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Dr. Beth Olson and Lauren Fleming chat about pelvic floor physical therapy

Restoring Balance & Strength with Pelvic Floor PT: featuring Dr. Beth Olson

Recently, our founder, Lauren, chatted with Dr. Beth Olson, PT, DPT, PCES, founder of Beth Olson Physical Therapy and the acclaimed online course Core and Pelvic Floor Foundations.

We loved talking with Dr. Beth about her daily life as a Pelvic Floor PT, as well as her approach to patient care and her own personal journey with pelvic organ prolapse. Our conversation was full of valuable tips for people in all stages of their pelvic health journeys, especially for those who are just starting out.

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


1. How to Start Restoring Balance & Strength with Pelvic Floor PT


How do you explain the importance of pelvic health or pelvic floor PTs to people if they've never heard of it before?

Dr. Beth:

I think a lot of people when they hear public floor PT, their immediate response is like, "Ooh, you're going to work down there," because they're very modest or they just don't understand what all goes into it. Although I will say the moms that come within that first year after having a baby, modesty is a little bit gone.

The main question we’re going to focus on first is, how are we going to get everything working together again? When we go through pregnancy, there are so many changes to our body. Our abdominal muscles are stretched out, our pelvic floor muscles are stretched out, how we stand, our postures are all different. A lot of muscle groups get tight, a lot of muscle groups get weak, and we just need to find that balance again. We need to get everything working together again.

When people come in to see me and they're having troubles with either leaking or prolapse or they're just not as strong, I explain it like this: here are the four pieces of the puzzle. The puzzle is your whole body, but small picture wise, we're looking at your diaphragm muscle, your abdominal muscles, your pelvic floor muscles, and your low back muscles. And right now each one of those things is in a different corner and we need to get them all back together and working together as a whole system. Then we can progress your strength. But until these four things are actually together again, you're just going to be spinning your wheels.


And I think that's such a helpful way to look at it. I think especially as a new mom, it can be hard to think, “What is happening with my body and why is it so different than before?” You think you should be able to just go back to strength training and things like that, and it may not be working. It's hard sometimes to understand why.

2. “Don’t I just do Kegels?”


I'm curious, what are some of the most common myths or misconceptions around pelvic health that you feel like you've come up against, either in your daily life or maybe that you see on social media or things like that?

Dr. Beth:

I feel like there's this whole debate that I personally see: "Do Kegels" or "Don't do Kegels" and all this stuff. And when patients come in to see me, they’ll say, "What is this? Don't I just do Kegels?"

And my first question is, "Did you try that?" 

They say, "Yes."

Then I’ll ask them, "Did it work?"

Well, no. Or they wouldn't be here to see me. Pelvic rehab or pelvic floor rehab is addressing the entire body so that the pelvic floor muscles can just do what they're supposed to do without being told.

It's just like your shoulder. If you came in for a shoulder injury, I would not have you just do bicep curls and be like, go home and do three sets of bicep curls twice a day for the next four weeks, and your entire shoulder complex will be all better. That’s not how it works. It's part of a system. And if you think about how, or you didn't think about your pelvic floor before you had any issues, you never thought about it because it was working together with everything else so that you didn't ever have to think about it. It just did its job on its own, and that's where we want to get you back to. Just doing muscle contractions like Kegels won’t get you there.


3. Dr. Beth’s #1 Tip for Promoting Good Pelvic Health


So I know we've been talking about how pelvic floor PT is not ‘one size fits all’, but what are a few of your top tips for simple habits or practices that people can do to promote good pelvic health on a day-to-day basis?

Dr. Beth:

I think the number one most important thing, and this is why I start every single patient with this, is getting the correct diaphragmatic breathing pattern down. When patients come in to see me, I have to explain why we're starting with breathing, even though they're like, "But I'm peeing my pants!"

I'll say, "Let me explain. Trust me." Because those four things I mentioned earlier–your diaphragm muscle, your abdominal muscles, your pelvic floor muscles, and your low back muscles–they all have to be working together. 

And it all kind of comes to this diaphragm muscle, which is muscle underneath your rib cage, and it's controlled by your brain [involuntarily]. So you can't say, "Hey, diaphragm muscle: contract!" It doesn't work like that. You have to train your breathing to be in the correct pattern, so that your diaphragm is doing the right thing, so that your pelvic floor can follow. And that's pretty much the number one step that I start everyone through. If you're doing that backwards, you can do all the rehab you want, but it's not going to produce the same change.


Yeah. Doing something wrong a thousand times doesn't get you where you want to be. But if you did it a hundred times correctly, you would be making a lot more progress.

Dr. Beth:

Exactly. That's one of those exciting things where if you can get a patient to nail down that pattern in two visits or something, they're like, "Oh my gosh, it already feels better. I haven't even done a pelvic floor exercise yet!" 


4. Relief is Possible with the Right Tools


What would you say is one of the most rewarding aspects of your work?

Dr. Beth:

I think my favorite thing, and I actually got to experience this yesterday at work, is when a patient comes in and they're like, "Guess what? I sneezed and I didn't pee!" Or, "I went to Disney with my kids the whole day, and I didn't feel my prolapse at all!" Or, to go to more personal topics, "I got to have a bowel movement, and it was normal!"

I deal with all of those things. So when a patient comes in and they're telling me that this is really working–they're not peeing, they don't feel their prolapse as much–I get really excited.


Those are huge! And as somebody that's dealt with all of those things, until you have pelvic organ prolapse or other pelvic floor disorders, it's like, when it works, you don't think about it, and when it doesn't work, it is at the top of your mind all of the time. It's so hard to focus on other things sometimes because you're just like, "I literally never thought about this before and now I can't leave it alone."

And especially until you feel like you can start making changes that will actually lessen it. Over time, for me especially, I was just like, "Oh my gosh, what has happened to me? What does my future look like? And can I do all these things that I used to do?"

I can relate to the Disney one. We recently took our kids on a trip to Florida, and I knew I was going to be carting around my two 35-pound kids who would want me to hold them. I knew it was going to be really hard. And so I thankfully had things like my support garment and pessaries where I could feel more confident that while I'm working to lessen my symptoms, I could have these tools that are often stigmatized, but that would really help me enjoy that day and not be thinking about my heaviness while I'm carrying these kids around.

Dr. Beth:

I also used both of those things early on with both kids. With my first son, I didn't know what was going on for a while, so it took me some time to figure out what support garments were. But as soon as I did, I was like, “Oh my God, thank God.” 

I wore a pessary, too, and the first time my own pelvic floor PT  suggested one, I cried. I was like, "I have to do what?" I felt broken. I felt like no one else in the world could possibly need this. What is going on?

Come to find out, that's not true at all. Once I found a good fitting pessary, I was like, "Oh my God, I can go to the gym. I can go for a run and I'm not scared that everything's going to fall out and I'm going to need surgery tomorrow!" 

So I was able to use that while I did my rehab and got stronger and stronger and stronger. And I'll never forget the day that I ran for the first time without a pessary, and I was like, "Oh my God, I just ran and everything feels totally normal." That was a big deal. And I wore support garments in the time frames when I couldn't wear my pessary.


5. Supporting Partners on their Pelvic Health Journey


I wanted to get your thoughts on how partners can be supportive when you are seeking pelvic floor health. A lot of times, people with POP or other pelvic floor conditions have kids or other responsibilities. Are there ways that we can encourage partners to be helpful along this journey?

Dr. Beth:

Everyone's relationship is different, but I think it's incredibly important to be able to explain to your partner what you're going through and how it's affecting you. Because especially if we're talking about something like prolapse that's affecting both people, most likely some hesitation in the bedroom when things are different down there. So being able to explain, "This is what I'm going through."

And it's just like any other injury. If I hurt my shoulder, we wouldn't hesitate to put in the time and the effort to allow me to go to rehab for my shoulder. If I had a knee injury, it would just be common sense that I would need to address this and need the time and resources to rehab it. It needs to be like that with postpartum rehab, as well.


I think that's a great point, especially because in a lot of these cases, it's not necessarily externally visible. Or maybe it is, but you don't regularly see it, like if you were wearing a shoulder brace or something. 

And so I think it can be harder for folks to understand and sympathize with you. And recovery can be very lengthy in terms of time or seeing healthcare providers. There's a lot that goes into it, and I do think it's often an invisible thing that people deal with, and so it can be hard.


Are you a pelvic floor healthcare professional? We’d love for you to be a part of the Hem Support Wear community! Learn more about our resources, including our clinic sample kits, healthcare-focused monthly newsletter, and more. If you’d like to be featured in our Expert Spotlight series, let us know!



**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.

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