232: How your pelvic health affects your lifestyle and sexual health: navigating perimenopause, menopause and more with Marie-Josée Forget
In this episode, we welcome Marie-Josée Forget. Marie-Josée is a bilingual Pelvic Health Physiotherapist, educator, and mentor with 18 years of clinical experience. She operates a private physiotherapy practice focused on treating pelvic floor dysfunction and teaches courses related to pelvic anatomy and health at Pelvic Health Solutions. Marie-Josée Forget speaks with us about women’s health. We learn about perimenopausal, and menopausal women and their pelvic health. How your pelvic health affects your lifestyle and sexual health, Kegel exercises, navigating perimenopause, menopause, and more!
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TRANSCRIPT
KK: We are on the brink of a mental health crisis, and this is why I am so appreciative of the folks over at BetterHelp. It provides the largest online counseling platform worldwide to change the way people get help with facing life’s challenges by providing convenient, discreet, and affordable access to licensed therapists. BetterHelp makes professional counseling available anytime, anywhere through a computer, tablet, or smartphone. Sign up today. Go to betterhelp.com And use a promo code ‘solvinghealthcare’ and get 10% off signup fees.
SP: COVID has affected us all and with all the negativity surrounding it, it’s often hard to find the positive. One of the blessings that is given us is the opportunity to build an avenue for creating change. Starting right here in our community discussing topics that affect us most such as racism and health care, maintaining a positive mindset, creating change, the importance of advocacy, and the many lessons we have all learned from COVID. If you or your organization are interested in speaking engagements, send a message to [email protected], reach out on Facebook at Kwadcast or online at drkwadwo.ca
KK: Welcome solving healthcare. I’m Kwadwo Kyeremanteng. I’m an ICU and palliative care physician here in Ottawa and the founder of ‘Resource Optimization Network’ We are on a mission to transform healthcare in Canada. I’m going to talk with physicians, nurses, administrators, patients and their families because inefficiencies, overwork and overcrowding affects us all. I believe it’s time for a better health care system that’s more cost effective, dignified, and just for everyone involved.
KK: Kwadcast nation welcome back. We have a tremendous episode with MJ Forget. She is a pelvic floor specialist in physiotherapy and sees a lot of perimenopausal women and was really knowledgeable in terms of the issues that she sees firsthand. Many people can benefit from a pelvic floor physio, for example, if they’re having incontinence, pain or with sexual health, this is such an important aspect of things. Then she dives into how holistic the approach must be how the physio can actually make some significant strides. How lifestyle changes can impact things. Honestly, I learned so much in this episode. So, we’ll jump on it right away here. But first, I want to give a quick plug to our latest newsletter on substack kwadcast.substack.com. Where you can stay up to date with all our releases, our blogs, or blogs or guest appearances, courses all are on one site and it’s all point. Check out kwadcast.substack.com and jump on the train. So, without further ado MJ Forget.
KK: Welcome to the show. We we’ve been talking more about women’s health, specifically, perimenopausal and menopausal women. One of the areas that I must say it was a bit foreign to me and I didn’t realize it was such a big issue was pelvic health. So MJ you’ve been at this for a while, like when you started? You said over 20 Maybe 25 years?
MJ: 25 years? Yeah.
KK: What lured you to pelvic health and like how big of an issue has is pelvic health ben for people?
MJ: When we graduate from university, you know, and the medical fields we get to find areas of interest when we graduate and that’s kind of all that we do. And you know physio, some of them want to do orthopedics and work with sports teams. When I graduated, I went to the hospital system, which is a lot of what physios do, and I worked in ICU and I worked on the floors, I did orthopedics, post knee posts, hips, and it really wasn’t where my passion lied by any means. But it was a really great introduction to all thing’s physios working in a hospital setting. So, when I thought about where do I want to go? And what do I want to do? I always had an interest at the time what we call more women’s health. Now we call it pelvic health because again, all genders have pelvic health issues. I had classmates who did their thesis on incontinence. I remember thinking at the time oh my gosh “That’s something that we can do?”. It really wasn’t anything we were taught in university, nobody really talked about, again pelvic health, women’s health, women’s health issues, menopause, that was never covered in our degree. So, I took my first course and Alberta back in 1997 and I never looked back. I had no idea how much pelvic health issues was a problem. Remember 25 years ago, nobody talked about any of that. Nobody talked about bladder control issues or bowel control issues. Certainly, nobody talked about menopause, and nobody talked about sexual health, which is a lot of what we do in pelvic health. So, I started my career, like I said, I was in my early 20s and that’s all I’ve been doing now, for 25 years. This is where I’m at.
KK: Wow. You alluded to, you didn’t realize how big of a problem it was, like how big of a problem truly is it?
MJ: If we talk just about incontinence in Canada, if we just talk about general stats in Canada, 3.3 million Canadians have bladder issues in Canada. When we think about gender differences, one in four women, one of one to nine men, so it’s significant. It actually gets a little worse as we age. That’s an issue with menopause. So, if we think about the female population, there’s about a 20% to 30% incidence of incontinence in our young adulthood. Think of like your 20s and 30s. Then that spikes up to almost 40%. By the time we get into middle age, which is kind of the perimenopausal menopausal age. Then it goes up as high as 50% in our elderly, which is a really big concern. One of the main reasons that our clients get admitted into nursing homes is because of bladder issues, and fecal incontinence rate, loss of bladder and bowel control is usually kind of an event where families then have a hard time maybe coping with taking care of their of their loved ones, and that will increase admissions to nursing homes. So, we’re not talking about small numbers. It’s a significant number and we have an aging population in Canada. We have a lot of people going through perimenopause and menopause. One of the biggest risk factors of incontinence is actually menopause. We have a lot of people right now who are entering kind of that phase, you know, and I think in Canada, the stats are that there’s 10 million of us in this age group in perimenopause, heading into menopause in Canada. That’s a big number.
KK: It’s massive. And I think this is what’s motivated us to cover some of this content because these are years of productivity, have high needs, like moms that are in that perimenopausal age where you’re active with your family, your career paths, like a lot of people this is where they’re starting to peak in their careers, a lot of demands just to be to be on the workforce, like when I think of health care workers. So, anything we could do to make them more functional and thrive. I think we need to really look at. I don’t know if I realized that, like this is kind of like the peak or one of the main concerns during the perimenopausal perimenopausal menopausal timeline. What can you do? What do you do to help?
MJ: There’s so much we can talk about this for hours, but we’ll try to kind of keep in to keep our timeline because I can get started. I mean, if we’re just going to focus on, we’ll talk the impact of perimenopause and menopause. Like you said, it’s such a difficult time. You know, people going through perimenopause and menopause, like you said, are working. They are often parents, with children that still require a lot of our attention. Plus, sometimes we’re taking care of our parents as well. We’re kind of like in that middle group where we’re busy with our careers. We may or may not have children, but we also may have parents that we help and it’s a really stressful time, and quality of life really starts to take an impact. So typically, when people come to see a pelvic health physiotherapist, or a physiotherapist who’s done postgraduate studies in pelvic health, what we do is we are often seeing people that come for problems of bladder control and bowel control. So that would say that’s kind of when I started that was the most of what I’ve seen, but we also help our patients with sexual function and the ability to have pain free sexual intercourse, which is a big issue again in perimenopause and it can actually worsen and menopause as well. We help with conditions called pelvic pain, pelvic pain can be anything like you know, our patients telling me I have vaginal pain or rectal pain, and when I treat my population of men it could be prostate related type of pains. Pain in the pelvis. A lot of pain in the pelvis affects sexual function and has an impact on your bladder and bowel function. So, it’s all related together. When you come and see a pelvic health physio, what’s important to know is we take what they call a biopsychosocial approach to care. So that means when you come and see us, we’re looking at you as a whole person. What’s really great about our profession is we have the luxury of time, because when you come and see us, we have an hour on assessment with you. Follow up treatments can be half an hour, 45 minutes or even an hour. So, we have the luxury of time, and we have the luxury of talking. S o the main thing that we always want to do is let people tell us their story, you know, why are you here? What’s bothering you? And how much is this bothering you? Because again, when it comes to menopause, or bladder issues, or sexual function, these are not subjects that people want to talk about easily, right? There’s a lot of taboo, a lot of embarrassment. A lot of my clients think they’re the only ones who cant have intercourse anymore than the only ones who are losing bladder control and can’t, you know, run a marathon. Everybody thinks they’re the only ones but there are in fact, not, the stats are actually quite high in terms of impact of blood, bladder, health and sexual health on our patients. So, we talk and then we address all things incontinence, bladder, bowel, sexual function, and things like constipation and pain in the pelvic area. So, we do all of that. It’s quite a bit and it spans quite a lot of topics. We also talk about lifestyle because lifestyle is important. On the on, on maybe my first visit or second visit, I’m going to talk to you about are you sleeping well? Are you managing your stress well? Are you having any issues with your mental health? depression, stress, anxiety that you’re not managing? Well, how are you feeling hormonally? Because part of what we do and what I’ve noticed during COVID a lot as well is we’ve kind of become a little bit of the gatekeepers, I want to see we really had to help our patients navigate the healthcare system, and a time that it was really difficult to navigate the health care system. I always tell my clients, I’m here to help build your team around you who do you need to help you navigate perimenopause and menopause so you can live your best life, because as physios, we have to stay in our scope of practice, we can’t do everything. So, if I talk about nutrition, I can talk about why nutrition is important, but I’m not allowed to give you advice on nutrition because it’s not in my scope. But I’ll send you to the people who do that. And the biggest challenge and menopause is that for a long time, there was nobody to send people to. Right? If you think about, you know, how many menopause clinics do you know, that exist out there? Right. There’s one at Mount Sinai. There’s just not a lot of menopause clinics that are run by a gynecologist and maybe have a nutritionist and a psychologist all working together and maybe with a pelvic health physio, that’d be great. That could look at that whole biopsychosocial approach to care to really help our patients navigate menopause. I think that’s now starting to change. I think now, you know, the tagline right now is menopause is having a moment while menopause is having a moment. I think partly because there’s a lot more of us in our field talking about it on social media, there’s definitely some gynecologist now that are much more vocal on social media, talking about hormones, talking about safety of hormones. When I started 25 years ago, hormones were a no go, there was so much fear around all things hormonal replacement therapy, and it was really difficult because as a physio, I could see how devastating some of the symptoms of menopause were and there wasn’t really a lot of options for my patients at the time as to what to do about it. Because everybody has such a fear of hormone, whether it’s topical hormones or hormonal replacement therapy, and I think that that’s shifting as well. So, we talk about all of these things with our clients when they come in. Then we help navigate and say, Okay, if you’re struggling with nutrition, who could we send you to? If you’re really struggling with your hormones, who are the hormone, menopause, hormonal experts out there to send you to? If your mental health is an issue, who do we send you to for that so that you can kind of work on your anxiety and your depression and your stress? There’s been a lot of stress, you know, in the last few years, and then as physios, we take care of more that kind of the physical kind of component of incontinence, pelvic pain, bowel health, constipation and sexual health.
KK: You know, what I’m really appreciating is you’re saying MJ is how holistic the approach is, it’s not so just the physical aspects and the rehabilitation, you need to know how it’s affecting your life, how you’re doing from a lifestyle perspective, stress level, sleep, how well you’re eating, and just approaching it that way. That’s what I’m finding really encouraging about this is that you know, you’re just not soloing the approach, it really comes down to how the person is doing as a whole. In my opinion when it comes to so many issues in medicine, this is the only way like, you need to really address so many of the needs outside the actual physical concern. Another thought just came to mind too, is just hearing all the, the symptoms that so many perimenopausal and menopausal women have to go through it, it just, it really is sad that so many people have had to go through without it go through all this without attention. You put it together, the hot flashes, the mental health concerns, weight issues,
MJ: the insomnia, the anxiety
KK: Then you add the pelvic pain, the incontinence on top of that
MJ: It’s significant, and it’s all today can be a very overwhelming time and our client’s life, because, again, they’re so busy, they’re under a lot of stress, they have a lot of obligations. Then they’re dealing with, you know, ‘I can’t have intercourse with my partner, it hurts too much. I’m leaking urine, I can’t exercise. Now I’m gaining more weight. I am going through perimenopause, I got insomnia, I can’t sleep’. That has huge repercussions on the human body. It’s important that we all talk about those things. And it’s important that we recognize the lane that we’re in as, as health professionals and find the right people, for our clients so that they get better. I think you know, again, it’s the tides, I think are changing that we’re taking a little bit more of this kind of like sort of biopsychosocial approach, looking at the whole person. Also giving permission to our clients to talk to us about these things that it’s okay to talk to me about your bladder issues and your sexual health concerns and, and your stressors in your life and how maybe you’re having really hard time balancing work life balance and seeing how we can help with that. We can all help with that, in our own way.
KK: Absolutely. Give us a sense, MJ when someone walks into the office what some of the stuff you’re assessing? what do you do as a physio to help patients that’s within your scope? the exercises? help me understand the potential and the things that you do to help address these issues.
MJ: So, once we’ve listened to everybody’s story, and they tell us what their main concerns are, and what their goals are, in terms of what would they like to achieve with our time together. We do a lot of education, and education can be like I said, lifestyle, sleep, how are they functioning with nutrition? Are they exercising? are they happy? Are they stressed? then we really go into the function of the pelvic floor. So, if we talk about the main concerns most of our clients are coming in with often it will be bladder issues, bowel issues, it will be sexual health issues, and maybe constipation issues, like some bowel issues, that all tends to act up in perimenopause. That’s when we take out our props. I have lots of props to explain to people about the pelvis. Because again, we are not taught anything about the pelvis as human beings. And if we think about our education in our primary schools, in our high schools about pelvic health, there’s none of that. So, we often don’t really know about the pelvis, right? And where the pelvic what’s happening to our pelvis. If we look at this wonderful pelvis has been with me for 25 years, so it’s falling apart.
KK: People listening, you might have to be extra descriptive, extra descriptive
MJ: Okay, so when we look at the pelvis, if I take the muscles out of the way, this is the front of your pelvis. So that’s your pubic bone. By turning the pelvis around, that’s your kind of your spinal column and your tailbone would be right here. And if we look at the bottom, while the bottom is all muscular, it’s just muscles down there, and you have layers of muscles, and we call it because we’re not very clever. We’re calling it the pelvic floor muscles. There’s a lot of fancy terms in anatomy, so we won’t go through that but for the sake of purpose, the pelvic floor and there’s layers. The first layer, which is the most superficial, so meaning that you can touch it from the outside. These muscles here go from your pubic bone to your tailbone here at the bottom, they wrap around your clitoris, and your vaginal opening, and then they also wrap around the anal opening. All of these muscles here, the main function of these little muscles are that the vaginal opening or for sexual function, which is why sometimes we can have difficulties with maybe having an orgasm, libido, desire orgasms, and maybe we have pain with intercourse. These muscles which are under voluntary control, so we can learn to use them, they must contract, but they must relax. When things go in the vagina, all these muscles must have the capacity to stretch into expand, and that should never cause us pain. So that’s this first little group. We’ll maybe dive into kind of sexual function a little later. But that’s the first little group. Then deeper inside your pelvis, you have another group of muscles that are deeper inside your body. These muscles, they’re quite big, quite large, they wrap around your vaginal opening and your anal opening all the way from your tailbone at the back to your pubic bone at the front, those are your bladder and bowel control muscles. So if I take that muscle out, just to show you how big it is, the big muscle, front to back. When you laugh, when you cough, when you sneeze, when you lift things that are heavy, these muscles tighten around your urethra, or tighten around your anal opening so that you don’t lose bladder control, you should be able to hold on to those muscles to get to the bathroom on time. Then when you sit to go to the bathroom, they relax this stretch the expand to allow us to go to the bathroom. So, when people come to see us for bladder issues, bowel issues, or sexual health issues and sexual pains, what we’re trying to determine is what’s happening to that little group of muscles, what’s happening to that pelvic floor. I always tell my clients, there’s two groups of you. There’s a group that come that comes to pelvic health physio, where when we evaluate the function of their pelvic floor, they just lost a lot of strength and endurance. We see that in perimenopause and menopause because this is my hormones are important. When you go through perimenopause, your hormones are starting to dip down. They’re not gone yet. But your estrogens are dipping your testosterone and your DHEA, which are your androgenic hormones are decreasing. We need estrogen for muscle strength, and protein synthesis and collagen. When we have a loss of estrogen, we start to lose muscle strength, we start to have what we call sarcopenia. Right. And that starts to increase as we age if we’re not moving and exercising. So, estrogen is really important for muscle function to testosterone, which we have, we don’t maybe have as much as our male counterparts. We do have some in it, it is important because it helps with muscle strength and muscle tone. That impacts the pelvic floor. So, I may have someone who has never had babies never, never could not have children or decide not to have children who come to see me, and perimenopause and menopause and they’ll say, Why am I having incontinence, I never got pregnant. Well, that’s because even if you have not had children, you’re gonna go through menopause, you’re gonna have those hormonal fluctuations. You can still have some symptoms of menopause and one of them could be incontinence. And the other thing what these pelvic floor muscles do, which is really great when they’re working well, and you’re able to use them properly, they help decrease the sense of urgency and frequency, right. So, some people say I go to the bathroom all the time I’m peeing every half an hour, I’m getting up three, four times a night to go to the bathroom. When we help regain function of these pelvic floor muscles to reduce incontinence can also reduce urgency and frequency and the need to get up at night. So, group number one may have a lot of weakness and loss of strength in their pelvic floor. Again, that happens in menopause with the loss of our hormones. A lot of the symptoms tend to worsen about seven to 10 years after you’re done having your menstrual cycles remember that you are menopausal if you’ve gone 12 months without your menstrual cycle, usually symptoms of menopausal peak a kind of that seven to 10 years. I’s about honestly, they’re saying about 50 to 65% of the population may have actually some symptoms, you know, at those seven years, post menopause. Second group of people that often come in is when we evaluate their pelvic floor, they have all the same symptoms will have bladder issues or going to the bathroom a lot. But then they tell us they have pain, they have pain with sexual activity. Then when we look at their pelvic floor, they actually have too much tension. Okay, and that’s a problem because if you look at this little layer of your pelvic floor, these muscles that wrap around the vaginal opening and your clitoris, so these are your clitoral muscles. So important to have orgasms if you have too much tension in these muscles like this when things going in the vagina start to hurt. Again, that can start to be a problem in perimenopause and into menopause, again because of hormonal changes. What happens is, you’re going through perimenopause, or menopause, or maybe you’re in menopause, your estrogen levels have dipped down. Estrogen is like the fountain of youth, estrogen plumps up our tissues, it increases blood flow to the area, it provides elasticity to all of our tissues, and that’s your labia, and at the vaginal opening. This area is really, really rich in what we call estrogen receptors. And of course, when we go through perimenopause and menopause, that’s a decreasing, and so things get a little thinner, things get a little drier, and things lose the elasticity. What often can happen is, my clients will have intercourse, and it hurts, and maybe they bleed a little bit, because again, you know, when estrogen goes low, everything gets a little drier and more sensitive, and they’ve been prone to maybe even some tearing, well, then that pelvic floor is actually very clever, these muscles here, they’re there to protect us as well. So, if you have pain, then the next time you think about engaging in sexual activity, your brain is going to say, You know what, that really hurt last time and right away, we start to tense up our pelvic floor. And then we get caught in this vicious cycle, where we have that episode of pain because of hormonal changes, then it hurts and then our pelvic floor tenses up. Then we keep trying to have intercourse, but then we keep irritating that area, then the pelvic floor just increases in tension and increases in tension. That can lead to more pain, with sexual activity as well. So, I always tell my clients that we need to figure out which of the two groups do you belong to? Do you have a pelvic floor that just needs strengthening? Or do you have a pelvic floor that maybe requires a little bit more stretching and relaxation, to help you regain proper sexual function? You know, having sexual function without pain? In everything that we do, you know, we always take that step back and go, Okay, well, you know, what are the stressors in your life that also increases muscle tension, right? So, stress and anxiety, and lack of sleep, all increase our fight or flight response. And that’s why sleeping is so important to kind of really get you restorative health, you know, and to make sure that we’re refreshed in the morning, managing our stress is really important, because when you’re under stress through the day, and you’re in that fight or flight responses, all your muscles tense up, including your pelvic floor, right? So, then what we do is we do a physical exam. This is kind of where, you know, doing a really good explanation of the pelvic floor is really important. So, I have these really great models that I’ve designed over the years. And what I do is I show all of the muscles, so you’ve got muscles at the vaginal opening, that can be the reason you have pain with sexual activity, you’ve got deep muscles inside that your bladder and bowel function muscles. So, when we do a pelvic exam, we do not use speculums. We don’t have you in stirrups, it’s not like kind of a pap, we’re going in manually with one finger and we start on the outside and we just have a look at all these muscles to see are they causing you any discomfort that could actually explain some of your pain with sexual activity. If we’re able to do that, then we can go in. We can look at all of these bands, all of these muscles that you see here that’s colored, these are all your pelvic floor muscles. We can evaluate all these bands of muscles right side left side to determine Are any of these muscles causing you any pain, because pain with sexual activity can be pain at the opening? or some people will tell me you know, it’s deep inside. ‘It’s like I can’t like we have to stop it hurts so much deep inside’. Then we evaluate these muscles I say, ‘Okay, if I said to you try to contract, try to squeeze those muscles, especially with people that have incontinence, bladder or bowel, I’ll say try to contract your pelvic floor’. That’s where we’re assessing strength and endurance, okay, how strong are your muscles? You know, how much endurance and power does your muscles generate? And if that’s lacking, we’re gonna work on that. So that’s kind of the physical exam and the physical exam is as per our client’s comfort levels. So, some people on day one will say, I’m not comfortable with a pelvic exam, maybe they need a visit or two to get comfortable with the idea. You know, some people are not aware that that’s what a pelvic health physio is trained to do. We are trained to do pelvic exams for the purpose of evaluating what’s happening to all these layers of pelvic floor muscles. So, you can regain bladder control bowel control, and sexual function. The other thing that this pelvic floor does, it’s like a shelf, it holds up our organs and so a lot of our clients will say, ‘I feel like feel like something’s falling out of my vagina’. They get diagnosed with something called the ‘prolapse’, which is everything kind of softening up and estrogen is important for that because estrogen is what we need to have strong ligaments and strong tendons. A lot of times heading into perimenopause or menopause, somebody may have had a prolapse when they had their, two, three children in their early 20s, and did absolutely fine. But now they’re starting to have symptoms because their estrogen levels are decreasing. That’s really altering kind of the function of what we call the collagen fibers in their tendons and in their ligaments. We have a lot of ligaments that hold up our organs, and everything just kind of soften. So obviously, nothing’s ever going to fall out of your body. It’s never going to happen but everything softens a little bit and part of what we have to do is strengthen that pelvic floor if needed to kind of create that supportive system from the bottom. It really is all about exercise. It’s about exercise.
KK: That was going to be my next question, maybe with that first option of picking up someone that is having issues with incontinence, assuming you’re addressing the lifestyle issues, and so on. But what’s an example MJ of exercises or type of exercises that they will be using to try and rectify the problem?
MJ: Everybody’s heard about those famous Kegels right? Everybody’s heard about Kegels
KK: I’m doing them right now
MJ: Kegel, he was a physician; he was a gynecologist back in the 50s. Dr. Kegel and who’s who had done kind of a lot of research on the field of the pelvic floor. We call them pelvic floor exercises. So yeah, we teach our clients how to properly contract their pelvic floor. What’s important to know is that you can read online on how to do cables, and how to engage your pelvic floor, but they’re not easy to do. It’s important to see a pelvic floor physio, because a lot of people think they’re doing them properly. Then they come and see us and they’re confident ‘Oh, no, no, I’ve been doing my ‘Kegels’ fantastic, I think I’m good’ and we test them, and they’re not doing them properly. We tend to cheat a lot. When we try to engage your pelvic floor, we’re holding our breath, maybe we’re squeezing your bum, or we’re sucking in our belly. Really, you should be able to squeeze your pelvic floor, you can think about I was kind of give the example to my clients, I’m like, imagine a little ping pong at the opening of your vagina and just try to grab and pick up your ping pong and for my patients that have penises, I’ll say try to lift up your penis, right. Those are some of the things that we explain. That’s how you think about engaging your pelvic floor or think about stopping gas. The reason it’s so important for us to do a pelvic exam is from the outside, I can’t tell if you’re doing a proper pelvic floor exercise. When we do a pelvic exam, it really tells us how well you are using those muscles. If you have pain, then we’re at least kind of finding out that there’s too much tension and if you have too much tension, I’m not giving you Kegels to do. That makes sense, right? So, if you’re coming in just for incontinence, I evaluate your pelvic floor, there’s no discomfort, when I’m palpating those muscles and you’re good to go. Yeah, then we’re going to work on some strengthening. If you’re already here, and then you’ve got pain, with intercourse, maybe it hurts to go to the bathroom, you’re not peeing really well. So the muscles are not relaxing, and I evaluate your pelvic floor and there’s too much tension, well, I’m not going to give you more Kegels to do. So, in that case, we’re doing things to relax the pelvic floor, and this is where we do breath work. And we do yoga-based movements, a lot of pelvic openers and yoga, a lot of breathing, maybe some meditative type of practices to help relax that tension. Once we relaxed that tension, once the pain goes away, then maybe we can do some strengthening, if that’s what your body needs at that time. That’s why it’s so important for us to do an exam because again, I can look at you and I have no idea if you’ve got a pelvic floor that’s too weak or a pelvic floor that has too much tension but when we palpate it we can see and then we can give you the proper exercises
KK: This is good because once again I think there is a lot of women that are struggling with these concerns and with that are maybe at a loss. Are there a lot of pelvic specially physios out there? for example if people want to get access to someone of your caliber and this is not something you could be doing virtually either right?
MJ: I did a lot of virtual; I still do. Virtual is really good for is sometimes even just the initial assessment like the first time because we do talk so much and we do a lot of education. So during COVID we did quite a lot of virtual and I continued to do so and sometimes that day one. Maybe you know if you’ve got COVID You can’t come into the clinic well then, I’ll just do a virtual with you do all the education and then you come back in to see me for kind of an in person visit when you’re feeling better you know when you’re not sick, things like that. So there’s a lot of us doing virtuals as well. The best place to kind of find a physio in your area that has the qualifications to do a pelvic exam and to do pelvic health, is to look at the website called pelvichealthsolutions.ca and there’s a find a physio feature there. You can actually click in your area, look at people’s names, it shows all the courses they’ve done, so then you can kind of look at, oh, this person’s done a menopause course, great. This person’s done a hormonal health course. That can help you choose a physio in your area. That’s a really great feature that we have. pelvichealthsolutions.ca is a great resource. There’s a lot because we’re, when I started 20 odd years ago, there was four of us in Ontario doing pelvic health. Now we have hundreds of physios who decided to take pelvic health courses as postgraduate training. We are not without pelvic health physios out there to help anybody who has a pelvic floor, anybody who has incontinence, anybody that has any problems with sexual health, anybody with constipation, there’s so much we can do. Like I said, we’ve become resources for our clients to help them find the right people to go see whether it’s nutrition, stress management, mental health and whatnot is really part of what we do to help her patients navigate perimenopause and menopause.
KK: Wow, MJ, pure gold. In terms of knowledge and resources I must say, this was some of the best explanations of the issues when it comes to pelvic health. This is the stuff as a physician, you hear about these concerns, but the way you just simplified it, using language that all of us can understand, conceptualizing it in ways that we will understand. Putting it into, for example, two frameworks, or two patient populations that you typically see, you’re the GOAT.
MJ: Thank you! That’s why we say to people, if you’re not sure at least come in for the first visit. So, you get a chance to chat, you know, and that’s a nice thing about doing virtual, you’re not sure about it, we’ll do a virtual and we can talk through and I think a lot of people then realize, ‘Oh, there is help for me, oh, sexual, sexual dysfunctions and payment sexual activity’. That’s not okay. No, it’s not okay. It’s not okay, that you’re not sleeping through the night because of hot flashes, right. Then really talking about the research and the evidence behind what we do. And we have a fairly high level of evidence in what we do in terms of treating incontinence and prolapse and pelvic pain. Having a chance to talk to our potential clients about that is good. Again, to make everybody feel more comfortable with topics that are not comfortable to talk about. I mean, there are still a lot of taboos around bladder and bowel health. There’s a lot of taboos around sexual health. There’s a lot of taboos about talking about menopause. Because we’ve been told, while menopause is just part of life and deal with it, suck it up, right, suck it up, you know, don’t complain about it, you know. I think, I think our clients are starting to get fed up with feeling so poorly, and so discouraged about their quality of life. Like I said, it’s not insignificant, there’s over 30 symptoms of menopause. If we can improve any one of them, I think we’re doing well, to help navigate, you know, and these challenges that our clients have. We have great research, I was just reading, just to get ready for today, that strength training again, we’re physios you know, we’re all about exercise motion is lotion. We encourage our clients to even get out like I always tell my clients, even your pelvic floor loves to go for a walk, just walk outside. The thing with walking is that you’re outdoors in the fresh air in the sunlight, you’re getting your vitamin D, you’re setting your circadian rhythm, there’s good research to say that if you get outdoors in the morning and bright sunshine for a good walk, you’re gonna sleep better at night. Right? But strength training, which we again love to encourage your patients to do reduces hot flashes by 44%. you know, again, this is kind of in the purview of a pelvic physio or any physio is we’re all about, you know, strength training to help mitigate the effects of losing estrogen and testosterone, right, strength train to reduce your hot flashes by 44%. Wow, you know, strength training to reduce osteoporosis because that increases when we hit menopause as well, because of all the hormonal changes, strength training to improve your insulin resistance so that you can lose weight and strength train for your pelvic floor because when you’re strong, your whole body, everything’s strong, even these little muscles here, and so kind of giving permission to your clients to exercise, but it’s hard, right? because, you know, it’s time, you know, and part of what happens in menopause is that people are overwhelmed with stress, and people are not taking the time to do the things they, you know, that we all get told to do, you know, eat well, sleep well ,exercise. So, it’s kind of helping our clients navigate, you know, where could they find time to sneak in a little bit of exercise? What can they cut out? Right? What can they let go? What’s not important, you know, and, you know, talking about the importance of strength training, I think, again, it’s an eye opener. So that’s why the education is so important, because when we educate people go, ‘Oh, okay, well, that’s a good reason to act’ maybe that’s the one thing you needed to hear, to allow you to go and think about strength training, and it doesn’t have to be a lot, you know, just a couple of, you know, 10-15 minutes a day can maybe be a good start. Because the impact is so amazing, just like the impact of yoga and osteoporosis and yoga and constipation and it doesn’t have to be an hour of yoga, you know, I can help find a video, that’s like, 15 minutes, maybe you do that before you go to bed, right to help you sleep and so education is really key, and to, to really help our clients navigate all of these crazy symptoms they have and making sense of it all. Hopefully, get that buy in that motivation that something that speaks to them that says, okay, I am going to try to make a change. When it’s hard, you know, you know, one of the things that happens with our clients and menopause is they stopped exercising because they’re losing bladder control.
KK: Yeah, that was actually one of the things you’re mentioning the resistance training. To create the habit, it’s not about the result always. You got there, you did your part of the process, even if you get to the gym for that five minutes, and you didn’t do all the exercises you were planning to do, but you’re getting that that habit developed. So, yeah, as you alluded to, it’s hard to do all these things. But to develop the habits, I think is, is where, if you could develop the habits, you’ll be moving in the right direction.
MJ: Yeah. And I think the more information people have about the benefits, beyond what we already know, right? I mean, we kind of go, weight loss, and I gotta quit smoking, but sometimes you can actually reduce your symptoms of menopause this way or that way, you know, again, that might be enough to persuade someone to say, okay, you know what, then I do need to carve out time in my day, I need to let go of the things that maybe are not that important, and really spend time on myself, and really improved my sleep, and improved my nutrition, and improved my stress management and try to think about exercising, because again, it doesn’t take a lot to make a really big change. It doesn’t take a lot to go for a walk, I’m happy if you start off with 10 minutes, I’m happy. If we decide Yoga is the best way for you to manage your stress or to help with your IBS or osteoporosis that you’re doing even 10 minutes of it. 10-15 minutes of it. We start small, and we build on that. We provide encouragement, because again, we all have bad days where we fall off the rails, and it’s okay, we’re humans, we’re human beings. As long as you just keep at it, you’ll start to see some changes. And, and like I said, it’s building a team, because our clients need to have the right people helping because MJ can’t do everything for everybody like that, you know, if we’re only one person, so who are the menopause experts out there who are the nutritionists out there who have a really good interest in menopause and Hormonal Health. Who do you go see if you’re having insomnia, right? Because there’s CBT there’s cognitive behavioral therapy for insomnia. Okay, who are the people for that? Do you want to get hooked up with a personal trainer to kind of motivate you to strength training? Okay, let’s find you someone to do that. It’s all about building a team and it’s all about dialogue, and always talking about these things and giving our patients permission to talk about what’s bothering them, and to be open about their frustrations and you know, if they’re having frustrations with their weight loss and okay, let’s see who’s out there who can help you with that.
KK: MJ, this has been grand, it’s been grand! How do people get a hold of you? I am working right now, I’m in downtown Ottawa. I’m at a clinic called Killens Reid physiotherapy, killensreid.com, we’re three pelvic physios at that clinic. There’s myself, my lovely colleagues, Natalie and Sophie all of which can help you with menopausal issues. You can look at that pelvic health solution website to find people in your area. It’s a great resource. That’s the group that I’m one of the teaching instructors for pelvic health. You can see how many great pelvic health physios we have all across Canada. There are also naturopaths, who have taken our courses that are listed. So, if you want to maybe work with a naturopath who has a knowledge of pelvic health, they’re listed on there as well. We have some nurse practitioners that have taken our courses, who again have developed an interest in pelvic health. You can find all those people on the pelvichealthsolutions.ca website. Killensreid.com to reach the clinic that I’m at, you can I have a website as well mjforgetpt.ca. I’m on Instagram ‘mjforget’. There’s lots of different ways to find us and, and to kind of help you with all your symptoms.
KK: I love it. I love it. Thank you, MJ, for the knowledge that you threw down the holistic approach the benefits of seeing the likes of you, I really appreciate you coming on. This is awesome. I appreciate any opportunity to talk about all things pelvic health, and I appreciate all of you’ve done again, because you’ve taken quite a holistic approach yourself as someone in medicine right in really thinking about nutrition or sleep or stress or you know, exercise mindfulness and it’s always nice to talk to kindred spirits, I say.
KK: Thank you so much. Alright, well, I hope you’ve enjoyed that episode. Please follow us on Instagram YouTube, Facebook, TikTok, Twitter at kwadcast. Please leave any comments [email protected]. Leave a five-star rating on wherever you listen to podcasts. Leave a review. Check out our newsletter at kwacast.substack.com. Everybody stay beautiful
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