From Stigma to Strength: Embracing Pelvic Floor Wellness with Dr. Meghan Rohde and Dr. Leah Mycofsky

As part of our Expert Spotlight Series, our founder Lauren interviewed Dr. Meghan Rohde PT, DPT, PhD, SCS and Dr. Leah Mycofsky PT, MS, DPT, CSCS, the founders of Revolution Wellness Collective in Milford, NH.

In our chat, Leah and Meghan explain why the pelvic floor is the unsung hero of athletic performance and overall well-being, emphasizing its role in preventing issues like back pain and enhancing mobility. They passionately advocate for improved postpartum care and open conversations to break the stigma around pelvic floor conditions, empowering individuals to take charge of their health. With inspiring success stories, the duo highlights transformative therapy experiences and shares valuable tips for partners to create supportive environments.

Catch the entire chat on YouTube, or check out 5 of our highlights below!

 

 

 

1. Your Pelvic Floor: The “Foundation of the Core” and “The Center of the Universe”

Lauren:

How would y'all explain the importance of pelvic health to somebody that's new to this and may have never heard of it before?

Leah:

I think one thing people don't really realize is that our pelvic floor is part of our core. So in our core, we have our pelvic floor at the bottom with our diaphragm at the top. We've got our abs in front and we've got our back muscles in the back. And if our pelvic floor is not working well, then that can create all sorts of issues. Maybe we're getting back pain, maybe we're not performing well athletically, maybe we are having hip pain that we can't figure out how to deal with. And because our pelvic floor is really the foundation for our core, if our pelvic floor is not functioning well, then our core is not functioning well. And then if our core isn't functioning well, we can't do the rest of the things that we need our body to do well.

Meghan:

I think I look at this as maybe a little bit more woo woo but I would also add that the pelvic floor really is the center of the universe. That's where all of us came from. I've worked with clients that when we really get down to the root of the problem, sometimes their pelvic floor is what's causing the problem, but they're coming in for back pain or hip pain or even knee pain. And then when we start to do a deep dive into their history and we discover maybe some not so pleasant parts of their history, it's really interesting how much overlap the pelvic floor has in everything else.

Lauren:

Yeah, I think that's such a great point, and one that I think a lot of us don't think of when we're thinking of those other symptoms. Our head doesn't go, "Oh, maybe my pelvic floor is struggling right now."

 

 

2. Why Postpartum Care Needs a Serious Overhaul

What do you feel like are some of the top misconceptions that you are continually coming up against in your practice?

Meghan:

Can I soapbox for a minute? Pelvic pain after you have a baby is not normal. It's just not.

And pelvic floor therapy should be standard of care during pregnancy and postpartum. We are the only industrialized country in the world that does not do that, and it really, really makes me mad. I see women whose OBGYNs didn't even look under the hood at six weeks. It's really just a follow up, like, "Hey, how's everything going? Breastfeeding okay?" Or "Are you breastfeeding or bottle feeding?" Whatever it is, just feed your kid, it doesn't matter. And then, "Let me ask you a couple stock questions about your mental health that aren't really diving into what's really happening with you as you care for this human." And that's it.

And then we end up seeing women six months or sometimes years after that. And my research over the last 10 years has evolved into trauma research as it relates to the pelvic floor. And so I ask those hard questions and I'll start asking questions from clients about their birth history. And I find out that mom labored for eight or nine hours and nobody was listening to her, and then they finally gave her some Pitocin to speed things up and then something was wrong and she ended up either having an instrument assisted or a C-section delivery. That whole experience is super traumatic.

I think aside from pelvic floor therapy needing to be standard of practice, I also think that western medicine needs to realize that women are pretty damn smart and we know our bodies and you need to listen to us when we're saying that something's not right. I'll step down from my soapbox.

Lauren:

I think that you cannot say those things enough because I think too often their stories or experiences are discounted, and they kind of just internalize it. It's like, “Well, this is just the way it is.” 

And I think it's so empowering to be heard when you get to dive into those and have someone like yourself listen and be like, "Oh my gosh." And you just realize how connected it all really is. So everything you hit on I fully support.

Leah:

I think the only thing I would add is that pelvic floor therapy is also more than just laying there without your pants on. There needs to be a whole lot more that goes into your therapy, including looking at your whole body actually doing functional things. And it's not just, okay, you're going to have some stranger invading your privacy while you're doing some Kegels. And I think a lot of people don't realize that it's more complicated than that.

Lauren:

It is so much more dynamic than just Kegels and yeah, just an internal exam. I think that's a great one.

 

3. Peeing “Just in Case”? Here’s Why You Should Stop for Better Pelvic Health

Lauren:

I know of course pelvic health and any sort of care plan is tailored to the individual, but are there any tips that you have on a more general level for folks if you're talking about daily things or just ongoing consistent things you can do to maintain good pelvic health?

Leah:

I think there are some basic ones, like not peeing "just in case." Our brain and our bladder are really trainable, kind of just like a puppy. And if you're constantly thinking, "Let me go to the bathroom just in case," then that can be something that over time is going to make your bladder more sensitive to having anything in it. So then that's going to feed into always feeling like you have to go to the bathroom, which can kind of avalanche into other issues. So just generally speaking, trying not to go to the bathroom unless you do truly have to go is going to be a big one.

And then another one that I know I struggle with because I am a huge germaphobe, is not hovering on toilet seats. I think I had to probably listen to Meghan tell me not to do that for at least a year and a half before I would even consider it, and even then I'm in the bathroom constructing this elaborate and toilet paper nest on the seat before, I'll be like, "Okay, this is acceptable for me to sit on."

That's just another one in terms of promoting emptying your bladder all the way and being in a good position for just maintaining your overall pelvic floor health. I think those are the two big areas where I see people struggle a lot.

Lauren:

Those are great. Yeah. I know I've even seen on social media where folks have talked about the "don't hover over the seat" stuff. People are just like, "I can't not do it. You can't make me." But I've heard how important it is. So I think both of those, a lot of people will be able to relate to.

 

4. Why Pelvic Floor Health Matters: A Lifelong Resource

Lauren:

Will you talk to us a little bit about how working with someone like yourself can be important through different stages of life? I know that for a lot of people, it's during pregnancy or postpartum that you're first keyed into pelvic floor physical therapy, but outside of that experience, and you can talk a little bit about that as well, why is it important for folks to know who you are and when to come see you as your body changes over time?

Meghan:

I'm so happy about this question because when we decided to open this practice and do this business, we sat down at a coffee shop one day and we were trying to figure out: what do we as a business stand for?

And so our, I guess "slogan", if you will, is "Empowering you to thrive in all aspects of life." And so our dream is that when somebody comes into our practice, either from the fitness side or from the physical therapy side, we're a little like the mob. We're not going to kill you and dump your body if you want to leave, but we're going to make it really hard for you to leave because we want to do exactly what you just said. We want to help you achieve whatever thriving looks like to you.

And so once you come in, let's say you come in for pelvic floor therapy, we're going to look at everything else. We have one client right now who initially came in to us for pelvic floor and she is just very stiff. She doesn't have a lot of really great mobility. And so that limits her from being able to exercise. She actually can't lie down flat, she sleeps in a recliner. To me, that is just a horrible way to sleep.

So she's kind of our ideal client because we want to do everything we can to help you in every aspect of your life. So you might come in that way, but we're going to attack the whole thing and give you, I think, usable tips and tricks that are easy and not like, "Oh, I need to go do my PT exercises," because for real, who does that? I'm a PT and I've been a patient and I don't do that, full disclosure.

Lauren:

I also think it's helpful to know that if I come in for this thing as my body changes, or as I get older and these other things change, you all are still such a good resource to come back to over and over again because of how everything comes back to your pelvic floor and how it can impact so many things that you're not thinking about.

I was so thankful when I first learned about pelvic physical therapy and have been able to come back to it over and over again because it has been a resource I've turned to over the years and plan on being able to continue to pursue that in the future. So I think that's a great point that we can take away from this, that it's not just pregnancy or postpartum. It's something that over your entire life, regardless of what the things you're dealing with, it can be a great place to start.

Meghan:

And one of the things that we also have tried to do in terms of networking in our community, we network with nurse practitioners and functional medicine and naturopathic physicians. I'll be 44 this year, so I'm in the thick of perimenopause. (Yay.) And experiencing that, I realized that western medicine is not going to give me anything to help me feel better.

So it's about finding people who, just like when you're pregnant and postpartum, will believe you when you say these are the symptoms you really have. We have worked really hard to educate ourselves as much as we can and network with people in our community so that we have a good place that we can refer our clients to as they're going through that stage of life and help them through those things. Because my husband gives me a hard time. He's like, "Well, men change too." And I'm like, "Ummm....did you really, though You're still wearing the same pants you wore when we met 13 years ago." I don't even know where my pants from 13 years ago are, and I've aged and had a baby and a C-section and my hormones don't know what end is up." We want to help navigate that whole thing for our clients.

Lauren:

Right. It's changing quickly, but I think we're learning a lot more, so that can cause that to happen.

 

 

5. Breaking the Taboo Around Pelvic Floor Issues with Honest Dialogue

Lauren:

I know a lot of times when people are coming to you for help, it can feel very isolating and it's all on their shoulders to do this. Do you have any advice for significant others or partners, or even friends and family members, for how they can provide support to a loved one while they're navigating some of these conditions?

Leah:

I would say creating an environment where it's okay to talk about these things. Meghan and I were talking about this a little bit yesterday. There is a lot of shame people have often when they're injured and a pelvic floor condition isn't necessarily an injury per se, but it's still a body part that's not working the way that you want it to.

But it's also embarrassing because people just don't really like talking about what's going on down there. And so I think it can be helpful to create a space where it's not taboo to talk about your bodily functions. It's okay to maybe talk about body parts that aren't normally talked about and just create an open environment. And I think for a lot of people, if they haven't been pregnant or had children and they have pelvic floor issues, there's an extra emotion in that they feel like it shouldn't be happening to them. So I think just being open-minded and trying to educate yourself as a partner in terms of what a pelvic floor is and why people have pelvic floor issues and try to be more aware and open to what's going on.

Meghan:

Yeah, I couldn't agree more. I'll always tell women, if your partners are comfortable, bring them with you because I think that helps.

There's also a book that I refer clients to if they like to read or listen to audiobooks. It's called "Come As You Are" by Dr. Emily Nagoski, and she does a really good job of unpacking sexual health as it pertains to pelvic floor therapy. And I especially think in the postpartum and even early childhood years, moms are tired and touched out, so "I love you, partner", and also, "Get off me."

But then as we age, we've got hormonal changes and we might not have the vaginal lubrication and things that we need for healthy sexual activity, but it doesn't mean that we're not interested. And she calls that "sexual incongruence" where my body wants to, or my brain wants to, but my body's not cooperating. And just dispelling rumors or myths that your sex life is over because you become a parent or because you're in perimenopause or you're in menopause; just having those free conversations. And like Leah said, really unpacking the shame that's surrounding it. Because when you talk about shame with somebody that you feel connected to, that shame goes away and then it just becomes something that you can work through together. So I think I wish we saw more of that.

Lauren:

Thank you so much both for sharing and thank you so much for having this discussion with us today. Is there anything, any other parting words you'd like to leave us with before we wrap up?

Meghan:

Thank you so much for having us. You asked us a lot of questions, but I just want to say I am really inspired by your story and why you created what you created. You were like, "Okay, there's nothing that I like, so I'll make my own." And I think that's awesome.

Lauren:

Thank you. I appreciate that.

 

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**Medical Disclaimer: This post is intended to provide information and resources only. This post or any of the information contained within should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your qualified healthcare provider with any questions you may have regarding your healthcare, conditions, and recommended treatment.