Painful Sex, Diastasis Recti & the Pelvic Floor Problems We Don’t Talk About with Dr. Sara Reardon

Sameena Rahman (: 00:00

intro information, we can just start a conversation really. Hi everyone, this is Dr. Smirnoff, welcome back to another episode of Gyno Girl Presents Sex, Drugs and Hormones. Today I'm super excited to introduce you all to the Vagina Whisperer. I love it, I love that name actually, I've been like just a fan girling over the name alone, but you of course are awesome as well. But I'm super excited to have you here today.

Dr. Sara Reardon (: 00:01

Perfect.

Sameena Rahman (: 00:28

Dr. Sarah Reardon. Dr. Sarah Reardon here today from New Orleans to talk about everything related to the pelvic floor. So welcome.

Dr. Sara Reardon (: 00:40

Thank you for having me. And I can't take credit for the vagina whisper name. It's actually a name my girlfriends gave me several years ago when I started practicing as a pelvic floor PT. And it's just really been awesome to kind of have that be like the name of the brand and, you know, and now putting the book out, people are so familiar with it. But it's really been fun to kind of be in the pelvic floor health space and have the word vagina be tossed around so not much because it used to be so taboo and…

Sameena Rahman (: 00:48

Sameena Rahman (00:53.376)

Yeah, yeah.

Sameena Rahman (: 01:03

I know. I wonder though, because you developed a great following. I wonder how long it took people to not censor you on Instagram.

Dr. Sara Reardon (: 01:10

You know, it's interesting because I actually started on Instagram in 2016 with the handle, the Vagina Whisperer, and I have to say, knock on wood, that I haven't ever really been censored because I think I was almost grandfathered in before a lot of these kind of, you know, screening tools and all of these things that were kind of shadow banning a lot of content. you know, was already...

kind of in the space and had a large following before that took place. Now, TikTok is a different situation. TikTok, my name is the Vag whisper because they don't like the word vagina. So it's a very different platform and they I think are much more active about censoring on that platform, even though it's all health education.

Sameena Rahman (: 01:50

Yeah, I know it's weird. That's interesting because yeah, sometimes even when I like talk about sex, I feel like some of the stuff doesn't get out there as much as it should because you know, of all the...

Dr. Sara Reardon (: 02:01

Totally, totally. When it's health education though versus like, you know, sexually explicit content, yet it's labeled as that, which is unfortunate.

Sameena Rahman (: 02:06

Yeah. Yeah. Yeah. It's so stupid. Well, welcome. And, you know, I'm super excited to talk to you. I know you do so much advocacy and education with your, your brand, but also, you know, on Instagram. And now you have this amazing book out, which I got, I got in the mail and haven't fully finished it yet, but I was, I was perusing it before you came on called floored. I love that name too. That's really, you're so creative.

But...

Dr. Sara Reardon (: 02:36

Well, you know, it's funny because I just have creative people around me too because my sister, my twin sister, as I mentioned to you before our call, lives in Chicago and she is in marketing and branding and then her husband is in advertising. So they are kind of really my sounding boards. we were coming up with a title for the book, was kind of we were all throwing around ideas and my brother-in-law said, what about Florida? And we're like, that's it. And so it's been really, you know, I've got a lot of really brilliant people around me. So I feel lucky for that as well.

Sameena Rahman (: 02:53

Yeah.

That's it. Yeah.

Sameena Rahman (: 03:01

that's wonderful. Well, let's talk about why you entered the space, like what's your why. And then, you know, if you want to talk a little bit about your own journey. I I love that you do so much fourth trimester and postpartum education too, because I feel like, you know, I don't practice obstetrics anymore, like most of my listeners know, but when I did, I, you know, was really felt like that. And having gone through three postpartum periods myself, and my youngest is six. So the third one I did right. But the first two, like you learn, you know, you learn how like,

I always felt like that for my first one, like I thought the first postpartum period was probably the worst, like, and it was like worse than the pregnancy. It's not because I had postpartum depression. I just feel like even as an OBGYN, like no one really like helped you navigated it all, right? Like it's just like, it's, know, as I can tell you from like, you know, when, when, when I was delivering babies, like, you know, the postpartum visit is included in a

and a global fee for OBGYN. So you get like the 10 minute visit and basically like, you know, most people don't get any elaborate discussion. mean, things are changing now, but I was just speaking about my, my oldest is 15. So I remember specifically how horrible that period of time was. And I think it was just because like, you just don't realize the amount your body and again, I'm an OBGYN and you still don't realize the amount of change, the changes that your body happened, like that happens to your body.

and then how you can react to it, right? Like you just don't even think about the fact that like, you feel like when you're pregnant, have this baby growing inside and then the baby comes out and you still look pregnant. And like, you feel like a foreigner in your own body for a very long time. I think it took me about a year to feel like almost normal again. after my first postpartum period, I was like, oh, I have to just like be there for like, know, the women because, you know, people are not there and it's not even a matter of like being fully like depressed.

Dr. Sara Reardon (: 04:38

Right.

Sameena Rahman (: 04:55

or having like, you real mental health issues, which we know make it so much worse. It was just the idea of just not even knowing how to experience what you should. you know, you're supposed to be all unhappy and like wonderful and it's not always that way and you'll sleep. And it's just like so many factors, right?

Dr. Sara Reardon (: 05:11

So many factors and you, I mean, I felt that I have two kiddos. are eight and 10 right now. you know, I think that, well, the reason for my why is I'm, you know, pelvic floor physical therapist by training. I have a doctorate in PT and I went to PT school thinking I was going to be a sports trainer for the New Orleans Saints, which is my hometown. And, but during my graduate school education, I have a professor, I had a professor who gave us a few weeks of lecture about the…

Sameena Rahman (: 05:29

Yeah.

Dr. Sara Reardon (: 05:37

pelvic floor and I was like, I've never heard of these muscles and we never talk about them. And as a woman, I felt like it was very interesting and fascinating to learn more about my own body. And when I started working with patients in pelvic floor therapy during one of my clinical rotations, I absolutely loved helping other women understand their bodies and helping them navigate, you know, painful intercourse or painful menstruation or, you know, constipation.

Sameena Rahman (: 05:41

Yeah.

Dr. Sara Reardon (: 06:07

or painful sex or urinary leakage, which they thought was so common. And then to be able to help them overcome these really intimate, often embarrassing issues and to get them relief and see them regain confidence in their bodies was so rewarding. And so I started in this field 18 years ago, right out of graduate school. I have a board certification in women's health and I am a pelvic health therapist now in New Orleans.

Sameena Rahman (: 06:22

Mm-hmm.

Dr. Sara Reardon (: 06:33

You know, over the course of the years, I've seen really an explosion of the awareness of pelvic floor therapy and really, as you and I mentioned, kind of the integration working with providers like yourself, OBGYNs, urologists, urogynecologists, know, primary care doctors, because these are muscles, like every other part of, you know, every other muscle in your body, but they're connected to so many systems, like, you know, digestion and defecation and urination and reproduction and menopause.

Sameena Rahman (: 06:55

Mm-hmm.

Dr. Sara Reardon (: 07:02

We kind of work across all of those spectrums and the muscles aren't often looked at as a culprit when something goes wrong, but they often are and then it goes unaddressed for a long time.

Sameena Rahman (: 07:05

I think.

Sameena Rahman (: 07:09

Yeah. Yeah.

A very long time, yeah. I feel like, and I remember learning at some point, I felt like in Europe that like every woman pulls apart and goes to physical therapy. And now it's become a little more trendy. I think now people are doing it more and most patients are going, but you know, I just remember after my first, like it wasn't a common thing. it wasn't.

Dr. Sara Reardon (: 07:29

Well, it's still not a common thing. And especially, I mean, you're in Chicago and I'm on the complete other side of the country in New Orleans. And I would say we're very delayed with how we are, you know, helping support women during pregnancy and postpartum. And a lot of the struggles that you describe, it's, you know, are, it's not, I'm like, it's not use. mean, I'm like, it's the systems are not in place to help support women physically, mentally, emotionally, professionally recover postpartum. They're just not. And so you were left floundering.

Sameena Rahman (: 07:41

Thank you.

Dr. Sara Reardon (: 07:58

and also physically compromised. And I think that, you know, to your point about the postpartum visit, it's short and I think doctors would love more time with women, but they're not being reimbursed for it by insurance. And 40 % of women don't attend their postpartum visits because they're back to work, they have other kids, they have childcare, it's hard to break away. That's what I'm saying. And so it's like the one touch point that's implemented, which is six weeks later, right? Which is way farther than it needs to be out from birth.

Sameena Rahman (: 08:15

I never went to one first part of a visit.

Dr. Sara Reardon (: 08:27

isn't even being utilized because there's so many barriers in place. So I think that the systems aren't supporting women. And I think that the awareness of pelvic floor therapy growing is because women really recognize the need for this care and they want it and they weren't getting it before.

Sameena Rahman (: 08:41

Absolutely. to your point, I just feel like from a system approach, even as a woman, even as a woman, female OB-GYN, you just, it's...

you're trained in a patriarchal system, right? Like this is like a system that you're trained in, the insurances, the other factors that really inhibit like good care. You know, if you're seeing 40 patients a day, like I was when I was in private, when I was in practice under hospital systems, it's impossible to give women the time and the care that you need and do it well, right? And I feel like that's another like barrier to treatment. And then you have all the other patients who just don't even, you know, like you said, because they have to go back to work or because of, you know, they don't have

Dr. Sara Reardon (: 08:56

Right.

Sameena Rahman (: 09:24

familial support. you know, what other culture like every other culture you look at around the world, like this postpartum period is so nurtured and valued. like people are really like, you know, my, my parents are from Pakistan. And so like, in that community, like you go to your parents house for 12 weeks at most part of you get taken care of, and the baby's taken care of, and you're taking care. And so I just feel like

Dr. Sara Reardon (: 09:42

Yeah.

Dr. Sara Reardon (: 09:47

The mother is mothered, yeah. The mother is mothered and that is not the case in our society in the US. Yeah, and I think that it's really interesting and I talk about this a lot in the book because there's so much historical context about how we ended up here. And a lot of it is, we have very transient families and jobs and we don't have a socialized medical system where you can kind of go in and it is insurance based which limits the amount of

care that someone can offer. But it was interesting because it's even things like, you know, we'll start implementing certain things which I think have really good intent, but it's something like vaginal steaming, right? I just did a post recently about like, that's not something that I would do. And they were like, but it's amazing and it has a lot of cultural context. And I'm like, it does, but it's kind of being taken. It's like cherry picked out of what the entire experience was where you were fed certain foods and your muscles were massaged and the mother was nurtured and cared for it.

They kind of sat in warm areas to help release muscle tension and aches. then, so it's a little bit of we're kind of cherry picking these kind of wellness practices from different places, which makes it feel really trendy. I think the intention is right. But again, like the cultural context is not consistent with what we're trying to implement. there's a lot of wellness things coming up with respect to like vaginal care and vulva care, which is great. I'm like, the more attention vaginas get the better, but.

I really am like, this is healthcare. Like pelvic floor therapy is healthcare. It's not trendy, it's not wellness. It is like this needs to be like going to the dentist or going to the OB-GYN, like a very supported facet of women's care. No, not at all. And I think we see it that way because it seems like it's popped up, but I mean, I've been doing this for almost 20 years, you know? It's just more known.

Sameena Rahman (: 11:13

Exactly, Right.

Sameena Rahman (: 11:25

It shouldn't be niche, know, it shouldn't be like one of those things.

Yeah. Yeah. This is more known. Yeah. And it's I think that, you know, when you think about like in other cultures and the support that they get and, know, here we have such a.

It's like, you know, if you go, it's a, there's a bounce back culture that is really hard to adhere to. And you see it on social media and you see all these people that are getting, it looks so great, like eight weeks postpartum and you congratulate them for going to work and looking great. You know, like the majority of the time after a woman delivers a baby, you know, they're forgotten about here in the States and probably most of the Northern America. And then the bounce back culture really aggravates me. Actually. I don't even like, you know, I always tell women it's not a bounce back. You're just going to have a new norm to like.

Dr. Sara Reardon (: 12:14

It is, and I think that that's great, and I think that that's, you know, I remember this one instance when I was one week postpartum after my first kiddo, and I agree with you. After, like, the postpartum recovery for my first son was hands down my hardest. I almost wanted to have a second baby. Well, one, I wanted a second baby, but two, I was like, I want to do over. You know, like, I want, I know. Like, yeah, you feel like you need to, like, rectify yourself because you did it wrong, but I'm like, we just didn't know what we didn't know. And there is a little bit of an obvious learning curve.

Sameena Rahman (: 12:31

Yes, that's exactly why I have my third. I was like, I want to this right.

Sameena Rahman (: 12:38

Yeah.

Dr. Sara Reardon (: 12:44

But it shouldn't be that hard, you know? And I think that the one week after I had my kid, I remember my twin sister calling me and she's like, what are you doing? I was like, oh, I'm baking a cake. And she's like, why? You have a one week old baby and you just gave birth. And I said, oh, because I want to take a photo with a cake with a one in it holding the baby like one week old. She goes, stop, stop right now. Stop whatever you're doing and just sit down. Like if your baby is sleeping or not nursing or not on you or not crying, like just

Sameena Rahman (: 12:55

Yeah.

Sameena Rahman (: 13:03

Yeah.

Sameena Rahman (: 13:08

Yeah.

Sameena Rahman (: 13:13

Go to sleep. Go to sleep.

Dr. Sara Reardon (: 13:14

chill. And it was like we have these expectations to show up in all of these ways and make it look cute and fun and pretty, but it's not. It's ugly and hard and exhausting. And I think as kind of tricky as social media can be, what it has done is it has amplified some of these authentic views of what motherhood and postpartum can look like, which it does help women feel less alone in that experience.

Sameena Rahman (: 13:38

Yeah, absolutely. Because I think if you're just stuck with looking at the magazines and these women looking amazing, these actresses who probably have a team of people helping them look amazing, it's not something that's not realistic.

Dr. Sara Reardon (: 13:51

And it's not fair. I'm like nobody's looking at my husband being like, what is he wearing? You know? Like, I mean like what are his abs look like? You know? And I'm like get off me. Like this is unfair. And even now, I mean I've got a 10 year old kid and I'm like my body is a different body. And I am not one of those women that says like I love my body. Like I miss the way my breasts used to look and I miss the way my skin used to look.

Sameena Rahman (: 13:55

Yeah.

Yeah, yeah.

Sameena Rahman (: 14:12

Yeah.

Dr. Sara Reardon (: 14:16

But it's a different life now and I love my life. I love my family. I love my job. I would not trade anything for where I am. But I think it is just kind of taking that pressure off of women and mothers to just always feeling like we have to do everything the very best when we're just like, just trying to get by some days.

Sameena Rahman (: 14:19

Yes.

Sameena Rahman (: 14:35

Yeah.

Yeah, absolutely. Well, let's talk a little bit about the pelvic floor and what really what's your passion around the pelvic floor is, what do you do in that recovery period? What kind of recommendations? As someone who treats so much sexual pain, I see people over Kegel all the time and it's like, we have this joke at issue, is it to Kegel or not to Kegel? Kegel is not the answer to everything and it actually can make sexual pain so much worse and all the things.

Dr. Sara Reardon (: 15:02

Not at all.

Sameena Rahman (: 15:05

So let's talk to me a little bit about the recovery period in the postpartum with regard to the pelvic floor, because we kind talked about some of the other issues, and then we can dive into a little bit of bowel and bladder function.

Dr. Sara Reardon (: 15:17

So your pelvic floor is a basket of muscles that sit at the base of the pelvis and they support your bladder, which holds urine, your balls, which holds stool, and a growing, you know, your uterus during pregnancy, which supports a growing baby. So during pregnancy itself, your pelvic floor is stretching, lengthening, and changing. If you think about, you know, a hammock holding up an avocado in the early stages of pregnancy, there's not that much change. But, you know, at the end of pregnancy, that hammock is holding a watermelon.

And that means the hammock is going to be stretched out. It's going to be not as supportive. It's going to be weaker. And that's what happens to your pelvic floor during pregnancy. So regardless of which method of birth you have, whether it's a cesarean birth or a vaginal birth, you can experience pelvic floor changes, which can lead to prolapse, hemorrhoids, vulvar varicosities, urinary incontinence, kind of a lot of weakness related issues and also abdominal separation.

Sameena Rahman (: 16:09

And I love that point before you go on, because I feel like, you know, when I was, when I was actively delivering, you know, we have the data that shows that like, you know, and the MRI findings that like the pelvic floor changes, no matter what your mode of delivery is, but people have the stigma in their head that they don't want to ruin their vagina or mess up intercourse or, know, have all these issues that come up. I don't want to become incontinent. So can I have a C-section? I remember these asks that I used to have, but I'm glad you emphasize it's just the fact that you're holding that much weight.

Dr. Sara Reardon (: 16:21

Right, exactly.

Sameena Rahman (: 16:39

And it's similar for women that like become like, you know, gain all this weight from obesity. I mean, I have patients that have never carried any children and have severe pelvic floor dysfunction related to just the increase in that abdominal pressure.

Dr. Sara Reardon (: 16:43

Yes.

Dr. Sara Reardon (: 16:48

Correct.

Dr. Sara Reardon (: 16:53

Absolutely, you're so right. And so, and I say that not to scare women, but to say like, hey, no matter which way you birth, you should be seeing a pelvic floor therapist after giving birth. So we do help and then we, you know, postpartum, depending on what type of birth you have, we usually ask women to check in with us around six weeks postpartum, but you can absolutely see them sooner. We just hold off on doing any intravaginal examinations until six weeks when we've gotten clearance from a medical provider. And in that six week visit, we work, we assess like how well are your pelvic floor muscles contracting?

Sameena Rahman (: 16:56

Yes, yes, absolutely.

Dr. Sara Reardon (: 17:23

How well are they relaxing? Is there any scar tissue? Are you still healing? What do your abdominal muscles look like? Are they weak, separated? How does your scar look? A lot of it is kind of reevaluating your body and saying, where should we start with rehab? mean, just like you go get a surgery and get your knee replaced, for that surgery, you see a physical therapist day one in the hospital and then ongoing, you know, for months after a knee surgery.

you're giving birth, your hormones are still changing, so the idea is to help you recover. You pushed out a human and, you know, studies show that your pelvic floor function is less than 50 % at six weeks postpartum. So at six weeks postpartum when women are getting advice to go back to exercise, go back to sex, their pelvic floor is functioning at less than half capacity. And I think that's why we're seeing a lot of long-term issues in women with respect to prolapse and urinary leakage and hemorrhoids and…

Sameena Rahman (: 17:53

It's just out of human, potentially.

Sameena Rahman (: 18:01

Yeah.

Dr. Sara Reardon (: 18:19

diastasis recti because they're not getting recovery. They're not helping build the foundation of their body back after this huge physical transformation. And, you know, there are things that can commonly pop up are, as you mentioned, urinary incontinence, pain with sex, pain with sex, incomplete bladder emptying, painful periods, and constipation are more common with cesarean bursts than vaginal bursts. But with vaginal bursts, we tend to see more urinary incontinence and pelvic organ prolapse.

The point being is that everyone needs this rehab. We see women for a six week postpartum checkup. We start them on exercises for strengthening or relaxation and then kind of help them get back to their normal function of exercise, sex, working, know, day to day mom life.

Sameena Rahman (: 19:03

Yep.

And I think those are so important to remember. just to remind patients, I've talked about this on other podcasts, is like, you know, when women are lactating, their hormones are so impacted that it creates a genital urinary syndrome of lactation is what we're calling it now. And it's so, it's just analogous to what happens to women in menopause with that estrogen deficiency. So to your point, the muscles then get even worse. They get worse impact because of the patients that end up lactating, not to pressure people to lactate or not to

Dr. Sara Reardon (: 19:14

Yes.

Dr. Sara Reardon (: 19:18

Yep.

Sameena Rahman (: 19:34

you know, but it does.

Dr. Sara Reardon (: 19:35

Right, and I think you're so right. kind of, but I think the thing is that women deserve this information. Like if you know that you may, it may take longer time for your pelvic floor muscles to recover, that you're going to have some vaginal dryness due to low estrogen levels, that your diastasis, your core could be a little bit more compromised. Like I think then we let them make the decisions. I'm a long-term breast feeder and so I bet, I mean, I was like, my kids were almost shaving and they were still breastfeeding. know, looking back, I'm like, why did I do that so long?

Sameena Rahman (: 19:59

That's me. That's me. That's me now.

Dr. Sara Reardon (: 20:02

I know, but it's one of those things, like I knew I was going to have dryness and I knew to use lubricant during intercourse and I knew to kind of minimize my higher impact activities until my pelvic floor strength came back. And one of the reasons I love being in this field is because I love understanding my body and feeling very informed about the physical changes with pregnancy and birth, but everyone deserves that information. It shouldn't just be you and me who kind of were lucky enough to pick these fields. And so I think it's one of those things that like, you know.

Sameena Rahman (: 20:27

Yes.

Dr. Sara Reardon (: 20:31

one of the most popular posts that I have on Instagram is like, how to take your first poop postpartum. And women are saying, this is more painful than giving birth. And I'm like, well, why isn't every labor and delivery room have my instructions on how to poop? Right? So I'm like, that was part of it. So, you know, constipation is very common after birth and it's due to blood loss, dehydration, pain medication, lack of hydration and eating during labor.

Sameena Rahman (: 20:36

Yeah.

Sameena Rahman (: 20:40

It was, was. Can you review that by the way? love that.

Okay.

Dr. Sara Reardon (: 21:00

And so you can often be very constipated. So the first thing I tell a woman is take the stool softeners day one after giving birth. Like if you're in the hospital, ask for them. You need to super hydrate because if you're producing breast milk, you need more hydration. And if you've got blood loss, which every woman does, and then when you get the urge to have a bowel movement, go ahead and go, don't delay.

But put a stool or if you're in the hospital, I even tell people to use like a sideway garbage can, bring your own squatty potty or stool to the bathroom, and then support your perineum, which is the area between your vaginal opening and your anal opening. Kind of take toilet paper and hold that area up. It's very vulnerable. It's likely healing if you had a tear. And when you bear down to push your poop out, I want you to exhale instead of holding your breath. So I say, pretend like you're blowing out 50 birthday candles and hold your vagina up.

If you had a cesarean birth, take a towel roll or a pillow, place that over your tummy and do the same thing. Feet on the stool, exhale and blow out. Because you need to protect the surgical sites, the incision sites, kind of the vulnerable areas, which are your abs after a C-section or your pelvic floor after a vaginal birth. But the thing is, that

Every woman is going to poop after birth, but no one is getting this education. And so why is that not happening? I've had women pop stitches in their perineum because they've strained so much or get constipated for weeks because they're scared. And this is such practical advice. And one of the reasons I wrote my book, Florida, is because I'm like, every woman needs a guide. Like if you were pregnant, you go to the pregnancy chapter and read everything you should do. If you're

You know, you want to think about having a vaginal birth or C-section. Read all the tips on how to do that and prepare for it and recover. I don't want you to have to sit on the toilet and like doom scroll on my Instagram feed about how to find that video. I want you to have a place that you can go and find it.

Sameena Rahman (: 22:48

Yeah, that's wonderful. And let's talk a little bit about also, you know, the habits we build, you know, we're all, you know, because I even, like I have two girls and sometimes when I'm like, mom, I'm having all this and I'm like, you're clenching too much or, know, like I'm always talking to her about like, don't hold your, you know, your bladder for so long, you know, it's creating bad habits for you. Can we talk a little bit about like bladder irritants, bad...

habits and the squatty potty. Because I feel like these are things that you hear about. think the SNL just did. They had a little, did you see this like two weeks ago? SNL just did this thing where they had like, there was a squatty potty in somebody's house. I can't remember. It was like a funny joke about a squatty potty. So I'll send it to you later. Yeah.

Dr. Sara Reardon (: 23:25

No, I didn't.

Dr. Sara Reardon (: 23:35

It's probably my house. I have one in every bathroom. So there are some really important tips and habits I think that women and all individuals should know about. And one of the reasons you and I need to know about them as well is because we need to educate our kids. Because if they get better pelvic health education, then they can do better and minimize the risk of pelvic floor issues. So the first one is with urination or what we call voiding. So I often say don't delay the urge to go. So if you have the urge to go, go.

Don't go just in case either. So only go when you have the urge to go. If you're going just in case, every time you pass the bathroom, your bladder can actually shrink and then you feel like you have to go all of the time. And then it gets harder to hold the urge and puts you at risk for leakage. If you delay the urge to go, which a lot of kids do, or if you don't like peeing in public, then you over tighten your pelvic floor muscles and it makes it hard to relax once you're ready to empty. So go when you have the urge to go. When you do go to pee, sit down.

Try not to hover over the toilet unless it's like absolutely disgusting, but line it with toilet paper, wipe it off, but sit down because that helps your pelvic floor muscles relax. And then don't push when you pee. When you pee, your muscles should be relaxed and your bladder is a muscle that squeezes the urine out for you. So all you need to do is sit, lean forward and take some big deep breaths. I don't even care if the stream trickles out, just don't pee, don't push.

because that will weaken your pelvic floor over time. If you're peeing six to eight times a day, which is the normal range, and you're pushing every time, to your point, it doesn't mean giving birth will cause you to have pelvic floor weakness. It could just be peeing the wrong way for many, many years. That could lead to weakness and prolapse.

Sameena Rahman (: 25:16

Yeah. And so I think that that's what we have to do for so many women is kind of retrain, have them retrain how they do things. Right. Do you have a program that you use for retraining or you just outline?

Dr. Sara Reardon (: 25:23

Right.

Dr. Sara Reardon (: 25:26

Yeah, I mean, I have an online exercise and education platform called The ViHive, which I started back kind of right after COVID when a lot of women who were pregnant and postpartum didn't want to go in to see their doctors or they didn't have childbirth education classes. So I started these pregnancy and postpartum like pelvic floor programs so that women could have this information. They could work out at home. They could prepare for birth and recovery. And then I expanded it to include painful sex, perimenopause and menopause, post-surgical recovery.

Because again, I just really want to make this accessible and nothing replaces in-person therapy with a pelvic floor therapist, but a lot of women don't have access to that. It can be costly. It can be out of network with insurances. You may not have one in your area. The wait list could be really long. And so I think it's really important to give women this education very early to prevent issues or start overcoming them if they already experience them. So you mentioned the squatty potty earlier though. And so that's really something we use a lot for bowel movements and pooping.

So again, for bowel movements, you can push, you can kind of push and bear down to empty your stool, but I recommend exhaling as you do it, so not holding your breath. But then putting a little step stool or kind of the name brand is a squatty potty underneath your feet lifts your knees up and that puts you in more of a squatting position. And that's the best way to relax your pelvic floor muscles to poop. So I even do this for my kids. Like instead of having their little feet dangle off the edge of the toilet, I put a stool under their feet so their feet can

hit the ground or hit the stool, then they can lean forward and then to push. Because if you tell a kid like push, they're like, I don't know how to do that. So I keep one of those little twirly straws that you get from birthday parties at kids birthday parties in the bathroom and I just tell them to blow through the straw. And that helps their pelvic floor muscles like push open, they're breathing out, their feet on the stool. And again, then if we educate kids on how to do this, constipation is one of the most common GI complaints for children. So if we can educate them on this stuff early, then it just like...

Sameena Rahman (: 27:09

swear to God.

Sameena Rahman (: 27:21

Yep.

Dr. Sara Reardon (: 27:24

then they don't become adults who have been struggling with these issues for years.

Sameena Rahman (: 27:27

Absolutely. Well, that's, those are really good points actually. Talking about some other things like to kegel or not to kegel. Let's talk about that because people are over keeling. Some people don't know what a real kegel is. So let's talk about who he was and let's talk about, and that whole thing.

Dr. Sara Reardon (: 27:40

Yes. Yeah.

Dr. Sara Reardon (: 27:46

So, Arnold Kegel was a gynecologist and then I think it was the 1970s who did a research study on assessing pelvic floor muscle strength, so how well a woman could squeeze her vagina postpartum and that he could name that squeeze, that contraction of the pelvic floor muscles a Kegel after himself. There are a lot of things about female, like they all do. There are so many like body parts in the female genitalia named after men and it's like let's do a rebrand here.

Sameena Rahman (: 28:03

Like they all do. Like they all do.

it's me. Yeah, exactly.

Dr. Sara Reardon (: 28:15

Unfortunately, the only thing we've ever heard about the pelvic floor is like, just do Kegels, tailbone pain, Kegels, painful sex, Kegels, better sex, Kegels, leakage, Kegels. A Kegel is just a pelvic floor contraction. It's closing the urinary sphincters. It's kind of lifting up those muscles. So it's like saying, you have back pain, just do a bunch of crunches. Like the care for your pelvic floor is much more nuanced than just tighten your vagina a whole bunch of times.

Sameena Rahman (: 28:20

Yeah. Yeah. Yeah. Yeah. Yeah.

Sameena Rahman (: 28:40

Yeah.

Dr. Sara Reardon (: 28:41

So if you do have pelvic floor weakness, which I have a whole checklist in my book about kind of how to run through different symptoms or different, even how to self-evaluate yourself to see if you have weakness or tension. If you have pelvic floor weakness, a Kegel or pelvic floor contraction, it would be a great place to start, but there's quick Kegels, there's longer hold endurance Kegels. You need to do these contractions in different positions. You need to make sure you're relaxing afterwards as well.

and you need to pull them into function when you're lifting weights, before a cough or a sneeze, things like that. But many women have pelvic floor tension. And if you have pelvic floor tension, a Kegel is the opposite of what you'd want to do. We often see pelvic floor tension with things like hard time starting your bladder, straining with bowel movements, painful intercourse, tailbone pain, hip pain, low back pain. I mean, it's like, we're also just living a really...

kind of upregulated anxious society. So I mean, like we're walking around clenching our butts all day and... But I'm like, my gosh, like I find myself, I'm like, okay, Sarah, relax your butt. Like you're just sitting in the carpool lane here. But it's one of those things I think that if you are told to do Kegels and you have tension, you're making your problem worse.

Sameena Rahman (: 29:39

I I always say if you're not clenching, then you're not paying attention.

Sameena Rahman (: 29:48

Yeah, yeah, yeah.

Dr. Sara Reardon (: 30:00

But unfortunately, so many women think that that's the only solution is to tighten, but it's not. You have to work on relaxation with breathing, posture, stretching. You know, a lot of these things that are just, and again, like learning how to just relax your pelvic floor because we're never taught to. So I often say it's not even a retraining, it's a training because we've never even been taught the first time of how to connect with this part of our body.

Sameena Rahman (: 30:19

question.

Yeah, absolutely, I love that. Tell me, what are your, there's so many devices out nowadays for the pelvic floor. feel like everyone's trying, I'm always like, these are not replacements for therapy, but what do you like, what do you like in terms of what's out there?

Dr. Sara Reardon (: 30:34

I love that, you're so right.

Dr. Sara Reardon (: 30:38

So I think that there is a place for vulva care with respect to moisturizers and lotion. So I am a fan of, especially for postpartum women, lactating women, perimenopausal and menopausal. I often see it in young women too who are on hormonal birth control. They can have like dryness, sensitivity, irritation.

Sameena Rahman (: 30:57

We call it hormonally mediated vestibulodinia, where they have it. Yeah.

Dr. Sara Reardon (: 31:01

Okay, yes, and it's due to kind of birth control. But this is one of the things, and like if you put a young woman on birth control, we should be telling them if these symptoms arise, you start having dry anus, painful set, like then they know that this could be a side effect and then they can get treatment. So, vulva bombs, my favorite one is by Medicine Mama. It's like an organic olive oil based bomb, but you know, there's one called Kindra, there's one by Diva, there's one by Stripes, kind of a…

Sameena Rahman (: 31:09

Absolutely.

Exactly. Yeah.

Sameena Rahman (: 31:26

Yeah.

Dr. Sara Reardon (: 31:28

pH balancing vulva moisturizer that you could use every day. I'm also a huge fan of working with a guy.

Sameena Rahman (: 31:31

Yep. Yeah. I have to say though, as a GYN who specialized in menopausal sex, like nothing replaces vaginal estrogen or... Okay, sorry. I was like, wait, wait, wait. Those are great, but nothing replaces... Yeah. Okay.

Dr. Sara Reardon (: 31:40

That was my next comment. was going to say, I'm also a huge fan of working with… No, no, no. So this is just the most… I was thinking more over the counter, but yeah, the other thing I often recommend to women is to use a topical estrogen cream because nothing does replace it. mean, with certain times in our life or with perimenopause and menopause, the tissues of the vulva vagina and the pelvic floor muscles then get thin, weak, dry. They're less supportive. They're less comfortable.

The topical estrogen cream is such an easy way to plump up those tissues, increase pelvic floor muscle tone, but it's also not the only solution. there's so much wonderful conversation about hormone use right now, but the hormone use doesn't replace pelvic floor training. So it really has to be hand in hand. And I think that that's a missing piece I see is that we can help promote blood flow and lubrication to the area and plumping the tissues, but you have to be strengthening as well.

Sameena Rahman (: 32:24

Sure, it's hand in hand.

Sameena Rahman (: 32:36

Absolutely. Absolutely.

Dr. Sara Reardon (: 32:37

The urinary sphincter loses 2 % of its strength every year after menopause and vaginal estrogen is not going to improve that. So you have to be doing a combination of both. I also, there are some internal Kegel devices. So those, think that they're a great place to start for some women who feel like they don't know how to do a contraction or relax properly. It's like a little device, almost like a large tampon you insert in the vagina. It hooks up to an app on your phone via Bluetooth.

Sameena Rahman (: 32:41

Yeah.

Sameena Rahman (: 32:50

That's what we're going do.

Dr. Sara Reardon (: 33:06

and it shows you what your pelvic muscles are doing. It's a great way to start. You don't have to have it. The research shows that there's no benefit from doing active exercise versus using a trainer, but it does help a lot of women kind of get started. But eventually you want to be able to exercise without it because you want to do these contractions with, again, weight lifting, with lifting your kids, with coughing or sneezing, but it's a great place to start. The things I'm not huge fans are of like these vibrating chairs that are in doctor's offices.

I think things like that are just really have short-term effectiveness and they're very costly and they're like promised 20,000 Kegels in 30 minutes and I'm like, you don't need to do 20,000 Kegels and throw them out. right. That's what I'm saying is that it could actually be causing another type of dysfunction. So we're not really training the muscle. We're just like hyper stimulating it and saying like come back in three weeks. And I just don't think that that's long-term effective care. There is no quick fix to these issues, but there are fixes.

Sameena Rahman (: 33:40

Exactly.

Sameena Rahman (: 33:45

You don't need to, like, you'll be seeing me for sexual dysfunction.

Dr. Sara Reardon (: 34:05

things that can help improve your quality of life, improve your pelvic floor muscles, help you reach your goals, but they do require some maintenance and some effort.

Sameena Rahman (: 34:15

I tell, because I treat a lot of agonism and sexual pain in my office. And so I tell my patients, you got to do the work though. You got to do the dilator work. You've got to come see my therapist twice a week. Like this has to get done. mean, I can't, like I can put Botox in your vagina, but you have to do the work after. that, those muscles have to be worked on with you and the health therapist. And so I feel like that's.

Dr. Sara Reardon (: 34:22

You do have to do the work.

Dr. Sara Reardon (: 34:30

Right.

Dr. Sara Reardon (: 34:37

You're right. And the way that you're practicing is really the ideal way because you're setting them up for long-term success. Like I see patients who they have Botox in their pelvic floor muscles and I'm like, well, they never got rehab after. That Botox wears off. They never learned how to breathe, how to stretch, how to engage, relax their muscles. mean, there just was no training. And so the effects of that are very short-term and then they feel like, it didn't work. I'm like, no, it's not that it didn't work. It did what it was supposed to do, but there's no kind of support.

Sameena Rahman (: 34:50

Exactly.

Sameena Rahman (: 35:05

Yeah.

Dr. Sara Reardon (: 35:07

from an ongoing pelvic floor training perspective. And I think a lot of what we do as therapists and even in my book, Florida's, we give you tips and tools for home. I mean, this is like, it should be like brushing and flossing your teeth. You see us for tune-ups, you kind of get something fixed, but you've got strategies and tools at home to help you long-term.

Sameena Rahman (: 35:09

Excellent.

Sameena Rahman (: 35:24

Absolutely, I love that. Okay, two other questions I want to ask. to be causing it every time. One is around, you know, the other issue I see in my office when I have my post, when I see for trimester patients is really that diastasis recti, right? So annoying for patients. Tell me what you do as a therapist to aid in that.

Dr. Sara Reardon (: 35:42

So diastasis recti is kind of a thinning of the midline of the six pack abs. And so obviously as you're pregnant, your belly stretches, that tissue between the middle of your abs gets really stretched and thin. And sometimes it can't support all the pressure that you're putting on it. So if you were getting out of bed during pregnancy or after giving birth and you see like a doming or a coning, or even like it looks like an alien kind of coming out of the middle of your tummy, or if you're like leaning back in your car or in a chair and you see that, that means that there's too much pressure on those tissues.

And it's very connected to your pelvic floor and it's something I addressed in the book as well because when you do pelvic floor training, your deep abdominal wall muscles that bring that back together and help stiffen it, it contracts with the pelvic floor contraction. So when I'm doing pelvic floor training, I'm teaching people to turn on their deep abs as well and vice versa. And there's actually been some research that women who have a diastasis also often have a high percentage pelvic floor dysfunction because they're not,

The pelvic floor is part of the core, just like your abs. And if one part of that canister isn't working well, then the whole canister can get affected. And so learning how to engage those deep abdominal wall muscles, strengthen them, feel comfortable and confident going back to exercise because you're like, well, what can I do? What can I not do? I'm really scared. But I don't want you to be scared of exercise. I want you to feel like I just know how to assess it. So you assess for that deep kind of weakness.

lack of tension or that coning or doming to know like, that's, you know, a double leg lift is probably too much for me. Let me just go to a single leg lift, keep working there, and as the muscles and tissues get stronger, then I can progress. I think it's just one of those things that, you know, it's really defeating as a woman that you give birth to your baby and you're like, why do I still look pregnant? And we haven't really rehabbed those muscles the way that they need to be supported. And some women go on to have surgery, which is a totally fine option.

I typically encourage them to wait until they're done breastfeeding or pumping until they're a year postpartum and that they're not planning to have any more babies. So that's a point where I say, okay, let's investigate surgery. Let's do training before to teach you how to use these muscles and what positions and postures and movements to avoid or modify. And then let me see you afterwards, retrain your abs after surgery, make sure that everything's functioning properly. And we've had patients get great results.

Sameena Rahman (: 38:03

Wonderful. Okay. then finally, if you so sometimes, you know, patients self refer themselves to help or therapists, right? They think they need to help. What do do when a patient feels like or what what have you told patients like they come to you that they don't know what to do about their condition? You're helping them. How do you allow patients to or what do do to tell patients to advocate for themselves? Like how do they? Both any all of them.

Dr. Sara Reardon (: 38:26

with physicians or other medical providers? Yeah, you know, it's interesting because a lot of patients do come in to see us directly. I would say most of our patients come in to see us directly. And I would love it to be a bit more of a mix that more medical providers were referring directly to us because it just makes it much more collaborative in their care. But, you know, I would say in my city where I've worked, in every city where I've worked, I have great relationships with physicians. So if I have a patient coming in and they have prolapse,

and we do some training, some training, say, you you really need to go see a urogynecologist. I have a great one that I work closely with and they may fit her for a pessary or they may say, let's monitor for now. They'll do like a urethra bulking agent and then we're still doing training. And then if they do have surgery, they see me before and they see me after. you know, I think it's, I feel lucky because I think sometimes like pelvic floor therapists, we have, we know the physicians who are really collaborative and supportive and won't be dismissive.

And so those are the ones that I tend to refer to. And I think it just really offers the most comprehensive care to the patients. But there are also doctors who are like, you're wrong. And I'm like, that's fine. Like we can have differences of opinions, but I'm still gonna, if there's a pelvic floor muscle issue, I'm gonna treat the patient. But we also have patients come in, like, I don't think this is a pelvic floor muscle problem. Like everything's checking out.

Sameena Rahman (: 39:44

Right.

Dr. Sara Reardon (: 39:44

you need to go see a medical provider, a urologist, a sexual medicine specialist, a pelvic clean specialist if you haven't yet. you know, we really work to find the right providers for our patients. And if it's not a pelvic for PT, like I'm not going to keep issue, I'm not going to keep seeing them. But we often need to pull in other medical providers for, like you said, Botox, injections, medications, topical estrogen cream, everything. Like it's very collaborative the way that we'd like to practice.

Sameena Rahman (: 39:58

Sure.

Sameena Rahman (: 40:10

Right, I agree. I think, you know, a great multidisciplinary team is really, you know, the clinician with the pelvic floor therapist and in the psych, you know, someone from doing cognitive behavioral therapy or some other sex therapy if it's a sexual issue. So I feel like that's a dream team kind of approach. So really.

Dr. Sara Reardon (: 40:30

It is. It really is.

Sameena Rahman (: 40:32

Yeah, helping the patient the most. But anyway, I really appreciate you being on, Sarah. This has been great. I just want to be cognizant of your time, like I said. So I'm going to put in the show notes where everyone can find you. What do you think are your best floored pieces of information you want people to know? What were you most floored about when it came to the pelvic floor?

Dr. Sara Reardon (: 40:54

I mean, it was almost depressing. was like, how terrible these issues are, you know? No, really, I think, you when I wrote Floored, it was really a way to kind of pour into what I've been practicing for over 18 years. There's some really amazing patient stories in there that I think will help women feel less alone. I go through every age and stage. So I go through everything from periods to starting to have sex to pregnancy, childbirth, postpartum, menopause, pelvic pain, because I think women don't even know that

Some women don't even know they have a pelvic floor, and if they do, they don't realize that their pelvic floor needs different things at different life stages. And so I really want to help encourage them to kind of learn what they need to know proactively, and if they're experiencing issues, what they can start doing right now. And I think every stage of a woman's life, we need to have these tips and tools because we do go through so many transitions, whether it's birth or menopause, but even just monthly during our menstrual cycles, we go through hormonal transitions that affect our pelvic floor.

And so I just really hope that we can start helping women sooner. And I also want women to know that it's never too late. You I think that we see women sometimes 60s, 70s, and they're like, oh, I'm past that. I'm like, no, if you're having issues, it is never too late to get help. I've worked with many women and they've gotten amazing relief and they're able to live like really healthy, fulfilling lives without worrying about leakage or pain. And so that's really my goal of this. And also I think to your point to help educate medical providers, I think that

Sameena Rahman (: 42:02

you

Right. Yeah.

Sameena Rahman (: 42:19

Absolutely.

Dr. Sara Reardon (: 42:19

know, in residency programs and fellowship programs, they just don't have that pelvic health education. So it's a great way to kind of start learning about the pelvic floor, to understand what a pelvic floor muscle exam is, and then also what your patients can expect when they go to therapy.

Sameena Rahman (: 42:34

Absolutely. Well, that's wonderful. I love the book. I love what you're doing and I love all the educating that you're doing. So I appreciate coming on today and I can't wait to meet you in person. You know, hopefully when you come to Chicago, otherwise, hopefully at Ishwish or something. yeah, of course. Thanks for joining me today, guys, for another episode of Gyno Girl Presents Sex, Drugs and Hormones. Remember, I'm here to educate so you could advocate for yourself. Please join me next week for another episode.

Dr. Sara Reardon (: 42:44

Hopefully in Chicago, absolutely. So thank you so much for having me.

Sameena Rahman (: 43:03

Yay!