Ep. 9: Pelvic Floor 101 with Rachel Moran
Caitlin Estes:
Welcome to the woven well podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you on your fertility while honoring the deep connection your fertility has with your faith. Let's get started. I'm excited to continue our focus on pelvic floor health today, by talking with Rachel Moran, a doctor of physical therapy with advanced certifications at pelvic floor rehabilitation, functional dry needling and reformer Pilates. She treats pelvic health patients among others at thrive physical therapy and wellness in Birmingham, Alabama. So I have so many clients, several who have seen her personally, so I know she knows her stuff and I wanted her to share some of that knowledge and experience with all of us today. So thanks so much, Rachel, for joining us.
Rachel Moran:
Yeah. Thank you for having me. Absolutely.
Caitlin Estes:
So last week on the podcast, I shared a little bit about what the pelvic floor is, but I'd love to have you explain it and share why so many women may have issues with it at some point in their life.
Rachel Moran:
Sure. So pelvic floor, it's a hammusculature it's at the base of our pelvis. It runs from sit bone to sit bone and then front and back from your pubic bone to your tailbone. And it has a variety of functions, but mainly it contracts to keep things in and it relaxes to let things out. It actually bulges during childbirth. And then of course it plays a role in sexual appreciation. So kind of along with your deep core, and your posterior chain, it stabilizes your spine as well, and then it works with your diaphragm kind of as a pressure management system.
Caitlin Estes:
Okay. That's a lot, that's a lot of good stuff. That's all good stuff.
Rachel Moran:
It's so important. Yes.
Caitlin Estes:
Yes. It sounds like it's really important and so with all of those things going on, that seems to be why somebody may have issues with it because it affects so many of those different avenues. Is that kind of what you're saying?
Rachel Moran:
Yes. And a lot of times our patients will have symptoms elsewhere and it ends being driven by the pelvic floor, just for the reason that you're saying. It feeds into so many other systems that a lot of times it might present as hip pain or low back pain, but the whole time it's really driven by some type of pelvic floor dysfunction.
Caitlin Estes:
Okay. Okay. So now, our audience is really diverse. So they're gonna be women who are single, married without children, pregnant and postpartum, and approaching menopause. There's a lot of variety there and I'm sure there are a lot of different conditions that affect each of them, but I'd love to hear what maybe some of the most common ones are that you treat.
Rachel Moran:
Yeah. And I think that you're hitting the nail on the head. Like we really wanna get, um, the point across to all of your listeners that it's so much more than just some postpartum rehab. Yeah. While that is so, so important. We see women with children, women without children, women who had children 30 years ago. Mm. We treat a variety of symptoms from painful intercourse, chronic constipation, tail bone pain, endometriosis. Of course we treat women during their pregnancy and post during pregnancy for exercise modifications. We do a lot of labor and delivery preparation. We treat them postpartum, just to rehab the body as a whole and kind of get them to whatever fitness activity they would like to get back to doing. We treat women for urinary incontinence that spans all sorts of ages, fecal incontinence, urinary, or fecal urgency. There's um, a lot of women we see kind of perimenopausal and that can be for vaginal atrophy or any associated changes that come with that change in estrogen. So the span is huge. It's a lot of different, so symptoms, it's a lot of different ages. It's with children without children. Um, it doesn't matter. We will see them.
Caitlin Estes:
Yeah. That is a lot. And I do wanna clarify one thing you mentioned treating endometriosis. It's not actually the endometriosis, but the pelvic floor pain that goes in addition to it. So if somebody were to have an excision surgery where they had that treated and removed, then following up and working with you all to help them in that recovery would be a huge benefit to them.
Rachel Moran:
Absolutely. Yes. We, we cannot treat the actual endometriosis, but it comes with a plethora of pelvic floor changes yes. And, changes in your abdominal wall. So we do, we treat the symptoms as we can.
Caitlin Estes:
Oh, wonderful. Wonderful. And I'm glad earlier that you mentioned issues that affect women who have not had biological children, because I think we often hear about this therapy as it relates to women who have just had a baby. And so you going over all of these different situations that could affect women outside of that one particular category is really helpful. Now I work with, you know, like I said, a lot of different women, but one thing that I actually hear a lot is women who deal with pain with intercourse. And there are lots of reasons why a woman could be struggling with that. It could be physical reasons, mental, sometimes it's something as simple as needing a lubrication or, I mean, there's lots of different stuff, but I'm interested in what pelvic floor therapy could do for these women specifically.
Rachel Moran:
Yeah. So a lot of times when you have pain with intercourse, it's caused by some type of muscular imbalance going on in the pelvic floor. People can have pain with initial penetration, they can have pain with deep penetration. And it normally is from maybe one muscle overactive or the whole sling of muscles in the pelvic floors overactive. And they almost are causing this reaction to a painful stimuli. And then what ends up happening is that your brain associates intercourse with pain. And we know through research that if you're anticipating that pain, it becomes a cycle and then intercourse will continue to be painful. So yeah, a lot of times in pelvic floor therapy, we're trying to just normalize the tone of the pelvic floor, the muscular tone. A lot of times the tone is higher maybe because of trauma or weak hips or weak core. And it's on most tighter in a compensatory reaction to a weakness found elsewhere in the body. But our goal is to treat that muscular change and then also to kind of combat that sympathetic nervous response to the painful stimuli and that, you know, the person experiencing this knows that the pain will decrease and then maybe it lessens that anticipatory reaction to intercourse. And with time intercourse will become less painful.
Caitlin Estes:
Yeah, that's great. Because like I said, I talk with so many women and, you know, I think that sometimes they're hesitant to move forward because they're not sure that they can actually get results. You know, they're not sure that that would actually work for them. So that's really encouraging to hear. So, I'd also like to ask, like how does a woman know that she may benefit from seeing someone who specializes in pelvic floor? Like what are some symptoms that she may have that could signal to her that she may benefit from pelvic floor therapy? So I imagine that there are women listening who may think, you know, well, I'm not postpartum and I don't have pain with intercourse. So this isn't for me.
Rachel Moran:
Yeah. I think that anybody who has had this history of low back pain or hip pain and it's maybe undiagnosed and say, you've tried to treat it before and maybe it gets a little bit better, but it never completely goes away, oftentimes there's a pelvic floor component in that. So I encourage anybody who has this, you know, hip low back, maybe abdominal wall pain, and it's just kind of there and you can't really seem to get it to go away, come see us. There might be a pelvic floor component. Anybody who has chronic constipation, there's normally a pelvic floor component, urinary incontinence, any fecal incontinence, tailbone pain. Any type of abdominal trauma. So maybe you had your appendix taken out and then all of a sudden you're noticing like ever since I had that done, nothing has really been the same.
Rachel Moran:
Like my low back has bothered me ever since, or maybe intercourse got painful after that, while again, the pelvic floor isn't maybe what had the trauma happen, that change in abdominal wall also affected the pelvic floor. And a lot of times I have women who are like, oh, I never even thought that that would cause anything or they're presenting in a way that we can't figure out, you know, why did this start? And then they tell me, well, you know, 20 years ago, I had this, this pancreas surgery, you know, and then we're figuring out, okay, well that's when your symptoms started. So anything just that's been undiagnosed in terms of hip low back pelvic floor, abdominal wall changes.
Caitlin Estes:
Yeah. Okay. That is super interesting! I did not know about that. So thank you for sharing that. So if somebody is listening and they're like, okay, well I'm, I think this could be for me, what advice would you give if they're considering scheduling an appointment? like what should they expect in their first visit in having their pelvic floor treated?
Rachel Moran:
So first visit is a ton of chatting. I really like to get a full idea of just my patient symptoms and a good history. And we do a physical assessment. It always includes evaluating the hips, the low back, the abdominal wall. We're looking at rib mobility, thoracic spine mobility. So how is your mid back moving? That's really why I love pelvic floor therapy because it is a very holistic. The pelvic floor assessment is an internal vaginal assessment. And it does allow me to understand the strength, the tone, the relaxation ability of the pelvic floor. Essentially you'll undress from the waist down and you'll be draped with a sheet and there's no stirrups, there's no speculum, it's just gloves and lubrication. It's much gentler than what we're used to with our annual pap smears. And it's just a one finger of palpation. And I would have you contract your pelvic floor, relax your pelvic floor, and then actually feel the individual muscles kind of for tone and tenderness. And then we always discuss what I found. We make a plan together kind of on what the patient's goals are and how we're gonna achieve them and we make sure you have plenty to do at home, but also I want the patient to feel very confident in what's going on kind of what we found and how we're gonna try to make it better.
Caitlin Estes:
Yeah, that's great. Now I have had people work with you, so I know if they come in and they're really intimidated by the idea of having an internal exam done, they could talk with you about that - be honest about their concern and you all would make a game plan together about how to move forward. Right?
Rachel Moran:
Absolutely. I have so many women who maybe we don't do the internal exam until the third or fourth visit. There is always so much more going on than just the pelvic floor. Again, there's all these other components. And so if someone, you know, isn't comfortable with that yet, and I get it, like maybe they just don't trust me. They don't know me. It's a first date.
Caitlin Estes:
That's right!
Rachel Moran:
Maybe they wanna get to know me a little bit better. Right. So weird. It is always in the patient's hands. Usually I will say the internal assessment gives us a really good idea of what is going on in the pelvic floor, but it can always be deferred or just totally eliminated at the patient's comfort level.
Caitlin Estes:
Uh that's great. I know there will be people who appreciate hearing that. Now, if someone happens to be in or near the Birmingham area and they're like, okay, Rachel sounds like my girl, this is who I wanna see. I wanna go ahead. Of course, there are gonna be a lot of people listening outside of that area, but for anyone who happens to be local and they may wanna work with you specifically, how can they reach out to you or work with thrive?
Rachel Moran:
Yeah. So our web address is thriveptal.com. And my email is RMoran@thriveptal.com So they are welcome to email me. They can go to our website and there's a little new patient forum that they can also fill out. It gets emailed to us directly.
Caitlin Estes:
Okay. So either one of those options is great. Okay. And I love that you gave your personal email. So if anybody wants to specifically email her to ask about working, you can.
Caitlin Estes:
Rachel, thank you so much for joining us. I really do appreciate it. I hope that it's been, you know, informative, but I know it's been fun just to chat and I've learned something new in our conversation. So that's great. So I appreciate it so much.
Rachel Moran:
Absolutely. Thank you so much for having us on.
Caitlin Estes:
Now to all those listening, I hope this episode has been helpful for you as you look at your own pelvic floor health and consider whether or not pelvic floor therapy or physical therapy with an emphasis in pelvic floor could benefit you or not. I know I've learned things today. Now we at woven fertility hope to provide more resources over the next few weeks or months about pelvic floor health specifically. So to stay in the know on all those resources, you can email me personally at caitlin@wovenfertility.com or follow us at woven fertility on Instagram and Rachel what's your Instagram handle?
Rachel Moran:
@ThrivePTAL
Caitlin Estes:
Wonderful. So you can follow them there to see all that they're up to as well. So thank you all so much for listening as we continue to explore together what it means to be woven well.