Pelvic Floor Physio: Common Does Not Mean Normal with Tamara Gerdis from Physio Down Under
Episode Details
Transcript
In this conversation, Tamara, a pelvic health physiotherapist, shares her journey into the field and discusses the importance of understanding pelvic floor health. She explains various conditions such as urinary incontinence, the significance of personalized assessments, and the impact of age and childbirth on pelvic health. The discussion also covers the role of education in promoting awareness and the normalization of pelvic floor issues among women.
Tamara emphasizes the need for open conversations about these topics and provides insights into when surgery may be necessary. The conversation concludes with a focus on the importance of seeking help and taking control of one's health. In this conversation, Tamara discusses the complexities of pelvic health, focusing on prolapse, its symptoms, and the importance of pelvic floor physiotherapy. She explains the evolution of prolapse definitions, the significance of symptoms over anatomy, and innovative solutions like vaginal support pessaries. The discussion also touches on genetic factors influencing prolapse, the growing demand for pelvic health services, and the importance of education in this field. Tamara emphasizes that it's never too late to seek help for pelvic health issues and highlights the need for qualified physiotherapists in this specialty.
Links & Resources
Tamara Gerdis at Physio Down Under
Connect with The F*CK You 50s
Speaker 0
I have had a lot go on in my life, and I'll try to summarize the portion relevant to, today's episode. In two thousand and seven, we moved to Singapore. In two thousand and eight, I had my youngest, Zoe, got and recovered ish from a mosquito illness called chikungunya that led to an autoimmune disorder diagnosis by a rheumatologist in two thousand and twelve. I underwent multiple surgeries in two thousand and fourteen, hip arthroscopy, and a tummy tuck diastasis recti repair, often known as a mummy hernia, and total hip replacements in two thousand fifteen and two thousand seventeen. Bear with me. I promise you this all ties in at the end. Circling back to the tummy tuck, which I prefer not to call it that because it really degrades the, issues surrounding why women get them. Thus, the diastasis recti repair. Note that all of my doctors refer to it as a mummy hernia. A diastasis recti is often caused from having large babies, multiple births, or gaining a significant amount of weight. What happens is your muscle wall separates. Different degrees will have different levels of needs and complexities. One complexity is dealing with a permanent looking bloated belly or when you have your period, you deal with looking very pregnant. The human populace needs to grasp that women's bodies do not look like a four by four flat board. Okay. Wait. That's a square. I guess like a four by eight. Okay. Like, whatever. Anyway, honestly, being asked every twenty eight days if I was pregnant was so fucking exhausting. I started to come back with, no. I have my period. I bloat so badly and bleed like someone just sacrificed a fucking pig. Here's a brief lesson in manners, and women are guilty of this too. If a woman's water breaks in front of you, that's the opportunity to say, Oh my god, you're having a baby? Otherwise, don't assume and shut the fuck up. I don't care if she waddles and rubs her belly. Maybe she's a Teletubby out of costume. Anyway, my GP diagnosed my diastasis recti after I expressed frustration about looking pregnant every twenty eight days. I tried reformer Pilates to address it. Surgery became necessary due to the remaining separation of my muscle wall. The wall is what protects your vital organs. So simply, if it is separated, it's not protecting your organs. Now let's say you get into a car accident, your steering wheel smashes into your stomach, and there's a good chance that you could cause severe damage to an important organ that could end up costing you your life. This is how my GP explained it to me. Well, we were still living in Singapore at the time, and the medical system there is vastly different than that of Canada's. We had medical insurance through my husband's company, and when you have a big ticket item, you have to take a quote from your doctor to your insurance company for approval. Now as a hairstylist, I've had many clients over the years share that they have had the diastasis recti repair, and I would say fifty percent were approved for insurance and fifty percent were not. I was of the knot. I do believe that if the surgery was recommended for men, it would be covered a hundred percent without question because if you're a man, we need to keep all y'all together. But if a woman requires some sort of potential life saving surgery, she's disposable. After all, there are plenty of fish in that HR department. I came out of my surgery with the doctor gesturing about how tight he got my muscle wall with a corset stitch. Two years later, arriving in Canada for the summer, I was lifting my luggage out of the car and suddenly buckled over with this overwhelming tearing pain. My mind immediately went to the corset stitch. Is it unraveling? Seeking medical attention in Toronto, I was told by a male doctor within five minutes that I had an ulcer. No one can tell you that you have a fucking ulcer until they've done a proper upper GI endoscopy. Sidebar, I don't have an ulcer. Anyway, fast forwarding back to twenty twenty two when we repatriated back to Canada, having dealt with increasingly annoying stress incontinence issues, I see my new GP in Toronto who tells me to work on my kegels, which Apple, by the way, as I draft this, auto cracks it to giggles. It's not funny. Anyway, unlike, kegels are not my issue. I see a menopause doctor who tells me aging is one culprit and to work on my kegels. Fucking hell. Apple correcting to giggles. Yet again, this is not fucking female hysteria. I went for a facial at a dermatology clinic who offers a complimentary trial a complimentary trial of the Emsella chair, which is a medical device that you sit on. It works by amplifying the pelvic floor muscle contractions. Think kegels, but on steroids. I saw a doctor who does urogynecology at Sunnybrook Hospital who also mentioned this Emsella chair, but added I am not a candidate for it as it would worsen my incontinence issues since my pelvic floor muscles are too tight. I don't want to say overworked because my husband would disagree with me and my kids would be disgusted, but overworked with kegels since almost every doctor shoves kegels in your face. Sorry. That's kind of like an unfortunate imagery. Apologies. There are many options available for women who suffer from stress incontinence issues, which include a bulking agent injectable that sounds like polyfil, which bulks up the urethral tissue. Or another option is using some of your abdominal tissues repurposed, in the surgery. But those like me who have had a diastasis recti repair may not qualify because of the scar tissue from that surgery. Anyway, there are many other options. But then you know what the doctor tells me that can add to incontinence issues? The diastasis recti repair surgery. The urologist added that probably having pelvic floor physio after my surgery would have helped me lessen the chances of suffering increased stress incontinence. My journey highlights the complexities of women's health and the need for better understanding and support. But now let's further dive into that pelvic floor. We're here to spread them, and by that mean, spread knowledge. Welcome to the fuck you fifties. Welcome to the fuck you fifties, the podcast for women who refuse to tolerate the bullshit anymore. This is real talk, real stories, and a long overdue reality check. I'm your host, Andrea Clare, and this podcast is the filter free voice you've been waiting for with a dose of f bombs. The fuck you fifties, unfiltered, unapologetic, and undeniably needed. My guest today is Tamara Girdas, who is a pelvic health physiotherapist and the cofounder of very cleverly named Physio Down Under, Singapore's first pelvic health physiotherapy clinic. Tamara has over twenty years of physio experience and a master's in incontinence and pelvic health physiotherapy. While I was living in Singapore, Tamara became a common topic with my private hairstyling clients who had shared their own pelvic floor issues with me. Well, in the vein of your new oversharing BFF, I too went to see Tamara, seeking help of my own what the fuck is happening to my body when I sneeze, cough, or try to jump for any amount of joy situation. I thought Tamara would be a perfect addition to the fuck you fifties conversation roster. She says this, just because it's common, doesn't mean it's normal. Let's hear all of the gems that she has to say. Welcome, Tamara. Speaker 1
Hello. How are you, Andrea? Nice nice to see you. Speaker 0
Yes. Nice to see you too. You get a different angle of me now. Speaker 1
Yes. Absolutely. Speaker 0
Yeah. No. I'm I'm well. Like, I'm freezing in Canada. You know, we've been back, in Toronto for two years now, so I definitely miss, like, the Singapore heat for sure. Although you guys are probably in rainy season right now. Right? Speaker 1
A little yes. It has been raining a lot, but I've still I've got the air con pumping in here, and it's, you know, it's it's all hot as always. Yeah. Yeah. Speaker 0
Yeah. It is what it is. Oh, amazing. Well, thank you so much for for doing this. I really, really appreciate it. So I remember, like, in Singapore because I would work on set doing photoshoots, but I also had private clients that I would see. I had, like, a one chair salon set up at at our our house on, Zender Road. And I had so many clients that were coming to me that were also either seeing you or heard of you or also maybe not even, but just, you know, as you talk to your hairstylist about, you know, various things. And and I'm, like, an open book. And and so it's it's and so it's interesting too because, you know, I've had three children as you know, and I was just developing problems with my pelvic floor. And it's like, you know, things like I used to work out, but I had to kinda stop working out because every time I would try to do some sort of exercise, I practically wet my pants, you know, which is embarrassing. And it's like and then you just stop doing things in life because, you know, you have that kind of thought, like, this is gonna happen to me, so I'm gonna stop doing this. Right? And and so I had clients that were talking about you and and just said, go see Tamara, and you have to go with, with an open mind, and and don't be shy. And, so and I just think so many women that have kind of these issues, right, for various reasons, you know, whatever. So, Tamara, just so, so I'm not, like, monopolizing this whole conversation because I wanna hear from you. If we can maybe start with, how did how did you get into it? What what kind of motivated you to get into, pelvic floor physio? Speaker 1
I graduated as a physio in nineteen ninety nine, and I moved to the UK, and I was working for the NHS. And it was terrible. There was a nine month waiting list. I was a newly qualified physio. By the time I saw anybody, their their pain was chronic. And occasionally, we would have pregnant women coming through, and they would get triaged quickly. And I just loved it. They got better. Moved to Australia. I got a job at the Royal Hospital for Women in Sydney, and I got trained up there. And I was like, right. This is it. And so that was in two thousand and four. So for over twenty years now, I've been specialized in pelvic health. I've gone on to do my master's in pelvic health physiotherapy. And, it's just it's very, very fulfilling. I'm an a type personality, so I like to be really good at what I do. And so to be a physio and be excellent at every joint in the body is impossible to stay up to date with everything. But for pelvic health, I can really stay up to date with this. There's enough to keep me interested, but it's small enough that I can be really good and and really know what's going on. So it's great. I've never looked back. Speaker 0
Amazing. Yeah. I would I would guess that there's probably a lot of of new thing. I don't wanna jump ahead, but, but to jump ahead, I, I recently heard about this Umsala chair. Is it new technology? Speaker 1
Look. It's been around for a number of years. I think people are always looking for a quick fix. Speaker 0
Right. And Speaker 1
the reality is is we come to see a pelvic health physio. You are almost always gonna leave with a little bit of homework. And, also, we're probably gonna ask you to get undressed, and we're probably gonna do a vaginal examination if you are comfortable with that. And a lot of people don't want to do that. Now an emcealer chair is uses high femme electromagnetic technology, and they sell it as you can be fully clothed. You sit on this chair for twenty eight minutes. You can read your book. You can have a cup of tea, and you're gonna be cured. The problem is is that the research is still very spotty, and I've tried one of these. I've sat on one at a conference, and it does eleven thousand con pelvic floor contractions in twenty eight minutes. Now that's a lot of pelvic floor contractions. And a lot of women don't have weak pelvic floor. Well, they do have weak pelvic floor, but they've got overactive pelvic floor. So the tone in their muscles is actually too much. And because of that, they can't activate and they can't release, which actually causes a lot of problems. And so if you go sit on this chair and you've got overactive pelvic floor muscles, you're gonna make all your symptoms worse. Speaker 0
Oh. Speaker 1
There's a small group of women who truly would benefit. And, actually, when I sat on it, I really felt it was only, working my superficial pelvic floor muscles. So there's three layers of pelvic floor muscles, and the superficial ones are more towards the outside. So if you can be assessed by a pelvic health physio or your gynae and you know what you need and then they prescribe the chair. That's fine. The other problem is it's super expensive. Yes. So that's my take on it. So I'm not saying it's terrible for everybody, but I would say really know what's going on with your own body before you go and sit on one. Speaker 0
I I guess in a way then it's kind of almost like you're saying, like, you get your doctor to kind of prescribe it so it becomes like a like, almost like an outside physio tool. I'm still having, like, pelvic floor issues. And, and I know because when I saw you, I only saw you a couple times, and then we were getting ready to move to Canada. So I've always done, like, the kegels and, you know, whatever. But I remember seeing you and you were saying, like, the, if I remember correctly, is that my muscles weren't necessarily my issue. Speaker 1
When we talk about urinary incontinence, we get two different types of urinary incontinence. So you have stress urinary incontinence, which happens when you leak urine if you cough, sneeze, jump, run. It's that we create too much press pressure in our in our abdomen, and that pressure causes us to leak. But you also get what's called urge urinary incontinence, and that is where your bladder is overactive. So it's women will describe this as, yep. As you know, they see the toilet and as soon as they see the toilet, they start to pee. Like they, their bladder just gets totally overactive. I mean, the other times, sometimes it's like running water or they get cold and it causes the bladder to get excited and they start to leak. So you can have what's called mixed urinary incontinence, which is a combination of the two. But we treat stress incontinence and urge urinary incontinence quite differently. So if you ever go see a pelvic health physio, so like when you came to me, you'll remember that we spent a good fifteen to twenty minutes actually having a chat in the beginning where I asked you lots of detailed questions exactly about peeing. I spoke we spoke about pooing. Showed you the Bristol stool chart. You identified which poo is usually yours. We spoke about, you know, is there any pain during sex? We spoke about prolapse symptoms like heaviness in the vagina. So we really get a good understanding of exactly what's going on. So if I look at you, you were having a combination of the two. So you were having a little bit of the stress and consonants and the urge. But your pelvic floor, it wasn't that it was super weak. It was kind of average strength, but you couldn't relax. So it was on the higher tone side, and pelvic floor muscles are meant to be dynamic muscles. So they're meant to be able to switch on and switch off when we need them. And I always describe this to my patients. Imagine your biceps muscle was constantly in a contracted state. You can imagine that over time, those biceps are gonna get shorter and tight. So if then you want to use your arm, those muscles are like, oh, no. Hold on a second. I actually can't do what you need me to do. And the pelvic floor is exactly the same. So we needed you for you, it wasn't so much about the strengthening in the beginning. We needed to teach your muscles to relax. We sometimes call that down training. Get back that coordination of those muscles and then get them to to strengthen. Pelvic floor physio is now very different to what it was, like, when I first started. So there's just so much else that we can do. But with you, the main thing would have been actually to get those pelvic floor muscles just to let go a little bit. The other thing is because of how close the pelvic floor muscles and the bladder actually sit is that if we have very sort of tight pelvic floor muscles, the muscles themselves can irritate the bladder. So that in itself can add to the urgency and the urge incontinence. Speaker 0
Right. I remember, and correct me if I'm wrong, but I remember you telling me too that, I'm probably of that age category where we're always when we were younger, always told, like, stand up straight, suck in your gut, and it trains your muscles. So you have a hard time kind of, like, letting letting go, relaxing them because you're, you know, from a young age, you're always told, like, pull your belly in. Suck, like, suck it in. Speaker 1
Yeah. So the problem with that is that, the diaphragm, which is the dome shaped muscle that sits under our rib cage so your diaphragm so when we breathe in, our lungs expand, the diaphragm descends, that in turn sort of is meant to push on the intestines and the pelvic floor. So when we breathe in, when we inhale, our pelvic floor is actually meant to lengthen. When we exhale, everything naturally recoils and our pelvic floor is meant to lift. Right? But if I walk around all day sucking my belly in, I cannot like, if you try now to pull your belly in and now trying to breathe into your belly, you won't be able to. You will only be able to do an upper chest breath. Now your upper chest breathing is like our fight or flight breathing. It's like a lion chasing me. That's what I mean to use. But so many women want to have flat tummies that they suck their bellies in all the time, and they lose this ability to to actually use their diaphragm to breathe. And I cannot tell you the number of women who come in. And one of the first things that I do is I look at their abdomens. I look at how they're breathing. And the number of them who are who cannot let go of their tummies. And if I say to them, you gotta let go. Let go. And they hate it. They hate that feeling. But if you walk around sucking in your belly, your pelvic floor cannot work automatically. It loses its automatic up and down that we want. The pelvic floor is part of our core muscles. It's part of our postural muscles. Most of the time, we shouldn't have to think about it. I often talk to my patients, like, imagine a young girl on a trampoline. She's not leaking urine, and she's not thinking about her pelvic floor. And that's because the coordination between her diaphragm and her pelvic floor is still perfect. But I often think as we become you know, we're going to teenage years and especially when we fall pregnant and we start to suck in, then we lose that ability. And so that's part of what we do. We do breathing exercises. We teach women how to breathe again. Speaker 0
Wow. That's amazing. And I have to say, like, as we're having this part of the conversation, I'm I'm realizing that I'm still in that bad old habit. Like, I'm standing here sucking in my gut going, And I'm not even trying to make a joke. Like, I literally I can I can feel it? And and, like, sometimes in my mind my mind goes back to our initial, like, discussions, and and I remind myself, like, I need to get out of this habit. It's such a hard habit to kick. Speaker 1
It is. But you are not you are not alone. I do find though that it's very difficult in the beginning, but once you get it because it's physiologically normal, your brain does it quite easily after that. Speaker 0
I I don't I don't know if it's gotten, like, worse for me, and I've talked to, like, other, like, people around my age as well. But, in in Canada, and I think they're available in Singapore as well, or there's these underwear called NYX. Right? They're like period underwear. So sometimes when I'm going to set, if I have a long day on a TV commercial or something, I literally will wear those NYX underwear just in case. Like, if I if I'm, like, in a dusty studio studio and I sneeze and, like, leak a bit of urine or something, like, it's so frustrating and talking to people. Like, people don't really wanna talk about it because they find it embarrassing, but then it's like when you're one on one with a friend or hairstylist or whatever, people kind of, like, open up a bit more. And I've I've told people, like, you need to find a pelvic floor floor physio. Where do you see like like, is it kind of, like, all ages that this can affect? Do you find it more so as women are getting older? Do you find it more so, like, women post children? Like like, what's, I guess, the root of this evil? Speaker 1
So, look, we definitely as we get older, the prevalence of pelvic floor dysfunction, so whether that's incontinence or prolapse, it definitely increases as we get older. And there's no doubt about it that hormonal changes that we go through first in perimenopause and then in menopause, plays a role in that. However, I absolutely do see teenagers who are leaking urine, and it's usually the athletes. And it's so ironic. Right? Because you would think it's the athletes who are so super strong, but it's often the athletes and it's often like the gymnasts or, sort of the sports that are very, very high impact. They have the tighter pelvic floors, and they've never been taught how to let go. If you look at studies where they look at crossfitters look. It's often things like double unders, which is where they do they're skipping, and they have to do two turns of the skipping rope in one jump. Right? Or things like box jumps. So very high impact. But many, many, many women, before they even feel pregnant, are having difficulties with controlling their bladders. And often the way they handle it is they just stop doing that sport, which is so sad. But the average rate is about at least thirty percent of all women will be experiencing urinary incontinence at some time in their life. But really, once we get beyond menopause, the the rate is closer to fifty percent. You know, we're trying to talk about it more and more. I think one of the biggest issue is is that the previous generations used to say it was normal. The biggest message I want to give to your listeners is that it's not normal. It's common, but it's not normal. And there's always something you can do about it. And even if we can't cure it, there's usually something we can do to help. We can usually take the act whatever you want to do, make modifications, and allow you to continue working, doing whatever you want. Speaker 0
So when people come to see you, like, I know it it's like they they really have to kind of leave their, embarrassment at the door, so to speak. Speaker 1
Look. I think you're right. I think the vast majority of women know what they're coming for, and they know what to expect. I do occasionally have women who didn't know that we the the gold standard way to assess your pelvic floor is through a vaginal exam. I mean, I can't look at anybody externally and know what they're doing with their pelvic floor. I would say ninety nine percent of my patients are always okay to have a vaginal exam. And we do I do a lot of explaining. You know, I bring out I've got my pelvic floor model. You know, I bring that out. I explain, you know, why we're doing it and what I'm looking at. I mean, often, I do a vaginal examination in standing as well. Because if a woman's got prolapsed and she's lying on her back, the organs sit very nicely in the pelvis. So, for example, a woman will be symptomatic. Like, she'll say to me, I can feel this heaviness. But I went to my gynae, and my gynae examined me and said there was nothing there. And I'll go, okay. Did the gynae look at you in lying or standing? Always in lying. And then I get them into standing. And because gravity pulls everything down, all of a sudden, you see this bulge sitting there at the vagina, and it validates it for them. Right? So I always joke and I say, listen. I want to examine you in standing. It's really not the most glamorous way for me to do an examination, but it's really useful for me. And I explained that to them, and they always say, absolutely. Let's do it. Yes. Look. We don't force anyone to do to do anything they don't wanna do. But people are coming because they either they've got an issue and they want to get better, or we get a lot of women who've just had babies. And more and more now, they want to check what's going on with their abdominal muscles, with their pelvic floor before they go back to exercise, which is so fantastic. Most women who've had a baby are like, where do you want me? Like, do you want my leg up? Yeah? Like, you know, like Yeah. Speaker 0
Yeah. Yeah. Speaker 1
Like, you know, it's actually more my younger patients. My because we see a lot of patients who have pain during sex. Actually, the new the new term for it is called genitopelvic pain penetration disorder, but it's pain during sex. Right? And so I I have a lot of patients who have never been able to have sex. Right? And so those women are definitely, more conservative. And, obviously, we go much slower with with the sessions. Speaker 0
Right. Do do you find, because it's also interesting, that you're seeing a lot of, like, like, younger moms that are that are coming in. Do you do you work with a lot of I would assume that you do, but do you work with a lot of OBs and, gynecologists? And are they starting to recommend that that's just like like, postpartum, like, you go see a pelvic floor specialist or physio? Sorry. Speaker 1
It's very variable. You do have the obstetricians who are very good that way. But actually a lot you know, social media has been really quite amazing. I mean, positive in many ways, not positive in some ways, but in spreading the word that this is what should be done. Actually, we're encouraging them to get their pelvic floors checked before during pregnancy. Because if we get a baseline during pregnancy, it's so much easier postnatally Yeah. To, because they know exactly what they need to do. Also, we now have a lot of evidence that there's so much that we can do to help with the labor and delivery in terms of minimizing pelvic floor issues postnatally. So that's also what we're pushing as well. But we have a lot of doulas as well who, refer a lot to us. And but, yes, absolutely, the obstetricians. But the obstetricians tend to only refer if there's a problem. Right. Right? Yeah. So then they would refer. Whereas a lot of women are finding us, even if they don't have a problem, they'll just say, look, I'm six weeks postnatal. I heard this is what I should do, and I'm here. Right? Speaker 0
Honestly, I feel like that that's that's amazing, like, moving forward that I mean, what I find, of course, being a woman, you know, women's health, I I find we we're so, like, the backseat to so many so many things. Right? Like and re recently, I've been you know, because I had an autoimmune disorder in Singapore, and I'm trying to kind of, like, see new doctors and stuff here. And, honestly, like, it's I've been back for two years, and it's still hard to kinda get any answers. But one one of the things that started spiking for me in Singapore was high blood pressure. And so, I went to see a hypertension specialist here. Like, long story short, because they were not talking about hypertension. But as a male doctor, I told my GP, I just I really prefer female doctors now. I just don't have the patience for male doctors. Maybe it's partly my age. But, so I guess they accidentally referred me to this male doctor. And then he such a jackass and was so condescending. And he also said to me that, basically, I was gonna be on this hypertension medication for the rest of my life, and he wanted to put me on two other medications. Just this is in fifteen minutes of seeing him for my appointment. And I said to him, you know, I'm fifty three. I'm in, like, perimenopause menopause, and I've read in doctor Jen Gunter's book that sometimes hypertension can be a, like, a menopause thing and that once you're finished menopause, your hypertension kinda disappears. And he said, I don't know who doctor Jen Gunter is, and I know nothing about hypertension in women. All I know is that you're gonna have a heart attack within ten years if you don't take this medication is what he said to me. And I canceled the rest of my appointments with him because it's like and and so it's it's like I feel like in in situations like this or opportunities like this where we're kind of learning and just understanding that that medicine for women shouldn't be only when there's a problem. You know, I'd love this, this idea of we get referred to seeing a pelvic floor specialist. You know? Even probably if you're thinking about having children, I would guess it's probably a good opportunity for someone to see you even to get the baseline before you're pregnant. Speaker 1
Absolutely. Actually, I'll go one better. Actually, because so many of our patients will say to us, why did nobody tell me? Like, why did I not know about this? Something as simple as good bladder habits. Right? As simple as, you know, if you think back to when you were a child and you were gonna leave the house and your mother would say to you go to the toilet and you go, no. I don't need to pee. And your mother says, yeah. But I don't feel like taking you when you go out, so just go now. And that starts to set up, like, bad bladder habits, which is going to the toilet when you don't need to pee. Right? So you should only pee when you have the urge, but something as simple as that. So Monica, who's my business partner, and myself, we've started going into the schools in Singapore, and we talk to anywhere between the fifteen to seventeen year olds, the boys and the girls. And we are educating them on good bladder habits, on good bowel habits, what is your pelvic floor, and for we're talking about periods as well because it takes on average about seven years for a girl to be diagnosed with endometriosis. And so we're talking about, like, what's normal in terms of pain and not. So we are trying to get in there as early as possible. And I know a lot of them sit there and they giggle, and they think it's funny. You know, we put up the poo charts, and it's all so funny. But for those kids who are having issues, they're gonna take away something from that. And that's that's gonna make a difference, because we're really trying to change the dialogue. And because I totally agree with you is that we shouldn't be only looking for help when we've got a problem. We should be taking control of our bodies way earlier. Speaker 0
Yeah. Amazing. So much great information. So there there is help for us. We could maybe go back to our trampoline days. Speaker 1
Yeah. Look. I you know, it's never too late to get help. Never. I think, look, trampolining is tough, for pelvic floor. It's it's probably one of the things that is difficult to get back to completely, but we can manage it. If you try to trampoline in a slight forward lean position, like as if you were in a ski jump position as opposed to throwing yourself back, you potentially gonna have less leaking. Because in that forward lean position, your pelvic floor can activate much better, much more effectively than if you're leaning back. But if you like, if you came back to see me, Andrea, and you said to me tomorrow, my goal is to go to a trampoline park. That is what I want to do. That is exactly what we would work towards. Right? I would never say to you, no. It's not possible. And, also, there are devices that can go inside the vagina, and they help to give support to the urethra, which is the tube where the urine comes out, and the bladder neck. And, actually so some women listening to this, they might say, just think about it. When you wear a tampon, do you have less leaking than when you're wearing a tampon than not? Because a tampon can provide provide a little bit of support to the urethra and the bladder neck. And you get these devices that are designed to go inside vagina and give that support. And for some women, they have zero leaking when they wear that. Now it's not a cure. Right? But it may allow you to go onto a trampoline without worrying about leaking. Speaker 0
So, and I'm sure this is, not a good thing to do, but I have had a couple of friends tell me that when they have something to do or they have exercise, they actually put in a tampon even though they don't have their period? Speaker 1
Look. It's it's not designed for that, and I do have patients who do a similar thing. But if they tell me they have figured it out themselves that it's working, I will direct them to the devices that are made out of silicone and designed especially for that purpose. I I use the tampon. I call it the tampon test. So I will do it in my clinic. We have a little trampoline, and I will get them to trampoline with and without a tampon. And we see if it makes a difference. So I know if the device is going to work or not. But, yes, women are incredible at figuring out ways around this. So if we can get support to that urethra and bladder neck and you know you're not gonna leak, you're gonna you'll everything's gonna be much better. You're gonna breathe better. We're gonna help to retrain that movement of the pelvic floor. So I would much rather do that than women are running or doing exercise, and they're bracing and actually doing it all incorrectly. And they're gonna it's it's not what we Speaker 0
want. I I I there's so much of this information that I'm, like, banking for myself. I'm like, okay. Note this. Note that. Tamara, if we can maybe just, like, circle back just to about the standing, what's the word I'm looking for? Exam. Yes. So for the standing exam. So so, again, what what what are you you're looking for prolapse. What exactly is prolapse? Speaker 1
Okay. So, I'm gonna show a little image, and I know some of your listeners won't be able to see this right now. Speaker 0
I'll post it. I'll post this on my Instagram account, like, yeah. So Speaker 1
Okay. So this is a sideways picture of the pelvis. So you've got your pubic bone in the front, and that's your coccyx or your tailbone at the back. Those are your pelvic floor muscles like a hammock that that go like that. That is the bladder with the urethra, the uterus with the vagina, and that's the rectum coming down to the anus. Now those organs, yes, they are supported by the pelvic floor underneath. But, actually, inside, we have what's called connective tissue or fascia, which is a really strong membranous structure that's actually holding those organs up, sometimes with pregnancy, sometimes with vaginal delivery, sometimes with chronic constipation. So every time we go to the toilet, we're washing and straining for twenty minutes. Sometimes women who have jobs that involve lots and lots of heavy lifting, like for nurses, like, thirty years ago when they used to do lots of heavy lifting. That connective tissue can either be stretched and sometimes it can can actually be damaged. And so, for example, if the connective tissue that's supporting the bladder is stretched or damaged, the bladder loses some of its support and it drops onto the vagina wall. Now the vagina is completely elastic. The vagina is not made out of concrete. It's completely elastic. Right? And so all that happens is the vagina molds into the shape of the bladder. And what women will notice is a lump or bulge coming out of the vagina. Now it's not actually the bladder that they can see. They can see the wall of the vagina, but the bladder's on top of it. Now there's nothing wrong with the bladder. Right? There's nothing wrong with it. It's just the support of it. Now we can have the prolapse of the bladder, the uterus, or the rectum, and you can have one, two, or three in combination. The definition of products actually changed in the last couple of years. It used to be very much based on what we saw. So if you went to your gynae and depending on where the organ was sitting, you would get given a stage, and you were told you've got products. And it's incredibly terrifying. If you go and Google products, doctor Google, you will think your life is over. You will think that is it. I can never run again. I can never lift my children or my grandchildren. That's it. I can't do anything. It's incredibly, incredibly scary. But the thing with prolapse is that it's all about symptoms. So I can see a woman where her front wall of the vagina is sitting outside of her the front wall of vagina is sitting outside of vagina, and she's not even aware that she's got it. Like, she cannot doesn't even know that it's there. She doesn't actually have a product because she's not aware of it. Right? Objectively, she does. Yes. Anatomically, she does. But really, she doesn't. But sometimes we get women where they've got very minor prognosis, and they're very aware of it. And it's often when we go through menopause and our estrogen drops off and our vaginas become dry. They become atrophic is what we call them, and everything becomes a lot more sensitive. And we get that in our postnatal woman as well because when we breastfeed, our estrogen levels are very low. We don't have periods. Estrogen levels are low, and our vaginas become very Right. Sensitive. So for example, if a woman comes to me and she's fairly early postnatal and I say so, and I can see there's some movement there, which is normal. Right? I will then see if she's symptomatic, but I also wanna know what exercise she wants to go back to doing. Because if she's just gonna go back to Pilates and yoga, which is great, but it's low impact, I'm less worried than if she says to me, I am going back to CrossFit at three months postnatal, and that is what I'm doing. Or my goal is to run a marathon in six months' time. So with those women, we I don't wanna stop them. I wanna and so what I can do is we can fit something called vaginal support pessary. So I'm showing these now. So there's different types. This is called a ring pessary with support, and it folds. This is called a gel horn pessary, and this is called a cube pessary. And we actually get loads and loads of different pessaries. These are made out of silicone. And these get, measured and fitted, and it goes inside your vagina. And I describe it as a sports bra for your organs. Right? So it goes in, and it just holds everything up. Now it doesn't sit like that. It sits at an angle. And now what's so funny is that my patients will see this, and they'll go, oh, that's huge. And I'll go, oh, this is a small one. This is a small one. So it sits at an angle. It sits behind the pubic bone like that, and it goes up inside the vagina. And you know what the amazing thing is? You can't feel it. And it's amazing. It can allow women to go back to doing all sorts of different things. It doesn't necessarily help leaking of urine. K? So there's different ones for leaking of urine. Speaker 0
So that's more like support for the prolapse? Speaker 1
This is support for the prolapse Okay. Which which is just fantastic. Speaker 0
And again, to to my listeners, sorry, I just wanna say to the listeners, I'm going to go go to the, the fuck you fifties, Instagram account because you can find I'll I'll have this video there. Sorry. Sorry. Speaker 1
And so what's amazing about these is that pessaries, traditionally, were only fitted by gynecologists, and they were only fitted in elderly postmenopausal woman who were no longer sexually active. So they weren't good surgical candidates. And it was put inside and they said, right, I'll see you in six months time. Leave it alone. Don't touch it. See you in six months. But that's not a good option for our younger patients. Right? Speaker 0
Yeah. Speaker 1
So it's been about maybe ten years now that we've started, teaching women how to manage them themselves. So we teach women how to insert it. They remove it. That means they can have sex when they want. They can use it. Some time my patients only use it for exercise. Put it in before they exercise and they take it out. And it's completely changed our options for women who have symptomatic products or are at high risk. And so high risk is also genetic. Right. So we always ask our patients any family history. So mother, sister, aunt, who have either incontinence or prolapse because what's coming up more strongly in the research is this genetic link. And it seems to be the type of collagen that we have. So we all have collagen, but we have these different types of collagen. And some of us have more type of a collagen that can stretch and come back, and some of us have more type of a collagen that kind of stretches, and then that's it. It can't come back. It can't go out. It's just done. So it seems to be quite genetic that. So if I have a patient who says to me, oh, my grandmother had prolapse. My mother had prolapse. I'm saying to her, look. I can't even if I can't see anything, I'm going we are going to treat you completely because we know that you've got this genetic plague. Speaker 0
Wow. That's really interesting. I didn't know that either. So I'm I'm curious too. When you were talking about, like, some women where when you exam them and you can see that they have, like, prolapse, but they don't notice it, would you still recommend that they treated them? Like, if they're not noticing it, you're like, okay. Or Speaker 1
No. It it depends. You know, one of the options when you look at the research for prolapse is watch and wait. Like, literally, that is one of the the treatment options. So it it doesn't mean that everybody's going to get worse necessarily. Right? So I think it depends. I mean, the reality is is that once your bladder is dropping beyond the entrance of the vagina, you're usually having some voiding dysfunction. So voiding is peeing. And then if it's the back wall that's dropping, so if it's the rectum, it's so interesting because my patients will say to me that they can't initiate a bowel motion very well or they don't feel fully empty because what happens is the rectum will drop onto the vagina. And so when the poo comes down and it's meant to come out the anus, instead, it gets stuck in this over here. I had a patient. She used to call it her holding bay. So the poo used to get stuck in her holding bay over there. So we actually teach these women to do what we call splinting. So they can either splint outside and lift, but actually more effective is a vaginal splinting where they put a thumb into their vagina and they push the rectum up before they poo to allow it to straighten out. And sometimes, when I do my my subject assessment, when I'm talking to them, when we're talking about pooing, they will say that they've have figured out that they actually have to do that in order to empty. And I know before I even look at them, they are they are going to have a posterior vaginal wall products. It used to be called a rectocele. Speaker 0
It's so crazy how women are so adaptable and, like, figuring things out, and it's also unfortunate. Speaker 1
Yeah. But they just do it. They they did they just end up doing it. And, and and nobody would have ever asked them that. Right? And they almost get, like, a little bit embarrassed. And then I'm like, well, you know, this is what we there's actually a device. It's called the FemiS that's been developed specifically for this. I describe it as a shoehorn for the vagina. And we we have some in the clinic. And I will take it out, and I'll show it to them. And I'll go, there are so many women who experiencing this that they have created something specifically for this. Right? So just to kinda say to them, you are not the only woman in the world that is having this. Right? Speaker 0
Yeah. I guess that that definitely is one thing one way to look at it is, like, when there's tools that are being developed for this, you are definitely not alone. No. You know? But, I mean, it's great. I I, I it's great that there's all this, like, technology and research and and, development out there. Speaker 1
It's it's a huge growing hugely growing area. It's it's it's amazing. It's actually I mean, to keep up with the research is quite something else at the moment. And when I first started in the field, I mean, we barely had anything. And now it's really taken off, which is just fantastic. And there's some really smart people doing some good research out there. Speaker 0
Who do you think, is there any kind of, like, one country or a couple countries where you're, like, they're the ones? Speaker 1
Australia is brilliant. They and they've got really strong pelvic health training, there. And they've got two options for your master's program in pelvic health physiotherapy. So there are almost every single physiotherapy clinic will have a pelvic health, physiotherapist working there, and you know they're going to be trained at a good level. Speaker 0
If someone is not available to to go to Singapore to see you and if they're looking for, like, a pelvic floor physio, I mean, I guess some of it would be referrals from their doctors, but, other countries don't have that opportunity. Like, what what would your recommendation would be aside from, like, looking at their resume? Like, how would you know that you're going to, a a good pelvic floor physio? Speaker 1
Look. Look. It's tricky. I mean, it is. It's looking at their sort of their bios. Look. They're definitely good, public health physios in Canada. Actually, one of our physios who used to work for us returned back to to Canada. So I know she is, She's in Toronto. She's in, Vancouver, but I can check for you. But she's great. And I know yeah. So she's there. And and I know she's working at a clinic where they've got, I think, multiple clinics. They do have definitely in the UK and America. The issue is is that it's much more spread out. So, you know, you remember how small Singapore is. It's so easy. Like, I'll get people traveling from the East Coast to come and see us, you know, Whereas I think in Canada, like, you're not really travel gonna travel these massive distances, right, to go and see somebody. There are different, sites where you can look up, like, who are trained pelvic floor physios. But I think it's often, like, if they've done that company's training. Speaker 0
Right. Speaker 1
Like, I'm on different international Facebook groups. So if I have patients who are moving overseas, I will often then do a search, and then I will look at the bios. And then I will kinda go, okay. This is somebody. Or I will I will ask on the forum and go, look. I've got a patient moving here. Does anyone recommend, Public Health Physio? Speaker 0
Not that hair is the same thing, but I was doing that too. And I would have clients leaving Singapore to another country, and they were, like, devastated about having to find a hairstylist. Again, not the same. I'm not comparing physio medical to, like, hair. But and then when I was leaving, I I was also looking at hairstylists in Singapore to recommend people to. It's a like, you get really attached to your your you know, client's patients. So and you wanna, you know, make sure that Speaker 1
they're Absolutely. Absolutely. And you want people to have, like, the best treatment. Right? And you want them to continue that care. Like, it's important. Speaker 0
I, I started seeing, a, menopause specialist doctor, and one of my clients from Singapore who's Australian who lives back in Australia. I had ranted I think it was about that hypertension doctor on my Facebook page. I ranted about my experience with him, and then she messaged me and said, you need to go and see a menopause, specialist. And I was like, it's hard to get them here. And, I mean, I know that there are menopause doctors that are available, but it's like a six month waiting list. But then I apparently, because because Canada is mainly public health. Right? But there's a little, like, private clinics that are popping up now, and menopause seems to be one of them, which I find kind of interesting. But that's what the government is choosing that we should pay for, which, again, is fine. I'm happy to pay for it. Anyway, sorry. This is a long way of getting to, so I I had this this appointment with this, menopause doctor, and I was telling her about you and and, and your clinic. And she just thought it was not only fantastic that you have this, but also love the name Physio down under. Right? Which you could easily easily franchise as well. Right? Because not only because you're you're Australian. Right, Tamara? Speaker 1
I'm actually South African, but I I lived in Australia, and my children were born in Australia. Yeah. Speaker 0
But it has it has so many meanings. Like, it can be Australia, but it's also can be. Speaker 1
I know. Exactly. Speaker 0
Amazing. Thank you so much. I feel like we're is there anything else that you wanna I know that that you did like, you wanted to kind of express to you that there's no time limit to, pelvic floor physio, that anytime is a good time. Speaker 1
Absolutely not. Anytime is a good time. It's never too late. Yeah. As a actually, often, the treating the elderly woman is actually just so rewarding because they actually just do so well because no one's ever showed in them any of this before. And they take it on board, and they've got more time in their lives often, and they can they can do it. Often with the, you know, the postnatal woman, it's tough. You know? They've got the babies, and they're learning to breastfeed and, you know, makes their tongue tie. And it's difficult to do all the stuff we ask them to do. Speaker 0
Yeah. Speaker 1
And, I always say to my patients when they tell me something or, like, I've seen it all. I've heard it all. Like, there's really nothing. I go, please try shock me. Please. Like, I'll just just go ahead. Speaker 0
What's the what's the eldest, age of of a patient you've had? Speaker 1
I've probably had someone in their late eighties. It's probably yeah. We don't look in Singapore, it's we don't get a lot. It's it's more I would say, we're seeing more between sort of thirty and sixty is probably the Yeah. The probably the age group that we're seeing the most. Speaker 0
But I think clientele, would you say it's mainly expat? So do Speaker 1
you get Changing. So when we started the clinic, it was definitely the majority of expats, because the locals didn't know that it even existed. And now it's changing. Local women are no longer accepting that the only option is surgery or that they have to live with it because that's what they used to get told, and they're seeking help. And so I would say we're now almost forty percent local, sixty percent expat. The other tricky thing is with insurance because the expats all have medical insurance, whereas the locals don't often. And so then it gets a bit pricey. So but yeah. But we're definitely getting more and more local women. Also within the clinic, we have two physios now who are doing men's pelvic health. So men have pelvic floor, and so they, those two physios are treating men. And the number one is doing pediatric, public health. So, I mean, obviously, we're not doing any internal exams with those with kids. Speaker 0
Yeah. Yeah. Speaker 1
Yeah. Of course. Also looking at that. Remember I mentioned that kids can have and fecal. Speaker 0
Yeah. I I was surprised about that too when, when I was doing research to kind of, like, look up questions of things that I could ask you, and it talked about children's, pelvic floor physio. And I honestly thought, does it have to do with, like, lack of exercise? Because kids aren't really getting out and running around anymore. And then so when you were talking about it earlier and saying how it's, like, gymnasts, ballet dancers, like, all these, like, high impact, you know. And I was like, oh, here I thought they were just the lazy kids playing video games. Speaker 1
No. But look. The the the little ones who are having problems is actually usually mainly related to constipation because the the distance in the a kid's body between the rectum and the bladder is much smaller because they're much smaller. So if they have a loaded rectum that's very full, that puts pressure on the bladder. And so then they start to have issues. So it's often bowel related with the the little ones. Yeah. Speaker 0
I I remember, like, Zoe, I still hate that I'm gonna go to this, but when she was when she was a baby, so it's fine. When she was born, she was born with a problem with her urethra, and it, there was one muscle that wasn't pulsating. So the urine would get trapped. And, she we discovered this when she was seven weeks old. She was diagnosed with, like, a she had a, like, a kidney infection. It was awful. It was a nightmare. Surprising to get through it. Like, I still tell the story, and I get all teary. You know? But then she so she was on medication for two years, and they were trying to decide if they were gonna do surgery or not. And I remember sometimes she would get so constipated where it we'd be hitting almost, like, the two week mark, and I'd be on the phone with her pediatrician saying, like like, I like, we need to do something. Like, this is, like, crazy. Speaker 1
Very stressful with that sort of thing. Very stressful. Yeah. Speaker 0
And, thankfully, she she grew out of it, and then just one day, the muscle just started pulsating. Speaker 1
Oh, amazing. Speaker 0
Amazing. Well, Tamara, thank you so much. I really appreciate your time. I know it's late for you in Singapore. Wait. Well, maybe if you're open, we can have you back another time. And, Cool. Speaker 1
I can talk for hours. Speaker 0
Yes. Me too. Thanks for tuning in to the fuck you fifties. If you enjoyed this episode, please take a moment to follow and rate the podcast. And we'd love to connect with you on Instagram, so be sure to follow us at the fuck you fifties. The fuck you fifties is hosted by Andrea Clare and edited and produced by Bespoke Productions Hub. See you next time. 
