“When you’re not worried about leakage, you can have an increased degree of self-confidence and quality of life.”

October 8, 2021 in From the Desk of a Doctor

We all know it’s important to maintain a strong pelvic floor. We know we’re supposed to do our Kegel exercises and eat well and exercise and, and.....But we don’t always know why. So we sat down with Dr. Kameelah Phillips, a board certified Obstetrician and Gynecologist with Calla Women’s Health (she’s also a wife, mother, and lifelong women's health advocate) to explore everything from pregnancy to menopause, and why the pelvic floor is so important throughout a woman’s life.

What’s the connection between pregnancy and the pelvic floor? What do pregnant and recently postpartum women need to do to maintain pelvic floor strength?

I tell people that it’s really important to stay as active as possible when pregnant because it affects every muscle in your body. The pelvic floor is very important during pregnancy. In the past, we thought of pregnancy as a time to relax and indulge and let your body go, but recently there’s been a paradigm shift as it relates to how we approach physical activity and a woman’s ability to maintain her body during pregnancy. There’s now an understanding that being active helps you have a healthy pregnancy and helps delivery. It doesn’t mean it’ll be the easiest delivery, but there’s a more rapid recovery from the process. So I encourage women to minimize-as much as they can- the amount of weight they gain in pregnancy. We have traditional guidelines based on a starting weight, but assuming the baby is growing appropriately, I encourage women to gain as little as possible. They can do that by eating healthy. Obviously at times the spirit overwhelms you and you indulge in sweets or fried foods- I get that. But for the most part, I try to encourage patients to make most of their meals healthy and plant-based.

I laugh when I remember being with a patient who told me her baby needs french fries. I was like, honey. Let’s be honest with ourselves. You want carbs and that’s how it is. But in all seriousness, weight gain over time impacts the pelvic floor, and it’s such an important group of muscles because it literally holds your entire body together. We possibly abuse it by not paying attention to excessive weight gain in pregnancy.


What are the warning signs of pelvic floor issues?

The most major risk is laxity or weakness of the pelvic floor. What I see is women complaining of having a sense of heaviness. They’re dragging themselves around. There’s a sense that everything is “falling out,” or they feel like their pelvis is low. They say they feel something in their vagina like their cervix or uterus. They also complain that their bladder is low and leaking. Again, weight gain is a huge culprit. There’s a natural tendency to gain weight, even during menopause. Over time, your pelvis will feel the impact of pregnancy and age related weight gain. If you experience these symptoms, discuss them with your healthcare provider.


How do you help women treat these symptoms?

First, I look for conditions that are unique stressors to that person. If, for example, they put on weight over time, it’s time to be honest about that impact over time.Also, it is important to identify chronic diseases that cause a cough, like asthma, allergies or, or acid reflux. While a chronic cough might not seem like a big deal, this intermittent pressure on the pelvic floor can add up over time. The cumulative impact on the pelvic floor can lead to leakage. We can try to control these conditions by changing your diet or consulting a pulmonologist for an inhaler.

I also provide guidance about working out and doing kegels. That’s easily accessible to most people. When you think about it, it’s intuitive and they understand how to do them. So I have patients start there while multi-tasking weight loss and management of chronic conditions that impact the pelvic floor. After this 3 step approach we can reassess their progress and decide next steps.


Is there a right way to do Kegels?

Yes and II think most women understand the concept. To be sure, however, I actually examine them while doing kegels to help them focus on the muscles of the pelvic floor. It is more than just “holding your urine”, but really a focus on the entire pelvic floor. I’m not sure that approach is used for everyone. So if you’re unable to conceptualize it or do it properly, you might consider working with a pelvic floor physical therapist. You can also do Kegels improperly and have injuries which can result in tightness or hypertonis. Proper care must be taken for improvement of pelvic floor laxity. If you are doing Kegels improperly it is similar to overworking or lifting weights improperly-you can injure yourself and not receive the full benefit of your time and energy.


When would a woman opt for INNOVO?

I think INNOVO is appropriate when someone is like, OK, I think I’ve done what I can on my own. I definitely do not want surgery, but I realize I have a problem and I’m ready to take the next steps to get better. That’s the patient I recommend for INNOVO - mild to moderate symptoms, who just needs time and a different approach to their pelvic floor, and specifically for incontinence issues. This type of patient could benefit from INNOVO.

What are the benefits to pelvic floor health?

We have to realize that the pelvic floor is a basket of muscles that is intimately connected to your core. It is integral to the strength of your body. It is not only important for core strength but also bowel and bladder control. Someone’s ability to control the movement of both stool and urine is life changing. Childbirth is a great reason to have a strong pelvic floor. Pelvic floor health can also influence sexual function. Depending on how a person experiences an orgasm, having a strong pelvic floor can enhance the process and help her be more connected to her pelvis and sexual organs. Also, when you have a health pelvic floor and not worried about leakage or that your uterus or bladder is hanging low, you can have an increased degree of self-confidence and quality of life that allows you to be a more sexual being.


What do you want women to know about their pelvic floor?

I want to encourage women to approach their healthcare provider if they’re having issues. Please t do not come to your visit and have cold feet about discussing incontinence. Writing down your questions on a piece of paper encourages you to remember that you must talk about the topic and start the journey of healing yourself and improving your quality of life. I find when women introduce the with family and friends they will find several other people saying yeah, I’m also dealing with that issue. There’s a community out there not only experiencing what they are, but who can also introduce them to methods of safe and effective treatment. They can learn about weight loss, earn about pelvic floor therapists, and INNOVO. They’ll see a community of people dedicated to the issue. It's important to bring it up to access the resources available.


Why do you think the issue is still so taboo?

Incontinence or pelvic floor dysfunction is one of the last remaining social taboos. In discussing incontinence, there is an admission that we do not have full control over our bodies. That helplessness is really humbling and also humiliating. When was the last time you wet your pants? You were five. Now you’re 55. This experience reminds you of a time when you’re embarrassed or punished for doing such a thing. There is a lot of negative emotion associated with pelvic floor dysfunction. This promotes secrecy. I try to normalize the experience with my patients. I ask, have you peed on yourself yet? What typically follows is a flood of emotions-it’s the release of anxiety and isolation in knowing that other people have experienced it. When they understand that this won’t always be me there is hope in the options they have for management . This is why it’s so important to normalize pelvic health for everyone. We have a lot of great options to help treat this condition.

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