A Holistic Approach to Pelvic Health

Brianne Grogan - also known as Dr. Bri - is one of the brightest stars in the world of pelvic health, with hundreds of thousands of followers on YouTube and countless visitors to her website. She's earned such a passionate group of fans because of the warm and welcoming way she helps patients overcome their challenges through movement, nutrition and the mind-body connection. Today she talks with us about a holistic approach to pelvic health, with an empowering message and simple, practical strategies to help you gain better control of your pelvic floor.

Visit Dr. Bri at VibrantPelvicHealth.com by clicking here.
Check out her YouTube channel here.
Visit her Instagram page here.

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Music:
Rainbows Kevin MacLeod (incompetech.com)
Licensed under Creative Commons: By Attribution 3.0 License
http://creativecommons.org/licenses/by/3.0/

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Transcript

The following transcript was generated electronically. Please let us know if you see any transcribing errors and we'll get them corrected immediately. 

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America's leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org.

Welcome back to another episode of Life Without Leaks. I'm your host, Bruce Kassover, and we're joined today by Brianne Grogan, though you may know her better as Dr. Bri. She has a YouTube channel, it's “Dr. Bri's Vibrant Pelvic Health,” with more than 300, 000 subscribers, which is a remarkable number. It certainly makes her probably the brightest star in the world of pelvic health and related conditions. So welcome, Dr. Bri!

Dr. Bri: Thank you so much for having me again. 

Bruce Kassover: Thank you for being a part of the podcast today. We wanted to talk about something that I know is close to your heart when it comes to helping women address pelvic health issues and that's holistic pelvic health. So can you tell us a little bit about what that is?

Dr. Bri: Yes, absolutely. So I really consider myself in the business of health and happiness and it's very, very true and something people may not have realized that our pelvic health impacts our happiness and our happiness impacts our pelvic health. To put it really, really simply, the mind body connection is powerful and it very much impacts our pelvic floor.

And so that's one aspect of holistic pelvic health is the mind body connection and how our emotions can impact our pelvic floor. And also, I mean, lifestyle is a huge piece of this too, so I could go on forever, but tell me what you'd like me to share about? 

Bruce Kassover: Absolutely. Well, I know that when we talk about mind and body, one of the things that we often talk about, for example, with bladder conditions, is that there is a connection between communication between the brain and the bladder that there are nerves that are connected and brain-bladder communication is essential for proper functioning of the bladder and proper, you know, continence health. But I get the feeling that what you're talking about is more than just simply nerve connections and just electrical transmissions, that it's more about that there's a mindset, there's an attitude, there's an approach that really plays into your bladder control and your – and potential bladder issues that you might be experiencing. Is that right? 

Dr. Bri: Yeah. Bladder issues, even prolapse and some of, you know, the issues that… the sensations that you may feel related to prolapse, all of these pelvic health issues and definitely pelvic pain are very, very much connected to what's going on in your nervous system as far as how kind of wound-up things are in response to stress, anxiety, uncertainty, threat, and, interestingly, pelvic health issues, all of them, prolapse, bladder leakage, you know, fear about bladder leakage, painful sex, things like that all increase our feelings of being threatened and uncertainty and all of these issues that can really percolate and set off the alarm bells in our nervous system and cause us to have more attention in our body. These things can create that to happen. That sort of like, wired, almost like fight-of-flight activation of our, you know, mind and body connection, that nervous system activation can increase because of what's happening in our pelvic floor.

And then that can set off this cascade of events that can cause more tension, which can cause more symptoms. So it's a bit of a cycle that I'm often addressing with my clients, and even with myself. I deal still with mass amounts of pelvic floor tension, and it's a very, very true and strong connection that when things are feeling out of control, when things are feeling overwhelming, anxious and stressful in our emotional life.

So aside from, you know, having pelvic health challenges, but things going on in our lives, when we feel that stress and anxiety for many people, one of the first places they feel tension is in their butt muscles, their pelvic floor muscles, in their hip flexors that, you know, fight-or-flight response that kind-of tenses everything up down in the pelvic girdle, also tenses things up in our shoulder girdle too, so we feel that unconscious; even minute amounts of tension in those areas can add up and make our symptoms worse in the pelvic floor. So it's really about finding ways to notice when that's happening, acknowledge what's happening, acknowledge the stressors in our life or whatever we need to kind of see and feel and work on and move through and learning how to, you know, anchor ourselves back in the present moment and remind ourselves that we're safe. We can relax these muscles. We can let go. And that's actually going to improve our symptoms tremendously. Just that simple act of reminding ourselves that we are safe, taking some deep breaths, unwinding the tension in our muscles.

Bruce Kassover: Even listening to you just describe that now, it's helping me relax a little bit. But you know, the funny thing is, you know, so often when we talk about incontinence and related conditions, it's all about muscle weakness. It's about, you know, your pelvic floor muscles are, have been weakened, they're not strong enough, but it sounds to me like some of what you're talking about is the opposite as well, is that there can be things that are, that are too tightly wound. 

Dr. Bri: Absolutely. And this is something that has been increasing in awareness for, for the last few years. And I've actually, I've been talking about learning how to release, but actually the release is the most important part of a Kegel exercise or a, you know, pelvic floor muscle isolated contraction.

The release part is really, really important. And it's something that I think is not often discussed enough because people typically think, well, we want, you know, we have an issue down there. We want to strengthen, we want to strengthen the muscles because they're weak. And it's really essential to remember that tight muscles can be weak and, you know, lax kind-of loose in air quote muscles can be weak, but it's not always loose, lax muscles.

Often tight muscles are what are weak because any muscle that can't do its full job and go through its full range of motion is weak. And so often the people that I see and work with in clinical practice, back when I was working clinically as a PT, and even now I've started doing some internal pelvic floor work again, and tension is what I often see people who feel that they can't do a Kegel. But what's going on is their muscles are already so tight that they, there's nowhere left to go to contract. And then if they do get a little bit of a contraction, they don't know how to release it. Sometimes they even contract when they're trying to let go.

I actually just experienced that the other day working on a client, is she tried to do a Kegel. She was already tight. Her baseline level was too tight and she did a little Kegel, did a little tiny squeeze. It felt quite weak simply because she was already tight. Her muscles couldn't really go anywhere else.

So she did a little contraction and then she tried to let go. She let go a tiny bit, but then her body did not know how to let go. So it did another contraction again. It was really interesting to witness and experience that because so many people are walking around the world, living their lives with too much tension in their pelvic floor, which is causing these symptoms that usually indicate weakness and the muscles are weak.

It's just that they're too tight. And why I mentioned that this has been something I've noticed more and more over the last few years is I, I do believe that with the, you know, world issues as they have been over the last few years with the pandemic and with all sorts of global things happening in the world, there's a lot of insecurity, a lot of threat, a lot of fear in the world. Things are moving fast and that again manifests with pelvic tension for most, if not all people. 

Bruce Kassover: Yeah, I found myself thinking about moving to a cave recently. 

Dr. Bri: Also, me too. 

Bruce Kassover: But that being said, this does sort of confirm what we often hear, which is that pelvic floor exercises are simple in principle but often very difficult for people to actually figure out how to do properly. And I'm wondering, is the, I'm sure that as a physical therapist, you'd recommend that, that probably working with a professional like a physical therapist is probably a good approach to make sure you're doing what you should be doing. 

Dr. Bri: Absolutely. Because many people, unfortunately, are doing the exercises incorrectly. They might be doing like bearing down, actually kind of squeezing their, their belly or maybe their butt muscles when they think they're doing a Kegel, especially if they're squeezing their belly, they're, you know, kind of pulling in their abs. That can actually cause a lot of downward pressure, which can contribute to a worsening of pelvic floor conditions, especially prolapse, bladder issues, that downward pressure. If they're doing, you know, 10 or 20 or a hundred, heaven forbid Kegels each day and every time they're squeezing and pulling their belly in instead of using the correct muscles, they could be definitely causing some damage over time. 

So just knowing, are you getting that squeeze and lift of the pelvic floor? And then the full release of your pelvic floor is really important. And many people aren't able to do that by verbal or written instruction alone. They've found that having an actual examination by a qualified professional is very helpful if that's available to you in your area.

Bruce Kassover: And I believe posture is also a really important component as well…

Dr. Bri: Oh gosh. Yes. Posture is so key. Posture and other pressure management strategies. So when you are standing or sitting with your tail tucked under your butt, tucked under, which happens when we, you know, sit in a chair for a long period or sit on a soft couch that can really shorten your pelvic floor.

So that can cause, you know, muscular issues. It also puts a lot of downward pressure, just that kind of crunched, hunched position of your spine, that rounded spine, causes a lot of downward pressure on your pelvic organs, which causes strain on your pelvic floor. Also, thoracic kyphosis, so a hunchy upper spine, is very similar in that it causes that downward pressure.

So, thoracic kyphosis, the hunchy upper spine, a forward head, which is so common, I do it too, I have to say, all of the texting, and the, you know, phones we use, and computers we use. Most people unfortunately have a forward head. So that leads to that thoracic kyphosis and that flattened low back. So where you don't have that natural lumbar curve anymore, you really need that alignment to be good, to support your organs, to put everything in the correct position and to reduce that increase in pressure in your abdomen and pelvic area, which can happen when you're hunching. So put simply: Don't hunch. 

Bruce Kassover: Now, what about breathing? How does that play into things? 

Dr. Bri: Oh, gosh. Breathing is huge. That breathing helps… proper breathing matters because your breathing diaphragm and your pelvic floor are actually, they work like partners. They work together anatomically and physiologically in your body.

At least they should work together when they're working properly. But a lot of times if people are very, very shallow breathers, that means that their diaphragm is a bit rigid. Often the pelvic floor will be quite rigid as well. So there's a lot of connections there between shallow breathing and just lack of movement and health in your pelvic floor.

The one issue why we want to really bring the breath down into our ribs, into our back rather than stuck up high in our chest. Another reason that breathing matters is learning how to couple your breath with your movement and different positions helps you manage that kind of, oh, kind of like, oh, straining feeling that can happen if you're lifting something.

For example, I always love to tell people to exhale with exertion. So breathe out when you're lifting something, especially something heavy, and that helps manage your intra-abdominal pressure. When you exhale, it naturally helps, you know, your lungs get smaller. The breathing diaphragm goes up. The pressure reduces in your abdominal pelvic area.

Also your pelvic floor naturally lifts just a bit and your deep abdominals gently, engage to help stabilize your low back. It's like, it does all these wonderful things to breathe out to help stabilize your core and manage the pressure so you don't feel that kind of bearing down, strainy feeling that can happen when you don't breathe properly. So the breath helps manage your intra-abdominal pressure. 

Bruce Kassover: And that naturally leads to a question about, you know, if we're talking about breathing properly and trying to, you know, trying to approach it with that sort of more relaxed and focused approach, what about mindset in general while you're doing your exercises? Is there sort of, do you recommend doing it as sort of a meditative process, or is it easy enough to just do without even thinking about it? 

Dr. Bri: Mm. Well, I just think it's so important to have awareness of this part of our body. It's been very hidden. I mean, it is hidden. It's inside. It's deep inside the pelvic bowl.

And so you can't see these muscles like you can a bicep, you know, your biceps or your quadriceps or other muscles on their body. They're hard to see. They're kind of hidden inside. And then add to that cultural you know, issues surrounding shame and just maybe some experiences and events in people's lives where they feel like they don't want to think about this part of their body.

There's lots of reasons where it can be easy to disconnect from the pelvic area and to just not know about it. It's certainly not talked about in school, you know, so it's really important to actually, in my opinion, when you're doing your exercises, have the mindset of awareness on your pelvic muscles, awareness of what they feel like of, you know, the fact that they are the base, the floor of the entire core.

They're a part of your core. So your core is not just your abdominal muscles. It's not just your six pack. It's the whole thing. It's your pelvic floor. It's your abdominals. It's your breathing diaphragm. It's all of this very important mid part of your body. So awareness is important and just respect and love.

If we're going to really go there, love for this part of your body, because it does so much for us. It helps keep us stable. It helps keep us continent. It helps with pleasure. It helps with childbirth. If that's a part of your journey, a part of your process. So, I mean, it's a very, very important part of the body.

So that's a piece of it. Another piece of it is, or, you know, breathing into that part of your body, sending that breath down, like we talked about earlier, and then just having the mindset of lack of fear, because knowing that if you are scared and fearful about these issues that you're experiencing. And most of that fear usually comes from lack of education because we're not taught about this part of our body.

And we're not taught about these issues that can occur. So if you can release some of that fear and have more of a neutral perspective, a neutral mindset of, okay, this is, you know, I'm feeling these feelings, but listen, there's things I can do about it. And I'm doing these things. And if I have fear, it's simply going to make my muscles feel tighter and more tense.

And they won't work as well. So just, you know, acknowledge the fear, but breathe into it and remind yourself, I'm making the choice to do what I can do to work on these issues in a conservative way, in a natural way. And I'll see what happens in the future. But right now I'm doing what I can do, all as well.

And just go through your exercises in as relaxed a fashion as you can, because of that mind and body connection. Because if you're fearful, intense, it's just going to be counterproductive to the work you're doing. Does that make sense? 

Bruce Kassover: It does make sense. And it sounds like a really comforting approach to it, also, especially for a lot of people who are trying to deal with these issues and face them head on for the first time. And that's got to be very reassuring to them. 

I'm wondering that, in addition to some of these very specific approaches that you're talking about for the pelvic floor, if you also believe that some complementary of exercise, maybe things like yoga or tai chi, or maybe something more vigorous than that – you know, cardio exercises or other sorts of, you know, muscle exercises – are worthwhile as well, you know, not just for general wellbeing, but also specifically for the pelvic floor?

Dr. Bri: Oh, yeah. I mean, listen, all movement is good movement. The entire body is connected from head to toe. And so any type of movement that brings you joy, in my opinion, can be worked with to make it appropriate for your needs.

I mean, yoga, Tai Chi, everything you mentioned there is wonderful. Walking is wonderful. You know, there's certain types of exercises that if people really, really love may need to be slightly modified, but they can still be done because fitness and movement is so important for your mental health, for your wellness, your general total body wellness.

And due to the fascial, you know, the, the fascial network in our body that connects everything again, all movement is good movement. It's all moving the blood throughout the body and helping to move all the tissues that the pelvic floor is in the center of it all. So it's a very, very good thing. 

If you are a person who enjoys and loves very high impact activities, running, anything that's very high impact and or heavy lifting, those may need to be modified or will need to be modified – at least at first – when you are dealing with certain pelvic health conditions and you can work with a therapist to help you with that. But in general, if you have prolapse, for example, you're going to need to modify your very high impact activities and very, very heavy lifting, at least at first, as you're learning how to manage that intra-abdominal pressure and kind of regain strength and control in the pelvic floor and the rest of the core.

But there's always ways around everything. Things can be broken down. Things can be modified, and movement is wonderful. I am a huge fan of exercise. 

Bruce Kassover: Okay, so you're, you're talking about some interesting challenges for people who have trouble getting involved in exercise, but tell me this, how does somebody go about getting started and how much time would you need to devote to this once you get started in the first place?

Dr. Bri: Yeah, that's a great question. And I am a person who loves exercise. It's, it feeds my soul, and I do need to always step back and remember that not everyone feels that way. And for some people, it is going to be a matter of starting very small. I actually am not a huge proponent of necessarily needing to go out and doing an hour long walk or fitness class or something like that.

It's not necessarily about length of time. It's more about getting out there and doing what you can, whatever feels good for you. Some people, it will be a longer session. Some people, it will be a five-minute walk, maybe twice a day, just even a few minutes is better than nothing. Motion is lotion. And so the more you can move your body, even in short intervals, the better.

And it doesn't, if somebody is not an ardent exerciser, it's not something that they're accustomed to. They don't love it. Maybe they're hesitant to go to the gym or something like that. There's so much you can do even just inside your home. As an example, I have an indoor walking workout on my YouTube channel that is, I think it's 10 minutes long, and there are actually many indoor walking workouts that you can do from the comfort of your own living room. And they're low impact. They are private and they're a minimal time commitment. So I just encourage people to just get up and start and make it a daily practice.

Even if it's just once a day, five minutes, that's fine. Better than none a day, five minutes. And then maybe you can work up from there. You know, that's really encouraging. 

Bruce Kassover: So tell me this, if you had one thing to leave somebody who's listening to this for the first time with, what would you say to them? 

Dr. Bri: I would say to start small. So start with just maybe one thing that we touched upon today, because we touched upon a lot – mindset and, you know calming your nervous system, maybe doing some deeper breathing. We talked about posture. We talked about exercise. 

You know, I didn't even mention digestion, which is also a part of this holistic approach. You want to make sure that, you know, you're, you're drinking plenty of fluids and eating plenty of fiber, so you're not constipated and chronically having to strain. But it is a lot. If you were to take all of that at once on board as like, “This is my plan,” I would say, “Choose one thing, one tiny thing to focus on and make that be your focus for the next couple of weeks and just see what shifts for you.”

Bruce Kassover: Well, Dr. Bri, I could see why you have 300,000-plus viewers on YouTube. I mean, your approach is, is absolutely it's welcoming and it's nonjudgmental and, more than anything, it's really encouraging. And I know the people who are, first, going through some of these issues, probably like, like you mentioned probably a little bit frightened, a little bit overwhelmed. And it's great to hear that the future does not have to be dark and scary for them and that there is light at the end of the tunnel. So I want to thank you for all of your words of encouragement and your insight and your expertise to help people find a better path to drier days. So thank you for joining us. 

Dr. Bri: Oh, thank you for having me. If I can just say one more quick thing, it's just a reminder that 51 percent is majority, right? And so if you're doing these things appropriately, 51 percent of the time, heck that's better than, that's better than nothing. So you don't have to be perfect to make a really big impact on your health.

Bruce Kassover: Excellent. Those are great words to close out on. So thank you again. I really appreciate it. Thank you. 

Life Without Leaks has been brought to you by the National Association for Continence. Our music is “Rainbows” by Kevin MacLeod and can be found online at incompetech.com.