088: [FEMALE HEALTH] Rethinking Pelvic Floor Health, Embracing Body Connections, & Aging Gracefully with Dr. Tanya Goodrich

Hi, dear community! Have you ever wondered what juicy sex, breathwork, and constipation have in common? If you’re like me, and you had no idea - this episode will be a t.r.e.a.t. for you! All my ladies (and men) out there listening: we’re diving into pelvic floor health with Tanya Goodrich, a PT, DPT, and expert in pelvic health. You’re going to love her infectious energy and passion for the health of our pelvic floor - and with good reason. These important, layered muscles are the base of our core and affect so much: from our breath to our ability to birth, poop, pee -> and have amazing sex. 

Some of what we’re gonna cover today: 

• What is the pelvic floor and how does it affect our overall health
• The link between constipation and your pelvic floor, urinary issues, painful sex, and so much more
• How to optimize your pelvic floor health pre- and post-pregnancy (and in perimenopause and beyond)
• Why Kegels are NOT the answer for everyone + the potential link between constricted pelvic floor muscles and your “Type A” personality
• Tips for birthing better
• What is diastasis recti, why it matters, and how to treat it

+ SO MUCH MORE! I was on fire after our interview. It is rare that I bring on a guest who covers a topic I know so so little about - but I truly think this is the FUTURE of wellness hype. Let’s dive in.

About Tanya:

Tanya Goodrich, PT, DPT, a distinguished figure in women's pelvic health, brings over 15 years of experience to her practice and advocacy efforts. With a background in dance from the California Institute of the Arts and a Doctorate in Physical Therapy from the University of California, San Francisco, she possesses a unique blend of expertise.
As the founder of Healthy Pelvis Physical Therapy, Tanya specializes in addressing a wide range of pelvic health issues, including those related to pregnancy, postpartum care, menopause, pelvic pain, bladder and bowel dysfunction, and sexual health. She extends her influence beyond clinical practice, serving as a recognized speaker on these topics and providing guidance to organizations like Ever now, focused on menopause care, and Blossom Birth and Family, a nonprofit supporting women and families in the Bay Area.
Through her comprehensive approach and dedication to education and innovation, Tanya Goodrich continues to make significant contributions to improving women's pelvic health and well-being. Tanya was recently featured in Maria Shriver's Sunday Paper as an "Architect of Change" for women's health.

Connect with Tanya:

 IG: Thehealthypelvis 

Chapters

• 0:01 Exploring Pelvic Floor Health in Women
• 9:09 The Role of the Pelvic Floor
• 17:06 Understanding Pelvic Floor Health in Women
• 24:14 Maintaining Healthy Pelvic Floor Function
• 29:06 The Mouth-Jaw-Vagina Connection
• 40:42 Postpartum Core Rehabilitation and Diastasis

Transcript

Kasia: 0:01

Hello and welcome to the Other Way, a lifestyle podcast exploring uncommon, unconventional or otherwise alternative approaches to life, business and health. I'm your host, kasia. I'm the founder of InFlow, a women's wellness brand that designs intentional products to help women reconnect to their unique cyclical rhythm and find a balance between being and doing. This podcast is an extension of my mission within Flow. Here we provide intentional interviews with inspiring humans, trailblazers, researchers, spiritual teachers and more on the journey of doing things the other way. Doing things the other way.

Kasia: 0:53

Hello, dear community, this episode is going to be an absolute treat for you. We are diving into pelvic floor health with Tanya Goodrich, who is a doctor of physical therapy and an expert on pelvic floor. These important layered muscles are the base of our core and they are connected to so many other parts of our body and they affect so much, from our breath to our ability to birth properly, to poop, to pee and to have amazing sex. All of those kind of lumped together might sound weird, but I feel like we need to get comfortable about this because it is so important to just our overall health, comfort in our bodies and so much more. So today we are going to cover what is the pelvic floor and how does it affect your overall health. We're going to talk about the link between constipation and your pelvic floor, urinary issues and your pelvic floor, painful sex and your pelvic floor, and so much more. We're going to dive into how to optimize your pelvic floor health pre and post pregnancy at any stage. We're talking postpartum, 10 years into the future or if you're going through perimenopause and you've never birthed before.

Kasia: 2:03

This one is absolutely for you. We're going to talk about why Kegels are not the answer for everyone and the potential link between constricted pelvic floor muscles and your type A personality. This one was like a personal one, so we'll definitely dive into that. We're going to talk about tips for birthing better, what is diastasis recti, why it matters, how to treat it, and the link between our mouth and jaw and throats and our vaginas so very cool.

Kasia: 2:33

I feel like I rarely bring on a guest who covers a topic that I know so little about, but this was definitely one of those topics. As women, we should absolutely be talking about our pelvic floor health, and so, without further ado, let's dive on in. Tanya, welcome to the podcast. Thank you so much for having me. I'm so excited Ever since I saw you speaking on that panel. I've been like dying to get you onto this podcast and really to talk about all things pelvic floor health, urinary health. I truly cannot wait. I feel like this is a topic that, at least I think from my end, you're probably not feeling this way, but it is like under discussed in the woman's health and wellness space.

Tanya Goodrich: 3:23

Truly Big time. I couldn't agree more with you, and I'm hoping that this class will feel like the physiology class that you never got but always wanted.

Kasia: 3:32

That you absolutely need. You need as a woman. All right, so we're going to get into all the things, but before we do, I'd love for you to start with three words that you would use to describe yourself.

Tanya Goodrich: 3:43

I love this question so much I would say maybe vibrant. I like to say that I'm almost loud. If you could see me now you're seeing that I'm wearing like a bright red shirt and just I feel like, especially the older I get, the more I'm just comfortable in my skin and just like feeling, not feeling like a nerd anymore or like just bringing the passion through. So I'll throw that in the vibrant category. And then I feel like I'm lucky enough to live in California and I really love the sunshine, so I would say outdoorsy maybe. I love to just be outside soaking up some sunshine and vitamin D. And then, oh my God, the last one sounds so cheesy, but I'm going to say it anyway. I feel like hungry is a good word because one I love food. It's so ridiculous. And then I also like it because I love good food. And I also just feel like I'm hungry for like in the bigger sense, like a metaphor for just like life and growing.

Kasia: 4:41

So, my God, I love that. It's so cheesy, I love that. I've never heard that, take it, take it, it's yours, it's yours.

Kasia: 4:49

I'm hungry, it's yours, I'm, and we'll see how long it'll be until somebody else chooses that word Maybe never and I love that for you. So, yeah, we're going to stick with that. That is fantastic. Okay, that is amazing, and I feel like it really does translate to your vibe and your personality. It's actually funny. Since we met in the real world, I always love giving folks a feel for someone's vibe, like who is the guest behind? Just the story that the guest is sharing, and it definitely lines up and I love it when that happens.

Tanya Goodrich: 5:21

Yeah, oh, I love to hear that. Yeah, you're going to get real authentic Tanya, so here we go.

Kasia: 5:26

Yes, and it's amazing because your first couple of words around like vibrant and stuff like that. I feel like that really translates to your passion about pelvic floor health and there is so much to get into about this. But you're definitely like, in my eyes, the pelvic floor expert. As a doctor of physical therapy, this is like your niche, and I want to start by firing like full cylinder out of the gate. What is one surprising piece of like knowledge or information about the pelvic floor that you wish all women knew?

Tanya Goodrich: 6:03

Aren't the answer for everything. That was just so easy for me to answer, because I feel like kegels and women just go hand in hand, like we've just been told. Like do kegels for any sort of vagina problem? And that is completely false. It's not okay and it's just like this word that has been overused and it's a throwaway term and yet somehow it's become the doctrine. So that is, first and foremost, my big. Yeah, kegels are the big. I don't even know what to call them. They're the big lie. There's a time and place for them, but I think that they're thrown around just hazardly and it's not okay.

Kasia: 6:39

Fired. I love it, okay. So I feel, though, we need to back into this a bit, because for a lot of women out there, they're like okay, pelvic floor. I may know something about it, I may know nothing. Probably women that are in perimenopause or have gone through giving birth might be more familiar with it, but it's a collection of muscles, right, like why don't we start there? What?

Tanya Goodrich: 7:02

is it Okay?

Kasia: 7:04

And I think that might also help us better understand, like, how to keep it healthy and why Kegels maybe are not the the Holy grail, so to speak.

Tanya Goodrich: 7:12

Yeah, I love this question because sometimes I talk about this so much I live in my own echo chamber that please feel free to cut me off and explain something. So yes, let's start from the beginning. So the pelvic floor is another word thrown around, and what does that mean? So it is, if you could see me I'm touching my pubic bone and if you're alone, go ahead and do it. So if you can touch your pubic bone and imagine where that is, and then if you can wrap around and grab your tailbone right, and then if you can imagine that the pelvic floor is the muscles that connect your pubic bone to your tailbone, so it's like the sling of muscles from the front to the back and it's what holds everything together. And we can break that down even more that there's three levels, but that's the idea. It's the hammock of muscles that support everything in between.

Kasia: 7:58

Okay, super powerful, and I guess, for women out there who are just like okay, well, first of all, even that visual, I think, is really helpful, because you can think about the front of your body, the back of your body, and then there's everything in between, and this is literally like a hammock.

Tanya Goodrich: 8:16

That's like keeping it all. It's like yes, right, yes, and what I want people to know and understand is that the pelvic floor doesn't just live in isolation by itself. I want women to understand actually men too, because men have pelvic floors too. They have a pubic bone and they also have a tailbone, so it's all the things in between. But what I want women to understand is that the pelvic floor is like the basement of your torso. In fact, that's what I like to start with is why is it called the pelvic floor? It's the floor of your torso, so it works in connection with. It's the basement. So if you can think of your core, that's the front door. If you think of your diaphragm and that's the muscle that helps you breathe, that's right at your rib cage, and then the back is the back muscles. That's the back of your house, and then your hips and the hip muscles in the side. That's the side of your house. So it is connected to the entire torso and legs.

Kasia: 9:09

Oof, okay, so forgive me if this is like a very primitive question, but is the pelvic floor, does it interact with all of these other major kind of body regions that you mentioned, or does it work? Yeah?

Tanya Goodrich: 9:26

And that's where it gets super exciting because it doesn't have to be mysterious. It literally is connected to the entire body system, and so when you think of it just like your shoulder or your knee, like your shoulder just isn't by itself. It's connected right to your back and your rib cage. It works together as a whole system, and so that's all it is. The pelvic floor is a group of muscles that works together as a system, even with your breath, and I hope we talk about that too.

Kasia: 9:53

But yeah, Well, that's actually one of the things that I was getting at, because I was thinking about it from a first principles point of view, and it's okay, this is the basement of quote, unquote the rest of the house, which is like your torso, and we know how much the diaphragm helps you with your breathing. I can only imagine that the pelvic floor is connected to these other functions. So, actually, what would be really cool? Could you break down maybe some of those like surprising interconnections between the pelvic floor and other functions in the body that might feel disconnected, and then we'll circle back and actually talk about maybe the more obvious kind of functions of the pelvic floor, but just to see how it is interconnected, like what are some of the other more might feel periphery in a way, like functions that the pelvic floor is involved in.

Tanya Goodrich: 10:41

Yeah, so being the first one is breathing. In fact, one of the easiest ways to start to connect to your pelvic floor and have it be less abstract is with breath, so we can do that right now. So, essentially, your diaphragm is at the top right and your pelvic floor is at the bottom, and they work in unison together, and what that means is that when you inhale, your diaphragm goes down and so your pelvic floor should also relax and drop a little. With my hands, I'm trying to show you so essentially, as let's do it together now inhale, and I want you to. When you do that, feel like air can go all the way down into your vagina.

Tanya Goodrich: 11:22

I like to call this vagina breathing, and a lot of people know it as like diaphragmatic breathing or low belly breathing, and that is good, but it actually needs to go even lower ideally. So that's a really good way to get yourself into relaxation mode is to do vagina breaths, as I made it up, but I like it because it's not just diaphragmatic breathing, it's actually getting all the way through and connecting as it should to the vagina, because I don't mind saying these words In fact, today it's not TMI. In fact, tmi is exactly what we're talking about. So I like to get right to the heart, or vagina of the matter, and that's one of the easiest way to start to connect your pelvic floor to your core and breathing, for example, in real life sometimes you're walking around and it doesn't have to have that big vagina breathing, it'll be on a much more shallow level.

Tanya Goodrich: 12:16

But let's say you're driving in the car and someone cuts you off and you have that stress-like feeling. Well, a lot of times that can just turn into chest or very shallow breathing, and that is not good. We want it to connect down into the pelvic floor so you can just go. Hey, hold on, wait, I'm feeling really stressed. I need to do some vagina breaths to get it to connect again to my system and even out my nervous system. And that's the other piece is then how breath is directly connected to our nervous system. So that's the other piece is then how breath is directly connected to our nervous system. So that's the direct, indirect way that the pelvic floor connects to the higher power of your whole system, which is the nervous system.

Kasia: 12:55

Wow, Okay, that is wild. I have so many follow-up questions to that, but I think maybe the first one that I'll just ask is for those in the wellness space, which are a lot of the folks listening to this podcast. We've heard or maybe some people have heard about like belly breathing and why that's so helpful because it triggers that parasympathetic relaxation state. Why should we be thinking about breathing further, Like maybe beyond just the fact that it's like nice to foster embodiment and connection to your vagina? Very like a good thing to do. But is there actually, is there like a reason behind that too?

Tanya Goodrich: 13:32

Yeah Well, like I mentioned, the pelvic floor is part of the core. It just doesn't like to get spoken about because it's the vagina muscles, but that is why it is part of your core. It is the lowest part of it, is the floor of your core, and if you leave with one thing today, that's huge. So, whenever you're doing core work, a lot of times people don't think about your pelvic floor, but it is intimately connected, and so that's all I'm trying to do is get people to understand that it's directly connected to core work.

Tanya Goodrich: 14:04

And should your core be on all the time? No, it is an on-off system, and so is your pelvic floor, so it shouldn't be on vacation, as I like to say, and it shouldn't be stuck in a tight squeeze aka a cable right. So it's finding that neutral ground and understanding how it connects to that basic breath. Again, so when you exhale or you're using your core let's say you're in Pilates class, right, and you're doing like a V sit up or just doing a classic sit up, yes, your core is contracting, and so is your pelvic floor, but then as soon as you come out of it, it should relax and go back to neutral. So that's why it's so like powerful and huge light bulbs. Hopefully are going off, because that's all it is. It's part of the core.

Kasia: 14:47

And that is so important for so many reasons and it starts to also bring to life.

Kasia: 14:52

The only reason, by the way, that I even know about the pelvic floor is simply because of going down this whole journey of looking at fertility stuff and whatnot, like at some point you end up.

Kasia: 15:04

If you're listening to other women's birth stories like you will run into experiences that women have postpartum where they talk about having pelvic floor issues. But it's so interesting because up until that point we don't really think. I think a lot of women don't really think about the pelvic floor or anything beyond what's happening there other than from the perspective of okay, the function or pleasure of sex, or I'm dealing with a UTI and have urinary issues, but we're not really thinking about how to take care of that part of our core. The way that we do other ab exercises or things like that for the more obvious parts of our body, and having you describe how important it is to both constrict or like contract and then release these muscles starts to make so much more sense because for a lot of women, postpartum like the thing you tend to hear about is pelvic floor issues, where everything is too loose and stuff is falling out and being in this state where you're either constantly contracted or too loose those are two extremes. That doesn't sound very healthy.

Tanya Goodrich: 16:10

Agreed completely, and it is just learning what that means, and so it's simplifying it and making it less mysterious. But the good news is that if you don't have any dysfunction in that area let's say you don't have any leaking and you don't have any pain that's with intercourse and you don't have any constipation issues and you can run and jump and exercise with no problems then your pelvic floor is functioning well, right? Every time you go for a run, you're also working your pelvic floor. It's when stuff becomes a problem and then it doesn't feel like there's any answers and so the problems get swept under the rug and then they just don't disappear and you don't feel like you have someone to talk to.

Tanya Goodrich: 16:51

But I want it to be just like your wrist. So if you had like wrist pain, you wouldn't just completely ignore it, you would work on it and you would get it feeling better. The same for the pelvic floor, but for whatever reason there's many reasons steeped in, just deep rooted. How often do we talk about vagina and vagina problems with your friends? But that's the point is that when it's starting to not work well, that's when we just want to fix it and steer it back in the right direction.

Kasia: 17:16

Powerful. So there was something really surprising that you mentioned there, which is constipation. Can you talk a bit about just rattling off for people, because I did not even know that could be in some cases, connected to your pelvic floor? What are the most common issues that people run into and this can also be some of the postpartum stuff we talked about, anything that comes up with age Could you just rattle off so people can connect the dots yeah, not just the lower part of your core, but like when there are issues. These are actually pretty all encompassing in our lives, I think. So what are some of the more common ones?

Tanya Goodrich: 17:51

Yeah. So again, the pelvic floor is just so neat because it's literally like the basement, the nether region, where everything connects, and it's pretty small real estate, right. If you can think about it as females, we have three holes right. We have the urethra, we have the vagina and we have the rectum and they're really close together, like I'm just picking up my fingers and that's really close, so you can imagine how intercontinental those systems inter-.

Kasia: 18:15

It's like iPhone size, right Like the length of an iPhone, if not smaller, correct, smaller, smaller it's smaller.

Tanya Goodrich: 18:21

Yeah, great, poor reference it's just like real estate, yet so important, right. Who wants to have peeing, pooping and vagina? Nobody, right? So we want to care about them, and so when you think about now how that real estate's so small, you can see how wow it all fits together. So again, this TMI region, where a lot of people struggle with constipation, often from childhood, right, when some people are on Miralax, like I see them, for years and years.

Tanya Goodrich: 18:49

That is going to affect the pelvic floor muscles because it literally sits on top of them, and so if there's a lot of weight and pressure on it, it affects the whole system. It just doesn't function as well. If your hammock has like a heavy rock on top, like that, would that starts to add up. And if I'm not like pooping, if I'm holding my breath and have to bear down, does that affect the pelvic floor muscles for years and years? Absolutely so that's where you're like oh wow, it really does all fit together and I want things to be working well down there. For example, as pelvic physical therapists, we work on bladder, bowel, sexual dysfunction. It all fits together, and constipation is a big one. I feel like I went on a tangent, but that is one of the big ones. It's just how the low abdomen, in terms of muscles, but also organs, and your colon and your bladder, all fit together.

Kasia: 19:49

So it sounds like urinary issues can also fall under the bucket of. There might be some sort of pelvic floor issue, pain when having sex, like constipation what are some other kind?

Tanya Goodrich: 20:02

of things. Yeah, okay.

Kasia: 20:03

Rattle off the things.

Tanya Goodrich: 20:04

Oh, I have some more, yeah, so again like all the super fun, hilarious, sexy slash not sexy stuff. So I'm talking hemorrhoids right, the good stuff. Hemorrhoids which I don't feel like get enough attention because they're not sexy topic. I would say that frequency and urgency. So urinary stuff. This is like one of my really fun things because I feel like it resonates to every single woman when I tell this to.

Tanya Goodrich: 20:28

But every like small bladder syndrome, where I joke, everybody has a friend in the friend group that knows where all the bathrooms are whenever they take a walk or wherever they go, and they feel like they have a small bladder. But guess what? More than likely they trained it to be small without knowing it because we're not taught this information. So I'm going to break it down right now and help everybody learn and I want you to tell this to all your friends and your family and your sisters. But normal peeing is every two to four hours. So what this means is that if you feel like you have to go every 45 minutes, it's a false alarm, and so what I want you to start to do is count the length of your pee.

Tanya Goodrich: 21:10

When you're peeing and I'm talking like one Mississippi, two Mississippi it needs to be at least 12 seconds long for a normal pee, and I know some people that are listening to this now are gasping like what?

Tanya Goodrich: 21:23

There's no way I pee for six seconds. And let me tell you, you trained it to do that without realizing it, and in our field we like to call it jicking, just in case peeing, and we say no to jicking, and what that means is starting to learn what normal is. So that's the first thing, like oh my God, I didn't know, that's what normal peeing should look like. And the other thing is so we have the people that go all the time too much, right, and then we also have my doctors and my teachers and my yeah that hold their bladder too long and they have what I like to joke is camel bladder and that's six hours long. That is also not healthy because you stop sending the signal to your brain when it's time to go. So we don't like that either. So two to four hours is a fantastic window. That's normal peeing and I think it's basic information that we should all learn, so it's- 100%.

Kasia: 22:19

I feel like the chronic UTI thing is the thing that really got me to remember to pee regularly. But this is like another really good reason, because I'm definitely like a camel peer. I hold it in four hours at a time.

Tanya Goodrich: 22:33

Yeah, it's so interesting how it can go either way, right, but yeah, so I want people to get into that. 12, 12 to like 29 second range is where we need to be, and it's super interesting because it's how urine is made. It's basically made like a drip system, like so, if you pee again in 10 minutes, is there something there? Yes, but you don't want to be peeing every 10 minutes. So what happens is that some people are going with that, your bladder, giving the first signal to your brain hey, we're starting to fill, but then they're going and it turns into this vicious cycle where then they're peeing at 25% full, 30% full. So I want people to start to be aware, which is why you jot the time at least in your brain, or you can write it down when you go, count the length of your seconds and then, all of a sudden, you can teach. You're literally retraining your bladder. So it's very exciting because a lot of this can really improve, honestly, like within two weeks, once people understand what's happening.

Kasia: 23:32

So, other than like training our bodies to pee properly, I'm curious what? You mentioned this a little bit earlier, but what does it look like to have a healthy pelvic floor versus unhealthy pelvic floor, right? So if you're running, it sounds like things are looking good. I'm especially talking about women who are maybe like aging we're all aging or like planning to have kids, or planning for that postpartum period, Like how do we know that we're in a good baseline in our lives today? What are some of those signs, or also signs of something being off?

Tanya Goodrich: 24:09

Oh, this is such a good question because I love how simple and basic it is and yet how important it is. So we want a healthy and happy vagina and vulva, right? So what does that mean? It is down there. It should be like an oasis, right? It's a nice, healthy oasis, and as we get older it has a tendency to be more like the Sahara desert. So we don't want that right. We want a nice, luscious environment down there. Want that right. We want a nice, luscious environment down there.

Tanya Goodrich: 24:38

So if things are going well and you feel like you are having orgasms and you are having sex that is not painful and you are peeing every two to four hours and, oh, at night you're not getting up or you're only getting up once, that's great. That's a perfectly healthy, functional pelvic floor, right, and you're exercising and you're not leaking. Those are all the check marks of a beautiful working pelvic floor. Right, and you're exercising and you're not leaking. Those are all the check marks of a beautiful working pelvic floor. But if something starts to go awry and as we age, no matter what our vagina starts to turn more into the Sahara desert and that creates problems, it creates problems for we want, like, a pH to be around a certain level so that we don't get certain infections or bacteria or UTIs Again, like in a perfect world, everyone's getting seen by a physician, that or nurse practitioner that is up to date on the current menopause and pairing statistics and evidence, so potentially being on everyone over the age of 35, in my opinion and in many other urogynecologists and up-to-date research today, it is what 2024 is that all women over the age of five would benefit from local vaginal estrogen and it should be handed out to all women, and that's because it keeps exactly what I talked about the oasis.

Tanya Goodrich: 25:57

So I'm going to tell you right now that if you are someone that is feeling like they have dry vulva, dry vagina, you need vaginal estrogen. It is safe for everyone. So that's my big shocking thing is that's what a healthy pelvic floor should look like, and if it doesn't feel like that, we want to make sure you're getting seen by someone who feels that they can help you.

Kasia: 26:19

Okay, love that. Super simple to remember and keep that in mind, and I also really appreciate your enthusiasm. Makes it way more interesting and exciting to listen to. What about women who are preparing for birth? Right? This is where the horror story started to come in for me and I was like, of all the things I thought I had to worry about, I didn't even know that was like a thing, right, which is pelvic floor dysfunction? What exactly is-?

Tanya Goodrich: 26:48

Yeah, so thank you for bringing me back to the pregnancy, postpartum piece too, because that's huge. So, essentially, right now for women, I feel like there's a lot of talk of especially when you're pregnant or getting pregnant about the baby and not so much about your pelvic floor and your body and what happens and the changes and what you should start to be expecting from the pelvic floor perspective. So as soon as you, for example, start to get pregnant, I want you to know what your baseline pelvic floor feels like, so that we can keep it strong and healthy throughout and then, throughout the pregnancy, make sure you're not just you know told oh well, you have back pain, that's normal, you're pregnant. What do you expect? Because that is not okay? Just because back pain is common with pregnancy doesn't make it okay or normal, or shouldn't be fixed so that, for example, all these normalized conditions and just being I don't know, I feel like there's a high tolerance for women's suffering in women. Oh, just suck it up, it's a bad period. Or you're pregnant, what do you expect? Or you just had a baby? Of course you leak, and those are the things that I want people's brains to start to go off. No, I want quality of life to be higher. I don't want to be suffering and I need to go to someone that can help me with those things. So not just taken for granted. So what does that look like? So when you're pregnant, basically in a perfect world everybody would get seen by a pelvic physical therapist.

Tanya Goodrich: 28:10

Right, because it takes such we talked about it being the floor of your trunk, right, it's the basement. And now all of a sudden that basement has a whole bunch of weight thrown at it, right? Just the biomechanics of being pregnant. So that really has a tendency to create some biomechanical problems, right? So that might be sometimes called lightning crotch, where you feel like sharp pain in the front of, like your pubis, for example, where we were talking about before.

Tanya Goodrich: 28:36

Sometimes you're feeling low back pain, right, because a lot of times women aren't exactly sure how to connect to their core once it starts to get stretched out. So I want people to connect to their core and not just have it go on vacation, but that can feel confusing. And then I want women to understand the role of the pelvic floor during labor and delivery so that they know how to connect, and that is both your core and also your jaw and throat, because I know I'm about to blow your mind and it's seriously. One of my favorite things about being a pelvic therapist is getting to talk about this connection, but your mouth and your jaw are directly connected to your vagina.

Kasia: 29:19

And I'm going to explain why I. I know you're blowing my mind right now. I, okay, yes, go on.

Tanya Goodrich: 29:24

I know I just I'm talking so much right now, so I hope that you're with me. Stay with me, okay? So this is why. Okay, so if you open your mouth right now and I'm gonna slow down so you can really follow me so here's my mouth, I open it, that's the beginning of my alimentary canal and then my vagina is the bottom of that canal, right. So when we're formed in the embryo, the cells of your mouth and your jaw start right from each other and then open from there. So it's the same tube. Yes, so we call that the deep anterior factual line. Right so your vagina and mouth were right next to each other when we started out getting made and it expands from there.

Tanya Goodrich: 30:05

There's a deep rooted connection and I like to think of it. When I saw chakras, I was like, oh my God, that is the Eastern version of the Western fascial plane. Of course, it's the beautiful marriage of the two and I seriously have chills. I talk about it all the time and it still gives me chills because it really is the chakra line. That's the deep anterior fascial chain. So check this out.

Tanya Goodrich: 30:29

So when you have a baby, when it's time to push one of the things we talk about in our clinic is relaxing the jaw. There's even like a deep rooted sense to moan or groan, and that is primal. That is connecting to your pelvic floor so that it can open. If I'm clenching my jaw, that is going to have a similar contraction of your pelvic floor. They work together. They should Now taking that same train of thought. Conversely, when someone's leaking, I'm trying to connect it to their throat and jaw. For example, a lot of women I'm laughing so hard I pee. That is that connection. I need to connect that tube together and so it's directly connected. And so those are like the two, like easy, functional way to show that.

Kasia: 31:18

This is absolutely mind blowing, like mind blown. It makes so much sense as to why women have like that primal urge to like groan when they are in labor. And it's wild to think that the two are connected and can actually help things like loosen and relax down there. Because one of the questions that I had was is there an aspect of when we're tense that it might be like more difficult to relax down there, right, like it's almost like an emotional thing, but it's like we also might be like grinding our teeth or like our muscles, right?

Tanya Goodrich: 31:55

Yes, that's literally on our pamphlet too. Is that TMJ? If someone has TMJ, they often have pelvic floor issues. It's the same clenching pattern, right? So it's a really easy place to store tension and that's where remember we talked we're circling back. Bringing it back to the first thing that we talked about is Kegels are not the answer for everybody, because if someone has a holding pattern where they're squeezing their pelvic floor, do I want them to squeeze more and more? No, I need to. I need them to do the opposite and connect and relax and open that pelvic floor. That's why the thing about just you have a problem, do kegels, is not okay. Boom, we just pulled it all together.

Kasia: 32:34

Yeah, oh, my gosh, that is wild. I'm curious in your practice, do you feel like women tend towards more of the gripping versus the releasing? Because I feel like kegels are difficult sometimes to do, but like I can do them right, but it feels almost impossible to me to like actually connect to the sensation of like relaxing. So what do you typically see? I'm curious.

Tanya Goodrich: 33:02

Yeah. So there's two things, two important things I want to talk about with that. First of all, I live in Silicon Valley and so everyone is type A or like on the go go. So is there a connection between being type A and having a tight pelvic floor? Yes, yes, In fact I like to Literally being anal.

Tanya Goodrich: 33:19

Sorry, I couldn't that's what I was going to say like a tight ass. That is not. That stems from that. They are, are connected. That is why you are called like, literally, you're holding tension. Isn't that so cool? I don't know, I think that's really interesting.

Tanya Goodrich: 33:32

Yeah, being anal, it's being overly gripped. So, honestly, in our practice it's like 50 50, where I feel like, whenever people think about, let's just say, vagina, that's oh, I'm supposed to be tight, but no, you're supposed to be neutral, you're supposed to be right in the middle, not tight, because overly too tight, as we just heard and learned, is not helpful. Right, I like to think of it like a fist. Right, I like my hand. I want my hand to be neutral. I don't want it to be stuck in a fist, because that's not functional for me. I can't relax to pick up anything if I'm already gripped. That's the same analogy for the pelvic floor. I don't want it to be living in a tight squeeze. I want it to be living in a neutral position so it can tighten when it needs to and then be back to neutral again. So that's the connection.

Tanya Goodrich: 34:18

Then, the second important thing that I wanted to talk about has been our clinic. We don't call cables, we call them blueberries and that is for a really good reason. So again, cables. I feel like it just has a lot of bad baggage. I don't like the term in general. It was named after an old doctor, dr Arnold cable, so we're done calling it that.

Tanya Goodrich: 34:39

We call them blueberries, and it's much better because it's a visual and the idea that we talk about is like an arcade claw. So you know the toys. You want to grab a toy. It claws it and then releases it. It's a perfect image for the pelvic floor. So the idea is that a perfect kegel or blueberry would be your pelvic floor isolating, closing and lifting up a blueberry and then releasing it. So if you're in the car, if you're listening, now try that imagery of where your pelvic floor I like to think about, like my vagina, just like closing and lifting a blueberry and then releasing it. So that's a really good way to start and a lot of times people already resonate with this. Oh my God, I joke that people are maybe a secret vagina clencher or secret butt squeezer and I want them to think about releasing the blueberry throughout the day and checking in multiple times a day, especially when they're stressed.

Kasia: 35:34

Oh, so important. I'm curious for the women out there who are okay, like they're in their pregnancy journey and now they're thinking about nearing birth. Are there like things that they should be doing to prepare? For this, or maybe things that they should keep in mind when they are going through the whole childbirth process. With regards to the pelvic floor, yes, yes, so, yes.

Tanya Goodrich: 35:58

So I didn't get to mention so I'm glad you're steering me into this direction but the role of the pelvic floor in labor and delivery and I don't think that it's like well-known knowledge. So a lot of times, even today, when you think about pushing right, a lot of times people are told or the image that comes into people's brain is holding your breath and bearing down right, and even nurses still do that, and I can understand why it's an effective from a physics perspective. If you plunge down a lot of pressure, it helps, right. But I want you to start to think about that beautiful pelvic floor. And if you are bearing down and pushing down for hours and hours, do you think that your pelvic floor likes that? No, it's really hard on the pelvic floor.

Tanya Goodrich: 36:47

So one of the things I want women to start to understand is how to potentially start to work with an open glottis like that open throat, primal breathing and then getting into good positions to help move that baby down another way. Now, sometimes is closed. Is holding your breath and pushing down important and can it help? Yes, but I don't want that to be the only way for three hours. So it's learning strategies and learning more about the role of how it all fits together. And then, of course, I'm looking also at like perineal massage, and are the practitioners like able to help, like support the perineum during, so it's not too much pressure, and especially we want to protect the clitoris and the things up high.

Tanya Goodrich: 37:34

So, yes, there's a bunch of techniques I want women to understand and partners to have a sense of, and birthing positions, and we could do an entire podcast on just that. But there's a lot that goes into it and a lot of cool information about what positions are good potentially to start to transition into and labor into, and the role of the pelvis, because the coolest part is that our ligaments right become more lax when we're pregnant and that's for a great reason so that the pelvis can open to allow for a baby to come out. And I just want to make that more advantageous to a woman as well, so that she can get into a good position to help move that baby down. So that is in summary yes, the pelvis, the ligaments, the muscles, the breathing it all fits together.

Kasia: 38:17

This is wild. I truly feel like every woman should work with a pelvic floor specialist, pelvic floor PT, during this time, because I feel like a lot of women end up going to see one after the fact because they have issues right when everything is loosened down and now you need to bring it back in and up right. I feel like this is basic, crucial information to even understand your anatomy, to understand like the like mouth, jaw, like connections to your vagina, and then to be able to think about this differently, because I think this is just makes the whole process so much more smooth and efficient.

Tanya Goodrich: 39:00

Yeah, Preventative care is best care and that's I really think it should be the standard of care for women, and so I'm fighting hard to just get the word out there and, honestly, women are doing a great job of advocating for themselves, of learning more, of understanding the role of what kind of how, like I see, honestly, in even in the last five years, how many more women have come forward and are starting to see us preemptively Like I'm just pregnant, oh, I'm 10 weeks pregnant. I would love to get seen by a pelvic floor therapist. I heard it's good and we are thrilled because then we can help see them all the way through and they can be supported in that way. So, yes, I cannot wait until it's the standard of care, cause I I do think we're moving in that direction and that thrills me.

Kasia: 39:42

I think that would be that's going to be so crucial. I'm curious for women who are past the point of birthing and now they're dealing with some postpartum recovery stuff like diastasis recti or I don't know what the most common conditions are, but could you talk about what should they be doing if they are experiencing any of these things and also what are the more common issues that can come up?

Tanya Goodrich: 40:09

Yeah, great question. So again, I want to say that even if you are 10 years postpartum, it's still never too late. So it's always appropriate to work on all of this stuff. And I would say, yes, that I like to joke that the baby comes out the sunroof or the door and that's physical trauma. So in my world, everyone in a perfect scenario would get seen one-on-one with a pelvic physical therapist.

Tanya Goodrich: 40:33

So if that's possible for you, I highly recommend it, and if not, I want people to just be aware of the things that can go wrong and then maybe how to start to do things at home. So the first one is think of it just like any other part of the body. So if you had like shoulder trauma or something, you would just want to get that shoulder moving again and working well and starting with basic things, and then, as you get better, you don't have to be as basic anymore. So same thing applies to the pelvic floor and core. So if you've had a C-section, I would want you to learn how to repair that as well, right? So again, I want the C-section scar to be looked at about six to eight weeks and then helping that kind of get reintegrated into the body and also feel like you learn how to connect to your core again so that it connects to your back. That's huge right.

Tanya Goodrich: 41:22

Just repairing after a C-section and then same thing after a vaginal delivery how are you, where are things at? And then repairing whatever got a little bit damaged. So I don't want it to be scary, I just want you to think, hey, the body heals, it just needs to get sent in the right direction. Now, with diastasis recti, I would say that's a really hot topic and in a way I'm super glad and in a way it worries me, because for the longest time no one talked about diastasis. It just didn't exist and women were just like oh, good luck, goodbye. And now I often feel like that pendulum has swung and people are terrified of diastasis, like I can't do anything, I can't lift anything, and that creates paralyzation, which isn't great either. But the idea is that you want to start to rehab that core.

Kasia: 42:10

And what is it as well, because I feel like there's some mixed signals about that too.

Tanya Goodrich: 42:16

Yes, so diastasis of the abdominis rectus is, if you can imagine, like the center. A lot of times it gets dark when you're pregnant, right? That line that gets dark, that's called the linea negra and that is where both sides of your abs connect and, if you like, have ever cooked chicken. When you're cut, there's like a white, kind of a white line. That's the fascia line. So that is the line that's getting dark. It's where the abs connect.

Tanya Goodrich: 42:42

Now, when you're pregnant and you have diastasis which a lot of women will get, no matter what during pregnancy you don't have to be scared of it. It just means that fascia line is stretched. Now they can come. Not all diastasis is all the same. Sometimes they're deeper, sometimes they're more shallow. A lot of people know about the finger width ones where they're trying to diagnose themselves. But all the diastasis recti means it's a stroke of that fascia. I like to joke that the baby goes hi-ya right and opens, especially at the belly button. But I don't want people to get scared and do nothing. I want them to.

Tanya Goodrich: 43:22

Again, we have a whole program that we do, but it's essentially like you're learning with breath, right? We talked about how the breath is connected with all the floor Same. So an exhale is when the core engages and we want to move back in that direction. So it's like the magic exhale where you blow out but you feel your core go in and now you're starting to activate that core to protect. So I know it's a little hard on a podcast to go over all of this, but that is essentially what's happening. And a hernia is the difference between a hernia and diathesis is a stretch versus a tear, and so a hernia typically needs a little bit of surgery. It's a very small procedure for hernia surgery, but that's the difference it tore through as opposed to just a stretch of the fascia.

Kasia: 44:07

Oof. Is there anything that women should be thinking about, like when they're pregnant, to prevent a tear?

Tanya Goodrich: 44:14

Yeah, so using your core so that magic exhale that I just talked about when you're pregnant is really great, because I want your brain to stay connected to the core and I want your core to be actively helping as much as possible, which also helps with back pain. But, yes, so exercise and movement and engaging the core is actually a great way to stay strong for the pregnancy and postpartum, so it all fits together, which is where we love to see people early on so that we can support them through.

Kasia: 44:44

Yeah, oh my gosh, tanya, I feel like I could chat with you for hours, but we are coming up on time. This was like it is so rare that I have a conversation where I feel like I'm being introduced to a topic that I truly feel like I know so little about. But you just blew my mind at least 10 times, so I'm sure that's happening for the audience as well, thank you, thank you. Thank you so much for joining us and, before we wrap, could you please share with the community where can people find you? I'll hyperlink things below so you don't have to spell them out, but where can people find you? Do you have anything cool coming up that you want to share? All that good stuff?

Tanya Goodrich: 45:25

Yes, I own Healthy Pelvis Physical Therapy and so we are located in the Bay Area and we have two locations. But the good news is, if you're not in the Bay Area, you can still telehealth with us. So we have telehealth. It's really easy to access on our website. We have a wonderful patient care coordinator.

Tanya Goodrich: 45:44

There's four of us and we're all super nerdy and awesome at what we do, so don't feel like you have to see just me, but like anyone you can get your hands on, and so that's healthypelviscom. I am also working with basically an expert advisor to EverNow, a menopause perimenopause company, which is really doing exciting things. So check out ever now, and I am. It's still in the works, but I'm slowly writing a book which is exciting, and so that'll be coming out. And I encourage everyone to go to healthy pelvis and jump onto my newsletter, because every month I do a really nice comprehensive newsletter with a product pick and a provider pick and a pelvic health tip of the month, and so that's a great way to get ahold of me.

Kasia: 46:31

And such an amazing resource. Thank you, Tanya. This was such a joy. Thank you so much for joining us today. Thank you so much, Gosh. That was so amazing to be here. Thank you so much for tuning into the Other Way. If you enjoyed this episode, please leave a five-star review. It really helps the podcast grow and I'm ever so grateful. If you want to stay connected, you can find information on how in our show notes. And finally, if you're curious about inflow and want free resources around cyclical living or moon cycles, check out inflowplannercom. And, of course, for all my listeners, you can use the code podcast 10 for 10% off any purchase. All right, that's all for today. See you next time.