but I feel like the best we can.

 

[01:33:34] Ashley James: Do the best you can. Excellent. I like it. Wow! Thank you so much, Katie, for coming here.

 

[01:33:42] Katie Tredo: You’re welcome. Thank you.

 

[01:33:43] Ashley James: Absolutely. You shared a lot of great information. Did we get to everything that you wanted to share? Was there anything else that you wanted to make sure that you covered?

 

[01:33:51] Katie Tredo: I think I covered everything I was thinking of. The one thing maybe I’ll mention just for people who like numbers or someone out there who’s just learning that this is common is some of the recent statistics in the research, just as far as after childbirth what women are experiencing. Twenty-four percent of women have pain with intercourse a year and a half after childbirth; 77% have persistent back pain a year after childbirth; 49% experience urinary incontinence one year after childbirth.

That’s half of the women are experiencing what you said. They’re talking with their friends. They’re laughing. You have a baby, you go home, you pick up this heavy car seat carrier, and you’re doing all of this stuff. It’ s not that surprising, but these are all reasons.

Twenty-nine percent of people have undiagnosed pelvic fractures after having a baby, and 41% of undiagnosed tears on their pelvic floor muscles. If you’re pregnant out there or having children or have them ten years ago, if you’re having any of these problems, get yourself looked at and evaluated.

I am happy, to the best of my knowledge, to give you resources, and how to find someone who’s trained in pelvic floor therapy, and be available. As Ashley said, I’m on her Facebook page, so if you have any follow-up questions or anything like that, I’m happy to try to help you find someone near you.

 

[01:35:18] Ashley James: Yes, please join the Learn True Health Facebook group. You can go learntruehealth.com/group, which will redirect you to the group or just search Learn True Health on Facebook.

Katie, we’re going to make sure your information is in the show notes of the podcast on Learn True Health so those who want to connect with you can. I know mainly you work with people one on one. You want to see them physically, but I know that you have also worked with some people over Skype as more of a consultation to help them to find the right practitioners for them.

For those who want to reach out and talk to you, we’re going to make sure that your information is on the show notes of the podcast of learntruehealth.com.

 

[01:36:04] Katie Tredo: Perfect.

 

[01:36:05] Ashley James: Excellent. It’s been a real pleasure having you here today. I want to implore the listeners to please share this episode with your girlfriends or the female family members of yours who are pregnant or have had kids because the more we spread this information, the more we can finally get this to be—

As you said, 50% of women are having pelvic floor issues even a year after birth. Half the population should be seeing a pelvic floor specialist for one thing or another even if we can do some corrections. It’s like going to the gym for our pelvis, and do some corrections, strengthen and stretch the right muscles, and hopefully, prevent a lot of things from going wrong in the future.

 

[01:36:58] Katie Tredo: Yeah, and we’ve talked a lot about how behind our culture is in treating these conditions we’re talking about. If we think women have it bad, men are like in the Dark Ages still because now doctors finally recognize these things in women, but these poor men are—I can’t tell you how many times I see someone for pelvic pain.

When a man has pelvic pain, 95% of the time, they do not have an infection, and 5% they have actual bacterial prostatitis. These men are given round after round of antibiotics and told that this is prostatitis.

I want to make that last mention because I probably see 70-80% is female and 20-30% male. I do focus a lot of my education on females, but these men need help too. I feel like there are not enough people talking about the problems that men have.

 

[01:37:52] Ashley James: Right. Because there’s shame in having pain in that area. Then you go to a doctor, and they’re like, “It’s probably an infection. Let’s treat it.”

Like you’re saying, most of the time it’s not an infection. It’s a pelvic floor issue. This is just eye-opening. Getting on round and round of antibiotics that aren’t needed is so damaging.

 

[01:38:14] Katie Tredo: It is, and discouraging. Not to mention if you keep seeing someone and you’re not getting better, it’s depressing.

 

[01:38:21] Ashley James: Right. You said that there’s an increased chance of depression and suicide in people who suffer from this pain.

You’re doing some really important work. I’m excited I had you on the show today. We allowed everyone to know and shed some light on this very important topic. I’m excited to continue this conversation in the Facebook group, the Learn True Health Facebook group, because I know we have a lot of great listeners wanting to thank you and also wanting to share their own experiences. So, thank you, Katie. This has been great having you on the show.

 

[01:38:53] Katie Tredo: Thank you. Thank you for allowing me to talk about this. It’s actually Pelvic Pain Awareness Month. My passion for this lies in educating people and teaching them about this. Thank you for giving me that platform.

 

[01:39:04] Ashley James: Happy Pelvic Pain Awareness Month.

 

[01:39:10] Ashley James: Are you into optimizing your health? Are you looking to get the best supplements at the lowest price? For high-quality supplements and to talk to someone about what supplements are best for you, go to takeyoursupplements.com, and one of our fantastic true health coaches will help you pick out the right supplements for you that are the highest quality and the best price. That’s takeyoursupplements.com. Be sure to ask about free shipping and our awesome referral program.

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