Ep. 272 – How Pregnancy and Birth Affect Your Pelvic Floor

September 18, 2023

Listen Now:

Laura and Shanna welcome guest Dr. Linda Sayyad, aka “The Vagina Doctor,” a pelvic floor physical therapist and the owner and director of Feminocentric Physical Therapy and Wellness in Pasadena, CA. During their conversation, Dr. Sayyad teaches Shanna and Laura what exactly the pelvic floor is, how pregnancy and birth affect the pelvic floor, how to get help for pelvic floor issues such as postpartum leakage, prolapse, diastasis recti and more. Visit Dr. Sayyad on Instagram, Facebook and TikTok, and visit her website to learn more!

Also, Shanna reports on her daughters’ first week back at school in TK and second grade, and Laura talks about her son’s first week of TK at a brand new school. Finally, they share their BFPs and BFNs for the week. Shanna’s kids are 4.5 and 7.5 years old, and Laura’s kids are 4.5 years old and 2.5 years old.

Want to get in touch with Shanna and Laura? Send us an email and follow us on social! Instagram, Facebook or TikTok at @bfppodcast

This episode’s show notes can be found here.

Join our Facebook community group for support and camaraderie on your parenting journey.

Visit our website!

Big Fat Positive: A Pregnancy and Parenting Journey is produced by Laura Birek, Shanna Micko and Steve Yager.

Show Notes:

This episode's sponsors:

Episode Transcript

Laura:

Welcome to Big Fat Positive with Shanna and Laura. This week, we have our weekly check ins. We have our special segment, an interview with Dr. Linda Sayyad, also known as The Vagina Doctor, who is a pelvic floor physical therapist who’s here to talk to us about pelvic floor health in the perinatal phase. And we close with our BFPs and BFN. Let’s get started.

Hello, everyone. Welcome to the show. This is episode 270. Hi, Shanna.

Shanna:

Hello.

Laura:

Hello. So let’s get straight to it. You’re back home, you’re no longer in Hawaii, and you got to tell me what happened this week.

Shanna:

Well, the very exciting thing is that my kids went back to school.

Laura:

Are you happy about that?

Shanna:

Oh, just a little bit. You know, I had a long stretch there with Cece home because she was sick, and then we went to Hawaii, and it’s good… I love spending time with my kids, but I also like having some time to myself to focus on all of the other things that I do. So that is exciting.

Laura:

Like working full time, for example, that little thing.

Shanna:

It was a total whirlwind. Coming back from Hawaii, we had one day, and I was like, oh, we got to get ready for our first day of school. I had to buy stuff, and I don’t know. It was crazy. But the week has happened. They went to school. Everything’s good. Cece started a brand new school. She’s in TK now, and she goes to Elle’s school. So that was like, the biggest thing of the week.

Laura:

Yeah, for sure. Having two kids at the same school is like the dream.

Shanna:

One drop off. One pickup. It’s wonderful.

Laura:

So, okay, how’d it go? You know, obviously, Elle’s been at the school for what, two years already? So it’s probably not as big of a shift for her. But Cece, this is like, a big change.

Shanna:

Yes. And she’s been excited about it, and she was so brave and so confident about going to school and starting a new school. She has a friend in her TK class that we’ve known and she was in summer camp with, so that was nice. I went to drop her off and say hi to the teacher, and she just walked right into her classroom without even saying goodbye. I was like, hello, can I get a hug? She’s like, oh, yeah. So, yeah, it was good. For those who aren’t familiar, tk is transitional kindergarten. It’s kind of like a pre-k thing. And here in California, they have instituted universal TK. And luckily for me, where I live in my district, that has been rolled out for all children four years old. So now she can go to public school for that’s. That’s nice, too, because I saved the money.

Laura:

You suddenly don’t have any preschool costs. You are out of the preschool era. Yay. Your YNAB you need a budget. Must be so happy with that change.

Shanna:

Yes. My idea is to just set aside the money that I would be putting towards preschool to make sure I don’t blindly spend it, and then we can make a conscious choice of what to do with that money.

Laura:

I like it. That’s smart.

Shanna:

All right, I’m going to send you a picture. Their first day of school pictures so you can see what they look like and their little back to school boards that we do all the time.

Laura:

Okay, let’s see. First up is Cece. Oh, she’s got the biggest smile on her face. She lists her favorite things are giving hugs away and watching TV. So sweet. And when I grow up, I want to be a Hawaiian helper in the club. Someone had vacation on the brain still.

Shanna:

Yes. And if you remember, the club is, like, where we ate every meal while we were in Hawaii at the resort, and she loved it. So that’s her future goals now.

Laura:

Okay, let’s see what Elle says. Elle’s going to be in second grade. Her favorite things are, oh, my sister and my family. That is so sweet. And when I grow up, I want to be working in Hawaii. I think that vacation had a bit of an influence on them.

Shanna:

Yeah, just a little bit. So the first week went well. I did start to see some deterioration of Cece as the week went on, I think the whole change started to get to her. And on Friday when I picked her up, she seemed upset, and I was like, what’s wrong? And she’s like, this boy pinched my neck and was really upset about something that happened in the day, and someone pinched her neck. And I was like, oh, I’m so sorry. And at that moment, I happened to run into her teacher, and she’s like, oh, I wanted to talk to you. She did get pinched in the neck, but it’s because she spit on a kid. I’m like, oh, great. TK’s going great. She’s, like, someone touched her headband, and she got upset and spit, and he pinched her neck. I just want you to know it’s not bullying or anything like that. I’m like, oh, no, this is par for the course. And I gave my spiel about Cece and her big emotions and regulation that we’re working on, and she’s like, yeah, and then she had a screaming meltdown and threw off her shoes. And I was like, yeah, that all sounds about right. And I just thanked her for supporting Cece and told her I’d be there to work with her throughout the year. So hoping next week is a little bit better on that front. But I get it. It’s a lot. It’s a big change, and she probably felt overwhelmed.

Laura:

Yeah, I mean, I’m going to talk about it in my check in, but it was also Augie’s first week of TK this week, and it’s a big transition. There’s a lot going on in their little brains and.

Shanna:

Yeah, but yeah, that’s pretty much my check in for the week, and I want to know more about Augie’s first week and what else is going on with you guys.

Laura:

Yeah, I mean, I’m basically going to be talking about Augie’s first week of school in my check in. Sebastian’s been at his school for a week, and he’s doing great and loving it and just waltzes in without even looking back. So that’s nice.

Shanna:

Yay.

Laura:

So, yeah, this week Augie started at his brand new school. He’s also in TK because he just happens to be the same age as Cece. It’s weird how that works. The interesting thing about his school is the TK and kindergarten classes are actually mixed. So I think his class is like a third TK and two-thirds kinder.

Shanna:

Okay.

Laura:

Which is kind of an interesting model. And their reasoning behind that is that the kids sort of inform each other and help teach each other and educationally, academically, there’s really not that much of a difference between what you do with the two grades anyway, so I guess that’s where they’re coming from. And he does have his best friend who is at the same school, but we found out last week that they’re not in the same class. What we did find out, though, is that they’re in adjacent classrooms that have a door connecting them, and the teachers said that they were going to open the door and do, like, free choice time together as a class. So I’m hoping they get to see each other some. Yeah, I don’t know for sure if that’s happening because reports from Auggie are spotty at best. Trying to decipher what’s happening at school from a four and a half year old is like, tricky. Tricky at best. Right?

Shanna:

Totally.

Laura:

I am not getting a lot of detailed information from this kid. I think I know better than to just come at him at the end of the day with like, how is school? Tell me all about it, because I know that’s not going to happen. Right. But I thought that laying back and being cool mom about it would let some stuff trickle out, but still, he is a steel trap. Like, he does not want to tell me what’s going on at school, so I have to rely on the newsletter that the teacher sends out at the end of the week, which is a nice thing.

Shanna:

Oh, well, that’s good.

Laura:

Yeah. She sent out a nice newsletter with pictures and stuff, so I felt like I was a little up to date on what they were doing and sort of like what their topics for the week were and what next week was going to be about. But as far as I can tell, he’s liking it. He goes to aftercare because the TK class gets out, I think, at 1:40, and then he goes to aftercare till I pick him up after I pick up sebastian. So Sebastian’s done at 3:30 and then I just drive down the street and pick him up at like 3:45. And every time I pick him up in aftercare, he seems to be having a lot of fun. Basically, it looks like preschool, to be honest. It’s just like Legos everywhere. And the class levels are actually separated for aftercare. So it’s just TK. So I mean, it’s basically preschool, let’s be honest, right? Like a bunch of four year olds. So as far as I can tell, it’s going well. He has been all over the place emotionally, though this week.

Shanna:

Oh, really?

Laura:

Yeah. It’s so interesting. Like, one morning I woke him up and this is the other problem. It starts at 8:10. His old school started at 8:30. And you did not have to be there on time. This one like, you have to be there on time. And it’s at 8:10 and he’s turning into an older kid who likes to sleep in. So I’m like having to wake him up every morning. And that’s tricky. That can set you off on the wrong foot. But one morning I woke him up and I never know what I’m going to get, right? I never know if he’s going to be upset at me or just super tired or whatever. But I wake him up this one morning and he looks at me and he goes, mama can’t give you a hug. And I was like, Absolutely, sweetie.

Shanna:

Absolutely.

Laura:

And I give him the biggest hug. And he puts his cheek right next to my cheek and just squeezes. And I’m like, oh, wow, this is a great hug. Thank you, sweetie. And he says it’s because I have so much love inside me. And I’m just like, oh, my God. You are the sweetest, most wonderful person on the whole planet. I absolutely love you. Fast forward to the evening. He’s a terror. He’s like an absolute banshee. He comes home from school and he’s like willfully, ignoring us, snatching toys out of his brother’s hands and just laughing maniacally. Oh, no, why have to wrestle him into the bath? I mean, it’s been very chaotic at our house, and I fully attribute it to all the big feelings coming out of this. Big change. Right. It’s expected, but it doesn’t make it any easier. Totally.

Shanna:

What was the thing I reported on once? The after school restraint collapse. I really see that going on this week, with Cece especially, and a little bit with Elle. Sounds like Auggie is feeling it too.

Laura:

Oh, big time. Big time. So I’m trying to just be respectful of it and trying to just give him his space and trying to load him up with carbs when he gets in the front door. But we’re still working on it. It’s a bit of a work in progress, but all things considered, he’s a little nervous going into school in the mornings and now we’re doing like a carpool drop off thing where you just drive up to the front and a helper unbuckles him from his car seat and walks him in. Which is a huge change from preschool where we would walk him in or at least walk him to the gate and he’s a little nervous about that sort of stuff. But by the end of the day when we pick him up, he seems totally fine and there’s not a lot of resistance. It’s almost like play acting resistance, like he knows he’s supposed to. So he’s kind of like but yeah, I think the first week of school went about as well as one could hope. Just a couple of meltdowns in the evening, but no one got sent home from school, so that was good. Yay, that’s a very, very big success. So, okay, that’s it for my check in. Shall we move on to our special segment?

Shanna:

Yes, we should.

Laura:

We are back and this week we have a very special, amazing interview with Dr. Linda Sayyad. You may know her as the vagina doctor on Instagram @the_v_doc. She is a pelvic floor physical therapist at Feminocentric PT in Pasadena here in Southern California. And I met Linda recently and we got to talking and I was just like, Linda, we have got to have you on the show because you are so brilliant and have so much to say about pelvic floor physical therapy in the perinatal time. So I just want to say welcome. I’m so happy you’re here. Hi.

Dr. Linda Sayyad:

Hi. Thank you so much for having me. I’m so excited to be here and dive in into pelvic floor and everything about women’s health.

Laura:

Well, let’s just get started because we have so much to talk about and we have so many questions for you. So before we get going, can you just tell us a little bit about yourself and what you do and what brought you to pelvic floor physical therapy?

Dr. Linda Sayyad:

Sure. So you did a little bit of an intro for me and my name is Linda Sayyad. I’m a pelvic floor physical therapist, but I used to be an orthopedic physical therapist and I had to experience pelvic floor issues firsthand before I actually have an interest in this field. So I’m going to share with you what my thoughts were on pelvic floor before and how it changed with me going through to pregnancy.

So I remember when I was in PT school, we had one class on women’s health and I totally did not pay attention. And I just said, hey, I am not touching someone else’s vagina, I am not listening to this lecture. There’s going to be two questions that I’m going to miss. So be it. And honestly, I did not pay attention at all in that class. I was like, ew, I’m not doing this. Then I went through my first pregnancy and neither of my pregnancies were easy. I had a lot of ups and downs, and anytime I brought an issue to my OB (and by the way, I love my OB. He is the best. I’m still with him) but I think our doctors need a little bit more education on this topic so they won’t dismiss women’s health issues. So going through my experience, anytime I complain about something, I was either told, well, you are pregnant. Well, it’s part of it. Welcome to pregnancy, welcome to motherhood. And I’ve never was given any resources and I felt dismissed and not really getting an answer to my questions.

And you know how you have this baby and all of a sudden all the attention goes to the baby. And now I’m not going to have any foul walks except for one, six weeks. And pretty much I was told back to normal, whatever that meant. Being a first time mom and always being in a good shape and athletic and exercising, now I had to deal with this big belly and I was cleared by my doctor to go back to normal. And guess what I did? I signed up myself for a mommy boot camp at eight weeks post C-section.

Laura:

Oh, wow, that’s ambitious.

Dr. Linda Sayyad:

Yeah, well, I was cleared back to normal, right?

Laura:

Sure.

Dr. Linda Sayyad:

I want to go back to normal. I want to go back to normal like I’ve been waiting to get back to normal. And obviously society puts that pressure on you. When are you going to get your body back? And all the other stuff we all know. And that mommy boot camp did not go well with me. Obviously I only completed a few sessions and I encountered a lot of issues. Now I have that vaginal pressure. Now I’m leaking again. And also I think I busted something in my knee, like all those squats, like deep squats. Like I heard something like pop, snap and it’s like, this is it, this is it. I can’t do this. I’ll come back to it. But I think my body is not ready.

So that person who did not care about Pelvic floor courses in school, now I am going to Dr. Google and I’m looking up, trying to heal myself and that’s how this journey started. And then I started taking more courses, now becoming interested in the topic and doing my own research, reading online classes. I went to my second pregnancy and to my surprise, the experience was way different than the first time. Same with my postpartum. I recovered much easier, did not sign up myself for a postpartum mommy and me boot camp this time. So I was more educated, more aware, more on top of how I should be taking care of my postpartum body this time around.

And obviously I did it for the sake of myself in the beginning. But then after my second pregnancy, I felt like I wanted to take this mission a little bit further. I want to take this information and share it with my community. So I started doing workshops and one thing led to another. I decided to start a women’s health center. Somewhere that women can come, be vulnerable, be safe, feel safe, share what they’re going through and spread my information to women. And that’s how Feminocentric came about. I started Feminocentric in January of 2020, not knowing COVID was going to hit. And yes, the day that the country went into a whole shutdown, I got the key to the office and I had to shut down before even I could open up the space. So I called my best friends, like, the day that should have been the happiest day of my life. And I’m crying.

It’s like, I don’t know what to do with this key. I just told her. I just told her, I’m just going to go to the office and sit there. I’m just going to pretend we’re open. We’re doing it. We are working on this mission. But again, that did not stop me. And I did workshop in the parks with Moms. We did online classes. And I just kept going and going and going. And now we have a beautiful office in Pasadena. I have three PTs that work with me. And we are working on the mission of spreading the word on women’s health, pelvic floor to our community and basically to all women around the world.

Shanna:

I love this story so much and I’m so glad that this is your mission and that’s what you’re doing, because you’re right, there’s, like, so much that a lot of us just don’t know about how to take care of ourselves during that time. And one question that comes to my mind is what exactly is the pelvic floor? I think a lot of people don’t even really know what that means. Could you answer that for us, just to start us off?

Dr. Linda Sayyad:

Yes, great question. I do a lot of workshops for the community and the first thing I start with is let’s talk about pelvic floor and go over the function and why we think it’s so important for us to know this anatomy. If you think of the pelvic floor as a bowl, it sits at the bottom of your pelvis, going from the front, your pubic bone, all the way to the back to the tailbone, and from one sit bone to another one. So it looks like a bowl, it looks like a hammock. It has three important functions. Every layer has its own function. So one of the important functions of the pelvic floor is keeping all the openings closed. People who leak, people who have urinary incontinence, fecal incontinence, unable to hold the gas in that first layer… it is not doing what it’s supposed to do. Then we have the deepest layer into the pelvic floor, and its job is supporting the internal organs. So all those uterus, bladder, intestine, everything sits in this bowl and then when we are pregnant, we have the additional weight of this baby that is being supported by the pelvic floor. So to summarize, it’s a bowl, so that’s the bottom of your pelvis and its job is continence, sexual function and internal organ support.

Shanna:

Is it a muscle?

Dr. Linda Sayyad:

Yes, it’s a group of muscles. It’s a sling of muscles that provide the support to the internal organs and activates to keep all the openings closed and not allow the pee and poop to come out.

Shanna:

Thank you for that explanation. That’s the best explanation I’ve ever gotten of it, and I think I completely understand it now.

Dr. Linda Sayyad:

You’re welcome. I’ll try to keep it simple and not use a lot of medical terminology as if I’m explaining it to my kids. Yeah, hopefully that made sense to everyone.

Laura:

Yeah, I think it’s so hard to visualize. So having that metaphor of the bowl is really just very clarifying. You can see that. So speaking of the pelvic floor and speaking of continence and incontinence, one thing that is so normalized around pregnancy and especially postpartum, is the idea that moms just pee a little bit every time we sneeze or run or jump. And that is just the way it is. And everyone claims that this is just normal. I imagine you have some opinions about that. Is it really inevitable that we’re all going to just have a little dribble drabble every time we sneeze?

Dr. Linda Sayyad:

I mean, society has done an excellent job of normalizing that. And I think us women had the biggest part contributing to this normalization by kind of like, obviously we want to support our sisters, want to support our family and friends, and when they share this information with us, that they are upset or disappointed that now, after the baby, they’re leaking instead of us saying, oh, have you done anything about it? We just normalize it by saying, “Well, I do too,” or make a joke about it. So no, as a pelvic floor physical therapist, that is not okay for people to pee when they sneeze and cough. It doesn’t matter if it’s just a trickle or just losing the whole bladder. There are treatments for it and we should keep our undies clean of pee.

Laura:

All right, that’s refreshing to hear because yeah, I think there’s a difference between supporting and making people feel not weird about it. Because it is common. It shouldn’t necessarily be normal, but it’s obviously very common. But there’s a difference between letting people know, you shouldn’t be ashamed of it versus saying, and there’s nothing you can do about it. That’s just the way life is.

Dr. Linda Sayyad:

Right. I mean, a lot of time women start having incontinence or leaking during a pregnancy, and what we hear is that the doctor or a friend or whoever, someone told them, well, just wait till your baby is out. So no, let’s not wait till the baby is out. Let’s just nip it in the bud and get it into treatment right now. Because the longer you let this issue go, the harder it is to improve it or resolve it. And also it’s just becoming chronic and something that is chronic and being going on for a lot of time, it’s harder to treat.

Shanna:

So it sounds like there are things that you can do during pregnancy to help with this. So what are some things that you wish every pregnant person knew about pelvic floor health? Or what kind of information do you like to impart on pregnant people?

Dr. Linda Sayyad:

Pregnancy is a trauma on your pelvic floor even before birth. Just imagine that bowl. Now before being pregnant, you had maybe like some apples in that bowl or some peaches, things that are little and all of a sudden there is this big watermelon. If you guys are tracking your pregnancy week by week, just imagine that week that the baby is the size of a watermelon. What’s going to happen to that bowl? Like things are being stretched out. And for nine months these muscles are working so hard to support this growing baby and provide support to the internal organs that without treatment, without staying connected with those muscles, definitely they’re going to suffer, they’re going to get weaker.

It’s like an elastic band or a hair tie. When you keep stretching it over months and weeks, then this just becomes dysfunctional. So I want every pregnant woman to know they should start when they’re pregnant. Their postpartum will be a lot faster as far as recovering, going back to normal. When we work with patients in our office when they are pregnant, they don’t have to spend so much time in our office postpartum because their muscles are already connected with everything else. They know how to use these muscles and they go into this labor to deliver with a strong muscle, which just sets them up for success during their postpartum versus those who don’t do any sort of exercises. They never went to pelvic floor physical therapy. They just let go of the pelvic floor, let go of the abdominals. And those are that they have to spend so much more time after as far as a postpartum recovery.

So my advice to pregnant ladies, get yourself into a pelvic floor PT, have an assessment, just figure out what’s going on. Am I able to activate this muscle? Am I able to relax this muscle? This is another topic we all think about kegel. Kegel. But in reality, it is way more important to be able to relax the pelvic floor before activating. So again, yes, check with the pelvic floor PT. Can I relax this muscle? Can I activate this muscle? Can I do fast rapid activation for when I’m sneezing and coughing? That’s what you need. Closing those muscles immediately. Am I able to hold this activation for 10-15 seconds? That’s endurance. If I’m doing aerobic exercises, if I don’t want to pee myself. I need those muscles to stay closed for over a period of time. So get yourself in a pelvic floor PT when you are pregnant, stay connected with those muscles, because when things start stretching, one thing we want to do just gets disconnected with those muscles, and then it goes weeks and months postpartum, we have a harder time connecting with those muscles.

Shanna:

Interesting. Wouldn’t it be so nice if this was just part of the prenatal care? Like everyone just did this? I wish I had. I mean, I’m in the camp of the people who did nothing about any of this, and I wish I had.

Dr. Linda Sayyad:

That’s the mission. So that’s my mission, to spread this education to women. And I do a lot of workshops at least once a month now that we’re busier. I’m busier being a mom and running the business and so many other things. But I try to do at least once a month a free workshop. Everybody tells me, oh, you should be charging. It’s like, okay, I’m charging through my business. Then I have my mission. And the mission is just to allow women to have access to this information. So I don’t want them to come to my office and say, well, nobody told us. I did not know you guys existed. So that’s what I’m doing. That’s why I go out and I talk to moms, to women. Pelvic floor, have you gone? Have you done it? And all of us together. I mean, you guys are helping me with this mission right now, and I’m very grateful for this opportunity to allow me to be here and talk about pelvic floor and woman health and how we should take care of ourselves from when we’re pregnant to when we give birth to later on during a postpartum. And menopause, let’s not normalize and accept that this is part of being a woman.

Shanna:

I love that.

Laura:

Yeah. I mean, I feel like this is something that I’ve started to hear more and more about in the past couple of years, but no one ever came to me during my first pregnancy and was like, you should go to a pelvic floor physical therapist. But I will say that I also might have been a little worried and anxious about going to a pelvic floor PT at that time because I wouldn’t have known what to expect. Can you tell our listeners what is a pelvic floor PT visit like? I think people, like, in your class, your initial class, you’re like, ooh, I’m not touching anyone else’s vagina. I think people still have some anxiety about someone else touching their vagina and their pelvic floor area. So what would you say to reassure someone who might be a little nervous about that?

Dr. Linda Sayyad:

Sure, definitely. I mean, this pelvic floor physical therapy, it’s very intimate, and obviously there’s a lot of anxiety around it. So just to address that with our own patient. We created a video of what happens in a pelvic floor treatment and pretty much they come in, we do history taking, we want to know all the details. And then comes the part that we have to do our objective measurements when we want to check on the range of motion, how strong they are. And also like any other muscles, we have to check on pelvic floor muscles which are located inside the pelvis area.

Some people may decline and they don’t want any internal done to them, which we respect. And there’s tons that we could do externally to assess pelvic floor. So there’s always that option. If somebody doesn’t feel comfortable, if they’re not okay with us doing an internal examination, we can do an external examination. But let’s say we’re open. We want to explore the pelvic floor, all layers. So pretty much it’s similar to an OB, but less invasive, meaning we don’t have any speculum. Things are not going to be stretched open.

Pretty much moms are being draped, covered and the therapist uses only one digit, one finger to enter to the vaginal canal and go layer by layer. Every knuckle is a representative of each layer of the pelvic floor going through 1st, second and a third one. And pretty much just imagine we are checking on a neck muscle. We want to see if it’s tight, toned, there’s, trigger point, pain restriction. So very gently we are just palpating or checking on those muscles. They should not really hurt. When we get a painful point, then that’s a sign that there’s a restriction or dysfunction in that muscle. And we go layer by layer. And then we will check for how strong the pelvic floor is. Asking the woman to do an activation. Or do a kegel or a kegel, tomato, tomato, whatever you want to call it. But yes, we’ll have them do a series of activation just to see if they’re able to activate, relax. Are they able to do a quick activation? Are they able to hold for 10 seconds? And then another thing we will check is the prolapse. Because a lot of women experience pregnancy postpartum or they may never have been pregnant, but we all do heavy lifting, costco, grocery shopping, whatever. So we will check for those internal organs. Are they supported? Prolapse is another common thing that we get a lot of during a postpartum because of the labor and pushing the baby out and the weight of the baby sitting in the pelvic floor for nine months. So we will check for a prolapse, and pretty much that’s the pelvic floor examination and we’ll share the information with the patient after.

And then we’ll come up with a plan of care. We found tightness, we found weakness, we found not being coordinated. So all those things are the things that we discuss and I want to share with you guys. A lot of the time, like I said, everybody’s just concerned with doing Kegel and getting the pelvic floor stronger. But in my practice we realize that we have to work on softening and lengthening and learning how to relax those muscles to have a better outcome. I created our own signature method that we move people into different phases going into relaxation, then activation or strengthening and then return to function, whatever that is. So for the pelvic floor it’s really important to work on that relaxation before we go into activation.

Shanna:

Well, that’s fascinating. That is not something I would have known. Definitely when I think of pelvic floor I think of the Kegel exercises and tightening everything up. So thank you for sharing that information, and I love that you’ve created a system to help people work through that. Is there anything birthing parents can do in the immediate postpartum period to help prevent long term problems?

Dr. Linda Sayyad:

Well, obviously the first few weeks we want to work on bonding with the baby and nurturing the baby and allowing the tissue to heal. One thing I always teach and tell our patients is that diaphragmatic breathing is something you want to start as early as week two because your breath works with your pelvic floor. If you know how to breathe properly, then your pelvic floor is doing what it’s supposed to do. A lot of time we have a dysfunction with breathing which we have to address in order to get the pelvic floor to do what it does.

I really don’t want to tangent off and get off the topic a lot, but I feel like I need to make a comment right in here that the reason we are not peeing and pooping is that those muscles automatically know what to do. We don’t have to tell our pelvic floor to activate and now relax. They’re just doing it automatically. And when we get a dysfunction, then there is something going on in the pelvic floor that interrupts that automation. So if we go and restore that dysfunction, then a pelvic floor should know what to do automatically. That’s another reason we don’t need to do thousands of Kegels for God’s sake. That’s a lot of tension. We just have to figure out where the dysfunction is, which a lot of time it’s tension because life is stressful and then getting rid of that is what is going to help the pelvic floor to be back on track.

So going through birth, that’s a trauma to the pelvic floor. And one thing that could start resetting the pelvic floor is the breath work so early into the postpartum before even going to be cleared by the doctor. Start with your breath work. And let me just point out you don’t need to wait till you get your clearance from your OB to start a pelvic floor PT, okay? At least in the state of California we have direct access and we see patients as early as four weeks. I mean, if they are our patients, we check in with them at two weeks. If we have concerns, they can reach out to us. If they have concern, if they have questions, but then we just tell them, come back, let’s get started. The sooner we can get to this dysfunction, the faster we can recover from this birth. So breath work is something we all want to start working on early into the postpartum and that’s safe. So whether you had a C-section or vaginal birth, breathing is just a safe exercise to do.

Shanna:

That’s wonderful advice.

Laura:

And I also think that new parents, they need to breathe. Everyone’s going to benefit from some good deep diaphragmatic breathing at that point in your life.

Dr. Linda Sayyad:

Besides benefit for the pelvic floor, that deep breath work is just going to calm the nervous system. It’s just going to help with stress and anxiety that comes with that postpartum phase.

Laura:

And you mentioned how even if you had a C-section, there’s trauma to your pelvic floor. So Shanna and I have had three C-sections between the two of us. And my first was a planned C-section because Augie, my four year old, was breach. The breach the whole time never changed. So we had a planned C-section and the reaction I got from everyone was like, oh well, at least your vagina is still going to be in good know. That was like their reaction to, you know, now that I’ve had a VBAC after the C-section, I will say they were lying to me about that. C-sections are not this easy way out or a free pass to pelvic floor health. So can you talk about the experience of having a C-section and how that affects your pelvic floor health?

Dr. Linda Sayyad:

Yes. So regardless of vaginal birth or C-section, your pelvic floor is affected going back to that bowl and the watermelon. So that watermelon is stretching that pelvic floor over weeks and months. So it doesn’t matter if you had a vaginal birth or a C-section. Those muscles are overstretched and weak now. Now let’s talk about the C-section. When you have a C-section, they cut through seven layers to get to your uterus and have this baby be born. Seven layers all the way down. And those layers need to be put back together, which runs the risk of scar tissue. And scar tissue is what restricts the pelvic floor and could restrict the bladder because that’s just right over your bladder.

So those are all the things that come with a C-section that we don’t really put any emphasis on that could cause the dysfunction. People with urinary urgency, they are the ones with C-section because that seven layer all the way to the bladder could cause restriction in the bladder. It’s like a tug being pulled at the bladder and giving you that urgency. So every time the bladder is filling up. Now we have one point that is restricted and it’s not allowing for this flexibility and mobility of the bladder. And that’s the sense of urgency we’re getting. So whether it’s C-section or vaginal birth, the pelvic floor is still affected. Your bladder, your health of the pelvic floor is affected by the pregnancy and C-section and vaginal birth, not just one or the other.

Shanna:

It’s so interesting to think about the seven layers because I’ve had two C-sections. And when I think of my C-section scar or any scar tissue, I think of the surface scar that I see. Right, but when you think about all of the stuff they have to put back together inside underneath that external scar, that’s the stuff that can start like tugging and pulling and really causing dysfunction. Right, I never thought about that.

Dr. Linda Sayyad:

Yes, and besides having a pelvic floor dysfunction, that scar tissue in the front, if it’s tight and is restricted, it creates problems in the back. So now I’m restricted in the front. My back muscles are being affected. Now I have this chronic back pain that nobody is able to get rid of. Let me just check in. Or somebody just says, hey, have you checked in with a pelvic floor PT? And of course, if we are working with someone and somebody says C-section, we will always go through that C-section scar. No matter if that person is six weeks postpartum or six years postpartum, we always go to that C-section to treat someone’s back.

Shanna:

Oh, fascinating.

Laura:

Okay, so Linda, you said whether it’s immediately postpartum or many months or years later. So can you talk about like, if someone’s listening and they’re like, oh, this is all well and good, but I’ve had these problems for years, my kid’s five and I don’t know what to do. Can you talk about are there options for people who’ve had these issues for a long time?

Dr. Linda Sayyad:

Definitely. So, yes, just imagine someone who had back pain for many years and now they decide to get treatment. They’re able to work on the back and they get better and they recover, go back to normal. Same thing with the pelvic floor. Those are muscles as well. FB, start working on those muscles. No matter how many years after having a baby, we’re still able to work on relaxation, flexibility, strengthening, and also being able to recover from whatever dysfunction we’ve been dealing with for many years. Us pelvic floor PTs, we always say postpartum is forever. So it doesn’t matter if you are six weeks postpartum or six years or ten years, you’re still postpartum. So there’s always time to get treatment. And the good thing is that muscle will respond to exercise, muscle will respond to mobility exercises, muscle will respond to neuromuscular reeducation. We can still connect with those muscles.

The only thing that is different is the prognosis. Somebody who is six weeks postpartum, they are into this healing phase, this healing window, that the body knows something happened and it’s just working so hard to get rid of that dysfunction. So they are going to have faster prognosis, faster progress, compared to someone who waited ten years, 20 years to resolve this issue and it became chronic. So it might take a little bit longer to improve, but they can definitely get improvement and get back to normal. And plus, as we get older, it’s just going to be harder for us to coordinate with some of these muscles. When I’m training someone who is in their twenties and thirties, things are going to happen a lot faster versus when I’m working with someone who is in their sixties and seventies, they still get the result, they still improve, but it’s just going to be a little bit longer.

Laura:

That’s very reassuring, I think, because I feel like some people just think, oh, I’ve missed the window. But it’s nice to hear that that’s not true.

Dr. Linda Sayyad:

No, our body is very strong. Our body can heal itself. Sometimes we just have to provide that guidance of how to heal, tell them how we can get past through this dysfunction. So those are the things that we as a physical therapist can help this person, this individual who’s recovering from an injury, just teach them what exercises, how to breathe, how to connect with these muscles for them to be able to recover.

Laura:

That’s amazing to hear. Okay, so you keep bringing up Kegels or Kegels. I’m really sad that you don’t know. Like you don’t have a definitive answer of how to pronounce it because this has been a mystery throughout time and it sounds like there’s no right answer, unfortunately.

Dr. Linda Sayyad:

You know what, that’s just the name of the person who came up with this one. And ultimately, it means pelvic floor activation. So I always go with Pelvic Floor Activation today just for the heck of this conversation. And people relate to Kegels better than Pelvic Floor activation. I use that word, but most of the time I like to use Pelvic Floor activation.

Laura:

Fair enough. Fair enough. Yeah. But I feel like most people have just heard of it. You get this advice, it’s like every time you’re at a stoplight, do ten Kegels or stuff like that, and it sounds like you have a different opinion on them. Can you tell us what you think about Kegels? Are we putting too much emphasis on them?

Dr. Linda Sayyad:

Yes. So Pelvic Floor Activation or Kegel may not be the answer for everyone. There is a place and there’s a time and there’s a place for it, but not everybody benefits from doing a Kegel. I’m just going to kind of give you an example. If somebody let’s just say, let’s just imagine it’s the end of the week, it’s Friday and you had a hard week and you work so hard being on a computer, your neck is really tight up and jammed up. What do you want to do? Do you stretch it out or do you go do more shoulder shrugs and get those muscles even tighter, what do you do?

Shanna:

Relax them.

Laura:

Yeah, stretch those out.

Dr. Linda Sayyad:

Relax them. Exactly. So, same thing with pelvic floor. If everything is just jammed up in there because of a stress, because of a birth, because of a trauma, because of a sexual abuse, because of I don’t know, I’m just a stressed person. I like to clinch everything together. Would I benefit from doing 20 Kegels at every red light? Am I adding more tension to this system that is going to give me more dysfunction? Or am I actually helping my pelvic floor? What do you guys think?

Shanna:

I don’t think that would be helpful.

Dr. Linda Sayyad:

Yes, it’s not going to be helpful. That’s the reason why when we get patients in our office and they say my doctor said to do thousands of Kegel, I did those. I did not get better. In a way I am worse. Because if you’re adding more tension to these muscles, if something is so tensed up, how could you ask this muscle to activate something that is tensed up? In a way it’s weak, so it doesn’t have that strength to activate and close the urethra and not allow this urine to come out because it’s just so dysfunctional and jammed up.

I always give the example of doing a bicep curl. So if you do really tight bicep curls all the way, activation to the end. Now try to activate some more. Do you feel strong with that activation or do you feel weak? And a lot of time people who are really connected with their body, they say, no, I can’t generate any more force. So, same thing with the pelvic floor. If things are tight up in there, then that muscle is not able to activate when the pressure goes up to keep the urethra closed and not allow the urine to come out. And those are the people that do Kegel and they get worse instead of getting better. So Kegel is not for everyone. Maybe I have a tight pelvic floor. Maybe I need to learn how to relax my pelvic floor to be able to resolve my incontinence. So always have an internal assessment or external. Just know where your pelvic floor is. Is it tight, is it weak, is it a combination of both? Are you able to activate muscle before you start any amount of Kegels?

Laura:

It’s so counterintuitive and I think it’s, I mean, I could go off for like an hour about this. How it ties into sort of productivity culture and grind culture and all this stuff where it’s like go, go. You got to optimize every moment and do all these key goals and no one talks about rest and the importance of rest and rest is kind of demonized, but that’s a rant for another day. But I really appreciate that you are evangelizing for relaxation and having balance, not just constantly doing those activations so that’s awesome.

Dr. Linda Sayyad:

I love how you said balance. That’s exactly what we need in our pelvic floor. We need balance.

Laura:

Well, Linda, I could talk to you for hours and hours but our whole show is around an hour so I should probably wrap things up. But we do ask every guest we have on the show if they have a big fat positive to share. So I’m wondering, do you have a big fat positive to share with us?

Dr. Linda Sayyad:

So yeah, something amazing we’ve been doing in my clinic this week is that we always promoting and having our patient do exercises and stay active. And last week when we had our weekly meeting, we talked about self care and how us as a therapist should really focus on taking care of ourself. If you are preaching it to our patients, then we wanted to also be very active with what we need to do to take care of ourself and pelvic floor. So we came up with this 20 days challenge in my clinic that everybody’s going to exercise whatever form and shape they want, walking, biking, yoga, whatever, at least for 10-20 minutes daily. And we have to put it in a chat, the group chat. And I am so excited. Today Friday. It’s a week from last Friday and we had this discussion and everyone’s still in the game, everybody’s exercising and we all are keeping each other I know we are keeping each other motivated and I used to do a long distance running but then when life happened, I stopped doing it. So I started with my walk last Friday and last night I was able to actually run and that felt really good.

Shanna:

That’s exciting. I commend you. That’s great. And I love some accountability with friends. That’s just such a great thing to keep you motivated.

Dr. Linda Sayyad:

Definitely. And obviously we’re going to give ourselves some prizes at the end when we make this 20 days of nonstop exercising. We don’t take breaks, not even the weekend. So if you want to win this prize, you have to do it every day and you have to post about it every day. So, so far, one week down, we are getting closer to our goals.

Shanna:

Right on.

Laura:

That is super fun. Shanna I would say that we should do that with each other but I feel like we are too close and we would not do a good job of keeping each other accountable. We give each other passes sometimes.

Dr. Linda Sayyad:

We also do these with our Instagram. So if you guys are on Instagram, just keep an eye for those challenges that we announce and we just keep each other accountable on social media as well.

Shanna:

Oh, fun.

Laura:

Well, that’s actually a perfect segue into our final question, which is where can our listeners find you on social media and in person?

Dr. Linda Sayyad:

Sure. So we are located in Pasadena, 133 North Altadena Drive in the city of Pasadena. And on social media we do have a TikTok account and an Instagram account, and they both have the same ID. You can either search us by the name of the facility, Feminocentric, which is ultimately a Women’s Center, or I go with the Vagina Doc. It’s the_v_doc. The vagina, doc. And you guys could just follow us there. If you start following us, send me a DM. I would love to get to know you guys, and there’s nothing TMI. Anytime you guys have any questions, just get in our DM. If you don’t feel like you want to put a public comment under the post, but send us a DM. We would love to get connected and answer any question you guys may have about Women’s Health, pelvic Floor, or anything in general.

Laura:

And I will say your Instagram is awesome. You guys share so many really helpful reels, so everyone should go follow @the_v_doc, because you’ll get a lot of great education just in your feed.

Dr. Linda Sayyad:

Yes. And we try to keep all the reels into less than 20 seconds, so they’re fun, they’re not boring, they’re not long, because I personally lose interest when something just gets more than 10 seconds.

Shanna:

Yeah, same. Well, thank you so much, and we’ll be sure to link all your information in our show notes and on our website so our listeners can easily find you. Thank you again, Linda, for joining us and educating us and spreading your mission. We are just so delighted to have you, and thank you for your time.

Dr. Linda Sayyad:

Thank you so much again for having me and allowing me this opportunity to spread the word about Women’s Health and Pelvic Floor.

Laura:

Thank you so much. And, Linda, hopefully I’ll be seeing you around.

Dr. Linda Sayyad:

Yes.

Laura:

Okay, so we close every episode with a big fat positive or a big fat negative from the week. And Shanna, you are up first. What you got for us?

Shanna:

I have a BFP. So as you all know, Elle has been doing theater camp for, like, six weeks of the summer, and one thing, of course, you learn in theater camp is acting. And I have a fondness for acting. I did a lot of acting growing up and everything. So a really cute thing we’ve been doing recently is practicing acting at home with the girls and the family and acting different emotions and stuff. They love to be like, “Mama, pretend you’re sad,” and I’ll be like, *fake sob*, and then I’’m like, you do it. And when they do it, they’re like *fake sobbing* and then they brighten their face, and they say “Acting!” And so it’s become this thing where we challenge each other to do an emotion, and they do an emotion, and then they brighten up and go “Acting!” And so I just think it’s really cute. So I put together a little compilation of some of their acting for you to hear.

Laura:

Oh, my God, I cannot wait.

Shanna:

Cece, show me sad.

Cece:

(Fakes crying) Acting!

Shanna:

Show me mad.

Cece:

What have you done to my shower? Acting!

Shanna:

Show me happy.

Cece: I love you, mama. Acting!

Shanna:

What about surprised?

Elle:

Oh, my gee! Acting.

Cece:

Oh, that was good acting.

Shanna:

Okay. Scared.

Elle:

Me scared. Oh, no.

Shanna:

Are you okay?

Cece and Elle:

Acting!

Laura:

Yeah. Oh, my God. That is the best ever. I am going to adopt this. Like, I just want to do this all the time. I want to be, like, acting just.

Shanna:

In your own life. As an adult.

Laura:

Yeah, as an adult. Oh, my God. It’s so cute. I kind of want to steal it and try this with Auggie and Sebastian. I want to see how it goes with them, because Auggie has a big dramatic streak, as you know.

Shanna:

Yeah.

Laura:

So I’m curious if he’d play along. Interesting.

Shanna:

Will you try it and see if you can get some good voice memos for us? Because I bet he’d be good at it.

Laura:

100%. Want to do this? Awesome.

Shanna:

One of my favorites is when I was, like, to Cece, “Act happy,” and her acting happy is, “I love you. Acting!”

Laura:

Emotional whiplash right there, right?

Shanna:

Oh, my gosh.

Laura:

Yeah.

Shanna:

So that’s it. That’s my little BFP. What do you got for us?

Laura:

I have a BFN, actually.

Shanna:

All right, well, tell us all about it.

Laura:

Well, so do you remember how last week you talked about your OMG? I’m freaking out about how your kids just are wild in public and you have no ability to discipline.

Shanna:

Yes, yes, sadly, I do remember that.

Laura:

Do you remember that conversation we had last week? Yes. Well, this week I was actually reminded of that because I had an interaction with Augie’s after school teacher. I went to go pick him up, and as I was signing him out, you go to the office to sign them out of aftercare, and then you go to their classroom. Right. So I happened to run into one of his teachers in the office away from the kids.

Shanna:

Okay.

Laura:

And she was like, oh, you’re Augie’s mom. Great. I actually wanted to talk to you. We’re having some trouble getting him to help clean. Oh. And I had, just, like, a sinking feeling in my gut, and she’s, you know, we tell him to clean up, and it’s like he just doesn’t hear us. It’s like he’s just fully ignoring us, and he’s not helping. And I’m wondering what we can do to help support him. Bless this teacher.

Shanna:

Right.

Laura:

I feel like at a lot of schools, they would have been like, so we’re giving him a discipline demerit or whatever. Right. But she was just like, what can we do to support him and help him? And I was just like, yeah, this might be a “me” problem.

Shanna:

Why do you think that?

Laura:

Well, okay, there’s two reasons. I thought that in the moment, I was like, yeah, we have the same problem at home. We try to get him to do stuff as I briefly mentioned last week, whenever we try to get him to do something like sit at the table or clean up, he just does it. And I don’t know what to do. I don’t know how to make him do things right. There’s a point where you can’t physically force a child to do something without resorting to corporal punishment, right? And I truly believe I’m not trying to teach compliance. Right. I’m not trying to just make him follow everything I do. But maybe sometimes it’d be nice if he actually listened to me and did what I say. So I was like, yeah, we need to work on this at home as well. And we will. A lot of times we don’t enforce cleanup because it’s too hard. And I gave her all these assurances like, we’re going to work on it. We’re going to work on it.

Shanna:

I have to say that cleaning up yourself as an adult, it really just goes so much faster. I mean, it’s like you pick your battles. Sometimes I see a big mess and I’m like, I could cajole these kids and ask them 9000 times and they’ll get distracted and not do it. Or I could just do it real quick and I just do it.

Laura:

I know. And this is what we’ve been doing because we’re just like, eh, it’s not worth it to have this fight.

Shanna:

Yeah.

Laura:

But now I’m realizing my BFN is like, oh, shit. This might be a life skill we are failing to teach him. So my BFN is that I just kind of realized that we kind of failed to teach him this as a life skill, and we’ve got to work on it also. I came home from school that day and looked around. I was like, this place is a fucking disaster. And it’s not just the kids stuff. Our shit is everywhere. We’ve been busy. The kids have been off school, right? They’ve been on vacation, and things just keep falling through the cracks. But I looked around and I was like, how am I going to tell him he needs to clean his shit up when we can’t clean our own shit up? So of course, the next day I was an absolute madwoman cleaning the house to try to be a good role model so that’s my BFN generally is just like, oh, realizing you’ve dropped the ball on something parenting wise. And yeah, now we have to change course.

Shanna:

Oof, that’s hard. And especially with Auggie, I feel like he loves toys and playing so much that getting him to stop doing that, which is fun, and move on to cleaning. And like, he probably just doesn’t want to lose focus on what he’s doing or something. I can see a bit of that too. Is that accurate, do you think?

Laura:

Yeah. I told the teacher, I was like, you know, one problem we run into is that we tell him to clean up and he’ll. Pick up one toy and then he just gets completely engrossed with the toy he’s supposed to be cleaning up. And I have to remind him it goes in the bin. It goes in the bin. It goes in the bin. And then he picks up another toy and then he’s, like, wanting to play with that toy. Like, he is so focused on these fucking toys. And so I tell her this and she’s like, oh, yeah, we’ve noticed that too. He just wants to play with whatever he picks up. I’m like yes. So, yeah, we’ll be working on that.

Shanna:

All right, well, I will be checking for updates on how that’s going, because I should probably start working with my girls a little bit more on their cleaning skills too, because we haven’t got any notes from the teacher, but I know that I’m lacking in that regard.

Laura:

Well, we’ll embark on this journey together.

Shanna:

All right, that sounds like a plan.

Laura:

In the meantime, shall we wrap up this episode?

Shanna:

I think we should. If you have any questions or comments about this episode or anything else, reach out to us. And if you want to find Linda Sayyad, visit her on Instagram or TikTok at the_v_doc. And Laura, where can everyone find us?

Laura:

We are on Facebook, Instagram and TikTok at BFPpodcast. We have a website bigfatpositivepodcast.com. If you want to send us an email, that’s a place you can always throw a voice memo. We love those. You can send it to [email protected]. And if you want to join the coolest group of people on the Internet and get some exclusive content from me and Shanna, just search Facebook for Big Fat Positive Community, request to join because it’s a private group, and answer those two membership questions so we know you are not a robot. Once you do that, we will send you straight through to all the wonderful, amazing conversations we’re having in there.

Shanna:

Our show is produced by Laura Birek, Shanna Micko and Steve Yager. Thanks for listening, everyone. Have a big, fat, positive week. Bye.