Taking Control of Pelvic Health: It’s Never Too Early or Too Late with Dr. Ashley Castellanos, DPT

As part of our Expert Spotlight Series, our founder Lauren chatted with Dr. Ashley Castellanos, a dedicated practicing physical therapist who has been specializing in women’s health and orthopedics since August 2020. She earned her Bachelor's degree in Exercise Science from Auburn University and went on to receive her Doctorate in Physical Therapy from The University of St. Augustine for Health Sciences.

In their chat, Dr. Ashley and Lauren dive into the interconnectedness of pelvic health with the rest of our body, highlighting how seemingly unrelated areas—like ankle mobility—can influence pelvic function. Dr. Ashley stresses the importance of a holistic, whole-body approach to pelvic care, explaining that dysfunction often stems from a variety of sources, not just the pelvic floor itself. Additionally, she advocates for proactive pelvic floor therapy, encouraging individuals to seek care early—before problems escalate. Drawing from her experience, she shares powerful success stories and calls for a more integrated approach to pelvic care, working alongside OB-GYNs for comprehensive, preventative health. By addressing the taboo and normalizing these conversations, Dr. Ashley encourages everyone—whether struggling or symptom-free—to take charge of their health for a better quality of life.

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

 

1. The Surprising Link Between Your Ankles and Pelvic Health: Why Whole-Body Wellness Matters

Lauren:

How do you explain the importance of pelvic health to somebody who either has very minimal knowledge or may have not even heard about it before?

Dr. Ashley:

I feel like the pelvic floor itself is such a small niche that no one thinks about day to day. We're probably not sitting there thinking, "How's my pelvic floor doing?" But if we have shoulder pain, we're like, "Okay, let's think about my shoulder sometimes," things like that. Because it's something that we don't see daily, it's not something that we think about daily until we start having dysfunction and we're like, "Hmm, is this normal? Is this not?"

I think there's also a lot of stigma associated with talking about pregnancy or postpartum. People will say, "Oh, everyone pees after they have a baby. That's just so normal. Everyone does it." And we're like, "Hey, it might be common, but it's not normal. That's actually a sign of dysfunction that our body is not managing pressure well."

So what I like to do when I talk to people about the pelvic floor is: One, I think I'm a very visual learner. My brain likes to see puzzle pieces put together. So I just start by saying, "Hey, this is what your pelvic floor is. One, everyone has a pelvic floor, not just women, men do too. Everyone has a pelvic floor. And when it's not working appropriately or when there's a puzzle piece that is not meshing with the rest of the puzzle, we can have dysfunction. And this is what dysfunction can look like. And if you have these symptoms, most likely we're having some biomechanical dysfunction within our body." Now is that in our pelvic floor? Potentially. Sometimes pelvic floor symptoms are present, but the pelvic floor itself is fine, but our diaphragm is restricted or our pelvis is not and is sitting in a good position, or our ankles aren't moving well, and we're running and we're leaking a lot because our ankle's not able to absorb the load.

So we recognize that our bodies work so holistically. And zooming out, but also taking it apart a little bit, I think when people understand how their body works, they're more available or interested in directing it.

Lauren:

Right. And really taking that whole body approach of like, "Okay, I could have a number of contributing factors to this." And once you start peeling that onion and you're like, "Oh, this is a complicated system."

Dr. Ashley:

Yes. I'll work on someone's ankle, and they'll say, "What are you doing?" And I'm like, "Well, you're leaking while you're running and your ankles are not moving,” and I'll fix their ankle and get them mobility a little bit better. And they come back next time. They're like, "That's so weird. But it worked." I know it's weird. I'm fully aware that what we just did doesn't make sense, but it shows that it works, we're going to keep on doing it, and that's okay.

 

2. The Case for Proactive Pelvic Floor Care

Lauren:

Another thing that I feel like I see a lot is people don't come to someone like you until they have a problem. It's often very reactive. Will you talk a little bit about how and why we should think about pelvic floor physical therapy in a proactive sense?

Dr. Ashley:

Yeah. I think US healthcare is a very corrective healthcare system. We go to the doctor when something is wrong and we want to fix it. And so what my passion and my vision is moving forward is that I want to move to more of a preventative health for society. 

Because, think about it, you don't take your car to get gas once it's run out on the side of the road and it's no longer moving, right? You realize like, "Hey, we're starting to get a little bit low. Let's go fill our car back up." Same with our body. Why are we waiting until something is fully wrong with it? And most of the time we notice things like, "Okay, hey, my shoulder's starting to twinge it a little bit," but we let it go. We sleep it off, we take some Tylenol, Aleve, we ice, heat, maybe do a little stretching, and we just continue prolonging it and it becomes a chronic cycle. And our bodies work on these neural pathways and they pick up on us waiting and they can heighten our experience with that. And so why are we waiting until there's a huge problem to fix it?

And so one big thing that I love doing is we do prenatal packages at our practice. And I tell my girls, "Hey, don't wait until there's an issue."

Once we're pregnant and we know we're pregnant and we're moving and we're getting out of that first trimester slump, I know that first trimester is just tough for most of our girls. Once we're out of that slump, come in, let's do an evaluation, let's get a baseline measurement, and then let's work together through this entire pregnancy to just be the best version of ourselves.

 So that one, when we get to our labor and delivery, we know how to appropriately deliver a baby or we are prepared for a C-section if that's what we're moving into.

And then two, we know what to do in that immediate postpartum recovery. We're not delivering a baby, and then in that hospital bed, thinking, "My body hurts, I don't know what to do, I don't know who to go to."

And three, we can just continue healing after. And then we have our baseline from where we started and kind of know what we want to get back to. And the same thing for postpartum. I tell my girls, "Once you have your baby, beautiful, you guys are both healing at six weeks. I want you to come in regardless if you think you have symptoms."

And a lot of times I'll have girls come in and we'll do an evaluation, and I'm like, "Hey, everything looks amazing. Here's what I want you to keep doing, and then I'm here if you need me in the future." And what that does is allow us to make sure everything's feeling well, because sometimes there's silent symptoms that we're not going to see, and then they can just progress over time. And then it gets to the point where they'll say their tailbone hurts. I'll ask when the pain started, and they'll say, "Well, when I left the hospital." I'm like, "Your baby is a year old, so we've been dealing with this, but we've just let it get to a point where it's so painful. Let's be more preventative, and so we can work on things early on so they don't get so heightened in our systems.”

Lauren:

I really love that because I feel like the more it can just be the standard of care and it's just expected that you are having this as a resource, I think it does so many things. I know I was fortunate enough that a pelvic floor PT had come and done a talk at a prenatal event that I was at, and so I had actually gotten her expectant parent package, and I was so thankful for it because I ended up having prolapse after my first child, and I was still blindsided by it even though I had some of these resources in place.

And thankfully I was able to quickly get to her. That experience was hard enough, even with having the resources. I can't imagine what it would've been like had I not known a pelvic floor PT or not had that relationship already established where it was like, "Okay, well I'm going in at six weeks and I can talk to her about this then."

It was so powerful. And I think the other thing too, to the point you made of even if there's not something that's bothering you and you can just say, "Hey, yeah, keep doing these things," I think anytime you can have those doors open so that when something comes up, it just reduces that barrier of, "Okay, well, who is my provider and who do I see?" And that whole thing. There's such that mental load that goes along with that too. I think the more you can have those relationships established, you're like, "Oh, this came up. I'm going to go talk to Ashley about it, and we can just kind of keep going."It's so nice.

Dr. Ashley:

Yes, exactly, I think being established with a person is so helpful. So the sooner you're established, the better. And like I said, we're very busy right now, so I always tell my girls, I'm like, "Hey, I'm not seeking out a ton of new patients right now, so I'm not going to keep you guys around for a lifetime." My goal is always a discharge for my patients, and I tell them that from day one. I'll say, "Hey, I don't want you to be here forever. I want you to manage this yourself. I want to give you the tools and treat you in the beginning. And then later if anything ever comes back or we get pregnant again or we have a surgery, I'm here again for you, and then we'll start back up from there." And I think people really appreciate that as well.

Lauren:

Right. Because I know some people have concerns that if they stop this, they'll never get to stop. And I mean, there's that fear as well.

So I think hearing that from the beginning can feel very helpful. 

3. Why OBGYN Visits and Pelvic Floor Therapy Should Go Hand in Hand

Lauren: And another thing I've heard some providers talk about, and I kind of take this approach myself, is also kind of considering it as an annual check-in. Like if I've got my OB GYN check-in, then I schedule my pelvic floor PT check-in at the same time, regardless of how my body's feeling, because I personally have a condition that I work to manage. But then also our bodies change. And so it's like where you were a year ago isn't where you are today. And I think that can be a helpful approach too, if you have the resources and means to take that approach.

Dr. Ashley:

Exactly. And I think I like what you said. We work so closely with OB GYNs, but we do such different things. I don't think people recognize that sometimes. They'll say, "Well, I go to the OBGYN every year." I'm like, "That is beautiful. I want you to go get your pap smear. I want you to go get everything screened because I'm not going to run this test for you."

But what they aren't doing is they're not checking the tone of your pelvic floor, the coordination, the strength, the quality of your pelvic floor. They're not assessing your pelvic alignment and where you're at. And so why not add it? And again, one day, my goal, my vision, my hope is that this is standard practice for all women across the board and men, too. But let's start with women, because it is standard practice in other countries. Our healthcare and our society hasn't caught up to that. So until then, we just keep talking about it. And I think that's the biggest thing that we can do.

And I love that you post these interviews and you talk about this stuff because I think prolapse is a huge one. It's either very scary for patients to hear about, or some girls have no clue what it is. They have no awareness of what a prolapse is.

And I'm like, "Hey, You have a prolapse. And that's okay." They come in, there's so much pressure down there, and they'll be like seven weeks postpartum. I'm like, "Hey, did your OB check after?" And they're like, "No, they didn't check, but I told them there was pressure. So they said to come to you." I'm like, "Beautiful that they sent you to me."

And we check. I'm like, "Do you know what a prolapse is?" And there's such lack of education surrounding women's health. And so I think the more we talk about it, the less taboo we make it because it can be very sensitive. I know it's very intimate. And if you would've asked me when I graduated school if I thought I would be talking about sex, I'd say "No, no, no, no." But now I see the more we remove the taboo around it, the better it is because we're struggling with it. We're dealing with a lot of these symptoms and people are insecure about it and they're hiding it and they're just dealing with it internally and it's bleeding into other parts of their life unknowingly.

 

4. Why Your Pelvic Floor Needs Tailored Care—Not Just Kegels from Instagram

Dr. Ashley:

And then Kegels--those are no longer a thing. We got to get those out of there. No one is purposely giving bad information, but we see a lot of misinformation surrounding Kegels or proper "pelvic floor workouts" by influencers or people online who have potentially had symptoms themselves, and it's gotten better, but what they are actually providing is the misinformation that is making people worse.

Kegels are not going to solve your problems. People online don't know everything. Instagram is a lie. You'll see someone two weeks postpartum running on the treadmill--that's really bad. But also, that's not real. So let's remove that. Let's stop comparing. Let's get you into the clinic. Let's see how you are doing, and then let's go from there.

Lauren:

That's the key, right? I mean, I think that's the other huge part when people see a lot of that stuff online is they think, "Oh, I'm leaking, or I'm this or I'm that. So I need Kegels. I need a strong pelvic floor, I need all those things." And sure, you do need a strong pelvic floor. You do, but can you relax it or do you have a tension issue?

And that's where I feel like there's a huge gap in knowledge. It's like, if I have this, I need to do this. And to what you said at the beginning, it is such an individualized practice and this body is this whole system. And without that knowledge of "Do you have tensity? Do you have laxity? What is going on?" Then you don't know which one you should kind of be self-prescribing and working on.

Dr. Ashley:

Exactly. And I would say 90% of my girls have a hypertonic, or overactive, pelvic floor that they can't relax. And I'm like, "Hey, you've been doing Kegels for six months because you found a program." And I get that they're trying to find an option that they can self resolve. I love that they're taking that step forward. So I'll tell them to do it; however, I tell them to seek professional advice first and find something that is specific to you, because everyone is very different

Lauren:

Then you can kind of guide them with the programs to look for. That's the part that I think is so great. It's not that all these online programs are bad ones, it's just knowing if that's the right fit for you.

Dr. Ashley:

Exactly. I love that.

 

5. Restoring Hope: A Success Story of Healing from Trauma and Pelvic Pain

Lauren:

Could you share a success story about just something you kind of come across in your work that's really resonated with people or would be good for people to hear about?

Dr. Ashley:

I love my prenatal and postpartum girls. That is probably one of my top passions. But I also work with trauma survivors, and that's another big passion of mine. That one has a lot of different components to it, for sure. And so getting involved with mental therapists and collaborating with other professionals has been a big one. And then I had a woman who got married. She waited until marriage for intimacy. Intimacy was completely fine at first. Unfortunately, she was a victim of abuse on the side and was a survivor. And so when she came to find me, she had not had sex with her husband for seven years because it was too painful. She has a diagnosis called dyspareunia vaginismus.

And it was not an overnight fix because there were a lot of walls to build down. And after seeing her--she's one of my longer patients for seven months now--she has pain-free intimacy with her husband whenever she wants, her barriers are broken down, her body responds to that space in a safe way now versus being a trauma reaction response. And so her body knows, she is safe again. And she said, "You saved my marriage." And I think being in that space to allow marriages to heal and help that, or help families bring new life and fill and heal a family with that, that is just probably what gives me the most amount of satisfaction and what I thrive on as well. So that's probably one of my favorite ones.

Lauren:

Thank you so much for sharing that. Because I think hearing stories like that are so impactful for so many reasons. I feel like sometimes people feel like they've had this forever and they can't fix it. And in that story, I think it's so impactful to hear she's had this for a long time and was able to overcome it and really achieve the things that she wants to. And I would just hope that people who hear this who may feel like, "Golly, there's no hope for me," or "I've been doing this forever. I can't change things," would know that there are people out there who want to help you. And there are tools, and it's not a one-size-fits-all, and you can take this very holistic collaborative approach and find what works for you. Thanks for sharing. I think it's very, very impactful.

Dr. Ashley:

Yeah. Some of my girls may come in thinking they probably came in too late to start this." I'm like, "It just might take more time, but as long as you're okay with investing your time, I would love to help you." And usually they're like, "I want it." And so we do it. And it's really cool to see the progress over time.

Pelvic floor therapy is not an overnight fix. And I always tell my people that I'm not magical. I'm not going to snap my fingers and you get better. I'm not going to touch one spot and everything is healed, but if you trust me and you do your part, you're going to feel a lot better. And usually that helps and everyone buys in and it's really cool to see the progress over time. And then we discharge, and then I don't see them again until the next season.

Lauren:

Are there any final thoughts or anything you wish everybody knew or that you'd want to leave us with as we wrap up?

Dr. Ashley:

I'm so grateful for you having me on this interview today, just to get the word out more about pelvic therapy. And I would just encourage the woman or men or anyone listening to this, if this resonates with you and you feel like," Hey, I have symptoms that've been dealing for so long or new, and I finally want to take the next step to work on this," Find a provider, find someone in your area. If you can't find someone in your area, reach out. It's not going to bother me. We do virtual visits and I can help you out, or we can find you someone in your area, but don't just keep sitting in it internally. Take the next step because it's so worth it. We have one body that we're given during this life, so take care of it. Let's heal it. Let's have the best life.

 

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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.