Today on Ask the Doulas, we talk to JoEllen Bender of Hulst Jepsen Physical Therapy in East Grand Rapids. She is a physical therapist who specializes in women’s pelvic issues. Listen as she gives some tips and dispels some myths about the pelvic floor. You’re doing kegels right now, aren’t you?!
Listen to the podcast on iTunes or SoundCloud!
Alyssa: Hello and welcome to another episode of Ask the Doulas! I am Alyssa Veneklase, co-owner and postpartum doula. Today we are talking to JoEllen Bender of Hulst Jepsen Physical Therapy. Hello.
JoEllen: Hi.
Alyssa: We actually had an event recently.
JoEllen: Yes, we did.
Alyssa: And I learned so much about what you do for pelvic floor. I wanted to talk a little bit about what that actually means and what you do for your patients, but when we say pelvic floor, what does it even mean?
JoEllen: So the pelvic floor specifically is a group of muscles that are at the base, where there’s the vaginal and anal opening. It spans pretty wide, so it’s from both hips and then the front of your pubic bone back to your coccyx or your tailbone, and that’s pretty much the typical pelvic floor musculature, but it spans and helps the whole body. So if you think about it, all the pressure that comes from the bottom of the body, so your legs when you hit the ground – your pelvic floor is your core. It’s a shock absorber. And then everything from above; so if you lift something, it also is a shock absorber for any of that pressure or weight. So it’s a pretty big area. The muscles themselves are in a smaller group, but it helps with so many things throughout your day.
Alyssa: So it doesn’t just have to do with peeing when you do jumping jacks?
JoEllen: No, it doesn’t. It’s so much more.
Alyssa: So you’re saying even when you’re working your core, you’re working your pelvic floor?
JoEllen: Exactly, yes. And that’s when issues can come in if you don’t use your pelvic floor and you specifically just use those six-pack muscles, those rock-hard abs type of muscles. So it’s very important to train the pelvic floor along with the core. I know when people typically think “core,” it’s those muscles in the front from your chest down to your pelvis, your hips, but it’s so much more than that. You have to add the core, the base of it, your pelvic floor in there, too.
Alyssa: So what does a typical woman come to see you for?
JoEllen: So there’s a whole host of things. A lot of it will be low back pain. There will be pelvic pain, constipation, coccyx pain. You could also have – there’s multiple diseases like vulvodynia, endometriosis, polycystic ovarian syndrome, lots of those types of things. But then the main thing that I like to specialize in is postpartum or pregnancy, so that is the bulk of my client baseload, but there’s a whole host of things that you could come in for with pelvic pain or things related to that.
Alyssa: So a pregnant mom comes in. Is she just doing preventative work, or is she usually having some leaking, or does it usually have to do with the bladder?
JoEllen: It can be to do with the bladder. There’s so many things that a pregnant mother could have issues with, so we would –
Alyssa: Like pelvic pain?
JoEllen: Exactly, yeah, so we can combat any of that. A lot of the typical symptoms would be low back pain. You start to grow a baby in the front there; it offsets your balance and your weight, and you’re using different muscles. Elastin in the body increases by 30% when you get pregnant, which increases the laxity of your connective tissue and your joints, your ligaments, all of that type of stuff. So back pain, I would say, is the biggest. Incontinence, leakage, would be probably second, and then a lot of times they’ll even come in with lower extremity swelling. So we can help with some of that, too, increase that lymph flow and all of that. So whatever they come in with, we try to meet them where they’re at and then just progress through the pregnancy as they need.
Alyssa: And then same with postpartum?
JoEllen: Correct.
Alyssa: Things have now shifted; you’ve had your baby, and there’s probably a whole host of other issues that now come along with the pelvic floor.
JoEllen: Exactly. So some of them can be the same of what happened pregnancy-wise, but then postpartum, I would say, biggest is probably leakage, incontinence; sometimes constipation still will happen frequently, and the low back pain is pretty constant, too. Most of the time, if it’s more preventative, it will be someone that wants to return to, let’s say, running, or some type of exercise, and now all of a sudden, they’ve had this impairment of leakage or pain or something like that. So then we’ll just take them through more of a postpartum exercise routine or things that you can reintegrate your pelvic floor to help get you back to the things that you want to do.
Alyssa: Okay, so that was my next question. What does that look like? What do you do as a pelvic floor physical therapist? And I know when we had our event together, you kind of mentioned that there were external things as well as internal, right?
JoEllen: Yes.
Alyssa: So how do those differ?
JoEllen: So internal would mean that we would go in vaginally, one gloved finger. It’s all up to patient comfort, and we can feel those internal muscles. There are ways that you can feel the more internal muscles externally, so if a patient came in and they weren’t comfortable with internal, of course we could always stick to external. It doesn’t mean that you always have to go internal when you see a pelvic floor physical therapist. I think a lot of people are worried about that and so they don’t come in, but we meet you wherever you’re at. So internal would be more releasing the muscles or giving tactile cues on how to find your pelvic floor or contract it. Externally, you could do the same, simple type of things, but it would be more like those tactile cues on how to find your pelvic floor or contract certain muscles or relax certain muscles.
Alyssa: So everyone thinks of Kegels; I mean, that’s what I think of. But it’s so much more than that, right?
JoEllen: Exactly.
Alyssa: And did you tell me that you can even do Kegels too much and have the opposite effect?
JoEllen: Right, so if you hold your pelvic floor at a higher tone, a higher resting tone – so it’s not in the good type of strength; it’s more of that high-tone irritability that can cause pain. You can’t get a full release to then get a full contraction, so you need the muscle to go through its full length of motion, meaning it needs to drop down and fully relax so that you then can contract it. If you’re doing Kegels all day, it’s the same as any other muscle. Let’s say you contract your bicep all day, and then all of a sudden you need to use it. Let’s say you feel like a leak’s coming on or something; it’s just going to give way and then you are going to leak; it’s going to go out. So same thing with the bicep; use it all day, and then you go and try to pick up your purse or something heavy: it’s just going to give, and it’s not going to be able to do what it needs to do.
Alyssa: Okay. So are there different exercises then that you said – you mentioned the core, but the lower core? So there’s different exercises like crunches and certain things that you would tell people to do?
JoEllen: Yes; not typically crunches, though. So there’s different types of muscles that are more postural and the ones that can transmit forces from, let’s say, your right side to your left side, which are the ones that we really want to get after. So those would be your deeper muscles, your typical pelvic floor muscles, and then those smaller abdominal muscles, not that six-pack, typical type of ab muscles.
Alyssa: These are abdominal muscles that you can’t necessarily touch by doing crunches; it’s a different exercise?
JoEllen: Correct. You can’t really see them; it’s a deeper type of muscle area. So a lot of times the first thing that I’ll take someone through is breathing because the top of the pelvic floor is actually your diaphragm, so it creates this cannister within you. The top is the diaphragm; the bottom is the pelvic floor. When you inhale, your diaphragm contracts and drops down, and your pelvic floor can then relax and drop down, so that would be the lengthening of the muscle. When you exhale, then the pelvic floor comes up; it contracts, and your diaphragm comes back up, also. So it’s kind of like a piston; they both drop down together, and then they come back up together, so the way to activate the pelvic floor in the beginning would be first by trying to find your diaphragmatic breathing; get that good expansion. A lot of people have that high chest-breathing; everybody’s stressed lately, and as a mother, postpartum, they have so many things that they have to think of, and it’s more of a stressful time. So they breathe with that chest, when really, we need to activate the pelvic floor which would be breathing with your diaphragm. So that would be first exercise, and then we would just progress from there.
Alyssa: So is there anything else about the pelvic floor for either prenatal or postpartum, things that maybe people think of as a misconception or that you would want people to know about?
JoEllen: So my big thing is, it seems to be that all of a sudden at six weeks you’re just magically better and you can return to whatever you want to do.
Alyssa: Postpartum, you mean?
JoEllen: Exactly, yes. I wish people would not say that because it took nine months for you to get to where you are, and your body changed drastically. It’s going to take about nine months to get back to where you were before, so I don’t want moms to think, oh my gosh, I’m not back to where I was. Or they see another mom that is now running marathons. Everybody changes so much differently, and we’re going to meet you where you’re at and then get you back to where you were, safely, rather than you trying to push yourself and then cause all these other types of issues.
Alyssa: That’s good advice. So how do our moms find you?
JoEllen: So I am at Hulst Jepsen Physical Therapy. It’s an outpatient clinic. The address specifically is 2000 Burton Street SE. We’re Suite 1, and that’s in East Grand Rapids.
Alyssa: So are you near Anthropologie? Is that a good landmark?
JoEllen: We are pretty close, right in that area, yeah. So the best way would be to call. The number is 616-608-8485. And then you would just schedule with me, JoEllen Bender. Just ask to schedule for pelvic floor physical therapy, and then we can get you started on whatever types of issues you’re having or if it’s preventative during pregnancy or any of that.
Alyssa: Now how far – this is something I didn’t ask. How far postpartum can you see a mom?
JoEllen: They could come in as early as they wanted, and then we would just space out treatment based on the timeframe that exercises would be safe to begin. So they could come right after, and we could work on some breathing and postural type things, and then after that, I would be comfortable starting more of the typical strength training types of things probably around the four- to six-week area.
Alyssa: And then what about a mom whose daughter turned five and still can’t do jumping jacks without peeing? What about someone like that?
JoEllen: Come in ASAP! There is still hope!
Alyssa: Speaking from experience…
JoEllen: I would love for anybody like that to come in. There’s always – I mean, don’t think you’re too far gone or anything like that. We can always work on it, and you’ll get back to what you want to do.
Alyssa: Good, awesome. Well, thank you for all that information. Get ahold of her if you have any questions, and then as always, if you have questions for us, you can email us: info@goldcoastdoulas.com. Find us on Facebook and Instagram, and you can listen on iTunes and SoundCloud. Thanks.
JoEllen: Thank you for having me.