Natalie Gross 0:01
Your baby does something hilarious and you start to laugh. But wait, but a little pee just come out. And is that normal? If you're experiencing issues with leaking or bladder control in general as opposed part of mom, you are not alone. So what causes this? Is it common? And what type of help is available to you? Those answers and more on this episode of Newbies!

Natalie Gross 0:29
Welcome to Newbies everyone! Newbies is your online on the go support group guiding new moms through their baby's first year. I'm Natalie Gross. I have a four year old boy and a baby girl. And we've got a great show today talking about bladder control, or lack thereof, and pelvic floor health after giving birth. I actually have the honor of having our executive producer and new mommy media owner on with me today. Sunny Gault has a lot of experience with this topic. And she's going to be sharing her story with all of you. So Sunny, since you're here before you want to get started. You want to talk about Mighty Moms for our listeners.

Sunny Gault 1:26
Yes. All right. So Mighty Moms you guys is our online community. And we just relaunched it, we revamped everything, made it completely free for you guys. And this is where you can continue the great conversations that we start here on newbies and all of our other podcasts. Because we actually have four other shows in addition to Newbies that we produce, and it covers everything from pregnancy and breastfeeding to having toddlers and of course, everything that we talked about here on Newbies, we also have a show that's focused on twins. So if you guys want to continue those conversations, learn about our upcoming recordings, and actually be part of these podcasts. And just have some fun with other moms in your community. You can check out Mighty Moms, you can go to our website, which is https://new mommymedia.com. And we have a couple banners on the homepage, but click one of the Mighty Mom's banners. That's the easiest way to get there. And we hope to see you online soon.

Natalie Gross 2:20
Yeah, absolutely. And you also have some wind down events, right where you drink some wine just to have some mom chats right?

Sunny Gault 2:27
Yes. Yeah. So this is a new thing for us to it's starting this month. So as of this recording, we're recording in July. So at the end of the month, we ask our Mighty Moms, all the people that have signed up and are part of our community, if you want to join us for a zoom, if you want to grab a drink, depending on where you're at, with having kids being pregnant, you know, obviously make wise choices. beverage and hop on a zoom call with us. We just want to get to know you a little bit better and chat as moms and have a good time.

Natalie Gross 2:58
Yes, absolutely. Come join us. All right, so let's talk bladder control after giving birth, what's normal, what's not. So joining us in this virtual studio today is Laura Chambers. She's a doctor of physical therapy and owner of Peak Wellness in Tennessee. Is that right, Laura? Yes, that's right. All right. So please tell us a little bit more about you as a professional and as a mom and share your story. And then Sunny, if you want to formally introduce yourself to our listeners when she's done, that'd be great, too.

Laura Chambers 3:25
Okay, yes. So as you said, I'm a Doctor of Physical Therapy. I have been a PT for 14 years now, the first 10 years of my career, I really focused on orthopedics, got a clinical specialization as an orthopedic physical therapist, and then met my husband slightly later in life than the average. And as we started talking about having a family, my interests started shifting. I am from a really small town, and we don't always have the same medical resources as big towns. And I felt like I was pretty high level in my career. I'd started in DC, I had a lot of resources, I knew a lot of stuff, and I moved back home. And I really wanted to bring those high level resources home. But I feel like most towns you can kind of throw a rock and hit about three physical therapy places at this point. You know, this is pretty saturated, which is wonderful. Of course, I believe a lot in physical therapy, but we had no pelvic health in our really region to be honest. And so as we started talking about family, I started shifting into pelvic health being a area of specialization for me. And so I started our first pelvic health program in our county and saw anything men and women in continents, sexual pain, lots of different things. And then the beginning of this year in 2023, I made a big change because I was a young mom I have at this point a three and a five year old and I love supporting moms. I love the the changes that the human body goes through to carry a baby, to conceive a baby, to deliver that baby, and then the support of a mom after that, because I know what it feels like to be a new mom. And everything is so confusing. But the hard thing for me was when I was in the clinic, I never saw moms because what mom has an extra hour of childcare on their hands one to three times a week to come see me for six weeks. So they're not coming into the clinic. So I made a change because I wanted to support this group, and I wanted to bring it to them where they are. So I started an online platform. And so I worked specifically with postpartum women, anywhere from eight weeks postpartum, two decades postpartum who have incontinence related issues, or pelvic organ prolapse related issues. My programs are all online. They're 100% supported by me, so I'm there you can text me questions, you can video chat with me, you can video message me. And then I can support women as conveniently as possible to their lives in what is such a busy phase of life. So that's my professional world. Again, I'm a mom of a three and a five year old stepmom of an 11 year old and outside of that professional niche. I really love fitness. And I also love teaching others how to love exercise. One of my main mottos in my business is when mom feels strong, she shows up for everything else in her life with more strength, and so outside of helping her feel strong because she no longer pees on herself. If she doesn't know how to start a fitness routine, I want to help her get there too. And that's really kind of my passion in life.

Natalie Gross 6:25
That's amazing. I love that. Laura, thanks for being here and sharing that with us.

Laura Chambers 6:29
Absolutely. I'm so excited.

Natalie Gross 6:32
All right, Sunny. What about you?

Sunny Gault 6:33
Yeah. Well, Laura, I'm so excited to talk to you today. You sound like you have such experience. And I'm sitting here in my workout clothes. I'm feeling really empowered right now by your workout speech as well. Alright, hey, everybody, I'm Sunny again. And I have four kids. And boy, my my journey through bladder leakage. And all this kind of stuff started with my firstborn, who this month is turning 13 years old. I can't believe that again. He's my oldest. And you know, I'll tell you more about my story, I'm sure throughout today's show, but yeah, it's been a while right. And I've been through a lot with it. It happened immediately after his birth or during his birth. And so he's 13 My oldest and then I have another boy who is 11 now and then I have twin girls who are nine. So that's a little bit about my mommy journey.

Natalie Gross 7:28
Okay, well go ahead and talk about your experience with leaking your bladder control, if you don't mind.

Sunny Gault 7:30
Okay, sure. So never had any problems, you know, growing up or anything prior to the birth of my first son, everything was fine. I had a great pregnancy with him. He was a little bit bigger than my other kids. Obviously, I didn't know that at the time. It was my first and I didn't know how big babies were supposed to be. But he ended up being about nine and a half pounds. When he came out. He was a vaginal birth. And I had an epidural, I was in a hospital setting. Actually, he came pretty much right on time, a few days after my due date, and everything was going really well. Overall, I can't remember exactly how many hours I was in labor. But it was a good experience. Like I was actually once I had that epidural, I was like, I was feeling good, I was able to really enjoy the whole experience I was really excited for my son to come out it was excited to push and all that kind of stuff. So what happened in my situation is because I had the epidural, I also had a catheter. And I don't know if you guys know a lot about catheters, but at least the type of catheter that I have, I don't know if they're all the same, but they kind of have a ball at the end of it so that it doesn't come out of your body right so if you push or do something like that it's supposed to stay in your body and not come out because if you have an epidural you can't get up and go to the bathroom. And so we were at the end of the delivery for my son it was time to really you know bear down and push and so I'm pushing and you know when you have an epidural you can't really feel everything that's going on down there you feel pressure, but I'm mainly just going based on what the doctor is telling me right I can't feel pain I can't feel tearing which I did have what a second degree tear afterward or something like that. But you can't feel that kind of stuff when you're pushing. And so I I pushed my son out and everything seemed great probably one of the best experiences of my life if you have never pushed out a child that way. I highly recommend it it's exhilarating amazing and there I was of a first time mom holding my son and everything was great and we delivered the placenta everything went smoothly from what I could tell fabulous experience Okay, so they take me in postpartum and over the next course of I'm not even sure a few hours or whatever. I'm not sure how long it took for the epidural to wear off I you know would need to have to go the bathroom or what Ever but I had zero control over my urine, like it would just come out, I wouldn't even feel a sense of, oh, I have to go to the bathroom, let me run because the bathroom was like right next to my bed. But I, you know, it was happening so fast, it was a completely different experience. And I tried to tell some of the nurses, the postpartum nurses about it. And they said, Oh, don't worry, just had a baby, not a big deal. And so I really didn't think much of it. And then my mom came in and you know, I think this may have even been the next day, you know, they were just telling me, Don't worry about it. You just had a baby. And again, first time I had a baby, okay? I'm just going based on what they're telling me. So my mom comes on, I believe it was the next day. And she's like, how you do it. And so I'm talking her, I'm like, I have no control over my bladder, like no control. And she's like, that's not normal. And I'm like, Well, I'm trying to tell people about this. But nobody is really listening to me, they're just telling me, hey, you just had a baby. You know, that's it, I tried to talk to the doctor who actually helped me deliver my child, and she did pay more attention to it. But the way the system, you know, I'm part of a large medical group, right. So the way the system is kind of set up is you don't really always see your main doctor. And so I was talking to a lot of different people. And there wasn't a lot of consistency in the support that I was getting. So it was after a couple days or whatever, I still, I mean, I literally was just wearing diapers, that's it. I mean, they gave me depends, I was pretty much just wearing diapers and hoping it would kind of fix itself or whatever. And they sent me home my son was, by the way, I mean, he was fantastic. Nothing wrong with my child, nothing wrong. Like I said, with the entire birth that I was aware of while it was happening, and took my son home and there was just no improvement. And at that point, you know, a couple days later, if you are sitting in you know, if you've got depends on or whatever, and your body is just sitting in urine constantly, it starts to really hurt, you know, it agitated. And so I started to get into a lot of pain simply because of, you know, the nature of the situation. And no one would really believe me that I couldn't hold anything in like there. It was just coming out the moment, you know, it was ready to come out. There was no control over whatsoever. And so I started the process I finally got in, I bugged him bugged it bugged my medical group, and finally someone would see me you know, like, it was, I don't know, maybe five or six days after birth, because usually they don't want to see you for like six weeks. So like, Okay, well, you know, come and see us. And I'm like, no, no, no, no, no, this is not normal. I need to come in and see someone. And all I will say is, the person that I saw was pretty much dumbfounded when when I came in. First of all, they wanted a sample. They're like, Here, give us a urine sample. I'm like, I don't think you understand. I can't gather enough urine to actually give you a sample. And yeah, she she looked at me, she's like, I've never seen a case like this before my life. Now this is not something you want to hear when you're 32 years old or whatever, I only think I was 32. I think that was with my my girls. I was 32. So maybe 28 or something, this is not what you want to hear, you know, you don't want to be one of those case studies. But long story short, I was I ended up having multiple surgeries, um, still didn't quite fix the issue, but it allowed me to get out of depends. And I, you know, just got a lot of treatment for it. I live in the San Diego area. So we had quite a robust uro gynecology department at the medical group that I belong to. So I did have someone that supposedly specialized in this, but it was a lot of heartache. A lot of embarrassment. And we're 13 years later, and it's something I still struggle with on a daily basis.

Natalie Gross 13:51
Hmm, yeah. Wow. So me, thank you so much for sharing that. Oh, my goodness.

Sunny Gault 13:56
That's crazy. Yeah. And I also want to say this is not typical guys. So I don't want to scare people out there. Like, oh my god, I'm never gonna have a baby, if I can't control my bladder. You know, everybody's body is a little bit different. But that's why I'm passionate about talking about this stuff. Because you just never know what's going to happen. And I think, you know, being prepared for something like this. There are certain things that I definitely wish I knew, and I'm sure we'll get into that as the episode goes along today.

Natalie Gross 14:23
Absolutely. So they said it was related to the catheter or like, how does that play into?

Sunny Gault 14:28
Oh, yeah. 100%. Yeah, related to the catheter. So basically, when I was pushing, actually, the doctor said at the time, and again, I didn't know this was unusual, but she's like, I can actually see the catheter coming out. And I'm going, okay, is that a bad thing that but later on, is when I learned Oh, there is a ball and if you can see the ball, that's bad. It's basically shredding the opening. Because it's not supposed to be coming out. But when you're pushing, I'm trying to push a baby out of my body. Right? Right. I'm not worried about a catheter, you know, I'm just trying to get the baby out and the catheter. I mean, it didn't come completely out. But the fact that she could see a large portion of it. Yeah, we knew right away what caused it.

Natalie Gross 15:13
Wow.

Laura Chambers 15:14
Yeah. What type of? You said you've had a couple of surgeries? Do you mind to describe what what they've done in the surgery?

Sunny Gault 15:20
Yeah, totally. So it was the you guys are probably seeing this on TV, all the lawsuits for the vaginal mesh slings, right. So I had a sling put in which was supposed to elevate essentially, the urethra I don't know all the technical, you know, technicality behind it, but it was supposed to elevate it. So they went in oh, by the way, they wouldn't do any of the surgeries until six months postpartum. So for six months I was dealing with depends, the only repre that I had was like sitting in a bath with Epsom salt that made me my skin feel okay, but the moment the air touched it when I got out, I mean, oh, if you guys can imagine, like, first time mom, I have a baby, trying to take care of the baby. Yeah. And then I'm dealing with all this incontinence issues. And you know, just kind of struggling and then, you know, some of the postpartum stuff. So I already have like, you know, I won't say depression, I never fully got depressed, but you know, your body looks different, all this kind of mental stuff that's going on. And again, trying to care for my son, who thankfully was healthy and beautiful and everything, so no problems there. But me as a mom, I'm a mess. You know, my husband's going, what is going on here? What happened to my wife? You know, there's, yeah, there was just so much that happened. So that was the first surgery was to put in the sling. And then so again, that was about six months, I did it as soon as I possibly could, six months after birth. And then I didn't notice, like much of a change after that surgery. So it was like a day later, I called up my, your gynecologist. I'm like, I don't know what you did. But I can't even tell the difference. So he's like, Okay, why don't you come in, in two days, I was like, two days later, I had another surgery to tighten the sling. And they actually woke me up in the middle of the surgery, and had me bear down to see if it helped, which was really strange. But he was he was trying to tighten it enough. But but if you tighten things too much, then you can't go to the bathroom. Like that would be really bad, too. Right. So that's, that's why he did that. And I will say that second surgery, you know, as far as tightening the sling that did help, that got me to a manageable level, where I didn't need the depends, but you know, as far as what most women go through with leakage, I mean, I still had all of that. And it really wasn't just stress base. So it wasn't just oh, I cough, and a little bit of pee comes out, or I'm laughing, and a little bit of pee comes out. It was a combination of stress, as well as it would just happen like I wouldn't, I wouldn't get the urge, I wouldn't get the urge to go to the bathroom, it would just leak out. And, you know, I think that was a little confusing for some of my doctors because they wanted to classify me as having stress incontinence. And I'm like, that's, that's not me. Like, I mean, that's part of me, but they didn't understand when I because they would like, oh, you know, tell us, you know, do this when you start to feel the urge? Well, what if you don't have an urge, sometimes I had an urge. And sometimes there would be leakage. And then sometimes I would just get up and it would happen, you know, I'd be sitting down and then I get up to do something, and it would happen and there was no urge. And that's actually the same thing to this day that I you know, had issues with so I wear pads but I don't have to usually wear the big thick pads, I tried to get a way with the pet panty liners and just change them out a few times a day. It's it's better certain times of the month. So I don't really know the whole anatomy and how everything works. But I'm assuming that has to do with my menstrual cycle and how things move around. So there are times of the month where I get a little bit of repre. And there's not nearly as much leakage. And then there's other times where it seems like it's worse. But it ebbs and flows. Yeah. Wow.

Natalie Gross 19:08
Wow. I'm so sorry. You had to deal with that, my gosh. But I hope your story today helps other moms, you know, yes. Know that they're not alone. And I know that's why you do what you do and share these stories. So absolutely. Thanks for that. Well, we're going to take a quick break and then we're going to continue this conversation with Laura. So stay tuned everyone!

Natalie Gross 19:34
Today on Newbies, we're talking about bladder control after giving birth and you've already met our expert Laura Chambers. So Laura, we've been talking about this, but how common is it for women who have given birth to experience leaking with laughing sneezing, coughing, etc. If it is relatively common or normal, how much is normal and how much is too much? We just heard from Sunny's story obviously. That was too much right? But what should what should moms know?

Laura Chambers 20:01
Yeah, absolutely. So generally statistics would show us that around one in three women who have a baby are likely to have some level of stress urinary incontinence. And Sunday mentioned this to a degree but there's a difference in what's called stress urinary incontinence in urge urinary incontinence. And just to very briefly say, urge urinary incontinence is when you get a sudden, super strong urge, I gotta go now, and I can't make it to the bathroom in time, and then I leave. So that's urge incontinence, and then more what I think we'll talk about today, which is with the laughing incident, and coughing, and that kind of thing is what we call stress urinary incontinence, some level of stress, the call for the sneeze or a jump creates the leakage. And so specifically to stress incontinence, I never want to call it normal, we've heard one and three are likely to have it. So yes, it's very common, but not normal. And Sunny also touched on this a little bit. But the reason I don't like the word normal is because it gives the woman that sense of permanence and of brokenness. And Sunny, I heard it in you a little bit. That is, to me the worst feeling of congratulations, here's your baby. And here's your new life of slightly broken this. And that is my number one goal is for women to feel strong, and potentially stronger than they were before having babies because they have to learn so much more about their bodies to recover postpartum, but they can get strong again, of course, there are situations. Sonny is a great example of this where something different happens. But that is not the one in three that we're talking about. That's much more rare, like like Sunday mentioned. So how much is too much, I would say very early on the first several weeks, if you're having you're noticing that your baseline at that point is a little leak with coughing or sneezing or whatever that stress event may be, then that's kind of your baseline, that's your body saying, based on what we had to endure between pregnancy and delivery. This is what we can handle. And that's kind of your baseline and it is what it is. But it's nice to take note of what you don't want to see is that worsening over time. So if it takes a big belly laugh to get you to pee, then three weeks later, you don't want to be chuckling and notice yourself peeing. If that happens, it's time to speak up for yourself and see if there's some intervention. And then later on six months or more after delivery, if you're still having any level of incontinence, that stress incontinence, then I would say it's time to speak up for yourself also and say, Hey, I don't want to say that this is my new normal, I think my body has the ability to get all the way better. I had a baby, my body is designed to have a baby, I shouldn't be able to get there. So six, six months or more after baby if you're still having any leaks, it's at least looking at what your options are to make an improvement.

Natalie Gross 22:46
Okay, well, barring a catheter causing this horrendous thing that happened to Sunny? What are the most common causes? I mean, maybe this is silly, but is it pregnancy related? And how the baby like squeezes your bladder all the time? Or is it something that happens in a vaginal delivery usually?

Laura Chambers 23:03
Yeah, I love this question specifically because it brings to light something which is I think we generally from from women I work with, and the information we're giving from given from obs and and all the standard medical system is I think we kind of conceptualize incontinence as a pelvic floor specific problem. And the truth is, we don't really generally know what our pelvic floor is, it's a muscle group that we don't usually we can't see. It's not like our bicep, you can watch it when it flexes or not. We don't touch it. We don't really interact with it for lots of reasons. And so this kind of muscle group we're uncomfortable with has a problem. And then therefore we have leakage. And what we see though, is there the 2013 study that said that showed women pregnant for the first time, so they've never delivered a baby, but they have they're carrying their first baby, when they looked at them. They had significant changes in their pelvic organ support. So how much their bladder and their colon and their uterus were supported within their pelvis, even in their later second trimester and into their third trimesters. So before they've actually delivered a baby, they're already seeing changes in the support for these pelvic organs. So we know it's not just the trauma of birthing a baby and stretching and potentially tearing that pelvic floor itself that there are other factors that go into that. So some of those factors include pressure, obviously, you said the baby is growing in there, it's pressing down on the bladder and the other pelvic organs is also stretching. So our pelvic organs are not only supported by just our pelvic floor, there's really thick fascia. So it's like the silvery lining. You see, when you cut up chicken, you know that it's really thick and and tough and helps hold things together. So there's this thick fascia that helps support our pelvic organs. It doesn't stretch very easily. It's not really flexible, but with prolonged and persistent pressure, it can stretch them and so as that fascia gets stretched than our pelvic organs have less less support from that. Another thing is during pregnancy, the body has to adapt to this growing human inside our abdomen. And so without even recognizing it, a woman is making postural adaptations, her spinal curves are going to increase, her shoulders will tend to go backwards, some her glute muscles are not going to be as active because of these postural changes. And so what that does is it changes the way that our whole core supports our body. And our pelvic floor is part of that core system. So if our abs are working differently, our glutes are working differently, our diaphragm, our breathing muscle is working differently because it's getting smushed from a baby, then that whole coordination of those muscles is changing. Therefore, the pelvic floor maybe isn't working as optimally, and we're not getting the same support to those pelvic organs as well. So all of that to say it's a much more complex system that I think we kind of conceptualize, there's organs that sit on top of a pelvic floor, and the pelvic floor either works, or it doesn't work. But really, there's a lot more pieces to it.

Natalie Gross 26:08
Gotcha, that's so interesting. And I asked that because I noticed when I was pregnant, I struggled with it more than in postpartum, like, I would cough or laugh and a little bit of pee came out. While I was like, second trimester on you know, and so I was always worried about that in public and you know, would have to wear sometimes like the panty liners. Yes. Okay, so I was just really curious about that. Thanks for answering. So what types of treatment and help are available to women who are experiencing this?

Laura Chambers 26:36
Yeah, so it can run the gamut. And, uh, you know, you watch TV commercials, and you'll learn that the help you can get as incontinence products and, and that will always be a pet peeve of mine, because it teaches women again, it's normal that you lead, you need this product to help you. Um, and then there's other options that go down the route of again, kind of pelvic floor specific. And yes, the pelvic floor needs to be addressed. But you know, the general advice women are sent home with often from their physicians would be to do pelvic floor specific strengthening, so Kegel types of exercises, there are also certain devices that are now becoming more popular, where you can insert a sensor within the vaginal canal. Or you can use electrodes to sense the activity of your pelvic floor. And there's games, you can play with an app on your cell phone that helps you strengthen your pelvic floor, there are surgical options. Sunni mentioned one probably the one of the most common ones I see in my practice is the bladder sling or the the tuck, as people will call it to help support that bladder, if it's really dropping down. And then obviously, my bias is there's pelvic health PT, which used to be called women's health. And so you'll see it turns to both ways. And obviously, my bias is, I feel like that's probably the best option for someone to start with, before you use more of a bandaid fix of using incontinence products or something like that, you know, long term, because as a PT, with a lot of advanced training, I am, you know, skilled to look at you as a person. And to address some of those things we talked about in the previous question. How is your posture changed? How are your muscles functioning? Is your diaphragm coordinating with your pelvic floor well, and look at things from a lot more holistic standpoint and hopefully get more to the root of what's going on for that person.

Natalie Gross 28:20
Okay. Yeah, this is so fascinating to me. And I'll share a little bit of my story. But I had a fourth degree tear with my son with my four year old, and I had always kind of struggled, I always got really strong urges to pee and I had to pee, like all day, like constantly. And I found my anxiety, about pregnancy, about really anything, just manifesting itself and having to pee. And so, you know, that had just always been me. And then of course, it got worse during pregnancy. And then after pregnancy, and after the fourth degree tear, I had very little time between when my brain sent the message that I had to go before I could get to the bathroom. And that was for pee, and number two. And so that's what I was struggling with. And I went because of the fourth degree tear, I got recommended to go to pelvic floor physical therapy. And after we took care of some of the bathroom issues that I was having to poo, my therapist was like, you know, we can help you with the bladder thing too. And in my brain, it was like, well, the bladder is an internal organ like it has nothing to do with pregnancy, actually, you know, and so I just was completely uneducated in this area. Do you find that many women don't know that this type of pelvic floor therapy and what you do is available to them?

Laura Chambers 29:38
100%. The number of people who walk in my office and are like you do what? And then the second question is How the heck did you get into this? And I think it is starting to get more common from a very basic standpoint as far as more women know that there is something about physical therapy that is offered have postpartum. But again, I don't think they understand what by any means that is, and you're a great example of that, Oh, I thought you only did this or that or commonly what I get is I thought you only were going to look at my pelvic floor. And yes, I can internally assess someone, I can tell you how strong your muscles are, or if they're too strong, and we need to relax them. And if there's trigger points and that kind of thing, but again, the pelvic floor is only one piece of that puzzle. And then we got to look at it more holistically, too. And so I find that that is the part that, you know, mind blown a little bit for people when they realize, oh, there's so much more to offer. And I think if more people understood that, then also, pelvic health therapy would be much more utilized. The crazy thing is in other European countries, it is standard to have six weeks of physical therapy after giving birth, it's just standard of care. And I think one thing that I impart on women, as much as my physical skills that I do are exercises I give them it's just the education exactly what you said, like our whole lives, you've never had to think about your bladder, how does it work, it just works. You've never had to think about your pelvic floor and you've been taught, it's not okay to touch it, or, you know, whatever the stigmas are, we know nothing about it. So if I can just teach a woman the basics, now she has so much more power to help herself, even if she doesn't need my actual physical therapy services. Let me empower her to understand her body, and so she knows what to do.

Natalie Gross 31:27
Well, more on that after another quick break.

Natalie Gross 31:38
We are continuing our discussion with Laura Chambers of peak wellness and our mom guests and executive producer Sunny Gault. Both of you have multiple children... I know Sunny you have 4. Laura, I think you said you had 2. Did leaking and bladder issues get worse with each child?

Sunny Gault 31:54
Oh, boy, in my case, I don't think it could have.

Natalie Gross 31:57
That's fair. That's totally fair.

Sunny Gault 32:00
I will say though, that one of the things that this prompted in my case, which was a bit of a heartbreak for me, when I was sharing my story earlier, I was explaining what an incredible feeling it was to vaginally deliver my son, that was such an empowering moment for me. And I remember shortly after and you know, going through and seeing the your gynecologist and having these surgeries, they told me that moving forward, I could not give birth vaginally anymore. And I was heartbroken over that. They said I could be wearing a bag. You know, I just heard all the horror stories. And I didn't know I was like, gosh, could even get worse than this. I didn't even know but I certainly didn't want to be in my late 20s walking around with a urine bag. Right? So I had to go through a process of letting that initial birth go. And you know, and being okay with, you know, having Why am I drawing a blank this having the C section having a C section. And I actually even went to some what are the group, there was a couple different groups but groups that help moms do usually postpartum after they've had a C section kind of deal with like the mental struggles they may be going through I actually went to some of those kinds of meetings prior because we knew we were going to have more kids. This was just the start. Right? I ended up with four it was three pregnancies because my girls are twins. But still, it was I had to let go of, you know, everything that I thought was so great about that first birth and that was that was difficult for me. But you know, did it get worse? Not that I'm aware of because I didn't have any more vaginal births. You know, even with my twins I was carrying more baby weight with them when they came out. They were both about five and a half pounds. So that's a lot of baby in you, but not that... Not that I'm aware of. I don't think it got worse for me.

Natalie Gross 33:53
Okay, Laura, what about you?

Laura Chambers 33:55
Yeah, for me my my first birth was quite opposite to Sunny's it was my much more traumatic one and 24 hours of unmedicated I was very raw raw, not going to have an epidural or any medication or assistance and it turned into an unmedicated assisted apisiotony birth with a grade three and a half tear they called it and so that that birth was for me the most horrifying day of my life and I did not want that to be the story of my second so I got the epidural with my second which, which allowed me to have that beautiful birth experience more like what Sunny described. And for me after my first I dealt more with pelvic organ prolapse, so a feeling of heaviness it felt like I was would have a tampon kind of coming out of my vaginal canal, I would I would feel if I would run or do anything more active I would feel that worsen and I would only lead with higher level things. I remember raising my husband down a hallway and be like, Oh my gosh, I just peed on myself. This is that thing. And I had dabbled in pelvic health at that point, but I wasn't really treating it intensively yet. But after my daughter whose birth seemingly went way smoother for me. I had much more incontinence related things, smaller leaks, but with coughing and sneezing, and then as I would pick up into just jogging and that kind of thing, I had definitely more of it with her. And I would I would say professionally, I see women who every birth is different. And I think it depends a bit on the birth. But again, like we talked about pregnancy itself can can contribute. And if the issues from one pregnancy aren't addressed, and we go into another one, I can see it compound, but it doesn't have to.

Natalie Gross 35:31
Well, that leads me into another question. You know, you started mentioning the the prolapse. So what are some other common pelvic floor disorders or reasons that women come seek you out? Seek the help of a fellow pelvic floor specialist related to pregnancy and childbirth? Maybe that's a loaded question. But I'd be curious.

Laura Chambers 35:48
No, no, it is. But I like this question because it gives women the again, the freedom to know, this is not okay. This isn't my fate in life now, because I've had a baby, it's okay to seek help. And so I think this is a very important question. So yes, pelvic organ prolapse would be a very important one, pain with intercourse. Sure, at your six weeks visit, when we all magically get cleared and suspect that healing is somehow completely finished, which is not, but we get cleared for intercourse and in our husbands are so thrilled, you might have some discomfort, but that should not persist. And if months later, you are still having pain with intercourse. It's not just your fate in life, there is probably something going on that couldn't be helped. And so that would be a definite reason. issues. And Sonny mentioned this with looping as much as peeing, it can be constipation that you never used to have. Or it can be trouble holding back gas that you never used to have, you can have issues on either side of that token. And then another thing that I see is women who swear they have a UTI, I have infections all the time, but my culture always comes back negative, they'll say the pelvic floor isn't always weak. So we always think of it as a muscle of insufficiency. If you have a problem, it's because it's not strong enough. We'll almost equally commonly in my practice, I treat women whose pelvic floors are overactive. And those overactive muscles can lead to other symptoms, it can feel like you have a UTI. And you may have no problem with your actual urethra or your bladder or your urine. It can be those muscles are so overactive that you get that burning sensation, or it can feel like a deep buttock for hip pain that isn't relieved with other general orthopedic, hip related treatments. And it can also contribute to constipation. So anything in that realm would all be very appropriate to go to a PT get your pelvic floor assessed again, get your kind of body analyzed to why there might be a pelvic floor related issue.

Natalie Gross 37:47
Okay. Yeah, that's all great to know. So let's talk kegels. You started and mentioned this. Were those exercises helpful for either of you when you were going through this? And if not, did you find any exercises that work to help get bladder control back after pregnancy? Sunny, do you want to talk about your experience with that?

Sunny Gault 38:06
Well, again, my case is so complicated, right? I mean, it wasn't just stress, it was urge, it was a combination. So you know, that's kind of the general thing that a lot of people say is do your kegels, do your kegels. So I'm kind of, I kind of have this stigma against kegels for that reason, because it didn't really work for me big. But again, I am a completely different case. There was something I forgot to mention this in the beginning. So I have those two surgeries. But there was something else that I tried. I didn't have success with it either. But you know, since we're talking about this, I wanted to mention it, I had a surgery and you know, I'm going to totally blank on what it's called Laura, fill in the blanks, as I go through this, but it was a surgery to put a device in my body, it actually went back. Um, well it was kind of a two part device. But part of it the the battery pack, if you will, went right back, kind of were above my hip, like my lower back and above my hip. And then there was this, oh, gosh, I'm going to use the wrong terminology. But there was something that hung down in my body and it would send it on the inside and the inside of my body by the way, that would send electrical pulses that were supposed to re stimulate the urethra and you know, just kind of make it work like it was supposed to work. And then I had this this little remote control that I could control it with. It was so weird. I felt like the bionic woman or something like that. And I could control like the frequency of the pulses, the intensity of the pulses, and I tried that because at the time that was kind of the latest and greatest. You know, I'd already had the two surgeries and I was you know maybe maybe I was five or six years out from you know, having my son I was like What else can we do? And so they did this surgery and you know installed this thing basically in my body. But the problem was, is that when I would move, so let's say I was sleeping at night, and I would cross my leg over my other leg, or if I was just standing in the middle of the day, and my would shift the weight from one leg to another, the intensity would change. So it was not consistent. And sometimes the intensity was way more than I intended. And it would almost feel like a cramping sensation because of it. And on top of that, I mean, what was it helping with the leakage? Maybe a little bit, but my mind was so preoccupied with this intense, I mean, it just feels like little, I mean, it doesn't hurt necessarily, unless you turn it up too much. But it's like little electrical pulses going through your body. And I never quite my body never adjusted to that at all. So I kind of used it for a year, on and off. And then I got so frustrated with it, I completely turned it off. And it stayed in my body for many years. Until, like a year and a half ago, I finally had the whole thing taken out. Because I was like, why is this thing in my body? I just need to get it out. And they're like, Hey, do you want us to replace it with another one? I'm like, Are you kidding? No, stay away from me. Like I'm done with this. So yeah, I mean, I wanted to mention that because there may be moms that have that opportunity to get that as well. I just wanted to share my personal experience, and maybe some questions that you can ask your provider if you're thinking about going down that path, because it's possible that the technology, you know, technology's always getting better and better, right. So I don't want to always, you know, I don't want to be like, Don't ever do this, because that was just my specific experience. At that time, when that type of technology was around. I'm hoping things get better and better. But I will say that my path has led me and this is just maybe this just happens the older you get in life. But BiPAP has led me to try to do things as natural as possible. So one of the things that I'm looking at now is even going back in if it's possible, I don't even know if it is and getting the mesh sling stuff taken out. Because I do believe that my body has the power to heal itself without tons of medical intervention, I actually feel like I hurt my body more by doing this kind of stuff. And as much pain I was in, you know, and I really wanted to get that surgery as quickly as I could, right six months postpartum. If I could go back in time, I wouldn't have done it. And I don't really know what I would have done. But I just I trust my body a lot more. Now, my mentality is, hey, my body has been through a lot. But I have given birth to now four children, two of which happened at the same time. So if my body can create these little humans, right, which is incredible in itself, I firmly believe that my body has the ability to heal itself in different ways. And I think we don't give our bodies enough credit for that. So I'm not against medical intervention or anything like that when it's needed. But I also want us to get back to our roots, if you will. And just just know that you know that it is possible for healing to take place naturally and to at least explore those options. And I'm hoping that more and more people start talking about that, because sometimes just throwing you know, a sling at it, or some sort of electrical pulsing device is not going to be the answer.

Laura Chambers 43:17
Oh, Sunny, you are speaking my language. I love that. And I love that encouragement to other women's have like your body is way stronger than you can even imagine and has that ability to heal. I think that's beautiful.

Natalie Gross 43:30
Laura, can you talk about some of the exercises that moms can do at home?

Laura Chambers 43:36
Yeah, absolutely. So first, I want to say that because I'm with Sunny in my professional world, kegels are so commonplace, and they're so the first line of defense that everyone seems to have heard of and rolls their eyes at that I tend to poopoo them, Oh, don't do this. But the truth is, they're not without some benefit. So a 2020 study showed a 25% improvement in urinary incontinence, and the only intervention was kegels. And so it's not that they're necessarily bad to do. One thing is we know that roughly 50% of women who are told to do a kegel, if you actually internally assessed them doing it, they're not actually doing it right. So it's not as simple as saying go to your kegel some women that might need coaching for it. But 25% improvement to me is wonderful for something free you can do at home when you're driving in your car, but I surely don't want to lack that last 75% of getting all the way there. So I don't want to completely say never do kegels. The other side of it though, is again, not every pelvic floor is weak. So there are some people who can do kegels and you might feel worse, you might feel like you have a urinary tract infection again and not have a positive culture or something like that. That would be a sign your pelvic floor is already overactive and doing more giggles is definitely not going to help and may worsen it. So there's my kegel sides feel Now on the other side, like I mentioned, my, my role is a PT. And this is to look at the body way more holistically and say, okay, there are ways to strengthen your pelvic floor. And by the way, there's tons of exercises that actually strengthen the pelvic floor way more effectively than kegel. And those are exercises that you're probably already doing squats, bridges, lower abdominal crunches, those kinds of things, they actually recruit more of the pelvic floor and will will lead to more strength gains than Kegel alone. But then we also have to look at again how your body is working together. And for me, this is paramount, because we have this whole core muscular system. And then to me, the core in this sense, is pelvic floor on the bottom abdominal muscles, which is four layers of individual muscles in the front, the respiratory diaphragm, on the top right at the bottom of the ribcage, pair of spinal muscles in the back along the spine, and then the gluteal muscles along the sides of the of the pelvis in the back of the pelvis, and each of them has to be functioning well. And if they're not, other muscles are going to compensate. One of the best examples of this for me is some women will learn a movement pattern where they recruit their upper abdominals, which is their external obliques more often. And so that might look like if you look at yourself in the mirror, just a little below your ribcage at the top of your abdomen, there's like this little crease line there. And whether you have a lot of adipose or a little adipose, you can still see this crease, or you'll feel your ribs really getting kind of sucked in in the front. And that means your body's strategy for stability and control is to really use those external obliques. The reason that I can see this as a problem with pelvic floor issues so much is imagine that this whole core we discussed is a balloon, the bottom of the balloon where you tie it off is the pelvic floor. If I squeeze the top of that balloon, can you picture all that pressure pushing out into that pelvic floor at the bottom. So if you're over recruiting your upper abs, you're constantly squeezing the top of that balloon, and you can have the strongest pelvic floor and all the land. But if you're not stopping that pressure coming from the top squeezing down, you're still going to be set up for dysfunction. So without trying to overcomplicate things, I find you really have to look at those pieces of the puzzle. If I had to pick my three favorite things for people to do at home, one would be fix your constipation. And that usually blows people's mind. But I've helped many a woman with incontinence and I've never touched her pelvic floor, we have only talked about constipation. So if you're having trouble going, a if you're straining a lot to get bowel movements out, that's obviously straining on the pelvic floor and the pelvic organs that be the colon, and the uterus and the bladder sit in this teeny tiny little pelvic bowl that we have. So if that colon is full with distended with stool, then it's also going to be pressuring into the bladder and give you less capacity for the bladder. I had a random reoccurrence of some leakage. And I was training for a half marathon a while ago. And I was like, What in the heck, this is my world? Why am I leaking? I was constipated. I didn't even know I was constipated. I would poop a couple times a day. But I had gone to the doctor for something else and had an x ray. And he said there was a backup of stool in my colon and I fix that and my incontinence went completely away. So....

Natalie Gross 48:22
Oh, wow. I am learning so much, Laura.

Laura Chambers 48:27
Oh, I'm so glad. The second muscle group that is often shocking, but it's so imperative to the pelvic floor is the respiratory diaphragm. In our balloon analogy of all those core muscles, the diaphragm is the top of the balloon and the pelvic floor is the bottom. So they have this inverse relationship all the time, every breath that you take. And if you're not able to get your diaphragm to expand well, and really be the primary muscle that you're using for breathing, then your pelvic floor cannot respond to what the diaphragm is doing and take cues off of it. So my favorite way to teach diaphragm awareness, and I think I can describe this over audio is you take your hands, you place them on the side of your ribcage so you're just kind of cutting the side towards the lower part of your ribcage. And when you take a big breath in, you want to feel your ribcage expand out to the sides into your hands so it presses your hands wider. At the same time. You don't want to feel a lot of tensioning in your neck and your shoulder shrugging up. The reason is when your diaphragm contracts the contract down like a like a an umbrella. So the point of the umbrella comes down. That's how we breathe and open up our lungs. But the sides of that umbrella widen out and our diaphragm is connected along our lower ribs. So as it contracts down, it has to widen the ribcage to allow IT room to move. So if you're really using your diaphragm, you will get an expansion in all directions of your ribcage. We With every breath you take, especially a larger breath, just small resting breaths, you may not have a very perceptible movement. But if you're not able to do that, you can re teach your body to preferentially use the diaphragm. Instead of sometimes we learn to use accessory breathing muscles in our neck and our chest and our shoulders in different things. Pregnancy almost forces us to do that, because there's a baby crammed up into that diaphragm. So for a while the diaphragm gets to go on vacation. And then sometimes unless we wake it back up, it doesn't kick back in. And by changing someone's breathing patterns, we can make a huge change in that pressure down into their pelvic floor. And a final piece of output to this is also your lower abs, the deepest layer of ABS in the lower section, so it's kind of below the belly button. And connecting in if you do a really big, strong kegel, if you're really good at taking your pelvic floor and squeezing it and also lifting it up, you'll often feel these lower ab muscles kick in at the same time, right, you're getting that softer part of your abdomen that below the belly button and reconnecting into those lower abs, making sure that they're on board so that when you're moving throughout life, they're staying more active is also a really great supporter to that pelvic floor. And I just want to quickly throw in here, this can be really overwhelming. And I don't want to overwhelm people who think Oh, my goodness, there's too much to do, I just can't do it all. On the other hand, I want them to know if kegels haven't worked, there are 157 more things that you can look at, to still help, it doesn't mean that you're a lost cause. And if you want to learn a lot more about this, I actually created a free 45 minute webinar that goes a lot more in depth to this whole core balloon idea that I talked about. It'll go through the multiple groups, it'll help explain why they're important. And it also gives you some exercises that you can start from home today to start addressing each of these places.

Natalie Gross 51:51
Well, I've learned so much from you, Laura. So thanks so much for being here on Sunny. Thanks for coming on and sharing your story.

Sunny Gault 51:57
Of course.

Natalie Gross 51:57
I hope that will be helpful for our mom listeners. I know it will be.

Sunny Gault 52:02
Yeah.

Natalie Gross 52:02
Listeners, be sure to check out Laura's website at https://peakwellnesstn.com. I'm guessing that's TN for Tennessee. T n.com. Also check out https://newmommymedia.com where we have all of our podcast episodes, plus videos and more.

Natalie Gross 52:29
That wraps up our show for today. We appreciate you listening to Newbies. Don't forget to check out our sister shows Preggie Pals for expecting parents, Parents Savers for moms and dads with toddlers, The Boob Group for moms who get breast milk to their babies and Twin Talks for parents of multiples. Thanks for listening to Newbies, your go to source for new moms and new babies.

Disclaimer 52:54
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Students and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Will such information and materials are believed to be accurate. It is not intended to replace or substitute for professional medical advice your care and should not be used for diagnosing or treating health care problem or disease or prescribing any medication. If you have questions or concerns regarding your physical or mental health, or the health of your baby, please seek assistance from a qualified health care provider.