How to Find Normal

It’s been about one month since COVID-19 took over and knocked us all off track. Day by day we were listening to the updates, what’s changing, what bad news is there, what else will be closed.

By now we know we’re in for it. School’s out and businesses are closed. We are home.

How do we settle into the new normal?

Sit down with a piece of paper. Set a timer for 5 minutes, and write freely about what “normal” means to you.

Then take a look at that list and categorize it into

1. What can you still do?

2. What are you better off not doing?

3. How can you modify to add it back in?

For example, I have been sleeping later (which I’m giving myself grace for), but I still get up and write morning pages every day with a cup of green tea (category #1).

Under category #2, I used to drive everywhere, like running to the store for 1 thing. I also grocery shopped several times a week. All of those are things I apparently can live without, and maybe am better off for it.

Finally, for #3, I miss going to the gym and yoga studio. Thankfully, both of those businesses are streaming classes online; I just need to remind myself to get it on the calendar and show up.

Now on to you: what kind of normal can you take back? Start small. Set an intention and hold it gently. Give yourself grace. Things are not normal. But in our small worlds, maybe some things can be.

Root Chakra

The root (or first) chakra is an energy center housed at the tip of the tailbone and associated with the perineum. In other words, essentially at the level of the pelvic floor.

Characteristics of this chakra include security, groundedness, power, and sex—certainly all things that I associate with the pelvic floor (even my western-medicine colleagues would agree that makes sense). It’s also associated with our basic needs—food, sleep, shelter, safety.

When those basic needs are threatened—as in our current world situation—our body can react by trying to grasp for them, trying to control them. In other words: it holds on.

Think of a dog that’s scared: it tucks its tail between its legs.

When we are scared—when our basic needs or power or security are threatened—we inherently “tuck our tail” too. But for us, that means we put all that tension in our pelvic floor. It is a false sense of control somewhere in our being, which in reality does not help us at all.

It can turn into pelvic pain, painful sex, tailbone, hip or back pain. It can change our relationship dynamics. It can give us feelings of scarcity or greed, a fear that we won’t have enough. That our basic needs will run out. (Hello TP hoarders.)

Take a couple minutes wherever you are to just check in with your root. If you’re rolling your eyes at the “woo” nature of what I’m saying, just check in with whatever parts of your body are contacting your seat.

Notice your sitbones, your thighs, your pelvis.

Take a couple breaths, and notice what you’re holding there.

What is serving you?

What is not?

Breathe into your pelvis, letting go whatever isn’t serving you. Let go of the tension. Let go of any unwarranted fear. Let it go.

Check in throughout your days: are you tense again? Let it go. This practice of checking in with your body becomes a mindfulness practice that can lead to feeling grounded, especially in these uncertain times. Release what doesn’t serve you, what is taking up precious energy in your body. Let it go.

Pelvic Floor Function #4: Stability

You’ve done core exercises, right? You’ve probably had a coach or a yoga teacher say “engage your core” or “tighten your core” or “we’re going to work on your core.”

But what is the core?

Let’s break it down:

There are two groups of core muscles: the deep core and the outer core. Think of deep as the “stabilizers” and the outer as the “movers”. The deep core prepares for movement by “zipping up” the trunk, then the movers actually, well, move.

Let’s dive into the deep core. This layer is made of four muscles that create the “canister” of the trunk: the pelvic floor is below, the deepest layer of abdominals (transverse abdominis) in front, the deep back stabilizers (multifidi) along the spine, and the respiratory diaphragm at the top. Connecting all of these muscle groups is fascia, which is like the saran wrap of body tissue, making sure they are all interconnected.

When all four of these muscle groups are coordinated, they sort of tighten or zip up just before you move a limb, keeping the trunk stable.

When one group is weak, injured, or uncoordinated, we lose some of that stability.

Think of a can of La Croix: when its’ sealed, it’s solid. You can squeeze the sides as hard as you can, or step on the top, and it’s going to stay solid. But as soon as you pop the top, you can squeeze the sides to crush it, or stand on it and it’ll collapse. Even if you break the seal just a little—the stuff inside will still squeeze out.

Our trunk is pretty similar. If the pelvic floor isn’t “sealing” properly when you cough, sneeze, jump, or laugh, some of the “stuff” inside leaks out.

Same goes for the back muscles, or the abdominal muscles in the front (think diastasis, which I’ll cover another day!), or if you’re holding your breath all day. If one or all of these muscles gets knocked off track, we lose an element of stability.

So next time you’re in a class and the instructor says to “engage your core”, add your pelvic floor into the mix.

Head back to read my posts about the other three functions of the pelvic floor for a complete picture: Sexual Function, Sphincters, and Support. And if you want a full tour, catch my video Tour of the Pelvic Floor here.

Pelvic Floor Function #2: Sphincter

When I as a freshman in high school, someone had gotten their hands on a dictionary of “dirty words.” Yes, this was an actual hardbound dictionary since we didn’t have Urbandictionary.com back then. The only word I remember learning was “sphincter.” Who knew that in my professional life this would be a word I talk about all the time? And: it’s not a dirty word at all. It’s just anatomy.

Sphincters are important. You probably appreciate yours right now if you think about it: are you peeing as you read this? Are you passing stool or gas? (Disregard if you’re reading this on the toilet). If you aren’t passing any body waste, are you thinking about doing a kegel? Probably not. Pretty cool, huh? Thank your sphincters.

A sphincter is simply a round muscle. You have one around each eye, your mouth, all through your digestive system, and most importantly for this post, around your urethra and your anus.

Both the urethral and anal sphincters have 2 layers. An inner layer is made of smooth muscle—which is the kind of muscle your guts and your heart are made of. You don’t have to remember to beat your heart all day, right? (thank goodness!) And digestion goes on in the background. These are smooth muscles and are run by your autonomic nervous system. And that’s the reason we don’t typically have to think about not peeing our pants all day long. SO GREAT.

Now when you DO feel an urge come on, or you feel some gas coming while you’re in an elevator, or you’re about to sneeze—you can squeeze to hold it back. That’s the second (outer) sphincter working, and you get to control that one. When you do a pelvic floor contraction, you are squeezing the outer sphincters of both the urethra and the anus (unless you’ve been practicing and are really coordinated at squeezing one but not the other, which quite frankly I can’t think of a real good functional reason to practice).

I call this the “Sphincter function” to stick with the S-theme, but really the function of these are continence, or keeping control of your bowel and bladder. If there is weakness in these muscles, it could lead to urinary, gas, or bowel incontinence. If these muscles are too tight, it can lead to difficulty emptying the bladder or bowels. We need a balanced pelvic floor for all of it to work smoothly.

See, sphincter is not a dirty word at all. If I could go back and be my 15-year old self, I’d tell those other kids about how freaking cool sphincters are, and that they should all be grateful for them. I’m pretty sure that’d give me cool points, right? Right...

Do you think they’re cool? Have questions? Hit up the comments below!

Stay tuned for the rest of this series on the Functions of the Pelvic Floor: Sexual, Support, and Stability.

Pelvic Floor Function #1: Sexual

This layer puts the “fun” in functional.

The most superficial layer of pelvic floor muscles is constructed of relatively small muscles that create a triangle around the openings of the vagina and urethra. When they contract, they do a couple things.

First, they help with arousal. They are connected to a little piece of skin over the head of the clitoris called the clitoral hood. When they tighten, they pull this little hood over the sensitive head of the clitoris, contributing to arousal.

Fun fact: did you know that the clitoris is the only organ in the human body that is solely there for pleasure?! It has no other function. Just pleasure. It is analogous to the glans penis, or the head of the penis, but even that is dual functioned since the urethra passes through it. How’s that for some great anatomy?! 

Another important fact: most women only have orgasms through clitoral stimulation. There seems to be long standing rumors that you are somehow lacking if you can’t have an orgasm through penetration alone—but if that’s you, you’re NORMAL! The G-spot is kind of an elusive thing that may or may not be real, but most arousal and orgasm do originate at the clitoris.

The second way this layer contributes to pleasure is to bring in blood flow to the genitals. A smooth rhythm of contraction and relaxation brings blood flow in and leads to engorgement. If you ever want a deep dive in to all that goes on in your body during arousal, check out Woman’s Anatomy of Arousal by Sheri Winston. She actually takes you on a tour of your anatomy that includes watching the skin color change at different stages of arousal due to increased blood flow to the labia.

Finally, the one that gets all the attention, is the Big O. During climax, the pelvic floor and uterus contract together to contribute to orgasm. Of course, it’s not just a muscular phenomenon, but they do play a major part. There is a little research that supports pelvic floor strengthening to increase orgasm, and a lot of “tools” to help you do that (for better or worse). It’s important to understand that an orgasm has a large psychological and emotional component as well, though. So kegels are not necessarily The Answer if you’re struggling in this area.

For the muscles to be able to contribute to optimal pleasure during sex, they need to be able to tighten—but they also need to be able to relax. If they are too tight during initial entry, there can be pain. If there are knots in the muscles, they can also cause pain during penetration, orgasm, or after sex, as well as pain with inserting fingers, tampons, and anything else.

There you have it: though they are small muscles, they have a mighty function. Stay tuned for the rest of this series on the Functions of the Pelvic Floor: Sphincters, Support, and Stability.

Questions or comments? Leave them below!

Back to Basics: Layers of the Pelvic Floor

The pelvic floor has 3 layers of muscle, and 4 basic functions. Today I’ll cover the anatomy and layers, but each function deserves their own post, so keep checking back for more detail over the next few weeks.

*If you learn better by watching and hearing, click here to get access to a video I made covering everything in this post!

The most superficial layer consists of relatively tiny muscles that are much appreciated. Their primary job relates to sexual function. They create a triangle whose angles land on the pubic bone in front and each sitbone. One muscle reaches on each side from the pubic bone to each of the sitbones. Another reaches sitbone to sitbone across the perineal body (a very important junction of muscle and tendon between the vagina and anus, which can be torn during birth). The third group of this layer wraps from the pubic bone, around the vagina and urethra, meeting at the junction of the perineal body.

The deepest layer acts like a bowl and covers the majority of the space between the pelvic bones. This layer is largely for pelvic organ support, and because of the relative size of the muscles, is most likely what you feel tightening if you do a kegel.

In between those is a middle layer that includes sphincters (aka round muscles) around the urethra and the anus. These are SUPER important (and do so much without us thinking about it!) as they keep us from leaking urine or stool all day long.

When you contract the pelvic floor, you’re likely squeezing all three of the layers, superficial to deep and front to back. Some people can differentiate front to back, but it takes a lot of body awareness.

Most of the muscles are just like any other muscle in your body: they can be strong and toned, weak, atrophied, tight, or have trigger points (or “knots”) in them. Crazy, huh? That also means they’re trainable, so if they’re weak, they can learn to be strong. If they’re too tight or painful, they can learn to relax. Sometimes they need massage or release. They’re like your shoulder muscles: if you hold tension there, you can remind yourself to drop your shoulders and relax. But often times it takes a good relaxing massage to really get them to release. The pelvic floor can be the same. (Please oh please make sure you find a trained and licensed professional to do this work!)

The next few posts will break down the functions of the muscles: Sexual, Support, Sphincters, and one I didn’t mention yet: Stability. Stay tuned or sign up for my email list to get it sent right to your inbox!

Back to Basics: Take a Look

Getting to know your body starts with knowledge of what you’ve got. While high school biology covers the basics it typically misses some pretty important parts. I can’t tell you how many people in the clinic tell me I am the first person to show them a picture of their pelvic anatomy—or show them their own with a hand mirror. While I hate that it’s the truth, I do LOVE being that person. It gives a person back a piece of their own power.

If you’re so inclined, grab a mirror, get comfy on your bed with good lighting, and follow along this little map to see these yourself. I truly believe the more we know about our bodies, the more ownership we are able to take. I know it weirds some people out, and that’s fine. But I truly believe there is nothing shameful about the human body, and these are important basics to know and experience.

Here’s where we start:

Women have 3 openings in their pelvic anatomy. From front to back, there is a urethra, vagina, and anus. This may be old news to you, but I can tell you—there are adults who don’t know this.

More on these openings:

Urethra:

This is where urine (pee) exits. You may or may not be able to see this on yourself, because our anatomy varies. Sometimes it’s easily seen just right there beneath the clitoris (that part deserves its own post!), but sometimes it’s tucked up more inside the vaginal opening. Separate the labia minora (literally “little lips”) and see if you can find yours.

Vagina:

This is where menstrual blood and discharge exit, where your tampon or menstrual cup goes, and where sex often “happens.” I once had a young new mom look at my pelvic model and ask “Where does the penis go?” THIS is where it goes (usually). And with a vaginal birth, it’s where the baby comes out. (It’s so good to know what it looks like before you have a baby, so you know what your baseline is! It will always look different after birth though)

Anus:

This is where bowel movements (poop) exit. While your mouth is the start of the digestive system, this is the end. Hemorrhoids can show up here too.

That’s about as basic as it gets. Start here to orient yourself. While you’ve got the mirror out, do a pelvic floor squeeze, and see what changes (you should see everything pull inward). Release then try pushing out a little (you should see everything push out a little). You might not see anything change at all, or you might see a LOT of movement.

Want a more thorough tour? Click here to get access to my free video Tour of the Pelvic Floor.

If you really want a more thorough assessment, get yourself to a Physical Therapist who specializes in pelvic health. If things don’t seem right down there, or if you just want to know more about what you’ve got, they can be a tremendous help. It’s YOUR body, after all. You deserve to know everything you can.

Image: @priii_barbosa

Reflection + Intention: The NEW “New Years Resolutions”

I’m not a big fan of New Year’s Resolutions. What are they—they’re ideas we get all excited about in January, then we do them hardcore for a month, then fall off the wagon, then feel guilty about it (if we even remember that we set them...). Amiright?

What if we did it differently. What if we replaced “New Year’s Resolutions” with Reflection & Intentions. The following is an exercise that in part I adapted from Kate Northrup. Carve out some time to try it out.

REFLECTION

Set aside an hour or so this week. Find a quiet space—maybe a coffee shop or maybe your kitchen table. Grab your calendar (or calendars if you’re me...) and a cup of tea or coffee.

Begin by closing your eyes, and focus on your breath. Get present with yourself and check in with your body. This is an exercise of noticing.

When you feel present and ready, start to look back through your 2019 calendar one week or month at a time. Look at the activities or events you have written down. Stop after each one and notice in your body:

What makes me expand?

What makes me contract?

For example, I looked back and saw a weekend in June that was filled with a friend’s Bachelorette party that included a bike winery tour in Hood River. You bet that made me expand—I smiled just looking at the words on the page. The next week I had four days of working at a job I didn’t enjoy—I contract just thinking about that.

INTENTION

After your reflection time, take out a blank sheet of paper. Or you might choose what my husband and I do, and tape a huge piece of butcher paper to the kitchen wall. There’s a G column, a Mandi column, and a shared one in the center.

Make a list of Intentions for the year. Some of them might look like goals. Some might look like tasks. Some are dreams. None are resolutions, and none have to be set in stone.

In 2019 our list included things like “get a dog, start a business, pistol squat, build garden beds, plan for retirement, go to Paris,” etc. A lot of them got crossed off. Our 10-year anniversary was on the list—that was going to happen no matter what, so it was a sure bet to get crossed off! Having it visible throughout the year gave us a sense of accountability to remember our dreams, a quick glance reminded us of some boring to-do’s, and the Sharpie looped into it made it gratifying to cross things off.

Try it out. If you do, please share in the comments below what some of your Intentions are! I’d love to hear. ✨

How to Stay Present During the Holidays (or any time)

As I grow older, I realize more how much goes into the holidays that I didn’t realize as a kid. We spend so much money. We stress over what to give who and which family to go visit. We make plans. We reschedule said plans. We realize that our partner made plans at the same time as our plans so we do two things in one night and realize we weren’t fully present at either one.

Why do we do this? What happened to all the magic that the holidays held when we were kids?

I think we just grew up.

Is there still magic in this season? Yes, I believe there is. Because I believe there is magic in every season, and in every day. We just have to sit still and be quiet enough to notice it.

I’m writing this down for both of us. Because I by no means have it all figured out. I just happen to be writing this from a tiny desk in a small room on a one-day silent retreat. This is all fresh on my mind because there’s no noise to drown it out.

How to stay present during the holidays (or any time)

-       Find stillness.

- Wake up early and read in bed.

-       Light a candle and invite your family into a moment of silence.

-       Stay up late sitting by the Christmas tree.

-       Take a walk. Notice the sky, the grass, the leaves, the lights.

-       Find a token. Look for a small rock and keep it in your pocket. Hold it or rub it throughout the day to remind you of the earth we inhabit.

-       Meditate. Sit comfortably. Or lie down. Notice your breath. Silently say “I’m breathing in” then, “I’m breathing out.” If your mind wanders, notice that, and come back to your breath. Do this for 5 breaths. Or 5 minutes. Or longer.

-       Do a sun salutation. No one says you have to go to a studio and pay for a 60-minute class to “do” yoga. Make it up in your living room, on your rug, or at the airport. Just move.

-       Write. Take out a notebook or journal and write 1 page, or 3 pages, of anything.

-       Take a moment to notice your body. Close your eyes. Feel where your body is contacting the ground, the chair, the air. Notice the angles of your joints. Notice areas of tightness, discomfort, ease. No need to change anything: just notice. 

There are a few things we have with us all the time: our body, our breath, our mind. We can use these things to touch down, to remember where we are, who we are, what we are. It’s so easy, yet sometimes so complex.

But it’s nothing short of magic. ✨

Your turn: how do YOU stay present during the holidays? Share in the comments—I’d love to hear more ideas, and we could always use more tools for this magic!

6 Tips for Smooth Moves

Whether it’s because of travel or a wacky holiday diet consisting of gingerbread houses, it’s not uncommon to feel your digestion sloooooow down during the holiday season. Here are some tips to keep things moving smoothly:

1. Stay hydrated

It’s recommended to drink about half your body weight in fluid ounces each day, and most of that should be water. For example, if you weigh 160 pounds you should be drinking about 80 ounces a day. Your body takes in all the fluids that you drink and disperses it for its own uses throughout your systems. If you’re dehydrated, by the time your food is all digested and ready to leave the system, there’s not enough water to go around, and your stool becomes hard and dry. That makes it hard to pass, sometimes causing constipation, painful bowel movements, the need to bear down, and hemorrhoids. Basically, a BM can be a big bummer.

2. Add in some fiber

It can be hard to keep track of how much fiber you’re taking in on a good day. Around the holidays, when your lunch might consist of the deli platter someone brought to work or the Christmas cookies your kids decorated, it can be even harder (which can mean your stool is harder too...)

The easiest way to get your fiber is to add in a supplement each day. My favorite recommendation is psyllium husk, but you might find another type works better for you. (*Ask your pharmacist or care provider for recommendations if you’re pregnant, want more direction, or if you are unsure of any interactions with medications you may be taking.)

Start by adding in the smallest dose recommended on the package, and continue that for one week. After a week, increase or decrease according to how your body is responding. Your bowels like habits, so if you’re hit or miss on a supplement, you won’t get the full benefit.

Taking it in the evening can prevent discomfort of cramping or a belly ache, and make sure you drink plenty of water along with it (back to recommendation 1!)

 3. Listen to your bowels

If they say they gotta go, they gotta go! They aren’t like your bladder where you can ignore the urge. Even if you’re at work or at a party, follow their lead. I always remind myself that everybody else poops, which makes me feel better about having a BM in a public restroom ;)

4. Try abdominal bowel massage

If you feel like you need to go, and it’s just not moving through, try this simple abdominal bowel massage. Start at your right hip bone, and massage in small circular pattern toward your ribs. Then continue across from your right lower ribs to your left, then turn the corner and massage toward your left hip bone. Continue this clockwise pattern until you feel some gas or stool starting to move. It’s just like magic. (for a video, check out my Instagram Highlights)

5. Get moving

Go for a walk. Head to the gym. Physical activity helps to stimulate our bowels. Take the whole family for a post-prandial stroll. I have fond memories of taking a walk around Kiwanis park in Great Falls, Montana with 4 generations of my dad’s family after Thanksgiving dinner. (Though I wasn’t thinking about my bowels back then!)

6. Put your feet up

I’m always a fan of the Squatty Potty, because it just makes pooping easier. Having your knees above your feet tilts your pelvis in a way that helps relax the pelvic floor and “un-kink” your rectum. Don’t have a Squatty Potty? Throw your kid’s step stool under your feet, or flip a garbage can on its side. In a pinch, if there’s extra TP rolls, just put one under each foot. It will make everything easier (and faster!)

There you have it. My six best tips for keeping your bowels moving smoothly throughout the holiday (or any!) season, no matter how much eggnog you take in. ;)

(If you try all this and find you’re still having bowel troubles, it might be helpful to see a PT. Schedule a free 15-minute phone consult here so we get you on the right track!)

6 Reasons to See a Physical Therapist BEFORE the Baby Arrives

If you’re like me, you grew up thinking that having a baby looked kind of like this: 

Your water breaks in a really dramatic gush. You rush to the hospital (that baby is coming any second!) then suddenly are lying on your back with your legs in the air while a doctor in a white coat catches the baby.

Add in some dramatic screaming and pushing and you’ve got the picture.

Can anyone else relate? While yes, there are births that I’m sure look like that—it’s TV.

Many people have days of labor, change positions too many times to count, and give birth not only in a hospital but perhaps a birthing center or a pool or the bathtub or their living room. The possibilities are almost endless, but—especially with the first baby—it’s usually not a quick process.

Labor & delivery is often a long, exhausting event. It’s something you need to prepare for—get in shape for, if you will. For example, if you’re pregnant and want to labor in a squat (a great option for opening the pelvis), you need to make sure you can squat before those contractions even begin. A deep squat takes strength, endurance, and a lot of hip, knee, and ankle mobility.

This is where physical therapy comes in to play with L&D. Most people don’t think of PT before labor, unless they’re having pain of one variety or another and were referred by their midwife or OB. Seeing a PT during pregnancy can prevent pain & discomfort, and prepare you for the big event.

6 Reasons to See a Physical Therapist BEFORE the Baby Arrives:

1.     They can teach you perineal massage. While we can’t say if this truly prevents tearing during delivery, we do know it helps you learn how to keep your pelvic floor muscles relaxed during the discomfort of a lot of perineal stretching. A relaxed pelvic floor = an open path to the exit!

2.     You can learn how to actually push during labor. Ask your friends: how many of them said they didn’t know how to push when the nurse or midwife started telling them to do it? A PT can help you learn what it feels like to lengthen the pelvic floor while pushing with your abdominal muscles so it’s familiar when the time comes.

3.     Practice labor & delivery positions. A PT can make sure you have the joint mobility to get into a deep squat, a lunge, hands and knees, and any other variety of positions that can help open the pelvis and move the baby down. We can educate you on the benefit of different positions and help you figure out which ones you need to practice before the big day.

4.     Make sure your partner knows how to physically support you during labor. Bring your partner to an appointment or two so they can learn ways to support you in a variety of labor positions, perineal massage (you might not be able to reach eventually!), and comfort measures.

5.     Balance the pelvis & uterine ligaments. If your pelvis is a little shifty or your ligaments have restrictions, it may affect baby’s ability to move down. As long as you’re later in the pregnancy, a PT can use manual techniques to make sure everything is balanced and ready to go.

6.     Get educated on postpartum care. When can you start doing kegels? When can you start doing abdominal exercises? What do you do if you had a cesarean? How do you get out of bed comfortably? We can give you guidance on all of this and more (with handouts, of course) so if you have questions after baby comes, you have the resources right there.

If you are expecting (congratulations!), I can’t recommend seeing a PT enough. If you’re in the Tacoma area, schedule a FREE 15-minute phone consult with me to get started. If you’re farther away, check out these resources here and here to find a PT near you. The best thing you can do during pregnancy is to educate yourself and be prepared for anything. Making a PT part of your team will be a huge benefit to that end.

Did you have PT during your pregnancy? How was your experience? What else would have been beneficial to know going into labor? Share in the comments!

These Are A Few Of My Favorite Things

Welcome to December. I like to refer to the time between Thanksgiving and New Years as the “slingshot season.” It’s like someone pulls back the slingshot in early November, lets it go on Thanksgiving, and sends us flying into the new year. It’s fast and furious, and typically comes with no small degree of stress.

I’ve taken a new method to gift giving in the past couple years, and it’s led to a lot more peace in this season. I’ve allowed myself permission to buy gifts when they strike me—no matter what month it is. Last year my holiday shopping started in August and was done by early November. With that, I’ve also tried to not stress over the perfect gift, but rather when something calls to me with a certain person in mind, I go ahead and buy it. No one on my list needs any of the gifts I’m buying, so it’s more about finding something that brings me joy to give, and will bring them joy to receive (yep, that’s straight up Mari Kondo right there!).

If you’ve still got some shopping to do after this weekend, here are a few of my favorite things. I think they make great gifts, though have to admit not every family member will be thrilled to open up a big box and find a Squatty Potty inside. Choose wisely. 😉

Dr. Mandi’s Gift Guide:

1.     For your partner: a Squatty Potty—the Unicorn in the commercial does not lie! Placing your feet on a stool really does open up the rectum and makes doing your business just a little easier...and frees up the bathroom faster ;) (Pro tip: I’ve heard Costco sometimes carries a 2-pack!)

2.     For the girlfriends you’re cycling with: The Moon is My Calendar—You’ve been hearing me talk about this, but I won’t stop! It has changed my life, and I can’t recommend it enough. (note: this is an affiliate link, fyi)

3.     For your yogi friend: Jade Harmony Yoga Mat—this is my favorite yoga mat, with the perfect amount of stickiness. They are also sustainably made! (Your local REI likely carries them)

4.     For your friend who wants to break up with their gym: An Ascent Fitness Class Punch Card—this is the best gym in Tacoma, in my opinion. ;) Share a few classes with a friend to bring in the new year! (Email move@ascent.fit to purchase)

5.     For your pregnant friend: Prenatal Yoga classes at Fern & Foster with Erica Davis. (She offers in-home private yoga too! Check her website for pricing)

6.     For your postpartum friend: Buy them a giftcard for some Physical Therapy! Whether they’re a few weeks out or a few years, if you keep hearing them say they should see someone, give them a nudge in the right direction. Email me to talk details.

7.     For your Mom—Surprise your mom with the gift of bladder control with my Live online Mind Over Bladder Workshop! It will be an early gift so that she can really appreciate the benefits by the time Christmas rolls around (seriously, the benefits are that quick!)

8.     For anyone else you’re stuck on: Give the gift of your time. Make a date to go on a walk. Give the classic homemade coupon book to babysit their kid (or dog) so they can get out. Make a brunch date. Sign up for a 5k together...and start training together.

Whether you’re a big shopper, making all your gifts, or nixing gifts all together this year, I wish you peace in this season. (But really, do get a Squatty Potty anyway.)

Mind Over Bladder: How to Take Back Bladder Control

Have you seen the commercials? You know, the ones where the woman is out shopping, or hiking, or at a wedding, and she’s holding hands with a little pink bladder that keeps pulling her towards every bathroom in sight. I’ve seen them. And they kind of make me mad.

If you can you relate to the woman—feeling like you need to go every time you see a bathroom sign, or needing to rush inside every time you put your key in the front door—I feel you. But of course, the commercial is for a medication. And frankly I get pretty frustrated at how much money is spent to reinforce the suggestion that most things can be fixed by a little pill.

The issue that this particular commercial is addressing is an overactive bladder. This typically presents as a strong sudden urge to empty your bladder, needing to get up more than once at night to pee, needing to rush to the toilet, or leaking on the way to the toilet. Basically—your bladder is bossing you around. It’s really frustrating!

But here’s the good news if this sounds all too familiar: you don’t necessarily need a pill.

Yep, there’s an alternative. It may take a little more work on your part, but the only side effect is a more well-behaved bladder.

I’m talking about Bladder Training. No—not potty training. You’ve gone through that already and possibly trained a couple of other humans yourself. This is grown up bladder training to get your own to behave. In fact, the American College of Physicians strongly recommends Bladder Training before medication. That’s straight from the top!

What does it entail? First of all—and possibly most important— you need to understand how your bladder works. Because when you understand how it works, you’re better able to tell it what to do. I covered a lot of the basics in my 3-part series on Urinary Urgency, which you can find here, here, and here.

I cover a lot in those 3 blogs, and it can be challenging information to digest just reading it. For that reason, I’m super excited to tell you that I’m launching some online learning resources—starting with a LIVE online Workshop called Mind Over Bladder on December 11. In the 2-hour workshop I’ll walk you through how your bladder works, teach you the steps to control your urges, and give you a ton of self-care tips for keeping your bladder happy. Check it out here!

If Bladder Training is not something you’re looking for, but you want to learn online from me, tell me what you want to learn about! Just comment below!

(Image source)

Disclaimer: This information and course is designed for educational purposes only, and is not intended to diagnose or treat a condition. It is also not intended to take the place of 1:1 medical care.

Do you NEED to do kegels?

I was talking with a fitness pro who I really respect recently. She told me that she always tells her clients and classes to just not do kegels. My ears always perk up when I hear recommendations like this, but instead of getting defensive, I got curious. Her reasoning is that she’s found more of her clients have tight pelvic floors, and aren’t having symptoms anyway. So all that tightening they’re doing may be doing more harm than good.

Well when you put it that way, I can say the same for a lot of my patients.

So that got me thinking: does EVERYONE need to do kegels? That’s kind of been the going narrative, right? If you’re a lady, do your kegels. If you had a baby, do your kegels.

And that leads to more questions:

How many do I need to do?

Do I need to do them for the rest of my life?

Am I even doing them right?

Let’s address the initial question at hand: Who needs to do kegels (aka pelvic floor exercises)?

You might need to practice pelvic floor exercises if:

-       You leak when you cough or sneeze

-       You know you have a prolapse

-       You leak urine or stool with exercise

-       You feel heaviness in your pelvic floor after a walk or run

-       You have trouble controlling urges (bladder, bowel or gas)

If you said yes to any of those, you might need to strengthen your pelvic floor. However, if you’ve tried and haven’t been successful, I 100% recommend you get in to see a Pelvic Floor PT to make sure you’re doing them correctly and that there’s not something else going on. If you want to check yourself, download my Guide to a Proper Pelvic Floor Contraction.

If you answered NO to all of the above questions, and have an active lifestyle, you probably don’t need to do kegels. Say what? Yep, you’re off the hook.

More importantly, you should not do kegels if:

-       You have pain with sex

-       You have discomfort wearing tampons or menstrual cups

-       You have tailbone pain or pain with sitting

-       You have trouble emptying your bladder

-       You have frequent UTI’s

If you fall into the latter category, you probably already have a tight pelvic floor. Trying to do 100 kegels a day will only make things worse.

Can you relate to symptoms in both lists? Is it keeping you from doing what you want to do, like run or hike or pick up your kid? Get yourself to a Pelvic Floor Physical Therapist! We can help you determine what’s going on with your pelvic floor muscles and how they can work better for you. Hop on the phone with me for a Free 15-minute phone consult, or find a PT near you.

As with most things in life, all of this is not black and white. You can leak even if your pelvic floor is strong. You can have painful sex if your pelvic floor is weak. You can have all of the symptoms above! And most importantly, you can overcome them all.

Is Sitting the New Smoking?

I’ve been thinking a lot about sitting lately. If you follow me on Instagram, you’ve seen me post a lot about it recently too. And—no surprise—I’ve been sitting a lot lately.

You’ve likely heard that “sitting is the new smoking” but I have to say, I completely disagree. Yep—you heard me right:

SITTING IS NOT BAD!

Let’s be real: a person can stop smoking. And we know smoking is bad for your health. But I dare you to try and stop sitting. You just can’t! And you don’t need to. Because it’s not a bad thing.

Sitting does not equal sedentary—necessarily. Yes, we know that there are tons of negative health effects on a sedentary lifestyle. We are not meant to be sedentary beings. Just look at all the ways our bodies are able to move—they are built to move! But throughout the day we tend to sit only in one way: in a chair, legs forward (or crossed). Hips flexed, knees bent, back probably a little slouched. This is fine for a while—but I bet after some time your legs fall asleep, your back starts to ache, and your butt gets store. Right? Then you feel like you need to get to a yoga class just to get your angry body moving. And quite honestly—your pelvic floor isn’t loving it either.

What if you could get through your day and not feel stiff because you moved your body throughout your day? What if you didn’t need to exercise your pelvic floor because it’s just working with you throughout the day? (More thoughts on exercising the pelvic floor coming next week ;) )

Here are some ideas to give your body some variety:

-       Move your laptop to the coffee table.

-       Read on your belly, or on your back.

-       Take phone calls or meetings walking.

-      Change up the way you’re sitting often

-       Stand on something at your standing desk (rocks, a tennis ball, Pranamat).

-       Send something to a printer across the office so you have to walk to get it.

That’s just the tip of the iceberg. We don’t have to make huge shifts to feel huge shifts. Choose one thing to change this week and see how your body feels. Maybe it’s just one hour sitting at the coffee table, or meeting a friend for a walk at lunch on one day.

What’s your favorite way to sit?

An Exercise About Exercise

Let’s do a quick experiment. 

Close your eyes. Well, no don’t do that because then you can’t read. But take a moment to just check in with your body. We’re going to do a word association experiment.  

Read the following words, then take a moment after each one to notice what your body feels like. What emotions come up? What physical sensations arise in your body? What stories come to mind about the words?

Here we go:

Exercise

Workout

Movement

Play

Take a moment with each one. You might want to write some things down if one brings up particularly strong feelings or stories. What stories do you tell yourself about working out? About play? How do you feel about yoga? Exercise?

This is a good exercise to check the barometer of your relationship with movement. Movement is really what all of the other words have in common, yet I’m guessing that “movement” might be the word you had the least strong feelings about. I can’t tell you how often I get the response “No but I should...” when I ask someone if they do yoga. When I ask how often someone works out they inevitably say “not as much as I should.”

I used to be the same way—a “workout” only counted if it was at least 30 minutes 4-5 times/week. And I had to sweat. Even in yoga. Somewhere along the line that shifted though. Now my “workouts” are just movement. And movement is something my body wants to do. It might mean 10 minutes of sun salutations in the morning. A walk with the dog. MovNat ground movements that I learned online.

Yes I go to the gym a couple times most weeks (and not just because I’m paid to be there!), but I go because the classes are fun and I like the people! It feels more like play most days than a workout. It’s sneaky fitness.

If you had a lot of negative associations with the words above, or if the stories you tell yourself are that you should do this or that, I encourage you to expand your definitions. Find a playground and hang from the monkey bars. Take out your yoga mat (or pull up some carpet) and move in ways that make your body feel good. Make it up as you go. Your body is wise and will tell you what it wants—that’s really what pain and stiffness often is, just a signal that your body needs something different.   

I want people to be liberated from the “workout” expectations that our society has built. It doesn’t have to be complicated. It doesn’t have to be expensive. You don’t have to look a certain way or wear certain clothes. It just needs to feel good.

So tell me: where are you going to start?

Should Sex Hurt?

Should sex hurt?

BIG, FAT, NO.

Pain with sex is never normal, but unfortunately not all that uncommon. I’ve often heard from my patients that they just have “the normal amount” of pain when they’re with their partner. They often just “grin and bear it.” Sister, there is no normal amount of pain with sex! It’s supposed to be fuuuuun!

In the medical world, we call pain with intercourse Dyspareunia. There are all sorts of sub-categories that I’ll get to in a different post, but in general, we can lump it all under dyspareunia.

Before we continue, I want you to know that dyspareunia is VERY treatable and NOT something you just have to grin and bear. THAT’S GOOD NEWS!

Here’s a simple breakdown of what might be causing the pain:

Tissue stretch.

This will typically be pain at initial penetration that may get better as you keep going. It’s common after having a vaginal delivery, especially if there was tearing. And it’s often pretty quick and easy to treat with desensitization and stretching—good news!

Try this just before penetration: put some lube on your thumb, then place it just inside the vaginal opening. Press downward to stretch the tissue, while focus on relaxing the muscles.

Overactive pelvic floor.

Our muscles react to pain by bracing for it, right? If you’ve had pain with sex in the past, your pelvic floor is likely bracing for it, aka tightening up. Which will likely, in turn, cause pain. And make you tense up more...and on and on. The key here? Learn to release the muscles. Sometimes it’s as simple as learning to relax the muscles. Other times, especially if it’s been going on for some time, the muscles may need to be released by a professional like a PT (basically a massage, but internal.) These muscles can get knots and trigger points just like any other muscle, and can be released just like any other muscle too.

Try this: Focus on your sitbones widening as you take in a big inhale, then release the breath. Now try pushing out with a big inhale. Focus on breath and pushing out to actively release the muscles while your partner pushes in.

Tightness in the hip rotators.

I can’t tell you how many times I’ve heard someone say “it feels like he hits my cervix.” The cervix is not typically sensitive! Most often when this occurs, usually with deep penetration, it’s a deep hip rotator called the obturator internus. More good news? It’s often easy to release.

Try this: Pull your knee toward your armpit (kind of like a one-sided happy baby pose), and relax there for a couple minutes. Or try that position during sex and see if it helps.

There are more complex causes of dyspareunia that we’ll get to later, but these three are the top ones I see in the clinic. Can you relate to something in here? Take it as good news! Find a PT (make a free 15-min phone appointment with me!, or if you’re not in my area find one here) and let’s get it taken care of. Often times it can be addressed in just a couple visits.

I can imagine a world where no woman says she just has to “grin and bear it.”

YOU are worth more than that.

About Insurance

Let’s talk about insurance.

I am an out of network provider. I do not contract with any insurance companies, and patients pay me directly at the time of service. In turn I provide them with a “superbill” which they can submit to their insurance to be reimbursed directly.

Here is why I chose this route:

I have never liked people telling me what to do without good reason. Ask my parents, teachers, and past bosses and they’ll tell you this is true. Some might call it stubborn, but I consider it self-advocacy.

When I started my practice, I had to decide if I wanted to take insurance or not. The first question a prospective patient asks is “Do you take my insurance?” If I answer yes, I have removed one barrier. However, taking insurance often creates more barriers:

-Many insurances require a referral for PT, which means one more appointment to make and get to, adding an unnecessary barrier. Most of my patients are busy moms—it’s enough to ask them to make an appointment with ME, where they’ll actually get some help! Having a visit simply to get a referral does nothing to actually help an individual, and the runaround often is enough to make a gal give up seeking the help she needs.

-Some limit the number of visits they’ll cover based on algorithms instead of your unique person and situation. It’s fairly common to see insurance approve “6 visits in 3 weeks.” This is fine for an ankle sprain, but for someone dealing with incontinence or painful sex for a decade, it really just doesn’t cut it.

-Some won’t pay until you hit your deductible, which can be upwards of $5,000. I’ve had patients complete several visits before getting a bill in the mail, only to realize none of it was being covered because they hadn’t met their deductible.

-They all require an absurd amount of administrative time for the provider. As a one-woman show, I believe my time is time better spent on providing excellent patient care. It’s what I’m good at. And really, that’s what you are paying for. 

Like I said, I don’t like other people telling me what to do, and I don’t want anyone telling me how to treat my patients. Ultimately, I believe this relationship is between you and me, and a third party shouldn’t be telling me how much I can treat you or how much your care is worth. I work for you, not your insurance. I want you to know the value of what you are paying for, no surprises.

Our healthcare system is broken—I don’t have to tell you that. It is too broken for one person to come along and fix it. I believe we all need to be our own self-advocates. The first step to doing that is to understand the coverage that you have individually. Often, it’s not as comfortable as we thought it was.

I encourage all of you to know your coverage. Don’t know where to start? Here is a list of questions to ask your insurance company. Keep asking questions until you REALLY understand your coverage. Keep advocating for yourself and your family.