Meant to Move Episode #21
Summary
In this insightful conversation, physiotherapist Nicola Andreacchio joins Vanessa Leone to discuss the often-overlooked world of pelvic health. Nicola shares her unexpected journey into pelvic floor physiotherapy and highlights the crucial role it plays in both male and female health. From taboo topics like erectile dysfunction and painful sex to broader issues such as endometriosis, prolapse, and hernias, they explore the physical and emotional implications of pelvic dysfunction. Emphasizing empathy, education, and the importance of listening to one’s body, Nicola advocates for de-stigmatizing these discussions and prioritizing preventative care to improve quality of life across the lifespan.
Transcript:
Vanessa Leone (00:01)
Hello Nicola, so nice to have you. Welcome to Meant to Move.
Nicola (00:05)
Thank you. Thank you so much for having me.
Vanessa Leone (00:09)
For anyone listening, I met Nicola on a hypermobility course. So shout out to anyone who’s listening in the hypermobile circles. This is why we do extra training humans to meet excellent and other wonderful humans. And today we wanna, I want to use as many random uncomfortable words that are gonna make people squeamish.
But we’re going to talk about, yeah, we’re going to talk about pelvic floor. And so I think a really good place to start is Nicola, like what’s a pelvic floor?
Nicola (00:39)
That’s my forte.
Pelvic floor. Okay, so number one thing, everyone has a pelvic floor. So the pelvic floor is just a group of muscles that sit in the bottom of your pelvis. That’s as simple as I can keep it. Yeah.
Vanessa Leone (01:03)
That’s a pretty easy description.
I don’t even want to call it embarrassing, I just think people don’t want to talk about it because of where it sits, right?
Nicola (01:15)
100 % and there’s a lot of taboo about what happens in the pelvis too. And like it’s not my words, but it’s dirty. Like we’re talking poo and wee here. We’re also talking things about sex and that often is a very big taboo subject. So it’s just a kind of, we know it happens, but let’s just not talk about it to make other people uncomfortable.
Vanessa Leone (01:28)
Mm-hmm.
Yeah, my regular guest on here, my mentor OD he calls the pelvis, it’s got like many different functions, he calls it like the pleasure centre, like the pleasure and play centre slash the emotional warehouse slash the crossroads of the body slash the baby making, you know, so like all of that reproductive function as well. When we start to
delve into it? What kind of drew you to bring this area of expertise for yourself?
Nicola (02:11)
The honest truth is it was such a coincidence. Like I remember back in uni we had like a very general introduction to the pelvic floor and I still remember thinking, I’m not even, no offence, I’m not really going to pay attention to this because this isn’t an area that I see myself going down. In my head I was going to be like a sports physio.
not being a sporty person myself. It’s just, I’m a human body nerd. And that for me just, you know, it was what I wanted to do. And then flash forward a few years, was truthfully just feeling a little bit, what’s the word, not satisfied. I wasn’t getting that work satisfaction that I knew I could get. And I was also getting a little bit bored. I just, it wasn’t what I imagined.
And then I went off and did a course because at our clinic we didn’t necessarily offer a lot of pregnancy support. So I knew of this course and it was about to wrap up and I thought, why not? It will give me a little edge. And my world absolutely blew open. I met my now business partner there and I also got a lot of answers for myself.
So I had been living my own little journey in silence and that was really challenging. And I really got to a place where I had disconnected with my own body and it was genuinely through recognizing what pelvic health is and what this space can bring about. Yeah, the stars align and I never looked back. So I accidentally fell into it and it has given me so far everything that I wanted in.
in that career satisfaction space. uses this side of my brain, it uses that side of my brain. So yeah, that’s how I ended up here.
Vanessa Leone (04:05)
Mm.
That’s incredible, super interesting and I find it fascinating. I came from the sports world as well. I like, yeah, I’m going to work in sports. Sports is where it’s at. No, it’s not. Humans, it’s not.
Nicola (04:21)
No, it’s really not.
It’s really not for multiple reasons and enduring on like my strengths as well. I’m a very like compassionate and empathetic person and it’s just a different world. It’s a different world. So this world that I’m in now is very much more aligned to me.
Vanessa Leone (04:34)
Yeah, and I’m glad that you brought up the compassion and empathetic side of it, because out of all of the physios that I’ve ever seen ever, pelvic health physios are easily the loveliest in terms of like their demeanour, their bedside manner, the way that they interact with clients who are in pain, who… And I think it has to do with the nature of the issues that you’re talking about, right? So let’s perhaps…
split the waters a little bit here because I think this is where men go, I know I have a pelvic floor, but I don’t really need it. Like mine’s sweet. I’m totally fine. So before the men tap out, let’s start there and go, okay, fellas and ladies with a fella or you know, whoever. What do you see that, you know, men typically have common issues with and what do you think is something that’s hidden for men that is really common?
Nicola (05:44)
Yeah, so the number one for men to draw their attention is erectile dysfunction. So anything that goes on with your penis that’s usually will get a man’s attention. And that can usually be a bit of an instigator that something’s going wrong here because there’s just such a sense of identity with your erection. For some, it’s what makes me a man. It had this so much to it. So usually other things have gone on in the background.
But as soon as erections change or there’s premature ejaculation or even pain, pain with an erection, pain during sex, pain with orgasm, that’s usually when someone would end up in front of me. And then the second one to that, they’re kind of interconnected. So I’m going to say I’ve got the population of the younger man and that’s usually where he’s having difficulty in the erectile department.
But then the other end of life, it’s your prostate health. And having someone had their prostate removed and now suddenly they’re incontinent and they can’t get an erection as well, they’re the two male cohorts that I would mostly see. And they’re big ones, they’re heavy. Yeah.
Vanessa Leone (07:00)
They’re heavy, yeah. And look, I think I felt myself, we all take this giggle or this little laugh at like, know, men talk about it and they’re like, But it’s not like as a female, we would get so angry if a guy started belittling all of our problems and we’ve come so far in talking about that. But I don’t think that we’ve come that far going the other way around. Right.
Nicola (07:25)
I agree you on that one. Yeah, there’s still such a, there’s such a difficulty in just opening up. It’s vulnerable to share these things with another human. It’s a really tough thing to do. And I see that and I respect it. And that’s where you mentioned in this industry. Yeah, there is a lot of compassion and empathy. There’s a lot of warmth and it’s needed because people are exposing some really intimate details
about themselves and unfortunately we live in a world with a lot of judgment so I’m going to live with this for as long as I can until it’s now starting to affect my core and I need to know that you can hear that and that you won’t get uncomfortable about it and that you’re in a position to help me with what you can and I think it does take longer for most men to get to that point.
Vanessa Leone (08:03)
Yeah. wholeheartedly agree with that. I think that this was, I mean, I’ve experienced pelvic health stuff, which we can go into later, but I think this side of it, when I was thinking about what to ask you today, this came up for me in a really big way because out of all of the male clients that I’ve worked with, especially that male-female interaction, sometimes it’s a little bit easier to talk to us.
but sometimes it’s not, right? And vice versa. And I think it’s so important for everyone to be able to have someone, people, you know, to be able to talk about this kind of stuff. Or even if they’re just listening and they go, okay, this is okay. Or maybe I made a joke about a mate and I wasn’t being very like sensitive or authentic. It’s okay. Like we all learn but perhaps we can change what’s happening.
Nicola (09:10)
Yeah. Yeah. Yeah. And half the time, think it’s also just, I’ve said this, but I’m watching your response because your response is going to dictate how the rest of this conversation is going to go. And there’s been a handful of times where when you first meet someone like I’m asking you to sit in front of me and pour out some really heavy things. And sometimes, and I know I’m aware of it. I know it’s happening. We can beat around the bush.
And then I would just ask a very direct question and I can almost see that sense of startle that, did you, did you just ask me about that? Like, we allowed to talk about that? And then all of a sudden Pandora’s box can just open and it’s almost, you see that veil go away and this almost sigh of relief that finally I’m somewhere where I can be heard, where I can be validated and that we can come up with a plan together. You’re here to help me. And
That’s a really special moment to be part of for someone.
Vanessa Leone (10:21)
And it’s so important in an allied health relationship because regardless of the type of pain or dysfunctional problem or whatever, it can be a hard conversation whether it’s in your shoulder or whether it’s in your junk. And it’s really important to hold space for everyone because at the end of the day, I know…
that I’ve had clients come in who have a back problem, who have a knee problem. And I’m like, that’s not a back or any problem. That’s a pelvic problem. That’s a pelvic problem. And to try to like steer them into that direction even is quite challenging sometimes.
Nicola (10:56)
Yeah, and we’re fortunate because we have the understanding of how one can impact the other. And I’m constantly reminding myself of that, that I am lucky to have that degree of knowledge because having to explain to someone or help them understand that, okay, you’re talking about back pain, but I actually might think that this is a pelvic floor related thing. And they’re like, I’m not wetting myself. Nothing’s wrong with me. Like that takes a lot.
So when you can sometimes you have to do it over several sessions, but then when you when someone then sees the value of it, but also someone sees the they understand that A plus B can equal C. That can just be you can get on top of things that they’ve lived with for years. And that is like, I didn’t think that that would affect that. But yeah, it all makes sense. The pelvis, I call it like the little it’s like a little mecca. It’s a little hub.
and it affects things up, it affects things down, affects things out to the side, it just it talks to everything.
Vanessa Leone (12:13)
Could you maybe go into a little bit more detail for someone listening who hasn’t heard something like that before? how is it a hub? How is it a connector?
Nicola (12:20)
Yeah.
So the pelvis, number one, it’s where we bear our weight. So it’s connected to your upper body, to your trunk. It’s connecting to muscles of your core, and I will always refer to the core as your foundation. If your foundation is not strong, then things coming off it can be a little bit wonky, and that really comes into effect with people who’ve had chronic pain or people who’ve been pregnant or whatever it might be. It’s the connection to your legs. Your pelvis absorbs shock.
There’s so many things and when it comes to the pelvic floor, we hold a lot of tension in our pelvic floor that I will look at, you know, when your body’s in a state of panic, fight or flight, fear, what do I do? I protect, I’m protecting my vital organs. This is a survival thing. My reproductive organs are in my pelvic floor. My intestinal organs are in my abdomen, which abdominally talks to your pelvic floor as well.
I hold a lot of tension around here. I hold a lot of emotion around here. There is so much going on around your pelvis that we can really just not acknowledge. And it’s not because I don’t want to, but
it’s just it is what it is. We’re not necessarily given those skills. So because the pelvis talks to so many areas of your body, can, dysfunction can present in multiple ways and often can present in the pelvic floor.
when the origin is so much further away physically or also emotionally and mentally as well.
Vanessa Leone (14:00)
beautiful explanation. Thank you. That’s great.
Nicola (14:01)
Thank you. I’m a little bit word vomit. I was pretty happy with that one too. For anyone, anyone who knows me knows that I like to talk and that I can just get into this like verbal dump and we’re both going on the adventure because I don’t know what’s coming out next either. Yeah. Yeah. Yeah.
Vanessa Leone (14:05)
No, it was a good one. It was a good one.
like this. This is going to be very happy journey today.
Okay, so we’ve touched on some men issues and I would say some very challenging men issues. This isn’t just like, you know, I sprained my adductor. This is like, this is challenging heavy men stuff. So men, we see you and thank you for listening. Very important that you’re aware of this. Talk to your mates about it. It’s important. Next up.
I think the ladies ones maybe get a little bit more airtime, but maybe still not as much as I think. What do you think?
Nicola (14:46)
I would agree. No, I would agree with that. I think when it comes to pregnancy and when it comes to after pregnancy, that is, I’d probably say more spoken about. It was called like women’s health physio, referred to pregnancy physio, women’s health physio for a long time. And I think a lot of people have only really acknowledged the pregnancy side of things, but it’s so much more than that. You don’t need to have experience to pregnancy.
or given birth to need to see a pelvic floor. Essentially, if you’ve got a bladder, if you’ve got a bowel, if you have a vagina or a penis, you can come to a pelvic floor physio because that’s usually where the dysfunction lies. And now we’re entering a time where thankfully more and more people are knowing the role of a pelvic physio and where we can come into play. So when it does come to things like endometriosis, adenomyosis, PCOS, dysmenorrhea,
menopause, really big one too, that are not getting a lot of air time at the moment but I think that that is increasing. More and more people will learn about what we do so therefore won’t have to just suck it up soldier on and accept that this will be the rest of my life because more often than not there we might not be able to fix everything to 100 % but I’m pretty bloody stubborn and I will do everything I can to get you to a better place than what you are now.
Vanessa Leone (16:03)
For sure.
Mm, yeah, that’s you listed off a whole bunch of issues, you know, that are so important. And I look at the kind of levels and the journeys that I’ve had with Pelvic floor and I’ll share my experience because I think sometimes it helps people. And so, first started in my relationship with my partner, you’ll hear him on here. And essentially, was just, sex was getting really painful. Like,
so painful to the point where I would tear, which is never a great time. And I would get consistent like UTI, consistent infection, bacterial and you go to the GP and the GP just gives you here’s your anti antibacterial. What’s the word I’m looking for? That’s the one same, same, but different.
Nicola (16:52)
No, it’s not.
Antibiotics. Yeah, Same, same, but different really. Yeah.
Vanessa Leone (17:14)
your antibiotic, you know, you go to the pharmacy and they’ll hear, here’s your cream or blah, blah. And they just kind of like, off you go. But when it becomes recurring, they don’t actually ask, they don’t actually ask anything. They don’t ask any questions. And you feel like you have to go and do your own investigation. And like you said, it’s a sensitive subject when you’re talking about things like sex, when you’re talking about what’s happening down there for someone. And it wasn’t comfortable.
Like it was not comfortable and that can really change a dynamic in a relationship, any type of relationship, right? And luckily enough, Michael was so patient. He asks all the right questions. Like, you know, what can I do to help? Like what’s going on? What’s happening? So eventually I figured out, I was like, I’m pretty sure I need to go see a pelvic health physio. I don’t know how I came to that conclusion, but I, but I did. And honestly, it was like life changing.
was the single most painful physio appointment I’ve ever had. But essentially, especially for a lot of fitness professionals, Pilates instructors, yoga instructors, people who are super sporty athletes, we don’t suffer from a pelvic floor that’s kind of lazy. Ours is like overdrive. Yeah, it’s overdrive. Mine was just like a…
Nicola (18:17)
I don’t doubt that. Don’t doubt that.
We’re the polar opposite.
Vanessa Leone (18:41)
so on, so, so I don’t want to, I don’t like using the word tight, but it was very restrictive. Overactive is the word. Thank you. No, no, no, no, no good. No good. And so this overactive-ness, so uncomfortable when it was releasing, when that, when that overactivity started to relax, like pain down my hips all of a sudden.
Nicola (18:46)
Overactive. That’s the term we use, overactive, because I agree tight. I don’t like tight either. There’s too much of a sexual connotation on tight. Yeah.
Vanessa Leone (19:08)
went away. Like my back was moving better. Like every, I could breathe deeper.
Nicola (19:11)
Yep. It’s amazing, isn’t
it? It’s amazing.
Vanessa Leone (19:16)
And then, you know, goodbye chronic tearing and infections and things like that, because that’s not an issue when you’re literally not tearing on the inside. And like that’s, that’s, that doesn’t happen anymore. That’s just a non-issue anymore. I, but that’s really common in young women.
Nicola (19:36)
so, so, so common and it’s really sad and like you, I’ve also been on the other side and my way into pelvic health was because I was also having pain with sex and I would bleed after sex and you touched on the impact that it can have on a relationship but also the relationship you have with yourself because, you know, for some people, the intimate aspect of being in a relationship is not important. Relationships are different for everyone.
For some people it is important and to not be able to connect with your person in that way, I don’t know about you, but for me, I really started hating myself and my body because my body’s not working. It’s my fault. I’m doing something wrong. And to then go and try and get answers and not get answers and then just go, well, this is going to be it. Like this, this is going to be my forever. That’s a pretty dark hole to enter.
Vanessa Leone (20:32)
It is.
Nicola (20:33)
But then when you are in front of the right person and you get the right information and like what you said, when one thing falls into place and you iron out some tension here, again, the pelvis is a hub. And when you think about it, if you’ve got this constant pull of tension in your hub, it’s going to traction on other things as well and something else is going to have to move differently. So then when you release that, everything else can just move a little freer.
Vanessa Leone (20:53)
Mm-hmm. Yep.
Mm-hmm. Yeah, 100%. And it’s such a great description of it. And I think that a lot of people don’t really understand is that we’re just a, like we’re a tension or fabric, you know? And so if one part has too much, it’s everywhere else is affected. It’s so smart.
Nicola (21:03)
Mm.
body so smart. It will always
try and do like what it’s meant to and right by you. Sometimes it can just go a bit skewwhiff. Yeah.
Vanessa Leone (21:26)
Yes.
No, and then I’ll continue. that, you know, that was maybe like, I’ll call it nine years ago. And so fast forward to the back end of last year, right before my endometriosis surgery. Now, interestingly enough, I didn’t put it into my head to go get physio treatment for endo, but I would, I had continued my pelvic floor relaxation.
All of, all of the things that I had been taught by my pelvic floor physio and took it away. It was so interesting. It was like a night and day experience for me getting surgery. I went to see the physio before surgery just to, you know, get a baseline, see what was going on, understand what was happening. I saw my physio, six weeks post and I was so like, I had a lot of pain post surgery, just healing pain really, but it was, it was quite full on.
But the scars healed well, it moving well. And then all of a sudden there’s no pain during a period or before a period or, you know, and that’s a whole other thing. And I was getting quite a lot of referral left, deep hip pain, just like for about a year really. And never enough to affect my movement, but just, it was just there.
And it’s just not there anymore. Do you know what I mean? And I think again, same things, women, particularly suffering from, you know, endo or all of these kinds of conditions. It’s amazing what we can put up with. And then when it’s gone, like that left hip moves so differently. I’m actually booked in to see, because you’re too far away, Nicola.
Nicola (23:16)
100%.
Yeah, sorry. Sorry. Yeah, great.
Vanessa Leone (23:25)
But I’m booked in to see a pelvic physio. And
because I like, I know now like when, when the inside there is just, you know, I’ve put too much tension in for me to be able to get to it, to release it myself. I just need a little bit of help now. And, that’s really the relationship that I have with the pelvic floor physio now. And it’s so liberating. It’s like you get a massage everywhere else on your body, right?
Nicola (23:54)
Exactly, it’s still skeletal muscle. You just can’t see it.
Vanessa Leone (23:58)
Yeah, yeah. Have you, in terms of endo and adenomyosis, what’s your experience in treating those kinds of conditions?
Nicola (24:07)
So I think at the moment, because my list does fluctuate a bit, at the moment, I reckon pain would still probably be the number one patient that I treat. So I treat a lot of patients with pain, a lot with endo having been diagnosed or not diagnosed yet, having had laps or not quite yet or wanting to put them off. I treat a lot of pain and it…
What you touched on before about those suffering with chronic pain, chronic pelvic pain, you put up with a lot. And I think a lot of people almost wear it as a coat of armour that, you know, I’ve got such a high pain tolerance and I like have a rule when you come into the room. I don’t want you to have a high pain tolerance. I actually need you to tell me what you’re feeling because having a high pain tolerance is an adaption strategy. It’s a survival thing.
and we need to like recalibrate your body on expectations of pain. So I do a lot of work with my pain patients just about. To me, I will always explain that I’m just trying to reconnect you with your body because over a long period of time, we’ve disconnected from it. And again, that’s just been survival. It’s too hard basket. This is just causing me a problem.
So I can’t take away the endo if there is endo there, I can’t take away scar tissue, but we can just try and calm down your nervous system, your muscular system to just give you a better experience. Even if we take it down a notch or two. And like you said, I really love it that you have now learnt about your body, because this is all the learning as well. You’re learning the signs of when this has now gone beyond what I can do for myself.
now I need to bring in my extra reinforcements and that’s how I see me. So I only want to be here when you need me. I want to get you to a space where you can take most of the control here. But then if you need me, you know you can come back and we might just need to release here because like you said, it’s just gotten a little bit too tight for you to reach. So in short, I do a lot of pain. Yeah.
Vanessa Leone (26:05)
Yeah, and I think for me I find it so fascinating.
So if someone’s taken an appendix out, or something internally from guts or internal organs, pregnancy, they’ve had sacs of fluid, or sacs of endo removed, what we don’t realise is when we have these growths inside our body, they have to go somewhere. They push on muscles, they push on other organs, and…
What you said before was like, it’s a, it’s a, it’s a, a pressure box as well. Right. So if you might not have even had a muscular problem, you could be having an organ problem, but have it present as a muscular problem in your back or in your hip. Is that correct?
Nicola (27:12)
Yeah. So like you said, we only have X amount of space inside of us as well. So when we do have growths and lesions that also does have to go somewhere. But then what can happen as well is you’ve got nerves, your nervous system, you can start getting referral elsewhere when those nerves get angry, then your muscles are coming in to defend. So they’re getting tight too. And that’s where everything in the system can now just become really angry and wound up.
So what started here and this might actually be where the problem started or these were the lesions were, everything else has just now come to the party as well. So it’s all, there’s a lot of, how do I say it? like a, it’s a problem to solve. It’s like I’m trying to crack, all right, so if we focus here, what’s this one going to talk to? And if you’re getting the pain where they’re, where can this actually be coming from? A lot of detective work in it.
Vanessa Leone (27:43)
That’s the interesting part, I suppose. Yeah.
Nicola (28:10)
It really is. Yeah, it really, I think it is. taking the emotion out of the situation, I think it’s a really just fascinating thing to work with is the body and just how it functions.
Vanessa Leone (28:17)
I would agree with that. Okay.
I’ve got some interesting populations for humans. I have had quite a few clients with a hernia. Now some people, again, I think hernia is quite misunderstood and I don’t love how people talk about it. It’s just, I think…
Nicola (28:31)
Yep.
Mmm.
Mmm.
What have you heard?
Vanessa Leone (28:50)
I think that a lot of people don’t think that it’s such a bad thing. And to me, it’s kind of terrifying, right? In my mind, I would love for you to explain it so that people get an understanding. And maybe then they’ll understand my terror and see how we go.
Nicola (28:57)
Yeah, yeah, And I’m curious, is this for you? So have you had majority of men or women come with a hernia? Men? Yeah, yeah. So look, I wouldn’t want to hernia. Very painful. And essentially, you’ve just had you’ve had I say just as if I’m talking it down, like with a hernia, you’ve had connective tissue that has like torn, and then you got a little hole, and something’s gone through that. So it can be like,
Vanessa Leone (29:15)
Men.
Nicola (29:39)
Sometimes intestine can get stuck within a hernia and like that can be a medical emergency because if you’ve got this organ being constricted that can lose blood supply and become necrotic and then you can become very sick. So some hernias aren’t severe enough to need surgery tomorrow. It is something that we need to be mindful of because certain practices, the way we move, the way we lift can make them worse if I’m not controlling around my core.
It can make them come back again. Some people are genetically predisposed to hernias because their connective tissue is not as tolerating of stretch and load put on it. So it might be a little bit more easily torn. And to me, they’re usually those people who’ve had one on either side or they’ve had to have multiple repaired. But yeah, essentially like a hernia is you’ve got to hold them, something’s fallen through it and for men it’s usually within the groin. Yeah.
Vanessa Leone (30:18)
Yeah.
And it’s like, is it usually a connective tissue issue or is it usually like an internal kind of tension which like… Okay, let’s…
Nicola (30:44)
I’m going to say more so connective tissue, connective tissue, but you’ve done something generating enough force to potentially just. Yep. Yep. Yeah.
Vanessa Leone (30:53)
tear and push something through.
Everyone, I hope you realize my terror now. You don’t want things poking through where they’re not meant to.
Nicola (31:01)
No you don’t and if you do think you have a hernia just get it checked out please. Like I said it might not be to the extent that you need something done at the moment but it certainly needs to be like acknowledged and monitored because they can turn.
Vanessa Leone (31:14)
Mm-hmm.
Yeah. I think the part that is really interesting to me about hernia, and I say interesting, again, that’s not an emotional side of it. It’s like very hard emotionally to deal with any kinds of pain. I’m talking purely scientific body information here, but a hernia happens outside of the usual holes. Whereas a prolapse is similar to a hernia in a way, isn’t it? Yeah.
And so could you describe a prolapse for someone who doesn’t know what that is?
Nicola (31:51)
So we will, I’m assuming we’re gonna talk specifically about like a vaginal prolapse, because you can also get other prolapses too. But we’ll talk, yeah, we’ll talk about vaginal prolapse. So vaginal prolapse is where you have had, again, connective tissue. We are full of connective tissue and connective tissue is like an elastic band. If you stretch it so far, you can lose some of that elasticity and it sits lower. And that is where…
Vanessa Leone (31:58)
Yep. We’ll start there.
Nicola (32:19)
So there’s three types of prolapses when we talk about vaginal. Think of your vagina as having a front, a back, and a roof. And a prolapse can occur where any or all of those three have dropped down. And for some people, that can actually mean that they have vaginal tissue coming outside of their vagina.
Vanessa Leone (32:26)
Mm, yeah, yeah. And that’s, you know, it’s common enough in pregnancy, but it’s not limited to pregnancy.
Nicola (32:41)
No.
So about one in three or one in four women will experience prolapse symptoms at some point in their life. And that is huge. So it’s, it is, and it’s this thing that it, it, it’s really unfortunate that we don’t talk about it a lot more because I felt like if we lived in a world and look, we’re getting better, but if we were a little bit more comfortable talking about this, we would realize that there are so many people around us going through a shared experience and
Vanessa Leone (32:55)
That’s so big.
Nicola (33:15)
It’s not just me, because this can be so isolating and lonely. So it’s huge. And outside of pregnancy, particularly childbirth, vaginal deliveries, things like chronic constipation. If I’ve been straining, straining, straining, think of that connective tissue again. If there’s enough load put on it, yeah, I can prolapse. And particularly for like constipation, I also develop like a rectal prolapse where the lining of the rectum comes out of the anus.
What else have we got? We’ve got like repetitive like really heavy lifting and I’d argue maybe with not great technique We’ve got people who’ve got chronic respiratory conditions Lots of coughing cough cough cough cough cough and again, that’s a big load put on your pelvic connective tissue and over a lifetime of several decades that can be enough to just, so straw that broke the camel’s back and now my my body cannot tolerate that load anymore
And hormones play a big role as well. when we look at in the menopause, perimenopause space where estrogen is such an influencing factor in our body and it actually has an influence on our connective tissue and our collagen make-ups. So when my estrogen levels are lower, which is often menopause, perimenopause, and also postpartum if someone’s breastfeeding, this can be a time where you’re
tissue might actually be a little bit less tolerating of what you’re asking it to do. And that’s not to generate fear. That’s just to generate awareness because I might actually need to take into consideration what I’m doing. Yeah.
Vanessa Leone (34:47)
Yeah, I think you brought up a great point there about like, lifting community and all just people who are very active because that’s a side of it that I see and I’ve coached a lot of coaches and…
you know, I hurt my back lifting or I did that. And again, trying to push people down the direction or not push, should say, try to steer them in the direction of have you looked at your pelvic floor? Do you understand what’s happening there? You’re doing a lot of heavy lifting, you’re bracing, you’re holding your breath, you’re bracing, you’re picking up a heavy load. That’s a pressure build up. There’s lots of connective tissue.
activation, there’s lots muscular activation, there’s lots of things that going on there that contribute, that can contribute to your overall pain and performance as well, right?
Nicola (35:43)
Yeah, yeah, hell yeah. And again, your pelvic floor is part of your core. And I need everything to be working at close to optimal to get the best result. But often what can happen is if I’ve, for whatever reason, and it’s usually one of being unaware, if one of those parts in that system is not up to scratch, and that often is the pelvic floor in certain populations, then
my core might not be as strong as it needs to be, so then I’m compensating in other ways and yes, my back is overloading and things like that. So it really does pay to just be aware of it.
Vanessa Leone (36:24)
Yeah, no, that’s great. Here’s an interesting one. How does a pelvic physio describe or kind of define the core?
Nicola (36:33)
The core. So to me I’m very anatomical. The core is it includes your pelvic floor, your six-pack muscles, your diaphragm, your obliques and your back. This is my foundation and if my foundation is not talking together, talking to each other and working together, then my body is going to have to find a way around that and draw extra strength from somewhere else. So it’s this part of me, that’s my core.
Vanessa Leone (36:53)
Yep. I often call it the core can. Yeah.
Nicola (37:11)
Yeah, yeah, yeah. The canister, sometimes I say it’s like a canister, it’s a pressure management system. And if I’m not managing that pressure, then pressure goes from high to low. I might lose that through the front when you see like people bulging or people getting particularly, any head of like abdominal separation, common like postpartum, when they get like the coning or the doming, I’m losing pressure out the front when someone’s incontinent.
I’m losing pressure down the bottom. So the way that my mind works is what’s not coordinating here? What part of our core do we actually need to be like working on?
Vanessa Leone (37:42)
Mm-hmm. One of the most impactful things for me when I was working with the pelvic physio first initially was they had real time ultrasound. Yeah. And people think that it’s for babies. It’s not, it’ll detect your muscles activating and, and, turning on, but it, because, you know, if you go to a Pilates class,
have mixed feelings about cueing pelvic floor for people, very mixed feelings about it. Because for a lot of us, we can see our mirror muscles. I can see my lats turn on. I can see my shoulders. I can see if my quad’s turning on. I can’t see if I’ve activated my pelvic floor. And it’s quite hard to feel. And we talked about this disconnect of what am I feeling? I have high pain tolerance, but it’s so subtle. like, can you describe? Yeah, a little bit about this.
Nicola (38:52)
Yeah, that’s a really good point, particularly with those who do like have an overactive pelvic floor. Like you said, you can’t see it. So I know when I’m clenching my fists, I know when I’m like straightening my leg out. But when it comes to your pelvic floor, this is all a sensation that you’ve got to guide you. So for some people, it is more intense than others. But often we have more of a sensation when we clench our pelvic floor. To let go for some people,
What does that even mean? Because that’s even yeah, it’s hard, isn’t it? In theory, this sounds really easy. But in reality, it is so tough. to so I don’t know about you. So when you go to your pelvic floor physio, do they do a lot of internal work?
Vanessa Leone (39:39)
They do some, it’s very gentle. It’s very gentle.
And it’s slow. Can you feel that? Let go. Can you take a breath? And they’ll have a chat to you to try to get you to relax and then they’ll try to pinpoint and they’re like, did you feel it? It relaxed, right? Because it’s not like a, I turned it on and I can turn it off.
Nicola (39:47)
No. No. A lot of people are the same. Yep.
Vanessa Leone (40:05)
That’s not what happens for me. I don’t know about other people. It’s definitely not what happens for me. It’s like, I think it’s turning off. It’s relaxing now. Oh, that’s what relax feels like.
Nicola (40:14)
Yeah. Yeah. Yeah. Yeah.
And then like we have such a vocabulary of different words to use to try and get to that point and then describe it. But like you said, it’s I’m simply whether I’m using the screen or whether I’m using my finger to get the feedback. I’m your like middle person in being able to tell you yet that sensation that you felt, we’re going to consider that to be your squeezing. Now you feel this one.
That’s you letting go. Let’s try get more of that so that when you leave me, you have some slightly increased understanding of what I’m trying to feel because I’m not going to be there to tell you, yeah, that was a good one. So I’m. No, I just going to say, so I’m just like it’s it’s all a what’s the word I want to use here. It’s just trying to help someone hone in on that sensation and understand what it means free of judgment. And I’m very big on that one.
because when I give that exercise, I don’t want you to sit there going, my God, I can’t do it. Like, that’s not the point of it. The point of it is just to have that moment where I can just stop what I’m doing, connect with my body and then go, you know what? I am feeling really tense today. What is happening in my world that’s probably influencing this? Okay, now’s not the right time for me to do this. this is such a learning experience as well, but learning about my body.
and myself. See, that’s what I’m here for. Yeah.
Vanessa Leone (41:45)
Mm, yeah. Nine times out of ten, it’s way harder to teach relaxing, turning off, than it is teaching turning on. It’s because it becomes such a subconscious habit, it becomes such a subconscious posture, it becomes such a subconscious thing that we do, that it’s so ingrained. And also,
Nicola (41:54)
Yeah. Yeah. So hard.
Vanessa Leone (42:14)
I think that this is a really big component. Your body doesn’t feel safe to let go sometimes.
Nicola (42:20)
Exactly. Yep. It’s a big stress response because if I am feeling vulnerable, if I’m feeling anxious, if I’m feeling stressed or anything negative, my body is defending against that. And realistically, if I clench my fist for long enough, well, my body’s going to go, okay, well, this is my new normal. This is our baseline now. But then if I’m still going through those experiences and my body’s still wanting to defend, I’m now going to…
tense even harder. And if I do that for long enough, okay, well now this is my new normal. So a lot of this is happening under the radar. It is subconscious. I’m not intentionally meaning to do this. My body is just doing what it needs to do. But it is so important to teach it how to be able to relax because like everything that was spoken about up until this point, these can be signs of, okay, something’s going on in my pelvic floor. And it’s not always just it’s weak.
More often than not, I would say it is overactive. And that doesn’t matter if you have a penis or vagina. It’s the overactive side of the equation that often blocks strength as well because it can’t be tight and strong at the same time. It just can’t be. One’s got to come at the cost of the other.
Vanessa Leone (43:29)
Well, I like that.
Nicola (43:34)
You can use that one. Yeah, yeah, it is a good explanation for a lot of things. And most people get it. Like, it just makes sense.
Vanessa Leone (43:36)
I’m going to use that one.
Yeah, yeah, no, this is excellent. I think there’s a lot of taboos unravelling here. If you wanted to say something just to everybody about the pelvic floor, there’s something that you want everyone to know about the pelvic floor, is there something that comes to mind for you?
Nicola (43:51)
Don’t be embarrassed about it. That’s the main thing that I’d just love to put across is don’t be embarrassed about it, whatever the issue may be. Usually we can get you out of this more often than not because I think that’s the thing that really gets to me is how long people put up with something. So actually I’ve got another one. Don’t be embarrassed about it and don’t just accept that this will be your forever.
So I’ll keep it very general with those two ones.
Vanessa Leone (44:37)
I like that because yes, it applies to pelvic floor, but I think that it applies to a lot of things in our life that we inevitably end up putting up with. But that’s great. My last question for you, Nicola, is I call myself a movement therapist because I think that lots of things in movement health, wellness can be therapy. What do you use to…
Give yourself some movement therapy for yourself.
Nicola (45:08)
Okay, so I’m a gym goer. The gym moving my body has been my strategy since high school. Sometimes I’ve used it little bit too much and I’ve had to refine and redefine how I use it in my life. But yeah, for me, I need to go to the gym to just have an outlet. I do a bit of running. I wouldn’t consider myself a runner, but I do a bit of running.
movement’s incredibly important in my world. I need to move. Like I said, it’s an outlet. If I don’t move, I don’t feel great.
Vanessa Leone (45:41)
Yeah, yeah, no, that’s amazing.
Nicola (45:49)
They say that movement is medicine and I wholeheartedly believe that. We’re designed to move.
Vanessa Leone (45:56)
Yes, that’s the name of the podcast everybody.
Nicola (45:57)
Yes, yes!
Vanessa Leone (46:03)
We’re really good at this, by the way. Nicola, um, I would like, I mean, I have, actually, I do have one more question if you have time, because I know that my bendy humans are here and they’re waiting for me to ask. They’re waiting for me to ask. I’m a bendy human. My challenge is an overactive pelvic floor. My challenge is that
Nicola (46:13)
Yeah, go for it.
Yeah. I see you. I see you. Yeah.
Vanessa Leone (46:32)
I did it today. I yawned and I slightly sub-laxed a rib. It’s a great time. And I know that it’s because I’ve been really stressed, I haven’t slept as well. The list. The list is there, okay? So, for someone who knows that they’re bendy, how important is it for them to acknowledge their pelvic floor? Yeah.
Nicola (46:40)
Very, yeah, very, cause they were, so like you said, your problem has been more on the overactive side and for a lot of bendy people, because your connective tissue may not have that rigidity, your muscles are usually working harder to accommodate that and your pelvic floor being a little, it’s involved in everything. It can just work really over time.
as a compensation but now that this is causing dysfunction. And this can be very much a situation where it is too overactive and it’s not actually strong enough. So when it is needing to work harder, the muscles just can’t produce the amount of force. So this is when I can leak with a cough sneeze, picking something up, just movement. Prolapse, unfortunately more common. Even like bowel issues more common, digestive issues, which can lead to things like constipation and then prolapse and whatnot.
So if you are a bendy person and you have any whiff of a pelvic floor thought, I’d probably just get it checked out. Yeah, I would. More often than not, you I love it when someone comes to me and they’re like, look, I got X, Y, Zed. I was sent here from someone just to make sure that everything was kind of like doing its job. I like those ones because usually we just have a big conversation of these are the things that.
I think you need to just be mindful of and if we changed how you’re doing this and we incorporated this, then it may reduce the likelihood of something happening down the track or we just slow it down. It’s harder when someone comes in and unfortunately it has gone unaddressed for so long and now you’ve got so many spot fires and you’re so stuck in this just chronic compensation that we just have to slowly unwind it. So if you’re thinking about it.
do something about it and future you will thank you for it.
Vanessa Leone (48:58)
I mean, it sounds like you just described preventative healthcare there. What a world. That would be the day.
Nicola (49:04)
I know it would be fantastic, what is it? I’d like to think that things are getting better.
Vanessa Leone (49:10)
Yeah, yeah. But I think the step, if you can take the step to preventative healthcare, like if you have control the ability, the time and the money to be able to do that for yourself, I think that that’s we’re the people who can push the system forward in the right way and demand the system to have more for us and help the people who are falling off the other side of it as well. So I
that I’m super passionate about preventative healthcare for everybody because that’s like, that’s what I do. That’s what Meant to Move is about. It’s about taking care of your health and your longevity. So yes.
Nicola (49:52)
And that’s why these conversations are so important to have because like you said, those who don’t have access to it, whether it be financial, whether it be geographical, whether it just be the understanding, the more these conversations happen, the more people they reach. So then the education can, and the knowledge can catch up. It’s so important.
Vanessa Leone (50:04)
Yeah, I love that.
Nicola, thank you so much for sharing all of this today. Absolutely loved it. And I will definitely be inviting you back on if you’ll have me. Love it. Yeah, perfect. All right. Thank you.
Nicola (50:19)
Thank you for having me.
I’d love it. I’d love it. You know I love a chat.
Thank you.
Vanessa Leone Movement Therapist 