Beyond Kegels. Easy Ideas for Optimal Pelvic Floor and GI Health (Think Bladder Control + Less Constipation) from Physical Therapist Dr. Anne Duch
Show Snapshot:
Look, talking about pelvic floor dysfunction isn’t sexy. But pelvic floor health is a critical part of wellness and everyday living. Think bladder control, optimal GI health, pain-free sex, and mobility as you age. This week’s show features board-certified Physical Therapist Dr. Anne Duch, who dives into how pelvic floor health is impacted by pregnancy and childbirth, aging, loss of estrogen, and by our modern, largely sedentary life. Anne offers simple, doable ideas and exercises that every one of us can and should take to keep our pelvises in tip-top shape.
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Quotable:
For three reasons—bladder health, bowel and GI health, and sexual health—we should all be talking about pelvic floor health, and how it relates to our everyday functioning.
Transcript:
Katie Fogarty 0:03
Welcome to A Certain Age, a show for women who are unafraid to age out loud. Beauties, people ask me all the time, 'What's the most surprising thing you've learned on the podcast?' Here's my answer: women in France don't pee in their pants when they laugh, sneeze or run. Okay, that may not exactly be true, but this is: my mind was blown when I learned that French women get free pelvic floor therapy after delivering their babies. Not only do they live in the land of incredible bread, they get 10 to 20 sessions of free pelvic floor therapy after each birth. And here's why that matters: Pelvic Floor Dysfunction can show up as incontinence, bladder leakage, constipation, pelvic pain, painful sex, organ prolapse and more. But even if you haven't had kids, pelvic floor health can be impacted by aging, loss of estrogen and by our modern largely sedentary life, but I have good news. My guest today has ideas to rehab and stabilize your pelvic floor at any age and at any fitness level. Anne Collins Duch is a physical therapist specializing in the treatment of women's health issues. She is a board certified women's health specialist and she was one of the very first physical therapists to receive that designation. She runs a PT center, a yoga studio, she's a mom and a marathoner. And she has simple, doable ideas that every one of us can and should take to keep our pelvises in tip top shape. Welcome, Anne.
Anne Duch 1:35
Hi, thank you so much for having me. I loved that intro so very much.
Katie Fogarty 1:40
Aw, I'm so glad, I'm really excited to have this conversation with you because I have learned from doing this podcast how critical your work is. Right? I have learned from the show that really too many women are suffering in silence from things like bladder leakage, incontinence, pain, and painful sex is a biggie I hear about a lot. But paying attention to our pelvic floor is critical, even if we don't have or yet have any of those challenging issues. I'm curious about learning what you see is the number one issue or concern for women when it comes to their pelvic floors?
Anne Duch 2:13
Yes so, in the pelvic health world, I've been doing this for 26 years or so. Just dated myself, but what I've seen over the years, and I am now also midlife, I'm 51, so as I've been working with women, through different stages of life, through pregnancy and postpartum and on into middle age and up in postmenopausal, I see these different issues arise in different ways. They kind of show themselves in different ways. And I think oftentimes, folks, when they are postpartum, there's this bit of acceptance about what's going on, you'll hear well, I had a baby. And folks will kind of accept leaking because I had a baby, or they might accept painful intercourse, because I had a baby. Well, just as you mentioned, that doesn't explain why other people who haven't had a baby would also have these issues, which oftentimes arise down the road as we enter in our mid-40s, 50s, and beyond. So the beautiful thing is when I received that designation, back in 2010, I believe is when that happened, there were only 60 of us across the country, public health therapists board-certified. And now there's many, many, many, there's hundreds, we might be in a thousand now, I don't know the number exactly. But the word about pelvic health PT has gotten out. And probably social media has a lot to do with that for all of the the good parts or the bad parts of social media. I think there's some wonderful parts where people have access to information that they just didn't have before. So I think there's, there's, well, there's definitely been a wave from when I first started. You know, and I had a, I had a patient today who said, 'Hey, I had to ask my OBGYN to refer me to you.' And she didn't know anything about pelvic PT. So it's, we still have a ways to go. But I've seen this kind of wave of people, at least knowing about pelvic PT, and I'm really always happy to get the word out. So I'm really glad to be here to talk to you about it.
Katie Fogarty 4:25
Yeah, absolutely. I mean, first of all, I'm delighted that the numbers grown from under 100 to about 1000 or, you know, give or take, but there are a lot of pelvises in this country and 1000 people sounds like a drop in the bucket for managing it because you know, pelvic floor health it goes you know, it's so critically important. It's you know, supports all of our internal organs. It makes our you know, our sex life work. It makes, you know, biggies work like our bladder and you know, it holds our rectum up. I've learned this from having a pelvic floor therapist on the show in the past. So let's, let's just do some stage setting. Like, why should women who are listening to this show be paying attention to and working on the health of their pelvic floor?
Anne Duch 5:10
Yes. Well, there's, there's lots of reasons. As you mentioned, our bladder health relies on it, our GI health relies on it, we could get into I mean, we could have a whole episode just on constipation alone. But if we're talking about bladder health and leaking, we're talking about GI health, and either constipation or trouble holding back gas, things that people don't talk about openly, very often. We talk about sexual health, pain with intercourse, I know you've had on some really heavy hitting guests that have talked about the hormonal implications having to do with why women will experience pain with intercourse, kind of sort of 'out of the blue,' I'm doing that in air quotes, at a certain point in their life, when maybe they didn't experience it before. And that has a direct, there's a direct correlation with hormonal status and what's happening to the tissues around the pelvic floor, the vulva tissues that typically rely on estrogen, to maintain their health. So for those, just those three reasons, bladder health, bowel and GI health, and sexual health, we should all be talking about pelvic floor health, and how it relates to our everyday functioning.
Katie Fogarty 6:23
Anne, I'm completely sold. So I'm so excited that you're here. You know, what's the starting point? Do you recommend that women get a pelvic floor evaluation just to get a baseline of where they are? Should they only be considering doing that if they've experienced any of the symptoms that you and I just outlined? What's the starting point for the woman who's listening to the show right now? How, how should she begin?
Anne Duch 6:48
Yeah, so you know, clearly, I'm biased. But I do believe I mean, you mentioned in France, you know, women who've had a baby who get, it's just standard care, it's standard care. And here, we have to seek out that care. You know you, maybe you're lucky enough to be with a provider who knows about pelvic floor health. And it is shocking that in the OBGYN world that is not standard, it's not standard education received in medical schools, at least in the United States. So yes, I think everyone could benefit from a pelvic pelvic floor evaluation. Certainly, if you're having symptoms, the old notion that you just kind of accept what comes your way, because it's part of the aging process. I hope we're starting to just completely do away with that thought process. Again, we have a ways to go there. Even if folks just go for an evaluation to get the education, to learn about things that they can do, and we'll get to that right, learn about things that they can do to manage changes that may not have happened yet, but that could possibly happen down the road.
Katie Fogarty 7:57
I love that. We're heading into a very quick commercial break but when we come back, let's talk about what it is that we can do. Because that's top of my mind. We'll be back after this break.
[AD BREAK]
Anne, we're back and I am, I'm you know, you've got me on the edge of my seat, literally. I want to know what I can do to take care of the health of my pelvic floor. What's my starting point?
Anne Duch 9:37
So, if we're talking about people in middle age, and that's why we're here, we want to first consider hormones. Right? So if we, if we know our hormones are fluctuating in our mid-40s and we're approaching, you know, perimenopause, we're approaching the menopausal years, we know there's going to be be a reduction in hormones. So and this is something you know, you discuss with, discuss with your physician, whether we're going to do some sort of hormonal management. And that can be oral, there's lots of ways to manage hormones. One thing that we know pretty much across the board that is helpful for pelvic floor tissues for vulvar tissues, is topical estrogen of some sort. And again, I'm getting into territory that is really to be something discussed with a physician. But I think we should all be having this conversation with our OBGYN to say, 'Hey, am I somebody that would benefit from topical estrogen?' That is something that is easily used, it's usually prescribed to be used once a week for a week, and then two times a week forevermore. So hormonal management would be one area that we definitely want to make sure that we're at least aware of, if not staying on top of. Beyond that, how are we moving our bodies? How are we managing stress in our bodies? How are we managing pressure, and I refer to the abdomen, the area between the diaphragm and the pelvic floor, we refer to that as the core canister. I always joke with patients, when I graduated from PT school in 1997, I'm a dinosaur, we didn't even use the word core. It just wasn't a word. We had the abdominals but the core was not something we talked about. That became more in vogue, you know, years down the road. And now out in the world, when folks talk about the core, I think they're just referring to the abdominal muscles. Got to get those abdominal muscles strong. And when I'm talking about the core, I'm talking about the diaphragm, your breathing muscle, I'm talking about your pelvic floor, the you know, the muscles that you're sitting on, if you're sitting on a bike seat, especially those muscles touching the bike seat would be your pelvic floor, your abdominals, your hips, and your back. All of those areas of the core canister equally important. And oftentimes, what's happening is, we come upon people who grip their bellies a lot, because we've been told tighten your belly, it'll help your back. We come upon people that are gripping, they don't breathe fully. And I stopped short of saying breathe properly, because there's lots of ways to breathe. If you're getting oxygen in, you're doing a great job, but there's different ways to access breath, that you might be able to get that diaphragm to help you out a little bit more. The diaphragm and the pelvic floor are kind of sisters in this core canister situation. And if the diaphragm isn't moving well, oftentimes that means the pelvic floor is not moving well. So and then we're looking at hip mobility, if someone's got, you know, if they have tightness in their hips, or overactivity in their hips, or on the other end of the spectrum, if they're really loosey goosey, their hips are really mobile, sometimes we have to rein that in a little bit. So finding a good balance throughout this core canister is really important. And that goes a long way, movement.
Katie Fogarty 13:00
It's so fascinating. I am so fascinated by this. I'm reminded of years ago when my sister in law, who's a singer, had me lay on the floor and put my hand over my, you know, my chest area and then on my stomach and said, 'Where are you breathing?' And I was breathing, you know, up in my lung area, versus doing that deep diaphragmatic breathing that a singer does. Or that, and the reason why we were doing this exercise was because I was in graduate school for broadcast journalism and I kept running out of air when I was doing my TV segments. I couldn't get through stuff. And I thought that was, you know we, we're not taught this necessarily. And so, I didn't know until you said this just now, that this actually, this sort of diaphragmatic breathing plays a role in our, our pelvic floor health. So now I'm even more motivated to learn how to breathe. How would we do that? What are, what are steps that we all, everyone who's listening to this show right now, can take to improve their breathing?
Anne Duch 13:58
Yeah, well just as you mentioned, and again, you'll hear me, you know, certain types of breath can often be vilified. But I want folks to understand that your ribcage should move, your abdominal muscles or your belly should be able to soften and expand as well as contract and engage. And oftentimes again, in the Western world, we focus a whole, whole lot on engage the belly, engage the belly, engage the belly. Well, nobody knows what that means, really. And we end up just gripping our way through life. We've got to be able to expand areas of our body, find space, fill with breath, in order to be able to also contract areas of our body. So the analogy that is often used not just by me, but lots of my colleagues. If you engaged your bicep, you flexed your arm really strong, and you walked around with your bicep engaged and working all day long. If by the end of the day, you could even use that arm, that bicep would not work very efficiently. So first and foremost, I think people think with the pelvic floor, they just need to engage it all the time or do what we know as Kegel contractions. It's just like a lift and lower of the pelvic floor muscles. And really, if we can reframe this to make pelvic floor health as much about how you're breathing as it is about how hard you can contract your pelvic floor, you'll find more ease in your movement. And you'll actually find you're managing pressure in that core canister more effectively.
Katie Fogarty 15:26
Okay, Anne you had me at ease and I'm recognizing that ease is not the same thing as easy. But I do like an easy button. So, you know how would we, what are some ways that we can actually practice this kind of breathing at home that helps with our pelvic floor health? Are there specific recommendations?
Anne Duch 15:47
Yes, one way I think, we have to be a little bit, some of us are kinesthetic learners, we have to feel some, feel something. Some of those, some of us need to see something move. So usually what I'll do is I'll have people put their hands on their side ribcage right under, right at their bra line. So if you just cup your hands right on both sides of your ribcage, and you take a slow breath in through your nose, and notice that ribcage fan out laterally, left and right, as you inhale, and as you exhale through your nose, notice that ribcage, draw down and in toward your midline. So finding that lateral expansion of the ribcage is a good way to start. Certainly, you can then take one hand on your breastbone and one hand on your belly, and do the same thing where you think about when you inhale, both the hand that's on the breastbone will lift up like a pump handle when you inhale, your belly will expand, and the opposite action happens when you exhale. So those are two ways to access breath, give yourself some tactile input with your hands to help you find some areas that maybe aren't really moving all that much.
Katie Fogarty 16:58
And do we do this throughout the day? Or is it sort of like, you know, like, like an HIT? Like a little quick fix that we do in the morning and midday in the afternoon? What are your recommendations?
Anne Duch 17:07
Yeah, so you know, my tip is usually every time you use the bathroom, because presumably you'll do that a few times throughout the day, use the bathroom, wash your hands, and then pause right there at the sink for three breaths with your hand on your ribcage, three breaths with hand on the heart, hand on the belly, and then go on about your business. So you're getting little tiny hits throughout the day, as you say. And then making it more habitual.
Katie Fogarty 17:35
I love that. I love the idea of attaching it to something because regular listeners of this show know that I'm still standing on one leg when I brush my teeth and I alternate legs because Dr. Vonda Wright, who's an orthopedic surgeon and an expert in sort of aging and mobility, shared that we you know, balance declines at a very young age and starts to decline, but we don't tend to experience it until we're in midlife, or maybe we fall over and damage our hips when we're older. So I you know, when we, so I literally now brush my teeth and I attach it to this sort of balance training. So this notion of just you know, every single time you've finished washing your hands, to do these breathing exercises, I find that such a great way of tethering, you know, one activity to another for habit stacking.
Anne Duch 18:22
Yes, and if I could blow your mind a little further, we might as well come back to balance, to continence, to being able to, you know, keep your pelvic floor healthy and strong. When we talk about continence, the requirements we need to be continent, to be dry. Think of, think of little kids when you're potty training, they need to be able to stand usually, they need to have the strength in their hips to be able to walk, they need to ambulate, and they need to have balance to do that. In an elderly person, it happens in the opposite direction, right? We start to lose our balance, we stop walking so much, and then continence becomes less assured. Because there is a direct correlation with what your hips are doing, with what your pelvic floor is doing. So yes, keep standing on one leg, do it and then do your breath work with it. Habit stack, you know. Do the breath work while standing on one leg, what the heck.
Katie Fogarty 19:14
Okay, we're all highly motivated now because you just outlined a lot of things that we, that we care about. You know I, one of the things that I feel like I've experienced from recording these podcasts is I really feel a commitment to functional fitness. We you know, we talk about longevity, we talk about you know, fitness not maybe for bathing suit season, but for the you know, every season of your life. We want to be able to carry our groceries, and lift our grandkids, and move, and we certainly want to enter our golden years as being continent. So I feel like you've motivated me and I hope you've motivated our listeners. I want to talk about something else that to me is sort of highly motivating. And it's this notion of organ prolapse. And to me this is a biggie because when I learned about this, probably decades ago when I was young, I was literally thunderstruck. Right? I was like, that can happen? You know, that's like, wow. And so I would love to do some quick stage setting. So we haven't covered this topic on the show yet at all. Not this show, but I mean the entirety of the catalog of A Certain Age pod episodes. What is organ prolapse? How common is it? Is this something that we need to worry about? And what are the steps we can take to prevent this from occurring?
Anne Duch 20:25
Yes, so pelvic organ prolapse is kind of the umbrella term for organs, it could be your bladder, it could be your uterus, it could be your rectum, that, for lack of a better term, drop down into the pelvis, kind of make their way toward the vaginal -
Katie Fogarty 20:43
Where they don't belong, right? This is where they don't belong.
Anne Duch 20:46
- where they don't belong, yes.
Katie Fogarty 20:47
Okay.
Anne Duch 20:48
And first of all, in order to define this conversation in the right way, organ prolapses are oftentimes graded of Grade One to Grade Three or Four depending on the scale that a physician might be using. Grade One prolapse is very, very, very common. Oftentimes, people will have a Grade One prolapse, particularly people who had a vaginal birth, or I mean, we can get into the nitty gritty, but a forceps delivery, things like that. They may have a small pelvic organ prolapse that is absolutely non symptomatic. They wouldn't even know they have it unless somebody were doing an exam and told them. Okay? Then you can have folks that feel some heaviness in their vaginal opening all the time, or they feel a little almost like they're sitting on a marble, they just feel like something's where it shouldn't be. When we talk about these things, the things we already talked about with regards to hormone management, oftentimes, a pelvic organ prolapse will be non symptomatic, for a long time. Like I say, you may have a vaginal birth and you've been told you have an organ prolapse and you're like, 'I don't really feel much.' Maybe you have a little bit of leaking. And then as you hit the perimenopausal years, because of the decreased situation going on with hormones, those tissues in the vulva that have been relatively supportive up until this point, start to become a little bit less supportive. And then a prolapse may become more symptomatic. Maybe not. But maybe. So this is what I see lots of women who said, you know, 'I didn't really notice this before, why would this show up now?' And that can be a reason. So for the same reasons we talked about before, managing pressure in that core canister, if we are gripping our bellies all the time, imagine like a tube of toothpaste - an old school tube of toothpaste - if you squeeze a tube of toothpaste in the middle, toothpaste is going to come out the bottom. So if we can kind of lessen that grip in the middle of our belly, pressure going down will be much less. So we want to do that first.
Katie Fogarty 22:57
That's such a fantastic image because, I like, I'm picturing my like little kids with their fists around a tube of toothpaste, squirting in every direction. We've all seen that.
Anne Duch 23:06
Yes, and in my office we actually have those rubber chickens, where you squeeze them in the middle, and the little thing comes out the bottom. To show with that, that's you gripping your abdominal muscles. So first and foremost, in managing, we'll just say POP (Pelvic Organ Prolapse), managing pressure in the core canister is a number one, then bringing your hips and your pelvic floor along for the ride, making sure that they are both able to engage and let go. Right? I think we always think if there's some sort of organ prolapse happening, we must just have a weak pelvic floor. And that's not always the case, sometimes the pelvic floor is overactive, it's doing too much. We have to teach it to let down a little bit so that when we do some sort of activity, it can then engage as it needs to.
Katie Fogarty 23:53
That's so, you could, your pelvic floor could be too tight is what you're saying?
Anne Duch 23:58
Indeed.
Katie Fogarty 23:58
Is that what you're saying? And that's amazing, yeah.
Anne Duch 24:00
Indeed, yes. And that can also lead to pain during intercourse and constipation, right? If your pelvic floor is overactive, it will give signals above, anything trying to come down, stay where you are. And that's when we're talking about bowels, you know, if you have an overactive pelvic floor, that can be contributing to your constipation, even more than your diet.
Katie Fogarty 24:20
That's fascinating. You know, I'm sure that, that so many women aren't aware of this. I mean, I know I wasn't and the, you know I think a lot of times when you think about the changes that are happening in your body, you feel like some of them are inevitable or it's like, 'Oh, if I'm constipated, it's because I'm not eating right,' or you know, these things happen as you age but it really, these are things that don't necessarily have to be occurring. We can, we can be more, we can be more in control of these things than I think we've been led to, to understand.
Anne Duch 24:52
Indeed, I think, that notion of just, this is just how I am. And you know, I like to say to folks, well, this is how you are but you've never done anything to manage this part of it. So let's see if this is really not how you just are.
Katie Fogarty 25:03
And so for anyone who's listening to this who's thinking, 'Okay, I don't want to deal with organ prolapse, I don't want it to get worse or get to the point where it's causing issues in my life,' you know, what are some of the steps that they might take? Is it simply, you know, being aware, getting the evaluation, doing either the relaxing, or the strengthening exercise, is that enough to mitigate against this occurring?
Anne Duch 25:28
Oftentimes. And there's, there are other things that can be done. There's something called a pessary. I don't know if anyone's talked about this on your show. A pessary is a device that is inserted vaginally that is a supportive device that can help support a pelvic organ prolapse. And that is something you know, 20 years ago, they really only gave these to elderly people, you know, and they weren't going to take them out, you're going to go back to your physician who would then take it out, clean it, put it back in. Now, pessaries have become more widely used for activity, if someone has a pelvic organ prolapse and it is disruptive to their day, they can use a pessary. If they were going to go for a run or do a workout or do something where they know their prolapse gets worse, they can use that pessary as a support just as you would if you had a, you know, ankle brace or something that you use. So that's one way to manage. Pelvic PT is obviously a really wonderful way to manage where we're teaching you whether your pelvic floor needs to be stronger, for lack of a better term, or learn how to relax that pelvic floor. Down train would be the term that we use. Via breathwork and via different types of exercises and movement.
Katie Fogarty 26:46
I love this, and this notion of, sort of doing these exercises, sort of training yourself, also being aware that devices like this pessary exist and so that if you are having any of the issues that we all sort of just, you know, touched upon here, you can educate yourself about what are the options and have these conversations with your doctor. Because that's one of the big takeaways that I've had. I connected with a female urologist named Dr. Angelish Kumar on the show. And she basically shared that women suffer in silence for far too long. And that, you know, most of what's, what's occurring in people's lives are, is you know, treatable, fixable, and that you do not have to suffer. So that's, you know, to me is like the big headline, that help is out there.
Anne Duch 27:28
Amen.
Katie Fogarty 27:28
So, Anne, we've covered like two big areas of concern. We talked about, kind of, you know, overall fitness and why pelvic floor health is important for longevity and mobility and making our body work. We've talked about organ prolapse, thank you for giving us some ideas to make that, you know, make sure that doesn't happen. And you mentioned on our pre call that these are sort of the big areas of concern. It's overall fitness, making sure our body works for the long term. Organ prolapse is something that women have heard about and are nervous about. But there's a third area that you often work with clients on. And it's about nervous system regulation. And I thought that was fascinating. I would love for you to share with our listeners what that is and what physical therapy offers.
Anne Duch 28:15
Yes. So my, as we mentioned, my practice, my physical therapy practice is housed within a yoga studio. And this is something, I'm a yoga teacher as well. And I became a yoga teacher a little bit later in my PT career, because I started to see this carryover between some of the things my patients were experiencing, and how I thought the nervous system might be playing a role in what was going on. And there's a lot of, if anyone's on social media, you'll see tons of stuff about the vagus nerve and how important nervous system regulation is via the vagus nerve. One of the things we see that if folks are kind of hanging out in their nervous system in the very sympathetic fight or flight system all the time, all the time, all the time, they are going to carry that activation in their body somewhere. And again, back to folks who grip their belly, or they're tight in their chest, or their pelvic floor is always gripping, or the big one, their glutes are always squeezing. It's like they're ready to run at all times. And then the other end of that nervous system spectrum would be what is referred to as the rest and digest system, right? That's the parasympathetic nervous system. That sounds like it's all well and good, and it is. Unless that gets too activated, and it causes this freeze kind of thing to happen where folks can't really mobilize. And if we were talking about mental health, we might talk about these two spectrums, in the anxiety way or in the depressive way, where folks experiencing kind of this low down part of their nervous system just can't mobilize. They can't, they don't really feel like doing anything. And the other end of the nervous system is people just can't stop. They're constantly in movement. And what I see in this midlife period is both ends of that nervous system spectrum. You can live that way on either end of that spectrum for quite a while. And then eventually, and it seems like this midlife area is the time where we see the experiences that we've had kind of really come to the surface. And again, is it because we're taking care of aging parents, and we're also taking care of kids, we've got jobs and all the things? But figuring out ways to regulate those two ends of the nervous system spectrum to somewhere in the middle, so that when we go into that fight or flight, the parasympathetic nervous system can come in, put the brakes on it just a little bit, tap the brakes. And that can be done through breathwork, that can be done through movement you enjoy, that can be done through getting outside, getting sun on your face. And again, I am a yoga teacher, so I'm biased in that way. I think it can be helpful for regulating the nervous system.
Katie Fogarty 31:01
You know, I think that every single person listening to the show probably has been in one or two of these camps or like has the hybrid, you know, where we're stressed out modern life runs at full tilt. We're constantly being bombarded with sort of digital asks, and as you shared, you know, natural things that occur in life, aging parents, kids, managing career, and this sort of sense of paralysis, where sometimes we just simply feel really overwhelmed by everything that's being thrown at us. So I feel like everybody needs these tools for regulating their, their nervous system in some way. I love the ones that you've outlined, yoga is something that I really enjoy. I've also picked up, you know, different kinds of racquet sports over the years, which has, you know, it's a lot of cardio, but it's also really social. So it sort of checks that box. You know, for somebody who is thinking to themselves, you know, 'I just haven't found the right thing yet, I don't love yoga,' you know, from from your expertise as a physical therapist, you know, how would you encourage them to think about this as a, kind of like a must do for their health? Because I think that sometimes women don't put themselves first and everyone else's needs rise to the top. But when we think about this as a medical need, we're more likely to prioritize it.
Anne Duch 32:21
Yes. And again, I also understand it's not as easy as just saying, 'Well, you need to move more, you need to meditate more, you need to do the thing.' Part of the problem is when you feel like people are telling you, 'You need to do this,' like I can't do one more thing possibly. I can't put anything else on my schedule. So making, I do believe making movement a priority - we joke, the term we use is, 'motion is the lotion' - so we want to make sure we're getting our body moving. Whether that looks like little, you know like you're doing, stand on one leg while you're brushing your teeth, like doing something deliberate that is doable. You don't have time in your day, and you know you're at least going to go to the bathroom five to seven times a day, typically. While you're in the bathroom, can you do a little wall squat? Can you put your back against the wall, put your hand on your chest and your belly, and take three breaths? That's movement. If you have time, if you have a five minute period of time, instead of picking up your phone and scrolling, going through Instagram or whatever your, your latest thing is there, go up and down the stairs in your home twice. I know it all sounds ridiculously rudimentary, but sometimes that's just the jumping off spot you need.
Katie Fogarty 33:36
Yeah no, I love those ideas because they're short, they're snackable, they're digestible, we can totally do that. And I'm going to encourage every single person who's listening to this to follow Anne on Instagram. Anne, tell us your Instagram handle.
Anne Duch 33:49
@PTforwomen.
Katie Fogarty 33:50
@PTforwomen. So I discovered Anne through @PTforwomen, and she offers very short little videos or short pictures that show these kinds of easy to do exercises that you can do in your home throughout the day. I was so motivated the other day, I saw her doing something she was calling 'standing pigeon.' For anyone who does yoga, you know pigeon is a great hip opener. And you can do this literally standing at your desk or perhaps at a countertop like on a bookshelf or a you know dresser in your home, where you're standing in front of it and you've got your leg up on it and you're doing standing pigeon. And I've been doing it everyday since and every time I do it, I feel amazing.
Anne Duch 34:30
Yay!
Katie Fogarty 34:30
Because it really is such a great hip opener and it's just a testament to the fact that exercise doesn't have to be hard or expensive or require a gym or even, you know, a trainer. Although, those can all be great and I, you know, avail myself of all of that, we can do a lot at home when we, when we get the right inspiration. So please go follow Anne, you'll find it to be so motivating. And you'll be in good company because she's got about 100,000 people following her because her stuff is terrific. Anne, we're gonna be heading into our speed round in just a minute. But I did want to just ask you a little bit about your evolution. You know, you were an early, you know, board certified women's health specialist. You know, I know you did that, it sounded like, in 2010, you've evolved your career, you've added yoga teacher. I know from your website and our conversation that you're a runner and a marathoner. I'm just curious, you know, how has getting to midlife evolved the lens through which you operate your business? Have your own mobility and pelvic floor exercises or, you know, routines change as you yourself have aged?
Anne Duch 35:38
Yes, that's a great question. And I think for me, you know, I was a college athlete, I was, I was a runner pre college, but runner post college, I was a self described cardio junkie, you know, I was raised in the 80s Let's Get Physical, right, let's do it. And as I have evolved in my practice, and in my own life, I started to see how that nervous system regulation might need something else, right? I can't run and run and run and run and run, my body would break down in different ways that I was just like, 'I don't understand why this is happening, I'm doing all the things I love to do.' But I needed that counterpoint. So for me, that counterpoint meant, hey, maybe today, instead of running, I'll take a walk, or I'll hike. Maybe today instead of running, or maybe I'll run less than I might have done 10 years ago. And instead, incorporate yoga or lifting. I mean, I've watched all of the fitness fads come and go. And I've tried to just take a little bit from each of those things and incorporate them in a much more, and I'm gonna use this word again, ease-full way. It doesn't mean I'm not working out hard, but it does mean there are times when I might take my foot off the gas and say, 'Hey, today, I could use a little something different, something more ease-full.'
Katie Fogarty 37:01
We're here, we're here for ease. You are, you're talking our language, Anne. I love that, I love that notion. You know, I think we could bring, we can apply it not only to our exercise routines, but to every aspect of our lives. You know, as we get to midlife, sometimes we need to work on being kind to ourselves and, you know, allowing ourselves grace to move through difficult things or to you know, kind of evolve how we, how we live our lives, because sometimes we get in one lane, and we think we need to stay there. But we can, we can change lanes and we can take our foot off the gas, and then we can push our foot down on the pedal when we feel like it -
Anne Duch 37:38
Indeed.
Katie Fogarty 37:38
- in every aspect of our life. I absolutely love this note to end on. Alright, we are gonna move into our speed round, which is going to be great because it's like we move quickly, and I know that you know, you're all about movement. So this is just very simple. It's one to two word answers, or a quick thought to answer these questions. So let's do this. We know you love yoga. What's another easy, accessible exercise that's good for pelvic floor health?
Anne Duch 38:06
Hiking.
Katie Fogarty 38:06
Hiking, okay, I love that. Surprise - this common activity is not good for your pelvic floor:
Anne Duch 38:15
Oooh.
Katie Fogarty 38:16
It doesn't need to be exercise, it could be just something that we do.
Anne Duch 38:20
Hmm. Oh, breath holding, breath holding.
Katie Fogarty 38:23
Oh, breath holding, okay. What about excessive sitting at desks?
Anne Duch 38:27
Yes. And sitting at desks, thank you, yes.
Katie Fogarty 38:29
That's cause I do too much of that. All right.
Anne Duch 38:30
Uh huh, indeed.
Katie Fogarty 38:32
You can take care of your pelvic floor with exercises at home, which we just covered, with a standing pigeon, what is an at home piece of exercise equipment we should all consider investing in?
Anne Duch 38:44
Ooh, I would say if you have a step, if you have stairs in your home, or, that's the best thing you can have. Either, you'll sit in a low squat on a stair, a step stool or a stair I would say, there's so many things you can do with that.
Katie Fogarty 38:57
Okay, nice. Aside from yoga, what's the lifestyle hack or choice that fuels peace and busts stress for you?
Anne Duch 39:04
I'm a, I'm a lover of reading. So I like to sit quietly and read. And I feel like that helps down-regulate my nervous system.
Katie Fogarty 39:13
I love it. Finally, what's your one word answer to complete the sentence, as I age I feel:
Anne Duch 39:20
Real.
Katie Fogarty 39:21
Real, nice. You were the first person in 126 shows to say that - I love it.
Anne Duch 39:27
Oh, yay!
Katie Fogarty 39:27
I love it, I'm thinking right now of The Velveteen Rabbit. Remember that was -
Anne Duch 39:30
Yes, yes that's exactly it!
Katie Fogarty 39:33
Speaking of reading, I loved that book when I was young and I read it to my kids and that's the first thing that popped into my mind. It's a beautiful note to end on. Anne, this has been terrific. You've inspired me, I'm going to incorporate more breathing exercises into my routine. I will think of you now when I'm washing my hands and doing my breathing exercises just like I think of Dr. Vonda Wright every time I brush my teeth. This has been an absolute treat, but before we say goodbye I would love for you to share how our listeners can find you, learn more about your work and services, and most especially see your coaching and exercises on Instagram.
Anne Duch 40:10
Yes, thank you so much. First of all, thank you. I'm so honored that you invited me on, I'm always happy to talk pelvic floor. I love your show. I love all that you do. Most, I'm probably most accessible on Instagram @PTforwomen. You can find all the details of things that I'm doing there. I am working on a couple virtual offerings, leaking basics 101, postpartum things, perimenopausal and menopausal exercise programs, so stay tuned for that. There's some things coming on there real soon.
Katie Fogarty 40:42
Fabulous. Thank you, Anne. This wraps A Certain Age, a show for women who are aging without apology. Before we say goodbye, two things. A quick thank you to everyone who has taken time to write an Apple Podcast review. I see and appreciate you. And, come follow the podcast's sister account over on Instagram. You can find it at @letsageoutloud. That account spotlights even more stories of women making the most of midlife. Have a story that you want to share? Please head over to @letsageoutloud to submit your story. We would love to feature you. Special thanks to Michael Mancini who composed and produced our theme music. See you next time and until then, take care of your pelvic floor beauties!