Summary of Kelsey Straatsma Transcript

Introduction to Pelvic Health and Personal Experiences (0:17 – 3:33)
Andrea begins by discussing her recent experiences with physical challenges, such as unexpected issues during activities like running, jumping, and maintaining bladder control. These prompted her to seek professional help and reflect on her body’s changes. She turns the discussion to Kelsey, who shares her journey into pelvic health physiotherapy. Kelsey, originally a general physiotherapist, explains how her first pregnancy and subsequent traumatic delivery illuminated the lack of awareness and education surrounding pelvic health, even among healthcare professionals. Her personal experiences and frustration with inadequate postpartum care motivated her to explore this specialty. She emphasizes the need for proactive education rather than reactive care during the postpartum period.

Awareness and Education in Pelvic Health (3:34 – 10:11)
Kelsey elaborates on her realization that many individuals, including herself during her first pregnancy, lack sufficient knowledge about pelvic health. She describes how her second pregnancy was approached with greater awareness, aided by additional training in pelvic health. This included taking a “non-internal” pelvic floor course to provide better education and tools for her patients. Kelsey shares the impact of offering even basic pelvic health advice to patients, underscoring the unmet demand in this field. Andrea agrees, pointing out the gaps in preventative care within the Canadian medical system and how a lack of education and resources leaves many women to address issues only decades later. Both women stress the importance of offering pelvic health education early in life, especially for women post-childbirth.

Understanding the Pelvic Floor: Anatomy and Function (10:11 – 14:45)
Kelsey explains the anatomy and role of the pelvic floor, using visualizations to describe it as a “hammock” of muscles, ligaments, and fascia that support pelvic organs such as the bladder, uterus, and rectum. She highlights how the pelvic floor interacts with other core components, including the abdominal wall, spinal muscles, and diaphragm. The pelvic floor contributes to continence, sexual function, blood flow, and spinal stability. Weakness or tension in these muscles can cause pain or dysfunction in various areas, such as the back, hips, or tailbone, due to interconnected referral patterns.

Impact of Menopause on the Pelvic Floor (14:45 – 17:07)
The discussion shifts to the effects of menopause on the pelvic floor. Kelsey explains how declining estrogen levels lead to tissue thinning, decreased resilience, and reduced blood flow, often causing symptoms like dryness, itching, and pain. These changes weaken connective tissues, increasing the risk of conditions like pelvic organ prolapse. She notes that approximately 50% of women over age 50 experience some level of prolapse, highlighting the significance of preventative measures and treatment to maintain pelvic health.

Pelvic Organ Prolapse and Pressure Dynamics (17:08 – 31:38)
Andrea and Kelsey delve deeper into pelvic organ prolapse, describing it as the result of weakened pelvic support. This condition can involve various organs, including the bladder and vaginal walls, and leads to sensations of heaviness or pressure. Kelsey explains how this pressure disrupts functions such as urination and can manifest differently based on the individual. Both women reflect on how understanding these processes, even as professionals, can be profound when personally experienced. Kelsey highlights the complexity of symptoms associated with pelvic floor dysfunction and the importance of education and intervention to address them effectively.

This part of the transcript focuses on the foundational understanding of pelvic health, its challenges, and the need for awareness and preventative care, particularly for women during pregnancy, postpartum, and menopause.

Understanding Symptoms of Pelvic Floor Dysfunction (Timestamp: 00:00 – 09:30)
The discussion begins with the host and guest exploring how pelvic floor dysfunction often manifests as a range of symptoms that might initially seem unrelated to the pelvic floor. Chronic low back pain, especially if it began during pregnancy, could be linked to pelvic floor issues. These symptoms often occur in conjunction with others, such as urinary or bowel incontinence.

Types of Incontinence:

  • Stress Incontinence: Leakage triggered by activities causing sudden pressure changes, like sneezing, running, or jumping.
  • Urge Incontinence: A sudden, uncontrollable need to urinate, sometimes leading to leakage before reaching the bathroom.

Other indicators include feelings of pelvic pressure or heaviness, incomplete bowel or bladder emptying, chronic constipation, and pain during urination or bowel movements (once infections are ruled out). The guest also highlights that simple adjustments, like positioning during bathroom use, can aid in better pelvic floor muscle relaxation.

Bridging Generational Gaps and Reducing Shame (Timestamp: 09:30 – 19:40)
The conversation touches on generational attitudes toward pelvic health. Historically, many women only sought medical attention when issues became severe, often resulting in surgeries. The guest emphasizes the importance of education and open conversations to reduce shame and stigma surrounding pelvic health.

The host reflects on how menopause parallels pregnancy in its all-encompassing effects on the body, highlighting the lack of comprehensive education on both experiences. The discussion emphasizes the need to empower women to seek help earlier and pass on awareness to future generations.

What to Expect in a Pelvic Health Appointment (Timestamp: 19:40 – 31:38)
The guest outlines what happens during a pelvic health physiotherapy appointment:

  • Pre-Assessment: Patients complete a detailed questionnaire to provide background information. This helps tailor the assessment while respecting the patient’s comfort level.
  • Subjective Interview: This involves discussing goals, expectations, and clarifying any questionnaire responses.
  • Physical Assessment: The physiotherapist may examine the low back, hips, and overall body alignment, as pelvic floor issues often correlate with broader musculoskeletal imbalances.
  • Internal Exam: With consent, an internal exam might be performed to evaluate pelvic floor muscle tone, coordination, and strength. The guest describes how muscle strength is measured using a standard 0-5 scale. The exam also assesses how well muscles relax and contract and identifies coordination issues, such as reliance on other muscle groups or breath-holding during exercises. The guest emphasizes that the internal exam is brief and entirely optional. While it provides valuable insights, external exercises and strategies can also address many issues.

Understanding Pelvic Floor Muscles and Rehabilitation (Timestamp: 31:38 – 37:40)
The guest explains that pelvic floor muscles are similar to other muscles in the body: they can weaken, tighten, or lose coordination. Rehabilitation often mirrors the approach used for other muscle groups, including regular exercises and stretching.

Lifestyle and Educational Components:
Patients may be asked to keep a bladder diary to track drinking habits, urination frequency, and symptoms. Education includes strategies for improving bladder capacity and voiding fully to prevent overtraining the bladder muscles.

Interestingly, the physiotherapist notes that most people should urinate 5-8 times daily and not during the night unless over 50, when one nighttime trip is considered normal.

Key Takeaways

  1. Pelvic Floor Dysfunction: Commonly linked to symptoms like incontinence, chronic pain, and bowel/bladder issues. Many symptoms are misunderstood or overlooked due to stigma or lack of awareness.
  2. Generational Education: Open conversations and education can reduce shame and empower women to seek care earlier, benefiting future generations.
  3. Tailored Care: Physiotherapy for pelvic health involves a mix of physical assessment, internal or external evaluations, and personalized exercises.
  4. Lifestyle Adjustments: Simple strategies, such as posture changes or bladder training, can have significant impacts on symptoms.Importance of Reducing Bladder Irritants and Proactive Pelvic Health Care (37:40 – 41:35)

The discussion highlights how certain lifestyle factors, such as excessive consumption of bladder irritants like coffee and tea, can lead to more frequent bathroom visits. Recognizing such irritants and adjusting habits can be a proactive approach to maintaining pelvic health.

The speakers emphasize the importance of being proactive in addressing pelvic health at all stages of life. For younger individuals and those in middle age, the motivation stems from understanding that incontinence is the number one reason people are admitted to long-term care. The impact of pelvic health issues extends beyond physical discomfort, significantly affecting quality of life. Concerns about activities like running or even everyday outings due to bathroom accessibility highlight the need for early intervention.

For pregnant women, proactive pelvic health care is critical in preparing for the stress placed on the pelvic floor during childbirth. Strengthening the pelvic floor before and after childbirth can mitigate future complications. The speakers stress the value of awareness and conscious muscle engagement during actions like coughing or sneezing, which should ideally trigger automatic muscle contractions.

Pregnancy, Postpartum, and the Role of Physiotherapy (41:36 – 42:39)
Physiotherapy for pelvic health is essential for pregnant and postpartum women. The speaker shares her personal experience of postpartum challenges, including a lack of proprioception (the body’s ability to sense movement and positioning) after childbirth. She reflects on how proactive pelvic floor strengthening could have improved her recovery. This is likened to the concept of prehabilitation, where individuals preparing for surgeries like hip or knee replacements see better outcomes when they strengthen the affected areas beforehand.

Scar Tissue, Episiotomies, and Perineal Massage (42:39 – 55:42)
The conversation shifts to the trauma caused by childbirth-related procedures like episiotomies and natural tearing. Scar tissue formation after these events often results in stiffness, pain, and reduced flexibility. Proper physiotherapy can improve the quality of the scar tissue and alleviate discomfort. Techniques like perineal massage, when practiced during the later stages of pregnancy (starting around 36 weeks), are discussed as evidence-based methods to prevent high-grade tearing during childbirth.

The speakers note that while many women endure these challenges silently, better awareness and physiotherapy interventions can significantly improve their quality of life. They argue that pelvic health issues are often dismissed as “normal” consequences of childbirth, perpetuating myths that prevent women from seeking help. Addressing these myths is critical to empowering women to prioritize their health.

Diaphragmatic Breathing: A Foundational Exercise (55:42 – End of Transcript)
The discussion concludes with a practical exercise: diaphragmatic breathing. This exercise is foundational for pelvic floor health, as it connects breath control with muscle engagement and stimulates the parasympathetic nervous system, promoting relaxation.

The speaker explains the exercise step by step:

  • Place one hand on the abdomen near the belly button. Breathe in deeply through the nose, feeling the abdomen expand outward.
  • Exhale through the mouth, letting everything relax.

She notes that people often struggle with proper diaphragmatic breathing, compensating with shoulder or chest movements. By focusing on the pelvic floor during the exhale, individuals can start building awareness of its movement and condition. This exercise is a simple but powerful starting point for improving pelvic health.

Key Takeaways

  1. Proactivity Is Key: Addressing pelvic health early in life or during significant life stages, like pregnancy, can prevent long-term complications and improve quality of life.
  2. Incontinence Is Common but Not Normal: Women should not accept incontinence or other pelvic health issues as inevitable. Physiotherapy offers effective solutions.
  3. Postpartum Recovery Matters: Strengthening and rehabilitating the pelvic floor after childbirth is crucial for restoring proprioception and muscle function.
  4. Scar Tissue Management: Techniques like perineal massage and physiotherapy can improve healing and reduce pain associated with childbirth-related trauma.
  5. Simple Exercises, Big Impact: Diaphragmatic breathing is a foundational practice for pelvic health, promoting relaxation and muscle awareness.

This conversation underscores the importance of awareness, education, and access to resources for addressing pelvic health challenges. With the right tools and proactive care, women can significantly improve their well-being at any stage of life.

Body Awareness and Pelvic Floor Connection (50:00 – 55:43)
The discussion focused on developing awareness of the body, particularly the pelvis and pelvic floor. Using analogies like a clock, participants explored sensations and imbalances in the body. For example, the “sits bones” represent the back of the clock, and the pelvis represents the front. Individuals were encouraged to notice shifts in weight or tension—e.g., feeling heavier on one side—and to reflect on what those sensations might indicate about their posture or condition.

The conversation also highlighted how tension in the pelvic floor can become an automatic response due to factors like fear or incontinence, which might cause people to unconsciously hold or clench their muscles. To address this, techniques such as focused breathing were introduced, starting with a relaxed position—lying on the back with knees bent—and gradually progressing to more practical, upright positions like sitting or standing.

Key Takeaways:

  1. Body awareness, especially in the pelvis, can help identify areas of tension or imbalance.
  2. Breathing and relaxation techniques are essential starting points for retraining pelvic floor function, though progressions are necessary to address real-world activities.

Practical Applications and Progressions (55:44 – 1:01:53)
Kelsey outlined the importance of integrating pelvic health exercises into daily life. While initial assessments often start in a reclined position to simplify the process, real-life applications require incorporating these practices into upright positions, where factors like gravity and fatigue play a significant role.

Progressions include practicing pelvic floor exercises while sitting, standing, or even driving, and eventually combining them with movements like squats or cat-cow stretches. These progressions aim to strengthen and coordinate the pelvic floor in functional scenarios, addressing challenges such as incontinence during daily activities.

Key Takeaways:
Starting with basic exercises in relaxed positions is effective but not sufficient. Gradual progression to upright and functional movements ensures that improvements translate to daily life.

Insurance Coverage and Access to Care (1:01:54 – 1:02:06)
The conversation transitioned to practical considerations for accessing pelvic health care. Kelsey clarified that pelvic health physiotherapy appointments are typically covered under general physiotherapy benefits. In most cases, a doctor’s referral is unnecessary, but insurance policies may vary, so individuals should verify with their providers.

For those without insurance, private appointments are available and can be booked directly online or through the clinic’s front desk. When booking, it’s essential to select the correct service—e.g., a pelvic health assessment—since the required forms differ.

Key Takeaways:
Pelvic health physiotherapy is generally covered under standard physiotherapy insurance, though policies may vary. Booking appointments is straightforward, and assistance is available for individuals unsure about their needs.

Advocacy and Preventative Care (1:01:54 – 1:02:06)
The discussion concluded with an emphasis on self-advocacy and prevention. Kelsey encouraged individuals to speak up if they feel something is not right with their health and to seek out supportive services. She acknowledged the limitations of brief doctor visits and highlighted the advantages of working with physiotherapists, who can dedicate more time to personalized care.

Preventative care was emphasized as an essential aspect of maintaining long-term health. By addressing pelvic health concerns proactively, individuals can prevent further complications and gain greater insight into their overall well-being.

Key Takeaways:

  1. Self-advocacy is crucial in navigating health care and addressing concerns.
  2. Preventative care, supported by professionals, fosters a holistic and informed approach to health.

Final Note:
The conversation underscored the interconnectedness of the body and the importance of listening to its signals. By integrating pelvic health practices into daily routines and accessing knowledgeable professionals, individuals can empower themselves to improve their overall quality of life.