Jun 2, 2022
Today, I’m thrilled to be joined
by a very special guest, Sarah Smith, who’s a pelvic floor rehab
specialist. Sarah and I share some pretty similar philosophies and
practices—we’ve both done intermittent fasting, we both cold
plunge, and we both mouth-tape—and I wanted to have her on the show
because of her expertise and unorthodox views. We start things off
with Sarah talking about her work and explaining the various kinds
of pelvic floor issues women can experience, including prolapses.
Sarah herself had a pelvic floor prolapse in 2015 and was
prescribed kegels as part of her recovery, which she found not only
didn’t help but actually made her feel worse. Instead, Sarah uses
breathwork to strengthen the core, and she explains how this helps
your body manage pressure and align itself as a support system,
ensuring that no one part of the body, pelvic floor included, is
doing all of the work. She also goes into more detail about the
problems with kegels and how the cause of pelvic floor problems
isn’t a weak pelvic floor but a lack of good connection in the body
that requires training to correct. Then she suggests some
indicators that you may have pelvic floor issues, including chronic
low back pain, chronic constipation, and discomfort during sex
(plus we discuss the importance of good lubrication!).
Next, Sarah shares some of the
breath practices she utilizes in her work that help people get out
of constant fight or flight mode (which is hugely important for
parents trying to co-regulate with their kids). We also talk about
our shared love of infrared sauna therapy, and Sarah shares the
impact that using the sauna has had on her health, including
dramatically improving her gut health. Moving on, we talk about the
modern tendency to accept a level of sickness in our lives and the
phenomenon of the depleted mom, with Sarah explaining some of the
reasons for this depletion and giving some suggestions for how moms
can reinvigorate themselves (including eating animal protein and
unfollowing social media accounts as self-care). And finally, we
talk about how Sarah uses kettlebells as part of strength training
to help women overcome pelvic floor issues before finishing up with
a chat about how we’ve lost access to ancestral wisdom as we’ve
become more isolated from our communities (and why the boomers are
to blame!).
The Finer Details of This Episode:
- I wanted to have Sarah on because she has
unorthodox views, and she has had a pelvic floor prolapse. And
because she goes about rehabbing via kettlebells and breath, which
is infinitely better than kegels.
- Sarah describes herself as a strength coach and an
educator for women. Her goal is to help women discover their inner
strength, both physical and spiritual, and their innate wisdom
about the body that may have been lost through the messages our
culture sends about our bodies.
- Oftentimes, the people who realize they need
help are postpartum women (whether they’re new mothers or had their kids decades
ago) struggling with pelvic floor issues as a result of the changes
and sacrifices they’ve gone
through after becoming mothers.
- Any organ can prolapse, which just means that
the organ moves out of place. A pelvic floor prolapse is when one
or more of the organs in the
pelvis slip down from their normal position and bulge into the
vagina. It can involve your bladder (as Sarah experienced after
the birth of her third son),
your urethra, or your rectum.
- Other issues with the pelvic floor include
difficulty connecting with and controlling it, which means that it
may not relax appropriately when it’s time to urinate or eliminate
stool, or it doesn’t create the support to stop the bladder being
relaxed all the time, which means pee can drip out.
- There are also people who overuse the pelvic
floor by constantly creating tension in the abdominals and pelvis,
which can negatively impact your organs, normal elimination things,
sex, and how you feel in your body in general. Sarah says that we
often teach our bodies to use muscles in a way they shouldn’t be
functioning in relation to the body, which makes them overworked and
tense.
- However, pelvic floor tension can also be the
result of constantly living in fight or flight and not using your breathing
mechanics, which means you’re not getting circulation to those
muscles.
- You guys know the story of when I blew out my
knee when I was in a Spartan Race. The doctor told me I’d never do
the race again unless I got surgery, and after I told him to hold
my beer and said, ‘Watch me,’ I started doing knees over toes
exercises, which train all
your muscles except your knees. And now, my knee’s fine because I
was using the full range of my muscles instead of letting my knees
take the strain.
- Sarah says the best way to strengthen the core,
including the pelvic floor, is through breathwork. Inhaling creates
pressure in the body, which meets resistance from your muscles and
creates stability in the body and causes your pelvic floor to
relax; exhaling engages your deep core muscles and again creates
stability.
- Think about the inner core and outer core as a
Pringles can inside a Crisco can, and don’t just focus on the
Crisco—make sure the Pringles can is operating
too.
- There’s an elevator piston phenomenon where the
diaphragm and pelvic floor have to move up and down while the
transversus has to move in and out. When those systems work really
well, you have natural and automatic stability.
- Oftentimes with pelvic floor issues, the
problem comes about because something around the pelvic floor isn’t helping it. It’s
not that the pelvic floor is weak or unable to do its job; it’s
that it’s trying to do everything without support.
- The pelvic floor is like a hammock: it needs to
be tight and strong and lift into support when you’re laughing or
lifting something heavy, but it’s also supple and responsive, and
it needs to be able to respond, relax, and come downwards to
accommodate the increase in pressure when you
inhale.
- Sarah thinks kegels create problems for many
reasons, number one being that a lot of people are already walking around
with tension in their pelvic floors, and kegels make that worse—in
fact, they can create inflammation and tension in the
body.
- The other main problem with kegels is that when
they’re used after pregnancy, when the body and muscles are
oriented differently, those muscles aren’t necessarily in the
position where they’re supposed to be squeezed and tightened,
leading to overwork and over-recruitment.
- If you pee on the trampoline (or elsewhere!),
it doesn’t necessarily mean your pelvic floor is weak. In Sarah’s
experience, it usually means that there isn’t good connection in
the body, and people need to train to get their pelvis oriented
better underneath their body so that the diaphragm is moving and
communicating with the pelvic floor.
- A statistic I’m very disturbed by is that 75%
of women polled in the US defined good sex as not painful. That’s
not the definition of good sex! It should not be painful, ever!
Make sure you’re communicating with your partner and that you’re
properly lubricated (organically or artificially!) during
sex.
- Signs that you may need some pelvic floor help
include chronic low back pain, chronic constipation not caused by
diet, tailbone pain, and discomfort in sex (see
above!).
- We tend to look at pelvic floor issues from the
bottom up—but what about all the stuff that’s above? One of the
best things to do with breathwork is to increase how much expansion
you get in the thorax because the more space there is in your
thoracic cavity, the less downward pressure.
- You can also use abdominal massage, which
increases blood flow and circulation and helps to increase drainage
of lymph and, in turn, gives you better support, better position,
and more stability in the position of the
uterus.
- I know what an impact breathing can have on
your body from my opera training (my bra size went from a 32 to a
36 in the first couple of years). I’ve talked to you guys about
cold plunging and Wim Hof breathing, and recently, I’ve started
mouth taping at night, which has changed the quality of my sleep
unbelievably.
- Some of the practices that Sarah uses in
breathwork are: getting your tongue to rest against the roof of
your mouth, which opens your nasal cavity, communicates with your
diaphragm and helps you to have better posture, and gives you
better stability in the pelvis; closing one nostril and slowing down the breath
to help career mouth breathers get comfortable with nasal
breathing; and getting on all fours to help people sigh out the
tension that’s in their belly.
- People don’t realize that when they’re in fight or
flight, they’re changing their biochemistry, raising the acid in
the blood and muscles, making you more tense and twitchy, and even
increasing any pain you feel. So simply getting out of that fight
or flight mode through
breathwork makes a huge difference for pelvic floor issues
alone.
- Sarah’s a big fan of infrared sauna and red
light therapy, which I talked about on the episode with Dr. Rimka.
Among the changes she’s noticed since starting are a dramatic
improvement in her sleep, better recovery and little pain from
workouts, and her long-term gut issues going away.
- Improving your gut health can help with pelvic
floor issues. A more balanced gut microbiome means you can extract
better nutrition for your food, providing better building blocks
for all your tissues and dramatically reducing inflammation, which
is often linked to pelvic floor pain. It’s also going to help you poop
more routinely and easily,
which gets toxins and old hormones out and stops you needing to
strain.
- It seems that we’ve all come to accept a level
of sickness in our lives, from sinus problems to hypoglycemia to
not sleeping at night. Sarah says that part of the reason for this
is some people find themselves in the trap of finding their
identity in an illness and locking themselves into that
story.
- I ask Sarah why modern moms are depleted, and
she suggests some really interesting reasons behind this, including the
expectations moms put on
themselves, social isolation, soil depletion, and external pressure
to do and have it all. In traditional Chinese medicine, prolapse is
a sinking, and Sarah says she sees that physical and
emotional sinking in women all the
time.
- She also has some suggestions for how moms can
reinvigorate themselves, including having a breath practice in place,
investing time in your social community to strengthen your
relationships, and paying attention to your diet (Sarah loves
broths as a way to get highly digestible nutrients and minerals to
help you body remit and repair itself after childbirth, no matter how long
it’s been).
- There’s a big push for plant-based foods right
now, but so many of our vegetables come from depleted soil that
you’re not getting and absorbing anywhere near the nutrients you
need. Animal protein is easier to digest and assimilate, especially
for new moms, and you can make it even more digestible through slow
cooking or sipping on bone broth.
- Sarah advocates unfollowing social media accounts
that make you feel like you’re not doing enough. Seeing those
accounts can stress you out and put you in fight or flight mode, so
removing them, even just until you can handle seeing them better,
is the healthy choice.
- One of the things I think messes women up about
nutrition and exercise is the social-media-influenced negativity
and conflict that encourages us to obsess over whether what we’re
doing and eating is right. Instead, as Sarah suggests, we’re better
off listening to our bodies and using our innate wisdom to figure
out what makes us feel good
and what doesn’t, rather than worrying about what our favorite
influencers say.
- Sarah’s a certified kettlebell instructor, and
she uses strength training in her work to help women overcome
pelvic floor issues. It helps women to reconnect with their bodies
and feel strong and capable again. She also has a kettlebell
program with core and pelvic floor and postpartum in mind—it’s
called Kettlebells for Cool Kids and is set to 90s hip-hop!
- I use a kettlebell too—I have one that sits in
the middle of my floor, and I do twenty swings every time I go past
it—but it’s really important
to get proper coaching before using one. There’s a technique to
kettlebells, and you can fuck up your back if you don’t
know it!
- We’re less connected than we used to be, which
means moms are trying to figure out parenting all by themselves.
Personally, I think the boomers fucked it up for us because they
forced us to reject them as part of our community, but we’re
starting to get back to our roots and ancestral
wisdom.
Quotes:
“My goal is really to help women to discover
their inner strength, both physical and spiritual, and their innate
wisdom. Because I think we have so much innate wisdom about the
body, and we lose that. The culture and athletics and things that
we’re told all the time about how our bodies function muddles what
we know and what we actually feel.”
“A lot of women accept it as normal, like, ‘Oh,
I pee my pants,’ or, ‘Oh, my bladder is falling out of my vagina,’
you know, like, that’s normal... And it’s like, it’s not, I mean,
it happens, but like, we can do better than that.”
“I realized shortly after the birth of my third
son in 2015 that I had prolapse of the bladder. And as you may have
guessed, I was prescribed kegels, all of the different kinds of
kegels, you could do fast kegels, slow kegels, long kegels, and I
did them, and they made me feel worse.”
“I think because of stress and different airway
issues, movement, things that happen in athletics, and whatever, we
teach our bodies to use muscles that help us to cope and to keep
going, but they’re not functioning the way that they should be in
relationship to the body. They’re overworking in some areas, doing
jobs that they shouldn’t be doing.”
“The best way to strengthen the core is through
breath work because your core strength really comes from the
ability to manage pressure.”
“Oftentimes, when we see pelvic floor issues,
you know, coming up, we have to look and be like, well, what else
around the pelvic floor is not helping it? Is it really that the
pelvic floor is weak? Or is the pelvic floor just not able to do
its job because it’s trying to do everything?”
“If somebody doesn’t have good posture and
alignment, and they’re not allowing their pelvic floor to fully
relax so that it can recruit and do its job, then why would just
squeezing it over and over and over again help anything? It’s only
going to make things worse.”
“Back when I was like twenty-one, I worked in a
restaurant, and we would try to do our kegels while waiting on
people and see, and it was like a contest, so like, nobody could
see it on our faces.”
“It’s amazing to me how much you can solve with
incontinence and also symptoms of prolapse just by getting people
oriented so that their ribcage is directly over their pelvis. So
then, now you have the thoracic diaphragm up top, talking to the
pelvic floor, and you manage pressure together.”
“People really, really, really don’t understand,
like, how important lubrication is for good sex. Like, it’s gotta
happen, like, either organically or artificially, I don’t
care.”
“Having the tongue on the roof of your mouth
opens your nasal cavity. It actually immediately communicates with
your diaphragm and helps you to have better posture. You have
better stability in the pelvis simply by having your tongue press
on the roof of your mouth.”
“A lot of people are walking around with
tension. They’re sucking in, they’ve been told that they’re not
supposed to have squishy bellies, they’re wearing really tight
pants, they deal with tension and stress and trauma by
internalizing it both in the gut and the pelvis.”
“I got too many dysregulated parents trying to
co-regulate with a dysregulated kid, and I’m like, y’all are just
giving them your chaos. You’re not giving them your calm, you
know?”
“I went in my sauna every day, like no, five
days a week for like a year. And I just stopped having the
digestive issues that I had been having for a really long
time.”
“Getting your gut health ducks in a row, I
think, makes a huge difference for any kinds of pelvic floor issues
whatsoever.”
“We see Instagram, Pinterest, Facebook, all this
pressure to look a certain way and have our homes look a certain
way and have our kids perform and look a certain way, and I think
women are just burned out.”
“Try to connect with people, even if it’s
online, it can be an online community, but connect with people that
really love you for who you are and respect your truth and are
going to be there for you in a meaningful way, that you can say,
‘I’m struggling, help. Can you bring me soup? I’m not feeding
myself.’”
“Over the past couple of years, you know, people
have been fighting a lot about health and nutrition and what works
and what doesn’t and what’s happening and what isn’t. I’m like,
stop throwing your energy towards all this negativity and conflict
all the time. How are you sleeping?”
“You can’t put too much stock in what you see on
the screen. You got to get more into your own wisdom. Listen to
your gut, no pun intended.”
“I use strength training to help women overcome
pelvic floor issues because again, it’s about training alignment,
training stability, and helping them feel strong and capable
again.”
“I like doing hard things. I think we need to
manufacture obstacles because we don’t have enough of
them.”
“I think the boomers fucked it up.”
Links:
Jamie’s Homepage -
www.jamieglowacki.com
Oh Crap! Potty Training –
https://www.amazon.com/Crap-Potty-Training-Everything-Parenting-ebook/dp/B00V3L8YSU
Oh Crap! I Have A Toddler
-
https://www.simonandschuster.com/books/Oh-Crap!-I-Have-a-Toddler/Jamie-Glowacki/Oh-Crap-Parenting/9781982109738
Jamie’s Patreon Page:
www.patreon.com/join/jamieglowacki?
Jamie’s Instagram Page:
@jamie.glowacki
Sarah’s Homepage:
https://www.sarahsmithstrength.com/
Sarah’s Pinterest:
https://www.pinterest.com/sarahsmithstrength/
Sarah’s Instagram:
http://instagram.com/sarahsmithstrength/
Dirty Strength Radio
podcast: https://sarahsmithstrength.com/podcast/