Pelvic Health as the Foundation of Physical and Emotional Wellness with Dr. Arielle Martone PT, DPT

Recently, as part of our Expert Spotlight series, our founder Lauren chatted with Dr. Arielle Martone, a Doctor of Physical Therapy, Pelvic Physical Therapist, and Certified Pre and Postnatal Coach with specialized training in corrective exercise, yoga, and postpartum nutrition. As a mother, Dr. Arielle understands the physical and emotional challenges of pregnancy and postpartum recovery. Driven by the lack of comprehensive care for mothers, she combines evidence-based science with a compassionate, holistic approach to help women heal, regain confidence, and thrive.

In their chat, Dr. Arielle shares her transition from neuro rehab to focusing on women’s health, inspired by her own IVF and postpartum journey. She emphasizes the importance of early intervention for pelvic issues like prolapse and incontinence, encouraging visits before the typical six-week checkup. Dr. Arielle advocates for a holistic approach to pelvic health, including movement, nutrition, and hydration, while breaking down misconceptions and offering hope and solutions for new mothers and anyone dealing with pelvic floor concerns.

Check out 5 of our highlights below, or catch the full chat on YouTube!

 

1. One Simple Tip to Make Your Postpartum Appointments More Effective

Lauren:

Will you talk to us a little bit about what a typical day or week looks like for you in your practice?

Dr. Arielle:

I focus primarily on pregnancy and postpartum. Of course, that postpartum period can continue on for years afterwards, so it's really any postpartum-related issue or maybe something that kind of flared up in that initial early postpartum period of time that was just never addressed, as it often goes for so many women.

So I am in the clinic one day a week and I am currently doing home visits for the remainder of my working time, which I am absolutely loving, and I do try to schedule it so that more of my home visits are for those really early postpartum visits. If I can get in to see somebody before their six week appointment, that is ideal, especially for the women that I've been working with during their pregnancy. But those who've had scheduled C-sections, getting into the home at least once, if not twice, before that first six weeks time frame, I find to be crucial for their healing.

Even for vaginal deliveries, I like to have that touchpoint within the early timeframe to just see how they're doing from more of an acute care, physical therapy standpoint, all those other things that are so important to our overall recovery that unfortunately get overlooked. So that's kind of how my day is. I would say currently it's about 50/50 pregnancy to postpartum, maybe a little bit more heavily loaded in the postpartum caseload. But again, that's because that timeframe kind of extends out a bit further.

Lauren:

I really liked what you said too about that timing to get in before the six week visit. I think it's important for people to hear that because I think a lot of folks, maybe if they're not as familiar with the work that a pelvic floor physical therapist can do, might be thinking their first check in is that six week visit and you're kind of on your own in that timeframe. And a lot of stuff can happen in that timeframe, symptom-wise, or things you might start doing if you're not ready.

So realizing that one: working with somebody like you is a really important part of the team; and then two, bringing it in before the six week visit is great. I was feeling symptoms of prolapse ahead of that, didn't know what it was, went into that six week visit and was raising my concerns and was kind of dismissed in that. And it was really hard physically and mentally because you're in this early postpartum period, you're checking in with your body, and then trying to seek help. But without those right tools in place at the right time, it can just make that journey a lot more challenging. So I think having that kind of schedule and working with someone like you so early on is just such an important part of that, if you can work it in.

Dr. Arielle:

Yeah, absolutely. I find it really gives the power back to the mother who is recovering, and I find my role to be, especially in that early time period, very much an advocate for their health and wellness. And to your point, if you are noticing symptoms of let's say, a prolapse before that six week visit, you can be seen earlier than that. And a lot of new moms don't realize that they can request an earlier visit and do a three week visit and then either a six or an eight week visit.

I think we can all benefit from more touchpoints in general postpartum, but some people can really benefit from that additional visit that they might not know that they can have or that they need. And then also preparing for that six week visit by writing down a list of questions, concerns, things that you want to bring up because that six week visit can feel so rushed. And oftentimes, as you mentioned already, you can feel a little bit dismissed and everything is kind of just normalized. If your uterus has returned to size and any stitches that you may have had are healed up, then you are good to go. And there's a lot to be desired.

Lauren:

I think the comment you made about writing things down is a really important takeaway. I know that when I would go to any of those appointments, especially postpartum, but also just in general, I feel like I would be mentally noticing things throughout the day or weeks leading up to it. Then when I got there and a healthcare professional would ask me a question, I would kind of blank or forget things. I'd be like, "I wish I would've remembered that important thing to tell them." Because in that moment, it's a lot of pressure to characterize everything that you've been feeling. And so I think having that regular check-in and then jotting it down, whether it's in your phone or on a piece of paper, can be a really helpful way to help keep that check-in with your body.

And then postpartum, because it's such a time warp, with lack of sleep and the days and nights running together, it can be challenging to really step back and be like, "What is really going on with me?" Other than just like, "Something's off."

Dr. Arielle:

And if you're someone who is a little hesitant to speak up in a doctor's appointment, it can be really helpful to just hand them the list. Because it breaks down that barrier. I know a lot of people that I work with will freeze up, have concerns, or get embarrassed. Your provider doesn't want to be rushed through the appointment--unfortunately, that is how their schedule is set up--but they really do want to hear your concerns. So getting them out, whether you're speaking them out or just handing them a list, is going to be helpful.

 

2. The Surprising Link Between Pelvic Health and Your Overall Well-Being

Lauren:

How do you explain the importance of pelvic health to someone who either has maybe not a vast understanding or has even never heard of it before?

Dr. Arielle:

I like to say that pelvic health is kind of the intersection between our physical health and our mental and emotional health. And that it's also kind of our foundation as a whole.

We can look at it as our physical foundation when we are looking at where all of our movements stem from--they stem from the core, and the pelvic floor is a big part of that. But then also because of the more autonomic response of the pelvic floor, how we're not thinking of our pelvic floor on the day to day. We just expect it to show up for us the way that it's supposed to. And when it doesn't, we are finally like, "Oh, wait a second. Yeah, what's happening?"

But there's a lot of that automation we don't don't need to think about. There's such an interplay between our nervous system and the pelvic floor and our emotions.There's interplay structurally, when we look at our posture and how it changes--we kind of tuck tail when we're nervous or uncomfortable, and that can affect the pelvic floor. There's just so much overlap between the two that I really like to look at it as that intersection, like I said, between both our mental and physical wellbeing.

Lauren:

I love hearing it that way. To your point about it being on autopilot, I do think that so many people don't think twice about it until you run into something. I feel like it's becoming more common to talk about pelvic health. But I think for a lot of people it's not until something goes wrong that you're like, "Wait, what is it? How does this work? And what are my options for help?" And so hearing that description I think is helpful.

Dr. Arielle:

And it's kind of a dichotomy too, because on one hand, we don't want to have to think about it. We want it to just show up how it's supposed to. But I think we also are a little bit disconnected from it, too. And that can lead to some of its own challenges, like dismissing our own symptoms that we're feeling and brushing them off, normalizing things. And when we're starting to work on it, just bringing some attention and awareness to that area and figuring out what it should feel like or shouldn't because we shouldn't be aware of it. That's part of being connected to it too, just having a general sense of what's going on with our body and especially with our pelvic floor and that whole system, our reproductive system, our bowel and bladder system--all the taboo things that nobody wants to talk about. We need to really connect back to that because those are vital to our functioning. So it's important to create that awareness, that connection to it, while at the same time being able to function without focusing on it all the time. 

 

3. Simple Habits for Supporting Pelvic Floor Health in Everyday Life

Lauren:

And a follow up I have for that is what would you tell folks who you may or may not be dealing with, but are some generally good habits for promoting good pelvic floor health?

Dr. Arielle:

I like to say pelvic health has pillars. And since I work with postpartum women, I also work with the pillars of postpartum wellness. And the great thing is that they very much overlap and connect with each other.

And so the things that we want to keep in mind for good pelvic health are also the same things we focus on for your overall well being. Your movement, your sleep and rest, your nutrition: all of those factors play into your overall pelvic health. So if we're addressing those areas, if we're staying hydrated, if we're eating the protein and the fiber that we're supposed to be eating, and if we are moving our body daily to promote digestion and promote blood flow, we will help the pelvic floor muscles to function, because again, they should be automatically kicking on whenever we're doing specific tasks. And then on the flip side, they should be turning on and off automatically when we're doing different activities.

So if you can start to just focus on your overall wellness (which I know it's so much easier said than done, right?:) eat, get your sleep, drink water, it really is a good place to start. It starts with the basics and then kind of going from there.

Lauren:

Which I think is helpful even though it is hard, because it's something that everyone can work on, regardless of where you are. And then knowing that it can change in different phases of life--maybe sometimes it's harder to achieve than others. And just knowing that those will pass and maybe the next phase is when you can spend more time on it.

Dr. Arielle:

Yeah, and to that point, if there's an area that you're particularly struggling in a certain phase of life, then maybe let's focus on some of the other ones while we can't focus on that one. So let's say you had a shoulder or hip injury or something like that, so you're not able to do the exercise that you were doing before. Or maybe you're early postpartum where you're not back to doing what you were doing before, but you can focus more on the nutritional aspects and the hydration and the rest.

And I like to group nervous system regulation into that as well. We know that especially in the pregnant and postpartum population, we're not always sleeping the eight hours that would be ideal, but that's okay. We can still find ways to support ourselves and to get rest without getting that solid night's sleep. It sounds impossible, but there are workarounds we can make it happen.

 

4. “​​You are not alone. A lot of people feel this AND we can do something about it.”

Lauren:

Can you talk to us a little bit about some of the common misconceptions that you see in this space that you feel like we need to phrase awareness on combating?

Dr. Arielle:

Yeah. I would say one of the common misconceptions is that there isn't really anything that you can do about your pelvic floor concerns. That is to say that a lot of our concerns are kind of normalized.

We'll talk about what this means for postpartum first, but this is true for other stages, as well. If you're going to talk about menopause, a lot of those complaints are also normalized. It's like, "Well, you're just in menopause. This is what you're going to have to deal with now." And same for postpartum, where if you're feeling symptoms of prolapse, like you mentioned earlier, you're kind of dismissed as like, "Well, that's normal." Some variation and some changes are normal and we can't expect our body to look and feel the same throughout our entire lifespan, but if it's causing a concern or a complaint to you, there is something that we can do about it. And so making sure that we get that out there.

I feel like the big one is bladder leaks with urinary incontinence is so common within that first year postpartum. And then a lot of times, because we know that if we're not addressing it early on and you're still having leaking at six or twelve months out, you're going to have it for a lot longer. It's not something that just goes away on its own with time. And in fact, it can actually be harder to treat the longer we let things go on.

We want to make people not feel alone. But we can't just normalize it because it's a challenge that a lot of people face. I think it kind of highlights the fact that we need to do better for our moms if this is so common. Yes, you are not alone. A lot of people feel this AND we can do something about it.

Lauren:

I think that's such a huge part of it because I think you're exactly right. One, a lot of people can feel alone and that no one else is experiencing this, or this is just what happens: once you've given birth, you leak. Those are not the messages that folks need to hear without the other part, which is "and here are the resources that you can begin to work through to find out what's going to work best for you."

Dr. Arielle:

Yes. And that is the key point. What's going to work best for you? Because our pelvic floor functions in a system, we can't look at it in isolation. We have to factor in the nervous system. We have to factor in your diet, your daily habits, because it all plays into what's going on to your pelvic floor. So there's not really a cookie cutter approach to any one person.

Lauren:

And I think that's an important piece too, because as we see more people raising awareness in this space, I think it can be a little bit overwhelming for folks where they see this one program or technique or something, and they think it's the thing that's going to be right for them. They may not be realizing how unique each individual body is, especially like you're talking about where it's the physical and the emotional and mental and all of that coming together. There's a lot of factors at play. You might have the same symptoms as someone else, but the way that you each are going to address those symptoms could be night and day different. And I think not understanding that nuance can cause more harm than good when people are trying to do the right thing, but don't necessarily understand what that right thing might be for them.

Dr. Arielle:

Yeah, absolutely. And to that point, if you've tried something and it didn't work, it's important to not to just give up. Maybe that approach didn't work for you, or maybe that approach just didn't work for you in the way you were implementing it. This is why it's so important to have somebody else help you through those things. But then also, every provider is different and we have different ways of going about things. So maybe you've tried pelvic floor physical therapy before and you felt like it didn't work for you, but maybe it's because it was a 15 minute session and you had to rush out to the gym to finish the rest of it with a rehab aide who you didn't know from last week was a different person, versus trying it again with somebody else who you're one-on-one with for a longer period of time. Those things, they matter.

 

5. Overcoming Postpartum Bowel Issues: A Success Story of Regaining Comfort and Confidence

Lauren:

Can you share with us, if you feel comfortable, a success story of somebody that you've worked with that you feel would be helpful for them to hear?

Dr. Arielle:

Yeah, sure. So I was working with somebody recently who had a lot of tailbone pain when she was breastfeeding, but then also when she would go from sit to stand, it would spike up again. And those were the two main complaints. And then as we were talking through the history, there were some more bowel symptoms that were coming up. So there was a history of constipation and then also some smearing. And again, that's a common thing that can happen postpartum. We hear bladder incontinence all the time, but bowel incontinence is also very common and not as talked about.

So she was hesitant to bring it up because she wasn't sure if it was related. (It's always related, so if you're anything that you're like, "Oh, maybe, no,"...just bring it up, it's related.) So we worked together for about eight or 10 visits, but during that time we did a lot of pelvic mobilization. We did a lot of manual work. She had a lot of tension in the back of her pelvic floor and also from birth and from previous history, her tailbone was in a different position.

So we mobilized that back into place while working on the muscles as well, so that when we got it back into place, it would stay there since things tend to shift and get repositioned. Our muscles can get tense in certain areas, so we need to release that tension, work on the mobilization, then build strength in the new range and go from there.

But her bowel symptoms cleared up pretty quickly, as far as the smearing and the incontinence. She still had the constipation because again, that was kind of an ongoing thing, but by the time we finished, her bowel movements were regular again. She didn't have pain when she was breastfeeding, didn't have pain in transitional movements, and just overall felt like a new person. There's a little bit of self-consciousness going on when you're having some bowel issues that, once resolved, kind of just gave her a new outlook, more confidence in how she was moving, how she was doing things, and then got back to doing higher level exercises and stuff as well. So it was great.

Lauren:

Thanks so much for sharing that because I think I always feel like it's really helpful to hear. There are so many takeaways in that where there's all these different symptoms that maybe don't feel related, but that can all be so tightly intertwined and then just seeking that help and working with somebody. It's not a forever thing, it's, it's this targeted effort and it can be life changing for your movement, for your confidence, for all of those things. And yeah, I just think it's so inspiring to hear stories like that.

Dr. Arielle:

And for your health long-term too, because when you're able to get back to moving comfortably and exercising again, you have all of those benefits of cardiovascular health and bone density that improve. And a lot of times pelvic floor symptoms keep people from doing those things. It really can impact your overall health and wellbeing when we're not addressing these, what people will consider "a little problem". Like, "It's only leaking sometimes when I run and lift, so I'm not going to do that." Okay, but then what?

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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.