S1 E26: Pelvic Floor Health & Fertility with Dr. Ryan Bailey


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Amanda: Hey, this is Amanda, women’s health dietitian.
Emily: And I’m Emily, nutritional therapy practitioner.
Amanda: And this is the Are You Menstrual? podcast where we help you navigate the confusing world of women’s hormones and teach you how to have healthy periods.
Emily: Each week we will be diving into a different topic on women’s health and sharing our perspective using nutrition, female physiology, and metabolic health.
Amanda: Our goal is to help you wade through conflicting health information and empower you on your healing journey.
Emily: We hope you enjoy it.

Amanda: In this episode, we’re discussing pelvic floor health and how much of an impact this can have on fertility. I’m joined by Dr. Ryan Bailey. Ryan is a women’s pelvic health physical therapist, mom of two, and owner of Expecting Pelvic Health. And she has been helping women for over 12 years reconnect to their body, heal injury, and restore function. Her philosophy is to use every moment in your day as a way to be mindful of your movement, posture, fitness, and overall health. Bringing this thinking into practice by nurturing a balance between efficiency and functionality in day-to-day tasks, exercise, body work, and self-care to promote long term pelvic health benefits. Dr. Bailey earned her doctorate of physical therapy degree from the University of New England becoming a board-certified women’s health physical therapist and prenatal and postpartum exercise specialist with training in pilates. Dr. Bailey’s passion is to help women harness their fullest pelvic health potential to achieve their motherhood dreams of conceiving, feeling amazing in pregnancy, having a positive birth experience, and transitioning into motherhood feeling empowered and strong in your amazing body.

And that is why Ryan is here today, because I just love her philosophy. I love how she teaches and educates women, very gentle and empowering. And that’s what I’m all about here. So really the goal with this episode is to raise awareness about the pelvic floor. We’re going to go through a lot of the basics, and then hopefully just help women gain a better understanding of how they can support their own pelvic floor health. So thank you so much for being here, Ryan here.

Ryan: You’re welcome, thank you so much for having me. This is a treat.

Amanda: I know, Ryan did a guest experts class for my membership so anyone that’s listening from the membership will recognize your voice. Great breakdown. So nice with visuals, we don’t have any visuals today, but I promise you’re going to get a lot out of this podcast. So Ryan, why don’t you start with telling us a little bit more about your own, like, health and healing journey and what got you so interested in pelvic floor health specifically for conception?

Ryan: For a lot of healthcare professionals, we kind of get into it because of our own journeys. And getting into physical therapy wasn’t my own health journey. But it was unexpected change in my life where my father passed away when I was in college. And so I decided that I wanted to get into the medical field. I’m a very hands-on person. So physical therapy was what really looked like it was what I wanted to sink my teeth into. The women’s health piece of it didn’t come until I was several years into school. It was at my first internship, and at this internship—it was at an orthopedic outpatient clinic—and I had two patients who were ortho but were in with that women’s health realm. One was a new mom and she had nerve damage and she couldn’t, she could barely walk, she could barely lift up her son. And so helping her achieve her goals of being able to walk the hills out in California and be able to lift and play with her son was an incredible experience. And then the second woman who I saw she had bilateral hip dysplasia, she had had lateral hip surgery for replacements. And she was newly married and so she was really nervous about intimacy and what she and her husband were going to be capable of doing because of her hip replacements. And so that’s not really something that we get taught in school. So I had to do a lot more research and dive into it a little bit more and it just really piqued my interest while in school. And then from there I, a local physical therapist came into some of my classes and she just kind of solidified my interest in helping women achieve this deeper understanding around pelvic health.

And that helped then my own journey, because I had a really difficult time conceiving. A lot of stress, being in school, graduating, become, you know, new professional, and then a lot of physical issues around conception and kind of the mechanical piece that I didn’t realize were there and were, and really interfering with my menstrual cycle. And so I did a lot of body work on my own—body rolling, very specific exercises, changed my diet and lifestyle piece over this two year window, so that I could conceive my daughter. I then applied a lot of what I learned about my own experience into my care with my patients. And that’s really when I started getting interested in working with women for conception.

And really, then, these past, I would say eight years since having my daughter, it’s really then shaped my relationship with my patients as I’ve become a new mom, and my experiences through my own pregnancies, and my births, and my postpartum. And my own healing journey from having home births, and from having diastasis recti abdominis and healing that, and then making sure that didn’t get worse than my second pregnancy, healing my own pelvic pain through both pregnancies and in my postpartum… And just really being able to learn a lot more about what women and what my patients go through during those times. As well as academically learning a lot more so that I could understand what was going on with myself and then apply that, again, with my patients. And it’s just brought so much more depth and really broadened my view of how I can help. And the gap that is there in our, in our medical fields for women during this time, and just wanting to be able to bring as much as I possibly can to them.

Amanda: Well, and you’ve been doing this for so long. But how you said specifically, like, after you had your own children it really shaped how you worked with your patients and thought about everything. I think when you go through it yourself, it just changes things—it gives you a new perspective. I don’t think we have to go through every single thing to help people with it, but I think having some experience like that it’s just different, you know. When it comes to pelvic floor health, I feel like women don’t address this until there’s an issue. When it comes to things like fertility, I don’t even think this is discussed at all. I’ve never heard a client bring up, that’s been struggling with fertility, bring up pelvic floor health unless they also have endometriosis, but it’s still not linked to their fertility. It is a separate, they’re two separate things, right. So we’re going to dig into that a lot more. But I want to start with talking about why, like, what our pelvic floor is and why women should care about it before it becomes an issue.

Ryan: Yeah, so our pelvic floor is the base of our pelvis. So if we’re all sitting when we’re listening right now, we are all sitting on our pelvic floor. And it is a set of muscles and connective tissue and ligaments and fat that makes up the, the bottom and the closure of our bony structure of our pelvis. It holds up our pelvic organs which include our bladder and our uterus and vagina and our colon and our anus. It really functions as the, the in and the out of our body, kind of sometimes gets a bad rap about not being functional or just kind of not being, kind of being forgotten about or kind of being taboo to talk about. There’s also the other end of kind of a lot of discussion about okay, well, let’s always do our kegels.

Our pelvic floor is super important to think about prior to conception because of the role that it plays in our bodies. And this role is important for men as well, but we are going to be really focusing on, on the female aspect of the pelvic floor. It controls what happens with our bladder, it controls sexual function, it controls our bowel function, as well as it has a huge structural support function for our pelvis and for our spine and to me our entire body.

If we are able to have an idea of what’s going on in our pelvic floor, muscle, mostly muscular wise…of course, it’s important to make sure that there’s no infection because our pelvic floor is involved with UTIs and yeast infections and that type of thing, but muscular wise, we want to know what our baseline is prior to conception so that we know if we have any tension or pain to deal with. Maybe it’s actually interfering with, with conception because of pain or endometriosis which we will get back into. Or maybe it’s weak and you didn’t even realize it. But you want to then start to work on that prior to becoming pregnant so that you don’t have an increased risk of incontinence or peeing your pants or prolapse, which is when our organs drop out of the position where they’re supposed to be and/or structural support issues that can lead to pelvic pain. Which is no fun I will tell you during pregnancy and afterwards as well as diastasis recti problems. This separation is completely normal, it’s when it becomes a problem and you have symptoms around it, that the pelvic floor can really help out with the situation. So that would be the biggest reason why we want to know about our pelvic floor prior to conception is to know if there’s anything going on that we want to take care of beforehand and then know what our baseline is. So that if nothing is going on, if something does happen, you know that it’s not normal. And then you can do something about it.

Amanda: I think, too, when I think of home birth… we’re gonna do home birth, and so a really big part of preparing for that is my pelvic floor and making sure that in a good place. Because having too tight of a pelvic floor can make natural birth very difficult. So there’s so many important aspects. I think even just the health aspect of how it does impact other areas. It’s not just our pelvis, it’s, it’s, like, it impacts our bladder, it impacts our bowel movements, so many other things. So it’s, like, we should all care about this. And the more I learned about it, especially now being pregnant, I’m like, oh, my gosh, I wish I knew all of these things so much sooner. Especially as far as, like, strength training goes and, like, doing breathwork with the strength training, I’m like, okay, this could have changed my life and probably avoided a lot of issues. So it’s just one of those things where I’m like, I know that a lot of women can be, like, I’m not pregnant yet, maybe they don’t even want to have kids, but I’m like, we still want to learn about this. So it still really matters. And I think a lot of the techniques that we’re going to talk about are helpful for everyone. It’s not just for those wanting to conceive.

Ryan: Absolutely. This information is for everyone, literally. I work with teenagers and being able to have them have this knowledge about their body well before so many other people, it’s incredible to be able to provide that for them. So it is definitely for everyone, regardless of if you want to conceive or not, because we all have pelvic floors. And it can be impacted by everything throughout our day. And we really just want to make sure it’s going to be the most efficient and least impacted by our day-to-day lives as possible so that we can stay as functional might not have to worry about peeing our pants or having pain.

Amanda: Especially, like, I think long term, like, pain during sex. And, like, as you transition to the season of peri and post-menopause. Like, we don’t want to wait until things get really bad. I, to me now, especially everything I’ve learned about pelvic floor health, I’m like this is, like, an essential part of women’s health care. That’s just, it’s unfortunately, usually not brought up until there’s an issue. What would you say that some of the biggest mistakes you see women make when it comes to their pelvic floor health?

Ryan: Yeah, so one of the really, the biggest ones, there’s always doing kegels, always. So our pelvic floor, as I said, is kind of the gatekeeper of our pelvis and it keeps things in. But it also is meant to let things out. The muscles and the tissues of our pelvic floor are meant to contract to keep our pee and our poop in our farts and everything and baby and if we’re pregnant and to help stabilize, but it’s also meant to lengthen and relax so that we can pee and we can poop and we can let baby out naturally. And so if we are always doing kegels, which only actually targets a small portion of the pelvic floor by the way, you’re only focusing on the contraction portion of the pelvic floor. And that in the long term can actually cause more problems than it can help. So that’s one of the biggest, biggest things that I see as a mistake.

Another mistake is thinking that it’s “normal” for a lot of symptoms that that people have. And that’s unfortunately, because of kind of our societal norms and how it, you know, the taboo speak around, you know, the functions of the pelvic floor, especially the sex piece and the pain. And then, or laughing off oh, yeah, I pee when I laugh or, or that sort of thing. And just making it normalized when it’s, it shouldn’t be. Yes, it’s extremely common, and it’s only common because we don’t take initiative to teach women that this isn’t normal. And this isn’t, this can be treated and you don’t have to deal with this. And so those are two big, big mistakes that I see in general.

Amanda: When I think about, previous to everything I learned in the last, like, few years about pelvic floor health, I would say when I think of pelvic floor, I think of kegels, right? That’s what most women I think are naturally going to think of and, like, do them at the stoplight, right. Do them when you’re, like, driving, like, that’s, like, what I think of, like terrible advice like that. And while some women, kegels do help them if they have a specific issue, I think for most women, it’s probably the opposite end. Like you said, like, we have a harder time with tightness, lengthening, that sort of thing. So can you talk about, like, what is pelvic core breathing? And how would someone do it?

Ryan: Yeah, absolutely. So this is the most fundamental thing that I teach all of my patients. And I love teaching, because this is where it comes into play of just that every day practice. So pelvic core breathing, to give a little bit more of an anatomy lesson, right? We’re all sitting. So if you’re not sitting, go ahead and sit. And we’re sitting on our pelvic floor. Our respiratory diaphragm is a buddy of our pelvic floor. And for those who don’t know, our pelvic floor is also a diaphragm, because it’s musculature that closes off the cavity of our body. And so these two diaphragms work together, they like to play well. And if they’re not playing well, then we can have some problems with our pressure system within our trunk. What I teach is to get these, these two muscle groups to coordinate and to work the way they are meant to work together.

So what is physiologically supposed to happen is when we inhale, our respiratory diaphragm contracts and pulls downwards, okay, even though our ribs are, are pulling kind of up and out, our diaphragm pulls down. And so at the same time, that displaces our organs downward as long as we’re not doing a really big belly breath, which is good for some things, like relaxation, but is not the way we’re, we should be breathing all the time. Our, and so our pelvic floor lengthens as well in a downward fashion to create space for the downward placed organs. And this is, like, millimeters, it’s not a huge movement of the pelvic floor. So when we’re breathing on a regular basis, you’re not going to feel it. But if you are very intentional about it, you can feel this movement. So on inhale, our respiratory diaphragm pulls down, our pelvic floor lengthens and moves down.

And something that I really like to do with our hands, again, for a visual for those who want to try this, you can put your hands kind of stacked on top of each other, like, it’s your pelvic floor and your, your respiratory diaphragm. And when you inhale, you move them downwards, so you’re getting that visual of down. Then when you exhale, our respiratory diaphragm relaxes and pulls back up. So then the pelvic floor can also move back up into its normal space or normal length position. This is then a great time to actually contract the pelvic floor, if that is your intent. If we’re, if you’re not wanting to strengthen the pelvic floor, don’t necessarily need to, or are working on relaxation, then you don’t need to contract it. But because the pelvic floor is already shortening during that exhale, that is then when you can do this great close and lift in contraction of the pelvic floor at whatever intensity feels right to you. So with those hands, they drop down on inhale and they move up on exhale. And so that is pelvic core breathing, in a nutshell. And then that can be applied throughout the day, to help with your lifting, coughing, sneezing, laughing, anything that you feel like you need extra support around the pelvis, especially as a new mom to reinforce that on demand control of that drawing in on exhale is a great way to start.

Amanda: When I first started doing this, I was like, I don’t think I relaxed my pelvic floor that much. Because that, when you’re breathing in and you’re relaxing, when…this is very graphic, but a friend of mine has this way that she explains it to people before they do strength training, and it really helps, like, relax your butthole is, like, kind of her way to be like…because I mean, it’s like what does it mean really, like, when you’re breathing in and lengthening? What does that mean? And if you actually really do relax, it’s like, okay, how often are you getting that? You know, I was kind of like, I don’t think I’m getting this very much. So it was definitely very eye opening. And then to also apply that whenever I lift, like, I do that all the time now. And I’m like, okay, this makes a really big difference with pain, with stability, even, like, with my hips and stuff. I used to have some hip flexor issues and I was like, wow, I think that really made a big difference. And it just shows you, and something that you taught us in our membership class was how connected the pelvic floor is to other areas of the body.

Ryan: Yes, yeah. And if you’re able to coordinate that breathing with exercise and not just the pelvic floor and the respiratory diaphragm, but the other deep core muscles, it makes then your other muscle groups, like, your hip flexors be able to focus on their true function. Where if you aren’t bringing in that deep core or if your body isn’t capable of doing it, it has to find ways to stabilize around your spine and around your pelvis so that your limbs can move. And that’s where other tension and tightness and pain can, can become involved with your movement.

Amanda: Yeah, and I just think back to, like, years of lifting and CrossFit and I mean, I was always under tension, you know. There was never any relaxation. I did breathe during the lifts and they do teach you that. Especially with, like, Olympic weightlifting, you know, like, they’re very specific with breathing patterns. I just wish that they went one step further and brought in the pelvic floor, both for men and for women, you know, definitely not just for women. But I was like, wow, if only I had this sooner, but I think the pelvic core breathing is something everyone can start with, like, even after listening to this podcast. And if you need a visual, Ryan has a million reels, guys. We were talking about this before we started the episode. I was like, Ryan, like, how do you make all these reels, but I’ll put her Instagram in the show notes so you guys can check it out. Lots of instructional videos, which I think is great. But even just that concept of like breathing in, relaxing, and then breathing out, up, and in, and, you know, it’s simple. I do it for, like, five-ish minutes before I do any sort of workouts. I do it every day, just because it feels good and I’m trying to relax my pelvic floor more, but it’s something that we can all kind of start with.

So let’s talk about body rolling. Because this is the other thing that you introduced in the class that we did and I was like, I’ve never heard of this before, you know, not even close. Like, pelvic core breathing, yeah, like, I understand the concept. I’ve heard something similar, but like, body rolling was very new for me. Can you kind of describe, like, what is body rolling, and who is it helpful for?

Ryan: Yeah, so this was something that I got more into for myself and took courses on and have found it so, so beneficial for my patients. So essentially body rolling is using a tool—like a foam roller or a ball, those are the two big tools—to roll out or massage or even just lay over specific points in the body and specific muscles in the body. And what that does, if you are, it can either just massage out a sore muscle, which can be helpful for athletes, and then that type of thing just as a kind of a routine part of their workout. But it can also be used in a very intentional way to actually change the collagen within our connective tissue and our muscles. And that can, can provide a much longer lasting change. Body rolling can be used throughout the entire body. I use it a lot in and around the abdominals and the waist and the back and the pelvis and through the legs. And essentially using either the foam roller or various size balls to stretch with a pressure and then time to get this, these tissues to soften and melt and relax so that they can then, again just like with the pelvic floor, go through their full range of tension.

Because just, just like the pelvic floor, we want muscles to be able to lengthen and be flexible as well as shorten and contract. And if there is any restrictions from scarring or adhesions or just past tension that creates bound up muscles, that, your body isn’t going to be able to function well because of that. And then what that can lead to is reduced circulation, your lymphatic system is going to be blocked, your nerves are going to be kind of restricted and compounded and so they’re not going to be able to communicate as well. And so that’s also where this kind of overlaps into other areas of health in terms of at least what I do, because I do a lot of the body rolling with my patients for their home program, because I do a lot of what’s called myofascial release manual therapy. And so it’s a great way to have them be able to bring it home with them. And so for those who are dealing with infertility or pain or congestion and even gut issues, right, they may be having some of those other physical pieces that are reducing the ability of their body to bring the nutrients to where they need to be. We’re getting rid of the excess hormones, or getting rid of the excess inflammation from a workout or an injury, and so body rolling not only works on the musculature but it then helps with these other systems so that you can bring a much more balanced state to the body.

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Amanda: I feel like people would resonate with being, like, I’ve seen people use a foam roller and stuff like that, but, like, you actually have videos of using different size balls and on your abdominal, and I think that’s the biggest difference. And when you talk about how it impacts the lymphatic system, because we have, we have lymph nodes down in, within our pelvis area. And so I just think that’s so interesting. And it just makes you wonder, like, women that struggle, maybe they have amenorrhea, like, they’re not having a period, women with PCOS… It’s like, how much congestion is going on down there. And then of course, like, the next thing we’ll talk about is endometriosis, but when it comes to, like, rolling out specifically to try to create more blood flow and improve that, what type of ball are you using?

Ryan: I really like a very specific ball. It’s from the, it’s Yamuna. And they have made very specific body rolling balls. And they have courses and videos and things like that. And they come in, in various sizes from, like, four-inch diameter to 10-inch diameter, and they have varying thicknesses of the rubber. Those are my favorite for body rolling. However, there are other balls that are out there that are, can be just as effective. But those are my favorite. And I like having varying sizes because, like, sometimes you can’t handle a small ball in a certain area and you need a larger ball or you need a smaller ball to get into a certain area. So having a variety of sizes, as well as a variety of densities can also be really helpful as well. Though for most people, I like ones that are firm but squishy, not as stiff as like a tennis ball. Definitely not a lacrosse ball—those are just too much on the body.

Amanda: And I think that especially for that, like, pelvis area, it’s, like, obviously that would probably be painful. But using, like, those softer balls and boosting that blood flow and lymphatic, like, actual limb movement that can be really helpful. It sounds like for just overall period pain, which we’re going to talk about. Which I think is so interesting how it can help a period pain, endometriosis, fertility, and just, like, improving congestion, especially for those women that maybe aren’t having a regular cycle.

Ryan: Absolutely. It’s, it is such a great tool, like I said, I used it for myself. The changes that I had from when I did my body rolling and continue to do it, because it’s a really nice maintenance tool as well, it’s incredible.

Amanda: So what kind of pelvic floor issues do you typically see with women with endometriosis? I’m assuming you probably see quite a few in your practice.

Ryan: Typically, as a physical therapist, I can’t actually treat endo, but what I treat are the kind of the side effects of it and how the body responds to it. And what is typically seen in the pelvic floor is high and tight. The pelvic floor is guarding, guarding, guarding against that pain and so it is completely restricted. That’s a very common thing that we see. And then depending on where the adhesions are, they may reach down into the pelvic floor and so there may be more restrictions beyond just the musculature that play a role in how we need to release, release the area. But, so typically, it’s pain, so pain with sex pain, pain with any form of penetration. So you know, like trying to use a tampon or cup or going and having an exam…anything that is inserted vaginally or rectally can be painful. It can also just be painful just without having anything inserted and just having vaginal or vulvar pain. And gut, gut pain as well so abdominal pelvic, that kind of that anterior pain.

If I see after, you know, an endometriosis excision, everything’s cleaned out but there’s still that muscular tension that is not then addressed, that’s in the pelvic floor that’s in the abdominal wall. I do a lot of manual therapy for that, I provide them the education about the body rolling for that. And then it’s a lot of education around how to use their muscles again in a safe way that they feel comfortable with. Because their bodies are so used to being tense and guarding that they have to learn how to relax again and lengthen and then contract in a comfortable manner, just with regular movement. That’s typically what I see is just the upper high with the pelvic floor.

Amanda: Yeah, it’s, it doesn’t surprise me, because the, you know, chronic pain is such an issue for those women. And I just think about the clients that I work with. And, you know, usually their hair tests, like, you can see stress all over it. It can be so surprising for some, because they’re like, I really don’t feel, like, that stressed anymore. A lot of women learn how to deal with the chronic pain. And I’m like, your body’s been in fight or flight, for, like, however long you’ve been dealing with this, usually it’s 10 plus years. And sometimes it’s 20 plus years, and I’m like, it’s, it’s gonna take time, like, their nervous system is usually shot. So I’m not surprised that it’s, like, the higher tighter kind of reaction in their pelvic floor.

Ryan: You know, a piece of a connection with the rest of the body that I also help them through is thoracic mobility—again, getting to that diaphragm—so that the pelvic floor and the respiratory diaphragm can play well together, you know. But that also gets into that fight or flight through our thoracic spine. Helping them with the mobility through there with body rolling and exercises and manual therapy can be, can really help their bodies get out of that chronic stress mode.

Amanda: Obviously, if there’s someone that was listening, and they were, like, listening to you describe the pelvic core breathing, and they’re like, I would definitely be interested in this…would you say for most women with endo, most likely, unless they know that it’s, tightness is not an issue, that when they’re doing the end, like they don’t necessarily need to contract?

Ryan: And it may be really, really challenging for them to feel any type of movement in the pelvic floor or even in the ribs, because when we’re

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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