Navigating Menopause: Your Guide to Pelvic Health

Today on the Menopause Uprising Podcast we are talking to the Founder and inspiration behind LWF Physiotherapy, Laura Ward. Laura graduated from Brunel University in 2006 and after working extensively in MSK Physiotherapy, she decided to upskill and transition to become one of only a handful of Full-time Specialist Women’s Health and Pelvic Physiotherapists in Ireland.

Laura is passionate about clinical excellence and providing a high-quality service in a caring, compassionate and understanding manner. Being both a Mom and a Leading Clinician she understands what it takes to fully Recover from a Women’s Health and Pelvic perspective, but it is her experience that really sets her apart, in that she understands that everyone is different and she can tailor the process to fit Your Needs. HERE is where you can follow Laura on Instagram.

Transcript -Automatically Generated
Welcome to Menopause Uprising with me, your host, Catherine O'Keeffe. The Baraka test. Have you ever heard about it? Pressure free, leak free, pain free. Why constipation is the second most prevalent reason for prolapses. Today, I was joined by Women's Health Physio, Laura Ward, and we had a Huge conversation on all things women's health, all things pelvic health, no stone unturned.

We covered many aspects of the perimenopause to postmenopause journey. I hope you enjoy today's podcast and please do leave a review on whatever device you're listening on. Thank you.

Laura, welcome to Menopause Uprising and I'm thrilled to have you join the podcast today. To start, let's talk about French women, and this is something I know close to both our hearts in relation to when a woman in France has a baby. Automatically afterwards, the first step in the postnatal treatment is that they get a number of weeks working with a women's health physio to make sure that their pelvic core health is as it should be after, you know, going through labor, etc.

We aren't in that position in Ireland, but we should be, right? We absolutely should be, Catherine. I mean, um, I'm in a position working privately that I get a lot of women coming for a six week postnatal check. And even after that, Catherine, a lot of these ladies don't have any symptoms at six weeks or they have had symptoms.

It would have been in the early stages postnatal, but at six to eight weeks, they're more or less feeling, you know, I feel pretty good. There's no incontinence, I'm not feeling pressure. And then we're doing our examination on their abdomen and their pelvic floor function. And listen, without fail, we're picking up.

Some differences in what we would like the muscles to be doing at that stage, which is understandable because there's six weeks. Um, oftentimes the muscles have, uh, well, they, they stretched up to 400 percent there. Yeah. 400. I'm here looking at my diagram here with my hands. I don't have it with me. Um, But the superficial pelvic floor muscles stretch up to 400%, okay?

And the deeper ones stretch up to 150%. I think what a lot of women don't realize is an episiotomy is a second degree muscular tear. It's on the right side, usually. Okay. So there's a lot of superficial perineal trauma. Um, that happens with a vaginal delivery. But even if we go before the vaginal delivery with the pregnancy, pregnancy alone creates a lot of length and load on these tissues.

So regardless how you have delivered your baby, whether it be by cesarean section or vaginal delivery, there is a process of recovery and healing. And the stages these women are at, at six, eight, 10 weeks afterwards, their bodies are naturally recovering. And if we can identify specific needs for that individual, and I, I'm really, I'm really Be specific to that individual, not this kind of generic, do your pelvic floor exercises.

We can work alongside their healing and really optimize their health going forward. We're in that absolute gold period of really that first 12 weeks, Catherine, if we can get women in at that time and as much as there's lots of environmental changes, but support them, uh, with the recovery and educate them and really.

You know, I, I start speaking to women very early on in their postpartum journey about forward thinking about perimenopause and things like that. But yeah, so listen, we're not in that position at the moment, which is so unfortunate because I really think we could offset so many women's health problems going forward.

And that's, I think the, the nugget there is that goal period, because if those challenges start postnatally. Then they're not going to improve themselves unless you get help, which means if we then move on to, maybe there's further pregnancies, but then if we move on to, and we're into perimenopause territory, things start to change.

And if you've, If you haven't had the, you know, if you haven't been fortunate to work with the women's health physio and kind of understand the importance of looking after your bladder and so forth, then it really can add to the challenges of menopause, right? Absolutely. And I think when women, Postpartum and those years afterwards are asymptomatic.

They kind of think they've come out of this time unscathed and we don't have to worry. But the muscle, the pelvic floor muscle, um, can do very well day to day, but still be weak. Okay, so you don't have to have this whopper of a pelvic floor muscle to be continent. There can be an underlying weakness or hypertonic, but because that lady mightn't be very active or maybe the occasional cough sneeze, they have that little mild leak, but it's nothing to kind of prompt them to maybe do something about it.

And that's it. They're unaware that there's actually changes within their pelvis that potentially going forward when they hit perimenopause and menopause is really going to start becoming a bigger issue. So again, you know, even with women who I'm saying are asymptomatic, which means they have no symptoms of pelvic health dysfunction, um, It doesn't exclude them from having symptoms later on.

Also women with cesarean sections, it does not exclude them for having symptoms later on. What we're looking to do in our assessments is, even if there's a functional pelvic floor, how can we better this? How, like your dental health, how can we, you know, Get the most out of this going forward for you. And also it's not necessarily that you've had to have a pregnancy that you could lead to issues down the line with your pelvic health.

Right. Just when you talked about there, that underlying weakness. So I know I've shared this story with you before. So that's what happened to me. So I was just probably a year, year and a half into perimenopause. I just started running. I was doing couch to 5k, which a lot of women do. So that's, you're the example of.

Maybe haven't been doing that high impact exercise. And then perimenopause comes, yes, I want to do it. Yeah. Yeah. And, and all of a sudden I realized, Oh, there's something not right here. Um, and luckily, um, I, um, I had already postnatally gone to, um, a local women's health physio, um, Maeve Whelan. So, um, I did that.

Yeah. She's just amazing. Um, so I went back to that again, but for me, if I hadn't. If I hadn't gone out that day running, I would have been none the wiser. So if, if you're none the wiser, how do you know? I think, um, that's, it's a really, that's really, um, hard to know because it is the higher impact exercises.

will tell you that there is maybe a dysfunction there because when we are loading our body and our pelvic floor, so when we're single leg loading our landing with running or double leg jumping and landing, we have a way increased ground reaction force, velocity, and intra abdominal pressure down through the pelvis.

So if there is a little bit of a weaker, um, Uh, point to the muscle it usually comes up in those activities. Okay. So when you're not doing them again you're unaware and then often time perimenopause we get the spark of I better do some exercise and we start doing this impactual exercise and then we have a leak and we get a fright.

And then often time now Catherine not. In your case, thankfully, with that leak, you go, Oh God, I better not run. Or I'm going to put on the liners. I'm at that stage in my life. I understand this is why I see all these advertisements on it. But in actual fact, like you said, it's, it's, it's a lovely, not lovely.

I know this. It's your body telling you there's a little bit of something happening there. And. If it's at that point, Catherine, that it's just getting you with running, it's really at a very manageable point and just come. And oftentimes it's, it's working with, um, coordination and reflexive training of the pelvic floor.

So getting it to kind of work a little bit quicker, uh, with movements of impact. So, yeah. So, I mean, it is hard to know. Um, and I think it's really important to be able to say, Hey, this is where I'm at if you're having no symptoms, but again, just like you might just check in with your dentist or you check in to get your bloods done, check in if you've never had a check before, it's a really good baseline assessment that we could be able to say, this is where you're at and this is what I would like you to include in your training and to be honest with you, Catherine, I want every woman to be doing impact training, every woman.

Yeah. To a certain extent. And I think, you know, one of the requests that was out there as part of the women's task force with the government was that, you know, in an ideal world at the age of 45, you'd get a little letter in the post that was your perimenopause check. And that one part of that check would be that you would have a review with a women's health physio.

I think it is so important. It's as important as your doctor. It's important as your counselor, anything else, because like that, you don't want to not run. You don't want to not do exercise because then that has other impacts, psychologically, physically, weight, et cetera, you know? So it is really, I think it's really important.

And what I found like that, it was just. Just tweaking, understanding the muscles. And then also, um, what I do now is I wear EVB shorts as well. I find them really brilliant for running. There's always a solution. Like we can always find something and it mightn't just be pelvic floor training, um, Catherine, to keep women leak free.

with exercise. There's other solutions like the EVBs, um, there's little pessaries that you can insert inside the vagina, which basically, if you think of it like, you know, someone who's had an ankle injury and they have a little bit of instability in around their ankle, oftentimes they would wear a little splint.

So something similar like that inside the vagina. So, you know, the message is that it's just, um, not to abstain from these exercises. It's For me, the damage of abstaining from cardiovascular and high impact exercise is worse than symptoms of pelvic health going forward in terms of medical, medically.

Okay. So if you're doing those high impact exercises, are they going to benefit? Your pelvic health as well. Yeah. So there's a fine line. Okay. So if I go back to that kind of postnatal lady, um, even if they haven't a big desire to go running or do like, um, conditioning style exercises, if they're at a certain point of, um, their pelvic floor, uh, range of motion, power, endurance, I then want to really work on their coordination and their timing, get this muscle so reactive, um, to be quick in the moment with impact.

So that would kind of resemble like a cough, a sneeze, um, a vomit and how I could best emulate that to get them to, you know, work through that at home would be a little bit of jumping or a little bit of skipping, but I always work to the point of a symptom. So even if, um, ladies are like, well, a lot of women come in and I can't jump, I can't do jumping jacks.

Okay. Fine. Do some jumping jacks for me, please. Let me see where you're symptomatic. And they might get to five repetitions with me and then they've had a leak. So just like we train for a half marathon, we can't just go out and do a half marathon. So you can't just go out and do all your jump jacks and skipping.

We have to train the muscle system. Around that. So it's breaking that down. Maybe change their, how they're landing, um, their repetitions, timing of when they're doing the exercise through the day, but still doing it. Yeah. And still doing it to the point that they're feeling comfortable and confident.

Oftentimes with incontinence, and we're talking about stress incontinence here, women will get a little bit of a warning sign and then it'll happen. So if I can get them training at home, um, to the point of that little warning sign and they stop. They go back to it a little later on and they do it again.

But by doing it in a controlled, comfortable fashion in their home, they're starting to train that muscle for higher impact. Okay. Does that make sense? Instead of just going through it. Yeah. So you're building up slowly. We're building up the stamina of the muscles. So oftentimes we would start with even just a heel smack.

So go up on your tiptoes, smack down your heels. And I usually say if the boobs are wiggling, the bladder's wiggling. So the bladder's wiggling, the pavichlor has to catch that basically. Okay. And we're working with that. Then we might start doing a little bit of single leg jumping or single leg jumping down off a little step and then progressing to maybe double leg hopping.

Progressing to skipping or if that person is like, I can't do jump squats in the gym. I can't do jump jacks in the gym. Then we're getting more functional to what she needs to do, but it's building it up. Yeah. Gradually. Yeah. Gradually. And trying to also test out in different environments. So morning time is going to be different than evening time.

Having a bladder that has just been emptied is going to be different than. Not having gone to the toilet, um, an hour before. We're trying to train the muscle system to react to all eventualities like wood. If you do a cough or sneeze or things like that. Why is morning different to evening? Generally we're a little bit more rested.

So we have a little bit more, uh, it says muscle energy in the morning. Um, if they have gone to the toilet, um, and they haven't drank loads overnight. So we just usually have a better, uh, tolerance for exercise in the morning in terms of our pelvic health symptoms than we would in the evening time when we're a bit more tired.

Yeah. And the other thing is when we're sick, our pelvic floor is sick as well, you know, oftentimes, you know, women get really distressed that they've done so, so well with having, you know, symptom free days and they've come so far with their recovery. Then they have a flu or something like that and they've been symptomatic, you know, and I always say to them, listen, just like you wouldn't 5k run when you're sick.

Right. have the flu because you're tired, you're sick, your muscle system is not working great. Same with the pelvic floor. So just give yourself a little bit of understanding in those moments if you are not feeling well. Yeah. And I think that's an important one, isn't it? Because you can make so much progress and you can, you get a cough and like, you know, that's going to be one that you're definitely, Oh God, have I made no progress?

Whereas you have, it's just a little step back to go forward. It's a little step back. And you're sick. Your pelvic floor is sick. Yeah. Yeah. Yeah. And when we look at, um, let's say the strength training in particular, because this is something I've recently started strength training myself. Yes. I'm loving it.

Yes, absolutely Loving it. I love it. But I think for me, um, I wanted to, I had a DEXA scan on. Yes. I wanted to make sure my bones were in a good place. You know, there wasn't anything I had to be aware of, but for. It's so important as you go through perimenopause, menopause, postmenopause, that strength piece, because when we look at it, you know, why are, why do most women end up in nursing homes?

It's generally because they have a fracture, broken bones, et cetera. So, I always kind of say doing that strength piece in your 40s like, gosh, you're just really setting yourself up for success. So if say, if someone wants to just go to the local gym, they just want to start doing some strength training, what you really want to do is.

them to do is just to kind of hone in then on the bladder and just kind of see how it reacts. And listen, when I first started, um, doing women's health physio, like I, we used to probably cue the pelvic floor to contract with your squat and do this, you know, contract and so on. Your muscle will respond to the task in hand.

Okay, so as we're sitting here chatting, our pelvic floor is doing what it needs to do to keep us content. If you are lifting, um, just say 20 kg bar on your back and you're doing a squat, if you're symptom free in that movement, so pressure free in the vagina, leak free, pain free, your pelvic floor muscles as your other muscles are working to support and control that movement.

So you are actually strength training your pelvic floor because obviously it's demands have been increased because you're loading it up. Does that make sense? Yeah. Now, if that person came to me and said, when I squat, I feel pressure, right? That's a different story. We now need to break down that movement and make sure that we are getting the, I suppose pressure changes, right?

Because every exercise creates pressure in the. abdomen and the pelvis. So we're trying to get to the point that we are symptom free. We might reduce down the weight a little bit. We might reduce her range of motion in that movement, but not take it away because a squat is a very important movement. Okay.

Does that make sense? Yeah. And just like we're building up for your half marathon, you're building back that reserve for that muscle. Now we might be looking, um, you know, uh, doing a observation or examinations, vaginal disease or anything else going on that we can bring to the table. And they might be doing isolated pelvic floor exercises, but just remember like a lot of women, um, you know, if you're doing strength training, your pelvic floor and your symptom fee, your pelvic floor strength training with you.

And it's a really good way to maintain pelvic floor strength. That's brilliant. That's just where you said that. Pressure free, leak free, pain free. So last night I was doing, I was introduced to goblets, um, squats. Lovely, big wide legs for goblet squats. I was saying to the guy, I was like, so is this a goblet of wine?

Like what's included here? Um, but I have to say, I loved, I loved them, but that's another thought for me now, because all I was concentrating on was, Getting the action right and making sure that you're, you know, you're balanced, you're not putting pressure on the back or whatever. But that's a nice other step for all of us to now think about is, are you feeling any pressure, um, in your, in your pelvic area?

Are, are you feeling a leak? And there's another question. Will you always feel the leak, Laura? Are, and I guess where that leads me on, there's probably two things here. And this is a, this is something we do need to talk about is sometimes this assumption that I'm getting older, I just need to start wearing a pad.

No. Yeah. Like, yeah, a couple of things there. Do I always feel a leak? No. So there's a lot of women who would experience more. Um, the, the way they would experience their leaking is just a feeling of dampness throughout the day. So they're not, aware of this kind of little trickle or the gush that you would typically hear.

Um, that could be down to a little bit of urge incontinence. So kind of as they're walking around throughout the day, the bladder is doing a little bit of a contraction and there's a little bit of a sensory issue that they're not really feeling. And it's so small, it's just like a little trickle. Okay. Um, there's two little valves through the urethra, um, Catherine, there's the intrinsic sphincter or the, yeah, and then the extrinsic sphincter.

The intrinsic sphincter. It's one of those things like life that weakens as we get older. Um, the extrinsic sphincter is working off your pelvic floor. So if you're strengthening your pelvic floor muscle, you're actively strengthening your extrinsic sphincter as well. So again, um, you know, the, the, what we're trying to do.

Good. And then with pelvic floor training and those women that might just feel quite damp throughout the day is to start strengthening those extrinsic sphincters a little bit more going forward. But no, it doesn't often just feel like a gush. Now that said also, Catherine, I think when women have had a leak and they know it's a leak, sometimes they can come become very, um, paranoid obviously about leaking and they forget then that when we exercise.

Or day to day in a hot day like today, there's sweat and there's discharge. And I often, you know, if, if women are like, I'm unsure, I will get them to maybe do a smell test. Um, urea has a very kind of strong smell, whereas discharge and sweat would be more sweetie. Um, or if they're really unsure is to do a Baraka test.

Um, so they would wear a liner, they would drink Baraka maybe twice a day and Baraka will stain our. Urine really yellowy, like fluorescent, I think it was Maeve Whelan who told me that, I can't remember. But yeah, so we can do a little bit of testing when there's uncertainty, you know, so like there's a lot, there's three things that can match basically.

But I think Laura, that's really important because look, a lot of this stuff, we just don't feel comfortable talking about it, but it is important because I know my, like I know I've spoken to women, they're kind of like, I don't know, I'm not sure, but if you look at it that simply. That's fantastic. And don't be afraid to, to smell and things like that.

Yeah. And also if you really kind of, uh, I don't, I, I, I'm always really, um, conscious of not the fine line again, Catherine, to not make women so hypervigilant about, like, so if I'm asking them to do a few tasks at home in terms of maybe investigation, I don't want to rise up their anxiety, paranoia, and I want to calm this down.

Yeah. System down. Yeah. Wanna get them comfortable and confident going forward. Yeah. What I was gonna say there, uh, yeah. So when, if you have a leak, the urethra is forward, it, it sits to the front of the vagina. So it's, it's a different sensation because it's more forward. Then the vagina space was just more quite central.

Okay. So even if they're, like, when I get women to kind of, uh, test out, like skipping or things like that, and they go, oh, I dunno if I leaked. I said, we just try doing again. Just really get a sense of is that feeling to the front or center? Yeah. And if I've just done an assessment, there might be lubrication there that they're like, oh, could be the lubrication.

Oh, okay. You know what I mean? I know. So it's, it's sometimes what I'm trying to say is there's a good few things that come out. Yeah. The vagina. Yeah. Yeah. Yeah. And it's, you know, not. Often, always, you know, as well. And, um, so let's, there two other key areas we I want to talk about. So let's just go onto one next key one, which is, so not that there are other things that come outta the vagina.

Yeah. And one of the biggest issues I see women will say to me, um, well, Catherine, I can't have vaginal dryness because I have a discharge. So, which I think there's a lot of kind of misunderstanding around that. Yes, you can have a discharge and have vaginal dryness. So Yeah. Let's just talk about that because vaginal dryness if left untreated can become chronic and also it can lead to your urinary issues.

Absolutely. And do you know what it is? Um, Catherine, and, um, this was, this was given to me by two or three years ago from an Australian physiotherapist. When we have lack of oestrogen in our body, Our vagina, our epithelium lining, obviously we get drier, our lubrication gets less. When that happens, it's not that we become more symptomatic in maybe a prolapse or SUI, okay?

It's the fact that having that drier system becomes more sensitized. So just say there is a Um, a little bit of a wall weakness that has preceded this lady pre, um, perimenopause. Okay. Maybe, you know, in their early forties, they've had it, but they never felt it. Once their, um, vaginal lining starts becoming a little bit drier, less, uh, lacking estrogen, it becomes more sensitized.

So they start, it's like prickly, I would all say. They feel things so much more. So anatomically things haven't changed, Catherine, but from a physiological point of view, the epithelium has become more sensitized. So what they're experiencing is now different than what they would have experienced with lots of research in there.

Does that make sense? I don't know if I've answered your question there. Um, no, no, no, no. You have, because it's, it's just, it is this whole area of. vaginal dryness, but also the fact that I, where I was coming from is the fact that so many people think if they have a discharge, they can't have dryness, but it's one of the most common symptoms of vaginal dryness.

And then obviously a pain with intimacy. When we do an examination on somebody who Clearly has vaginal dryness. It's just such a telltale sign. You can see with the vulva tissue straight away. There's atrophy. There's thinning There's often you can see physical dryness, maybe a little bit of redness when we do an examination like i'm so Mindful to be so careful because I know yeah, you know and even um So the pelvic floor muscles is kind of inside the vagina to two sides like even to go from side to side you Can feel how dry this is and you know, then you're starting that conversation of, um, you know, Eastern topical Eastern and so on to them, but it really is such a simple treatment to give such relief to so many, uh, symptoms within the vagina, you know, so, you know, those symptoms of urgency, frequency, nocturia, um, even the prolapse symptoms, uh, but also just feeling of.

Comfort. Yeah. That burn. That itch. That, you know. Cause I always say it's, I always say don't self diagnose trush because the symptoms of um, dryness looks so similar to the symptoms of trush. And then you can go and you can treat yourself like you've trushed and actually can make it worse. Yeah. You know, depending on what you're doing.

So I think that's where I just think it's so important to understand. If you do have vaginal dryness, because it can be treated and you can see relief within two to three weeks once you have the right treatment. And I think, um, uh, I think it was a Dr. Cuiva Hartley who was saying recently, I think we've always kind of said that, you know, it's 50 percent of women who experience it, but I think she was actually saying it's higher and you would probably say that.

Objectively seen, like I would see it nearly. I don't know, definitely, yeah, I'd choose definitely 75 percent to 80%, for sure, Katherine, you know. But Katherine, would you believe the breastfeeding population can have the vaginal dryness as well because their estrogen is reduced. So again, we need to kind of, you know, and, and, um, as Better, our GPs are definitely are prescribing, um, oestrogen for our perimenopausal.

With breastfeeders, it's a bit of a scary territory, but again, if they're experiencing as we discussed, vaginal dryness, pain with intimacy, discomfort, thrush like symptoms, you know, I've often written a letter to say, would you think and consider vaginal oestrogen for this lady, um, at this time, because, you know, she doesn't want to give up breastfeeding and, This is going to affect her vaginal health.

A a as it's at the moment, you know, this is where the power of, I tell you Laura, if I won the lotto, I know I would, uh, I would put it out there that every woman gets a free women's health check. I know. At like 45 or something. Because if you do it, what is one treatment? Yeah. One review. You can just front load so much.

Yeah. There's a lot kind of issues down the line, you know? Yeah. That's it. Like, even as I said, you know, from a, from a monetary point of view, it shouldn't. need to be paid for this at all. But even if it is the case that, you know, even to get a one off consultation, just to see where you're at, is there anything else I could be bringing to the table here?

You know, it really is a valuable tool to your life going forward. Yeah. And just even like, even picking up, I know Lidl and Aldi, a lot of, you know, tend to do the weights and things. Um, I think, Good prices, different times of the year. It's just even understanding how you can do your squats and different things at home, that'll bring the strength up.

And that's one of the things that I'm hoping to do now, as I go through all of this is try and share with people, look, this is how you can do it easy at home. Yeah. You know, it doesn't, you don't have to go to the gym if you, you know, do you know? You know, um, Catherine, the other thing I think is quite misleading is, um, I suppose gyne surgery, like a hysterectomy and things like that.

There's a lot of, you know, the consultants are great at doing the procedure and there's definitely a healing process for sure. But usually they have left the consultants a room and have been told don't lift anything heavier than a kettle going forward. And that stays with them. And I think there's a bit of misinterpretation maybe from the consultant saying, obviously within a healing time, we don't want to be loading.

But once the scar tissue, um, has formed from the surgery, you know, we need as, as physiotherapists, our job is to think about what that lady needs to do in her life. Okay. Not just from a post recovery point of view. Does she have grandchildren? Uh, does she shop? What's her activity? But when that seed is sown that not to lift the kettle, oftentimes they come into me about a year later.

And they're, they're not, um, they're not open to movement or strength training because of this has been told to them. And like that, then we're going down the whole, you know, osteoporosis, cardiovascular health, your muscle atrophy and things like that. We actually should be saying like, you know, your muscles will weaken at 2 percent every year and we need to, You know, get on top of that, but safely, obviously, like, you know, never under a guidance or so on.

But, you know, it is really important for women throughout and whatever kind of medical needs they have that they, but we're adapting and doing some form of movement and loading on their tissues at that stage of perimenopause, menopause. and into postmenopause. Yeah. Yeah. Big time. We talked about, when I look at dryness, I, I now look at it in three levels.

I look at the skin. I think of internal vaginal dryness, but I also think of, and I know this is, we've, we've talked about this before, the dryness of the digestive system, which leads to issues with our bowels and constipation. I think this is something. We are not talking about enough because it, it would have been my, one of my earliest experiences in perimenopause was that my bowels just were not as regular as they used to be.

And I, I went out of hell for leather, you know, I was loads of flax seeds, loads of fiber doing everything to really work at keeping my bowels regular. But that's time when. I started running and I noticed that bit of leak when I, um, when, when I then started to look at it. I also know that constipation was an issue, which was putting further pressure on the bladder.

Yeah. And I just think that that's, that's an aspect we're just not thinking of. Well, these organs sit right beside each other. So you have your bladder to the front, your uterus, vagina structure, and your rectum at the back. They work together. Okay. Okay. So. If you're constipated, there's more heaviness and fullness in that pelvic cavity, which can bring on more symptoms of pressure.

So prolapse symptoms are definitely more incontinence and urgency and so on. Um, and you know, your bowel and your gut is a muscle that needs to be Managed as well and can change throughout our life cycle, but constipation, you know, I think we brought up earlier on about, we talked about pregnancy and delivery about being a bit of a dysfunction, a predisposition for pelvic dysfunction going forward.

Constipation is the second most prevalent reason why we have prolapse. Okay. Okay. Straining on the toilet, if you think about the movement or that motion of straining, it's not far off what we might have done, you know, in the labor room, um, with our delivery. Now, obviously we've lots of new, Um, forward thinking techniques to deliver baby birth.

That's another discussion. Um, but also there's a way to have a poo, you know, and we don't want to do that Valsalva movement, hold a breath and bear down. We want to take a breath in, exhale out, expand the belly and extend our, um, you know, the pressure is through the back passage and not through the whole system.

If we elevate our face. On a little stool, which are widely, um, sold in shops across Ireland, like that kind of 20 centimeter, 30 centimeter stool, we have a better anal rectal, um, angle for, um, defecation. So instead of being kind of, it's hard to describe this on a podcast, but instead of being kind of at a slanted angle.

Like I think of it like a ski slope. We want more of a vertical alignment and having your feet on that stool allows you to have that leaning forward. If you have been to a physio or if you suspect there's a bit of heaviness, particularly before your bowel movements, that you feel pressure in the vagina, there's a lovely technique that you can do just to splint the perineum with your hand.

So wrapping your hand, uh, toilet paper around your hand and counter press up. your perineum and maybe the entrance of the vagina to allow that support as the pressure comes down through the back passages. Am I making sense? Do you understand what I'm trying to say? Visual would be amazing here, but I, I know I am trying to visualize the anal cavity.

Obviously something comes out of that. So you want to kind of splint with your hand the front area. So that's your supporting it up. You're supporting it. Okay. Now, women who have a posterior wall weakness. So that would be your rectoceles. Okay. Um, um, When you do before bowel movement, oftentimes stool, because of that weakness can get caught in that area and pushes forward into the vaginal cavity.

And that's what gives women a lot of heaviness before bowel movement, or sometimes when they haven't evacuated correctly or defecated correctly, and they might get a little pocket of stool that's sitting there. So they might have. gone to the toilet and go, God, I don't feel like I've got a full empty there, or it's getting caught.

Often women will come in and they'll feel like it's getting caught. There is a lovely apparatus that can help you splint that wall as you defecate to get that full empty because we're going into a bit of a vicious cycle. If we are pushing in strain and getting caught into that tissue, it's just going to get worse and worse.

Um, if you look up a constipation on online, they say, I think it's like, if you, it's quantified as like, Uh, two bowel movements a week is the concept. Like for us as Pelvic Health physios, we want daily regular soft stools. If you aren't aware of the Bristol stool chart, have a little luck. We want kind of a time, three to four, uh, stool consistency.

So we don't want Definitely don't want those pellets. Um, rabbit pellets that really kind of dry looking stool. That's a sure sign that you are lacking water, um, in your diet and you need to up that water intake. We don't want all, obviously the kind of the softer, softer stools. Um, and diarrhea, obviously there's Books and stuff like that we wouldn't have because that's hard to control.

So women who have maybe a little bit of sphincter weakness in around their back passage will have a much harder time with fecal urge and fecal incontinence with that kind of stool. So oftentimes we work with dieticians as well to really get that person's um, like, Food and nutrition side of things that can really help manage then faecal urge and constipation.

I, I, constipation is just, it's so important. And I always say that when I'm doing my talks, that it has to be one of your top priorities is bringing your menu, your food together so that you're really, yeah, it just really encouraging. The good bowel health. And I will say, I know I've shared it. I have the stools at home.

I use them every time. I mean, I, I would notice the difference between having a bowel movement when I have the stool and you're at a different angle versus maybe when you're out and about and you don't have that. It prevents you from straining. That angle really takes that kind of bear down, push down.

And again, if you're bearing down, pushing down, remember with your feet on the ground, you're on that ski slope. So you're pushing down into that vaginal tissue. And that can create problems going forward. Let's say you're, cause this I, this is, would be I guess something that I find really helps me. So at home, I've got the little stools in the toilets and everything.

So that's fine. Let's say you're at work and you know that this is really helping you. Yeah, is there any, listen, um, I struggle in the cubicles because there's usually, if I'm in a hotel, if I'm in anywhere, anyone's house, I'd often bring the little, um, bin over. I'll find something. Right. But in the cubicles, it isn't.

Is a bit difficult. We don't like, if you go on your tiptoes, you're creating that a little bit, but what's happening when you go on your tiptoes is you're working your muscles. Your calf muscles are working your hamstrings, your glutes and so on. So you're not getting that full kind of relaxation, but I guess it would be an E a better solution than feet to the ground.

Okay. If you, um, you know, Even if you are having, you're in the cubicle, feet to the ground, leaning forward really helps. Breath in, exhale out, and allow that tightening of the abdomen as you're, um, emptying your stool can be a good one. Um, I've seen, uh, one of the girls on Instagram, um, going through noise.

It's nice, again, in the cubicle, you might want to do this, but like, if you make it, I guess, noise, you can't strain down. You have to do the kind of right mechanics to empty the, um, the bowel motion without kind of strain down. So there is little things that you can do, but hopefully. have to check who's in the queue.

Exactly. Is there anyone there? But yeah, from a work point of view, but listen, Catherine, there's, There's stools have come in, in, in the maternity hospitals. Mm-Hmm. Again, if we talk about kind of employer, employee Yeah. Relations in terms of menopause management and mindfulness and wellbeing, there should be stools in, in these toilet, like do we bring them into the workforce?

Yeah. That's a really interesting one because I would have a whole list of the practical steps. Employers can take the work. We have women in our work. We have two toilet, we have um, two stools. You're womans have physio. To have one. Yeah, yeah, exactly. But that isn't that really interesting though, because if you think, I did a podcast recently on ageism, and if you think from both perspectives, if you just isolate to menopause, but then if you also isolated to ageism, but if you also say it's it, it applies to all people, kids, not, not just women.

Kathryn. My children, I have trained all my children, I can hear everyone what's happening in the toilet because my husband does it. I haven't got that far, Laura. No, this is, this is how they should be doing it. So, you know, I know it's, it's something that we should be encouraging, um, and educating as we're toilet training.

You know, that's a, that's a new one for now. Think of the other thing, can I just say at work, because I think we're all culprits of this one, when you do need to, um, go to the toilet. I, I think ideally, if you can, don't put it off. Do you know the way sometimes, Oh, I've got to go to a meeting. I've got to do X, Y, or Z and we can just say, Oh, I'll go.

And then you might be running into it. Yeah. Yeah. Yeah. It's a really hard one. Like, you know, we classify bladder urge from zero to four and, Oh, I could go into this a big time, Catherine. I don't want to. Going to too much, but yeah, I always think, you know, there's obviously a point that we have frequency and there is obviously the bladder is filling maybe at a smaller capacity and it's giving you a four to four urge.

The biggest take home is just don't hold it. Okay. Even if you've gone to the toilet 20 minutes before, so on, if you have that urge, you know, go to the toilet, particularly in a work situation. But know that if you are going to the toilet very, very regularly, there is an underlying issue and then it's something that we can work on, but we do a lot of bladder training and the main focus of our bladder training is to make sure we're comfortable in the bladder and not, you know, I suppose a few years back we would have said, no, hold it, hold it, keep on holding.

That's ridiculous. You know, you need to kind of train your bladder, but we have a lot of bladder pain syndromes that can, um. evolve and women to be very, very uncomfortable. Um, so yeah, I would say at work, if you're feeling that you need to go to the toilet, don't let it go to the four. You should be going to the toilet at a comfortable two or three urge.

Okay. Not to the point that it's going heavy into that four, which is really, really bad. really when we get a lot of urge incontinence. Okay. And are you talking there from both bowel and urinary perspective? Bowel. Yeah. Like, I mean, you know, women come in and say, I have faecal urge. How long can you hold it?

Two or three minutes. That for me wouldn't be very, like, that's, that's pretty good. You know, um, if you can, if you get the faecal urge on your seconds, You know, that's a whole different situation. We're really trying to get that woman to evacuate before she leaves the house if she's going to work. So there's lots of modalities we have, including self irrigation, you know, lots of things to get her competently empty and so she can fecal urge and fecal incontinence, Catherine, it breaks my heart.

I know. I know. It is. Beyond distressing and we need a whole holistic team to help. It's, it's not physiotherapy only, it's a few different. And the, what I would see there is the anxiety it creates for women at work is just unbelievable. And it, and it's, there's no need for it. If you have the right support and you know, you know what you can do to support, you know, the steps you can take, we should be able to combat.

Yeah. Yeah. But can we just, can you just talk a little bit about your experience with that in relation to. For women who are at work, because we lived, you know, you could have nurses, you could have someone who's in retail behind the desk, you could have someone in an office environment. Yeah. It, it, it's very challenging in menopause when you have issues with pelvic health.

Yeah. And it's so, I know we, we love the word taboo, but like. They do not, you know, if we weren't feeling well, we would say that maybe to our, uh, line manager or so on. But when it comes to these symptoms of heaviness in the vagina, uh, urgency, stress and contents, fecal urge, they don't say it. No, no. They're suffering in silence.

They're like, it's so distressing. I have ladies in tears talking about, um, you know, going into meetings and I guess because they're in that kind of cognition. cognitive, um, stage of perimenopause or menopause, they're also their confidence and their anxiety. It's like driving them their urinary, um, symptoms and vice versa.

Do you know what I mean? Making it worse. We're talking about kind of the behavioral side of things as well. So it really is so distressing for women. And Every line of work, no one's kind of exempt, yeah, because we have women who are standing all day that would feel a kind of heaviness or pressure. And then there's women who, you know, have meeting after meeting and they mightn't be able to get to the toilet beforehand or, you know, even just sometimes a lot of the time when we have a bit of adrenaline, um, And anxiety, it can bring on the urgency and urge incontinence more.

So we're really having to calm down the systems, uh, fecal incontinence, fecal urge is a whole different ballgame. We're really trying to get that woman to. clear out her bowels best we can that morning. And there's a whole strategy and again, a whole team around to really get that process working for that lady.

For someone who is suffering in silence at work. And we know there are many women in particularly around, um, the anxiety is one side of it, but particularly around the urinary issues, I would see that on a weekly basis. I will hear from someone who's struggling at work and, you know, one example, uh, would be someone who might be now they could be back hybrid working, but they might be, you know, very far from the restrooms, but they're going maybe every one or two hours and they feel it becomes a walk of shame.

Yeah. And now, you know, in situations like that, I would very much, you know, it's the natural really understanding what is going on, what's happening. But what advice, Laura, would you give to women at work? For that lady who's kind of going. Or for anyone who is just struggling with urinary pelvic issues during their workday, what can they do?

Again, it is. There might be a few things that could be brought to the table. So obviously pelvic floor training to capacity can help with, um, urgency and urge incontinence at that time. When it, when we talk about frequency to go to the toilet, we're doing a good evaluation of their bladder intake and output for 48 hours.

So seeing exactly what's happening. Is there any triggers in that time, teas, coffees, are they gulping water? Um, so a lot of. A lot of even, um, simple strategies like, you know, reducing down the caffeine, as we know, um, looking at water intake, sufficient water intake, but not kind of gulping it, not abstaining from it either, if you're in a work situation.

And then a little bit of a behavioral thing that management. Then do we look at the physiological changes that are happening? So maybe that lady needs to do a bit of a urodynamics test, which can be difficult to get referred. It's not difficult to get referred to, but to get the appointment can obviously take, you know, weeks privately, very long time publicly to see, is there a bit of an overactivity in the tissues and muscle that maybe a medication can calm that down.

Is there a hormonal component to this or are we looking at HRT, oestrogen can really help Vaginal oestrogen can really help. So it is a holistic approach, Catherine, you know, it's never like in that they're complicated in those situations. I am one part of the team around that lady and it's a, it's very important that we are giving her that information on if she's, if I'm her first point of contact that we're getting her GP involved and maybe if there's a guiding referral needed and we're getting a good evaluation of what's happening, it's not very, it's not straightforward, it's not one answer.

And the other thing. Just to mention, because I know, correct me if I'm wrong, a lot of health insurance providers will now cover appointments, treatments with women's health care, won't they, to a certain extent, but you know, it all helps, you know, and it's certainly worth looking at your insurance and just looking at it.

Seeing if it is covered. Yeah. Like, I mean, um, some, I think that the, maybe the lesser um, coverage might give 20 euro back, but then you can get up to maybe 75% back and Yeah, it all helps. It all helps. Exactly. And even if you can just do one appointment and get a good understanding of where you are, where the land lies.

Yeah. I think it's a lot of the time with pelvic health because we're not treating pain. Catherine an awful lot. We're treating symptoms. So it's not like physiotherapy. You might kind of think lower back injury, maybe four to six sessions to reduce the pain and get, you know, functional or whatever. With pelvic health, it's a little bit different.

Like I sometimes in my most quick appointment, if they're hypertonic or things like that, which is overactive pelvic floor might be reviewed in 10 days. But. You know, maybe the first two appointments might be within two or three weeks and then again. But then we're on kind of education and getting you to do things, checking in maybe a six weeks then, maybe two months.

A lot of women then, um, when I discharge from like they've reached their potential, they say, I'm going to check in with you in six months time. No problem. Or I'm going to check in with you in a year's time. No problem. That's what I do at Maeve. I kind of check in, you know, every so often because, yeah. And because I'm just so conscious, I need to work on that, you know, just to keep on top of it, you know.

Um, Laura, that was absolutely fantastic. Are we done already? Well, we could keep going. I mean, there's so much. Yeah. Yeah. The Baraka test now is one definitely, I think, uh, I'll tell you. Talking about that one, but thanks so much. And, um, Laura, I'll put all your details in the show notes so everyone can see where they can find you.

And thanks so much. And, uh, I'm sure we will do another podcast on another aspect of menopause. Thanks, Laura. Thank you so much, Catherine. Really enjoyed that. Thank you.

Thank you for listening to Menopause Uprising with me, your host, Catherine O'Keeffe. I really hope you enjoyed this week's episode. Don't forget to like, subscribe, rate and review as it really helps the show. Tickets for the fourth Menopause Success Summit on Saturday, the 14th of October in the Royal Marine Hotel in Dun Laoghaire, Dublin are on sale now from Menopause Success Summit.com