[Stephen} Hey guys! What’s up? It’s Stephen Dunn with CORE Therapy and Pilates and welcome to our Mindful Movement Monday class. Today we have Megan teaching and what you’ll need for class is a chair to sit in and a mat. Some will be sitting and some will be lying on the mat.

[Megan} Today we are going to talk about the pelvic floor and the pelvic wall and how to find that, how to strengthen and certain exercises where we can feel like we’re finding that pelvic floor. I have to start with a pelvis right here and I just wanted to show you all where that pelvic wall is actually at and what we want to feel like we’re lifting.

We have this little purple slinky here and I’m just going to show you that we’re putting that purple slinky right about in the center of the pelvis right there. I’m giving you this visualization because what I want you guys to feel is that we’re pressing down into the sitz bones and we are actually going to lift that pelvic wall like the slinky we are lifting up.

We don’t want to squish that slinky in together. We want to find that it doesn’t get stuck and it is just lifting directly up.

Everyone is on their chair and I think the chair is the easiest way to feel this and find this. We are going to get nice and tall on our chair.  I want to feel that our feet are firmly planted into the ground and that our sitz bones are pressing into the chair that we are seated on.

We are just going to start by doing a couple of deep belly breaths. Everyone I just want you to take a deep breath into the belly and on the exhale I want hot air coming out of the back of the throat like you’re fogging a mirror or that you’re making the verbal “ha” sound. Deep breath into the belly and exhale and let’s do one more just to kind of finalize where that breath is at…  take a deep breath in and exhale from the diaphragm.

So now you guys just keep breathing and I’m going to talk through and I want you guys to feel that  pelvic wall activation. What we’re going to do is we’re going to take an inhale; on our exhale we are going to push all the air out of from our diaphragm as we feel like we are pulling that slinky up towards the middle of the ribs.

We take an inhale into the belly and on our exhale all the air is coming out of our diaphragm to create space to find that lift of the pelvic floor. Let’s do a couple more guys, taking a deep breath in and exhale finding the lift. I don’t want you guys to feel like we are trying to jam those sitz bones together but that we are finding that deep deep internal lift. Again it’s just kind of come right through the center of the sitz bones that we want to feel those drawing up and end.

Does everyone feel that we have a little bit of a connection and some awareness to it?

Now I’m going to have everybody go ahead and stand-up. We are just going to take our chairs, I’m not going to move them off the mat, off to the side. I wanted to practice finding this pelvic floor activation and a couple of different plans.

First we are going to start with standing and just basic squats.  Everyone I want you to take an inhale and we are going to press through our heels and squat down. And on that exhale, I want you to press into those heels and find that lift coming through the center.

We inhale as we squat down and then finding that deep internal lift as we extend the legs and come back to straight.  Let’s do two more guys: so inhale, we are going to squat down, find that lift. You can also feel that you are lifting your bladder or that you’re pulling a marble from your root all the way up to the diaphragm.

And really find that deep lift as we extend the legs. What we are going to do is we are going to drop down to the floor and I want you again to find that connections with the sitz bones into the ground. Also you want to feel that you can really support yourself from your feet .

What we’re going to do is we are going to take an inhale at the top and then as we exhale we’re going to start by lifting that pelvic wall and rolling down. I don’t want you to get compressed in those ribs and just sag but we’re keeping our ribs away from the pelvis as we roll back. When you get to the bottom, I want you to go ahead and take on inhale and on the exhale we’re going to find that deep internal lift again, pressing into the hills as we roll up.

Again you’re keeping that space that we’ve just created as we’ve rolled up. We are going to take an inhale at the top. Let’s do this again, exhale we’re going to press our sitz bones into the ground, still feeling that connection with the feet, finding that lift and the ribs are away from the pelvis. When we get to the bottom, go ahead and take a breath of air and then exhale as we find that deep internal lift and we’re going to roll out by finding that connection into the back body.

Now we’re going to take this and we’re going to find it in a quadruped position. I want everybody to get into their hands and knees. Let’s just find it right here in this position before we start doing the hand movements.

We are going to take an inhale and on that exhale I want you to find that deep lift and again it’s going to feel like that belly button is kind of drawing closer to the spine. I don’t want you to feel that you’re arching your back or curling your back but rather you are finding that internal lift. And you are kind of holding your bladder up in towards the body and then we exhale and release.

On this next one, we are going to take an inhale, on our exhale we’re going to lift off our left hand and our right foot. So exhale finding that the pelvic floor and we’re extending finding through oppositions, stabilization into the pelvic floor into the core and then go ahead and drop those arms and legs back down and find the other side. Take an inhale to begin and then exhale as we float that right hand and that left foot back. Finding that stabilization coming from the core and then go ahead and come back in.

Let’s do one more time on each side. So take an inhale, on that exhale we’re finding, lifting as the legs are extending and coming back to center and last one.  And holding for a second and then slowly bringing our legs and feet to touch the mat.

Just one more final little thing, we’re going to have a seat. Let’s sit back on our chairs for this one. So this one we’re just going to find that pelvic wall and we’re going to hold for about 5 seconds and you can do this a couple of times a week and it should help you with kind of keeping some of that pelvic floor strength.

Again ladies and gentlemen, we are going to find those sitz bones so you can wrap around, side to side and can take those hands and spread your cheeks feeling that we’re really pressing down into them. We’re going to take an inhale, on the exhale we push down into the sitz bones as we lift that pelvic floor. When you feel that pelvic wall is engaged up and around the diaphragm, hold for around five seconds. Keep trying to breathe and maintain that contact.

And then go ahead and relax and release. Let’s try to find that again, deep breath in and exhale as we push our sitz bones down, find that internal lift and hold and release. And last one, taking a deep breath in, exhale getting those ribs down to create space to find that internal lift and relax.

Thank you, everyone, for participating.

Thanks and we hope you have a great day.

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Stephen Dunn: Alright, hey guys. What’s up? It’s Stephen Dunn here, with CORE Therapy and Pilates. I have a very special guest with me today, it’s my brother, Dr. James Dunn, who’s a urogynecologist out of Northern California area right now. We did one of these discussions, it’s been several months ago and we talked about pelvic floor health and we talked about some of the programs that Dr. Dunn does for his pelvic floor patients. We talked a little bit about the difference between what is urogynecologist and what is the difference between seeing a urogynecologist and a regular OBGYN for the kind of surgeries that he does.

My reference or my discussion, was I like to compare it to a dentist and an oral surgeon. You can get your dentist to pull your wisdom teeth, or you can get an oral surgeon to pull your wisdom teeth. Both of them can do the job, it’s just one of them does a lot more than the other and one of them would be more of an expert of the surgical part and one would be more of an expert of the other things. So I think that’s a real simple way to talk about it. If anyone has any comments, put them below and we’ll be happy to answer and questions.

What I wanted to do is just continue the conversation because something that I find is of importance or that I find is … we’re at a place now where it’s okay for women to have urinary incontinence. There seems to be a push, the message from watching TV, it’s all about medications or it’s all about diapers. Wear diapers, adult diapers, and I think there’s a different way of approaching things other than just spending money on adult diapers. I can’t remember the figure but the amount of money spent on adult diapers-

Dr James Dunn: Billions.

Stephen Dunn: Billions, versus actually trying to get it taken care of, way less, on a yearly basis. With that said, thanks for being here, Dr. Dunn.

Dr James Dunn: Hope you had a wonderful Thanksgiving.

Stephen Dunn: We got to spend some time for Thanksgiving and he’s leaving today, so I took advantage. “Hey, give me 10 minutes and lets go through some stuff.” So my first question to you is, if a woman is having … when is the right time for a woman to come see you?

Dr James Dunn: I get consults all the time, ignore that, with more advance problems, moderate and severe problems in older women. I think the best time is 30’s and 40’s, after childbirth. Definitely start on some kind of pelvic floor therapy on their own if the symptoms progress or don’t respond to simple kegel exercises and pelvic floor training at home, weighted cones, vaginal weights, things like that that you can do on your own, then yeah, physical therapy, more aggressive treatments. I would start right after childbearing.

Stephen Dunn: Basically is it normal to be having any urinary incontinence?

Dr James Dunn: It’s not normal, it’s just-

Stephen Dunn: Common.

Dr James Dunn: It’s common. It’s a common thing, I get that question a lot. It’s just a common consequence of childbirth, and pregnancy is the number one risk. Especially vaginal deliveries. You get some protection from cesarean sections, but pregnancy itself is the number one risk factor.

Stephen Dunn: If someone comes in with urinary incontinence the treatment plan doesn’t start with surgical intervention. It starts with other stuff first, correct?

Dr James Dunn: Very rarely does someone come in, already made up their mind. They’re like, “I want surgery,” ’cause of whatever they’ve heard or read, or, “My friend had surgery and I want that surgery.” Most women come in and say, “Yes, I prefer conservative, non-surgical, medications if there are, therapy.”

Stephen Dunn: Mm-hmm (affirmative). If someone goes through the conservative treatment, they do the kegels, pelvic floor strengthening, they do the possible probes and e-stim training. What’s the numbers of people, the percentage of people, that go through that program and then up needing to have surgery?

Dr James Dunn: We’ll go to the positive, about 70 to 80% improve or significantly get better where they don’t need surgical therapy, or other therapy. That leaves about 15 or 20% of women who need surgery or fail conservative options.

Stephen Dunn: Let me ask you this. You and I have had this conversation, if you watch the TV, you see all these lawyers advertising if you’ve had mesh surgeries, to call them for this and that. I think there’s been some misinformation or some bad information out on these mesh products, where I have people ask me questions about the mesh, because they’ve seen the lawyers advertising.

That’s something that I don’t really understand or know, but you mentioned to me that if you were concerned about the mesh, that no surgeries would be happening. It’s kind of what you talked about, it’s been several months ago, but with the mesh and the fear factor out there of, if you get this incontinence surgery and they’re using this certain mesh, that there’s gonna be a long term problem or lawsuit after.

Tell me a little bit about that.

Dr James Dunn: The mesh surgeries are definitely there. They have mesh surgeries and they have non-mesh surgeries that I offer, and we have that long discussion as far as the consent process. Do you want this with these risk and benefits and this surgery? The main concern with the lawyer ads is based on the pelvic surgery with mesh. It does have a higher complication. I haven’t been doing that mesh surgery. I still do the sling surgeries but with a longer discussion and say, “Yes, every surgery has risk. The mesh surgery has some specific risks, only related to the mesh.” So you have to say, “The risk of 90% plus for successful, and a couple percent chance of this things you see on TV.”

Then you go from there, after that process.

Stephen Dunn: Got it. These are just some questions that I get, questions that I don’t always know the answers to. So while you were here I wanted to go through and ask a few question. We’ve got a few people that have jumped in.

Hey, Jared. What’s happening buddy?

We don’t have any questions that have popped up. So let me finish with this one. If someone goes through this procedure, or they go through the surgical procedure for a sling for example, what kind of recovery is after that? And how long before they’re able to do normal exercise, and when should they start doing kegels?

Dr James Dunn: Probably right after surgery, you start your kegel therapy ’cause that doesn’t complicate the recovery. For after the surgeries, I typically do a combination of pelvic surgery, bladder lifts and sling surgery, so I ask those ladies to go slow for six weeks. Not do nothing, I want them to get their cardiovascular fitness so they can walk and treadmill and swim and do light … I just ask them not to lift anything heavy. Low impact. We made the number up, 20 pounds, don’t lift more than 20 pounds. But we don’t have a study that says yes or no.

I tell them, be moving but be mindful of how much pressure you put on the pelvic floor.

Stephen Dunn: Got it. ‘Cause that’s a question that I get, and usually by the time they’re coming to see me after surgeries, it’s been more than those six weeks. Just based on the whole process. But that’s a question that I’ve gotten, and six weeks is kind of a safe zone for many things in medicine. Bones, fractures heal in six weeks, lot of stuff happens in about six weeks. So that’s typically a safe answer, but I just wanted to get your clarification of that.

Alright guys, so with that said, we are done for the day. Hey Andy, what’s happening buddy? So if you have any questions, if you’re watching it later on the replay, put some questions down below and we’ll be happy to answer them. I got Jamey in town for the rest of the day and I wanted to take advantage of sharing some information that can be useful to our clientele.

So with that said, thanks for your time. Thanks for your time, Jamey, and thanks for your time for watching. We’ll see y’all on the flip side, guys. Now he’s got a Pilates class.

Dr James Dunn: Pilates.

Stephen Dunn: Peace, guys.

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