Women spend almost half their lives post menopause. Why is it still so misunderstood?

Menopause is something that every woman will have to contend with - and nowadays, women spend 40% or more of their lives following the transition. You'd think that something that's so common would be better understood. Unfortunately, there are still an enormous number of misconceptions about menopause - what it is, what to expect, how to treat it and more.

Today's guest is Ingrid Harm-Ernandes, a physical therapist with more than 40 years of clinical experience, here to dispel some of those misconceptions and help women have a more comfortable, confident journey through menopause and beyond. 

She's currently co-director and mentor for the Women's Health Physical Therapy Residency Program at Duke University and a member of the Medical Advisory Committee of the National Menopause Foundation. She's also the author of The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms, aimed at helping women understand and address a range of pelvic floor conditions.

To get your copy of The Musculoskeletal Mystery, click here to purchase from Amazon.com or click here to purchase from DesertHarvest.com. 

For more about Ingrid, visit her Facebook page here. 

For more information about the National Association for Continence, click here, and be sure to follow us on Facebook, Instagram, Twitter and Pinterest.

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

TenderHeart Health Outcomes offers individualized care plans and superior products to meet your unique needs.  Their coaching focuses on asking the right questions, and their high-quality products prevent leaking, are comfortable and skin friendly. Plus, their trained staff focuses on your individual needs. Your total satisfaction is their goal and healthy living is their mission. Learn more at www.tenderheart.com or call 1-877-394-1860 today.</

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 joining us as always is Sarah Jenkins, the Executive Director for the National Association for Continence. Welcome, Sarah. 

Sarah Jenkins: Thanks, Bruce. Good to be here. 

Bruce Kassover: Today is going to be a good one because our guest today is Ingrid Harm-Ernandez. She's been a physical therapist for 40 years and began specializing in women's health almost 30 years ago. She's a board-certified clinical specialist in women's health, physical therapy, and pelvic floor biofeedback. She's co-director and a mentor from the Duke Women's Health Physical Therapy Residency Program. And most importantly for today's podcast, she is a member of the Medical Advisor Committee of the National Menopause Foundation. So welcome, Ingrid. Thank you for joining us today. 

Ingrid Harm-Ernandes: Thank you for having me. 

Bruce Kassover: That is a very impressive list of affiliations and credentials. Maybe you want to tell us a little bit about how you got to be where you are today?

Ingrid Harm-Ernandes: Yeah, so when I first started as a physical therapist 40 years ago, there really was no such thing as pelvic health and women's health, and I felt kind of frustrated even during, through my career that I was not seeing patients very quickly. In other words, it was taking the patient 5, 10, 30 years to see me as a physical therapist or as a pelvic physical therapist because they didn't know what to ask for, and the clinicians didn't know how to refer them to pelvic PT.

So I feel like a lot of my path has been, first, just trying to find my way, which I would say very interestingly was thanks to a couple of my pregnant patients. So when I was in a private practice setting and some of my pregnant patients would say to me, you know, Ingrid, I had this little bit of leakage and, and I don't know what to do about it.

So I give them a lot of credit. because they asked me when no one wanted to talk about this that long ago, and I'm going to super date myself because I had to go to the library to figure out what was this leakage, what was this incontinence? And then I educated myself. And even with just a little bit of education, I discovered, wow, you know, I can really make a difference in my patient's life and their quality of life, even more importantly.

And over this time, and educating myself, and then finally finding some courses in education. They were doing things in Europe and Australia, and then finally brought things over to the United States. States and really worked hard on getting that education, educating myself, working with others, not really having a mentor myself because it didn't exist, which is why I'm such an advocate of mentors now.

And then as taking more courses, seeing that there was so much more than just incontinence, but things like pelvic or organ prolapse and constipation and pelvic pain and pain with sex and I could go on and on. So that really pushed me to learn more and do more. And when Duke, when we developed the residency program, which was the first one in the country, we really saw that need for education. 

So I went more and more into the education path. That was the way I started to travel. And I started educating not just physical therapists, but physicians and nurses, and then out into the community. And I discovered that there was such a need to educate people on both sides.

So whether you're on the medical side or you're on the patient side, everybody needs to kind of be on the same page and understand the same language so that that care can happen. And there isn't this 5-, 10-, and 30-year delay that I was mentioning. We really shouldn't be seeing that anymore. And unfortunately, even in this day and age, we still are seeing it. So we still have such work to do on education. 

Bruce Kassover: It's interesting how neglected this area has been for an enormous amount of time, isn't it? 

Ingrid Harm-Ernandes: It unbelievable. And you know, there are many reasons for it. I think embarrassment is one. Lack of education is another. We have the tools. Educating is that tool to get everybody on that same page and get rid of that neglect and have people not feel so embarrassed about even talking about it.

Bruce Kassover: Yeah. And I suppose one of the things we want to really sort of focus on today is on menopause. Is that something that you find really has also been underplayed and underappreciated as something that's really worthy of attention? 

Ingrid Harm-Ernandes: Oh my gosh, yeah. So it has been very under-researched, underlooked at misunderstood.

I would say that it is such an important thing right now to talk about it and not just in the, kind of the confines of, oh, we get hot flashes. You know, someone will have hot flashes or, yeah, they might have a little trouble with their sleep, or, yeah, they might have dry tissues. There's so much more to it, and I think social media can be a good thing, it can be a bad thing. I think the focus has been so much on hot flashes and estrogen that we are just so not looking at all the other components of menopause and menopause transition, and we really, really need to change that narrative. 

Bruce Kassover: It's funny you mentioned that. You talk about the emphasis on hot flashes. We were recently putting together some advanced materials on menopause for the people who visit the NAFC.org website and when it came to listing the range of symptoms that people can experience, it's like unbelievable. It's, it really went on forever and I was surprised to see just how many different things sort of fall under or are related to that part of the change that you're experiencing.

You know, in fact, maybe you could talk a little bit about the whole process of going through menopause, what it actually means, and what you might be experiencing along the way. 

Ingrid Harm-Ernandes: That's a great question because it encompasses so much more of people's lives than originally thought. So the menopause transition, or perimenopause is a phrase a lot of people know, but menopause transitions a little bit more accurate because it really talks about the changes that are occurring during that timeframe.

So perimenopause and menopause transition can actually start in someone's forties. It can be as early as 35 when we're talking about. Someone, let's say, who smokes or has had surgical intervention of some sort or was taking medication that can cause this earlier transition. But for most, it's somewhere between 45 and 55, and you notice that's a decade.

That's a long time for someone to go through these transitional time period. And then the actual definition of menopause is, it is 12 months or one year after your last period. So we're only defining menopause after the fact. So it's very hard for someone to say, “Oh, I'm in menopause,” or so forth – unless you've hit that definitive time period of those 12 months.

And I think that makes it harder to study, harder to look at, harder to recognize, right? So we need to do a better job, I think, about understanding these transitions and when they occur. And I'm going to add an extra wrinkle in there because women are having babies later, which means they're going through both pregnancy and fourth trimester, what we need to be talking about is fourth trimester, because that includes not just the six weeks, but actually three months and beyond a year, whatever it takes, where those symptoms are still occurring. Those symptoms are very, very similar to menopause, menopause transition, and if people are having babies later, what we're seeing is they're already going through these symptoms in this fourth trimester and then segueing right into menopause transition and menopause.

So data is now showing that at least 40% of a woman's life is spent in post menopause. If we now look at menopause transition, and even before, it's well over 50%. Of over 50% of the population that is going through these symptoms, and yet we're ignoring them. We're not talking about them. We're not seeing, what can we do for those folks at that time period.

If we get that recognition that it's occurring over a much greater time period, then we may have that recognition that there are treatments available. There are many treatments available, and we start looking at it instead of, “Let's sweep it under the rug, let's not talk about what's going on down there.” It's more, “Hey, this is happening. What do we do? What can we do? What great resources are out there to help us?” 

Bruce Kassover: What actually is happening inside the body that's causing these sorts of changes? 

Ingrid Harm-Ernandes: So the drop in estrogen and the changes in progesterone are like the main reasons for those changes, so they accelerate.

So what we might know is like the aging process, they accelerate that a little bit during that timeframe, which is why there are more of these many symptoms that can occur. So if during the menopause transition, at one point you have high estrogen and the next point you have low and then it changes to mid and then high, it's these changes that the body's struggling with trying to keep up with. So the body's trying to find ways to, you know, put up with that with something it's never experienced before in its life. And then we end up with these symptoms where hot flashes is like the most notorious. 

But then if we talk about, it can change the actual tissues at the pelvic floor, and we can talk a little bit about the musculoskeletal syndrome of menopause in a moment, but I'll just phrase it right now with the pelvic floor, that it then changes how well does the muscle work. How well does it function. Does it get weaker during this time period? Is there less moisture out there? Is there less lubrication giving us problems with intercourse? Is there less ability for the urethra than the sphincter for, from our bladder to, where we pee through, the urethra is where we pee through, and the sphincter, do we have less control over it? Does leakage increase? Do we have problems with constipation? Motility of our bowels have slowed down, or the pelvic floor has gotten tight, making it harder to have a bowel movement. Do we have less elasticity of the tissue increasing risk of prolapse during this time period? Or did the birthing process set us up and now the menopause transition has increased that issue, has increased the risk factor for having that. 

So just the estrogen alone, I think is one part. But we do realize that decrease in muscle mass and decrease in bone density occurs, those changes occur more rapidly during menopause transition, and then especially in the post menopause phase. So we do have to look at all of these different components and not necessarily say, well, estrogen is the only answer, but the right kind of exercise, the right kind of activity, pelvic physical therapy, right kind of diet, better sleep. All of these things can improve those symptoms. If we learn during the menopause transition and during post menopause, it's never too late. Don't get me wrong, it's never too late to learn these, but if we can learn it earlier, I think we prevent some problems from happening or make them easier to treat as we go along.

Bruce Kassover: It makes sense and I mean, it already is not sounding like the most fun time in the world with a lot of these changes, but I'm wondering if maybe we could also talk about some of the additional symptoms beyond the sort of the physical ones you were talking about, because I know there's a whole bunch of other things that women might recognize, that they experience without realizing that it's necessarily related to hormone changes and menopause.

Ingrid Harm-Ernandes: So, one end of that spectrum is the sleep loss and the brain fog. So, you know, we talk about like mommy, baby fog, that kind of thing. Well, it's very similar to the brain fog that occurs during menopause transition and even into post menopause. There's anxiety and depression, hair loss. They're all part of the menopause transition and menopause that aren't necessarily attributed to it and they're ignored.

And then alternate kinds of medication and treatments are prescribed rather than looking at the root cause of it and looking, do we need to change diet? Do we need to change sleep hygiene? Do we need to change pelvic floor care? Do we need to change exercises? And that brings me to the other side, which I think really isn't looked at now, the musculoskeletal syndrome of menopause.

That was looked at and there was a great paper released last year on this, and that looks at the greater kind of scope of what happens that really isn't attributed to menopause. And that is indeed things like arthralgia or joint pain like through the body that is joint limitation. It is stiffness, it is frozen shoulder adhesive capsulitis.

It is. Things like bone mass loss, which is huge. That occurs much earlier. I mean, we do bone density screening so late in life that we might not capture when it's really happening and changing. And then there's muscle mass loss sarcopenia, which is usually attributed to someone getting older. It's like as you get older, you lose muscle mass. It's called sarcopenia, but there's also adipose sarcopenia, which means that not only are we losing muscle mass, we're gaining belly fat or we're gaining visceral fat, so that what a lot of people complain is, “My figure is changing,” and that's a real thing. But the important thing is to say, with early intervention and really looking at it, that we want to make sure that women are understanding that exercise is extremely important during this phase of life.

What's going to happen? They're going to say, I'm embarrassed, I'm leaking. I'm going to stop exercising. I'm going to stop doing them. More like the hopping, skipping, jumping. That's great for our bone density. I'm not going to do that because I'm leaking. I'm not going to do weight training because I'm leaking, I'm embarrassed or have increased prolapse.

You know, they have fear of increasing these symptoms and that's so sad because this is the timeframe women really need to be told, “You need to do strength training, resistance training, elastic band,” not necessarily cardio. Don't get me wrong, that has its own good factor, but we need to encourage strength training, where for decades, women have been encouraged not to do that, just to do cardio… “we need to be skinny,” not “we need to be strong,” so that the narrative has to change during this timeframe of being strong at the pelvic floor and through the body, which leads me to just to go back to the pelvic floor because genitourinary syndrome of menopause, or GSM, because that's a mouthful, occurs during this timeframe, but even this paper, The Musculoskeletal Syndrome of Menopause, had only two sentences about GSM, right?

And we need to realize it is part of our musculoskeletal system and we can't ignore it. So just like we want to look at arthralgia and joint problems and muscle mass, we want to make sure the pelvic floor is part of the narrative of pelvic health and of muscular health during the menopause transition in menopause.

Bruce Kassover: I love hearing that because one of the constant battles that we face and, uh, so many people with symptoms of incontinence face is that it's just hard to talk about. Nobody wants to mention it for reasons that we could all understand pretty implicitly, so that we're trying to normalize it and address the things that stigmatize it is really helpful.

I also find it surprising some of the things you're talking about. I'm wondering if you encounter when you deal with patients, people who've had a lot of misconceptions, misunderstandings about menopause, and if so, can you maybe, maybe dispel some of those for us and, and you know, help us set a straight where we might be mistaken about things.

Ingrid Harm-Ernandes: So I think the, you know, the misconceptions of menopause is that it is something that is just older women. It is a year or two in their life and that they should just go live with it. What that does is, if we say it happens, “Go live with it,” then the thought, “There's nothing I can do for it. I can't help myself.”

So if I suddenly start leaking at age 48 where I never had the problem, “Well, it's because I'm going through the menopause transition. It's perimenopause and I will just go live with it.” And I think that it's really sad that these misconceptions are keeping people from getting appropriate treatment. So if we can dispel the myth and say these are things that happen and they happen to so many of us, a great deal of prep.

So I'm sure a lot of your listeners are aware, or maybe they're not, that at least one out of four women have a pelvic floor disorder. And incontinence is one of the largest ones, right? So what a disservice we're doing by saying, “Well, incontinence is just something you have to live with. Go put a pad on and live with it.”

No, we need to really, really change that and start people saying, wow, I've got these symptoms. Let me go to my doctor and let me discuss it. And if that doctor doesn't understand it, let me ask another one. Let me use resources and let me prove that these issues are there. So I encourage all patients to really be an advocate that way. And then I'm encouraging practitioners on the other side to be advocates to say, “I understand. Let me listen to your symptoms. Let me put them together and here are some things, some wonderful things we can do.”

Sarah Jenkins: I have a question, Ingrid. I know you were talking about weightlifting before muscle training and I just was wondering for people who do have incontinence or compromised pelvic floors and are scared to start that, what do you suggest? Are there safe exercises that are easier to do, that are more protective of the pelvic floor than others? And you know, how should someone approach that If they want to get into weight training but they're nervous or have been told that, you know, you shouldn't lift heavy weights? And I guess what is, what is too heavy? 

Ingrid Harm-Ernandes: Yeah, great question because there are tons of layers to that. I mean, overall, one of the things that I always encourage folks to do is, if you're not sure about your program, do use a specialist to help you start. So if you've never been doing exercise and this is very new to you, it can be very confusing as to what to do.

Some of the very simplest things that I tell people is, a simple walking program, believe it or not, goes a long way for bone density, cardiovascular, for pelvic floor health, and just for overall health. So, you know, a walking program sometimes is the easiest thing to do, and start flat ground, start slower pace, increase your distance, then increase your speed, right?

And then if you do discover you're having a leakage problem, this is definitely a time to see a pelvic PT. So I think what I want to maybe differentiate with this… I'll give you an example: So athletic trainers and physical trainers are getting better at incorporating pelvic floor education in the basis of education. So right now, I'm doing a module for athletic trainers on the pelvic floor itself. So they recognize it, they can start their clients on it. They can refer to pelvic PT when it's appropriate, so they actually know that whole scale of what needs to be done. If you are having symptoms, it is important to see a pelvic PT to find out, are you doing pelvic floor exercises correctly?

Are you doing them, what's appropriate for you? Do you need to do relaxation techniques rather than strengthening techniques? Are you increasing symptoms or you're decreasing symptoms? That kind of thing. And then take that knowledge and use the pelvic floor appropriately while you're doing exercise. Are you using your pelvic floor the way it's meant to be used or are you straining the pelvic floor?

Because there is increased risk for prolapse and incontinence with heavy duty weight trainers and lifters, and I think it's not so much that they're doing this weightlifting, it's more that they were never taught how to use their pelvic floor appropriately to help them through their lifting and prevent pelvic floor problems.

So one of the keys is absolutely understanding how the pelvic floor should function and what you should do during your exercise to not only prevent the leakage but keep you healthy through the rest of your life. Does that make sense a little bit?

Sarah Jenkins: That makes a lot of sense and I think that you're so right that if you're having problems, you really need to see a specialist to learn some of these techniques to either strengthen or relax or just learn how to keep your pelvic floor healthy and intact when you're doing these exercises. So that's great. Thank you. 

Bruce Kassover: Sarah, I think that actually brings up an important point. When you realize that you're experiencing these symptoms and it's reached the point where it's bothersome or you're concerned, what should you be doing? I mean, would you immediately go to a physical therapist? Would you reach out to your physician, and if so, would you go to your general practitioner or see a specialist? How would you go about trying to get some of these things addressed the best way? 

Ingrid Harm-Ernandes: Some of it is a little bit where you live because you'll have areas that are very rich in having lots of pelvic floor specialists, and so it's easy to go. If you're a little more rural, it might be a little bit more difficult. 

So thinking of it from that lens, I would say there are some who are super specialized in it, your urogynecologist generally. No more OBGYNs, mostly no more. Some family medicine physicians are getting a lot better at recognizing it earlier, and sometimes that family physician will be able to say, “Hey, you know, so you are having these symptoms. I think pelvic PT is the route to go,” using good resources to kind of build that idea of what is the pelvic floor, what does it mean to do pelvic floor exercises, that kind of thing.

And I will say that if at all, you're having pain, you're having difficulty, you've tried to do pelvic floor exercises on your own and you can't find your pelvic floor, or you're having pain doing it, that is absolutely the red flag of go see a pelvic PT if you're having pain. That is, is such an important factor because it means that those pelvic floor exercises need to be so specific to your needs, which they should be anyway.

But I mean it particularly with pain, sometimes we need to work on getting that floor to relax before we ever even think about trying to get it stronger. We need to get that muscle to work appropriately and function at its best so that the strength makes sense and, and it doesn't create more problems.

Bruce Kassover: That makes sense. Now, you were talking earlier about, in addition to physical therapy, about hormone therapy as well as a treatment. I'm wondering if you could talk a little bit about the broader range of treatment options that a patient might find available. 

Ingrid Harm-Ernandes: Yeah, yeah. So when we're talking about like, you know, social media stuff, immediate thought, we’ll go on, you know, estrogen, because it's going to solve all your problems.

And one of the things I've been around long enough to see, you know, long ago estrogen was handed out like candy and then we had the WHI study and everybody got scared and now they're saying, “Well, that was not interpreted correctly.” So there are many more women who can benefit from estrogen than originally thought.

And now I see this pendulum swing a little bit too much almost. “Well, let's put everybody on it.” And in the medical world, it's very difficult when we do these pendulum swings. We need to find what's appropriate for the individual. For some people, the hormone, the estrogen, that might be great, that might work. For others, it might make symptoms worse. It might be difficult for them. They may not want to do it. They may feel that their risk factors are too high for it. You can do estrogen, you can do other things. You can do both there, like they aren't such that you can only do one and not the other either. The other things that are important.

I think for everybody to take into consideration because there are life kind of altering or life changing things that you do. They're habits that you do that you use for the rest of your life that help you with everything. So those would be pelvic physical therapy can change your life and show you how to do things for the rest of your life, that will help you no matter what happens. It shows you how to use your pelvic floor right, shows you behavioral changes you can do, shows you strategies that help you prevent incontinence or stop incontinence or stop prolapse or stop constipation, and I can go on with that. 

Then you might say, “Well, I need a nutritionist to help me see that some of my eating habits are increasing my symptoms. I need to work better on sleep hygiene, which simply means I need to be better about. When I go to bed, how long I sleep, what's in my room, what am I doing? Am I on electronics and media just before going to bed?” They're all, that's, that's a whole science in itself. 

Do I need a sex therapist to help me understand relationships better – that it's not just necessarily the dry tissue? Or is it the pelvic floor tension that's causing a dry tissue sensation? Right. We might need someone to help with mental health aspects. A lot of times it's, the jump is, let's just go on medication with that, too. But maybe it's someone who needs to show you strategies to help deal with stress in your life, which is huge usually during this timeframe because it's the sandwich generation and we're taking care of our children and we're taking care of our parents at the same time. So there's a natural increase in stress in our lives. 

Do we need someone to help us work our way through those and get better strategies in that as well? Do we need an acupuncturist? There are so many different practitioners that can help us gain better strategies and better techniques and better tips to help us through our life.

And it's so important to recognize that in that menopause transition and menopause because I feel like we can do things naturally in such a great way that help us, not at the moment, but through that continuum of life, that whole time period that we were talking about before. 

Bruce Kassover: Tell me if I'm mistaken, but it sounds like the main sort of message that you're suggesting here is that you have to be willing to take charge. You have to be proactive and recognize that you don't have to live with a symptom if there are ways that you can address them. Is that fair to say? 

Ingrid Harm-Ernandes: Yeah. It's why I'm such a strong advocate of teaching. I, so, you know, in my book, The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms (Amazon.com, DesertHarvest.com), it's for everybody.

I teach everybody what's going on in your body, what the symptoms are, how to address them, what that interdisciplinary team is. So we were just, what I was mentioning is an interdisciplinary team, that the patient is often the center of that team and helps pull things together. So if you don't necessarily have a practitioner that can pull in.

The specialists, you have better knowledge of pulling the specialists in, so the advocacy that I really push is that it's on both sides. It's on the patient side where they really gain that knowledge and that education and on the practitioner side so that they can help their patients better with a really good team of practitioners rather than thinking, “Wow, I have to solve this per this problem on my own for my patient without pulling in help mates, you know, in that team.”

Bruce Kassover: Let's talk about education for a second, because if I'm not mistaken, you recently came out with a book. Does that sound right? 

Ingrid Harm-Ernandes: Yeah. Yeah. So the, The Musculoskeletal Mystery: How to Solve Your Pelvic Floor Symptoms is the, the book that I wrote because I was so frustrated with seeing patients wait 5, 10, 20, 30 plus years to walk in through my door.

And it was because they themselves didn't know what to ask for, and their practitioners didn't know that pelvic PT even existed. So I wanted everybody to understand that the musculoskeletal system is a major key player in pelvic floor symptoms. That the pelvic floor and the entire core is what can be the cause of the problems. 

Not just our organs, not just hormones, but the musculoskeletal system. And if we don't address that, we may not be able to solve these issues. So I really love it that the book talks to everybody. Puts everybody on the same page, literally and figuratively, and makes sure that everybody can talk about this comfortably.

And a person can go grab my book, walk into their doctor's office or their nurse's office and open the book and say, “Hey, you know, I've been reading about this and this is what I see, “ and, “Can I get help for this?” Like it legitimizes their conversation. And on the flip side, that practitioner can have the book in their office, in their library and say, “Look, you know, this is what's really going on, so I think pelvic PT is your answer,” or, “I think, you know, going to sex therapy is your answer,” or, “I think…”, right, and the patient says, “Wow, this is something that's real. It really happens and I'm not making it up or not being told to just go live with it.” It's an actual issue, which is why being on a team is in the book as well.

I list all these separate organizations so people can see, reputable sources to look up information. So before I mentioned reputable sources, it's important that you have reputable sources to say, this is what's really going on and this is what I can do about it. Because I don't want to just say we have a problem. I want to say, how can we solve the problem? And that's why the book as such is to solve those pelvic floor symptoms and really help people get that care better and faster. 

Bruce Kassover: That's very cool – I love that. So now tell me, where does somebody find your book?

Ingrid Harm-Ernandes: You can get it on DesertHarvest.com or on Amazon. Either one. 

Bruce Kassover: Excellent. We are going to put links in the show notes so people can kind of get right there with just a simple click, so that's great. 

Now, for patients who find that they're facing all of these issues, you know, they're considering going to a physician or they've been to a physician or a physical therapist or they've seen some sort of a specialist, is there anything else that you would recommend they do or keep in mind to sort of help them make it through this transition as comfortably as possible?

Ingrid Harm-Ernandes: Yeah, so as early as possible, when you're starting to witness symptoms, address them. Don't let them linger on, because in the musculoskeletal system, if we let it linger on, chances are that over time it will get worse. It won't magically go away. And a lot of times people are told, oh, like during pregnancy, if you get incontinence, it'll go away.

Well, no, for many people it doesn't. Prolapse doesn't necessarily go away or it returns later in life. So please, whatever you do, try to get that care earlier rather than later. If you're in the throes of it, you already have those symptoms, you're only hearing about this now, then absolutely immediately go, you know, try to get that care.

We talked about, whether it's talking to a physician, a nurse, a specialist these days, you're seeing a little bit more in people being specialized in perimenopause and menopause care. Which is great. There are some organizations that are offering certifications, so you can look for that to make sure it's someone who's really very knowledgeable of what's happening in the menopause timeframe.

So I think that would be helpful as well. And then, you know, don't give up. We were talking a little bit before about saying, you might have to say, “I need to ask another practitioner.” Take my book with you. Take those resources with you. Learn as much as you can so that you can advocate for yourself. Bring someone with you who maybe knows a little bit or can back up what you're saying, you know, whether it's that brain fog or the other symptoms we talked about, that they can, you know, they're part of it. There's partnership in, you know, intercourse, bring the partner along if you need to, you know, have that discussion so it becomes a lot more real and more and stronger rather than just saying, “Well, you know, I leak a little bit,” because if you just say, “I leak a little bit,” chances are you're not going to get the response you want. And I can't tell you how many people that I've assessed where, you know, if you ask them, “Do you leak?” They're like, “Yeah, not really.” And I say, “Well, do you have even a drop of loss when you cough or you sneeze?” They're like, “Oh yeah, that happens all the time.”

But that's perspective. That's what people have been taught is that that little bit of leakage is not really leakage, right? So it means staying with it and starting when the symptoms are smaller and slighter, so that we can get the care, but even if they're there, just push and ask for that help. Don't give up.

Bruce Kassover: I love that. That is really excellent advice. But as you know, this is Life Without Leaks, and the one thing that we do at the end of every episode is we ask for one extra little hint, tip, strategy, bit of advice to help people live a life without leaks. So maybe you could share one with us today. 

Ingrid Harm-Ernandes: So the pelvic floor itself, since that's what I kind of talked about a moment ago, is, you know, making sure that you're doing it correctly, I always tell folks, don't think about squeezing, right? Because when we squeeze, what most people will do is, they'll grab their buttocks tight, they'll grab the abdominals, they'll grab their face tight, you know, they'll do anything. They'll, they'll curl their toes, but they really don't use their pelvic floor.

So I tell folks to think about this image of having a straw in the vaginal or anal canal, and that you're using the muscles of the vaginal canal to pull up and in. So the idea is that you're pulling your pelvic floor up and in. If you're sitting away from the chair that you're sitting in and relaxing it down.

If you can feel that, then you're on your way to understanding a pelvic floor contraction, and you're starting with just a couple-second hold and release. That's where I was saying before, if you can't feel that, you are not getting the connection between brain and pelvic floor, or you're having pain, stop trying to do it and go to a pelvic PT, right? 

So I think that gives a little bit of connection with the tip that we were talking about before, is making sure that those exercises are done correctly so you get the best benefit you can possibly have from it. But absolutely, please, please see a pelvic PT if you feel like you cannot do it or you're having pain.

Bruce Kassover: That's a fantastic bit of advice, and it's something that we reiterate ourselves as well, is that, yes, Kegel exercises can be a challenge and they don't have to be, so find help and make the most of them. So thank you. I appreciate you sharing that and I appreciate you sharing all the information with us today, and I certainly hope that the women who are listening will take advantage of it and also check out your book and really learn what you have to say in depth. So thank you for joining us today, Ingrid. We really do appreciate it. 

Ingrid Harm-Ernandes: Thank you for having me. I had a great time. Love the conversation. Hopefully people got some good little tips out of what we were talking about.

Bruce Kassover: 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. More information about NAFC is available online at NAFC.org.