A Doula's Perspective on Pelvic Health for Every Life Stage with Dr. Ally Loupe PT, DPT
As part of our Expert Spotlight Series, our founder Lauren chatted with Dr. Ally Loupe PT, DPT. Dr. Ally has over 10 years of experience as a pelvic health and orthopedic physical therapist treating a wide variety of conditions. She is passionate about all things pelvic health but is especially interested in labor and birth prep, prolapse (including pessary fitting) and supporting women through the season of menopause. In addition to her physical therapy services, she also serves on Genesis's Doula team as a birth doula, is a yoga instructor, co-creator of Move Through Motherhood (an self-paced pregnancy, postpartum and loss program) and a course educator for Pelvic Powerhouse, providing continuing education on pelvic health to other healthcare providers.
In this interview, Lauren and Dr. Ally discuss the importance of pelvic health for everyone, regardless of gender or age, and debunk common misconceptions and harmful stigmas about pelvic floor therapy. They emphasize proactive care and Dr. Ally shares her top tips for good pelvic health. They also highlight the value of addressing pelvic health early, with Lauren reflecting on how her own prolapse experience has shaped her approach to teaching her children about body awareness and healthy habits.
Check out 5 of our highlights below, or catch the full conversation on YouTube!
1. “Anyone With a Pelvis Can Benefit From Pelvic Floor Therapy.”
Lauren:
Can you tell us a little bit about how you would explain the importance of pelvic health to someone who either doesn't know about it at all or maybe has a very minimal understanding?
Dr. Ally:
Yes, totally. So I frequently say that anyone with a pelvis can benefit from pelvic floor therapy. So that's literally everybody, because our pelvis is at our core and it plays such an important role in so many areas and functions of our body that people just don't even realize. And so that's one thing that I'm constantly trying to spread the message on is that pelvic floor therapy isn't just for pregnant people or just for people who are leaking. It's for anybody who has pelvis. And chances are there's some point in time in your life when you're experiencing some kind of pelvic floor issue, big or small.
Lauren:
Great. I think it can feel abstract to folks if they don't have that understanding. So I think that really helps to make it more familiar.
Dr. Ally:
Yes.
Lauren:
And I also love the fact that it's can help everyone with a pelvis, because I know with some people I talk to too, it's like, "Oh, this is only a women's thing," or "It doesn't apply to men," and it's like, no, it applies to everyone. Literally.
2. Overcoming Misconceptions about Pelvic Surgery
Lauren:
What do you encounter as some of the common misconceptions around pelvic health?
Dr. Ally:
Oh my gosh, where do I even begin? It's such a long list. I feel like I've spent my entire career trying to just educate the world on all the misconceptions about the pelvic floor, all the different myths that are out there.
A big one is that surgery is the only option for things like prolapse or endometriosis or other conditions. And it's like, no, there are other options for helping to manage those symptoms, especially for prolapse, before we need to immediately go to surgery or hysterectomy or something like that.
Lauren:
For things like prolapse, that's something I've experienced personally. And I do see a lot of folks who might be hesitant to seek care because they think surgery will be their only choice and they don't want to have surgery, at least not at that point in time. And I see it hinder a lot of folks from reaching out and getting the care that they need. And so I think it's so important to hear things like that, that it's not the only choice and there are many options for not only prolapse, but other conditions as well. So yeah, the more we can talk about that, the better.
Dr. Ally:
And I think there's just so much fear around the conversations that are had over those symptoms and diagnoses, and so being able to break them down and not have so much fear placed in talking about them and just really providing knowledge. Knowledge is power.
3. Breaking the Stigma: Changing Perceptions of Pelvic Floor Physical Therapy
Lauren:
Yeah, I think that that's huge. I think there's also the stigma of needing to see a pelvic floor physical therapist. I was just at a networking event last night, and I was explaining to people my company and what I do, and the person I was talking to turned to someone she worked with. She was like, "Oh, well you had a baby. Did you need to see a pelvic floor physical therapist?"
And her response was like, "No, I was fortunate I didn't have issues." And it was almost like a sense of pride that she didn't need to see a Pelvic Floor PT. And I was like, "Man, how disappointing is that?" One, it was great that we were talking about those kinds of topics, but it was a letdown to hear that.
Dr. Ally:
It's so interesting that you bring that up because I feel like that's something that happens frequently. I don't know that I've ever had a conversation around this topic before, but as a pelvic floor therapist myself, when I hear that statement where it comes from a sense of pride like, "Oh, I didn't need pelvic floor therapy," it just breaks my heart because I'm like, "Oh, what did you miss out on?"
And I mean, there really truly are people who don't need pelvic floor therapy. They're genuinely doing great. But there are a lot of people who just are not doing parts of their life because they can't, for whatever reason, because of probably some symptoms that maybe could be resolved with pelvic floor therapy, but that sense of pride is kind of standing in the way. And they just don't know. It's not their fault. I love that you brought that up.
Lauren:
And I feel like people think that if they're not leaking or having these major things, then pelvic floor therapy won't benefit them. But maybe their low back pain or something like that is tied to their pelvic floor and that could potentially help them.
And I also think having that mindset going into it is challenging because as things change over the course of your life, I feel like having an ongoing relationship with the pelvic floor physical therapist is so beneficial because you already have that trusted resource who can help you monitor your body and adjust things as you go and be more proactive versus always being reactive. So it was an interesting conversation and it was one I kind of left wanting to talk to her about all the benefits of pelvic floor physical therapy outside of "I had an issue postpartum and now I need to see one."
Dr. Ally:
Yes. Oh my gosh. I also love that you just brought up having a pelvic floor therapist as somebody who you see throughout seasons of your life, kind of like your dentist. You're checking back in with your dentist on a regular basis, and maybe it doesn't need to be that regular with a pelvic floor therapist, but you're so right. Maybe you're in the season of pregnancy and postpartum or trying to conceive and you're in your twenties and thirties or early forties. Then we start to see symptoms of perimenopause set in, and so many women just have no idea that those symptoms can start in their later thirties, early forties, and last through their fifties. Menopause is just something we think of when we get older, but there's so much help and hope to be had along the way through that journey that can really bring about so much quality of life. So I love that you brought that up.
Lauren:
Yeah. That's why I tell everybody, "See one now, check it out. Keep it in your toolkit of things you're doing on a regular basis because it can help with so many things."
4. Dr. Ally’s Top Tips for Better Pelvic Health
Lauren:
I know of course everybody's unique in terms of what's going on in their body, but are there a few tips that apply to a wider population as far as good pelvic health habits that you could share?
Dr. Ally:
Oh, definitely. So here are a couple of my top things that I'm always recommending. First of all, learning to breathe better and just learning about how you breathe. It's something that we just do all day every day and we don't think anything about it, but so many people are breathing poorly. I myself was breathing poorly. I still do sometimes breathe poorly. And that can have such a profound impact on how so many body systems are working, including our pelvic floor and our nervous system, our gut, everything. So breathing better is I think one of the number one tips.
Another global tip is to tune into your body and stop clenching your glutes or your jaw or your toes, those different areas of your body that sometimes hold a lot of tension. We subconsciously are just always tensing up all these weird areas. Usually when your glutes and your jaw or your toes are tense, your pelvic floor muscles are also tensed up, too.
I would recommend making sure that you're pooping daily and getting a nice big bowel movement out so you're completely emptying your poop on a daily basis. I have so many people who come in and they're like, "Well, I poop three times a week, but I've done that my whole life, so my doctor says that's normal." And I'm like, "But is it? Maybe we should investigate that. How would that impact your prolapse symptoms?"
And then the last two things I think would be to integrate daily exercise that's meaningful. So many people have such a hard time getting an activity, and I think a lot of times it's because it's something that they're forcing themselves to do. So I really encourage people to find meaningful exercise. Motion is lotion.
And lastly (and I want to say this is my favorite thing, but all of these things are my favorite things) is to tell people is to not be fearful of pain and discomfort when your body is not feeling well, but rather to allow it to be a way that you learn about a change that your body is requesting. We can learn so much from having symptoms if we are really tuning into them to see what our body is asking and requesting of us.
Lauren:
I love that one. Yeah, I've got thoughts on all of them. I love the last one because I feel like for me, a lot of what I experienced postpartum with my second child was so much low back pain and for a long time. I feel like as I worked through it with my pelvic floor physical therapist and other folks, it was a lot of the strengthening that was needed. It was like my glutes were really weak and stuff like that, and it was by tuning into that, I was able to have good conversations with them and then they could help provide good direction for me as far as what to address and then help work to mitigate that over time.
And it does take time to pause and listen versus just being like, "Oh, I feel bad." It's like, well, what really is bothering you? And tuning into that and taking that time to just take a few minutes. I think especially with how busy we are anymore, especially if you have kids, it can be hard to pause and reflect on, well, what is going on with me right now?
The breathing one is also something I was thinking about because I know in preparing for the birth of my first baby, I was reading a lot about how to prepare. And breathing, of course, is such a huge piece of that. And it was interesting because my husband is a musician and he teaches as a choir director, so he was very familiar with breathing. And so I'd be telling him about these different breathing techniques. He's like, "Oh, well Lauren, you're not expanding enough down here," "You're not holding your mouth," or "You're not doing the full exhale." And so it was so interesting for him and I to work through that together, but then for him to be so familiar with proper breathing techniques and how the diaphragm works and all of that. So that has been an interesting one for me to learn about at the beginning of that and then try to keep in mind now.
Dr. Ally:
That is so cool.
5. How Addressing Pelvic Health at the Pediatric Stage can Set Kids Up for a Lifetime of Success
Lauren:
Okay, so another thing I wanted to touch base on is a little bit about how pelvic health comes into play during all the stages of life. I think the more we learn about how this comes into play at different stages, it's really helpful just to have that better understanding.
Dr. Ally:
I think if I can mention one thing, and this is not an area that is my expertise at all, but I feel like it's worth mentioning because you never know who is listening. There is a whole area of pelvic health for pediatric clients, as well. So kids who are having issues with potty training, constipation, bedwetting, issues with core stability, all of that kind of stuff. It all kind of comes back to, okay, what's going on with their motor development and their core and how their pelvic floor is initially learning to coordinate. And really, if we can address some of those things at a pediatric stage, how much are we going to set our kids up for success once they're adults and then going into things like pregnancy or menopause if they don't have this history of 40 years of constipation that started when they were two.
Lauren:
Yeah, I think that's a great point.
I really love that. I know for me, having experienced prolapse, which I didn't know about before I had it, I'm extra sensitive to my girls with potty training and not straining and managing constipation and all of those things. And had I not experienced that, I know I wouldn't have that same mindset with how I watch and monitor and teach them. So it is interesting where I've gone through this hard thing but now have this learning. So I think hearing about that and knowing that there's resources available for kids in pediatrics is great as well. I don't think you hear about that as much.
Dr. Ally:
I have a question for you on that same topic. Do you feel like, because you've been able to go through some pelvic floor things yourself with your history of prolapse, that has helped to influence and shape how you're teaching your girls about their body? And I know you shared with me that they're still pretty young, but how you plan to talk them through their anatomy and when to have certain conversations and just maybe if we're, again, giving those tools and words to people younger, how that can set them up for success for even just being able to have conversations with their doctor when they're 20 and experiencing pain.
Lauren:
Yeah, I think it has definitely impacted how I talk with them. And it is funny that you asked that because my husband and I both are very pro-using anatomically correct terms and talking about their body parts and talking about what's appropriate and what's not for them and other people. And it is so funny because the girls, whenever we go visit our in-laws, Harper (my oldest) will be like, "Oh, I need to use the restroom," or "I need some toilet paper to wipe my vulva" and my mother-in-law's just almost in hives. And she'd be like, "Oh, do you need toilet paper to wipe your baba?" She's like, "Nana, that's not what it's called. It's a vulva." She'll be like, "Nana, I don't know what a baba is. It's my vulva."
Dr. Ally:
I love that. Look at your girls teaching the older generation. That's amazing.
Lauren:
Yeah, it's been great. And I love my mother-in-law and she's just like, "Oh my gosh." But it's funny because Harper is like, "Yeah, this is my vulva." And when she's talking to her younger sister, as she just recently is going through learning how to use the toilet and those kinds of things, they can have very real conversations. And it has been important. And it's even interesting when I'll use my pessary explaining to her what that is, how it provides support for me, and talking about the pelvic floor. And my oldest does deal with some constipation, and so it's something we've had to be really careful about and explaining to her, "Hey, don't push really hard" and why it can be challenging.
And it is cool to see her at four where she can really start to understand some of those things and change her habits. At first, we were approaching a few things not in the best way, and we've since course-corrected. And you can see her course-correcting and being like, "Okay, I don't do those things anymore. Now I do these things and I take my deep breaths and let things come out." And had I not had prolapse, it would've been a different story. Different story.
Dr. Ally:
That is so amazing.
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