Pelvic Health & Pelvic Floor Dysfunction

# Pelvic Floor Health in the United States | Stephanie Bertoli | TEDxIndianaStateUniversityWomen
# https://www.youtube.com/watch/uIFC5fKs7Aw

00:00:05.359 hi my name is stephanie i’m a
00:00:07.440 stay-at-home homeschooling mom to three
00:00:09.360 little ones and a passionate advocate
00:00:11.360 for women’s health prior to becoming a
00:00:13.840 mother i was a d1 track and field coach
00:00:16.000 and way way before that i was a two-time
00:00:18.320 ncaa national champion in the pole vault
00:00:20.800 a collegiate gymnast and an ncaa woman
00:00:23.199 of the year honoree i have a bachelor of
00:00:25.519 science in exercise science and a master
00:00:27.439 of science in sport management
00:00:29.679 and through it all i have been literally
00:00:32.238 peeing in my pants
00:00:33.920 whether male or female your pelvic floor
00:00:35.920 serves an irreplaceable role in your
00:00:37.520 body made up of muscles connective
00:00:39.680 tissues nerves and part of your core not
00:00:42.160 only does it help you move laugh cough
00:00:44.079 breathe and have sex but it holds your
00:00:46.000 organs up and your stool and urine in
00:00:49.120 pelvic floor dysfunction is when it is
00:00:50.960 not fulfilling these roles
00:00:52.960 common symptoms may include leaking of
00:00:54.879 urine pain with intercourse back pain or
00:00:56.960 pelvic organ prolapse it can happen for
00:00:59.359 a multitude of reasons such as injury
00:01:01.440 pregnancy aging or even chronic
00:01:03.280 constipation
00:01:04.640 while it can affect all genders it is
00:01:06.720 much more common in women if you have a
00:01:08.880 mother sister wife daughter or
00:01:10.560 girlfriend if it’s not you odds are
00:01:13.280 someone you know is dealing with core
00:01:14.799 dysfunction and it is prevalent
00:01:18.080 studies have shown that as many as one
00:01:20.159 in three women will experience some form
00:01:22.640 of pelvic floor dysfunction within their
00:01:24.880 lifetime depending on the root cause in
00:01:28.000 many cases it can be both preventable
00:01:30.159 and treatable yet whether it be from the
00:01:32.479 stigma associated with it under
00:01:34.240 reporting misdiagnoses lack of education
00:01:36.799 or mismanagement of care so many do not
00:01:39.439 receive the help that they truly need
00:01:41.920 so what about me
00:01:43.600 now before i start for those of you who
00:01:45.360 know me and don’t wish to know that much
00:01:47.200 about me i highly recommend you turn
00:01:49.439 around and walk out now because things
00:01:51.759 are going to get really real here this
00:01:53.920 is your warning
00:01:55.680 for me it started when i was a teenager
00:01:57.920 around 15 as a gymnast i was this shy
00:02:00.960 incredibly awkward insecure young woman
00:02:03.200 and one day i was tumbling and for
00:02:04.960 whatever reason just peed in my pants
00:02:07.600 again
00:02:08.560 and again
00:02:09.758 i was mortified i had no idea what was
00:02:12.319 going on i thought to myself that maybe
00:02:14.640 it was just a fluke maybe i drank too
00:02:16.480 much water before going to practice or
00:02:18.000 something but then it just kept
00:02:19.760 happening over and over again day after
00:02:22.160 day
00:02:22.959 i was too shy to say anything to anyone
00:02:25.520 but i knew that people knew
00:02:27.760 in the beginning i didn’t even think to
00:02:29.280 wear a pad so it definitely showed at
00:02:31.760 times
00:02:32.800 in addition several of my teammates
00:02:34.400 would ask with a knowing tone things
00:02:36.400 like why do you run to the bathroom all
00:02:38.400 the time why did you have to change your
00:02:40.080 leotard did you just spill water on your
00:02:42.319 shorts
00:02:43.519 at the time i felt guilt shame confusion
00:02:46.239 why me what was wrong with me
00:02:49.519 in hindsight though i feel anger
00:02:51.599 resentment outrage where were my coaches
00:02:54.480 my network my support system where were
00:02:56.959 the adults looking out for me as a kid
00:02:59.760 this went on for years club gymnastics
00:03:01.920 to high school gymnastics to collegiate
00:03:03.599 gymnastics
00:03:04.480 not once in all of my years as an
00:03:06.720 athlete was i ever offered help or
00:03:08.640 guidance by a coach or trainer no one
00:03:10.879 even acknowledged it
00:03:12.720 during those first few years i spoke
00:03:14.319 with my family doctor very quietly very
00:03:16.640 quaintly without ever learning what the
00:03:18.720 root cause was based only on a few
00:03:20.879 questions i was prescribed medication
00:03:23.280 for an overactive bladder and told to
00:03:25.120 drink less water before practices
00:03:27.599 another time another doctor again
00:03:29.680 without an exam i was referred to a
00:03:31.599 physical therapist who sat me down
00:03:33.680 behind a curtain in a busy room and
00:03:36.000 asked if i’d like to use the biofeedback
00:03:38.000 device
00:03:38.959 now this is where you take a wand
00:03:41.200 attached to a cord attached to a
00:03:42.879 computer and you insert it into your
00:03:44.959 vagina to monitor your efforts
00:03:47.680 i don’t want to do that now as a mother
00:03:49.519 of three kids having lost all sense of
00:03:51.440 modesty and privacy through my
00:03:52.799 pregnancies and births let alone as a
00:03:54.799 teenager behind a curtain in a busy room
00:03:57.920 politely declining i was instead given a
00:04:00.080 handout of stick figures doing various
00:04:01.920 core exercises
00:04:03.599 i never went back
00:04:05.680 in addition to gymnastics i began pole
00:04:07.680 vaulting at first i was completely
00:04:09.840 asymptomatic but as time went on as with
00:04:13.200 any condition left untreated my symptoms
00:04:15.360 worsened eventually even pole vault left
00:04:17.759 me frustrated and in tears doubting
00:04:20.320 absolutely everything about me and my
00:04:22.079 body
00:04:23.120 pelvic floor health is tricky like that
00:04:25.520 while it’s a physical condition it’s
00:04:27.120 truly a lifestyle issue leaving its mark
00:04:29.759 on you mentally emotionally socially and
00:04:32.080 relationally
00:04:33.600 now sometime after college i talked with
00:04:35.360 my ob about my experience as an athlete
00:04:37.520 my family history of pelvic floor
00:04:39.040 dysfunction my desire to have children
00:04:40.960 in my hope to avoid surgery down the
00:04:42.720 line she said better start doing your
00:04:45.199 kegels now
00:04:46.479 i felt dismissed unheard and still very
00:04:49.120 much in the dark pushing for answers i
00:04:51.680 asked how do you do them how many how
00:04:54.160 often
00:04:55.440 now i know an ob is not in the business
00:04:58.160 of exercise prescription but i was told
00:05:00.320 to just squeeze like i was trying to
00:05:02.000 stop a flow of urine whenever i thought
00:05:04.000 about it watching tv driving in the car
00:05:06.560 sitting in a stoplight maybe i should
00:05:08.560 even put a few sticky notes up around to
00:05:10.240 help me remember
00:05:11.919 as someone who just graduated with a
00:05:13.680 degree in exercise science my gut told
00:05:16.400 me there had to be more to it than that
00:05:19.039 but i took her advice and i just started
00:05:20.880 squeezing away
00:05:22.800 then i had my first child
00:05:25.039 a second degree teared to my perineum a
00:05:27.360 society that told me i had to
00:05:28.880 immediately bounce back postpartum the
00:05:31.280 mind of a former collegiate athlete and
00:05:33.360 on top of it all i was a new mother
00:05:35.199 completely overwhelmed with being a new
00:05:37.520 mother
00:05:38.720 i showed up for my six week postpartum
00:05:40.720 check the doctor examined me for two
00:05:42.479 seconds told me i was good to go to do
00:05:45.520 whatever
00:05:46.720 i wanted to do
00:05:48.800 you can only imagine what happened
00:05:51.280 though i was peeing in my pants when i
00:05:53.520 coughed and sneezed even though i never
00:05:55.600 did any kind of quarry training it
00:05:57.600 wasn’t even suggested without someone
00:05:59.759 telling me to start small and simple you
00:06:01.840 guessed it i dove head first into the
00:06:04.000 world of fitness
00:06:05.440 i was doing hit i was running i was
00:06:07.199 jumping i was getting my body back
00:06:10.000 even with my experience in education i
00:06:12.560 just didn’t know
00:06:14.000 i didn’t know what my body needed where
00:06:16.479 to start how to progress or even who to
00:06:18.880 turn to for help
00:06:20.639 i was given the all clear the doctor
00:06:23.199 should know right she should have my
00:06:25.120 best interest in mind right she wouldn’t
00:06:27.520 let me do anything that would
00:06:29.280 potentially hurt me right
00:06:32.080 yes things got worse
00:06:34.479 fast forward 19 months i had another
00:06:36.639 baby thankfully no tearing this time
00:06:38.880 around but i also no longer felt like
00:06:41.360 diving back in to reclaim my body i was
00:06:44.160 burned out and my body felt like pulp it
00:06:47.039 was time to slow things down
00:06:49.360 i started googling things symptoms
00:06:51.280 exercises treatments just helped me i
00:06:53.759 was finally starting to take charge of
00:06:55.840 my pelvic health
00:06:57.520 i went to see yet another doctor i told
00:06:59.840 her my spiel again history symptoms
00:07:02.080 worries and fears and i finally asked
00:07:04.240 for clarity what is this elusive kegel
00:07:07.120 that everybody is talking about is it
00:07:09.520 really all that it’s cracked up to be
00:07:11.360 will it really fix all of my problems is
00:07:14.000 there anything else that can help me
00:07:16.880 she literally printed off a one-page
00:07:19.120 piece of paper on how to kegel
00:07:21.280 this was the last straw i was done being
00:07:23.680 ashamed i was done being timid i wanted
00:07:26.080 answers
00:07:27.199 i booked an appointment on my own
00:07:28.960 without a referral to a physical
00:07:30.639 therapist who saw pelvic floor cases
00:07:33.440 while i showed up full of hope my
00:07:35.199 frustration would only escalate now
00:07:37.680 let’s pause for a second
00:07:39.680 there are a lot of ways that you can get
00:07:41.680 help for any number of ailments there’s
00:07:43.520 a lot of people you can see they will
00:07:45.440 all handle things a little bit
00:07:46.879 differently and some will be better than
00:07:49.520 others healthcare can even vary region
00:07:51.680 or region some things will naturally
00:07:54.319 fall through the cracks we are all human
00:07:56.639 even our providers
00:07:58.400 i get that
00:07:59.840 i wasn’t expecting perfection but we’re
00:08:02.639 going on 20 years here and numerous
00:08:05.120 doctors you would think that someone
00:08:07.520 somewhere along the line would have had
00:08:09.919 some answers or at least would have been
00:08:12.000 able to point me in the right direction
00:08:14.560 but back to pt i will give her credit
00:08:17.120 she attempted to help me learn how to
00:08:18.800 kegel through external feedback she gave
00:08:20.720 me legitimate core exercises and a
00:08:22.879 simple progression to follow
00:08:24.960 but i was still without a diagnosis i
00:08:27.680 still didn’t know why all of this was
00:08:29.360 happening or what we were actually
00:08:31.039 trying to fix and when i told her i
00:08:33.200 suspected prolapse as i was experiencing
00:08:35.519 symptoms she dismissed my concerns
00:08:37.679 completely and said i couldn’t possibly
00:08:39.679 have that because i wasn’t overweight
00:08:42.719 now whether i did or did not a broad
00:08:44.959 sweeping statement without an actual
00:08:46.720 physical exam is simply unacceptable
00:08:50.000 seemingly out of resources out of
00:08:52.080 patience and hungry for change and help
00:08:54.399 i want online q dr google
00:08:57.519 i found a woman in canada who
00:08:59.120 specializes in quarry training signed up
00:09:01.279 for her class and devoured all of the
00:09:03.279 information i could regarding the pelvic
00:09:04.959 floor core dysfunction and exercise
00:09:07.040 prescription this was the beginning of
00:09:09.120 truly owning my story this was also
00:09:12.399 right around the same time when i
00:09:13.600 started wondering about other women
00:09:15.920 here i am with a degree in exercise
00:09:18.080 science having been a collegiate coach a
00:09:20.080 high level athlete fairly fit no major
00:09:22.240 health concerns concerns relatively easy
00:09:25.760 pregnancies and births relatively young
00:09:28.000 especially when things started i had
00:09:30.160 health insurance i was eager to find
00:09:31.760 answers and maybe most importantly i was
00:09:34.480 brave enough to ask questions
00:09:37.040 so what about other women with less
00:09:39.360 advantages and greater obstacles what
00:09:41.600 are their stories and their experiences
00:09:43.760 like
00:09:44.880 i couldn’t help but feel like i was just
00:09:46.560 seeing the tip of the iceberg that this
00:09:48.640 problem this lack of information
00:09:50.720 guidance and support was deeper and more
00:09:52.880 widespread than most cared to admit
00:09:55.360 that perhaps it wasn’t just me that was
00:09:57.360 missed in the system that perhaps the
00:09:59.120 system was not set up to help and heal
00:10:01.519 the whole woman
00:10:02.959 that perhaps there’s a huge piece of the
00:10:04.720 puzzle in women’s health that is being
00:10:06.480 glossed over by the majority
00:10:08.800 making my story more common than i
00:10:11.040 originally thought
00:10:12.800 but isn’t that what happens with most
00:10:14.720 taboo topics they tend to be hidden away
00:10:17.519 talked about in hushed voices and
00:10:19.120 ignored at least on the surface so as to
00:10:21.680 not offend or embarrass anyone
00:10:24.640 but what’s so taboo about a muscular
00:10:26.800 system in the body who cares if it
00:10:29.040 involves urine stool and sex if it’s not
00:10:31.680 functioning shouldn’t it be treated with
00:10:33.279 the same care and respect as any other
00:10:35.519 system in the body
00:10:37.200 if a baseball player tore his rotator
00:10:39.279 cuff in a game wouldn’t he be seen by a
00:10:41.600 doctor diagnosed with an injury given
00:10:43.680 appropriate rehab progressions and then
00:10:45.839 given the all clear to play again only
00:10:48.320 after he was fully healed and his body
00:10:50.880 was able to handle the work demanded of
00:10:52.959 it
00:10:53.920 then why might i ask can a woman in the
00:10:56.399 united states carry a baby for nine
00:10:58.320 months go through who knows how many
00:11:00.560 hours of labor and delivery tear herself
00:11:02.480 from vagina to anus and there not be a
00:11:05.120 protocol in place
00:11:06.800 why is she not immediately given
00:11:08.640 resources specific steps to follow and a
00:11:10.880 referral to a specialist
00:11:13.200 she deserves an entire network let alone
00:11:15.279 just a little bit of guidance and
00:11:16.640 education to help her get back on her
00:11:18.240 feet
00:11:19.120 and all of this should be done prior to
00:11:21.519 be given the all clear
00:11:24.160 instead i fear that most women are just
00:11:26.000 given a sympathetic smile as she has
00:11:28.320 handed her ice pack tylenol and her
00:11:30.560 prairie bottle and then sent on her way
00:11:33.279 we have to ask ourselves why are coaches
00:11:35.920 and trainers not given the tools and
00:11:38.079 resources needed to address and guide
00:11:39.920 athletes with core dysfunction why are
00:11:42.399 women feeling dismissed when they tell
00:11:44.160 their doctor that they pee in their
00:11:45.440 pants
00:11:46.560 why are women being cleared postpartum
00:11:48.560 when they are clearly not healed
00:11:50.880 why are women being treated for core
00:11:52.480 dysfunction prior to an actual diagnosis
00:11:56.240 why is core dysfunction treated as
00:11:59.040 normal and just a burden we women must
00:12:01.040 bear for having children or god forbid
00:12:03.360 for aging
00:12:04.720 i refuse to accept that just because
00:12:06.800 something is common it is normal and
00:12:08.880 that i will just pee in my pants until
00:12:10.639 the day that i die
00:12:12.240 instead i firmly believe that with a
00:12:14.160 proper diagnosis and a little tlc i can
00:12:17.519 and will
00:12:18.720 change what has been a burden for so
00:12:20.480 many years
00:12:21.920 now let’s fast forward to postpartum
00:12:23.519 with baby number three
00:12:25.680 knowing what i knew knowing that i
00:12:27.760 deserved better and truly believing that
00:12:30.000 given the chance my body would prove
00:12:32.480 capable i specifically asked to be
00:12:34.959 referred to see a pelvic floor physical
00:12:36.880 therapist who does internal exams
00:12:39.680 and that’s exactly what i got
00:12:41.760 thanks to my pt after so many years of
00:12:44.800 waiting i was finally given a diagnosis
00:12:48.320 i was told that i had a hypertonic
00:12:50.160 pelvic floor so my muscles were actually
00:12:52.079 too tight and not able to go through the
00:12:53.839 full range of motions so this idea of
00:12:56.560 more kegels equals stronger was actually
00:12:59.040 making my simple symptoms worse
00:13:01.760 i had a weak pelvic floor an
00:13:03.760 uncoordinated pelvic floor so the
00:13:05.519 contractions and the movements were out
00:13:07.360 of sync
00:13:08.399 a bladder prolapse my bladder had
00:13:10.320 dropped out of optimal position
00:13:12.880 and a little bit of rectus dice or a
00:13:14.959 little bit of diastasis rectus abdominis
00:13:17.279 or a separation of the abs
00:13:19.360 i finally learned how to do a kegel
00:13:22.639 i was finally given a true exercise
00:13:24.800 prescription for my core my pro my
00:13:27.519 progress is finally able to be monitored
00:13:29.680 and assessed as we move along and most
00:13:32.160 of this would not have been possible
00:13:33.920 without a skilled pelvic floor physical
00:13:35.760 therapist who works internally
00:13:38.480 and it has helped you may ask
00:13:40.560 yes
00:13:41.360 a million times yes in only a few short
00:13:44.240 weeks i saw improvements and within a
00:13:46.000 few months i was stronger than i was
00:13:47.839 pre-babies i can finally cough sneeze
00:13:51.120 run and jump without peeing in my pants
00:13:54.959 no it’s not perfect yet i still have my
00:13:57.600 moments
00:13:58.720 but if there’s anything that my journey
00:14:00.399 has taught me it’s that health is a
00:14:02.240 lifetime commitment and healing is not
00:14:04.240 linear i know that with time and
00:14:06.639 intentionality i will only continue to
00:14:09.199 improve
00:14:10.560 yet i cannot help but wonder
00:14:13.279 what if i would have gotten help sooner
00:14:15.360 five ten fifteen years ago would my
00:14:17.920 symptoms have gotten as bad as they did
00:14:20.000 would my pregnancies labors and
00:14:21.600 deliveries have been any easier would i
00:14:24.320 have been able to avoid a prolapse
00:14:26.079 altogether
00:14:27.279 would my quality of life and
00:14:28.880 relationships have been any better over
00:14:31.279 the years
00:14:32.720 pelvic floor health impacts the whole
00:14:35.120 person it touches every single aspect of
00:14:37.760 someone’s life
00:14:38.959 while poor health is not
00:14:40.399 life-threatening it is most definitely
00:14:42.720 life-diminishing and that’s something
00:14:44.959 worth fighting for
00:14:46.800 if my story can help just one person
00:14:48.959 live a fuller more stress-free life if
00:14:51.279 my experience can empower just one woman
00:14:53.760 to find her voice and the courage to
00:14:55.680 speak up that’s worth me getting up here
00:14:58.240 and telling the world that i’m a chronic
00:14:59.839 pee in my pantser or at least that i was
00:15:03.279 so where do we go from here
00:15:05.519 i want to challenge you
00:15:07.600 help me drop the stigma of incontinence
00:15:10.079 and other core dysfunctions the more we
00:15:12.320 talk about it the more honest we are
00:15:14.079 about it the less taboo it will become
00:15:16.399 no we don’t all have to do a ted talk
00:15:18.720 about it but we can start having real
00:15:20.639 conversations about it with those we
00:15:22.399 trust talk to your mom daughters
00:15:24.480 husbands wives sisters friends about
00:15:26.639 your experiences open up that
00:15:28.800 conversation for change
00:15:31.279 if you are a coach or a trainer
00:15:33.680 learn about core dysfunction routinely
00:15:35.759 screen for it know what symptoms to look
00:15:37.759 out for and know where you can refer
00:15:39.759 your athletes and clients to
00:15:41.839 do not be afraid to bring it up if
00:15:43.680 needed you might just be changing that
00:15:46.160 person’s life
00:15:48.000 if you are a person with a pelvic floor
00:15:50.399 aka everybody
00:15:52.639 seek out information on how to take care
00:15:54.560 of it and what symptoms to look for in a
00:15:56.639 non-functioning core
00:15:58.800 if you are experiencing symptoms do not
00:16:01.199 allow anyone to dismiss you or your
00:16:03.920 desire for help regardless of your age
00:16:07.040 fitness level education level how many
00:16:09.360 children you may or may not have or how
00:16:11.440 you gave birth insist on a diagnosis
00:16:15.040 request to see a pelvic floor physical
00:16:16.880 therapist and refuse to settle just
00:16:18.959 because something is common
00:16:21.199 and last but not least if you are
00:16:23.279 pregnant or having recently given birth
00:16:25.759 know that you need to progress slowly do
00:16:28.240 not accept that postpartum bodies are
00:16:30.079 just supposed to bounce back
00:16:32.240 and resist the urge to go from zero to
00:16:34.320 100 just six short weeks after birth
00:16:37.440 find a pelvic floor physical therapist
00:16:39.360 and give your body the time and the
00:16:41.040 grace that it needs to heal
00:16:43.519 i stand before you today not as a
00:16:45.600 medical professional or exercise
00:16:47.519 specialist but as a woman mother and
00:16:49.600 friend urging you to join me in my
00:16:52.000 crusade of demanding more of our health
00:16:53.920 care system and fitness professionals
00:16:56.160 help me drop the stigma of pelvic floor
00:16:58.320 health share your stories voice your
00:17:00.320 concerns and refuse to suffer in silence
00:17:02.880 you are truly not alone
00:17:05.839 perhaps together we can create the
00:17:07.679 support network in women’s health that
00:17:09.520 is so desperately needed thank you