All Things Pelvic Health with Dr. Tara Sullivan

In this episode, Jacqueline is joined by Dr. Tara Sullivan, a pelvic health specialist, discussing everything pelvic health-related. Tara and Jacqueline discuss a variety of topics that sometimes can be overlooked in postpartum. They clear up some common misconceptions and establish a baseline for pelvic health in general. 

Dr. Tara Sullivan has specialized in Pelvic floor dysfunction, treating bowel, bladder, and sexual dysfunctions. She addresses these issues in postpartum, and how to seek a practitioner near you. Tara also gives some insight to prevent children from bedwetting, and some other great tips for pelvic health.

In this episode, you’ll hear:

• How to tell if you need to seek out a pelvic health specialist
• Where to find a pelvic health specialist
• About postpartum bowel/bladder/sexual dysfunction

A glance at this episode:

• [8:01] Pelvic floor and pelvic health
• [12:47] How to get help for pelvic floor dysfunction
• [17:17] Catheter and urinary retention after surgery
• [21:31] What hormones affect the pelvic area
• [25:43] How to determine whether or not to use cables
• [32:31] How to prevent bedwetting in children
• [39:48] Misconceptions about perimenopause and life expectancy
• [45:37] Establishing a baseline for pelvic health
• [50:32] Where you can find a pelvic floor specialist

Related Links:

• Dr. Tara Sullivan’s Website
• Be a Guest on the Show
• Holistic Lactation Website
• Discount on Products Use Code ‘PODCAST15’
• Follow on Instagram
• Book an Appointment
• 🍼 If you are truly struggling with breastmilk production, check out our Advanced Lactation Formula supplement or consider boo

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Transcript

Jacqueline Kincer  0:03  

I just wanted to take a moment and say thank you. Thank you so much for listening to this podcast. This is our 100th episode. And this podcast has been around for a little over three years now. I find that kind of hard to believe there's been some consistency with episodes, there's been some breaks from episodes. And right now the plan is to bring you weekly episodes as much as we possibly can. Sometimes things come up though, with life with our guests lives with our podcast managers' life. So bear with us, you know, this is imperfect motherhood over here. And we are here to support you in that journey as well. So I just wanted to bring your attention to a few things. 

If you're a new listener to the podcast, any of the old episodes based on a particular topic or area of interest are absolutely worth listening to. They are not outdated. This is not that old of a podcast. So we have lots of great episodes on things like tongue ties, obviously, just anything related to breastfeeding, postpartum, motherhood, all of those sorts of things. We've got many more awesome episodes coming your way. And if you ever have any suggestions for things that you'd like to hear on the show a particular guest or topic, we'd love to hear from you. One of the best ways to get in touch with us would be to send us a DM over on Instagram at Holistic Lactation. But you can also send us an email to podcast at holistic lactation.com. 

If you yourself are interested in being a guest on the episode, we would absolutely love for you to apply, just head over to the show notes. And we have a link to the application right there for you. Whether you're a mom wanting to share your journey to inspire others, or show your sisterhood along with someone else who's probably been there and listening to the show, or you're an expert in something related to perinatal health or breastfeeding and lactation, we'd love to hear from you as well. 

What we are not looking for are sponsors of the show, because this show is actually sponsored and put on by Holistic Lactation. So if you did not know that we are a company that offers several things. One is our virtual telehealth appointments that we do with our clients all over the world. So we have a team of lactation consultants that are actually based in different countries. So we can accommodate many different time zones. As long as you have a good internet connection, and you speak English or Spanish, we can accommodate you and serve you. 

We also have a program called The Nurture Collective, which is our course and community designed for breastfeeding moms. So within that program, we actually have what I would call mini-courses if you will, that covers everything from how to prepare for breastfeeding from pregnancy, through how to wean your baby when you are done with breastfeeding. But more than that information, we have an interactive community that's led by myself, experts on our team that are IBCLC or breastfeeding specialists. And we've also got some seasoned members who have been with us from the very beginning. They've been members for a year now. And they are there. And they're providing peer support and expertise and just emotional support and encouragement along the way. So we love having those discussions. We actually do live calls with our group there. We respond, you know, in the form to questions and messages that we get. We surprise you with things. We've got exclusive discounts for our members. And it's just a really, really wonderful, unique place. That is not the hot mess of a Facebook moms group. That is not just a course where you cannot get deeper information or ask questions. And it's a little bit like the podcast in the sense that we have guest experts come in. But unlike the podcast, they are sharing presentations with us. They are teaching us actionable things. They are making themselves available to you to answer your questions directly. You can hop on with them live, you can ask your questions in advance if you can't make it live. And those recordings are actually really courses unto themselves. 

So we've got different experts that come in on a monthly basis that go much deeper than they do here even on the podcast. So if you're interested in that, check it out at the nurture collective.co Realistically it costs you less than a day dollar a day if you want to sign up for the monthly membership, you also have the option to buy the lifetime membership, which is access to the course for all time, you don't have to pay on a regular basis as well. So check that out. And the final thing that we offer are dietary supplements for lactation. Right now we've got two products, our advanced lactation formula and the lactation flow formula. These are designed to support breast milk production, your milk supply, breast health during lactation, preventing things like clogged ducts or encouragement and working with pain related to those sorts of things. These supplements are something that I am I personally developed based on my years of expertise of recommending individual supplements, thoroughly going through the research on all of the options available and treating patients in my own clinical practice. Of course, I've always worked collaboratively with my colleagues on treatment of patients. And so from that really came out with these unique products that are special blends that are really not found anywhere else on the market. 

So those are available on our website, holistic lactation.com. Or you can actually find them over on Amazon and soon and select CVS stores. So we would love to hear from you if there's anything else that you'd like to hear about on this podcast. And we'd love for you to join us over on our Instagram or Tiktok at holistic lactation. We're also going to be posting more on our YouTube channel, which has been around for quite a while, but does not have many videos, and certainly not recent ones, also at holistic lactation. And then if you're so inclined, and you would benefit from an appointment, you can book one of those on our website, you can join the nurture collective. Or check out our supplements if you think those are right for you. So thank you so much for being a listener. If you haven't subscribed to the show, please go ahead and do that. And as part of our celebrating our 100th episode, we would love to see more reviews on the podcast, so you can leave those on Apple podcasts or Spotify. Thank you so much for listening and enjoy the show. 

Welcome back to the breastfeeding talk podcast. I'm your host, Jacqueline Kinser. And today I am joined by Dr. Tara Sullivan. She is a pelvic health specialist. And I actually connected with Tara through a mutual friend. Just so happens that we got together One summer day and our kids have played together. And of course, we had a chat about what we do. And when she told me that she is a pelvic health specialist. She's a PT when I wanted to have someone come on the show to talk about this because I think it's a really important topic for anybody who is going to bear children is very in them or has forgotten them. So Tara came to mind. I'm so glad she agreed to come on the show. And yeah, I'd love to just welcome her to the podcast. It's so fun to have somebody else who's like local to the Phoenix area. So tell us a little bit about yourself, Tara, what you do your training and all of that. All right. Well, thank

Dr. Tara Sullivan  8:01  

you. I'm excited to be here. This is my first podcast. So this is fun. Yeah, I so I have my doctorate in physical therapy. And then after that training 10 years ago, when I graduated from school, I went into pelvic floor training, which is a specialty. And so we call it pelvic health therapy now and we basically treat bowel, bladder and sexual dysfunctions in men, women and children. And then I just went on with my training to get board certified as a women's health specialist and I did a fellowship in sexual medicine, and just teaching other pts. This specialty is another thing that I do on the side, in addition to treating my patients and just I love this field and helping women especially I do treat men too, but just helping women realize what's normal, what's not normal, and what we can treat and how to get better.

Jacqueline Kincer  9:02  

Ah, that's amazing. Well, you're doing all the things clearly I love it. And you know, you're just such an expert with all the training you have had and continue to get. So I think that is just such a, you know, such a wonderful asset to healthcare, right? Like you said, it's kind of becoming its own special field. So, you know, when it comes to women's specifically, and the pelvic floor and pelvic health, like tell us a little bit more about what that is because, you know, I think it's like a buzzword that people have started to hear about, but it's not necessarily a conversation that they're yet having with their doctors. And you know, even in their childbirth classes, right? So just some basic education for our listeners would be great.

Dr. Tara Sullivan  9:50  

Yeah, so mainly what we treat is incontinence, which I think is the most known diagnosis out there that people relate to pelvic floor. But there's a lot more we treat anything to do with the bladder, whether it's incomplete emptying or burning during urination or any bowel related issues such as constipation, and we treat different sexual dysfunctions, like pain with intercourse. And of course, we treat pelvic pain as well. And we see a lot of these complications and women who had babies, whether it was a vaginal birth C section doesn't matter. They all come with their own complications, unfortunately. And there's just a lot of misconceptions out there that, you know, oh, well, I had a baby. So I'm always going to leave when I'm on the trampoline, or I'm always going to leak when I sneeze or sex is never going to be the same again. Or, you know, whatever the misconception is, I think our field is trying to educate the world and other health care providers and women out there that they don't have to live with what they think is normal.

Jacqueline Kincer  11:05  

Hmm, yeah. I love that. Because I wonder if some of these problems were maybe in existence before pregnancy, but then that exacerbated issues? Like would you say that's the case?

Dr. Tara Sullivan  11:18  

Absolutely. A lot of these times we see childhood experiences. And I don't mean trauma doesn't have to be that at all, but just habits that your parents gave you about going to the bathroom. And you know, that leads to some bladder dysfunction. And then you get pregnant and you have a baby sitting on your bladder. And by the time it comes out, we always like to joke that the, you know, the baby likes to grab something on the way out, things aren't sitting where they're supposed to. And that usually ends up being the final straw. And so issues that you've had, you may have been able to accommodate before the pregnancy or before the birth now have become something that you you can't do or tolerate anymore.

Jacqueline Kincer  12:07  

Hmm. Yeah, yeah. I think what you said about, you know, jumping on the trampoline or sneezing and, you know, crossing the legs or, you know, all of that. It's a joke every time I take my kids to the trampoline park with fellow moms, and, you know, it just, I know, right, that, you know, because I've I've, you know, met people like you. And I've learned, you know that that's not normal. But it's sometimes difficult to have that conversation because it's so common that it's just this belief that's like embedded where it's not really recognized as a problem. So, you know, if somebody you know, does have those issues, like you said, you know, is what is their first stop? I guess, if they're suspecting something's wrong, like, do they talk to their OB, their primary care provider? Do they just, you know, straight, go and look for someone like yourself, because I think, knowing that there's an issue and but then knowing how to get help can be like, two very different things for a lot of people, right, and we're definitely trying to close that gap.

Dr. Tara Sullivan  13:10  

So we always say anybody who's been pregnant or given birth, any either way, that they should always see a pelvic floor therapist, we are the ones that are going to really assess the muscles and see how the muscles are now functioning. Postpartum, we'll talk to you about hormones, we'll talk to you about what's normal, what's not normal. So we're trying to get this movement going, at least here in Phoenix, where the hospitals send an automatic referral, after you have a baby and you deliver in the hospital, they're sending a referral to our call center, and then the call center calls and says, Hey, you had a baby, let's schedule your eight week follow up with a physical therapist. And so we hope that the word gets out there that as soon as six to eight weeks after you have the baby, you can come see a physical therapist who specializes in pelvic floor, we'll get you back to the exercises that you were doing either during pregnancy or even pre pregnancy. We'll assess again, like the muscles to see if they are activating when they should and maybe that's why you're leaking urine we can resolve that. We'd like to say that it's common, but not normal to leak urine after having a baby and and then we'll look at the tissue. We'll talk about hormones. We'll talk about what to expect. Another misconception is that sex has to hurt or will hurt or won't feel as good and so we assess again that tissue and muscles that go into that and see how we can help there as well.

Jacqueline Kincer  14:58  

Yeah, That's, that's incredible. Man, we got to talk more about this whole tying in hospitals thing because, okay, if they could just refer these breastfeeding moms to an outpatients. ibclc after discharge, that would be amazing. Yeah, that's, you know, they're just, you know, as well, checks aren't super often and, yeah, all of that, but I love that that's so great. Um, and what you said too, about just just the muscles and things. You know, maybe you could give us like a little anatomy lesson. I know, this is audio, but like, what? What are all of the parts? You know, there's the pelvis, the bones, but there's all these muscles and soft tissues. So what are all of those pieces that work together? You know, what are the muscles that you know, are, you know, having some dysfunction? Because I think that is something that, you know, we're just sometimes not even really aware of all of our own anatomy and what's going on internally, right. So I know for me, too, I'm, I'm learning but I'm still not an expert. And I'd love to learn more.

Dr. Tara Sullivan  16:07  

Yeah, so the pelvic floor muscles are basically the bottom of the pelvis. So we think of like the pelvic girdle is the pelvis and all the muscles that attach to it and the bones. And then we have the pelvic floor, which basically run from the pubic bone to the coccyx bone. So you can imagine like a bowl or a sling at the bottom of the pelvis. And those muscles are responsible from keeping you from, you know, urinating when you don't want to, or fecal incontinence, or they have a huge role in intercourse. And so they attack they attach from pubic bone to the tailbone, and then they also surround the vaginal opening, they surround the urethra and they surround the anus. And so again, they they're in charge of opening and closing the openings there. And then that leads to us why we do inter vaginal exams, because that's how we assess the muscles and to see if their tone and their strength is normal, and what we need to do to fix it. So we do all intra vaginal work.

Jacqueline Kincer  17:17  

Hmm, yeah. That's, it's so fascinating. I was telling Tara, before we started recording, I just had spine surgery a little over a month ago, and I've never had a catheter, I've never had a major surgery. So good times. Yeah, I had urinary retention after my surgery, it turns out it was due to a particular medication that I'm so grateful that that hospital doctor figured out because they were going to send me home with a catheter for two weeks until I could see a urologist that would have been worse than my surgery. Like I can't even imagine. But I just remember like, worrying in the hospital, like, oh my gosh, did something happened to the nerves or my pelvic floor? Like, what is going on? Why can I not pee? I'm trying so hard, and it will not come and, you know, I guess there was just this medication causing that effect. But it was, you know, it was like really, really scary, right? And then things kind of felt different down there for a little while. Turns out that a catheter can lead to some scar tissue in the urethra and limits the opening. It's all resolved now. But you know, all these things that I like, started Googling and going oh, wow. Yeah, there's a lot of like, different connected pieces here. And I didn't think that was something I needed to worry about. And you know, just trying to educate myself. Right and, okay, who would I see if there is an issue which would be someone like you because yeah, it's it's scary when that stuff happens.

Dr. Tara Sullivan  18:47  

That yeah, yeah. That you didn't end up having to see us

Jacqueline Kincer  18:52  

personally to like, it was relief. I was like, I've seriously will just, I don't know, cry until the end of time. If I have to go home with a catheter. That just sounds awful. But I'm sure people do it. You know,

Dr. Tara Sullivan  19:04  

you would have survived I would have been there for you. I would have helped you.

Jacqueline Kincer  19:10  

It was like the doctor was like, Oh, well, we have this little strap you can attach the bag to your ankles so you can walk around and I was like, that's what I want to do. It'll you can hide it under your pants. Dude. No, no, that's not my

Dr. Tara Sullivan  19:23  

lillo's

Jacqueline Kincer  19:25  

Right? Oh, like no thanks. But yeah, it's just it's it's crazy like how it's all so connected like you said you know just from you know leaking urine to retaining it or you know, all of these different things and you know, I think some some women you know, trauma or no trauma right might might go hmm, an intra vaginal exam that I don't know if I'm comfortable with that. So I mean, you know, use pap smears are no picnic. So that speculum crank and everything open is not fun. I imagine that at yours are not so ours are mechanical

Dr. Tara Sullivan  20:05  

doesn't Yeah, we don't use stirrups, we don't use a speculum, you're comfortable your bolster pillows and we use just the glove digit lube in, we try our hardest to not hurt you. We're really just trying to get an idea of what we need to do to get those muscles back to normal. I mean, it makes sense that they just had a major trauma C section or vaginal, that is trauma on the pelvic floor. It's you know, trauma to a lot of the tissue there, plus all the hormone fluctuation, which can lead to the incontinence as well as painful sex. And so we try to make it as conversational and less clinical as possible is definitely not like going to the GYN where you're just laid open and you and most Oh, I think all of my patients have always said like, Okay, that was better than I thought it was gonna be.

Jacqueline Kincer  21:11  

Sounds good, right? I'm like, if you can do a Pap smear, you can totally do that. Oh, gosh, yeah. Different. Different level? Oh, yeah. No, that's, that's awesome. Um, you know, you had said something about hormones. And, you know, there's obviously so many when we're talking about this stage of motherhood in life. What are the different hormones that come into play? And how do those affect things in the pelvic area?

Dr. Tara Sullivan  21:36  

Yeah, so the most important and the most common problem that we see postpartum is that the vestibule which is the tissue that surrounds the vaginal opening, is often very depleted of estrogen or estradiol. And that is a lot of reasons even before getting pregnant, it could be a history of being on oral contraceptive pills that affects it, and then getting pregnant, you have the pregnancy hormones that affect it, and then postpartum your hormones are a whole nother level. So that affects it. And then as you know, breastfeeding is a big trigger for affecting that tissue. And that tissue is so important because the muscles connect into that tissue. And if that tissue is painful than sex will be painful. And sometimes it's not actually the muscles, it's the tissue. And we recommend a little bit of extra dial cream to put on that tissue. And that is fine to use while you're breastfeeding, because it's not systemic. So it's not like taking estrogen or testosterone or taking something where we're trying to raise your hormone levels, we're doing just a little bit of estradiol cream, it's point zero 1%. And, and a lot of I mean, almost all of our patients who have any pain with sex, after having to after giving birth, that is usually the number one reason and that estradiol cream is like a magic cream. And yes, we that doesn't affect their milk supply. And so that again, another thing where it's like, oh, I have to live with SEC stop feeling good, you know, so not true, we can help you there.

Jacqueline Kincer  23:32  

Yes, no, I think that's really important to know. Because, you know, depending on the person, they may value their sex life more than someone else. And so for those that, you know, really, you know, prioritize it, they can be really frustrated with that dryness and think, Oh, well, you know, it's breastfeeding. So maybe I should give up breastfeeding because it's making things uncomfortable. Or sometimes moms will know about the cream that you're describing. And they'll worry about it impacting their milk supply. But you know, I try to remind moms that like, you know, by the time you're even getting prescribed something like that, your milk supply is well established, you've moved out of that hormonal phase of driving the production anyhow, there's still hormones involved, but it is topical, we're not asking you to, you know, take a certain form of you know, a birth control pill or something like that. It's it's something you're just putting exactly where it needs to go. So, hopefully, that assuages Any big fears. But

Dr. Tara Sullivan  24:31  

you know, it's always something to talk to your doctor about because, you know, it's not right for everybody, but it's such an easy, easy fix for anybody who's really struggling with that, right? Yes, and we we take the time. The great thing about being a physical therapist instead of an MD is we have 45 minutes to an hour with every patient. So we have the time to sit down and talk to them about their fears and about their concerns and we can show them exactly where it goes and why and how Latin and you know, it's it's just something that unfortunately in these have 510 minutes with a patient and they say, here's the Korean music, it's getting used wrong, you know, like, we have to say no, this is what that prescription means and what it does, and we can help them with that.

Jacqueline Kincer  25:16  

Yeah, yeah. Oh, it's a big difference for sure. When you get to spend that time with with somebody, you know, regarding, like you said, you know, mentioned exercises and things. There's been, you know, this knowledge of key goals, and then this sort of like anti Kegel, don't do those, those are terrible. Like, what is the truth? Because there's just, you know, social media, like snip? That's right.

Dr. Tara Sullivan  25:44  

That's a great question. And the truth is in the middle, because it depends on the patient. And that's why we exist because we establish, we assess the muscles, and then we can establish whether or not you need to do cables or not, not everybody is a good candidate for cables. So for example, if you don't have pain, any type of pelvic pain or pain was x, if you're having some laxity, some weakness, maybe even a prolapse of some sort, we would most likely assess your muscles and say, yes, you're a good candidate for cables, there are certain positions we would have them do, depending on what their issue is. Let's say somebody came to me though, and they had really painful intercourse, or daily pelvic pain. And their muscles were what we call overactive or they have increased tone to them, which isn't equal to string. So some people are like, well, I want tone, right? Like you go to the gym, you're trying you want to know, when it comes to the pelvic floor, we want normal tone, but we don't want increased tone, because that causes a lot of problems, that can actually be a reason why someone is leaking. It doesn't always have to be weakness. But usually, the general rule is if it's a pain patient, then we don't often start them with cables. Because we're trying to down train, first, we're trying to get rid of the tone, normalize it. So they have normal tone, and then we can progress to the strengthening part. So it, the studies show that most people also don't do cables correctly. So that's a whole nother side of it, where it's like, even if you need cables, you don't know that you're doing them correctly. And so that that's again, another thing that we can assess and say, Yeah, you're doing it right. You're not doing it. Right. This is how you do it. This is the position. So it yeah, they're important, but they're not our first line of treatment. And it really is a very small fraction of what we do.

Jacqueline Kincer  27:56  

Hmm, yeah, no, that's, that's really good to know. And it makes sense, right, that might be appropriate for some people and not others. You know, and it made me think about to like you were saying you could have, you know, kind of this high tone or low tone. Are there things outside of, you know, the pregnancy and birth experience, just like daily habits that could play a role as well. Like, I was just thinking maybe the way that somebody sets or walks? You know, I feel like, you know, like you said some people might have sort of had like some issues beforehand, now they've become a parent. So just curious about that as well.

Dr. Tara Sullivan  28:34  

Yes, certainly, the way they sit, especially when they're breastfeeding, as you know, they can develop a lot of asymmetries and muscle imbalance is, is there. A lot of what we go through, though, are more like day to day bowel and bladder habits, which most people don't make the connection, but the way we drink water and how much water we drink, and what we're eating actually affects the pelvic floor a lot. And because of that, a synergistic role between the pelvic floor muscles and the balance bladder, we're always trying to work on their habits, like for example, if somebody's drinking a gallon of water a day, probably not indicated. And so we'll talk to them about proper hydration and not overloading the bladder, not overloading the pelvic floor. And so that's a lot of what we do besides evaluating their posture. And there's mechanics as far as like sitting, we're going to focus on their bowel and bladder habits and what they do just eating and drinking and bladder irritants, things like that.

Jacqueline Kincer  29:44  

Yeah. Oh, that makes so much sense. You know, and even just like, you know, let's talk about toilet stuff.

Dr. Tara Sullivan  29:51  

Right. I want to talk to you about toilet stuff.

Jacqueline Kincer  29:56  

Yeah, like,

Dr. Tara Sullivan  29:57  

that's what everyone wants to talk about that All right, yeah, so we do we recommend that you have a stool underneath your feet. The main reason for that is because basically the poop has to go around a corner before it comes out. And if you put your feet up on a stool, and you have hip flexion, a little, little bit greater than 90 degrees, then that straightens that corner out so the poop can come right out. So that makes bowel movements a lot easier, prevents constipation. And then habits as far as bladder goes, we recommend generally speaking about four to six ounces of water per hour, but every hour discontinuing drinking water before bed not paying just because the toilets there or your you know, you want to go out shopping so up before you leave, you know, things like that we don't recommend all of that will affect the pelvic floor and bowel bladder function.

Jacqueline Kincer  30:58  

Hmm, yeah. What about peeing standing up? I saw Oh, boy. Anything about don't do that. It's bad for your pelvic floor.

Dr. Tara Sullivan  31:06  

Yeah, don't pee standing up or hovering. Now, of course, you know, we're camping. But we're gonna hover if, you know,

Jacqueline Kincer  31:13  

I don't know for weathering over the public toilets is like a big thing.

Dr. Tara Sullivan  31:16  

Yeah. So I would say if that happens once or twice a year, you're not going to hurt yourself. But if you're peeing in public, often because of your job, or you're out and about. And so, three, four or five times a day you're hovering over the toilet, that's going to lead to a dysfunction. Because we truly need our pelvic floor muscles to be relaxed. The only time that they are fully relaxed is when we are pooping, and peeing. And so if we don't sit on the toilet, they don't get a chance to fully relax.

Jacqueline Kincer  31:49  

Oh, wow. So no peeing in the shower either.

Dr. Tara Sullivan  31:54  

So this beyond the reason I'm standing in the shower, the reason why we don't recommend that is because the bladder is the most trainable organ in the body, and it actually will start to associate running water with peeing. And so the same thing about like, don't turn the faucet on while you're peeing, it will, your bladder will start to be like, well, there's water, that means I'm peeing. So now when you go to wash the dishes, they hear the water running, they're like, your bladder is like, that's paid. So you leave or get that urge. And then you have to run to the bathroom. So we try not to create those associations.

Jacqueline Kincer  32:31  

That makes sense. So when I could not urinate in the hospital, the nurse was like, I'll turn on the faucet for you. Sometimes the running water gets you going. And then I was like, you know, do you guys have like one of those parry bottles that I can like, you know, spray like, see if that'll, and none of that works? Now, it probably wasn't gonna work for me anyway. But like, I don't really have that association. So

Dr. Tara Sullivan  32:55  

yeah, those we wasted a lot of water. Right. And so that goes back to what I was saying, like, as a childhood to like, those are habits that like us, as parents, we do not knowing any different and like, you know, our kids on the toilet, we tell them to go go before we leave the house. I mean, we're just naturally doing this because of our own sanity. But, and that's fine. As they get older, we want to establish habits that once they're in control of their own body and their timing that is less to less training of the bad habits and more training of the good.

Jacqueline Kincer  33:35  

Oh, yeah, that that kind of makes me think about, you know, I, I know so many people that listen to the podcast, you know, have, you know, older children, right? Or they're thinking ahead. And, you know, toddlerhood and potty training. There's all these, you know, sort of methods that people are sold on and ideas of, you know, three days or, you know, no underwear or put on the potty every 30 minutes. Like, I mean, yeah, like you said, there's, you know, a lifetime of habits, and you can sort of shift those later. But is there like something that you would say is like, you know, you really would like to see parents of waiting when they are potty training or, you know, any sort of like good habits that they could try to establish with their child because, you know, I don't know if it's like an awareness issue of, you know, they've gotten so used to having a wet diaper and it doesn't faze them anymore. So like, I think there's so many questions that parents have, and they just really, you know, it's a lot of trial and error for us, basically, we just do not know,

Dr. Tara Sullivan  34:32  

it definitely is trial and error. Unfortunately, I don't have advice on potty training because I don't treat that young of a population. So I don't want to pretend to say like, right method, wrong method. I am sure there are better methods out there than some that I've heard, but I don't really, really want to speak to that because that's not my realm of expertise. But I will say I can tell you what's normal for older age kids like from once there potty trained. And younger than the age of 12, they really should be going to the bathroom about every hour and a half to two hours. And then once they're about 12 go into the bathroom every three hours, like an adult should is more normal. I was just seeing an eight year old girl the other day, and she has pain when she's peeing. And a lot of it just has to do with not drinking enough water, but then also holding her urine all day when she's at school. So then that urines building up, she's pretty dehydrated, because she doesn't drink enough water and then it comes out really acidic, and it burns that tissue when it comes out. So she'll get that stinging feeling. So really, it's just what I do with kids, which is I don't treat kids on a regular basis, but it's more general bound bladder education of like, what we like to see what's normal.

Jacqueline Kincer  35:56  

Hmm, yeah. And I guess on the flip side of that, like, for those those children around those ages, Bedwetting, you know, I think, you know,

Dr. Tara Sullivan  36:07  

most parents are pretty aware of, you know, limiting fluids before bedtime, but it might still be an issue. And I'm curious what you normally see is going on when that happens, yeah, so we do consider anything above the age of five to be something that we should be trying to correct. I mean, anything before five could still be their body, figuring it out, if it persists past five, and it's not getting better, I would definitely see a pelvic floor therapist for that. It really does come down to habits during the day, we'll do what we call bladder retraining with the kids. And then the interesting thing is that milk happens to be the number one trigger for bedwetting. And so the first thing that we'll say is to try to cut off any milk or dairy products, mainly milk in the evening, or sometimes people just they need to eliminate it altogether if they have a sensitivity to it, but milk does change that osmotic pressure of the bladder. And so we see that being the number one trigger for bedwetting and older kids. But it does it has to do with are they paying enough during the day? Are they hydrated? Are they stopping their fluids? And then are they drinking a lot of milk?

Jacqueline Kincer  37:23  

Yeah, wow, that's so fascinating. I never knew that about milk. So that's good to know. And then kind of like fast forwarding to to the other side of the coin. So many women these days are having babies at older ages, you know, just society has shifted people are more involved in their careers or, you know, they just feel like I'm gonna be, you know, more responsible or better off financially or what have you, right, so many reasons. Maybe there's fertility struggles, right. So like so many clients that we have, you know, that are over 35. And then you know, they have babies and pretty soon they're hitting perimenopause. So there's big changes in hormones there. And I'm assuming we probably see some pelvic stuff changing too. So I'd love to hear your thoughts on that because I feel like perimenopause is kind of a thing that like some OB has addressed with people, but they're usually like, come back and see me when you're actually in menopause. And there's just like, a lot of, of lack of information out there.

Dr. Tara Sullivan  38:26  

There is and we're we're starting to see more research supporting, using hormones, Peri menopause, because we want to prevent the the truck hitting you all the sudden, you know, you're living life, okay? And then all of a sudden, you're in menopause, and things just go, Hey, haywire, we can prevent that. Because there are a lot of little signs along the ways where we can say, Oh, you're probably low on estrogen, maybe that's progesterone, maybe that's testosterone and we can get those levels, normalized and balanced before you hit menopause. And then when you go through menopause, it doesn't have to be so horrible. It doesn't have to be hot flashes and painful sex and you know, all the things that come with menopause. So I'm actually a big supporter of for if it's indicated for the right that person to get on the right hormones, Peri menopause and not waiting until menopause. And Flora responds to that just like I was saying about the vestibule and the estradiol. Keeping that going and keeping our hormones healthy for a longer period of time is going to prevent a lot of the issues that we see postmenopausal

Jacqueline Kincer  39:48  

hmm yeah, no, I I've seen more and more you know, sort of progressive OB is talking about that and even the estrogen cream like you were mentioning that that is something that we should just make available to people that are going through perimenopause. Like why should you suffer and your sex life be miserable, like, so

Dr. Tara Sullivan  40:09  

there's kind of those misconceptions. Yeah. I mean, I don't remember what year it is. But I was, I was actually just reading something that said, you know, the average age of menopause has always been around 50 years old, somewhere in there 50 to 52. But there used to be a life expectancy of like, 60. So you know, you're suffering for maybe 10 years doesn't seem like as big of a deal. Maybe back then it didn't, I don't know. Or if you don't start menopause till you're 52, and you don't even live past 60. Now really, living till at 85, that's 30 years of living with these vasomotor symptoms and discomfort that it's like, No, we should be preventing this. We know more now than we did then. And we have a lot longer life expectancy. And nobody should have to suffer for any amount of years, whether it's five or 10. But 30 I mean, we shouldn't just say, Oh, well, that's, that's being a woman, you got to accept it.

Jacqueline Kincer  41:11  

Right? No one wants to be told that, you know, and it's, it's crazy how long it goes. I mean, you know, we as a species, right, used to be having babies in our teens and early 20s. With that shorter life expectancy. Now, it can be late 30s 40s. I mean, my oldest patient was 46. So and it was a surprise, like, she thought she was just not fertile anymore. And then surprise, there's a baby, you know, like, she's like, Oh, okay, I guess I can still make babies, which was great. She had always wanted one. So yeah, it was awesome. But like, you know, so if you're just having a baby at, you know, 40, let's say, right, you've still got like this longer time period to go. And I wonder if you know, a lot of moms kind of, you know, that are older chocolate chocolate up to their age, right? Like, they're told in pregnancy. It's a geriatric pregnancy, which is like, the wrong word to wear. So now, they're just thinking, Well, I've had a baby, I'm too old, I don't have the same energy anymore. And, you know, maybe that's not actually what's going on, right?

Dr. Tara Sullivan  42:18  

I mean, we know that babies are exhausting. But a lot of it is hormonal. I mean, I was kind of middle of the road, I was not quite geriatric. I was 34 when I had my son, and, and he's nine. But though, I had no energy, I had no libido, I had brain fog. And I was really suffering from postpartum depression to and it turned out to just all be heart, not just but it was hormonal. And yes, Everyone kept saying, but you're a single mom, and you work and so you're tired. And I'm like, worked hard. My whole life, this is different. And so recognizing that hormones actually plays such a role on our mood, our energy, all of it is, I hope, eventually it gets more recognized.

Jacqueline Kincer  43:11  

Hmm, yeah, that's, that's a really good point, you know, just the dismissing of, you know, Oh, it must just be, you know, your life and the way that things are. Exactly. And yeah, with hormones, too, you know, I think there's like that excuse for like a lowered sex drive of a world you're just busy, or, you know, that baby, you're, you're touched out or whatever. And, you know, I'm sure that obviously plays a role. But, you know, I think from everything that you're saying, you know, it's affecting, you know, those tissues in the pelvic region, but so many other things, you know, are there, I guess, for for moms who are listening to this, you know, and just kind of wondering like, Hmm, maybe I should get my pelvic floor checked out. Like, what are some of those? I don't know, red flags, even yellow flags that, you know, would really, I mean, in your ideal world, I'm sure you would love everybody to go get checked out rights, which would be amazing, right? But for those who are like, ah, yeah, I wonder if this is related. Like, what would be just one of those things that someone could kind of self assess and check in and go, I should really see somebody?

Dr. Tara Sullivan  44:19  

Oh, besides the obvious, we know if you're leaking PII, for sure. Yeah. Obviously, if you're leaking, I think that I think, mainly is they think I'm dry? It's because I'm older. And that's something that is not true, or that I just can't accommodate that position anymore, or I don't, that's that's actually a hard question for me. I'm trying to think what I don't even know we'll cut this part out of the podcast because I mean, besides the obvious, like, nobody's really looking at themselves and maybe they should be looking to See, like what changes are occurring down there? Take a mirror. And look. That's what I would recommend. And if you're noticing paleness if you're noticing redness or irritation, and it comes along with pain with sex or any pain at all, maybe it's pain when your pain or discomfort or steam, anything just doesn't feel normal in that area really is an indication to come to a pelvic floor therapist.

Jacqueline Kincer  45:29  

Oh, I like that. I think what I'm hearing you say to is, take a look now, like go pause this episode. Yeah, go on your bathroom mirror? Let's let's establish a baseline. And then you'll know, right? It's like doing self exams of your breasts, you know, you got to know what the normal is to find out if there's a lump there. And I would I that's one of the things I always recommend during like, if I do like prenatal consultations for breastfeeding, is you know, the breast tissues are obviously are starting to change by virtue of pregnancy, but feel it and on a weekly basis, just feel how, you know those milk sacks are expanding and growing. And you know, the amount of pressure that feels comfortable for you and get familiar with that, because they're going to change super rapidly within those first three days after you give birth. And if you haven't gotten somewhat familiar with it, you could freak out and panic that something's wrong. You could go oh my gosh, my there's lumps everywhere, I must have clogged ducts like Well, maybe you don't you know, so if you don't know, kind of a baseline of what's normal for you, it can be really hard to tell, like you said, you know, how do we even know most people aren't really examining,

Dr. Tara Sullivan  46:39  

right? I mean, we don't even at a young age, we don't really look at ourselves, we always give our patients a mirror on the first day. And they watch in the mirror as we're going through and assessing all the different external structures. And so many of them have said, Oh, my gosh, I have to look I've never looked at before. But you can't know if something's wrong or abnormal if you don't know what your normal is. And there's color changes. There's structural changes that can occur as we age after we have a baby, and some are normal, and some are not. So if there's any question about it, then I would definitely come see a pelvic floor therapist for that, too. Yeah, I love that. Yeah, I

Jacqueline Kincer  47:24  

think, gosh, you know, this is just so much wonderful information. And, you know, so applicable to anybody who's had a baby. And, you know, I think it's one of those things that you know, is is becoming like a big concern. One other question I had for you is about pelvic pain, because you mentioned that I've just by virtue of me having some issues in my lumbar spine. I've seen it discussed frequently that like Well, is it actually your low back? Is it pelvic pain? Is it your SI joint? Is it because this pain can be sort of referred or, or nonspecific? Sometimes? So I don't know. I'm sure it varies, obviously, from person to person. But is there like a general sort of descriptor you could give of pelvic pain? Like does it feel like a muscle? Could it feel like something else? Because I think people sometimes just go, oh, I have pain, but I'm not really sure where it's coming from? Yeah, maybe it's obvious with pelvic stuff? I don't know.

Dr. Tara Sullivan  48:27  

No, no, it's not always obvious. Usually, someone who I would see for pelvic pain could have very specific pain where they might refer to it as their ovaries, their ovaries hurt, because it's in that general area. Oftentimes, patients will go to the ER and think they have appendicitis is when it's actually pelvic floor, because it can refer up that high on the right side. Well, while on either side, it can refer up that high, but it'll often mimics appendicitis. Also, a lot of people will complain that they feel like they're having menstrual cramps, but they're not on their period. And then a lot of people who have endometriosis or adenomyosis, or some sort of condition like that, will have a lot of pain because that those conditions are painful, but don't know that the pelvic floor could be part of their pain. And so we can actually help them manage their pain by treating the component of it that's coming from the pelvic floor. And then yes, the pelvic floor muscles can definitely refer to the back or the tailbone. It's common, that's not typically what I'm seeing. I'm seeing more of like the, the front menstrual type over a type, you know, pain, but there There's definitely tailbone pain though we we know the pelvic floor has a huge role in the tailbone. Because those muscles actually attach there. If it starts to get a little bit higher, it can be referred pain to the lumbar sacral area, but then also is accompanied by maybe having also the sacral, or lumbar dysfunction with it. And then we discern that we discern like, oh, is this actually coming from the back? Or is it referring to the back? And that's something that we can diagnose?

Jacqueline Kincer  50:32  

Hmm, yeah. Wow. I just learned a lot. That's right, exactly. And I'm hoping all of our listeners have to, and, gosh, you know, you're just an excellent wealth of information and such an incredible, you know, asset and resource for our community. You know, I know, so many people listening are not local. So I'm wondering if there's like, if somebody is looking for someone like yourself, elsewhere in the country? Is there like, Are there any organizations or directories or, you know, specific things they should ask their their doctor? Or how would they go about finding a pelvic floor specialist?

Dr. Tara Sullivan  51:17  

Yeah, I always recommend pelvic rehab.com. It says, Put on through Herman and Wallace, which is the pelvic institute that trains us, the main institute that trains us to do what we do, and they have a directory, just type in your zip code, and it'll pull up those who are trained and usually certified in pelvic floor. And that's a good place to start. I actually have a website where they can email me and then I can direct them if they're not in my area. And my website is designed for patients. So it's all about patient education. A lot of what we talked about today is on there and how to like walk yourself through it. And so that's pelvic floor specialist.com. And they can email me directly from the website, and I can send them in a direction if I can help as well.

Jacqueline Kincer  52:13  

Awesome. Yeah, definitely check out Tara's website, there is a lot of great information on there. That's just, you know, really nicely broken out, sort of by topic and everything. So yes, it's a good written summary of everything that you share.

Dr. Tara Sullivan  52:29  

There's so much more, this is just the tip of the iceberg.

Jacqueline Kincer  52:32  

It really is. But I hope that you know, by you sharing this information that some people out there will recognize that they may have something going on, and we'll be able to get the right help with it. So thank you so much for being here. It's an absolute pleasure to talk to you. You too.

Dr. Tara Sullivan  52:48  

Thank you so much. And thank you for what you're doing for all the women out there.

Jacqueline Kincer  52:53  

Thanks. Yeah, I you know, I feel like when it comes to breastfeeding, it's so much more than boobs and babies, and you've got other things going on in our lives. You know, if you're breastfeeding, you've clearly had a baby. So let's talk about all of those related things. Exactly. All right. Well, thank you again, and I'll see everyone else on the next episode.