Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2: 0:19

Hey everybody, and welcome to episode 12 of the Healthy Matters podcast. I am David Hilden, your host, and today we are going to launch into the first of a kind of a two-part series about pelvic health. Today we'll focus on pelvic floor issues, something more commonly affecting women, but also men as well. And in a few weeks we'll be talking to a urologist and focusing a little bit more on men's urologic health. Now, over the years in clinic, I've seen a ton of cases of pelvic floor issues, people who have incontinence , um, mostly in both men and women. So it's, it's really not that uncommon today I've asked an expert in that to help us out with pelvic floor issues. Dr. Be Agora is a doctor of physical therapy here at Hennepin Healthcare in beautiful downtown Minneapolis and a colleague of mine. Beth, thanks for being on the show.

Speaker 3: 1:06

Thank you for having me.

Speaker 2: 1:07

So for our listeners, let's start with the basics in some definitions. Um, what do , what do we mean when we say the pelvic floor?

Speaker 3: 1:14

Yeah, the pelvic floor is something that people say often now, and it really is just that group of muscles that's in the bottom of the pelvis and it's connected to the pelvis with ligaments and to the bony structure of the pelvis. And anyone who has a pelvis has a pel floor. Whether you are assigned male at birth or female or if you are a child or an adult, everyone has a pelvic floor. So

Speaker 2: 1:37

These are muscles we can't see. Correct. When you say muscles down there, you know, people are imagining your biceps and all that. These are muscles that are buried in your pelvic bones. They're

Speaker 3: 1:46

Very deep. Yeah . What do they do? So they actually have five different functions. So we, in the pelvic floor world, we often say the five Ss of the pelvic floor. One of the primary ones is that it supports the organs within the pelvic cavity. So it will support the reproductive organs, the bladder, the bowel tissues. The other S is sphincters, so a lot of people know about that one. The pelvic floor controls urine, stops urine from flowing, it stops stool from flowing. And it also stops gas too, those sphincters. The other s is also sexual. And so the muscles within the pelvic floor for both people who are assigned male at birth and people who are assigned female at birth play a role in sexual function for both erectile tissue and for relaxation. And the pelvic floor muscles also provide stability to the trunk. That's another one of the yeses. So when we go to stand up from our chair, for example, the pelvic floor muscles stabilize our tailbone and our pelvic bones. And lastly they serve as a sump pump. So they help to move fluid, whether it's our circulation or our lymphatic fluid, they help to move that out of our trunk and up to our heart and the rest of our blood flow areas.

Speaker 2: 3:00

Wow . You've got stability, support, sexual function , uh, you've got sphincters and sump pumps into that. You guys must be just like a riot at a dinner party.

Speaker 3: 3:10

<laugh>, yeah, we, that's about all we talk about in our office and at parties, but that

Speaker 2: 3:15

What's, what's fascinating about that is that that's a lot of functions that people probably don't think about. And although I don't know if a clinic goes by that I don't see people with some kind of urologic or pelvic function, it's just very, very common. But I haven't even thought about all of those functions. And so could you talk about more and, and maybe specifically on women, people assign female at birth. What is the role in pelvic floor health for quality of life? Just if you could just kind of talk from a high level before we get into specifics.

Speaker 3: 3:44

Yeah. I would say that it impacts quality of life in a lot of different ways and we have have a lot of research about that and we have a lot of experience with that, especially urinary incontinence. People who have incontinence tend to stop doing activities that they used to do or that they used to enjoy that maybe they don't go shopping with their friends or they don't go out to restaurants because they have to urinate and they don't have access to a restroom. They might actually stop drinking water when they know that they're going to be out at appointments, for example, for a day. We know that there's also an impact on quality of life within relationships. So it impacts ability to have pain-free sex or sexual relationships. And so a lot of times that can impact people's relationships with their partners and then it impacts mental wellbeing. So I see a lot of patients who are very embarrassed about their either urinary or fecal incontinence or gas incontinence and they will be really self-conscious about whether they have a smell or whether people can hear or see that leakage. And so they'll really avoid a lot of activities. That's huge. It's really huge.

Speaker 2: 4:51

That really is huge. I really appreciate you kind of , um, you know, encapsulating that for us. Let's get a little specific. So what's the most common thing you see? Is it incontinence? Absolutely. Urinary incontinence. I guess more

Speaker 3: 5:01

Specifically, urinary urinary incontinence is one of the number one things that we see here in the pelvic floor physical therapy world. And again, affects people assigned female at birth, people assigned male at birth, it affects children, it affects adults. There are different types of incontinence as well. So there's what we call stress incontinence. And stress incontinence is when you have urinary leakage or stool leakage. When you laugh, cough, sneeze, jump, run. There's also urge incontinence, which is when you feel the urge to urinate or have a bowel movement and you have difficulty holding it until you get to the bathroom. That's a really impactful one too. People start to avoid going places when they have urge. Urge

Speaker 2: 5:41

Because you can get there fast enough .

Speaker 3: 5:42

Exactly.

Speaker 2: 5:43

Are they caused by the same thing? They must be a little bit different.

Speaker 3: 5:46

They're , they are a little bit different and that's where kind of this one size fits all treatment for pelvic floor physical therapy is, doesn't really work because those who have stress incontinence would do a different treatment type program than somebody with urge incontinence. Those are very different protocols for those two issues.

Speaker 2: 6:03

And later in the show I'm gonna ask you to get into kind of specifics about what treatments you do because listeners , um, Dr. SRA is a physical therapist who specializes in this work. And so there are treatments, and I'm gonna take a little bit of a preview and say that tho there are some effective treatments, so stay tuned for what you can do about it if you have it. So that's urinary incontinence. What other pelvic floor problems do you see particularly in people assigned female? Yeah,

Speaker 3: 6:28

So a lot of times we also see pelvic organ prolapse. So what's that? That, yeah, that's something less commonly talked about but very commonly experienced. So pelvic organ prolapses, anytime that your bladder urethra, your uterus or your rectum can sit a little bit lower. And what that feels like for people is it feels heavy. It feels like there's a fullness in your pelvis and not a lot of people talk about it. You can have prolapse and you can have incontinence or you could have them separately. And so some of the risk factors for those are things like being pregnant or having vaginal births or having more than two C-sections. So a lot of times we do see pelvic organ prolapse more common in women.

Speaker 2: 7:11

I'll bet loads of people listening to this right now are nodding their heads. Yeah, I got that. And I'll bet none of them ever talk about it. I I I can see why that might be. Is that because the support functions of those pelvic muscles are giving way ? Correct. Yeah . Is it inevitable?

Speaker 3: 7:25

Uh, I would say not inevitable. I think it starts with awareness first that there are some things that put you at more risk for things like incontinence or pelvic organ prolapse. And it's really about mitigating those impacts. So for example, if you're a high level athlete who does a lot of lifting or impact jumping or things like that, or if you do a lot of heavy lifting at your job, you can modify your workplace or your activity to make it less impactful on your pelvic floor and not have those symptoms.

Speaker 2: 7:53

We've talked about incontinence, we've talked about organ prolapse. What about pain disorders? I, I do have patients come to me and say things like, I just have pain down there.

Speaker 3: 8:02

Yeah. And so you can have pain in a lot of different structures within the pelvis, whether it's some of the structures in of involving arousal or whether it's some of the structures with urination or bowel movements. And so it's really important to talk to your healthcare provider about those issues to make sure that you screen for other causes of pelvic pain that might not be musculoskeletal or related to your bones and joints.

Speaker 2: 8:27

Yeah . There are other things other than pelvic floor muscle problems. You can , women get endometriosis. Mm-Hmm. <affirmative> , they get other kinds of things. So it's a great bit of advice to get that looked at. Yeah. If you're having pelvic pain,

Speaker 3: 8:37

Yeah you can have a , a urinary tract infection or something like that. So anytime you have pelvic pain you should always bring it up to your primary care provider. Let's

Speaker 2: 8:46

Talk a little bit more about some of the risk factors that can lead to some of these issues. Now you mentioned pregnancy, could we focus on that a little bit? Pregnancy, childbirth and what some of the potential long-term effects of those. Obviously very natural, normal, wonderful things but can lead to some long-term pelvic floor issues. Right.

Speaker 3: 9:05

Yeah, and I think you kind of said it perfectly that I think we justify this, you know, we , we had these beautiful babies and we should just live with incontinence and it's just one of those things that we should have to deal with

Speaker 2: 9:17

The price you pay for this miracle, the price . Yes .

Speaker 3: 9:19

But, but it's not. And then , and I'm here to tell you that we have so many , uh, studies and research that shows people get better, especially if we can get patients in while they're pregnant or even before you get pregnant, to help get those muscles the right coordination and control that they need to hold up a baby for nine to 10 months. <laugh>.

Speaker 2: 9:38

So these same , these same pelvic muscles have to hold that developing fetus up.

Speaker 3: 9:43

Correct. And by design, the uterus sits right on top of the bladder. So that growing fetus continues to be a weight on top of the bladder, which means more and more pressure on the bladder, meaning more control is needed within the pelvic floor to make sure urine stops.

Speaker 2: 9:59

Do some of the incontinence symptoms that start during pregnancy or is this something that occurs years later? Typically

Speaker 3: 10:06

We can see incontinence within maybe the second or third trimester is a common time to see it. And a predictor of having incontinence in the postpartum is if you have incontinence during your pregnancy, the likelihood you would in the postpartum is, is a lot higher. So if we can try to again, prevent it while people are pregnant and you can still do a lot of treatment even when you are pregnant, we can prevent it in the postpartum too.

Speaker 2: 10:30

What about the number of kids you've had or the birth method if you will?

Speaker 3: 10:35

So those do correlate to pelvic floor issues. So for example, being pregnant by itself is a risk factor for incontinence.

Speaker 2: 10:43

Just one time being pregnant.

Speaker 3: 10:44

Just being pregnant. And then we talked about the pelvic organ prolapse for example, that heaviness. So the more children that you have, the more likely you are to have pelvic organ prolapse and it, it continues to exponentially increase the more children that you have. And then the other thing that I think is interesting is that even if you had two or more c-sections, you're also more likely to have pelvic organ prolapse as well

Speaker 2: 11:09

Even though the birth wasn't vaginal correct. It's just being pregnant and the and the stretching and the

Speaker 3: 11:15

The downward pressure. Yeah ,

Speaker 2: 11:16

Everything's head south. Yeah. <laugh> , there's gravity. Yeah.

Speaker 3: 11:20

So all of those things are, are again treatable while you're pregnant and in the postpartum that is a big time. When we do see people with incontinence issues, there is frequency because that baby is sitting on your bladder. So we do see people getting up a lot in the nighttime to urinate, which is another pelvic floor issue. But while you're pregnant, urinating at night is normal one time and if you're over 65 urinating one or two times is normal. So anything more than that is considered abnormal too. So if you're not pregnant and you're not over 65 and you're urinating more than one to two times a night, that's another time to ask for help too.

Speaker 2: 11:57

Other than pregnancy, what are some of the risk factors for some of these conditions?

Speaker 3: 12:01

Yeah, we see a lot of people after they hit menopause. So with menopause we can see some decreases in estrogen. Estrogen is a hormone that occurs that helps give a lot of our ligaments elasticity. I always think estrogen elasticity, when we lose that hormone, a lot of the organs or ligaments that support those organs gets a little bit more lax or droopy. And so we can see some changes in structure or things being a little bit lower. Postmenopausal and estrogen also affects some of those sphincters that other s that we talked about earlier. And so some of that control over, especially the urethra gets diminished when estrogen decreases. So we see a lot of times people when they have babies postpartum and then maybe we don't see them for a little while until they hit menopause and then problems start to come up again.

Speaker 2: 12:53

What about things like , um, carrying too much weight? Obesity?

Speaker 3: 12:56

Yeah, just like you mentioned with the downward pressure of a baby, the same thing happens with body weight too. So any abdominal weight that you're carrying up top is going to be downward pressure on the bladder on those pelvic floor muscles. And so it's constantly straining those tissues so it can cause incontinence, it can cause pelvic organ prolapse, but for those things to feel heavier too. Also things like constipation too. So chronic constipation, having a lot of stool sitting in your intestines pushes down on those muscles, pushes down on the bladder and again, can cause some issues with urinary leakage.

Speaker 2: 13:30

And you're straining then as well.

Speaker 3: 13:31

Yeah. So if you're trying to push too hard, that does impact your muscles as well. The other interesting group of people that we see with urinary incontinence are folks who are older. And so one risk factor for going into a nursing home is urinary incontinence. So one of the leaning factors that people actually enter a nursing home is urinary or fecal incontinence that they're unable to take care of that on their own. Then what we see is once people get into a nursing home, over 50% of people in nursing homes actually struggle with urinary or fecal incontinence too. So I think that's a, a great place where we could make a big impact on quality of life

Speaker 2: 14:11

Completely. That is, I'm so glad you brought that up because I hear that all the time about patients who, oh, they're doing okay, their hearts are okay. You know, they, they , they don't have like chronic conditions, they don't have cancer, but they tell me the problem is this, it's this issue, my incontinence issue and that very basic human function that many of us take for granted so many of us will struggle with when we're older. I'm really glad you brought that up. We're talking with Best de she is a physical therapist here at Hennepin Healthcare with a specialty in pelvic floor conditions. When we come back from our break, we'll talk about what are some of the treatments that you do in your practice and what help is available for folks. Stay with us. We'll be right back

Speaker 4: 14:53

When Hennepin Healthcare says we are here for life. They mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 15:30

And we're back with Beth sra . So Beth, we've established that it's pretty common, but when we say common, what are we talking about?

Speaker 3: 15:37

Yeah, it's actually pretty staggering the , the numbers. So the recent numbers that just came out say that about 25 million Americans experience either temporary or chronic incontinence every year. And daytime urinary incontinence is also really common in kids too. We see that almost seven to 10% of children who are five to 13 years of age also experience incontinence. So it, it spans the lifetime that is

Speaker 2: 16:02

Staggeringly large number of people and the impact to the healthcare system must be pretty big as well.

Speaker 3: 16:08

Yeah, I mean if you've ever watched TV at night, you'd see so many ads for incontinence products. Oh gosh, yes . Targeting populations, right. And in the US alone, the cost of managing incontinence is about $20 billion a year. And that's for pads, medications, surgeries, things like that. Wow,

Speaker 2: 16:25

Okay. So listener, maybe you're saying I've got this or I know somebody who does, but you haven't, you haven't gone in to be seen for it . Well there is help, there are effective treatments available. So let's get into that. So first of all, how do you diagnose what the problem is when people first come in to see you?

Speaker 3: 16:42

Yeah, so a lot of times we see patients who come in because they've talked to their primary care about it. And so I would say establishing a healthy relationship with your primary care to talk about these issues is really important to help get you in the door to pelvic floor physical therapy. So I know a lot of people might be embarrassed about this issue or fearful about what the examination might look like, but once you get into pelvic floor physical therapy, we can really adapt what that diagnosis and and testing looks like. For example, when somebody comes to see us in pelvic floor physical therapy, the majority of the first visit is about talking about bladder habits. What are you eating? What are you drinking, how often are you going to the bathroom? What's causing you to have leakage? All of those things because there's a lot of treatment that we can provide by just cleaning up what you're eating or drinking or how often you're going to the bathroom. So there's a lot of behavioral things that we can change first and a lot of that can stop the incontinence right there. And then we'll continue on to figure out what kind of incontinence or problems that you're having through conversation. And then we can do some testing. And testing can look a lot of different ways depending on patient comfort. So it could be watching you get out of a chair, it could be watching you walk, it could be as easy as that. Sometimes pelvic floor physical therapy could include an internal examination similar to a pap smear where we would internally check the muscles of the pelvic floor to see how strong they are or how tight they might be because you need both, you need the muscles to be strong, but you also need them to be flexible. You need them to be strong to stop urine, but you also need them to be flexible to let go so you can void urine and stool.

Speaker 2: 18:28

It's actually quite amazing that these bodily functions go on for most of us and we don't think about how great it is that they work, you know , until they don't <laugh> . Until they don't. Okay. So you can do an exam. Can you also detect things like prolapse and other things, organs that are not really where they're supposed to be? Yeah,

Speaker 3: 18:44

Yeah, that we can, A lot of times patients can tell us that, so we already know what's going on by just the symptoms that you're experiencing. But there are certain examinations that you can do where you might be lying on your back and we would have you push down and at that point you can typically see that prolapse coming down and we can tell what tissue it is too because that's also really important in managing treatment is knowing which structure is actually sitting lower. You

Speaker 2: 19:09

Said a phrase earlier that I want to come back to, depending on patient comfort, a lot of this stuff you're talking about sounds a embarrassing, it doesn't sound particularly comfortable, this is not the most fun day you're ever gonna have. Could you talk us through how you help to make patients more comfortable?

Speaker 3: 19:25

Yeah, and and we, we are very mindful about patient comfort that we don't do any testing that patients aren't comfortable with. So again, we can get a lot of this information about the diagnosis just from what patients are experiencing and start treatment there. The other ways that we can also do some of the objective testing, we have ways that we can measure muscle function without internally checking the pelvis. So we can put little electrode patches externally along the vulva for example, and we can actually watch on a computer screen and watch that muscular activity on a computer screen without any internal examination. So we really are mindful about modifying how we examine patients and don't push beyond that comfort level.

Speaker 2: 20:10

Do you ever work with urologists in , in the like to determine how people's urinary function is working?

Speaker 3: 20:15

Yeah, the urinary exams that urologists perform can be really helpful in helping us to determine how, well, let's say the bladder's emptying. So you might do an exam with your urologist where you, maybe you're not feeling like your bladder empties all the way because you, you urinate and then 10 minutes later you have to urinate again. And so with the urologist you can do a test where you, they actually measure how much urine is in your bladder, then you urinate and then they check it again to see if you actually are emptying your bladder. So we use that knowledge to then help us either strengthen or relax the pelvic floor to help empty.

Speaker 2: 20:51

Okay. So you have a diagnosis of whatever it might be, urge incontinence, stress incontinence, prolapse , uh, you know, some pelvic pain disorder. Talk us through what some of the treatments are because I think many people might not be aware of what a pelvic floor physical therapy treatment program would look like.

Speaker 3: 21:07

Again, our first meeting is talking through what's bothering you, what activities are bothering you, and then really looking at lifestyle. One of the big triggers for incontinence or urgency is what we eat or drink. And so when patients come to me and they say, I drink carbonated water all day and a pot of coffee and I urinate every half hour, well if we can change that, you probably won't have a frequency problem. Changing those types of things is really, really easy.

Speaker 2: 21:37

Easy for you to say I drink a pot of coffee every day . <laugh> .

Speaker 3: 21:39

Yes. And we try to take things away too . We try to balance lifestyle too, so how do we maybe hydrate a little bit more? And then one of our unique treatments is obviously working on the pelvic floor muscles. So in some of the symptoms and in the objective testing we can kind of tell if those muscles are maybe not strong enough to support and stop urine or if they're too tight. So too tight of pelvic floor muscles will also cause problems as well like maybe pain or difficulty with emptying your bowel or bladder

Speaker 2: 22:14

So you can actually work on some muscular exercises with patients. Mm-Hmm, <affirmative> Now did , is that something that you do in your clinic or in in your physical therapy facility or is that something you say go home and do a bunch of kegel exercises, which I do want to talk about?

Speaker 3: 22:27

Yeah, so we really try to make sure that patients are doing that movement, whatever it is, whether it's strengthening or relaxation, doing that well before they leave because we don't need them to go home and do that exercise incorrectly and just make things worse. So we make sure that they're doing the exercises correctly before practicing at home. And again, depending on what issue you're having, how often you do those exercises at home is going to be different.

Speaker 2: 22:52

And I, I assume, well I know that sometimes medications are part of the deal, sometimes there's even surgeries now , now neither you or I are surgeons but sometimes do you suggest to people you need to, you need to talk to somebody who can fix this surgically?

Speaker 3: 23:06

Yeah, absolutely. So there, there are times when surgeries definitely warranted. So things like a more involved pelvic organ prolapse where you might see tissue exiting the vulva would be a a great example of that. And what we also know from the research is that doing some pelvic floor physical therapy before that surgery and after can help improve outcomes of those surgeries. So there's definitely a time and place for surgery. Typically pelvic floor physical therapy is a great place to start because it can help to improve symptoms maybe fully, but in most cases it improves them somewhat to improve your quality of life.

Speaker 2: 23:44

Can I be honest in my, I do primary care and I, the only thing I got in my arsenal is medications and referral to people like you and to surgeons. The medications are somewhat underwhelming for me and so I do like to tell patients , uh, you might get some relief for this, but I'd love it that we're talking about a multimodal uh, practice here. There are other things just than taking pills.

Speaker 3: 24:05

Yeah, in medication we do have some medications that help with overactive bladder more specifically but not, they're not as helpful for things like stress incontinence. Some of the other things that we don't think about as much in the pelvic floor treatment are things like pessaries and pessaries. Do

Speaker 2: 24:23

We still use those?

Speaker 3: 24:24

Yes. Yeah , actually they're very commonly used now. So pessaries are devices that can either be over the counter or custom fit to your vaginal vault and they are inserted vaginally and they help to hold up structures and put pressure perhaps against the bladder. So if you're having issues with stress incontinence or pelvic organ prolapse, those pessaries can be really, really helpful to wear during those activities that

Speaker 2: 24:50

Continence . Do you bring that up with patients in your sessions? 'cause somebody might be saying, wow, that sounds weird, don't know anything about that, but maybe that would help me. Where did they go for that?

Speaker 3: 24:58

Yeah, again, we really wanna promote access to these different types of treatment too. And not everybody has access to pelvic floor physical therapy, but if you are somebody who struggles with stress incontinence or that heaviness feeling within the pelvis, you can buy over the counter pessaries and they're, they look exactly like a tampon. It's spelled P-E-S-S-A-R-Y. People always wonder and try that with an activity and see if it helps. And then if it does help then you can look at having a urologist or an OB GYN fit you for a custom fit pessary. Great

Speaker 2: 25:33

Advice, great advice. So we've talked about the treatments and I'm glad you brought up access to pelvic floor. Physical therapy isn't always available to people. Fortunately here in downtown Minneapolis at Hennepin Healthcare we do have that and and in the form of you and you have a great physical therapy department right here at Hennepin. Before I let you go, I wanna talk about sort of lifestyle and preventive kinds of things. How important are preventive measures or what people are doing in their day-to-day lives?

Speaker 3: 26:01

So I would love it if everyone worked on their pelvic floor before they had issues, right? If we talked to kids about pelvic floor or people before they got pregnant about pelvic floor or had a class before you retire about the pelvic floor. So I think prevention would be a great place to start. But some of the easier things to think about as far as managing pelvic floor issues are things like maintaining a healthy weight. So the more weight that you carry, obviously that impacts and strains the pelvic floor more. Thinking about your lifting, we talked about high impact athletes or people who have jobs that do repetitive lifting, trying to modify those types of activities that are less impactful. We also talked about how constipation can impact the pelvic floor and so making sure that you are avoiding foods and beverages that irritate the pelvic floor. Some things you might not think about are spicy foods, irritate the bladder, dairy, chocolate, <laugh>, all , all of the great things , uh, really do irritate the the bladder and cause more issues. So trying to avoid some of those things and then making sure that you get proper hydration within your stool so that you're not straining during bowel movements is really important.

Speaker 2: 27:12

Could you talk about a word we used a little bit earlier? What's a Kegel exercise? How do you do it? Should people be doing it? Good

Speaker 3: 27:19

Question. So I think any magazine that you read will say do Kegels, right? And so very broadly a kegel is when you think about the muscles between your pelvis in maybe a giant triangle like from the front of your pubic bone to your two sit bones. If you think about those muscles closing and lifting, that would be a Kegel. Mm-hmm . Now there's a couple different things that you wanna think about is you wanna be able to close and lift those muscles, but then you also wanna be able to completely relax them again. Again, whenever we void , urine or stool, you have to be able to let go of those muscles. So it's really important that if you do train those muscles, you also let go of those muscles each time as well.

Speaker 2: 28:00

Do you recommend that people do 'em, like just everybody, everybody listening, should they all be learning to do Kegel exercise and do 'em every day ? Or is this something that more when problems arise? Yeah,

Speaker 3: 28:10

I would say people should preventatively do these exercises. We do seem more issues because we're more sedentary, right? We sit all the time in our cars or work and so we don't naturally get a lot of the pelvic floor strengthening that maybe we used to when we squatted or stood more often. So I do think doing some preventative work is really helpful and if that works for you and you don't have issues, that's great. And then if you say you try those exercises and it doesn't work or makes things worse, that's a really good time to come back to your healthcare provider. So

Speaker 2: 28:40

If someone wanted more information about doing exercises at home , um, is there someplace they could go or , or should is the best advice just to go see a physical therapist?

Speaker 3: 28:48

Yeah, I would say we have a lot more resources out there with the internet and social medias and with that it's very important to make sure that you're taking into account who is giving that message. So there are a lot of great pelvic floor physical therapists out there who have different channels or things that you can watch. But I would say the number one thing is to normalize it, talk about it. You're not alone with this. A lot of people struggle with it and it can happen at any point in your lifetime and it could be temporary or it could be chronic, but preventative work is really helpful. So no matter gender or what point you are in your lifespan, working on those muscles just like you would at any of your other muscles is really important.

Speaker 2: 29:32

So Beth, before I let you go, as I understand that you also have a secondary expertise in the health effects of climate change. What's that about?

Speaker 3: 29:40

Yeah, so over the last couple of years I've been learning more about how climate change is impacting our health both mentally and physically and we see a lot more air pollution and heat impacts and so we're really noticing the impacts on physical and mental health. Would

Speaker 2: 29:56

You be willing to talk about that on a future episode? Absolutely. Okay. We're on it. We're gonna start working on that episode right away. Beth, thanks for being here today.

Speaker 3: 30:03

Thank you for having me.

Speaker 2: 30:04

It's been great having you listeners. Thank you for tuning in and I hope you'll join us for part two of the series in a few weeks when we'll have another great guest about men's urology and we'll get into some erectile dysfunction and condition that doesn't just affect people assigned male , but they're partners as well. It's an important topic to discuss and we hope you'll join us for that. In the meantime, be healthy and be well.

Speaker 1: 30:25

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden. To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Please remember, we can only give general medical advice during this program and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.