Let’s Talk About Butt Stuff with Hayley Kava, Pelvic Floor PT

[00:00:00] Gina: If you’ve been dealing with anything related to your butthole, such as hemorrhoids, constipation, anal fissures, maybe even incontinence with fecal incontinence or gas, this is the episode that you can secretly listen to, to get some advice on how to resolve it, because you can absolutely find relief from all of these symptoms that may feel more shameful, they may be impacting your quality of life, because we don’t talk about them very much.

[00:00:25] Roxanne: No one talks about them.

[00:00:25] Gina: Nobody wants to talk about anything related to their butthole, and I don’t blame them. And so in this episode, we have Hayley Kava, who’s a pelvic floor physical therapist, who’s going to break down all of these different things with us, plus solutions to help you find relief to improve your quality of life, because you do not have to deal with any of this just because you’re pregnant or you gave birth. It is not a badge of honor, by any means. We can find relief.

[00:01:41] Gina: Welcome to the MamasteFit Podcast. In this episode, we’re going to be talking all about butt stuff with pelvic floor physical therapist, Hayley Kava, and we’re going to be talking about hemorrhoids, constipation- all the things with your butt that you may be afraid to be asking about, but may be dealing with during your pregnancy and your postpartum.

[00:01:58] Gina: So thank you, Hayley, for being here to talk all about butt stuff with us.

[00:02:01] Hayley: Yeah, excited! This is the best.

[00:02:04] Roxanne: You love butt stuff!

[00:02:05] Gina: Whenever I mentioned this episode title to Roxanne, she’s like, “We’re going to be talking about what?!”

[00:02:10] Roxanne: Butt stuff? What do you mean? What are, we doing here with our podcast?

[00:02:16] Hayley: Yeah, I feel like as it relates to like pregnancy and postpartum and pelvic floor, we’re so willing to talk about peeing your pants, or talking about like leaking when we jump or sneeze, and like that, that, taboo is like starting to fade. But I think in terms of problems with our buttholes, that those taboos are still really there. And it really limits people from accessing the care that they really deserve. And, so yeah, let’s break it down!

[00:02:50] Gina: I feel like that’s even the same for me when I’m making like posts and stuff. Like I’ll be like, “Leaking urine or leaking pee?” And then it’s like uncomfortable when I’m like, “…or farting uncontrollably and pooping…”

[00:03:01] Roxanne: Yeah.

[00:03:02] Gina: And so it’s almost like this little like disclaimer that I want to add in, cause I know it’s a part of like incontinence, but it’s like, I don’t want to make people feel uncomfortable by saying like farting and pooping.

[00:03:14] Roxanne: Yeah.

[00:03:14] Hayley: It’s almost like you wish people could comment anonymously because I think people don’t want to engage with that type of social media post, even though they maybe really identified with it, because they don’t want like a friend to see that they commented like, “Oh me too, I’m sharting!” Like no one wants to be a part of that club.

[00:03:37] Roxanne: Yeah.

[00:03:38] Hayley: But I think, yeah, the more we can talk about it, the less shame we feel and the less scared we feel to get help for it, and so.

[00:03:46] Roxanne: I think we’ve had people even message us, though, like when we’ll do a post on leaking or even, sometimes, I think I did a post on hemorrhoids, people will be like, “I don’t want to comment on the post, but this is what I’m experiencing,” in our messages.

[00:04:00] Roxanne: And we’re obviously open to that. And we want to support people if they don’t want to comment on it. But I think that there is this like taboo, like almost shame if you are having hemorrhoids in the postpartum, or you are like leaking uncontrollably or can’t control when you’re passing gas, which is like a huge issue that we want to address and for people to feel comfortable sharing with us, but it is, it just has this such like embarrassment and shame still associated with it. Whereas leaking no longer, I feel like people are like, “Oh, we all leak! It’s fine.”

[00:04:32] Hayley: Yeah.

[00:04:33] Roxanne: Like, why? Why are they too… they’re pretty much the same thing, but.

[00:04:37] Hayley: Yeah, it’s just a different hole.

[00:04:38] Roxanne: No one’s going to be like, “I shit myself today!”

[00:04:42] Hayley: Yes. So I had this conversation with a client the other day, and it was like, you can probably still feel like your most powerful version of yourself if you had to go in front of a room and give a speech and you had a bladder hat on, or you like leaked a little pee, that probably wouldn’t disrupt you so much. If you had to go and talk to a big room of people and you were worried about having like poop in your pants, like that would get, like that would get to you a little bit more. Like you’d be nervous, does this smell? Can anyone else tell that this has happened? And so the impact on our quality of life, our mental health, all of it is like way more dramatic than (urinary incontinence).

[00:05:27] Roxanne: Which is why it’s such an important thing to talk about.

[00:05:30] Hayley: Yeah.

[00:05:30] Gina: So let’s start with pregnancy. Constipation is something that I have been dealing with, just to be vulnerable here.

[00:05:36] Hayley: Yeah!

[00:05:37] Gina: So let’s talk about constipation during pregnancy. So the GI system slows down because we’re trying to absorb all of the nutrients that we can during our pregnancy. And then…yeah, just poop just does not want to come out. I grab my little squatty potty, I’m sitting on the chair, I’m like, shifting around, and Roxanne’s knocking on my door, “Can you unlock it?” I’m like, “I’m trying to poop.” “You shouldn’t sit there for too long, you’re gonna get hemorrhoids!” And I’m like, “But the poop won’t come out!”

[00:06:01] Hayley: Yeah!

[00:06:02] Roxanne: But it’s an uncomfortable feeling, though, like, when you feel like you need to poop, it’s right there. It just won’t come out.

[00:06:08] Hayley: Let’s grab some pelvic floor.

[00:06:11] Roxanne: So if you’re watching our YouTube video…

[00:06:13] Hayley: Subscribe to the YouTube channel!

[00:06:15] Roxanne: Hayley has some props.

[00:06:17] Hayley: I’ll do my best to explain it for the audio listeners, but, yeah, there are lots of different mechanisms of constipation, right?

[00:06:24] Hayley: So that could be a gut motility issue, so how quickly is your digestive system processing that food? And we know in pregnancy, that process is slowed down so we can absorb as many of those nutrients as possible. So it is a good thing that happens. At the end of the tube, we have our pelvic floor muscles. And part of continence, so part of being able to hold our poop and pee inside of our body, is the job of our pelvic floor muscles. And when we are in pregnancy, our orientation of our pelvis and the orientation of our pelvic floor muscles also sometimes changes as we know, like, all those postural changes of pregnancy. And those postural changes sometimes happen even early on. But we can end up in those postural patterns with some more tightness in that back half of the pelvic floor. The muscles that keep our poop in, so the anal sphincter, as well as the deeper pelvic floor muscles in the back part of our pelvic floor, they are a little bit more like on. So they’re holding, like they’re more willing to hold stuff in. So even though our GI system is doing exactly what it’s supposed to do, the poop comes into the rectum, this is the little storage area, and we really shouldn’t be storing poop in here too long. Once poop comes in there, our internal anal sphincter should say, “Hey, Gina…”

[00:07:59] Roxanne: “Hey, Hayley.”

[00:08:02] Hayley: “Hey, Roxanne! There’s some poo here.” It will also give us info if that poo is solid or if it’s liquid or if it’s just gas. So we have a sensing reflex.

[00:08:13] Hayley: And so if it’s gas, our sphincters go, “Sweet!” And should let it out. If it’s solid, we get a signal that says, “All right, we’re going to sit on the toilet and then relax.” And if it’s liquid, it’s going to tighten up and we don’t have to control that at all. That’s going to all happen without us doing anything about it.

[00:08:32] Gina: Which I appreciate.

[00:08:32] Roxanne: Yeah.

[00:08:32] Hayley: We appreciate that. But then, sometimes in early pregnancy, again, GI system’s a little slower, that stool is a little drier because we’ve sucked more of the fluid out because we’re trying to create all this new blood volume.

[00:08:46] Gina: Mmhmm.

[00:08:48] Hayley: We need all these nutrients. And so we got this dried out turd sitting in there.

[00:08:53] Roxanne: Drink water.

[00:08:54] Hayley: Yeah, water, in that, it doesn’t have the hydration that it needs to help also make that process smooth as it comes out. And we also then are getting a little clenchy in our butt cheeks, we’re getting a little clenchy in that pelvic floor. And even though we have the sensation, “Gotta go!” We sit, and it’s like, “JK. This is not going to slide out the way we want it to slide out.”

[00:09:21] Hayley: So we love things like the Squatty Potty, right? Where our feet are a little bit elevated. Because what the Squatty Potty does, when we take our knees a little higher than our hips, it helps the back part of this pelvic floor to elongate a little bit and helps unkink the muscle, puborectalis muscle that holds our poop in there so that then this shot is straight. So then that poo can come straight out.

[00:09:52] Hayley: But again, if our muscles are super tense and super tight and we’re constantly trying to bear down and create that pressure, that kink and where the poop goes can actually get pushed forward. So now we’re pushing that poo almost forward to the vaginal canal. I don’t have my vaginal canal, but, pressure into the vaginal canal, and so we can get this pseudo rectocele essentially, like this pocket, right? And that could eventually turn into a rectocele, a prolapse, if we do that over and over and over again. Now we are like trying to push this poo out, but it’s stuck, essentially, against this little pocketing that’s happening.

[00:10:36] Hayley: And so that’s where things like splinting, right? You could splint externally where you’re pushing on like that perineal body to just encourage that poo to come back in, in line. Or you can splint internally where you may be using like a clean thumb in your vagina to help make sure that, because often it’s when it’s poo’s really hard and really stiff, you have to push the poo back a little bit. And then again, that helps your breathing be a little bit more efficient. So then that poo can exit.

[00:11:06] Roxanne: Yeah.

[00:11:08] Hayley: And so yeah, those are really normal things that people deal with all the time.

[00:11:15] Roxanne: That nobody talks about.

[00:11:16] Hayley: That nobody talks about, or people figure out on their own. So a lot of times people begin to splint, whether internally or externally, to help themselves poo if they’re constipated, and again they think they like have discovered this brand new thing that no one else has ever done and feel like this is really, this must be really gross. Like, “I can’t believe I just did that.”

[00:11:36] Roxanne: Yeah.

[00:11:36] Hayley: But, we teach people how to do that because, while we don’t necessarily want to have to splint forever, we don’t want that poo to get, continue to build that pressure and not be able to completely empty our bowels. And so we can use the splinting as a tool to help us bridge the gap as we’re learning how to manage the tension in our pelvic floor and balance the muscles around our pelvis, so that we can get those straight shot, easy ghost poops more often.

[00:12:07] Roxanne: Yeah, because obviously TMI, I had, I have to splint, not have to anymore, but in the immediate postpartum period, for sure. It’s still healing. But in order to poop, I had to splint with either like externally or internally to, have a bowel movement, because it gets pretty uncomfortable, especially postpartum, it’s pretty sensitive. Yeah, it’s already a pretty sensitive area, so then having to splint to poop, while, again, no one wants to talk about it, it happens.

[00:12:39] Hayley: Yeah. And sometimes in pregnancy, at the end of pregnancy, we’ll have this like splinting conversation before to be like, “Hey, if at that first bowel movement…” everyone’s scared of that first postpartum poop.

[00:12:53] Roxanne: Oh yeah.

[00:12:54] Hayley: And maybe we probably, we initially postpartum, we don’t want to splint internally just because a baby just came out of there, and we may have tears or stitches that we don’t want to like interact with.

[00:13:05] Roxanne: Mess up.

[00:13:05] Hayley: But we’ll talk about external splinting and that for those first couple poops, almost as a protective tool, as well as once that initial healing has happened, using internal splinting as a prolapse prevention tool.

[00:13:22] Hayley: So we’re thinking of it as a, “I’m doing this not because like there’s something wrong, it’s I want to prevent this totally normal physiologic thing that has happened where my vaginal wall is more lax. I’m just gonna reinforce it so that I don’t end up in this cycle of constipation, straining, difficulty emptying my bowels, blah blah blah.”

[00:13:47] Gina: So constipation can be like a normal symptom or experience of pregnancy, but it can lead to issues if we’re like chronically constipated, if we’re like constantly bearing down, if we got a little poo pocket. So what are some of the things that constipation could lead to?

[00:14:03] Hayley: Yeah, so if we are straining to poo all the time, or we’re just not pooing very often, and so we’re getting a lot more, this little storage area is now filled with three days worth of poop, versus one day or half a day’s worth.

[00:14:19] Gina: We should poop every day.

[00:14:20] Hayley: Yup. Yeah. I think the normal is three times a day to three times a week. I like my clients to be pooping at least once a day, ideally.

[00:14:31] Hayley: But now then this rectum can get expanded, and it’s bigger because it’s having to hold more stuff for longer. And so if that’s a little bit, like, has been stretched a little bit, it’s more susceptible to things like rectocele. We’re more susceptible to things like hemorrhoids, right? If we’re straining and sitting on the toilet for a long time, which is when a vein inside of our rectum bulges out- which is super common in pregnancy because our veins become more flexible, so they’re just a bit more vulnerable to prolapsing, essentially. And then, also anal fissures, right? And if anyone’s ever had an anal fissure, it’s like a little cut a vertical cut in that bottom part of your butt.

[00:15:29] Roxanne: It’s a little cut in your butthole.

[00:15:33] Hayley: And it makes it really painful for the poo to come out.

[00:15:39] Roxanne: It starts a cycle.

[00:15:40] Hayley: It’s a horrible cycle. It’s like the worst possible cycle. And that, then, every time you have to poop, you’re nervous, so you clench your butt. And then the clenching of the butt makes it hurt more, but the poo is now dried out because you’ve held your poo back for three days. And so then when you then go to poo, guess what happens? It rips back open again. So yeah, we don’t want that.

[00:16:02] Roxanne: No, we don’t. Again, TMI, I had anal fissures for a long period of time in my life. I’ve, oh my gosh, the number of sitz baths that I’ve taken from like teenage years to 34 years of life is a bit much.

[00:16:18] Roxanne: But no, it took so long to heal. There’s so many things that you could buy on Amazon. They’re like, “This will heal your anal fissures!” But I’m like, but why did they happen? No one would tell me like why it would happen. And then again, it’s like the shame and embarrassment of, “I’m not going to talk to my friends about this, anal fissure that I have. It like hurts to poop. What the hell is this? What are you solving? How do you solve your anal fissures?” Cause this is, it’s been like 10 years. But yeah, I think I went to a GI doctor too, to be like, “Why? What is wrong with me?” And they’re just like, “It happens sometimes in people.” But like, how do you heal it? They’re just like, “You just take some stool softeners.” But I need more. I need more from you.

[00:17:02] Hayley: So stool consistency is one piece of it, but again, there’s those anal sphincter muscles that tear is potentially even extending into, or the skin right above them. So if we are always clenching those muscles, just like you would if you had a bad sunburn on your shoulder, you tense your shoulders up. Or if you have a cut somewhere, you tighten the muscles around there. So we can help break that cycle of tension and pain and tearing, retearing, whether it’s a hemorrhoid or a fissure, and then we can get some better regulation of those muscles. Now that cut can heal, right?

[00:17:40] Hayley: Whereas if you’re, if you have a cut, like in one of your little fingers and you keep your fist like a baby, or like baby fingers sometimes, where they get kinda gross, you keep that closed, now that environment is not good for healing. So we need to free the buttholes!

[00:17:57] Roxanne: Yeah. Yeah!

[00:17:58] Hayley: We really need to! I think, I don’t know when, was that 2020 where they’re talking like sunning your anus or something? Like, we don’t need to be doing that.

[00:18:05] Gina: It’s a new biohacking trend.

[00:18:07] Hayley: But, we need to relax our buttholes.

[00:18:11] Roxanne: Yeah.

[00:18:11] Hayley: Or they need to know how to go through their full range of motion so that those little injuries that happen can heal appropriately.

[00:18:19] Roxanne: I will say, I haven’t had an anal fissure since I started seeing pelvic floor PT.

[00:18:23] Hayley: Yeah!

[00:18:25] Gina: Yay!

[00:18:25] Roxanne: If only I would have done that earlier.

[00:18:28] Hayley: I think that alone, knowing, “Oh, I have this fissure, all of these providers have told me it’s totally normal, I just need to take stool softeners, or use this cream, or whatever, but it’s not working,” to know, “Ooh, there’s another option here!” And that’s pelvic floor.

[00:18:45] Roxanne: A 20 year old Roxanne would have been really benefited from pelvic floor PT.

[00:18:49] Hayley: Yeah. Absolutely, I think. And butt problems I think show up more also, not that we’re here to talk about men, but happen more in like a male population.

[00:18:59] Gina: They sit on the toilet for minutes.

[00:19:00] Hayley: They sit on the toilet for a long time. So obviously, they’re not doing a good job relaxing their buttholes. And then they end up with a hemorrhoid, or a fissure, or back pain or… And so, if your spouse is on the toilet playing on their phone for three hours, their karma is gonna be some butt problems.

[00:19:24] Roxanne: Oh, interesting!

[00:19:24] Hayley: And they probably will maybe need a pelvic floor PT, too.

[00:19:26] Roxanne: I recently, I sent it to my husband, but there’s like a reel where this man was about to walk into the bathroom and the wife like sprints down the hall, grabs his phone, and like presses the combination until it unlocks and it’s like, “Try again in 15 minutes,” and then hands it back to him, and he’s like, “What the hell?” I was like, “I’m gonna do this to you.” And he’s like, “I’m just going to bring in a magazine then.”

[00:19:45] Hayley: Yeah. So mindful pooping, right? Like in going to the bathroom, maybe leaving your phone out is really good for all of us. None of us do it.

[00:19:55] Roxanne: We shouldn’t honestly be bringing our phone into the bathroom. It’s pretty gross in there. Like, bacteria. Like, then you carry your phone from the toilet that you just wiped poop on, to the sink. And then do you wash your phone? Are you washing your phone after you just wiped yourself and then walked to the sink?

[00:20:14] Hayley: That’s good. That’s good, yeah, phone hygiene.

[00:20:18] Roxanne: Have some alcohol pads, wipe it down, guys.

[00:20:22] Hayley: In terms of birth preparation, you guys talk about this, is we can practice this down regulation of our pelvic floor on the toilet. Laboring on the toilet’s a great place because it’s a place we naturally relax our pelvic floor as we’re used to doing that.

[00:20:38] Hayley: And we can have mindful pelvic floor prep practice throughout pregnancy. It’s not only going to help us mitigate constipation, but also hopefully help us when we’re giving birth.

[00:20:51] Roxanne: Yeah. Very beneficial.

[00:20:54] Gina: So let’s talk about hemorrhoids, because that’s like a big question that we get.

[00:20:57] Roxanne: Yeah, number probably one question that we get.

[00:21:00] Gina: We get people that are pregnant, people that are postpartum, they, they push for forever, and they’re like, “What is happening down there?” Or even, we’ve had some folks that are like, “I didn’t have any issues, other than four or five weeks postpartum, I have all these problems.”

[00:21:13] Roxanne: Hemorrhoids.

[00:21:14] Gina: “What is going on?”

[00:21:15] Roxanne: Yeah.

[00:21:16] Gina: What, is a hemorrhoid? I think you briefly talked about it.

[00:21:19] Hayley: Yeah, so our perineum, like our whole pelvic bowl, our whole bottom of our pelvis is really heavily vascularized. So there’s lots of blood vessels, there’s lots of veins. It’s like a stopping point for all of the blood flow from our lower body up to our upper body to help our circulation. And inside of our rectum and around our rectum and anus, there’s a lot of blood vessels. And so when you have a lot of pressure change on your pelvis when we’re in that pattern where we’ve got more tension in the back part of our pelvic floor- we may be straining a little bit more, or just like the things that we’re doing day to day are increasing some of that strain on the area.

[00:22:11] Roxanne: Like sitting.

[00:22:12] Hayley: Yep. Yeah. It’s that those veins are a bit more vulnerable to pushing out. So the vein that’s maybe sitting inside your rectum can get pushed out and can be internal, we can have internal hemorrhoids. Or we can have external hemorrhoids, meaning it’s just a little lower down and you can see it on the outside.

[00:22:35] Roxanne: And it’s not like a huge thing protruding from your butt.

[00:22:39] Hayley: Sometimes.

[00:22:39] Roxanne: Sometimes it is, and it can even like start to bleed and thrombose, so it’s like clotting. And that’s probably an emergency. Probably go to your doctor if it’s like super, super painful, and really large, sticking out of your butt.

[00:22:52] Roxanne: But like a lot of the time it is like small, it’s kind of like sticking out, and people are just like, “I don’t know what this tiny thing is, but it’s like really annoying.” Because what are like the common symptoms when people have hemorrhoids?

[00:23:04] Hayley: They’re irritated. They’re itchy sometimes. They can feel like, yeah, just like uncomfortable. Yeah, they can bleed. Anytime you’re having bleeding from your butt, definitely get it checked out. Even if you have a history of hemorrhoids, and they like all of a sudden start bleeding, or they did bleed and they didn’t and then they started again, any kind of bleeding from your butt, do not mess around with.

[00:23:31] Roxanne: Just go to the doctor.

[00:23:32] Hayley: We know colon cancer rates are on the rise. Get it checked out. But, but yeah, they can bleed. They can be, yeah, just aggravating. I’d say, sometimes they’re painful. I would not say that they’re usually hugely painful, like an anal fissure. But yeah, they can, feel like throbby, they can feel irritated. And then if you’ve been pushing for a long time, or even if you haven’t been pushing for a long time, they can pop up during birth, they can happen during pregnancy.

[00:24:06] Hayley: And then I’d say what tends to happen in those people where it pops up three weeks postpartum is that our perineum, pelvic floor is so vulnerable in those early weeks postpartum, and so those veins, like they’re dilated, they’re stretchier than usual. It’s like how sometimes prolapse symptoms pop up a couple weeks to months postpartum, is that they were doing okay, they were healing, but we just, did a little too much, and they were like, “JK, core!”

[00:24:42] Roxanne: Go TV shopping, go to a wedding.

[00:24:44] Hayley: Yeah, and that the system was like, “We’ve been, we’re holding on, we’re doing the best we can, and we just can’t anymore.” Or, we end up with a pretty big episode of constipation postpartum or there’s a bit of that pocketing. And so we’re straining against that pocket, which then maybe is too much and those veins can push out.

[00:25:05] Hayley: And so, yeah, there’s lots of different reasons for that to happen. And how we want to address it is really similarly. We want to learn how to find balance across the front to back of that pelvic floor. We want to match how much intensity of like how much bracing and how much like, core activation, slash, instead of bearing down when we’re lifting things or moving or picking up our kids, so that those other lifestyle things that we’re doing aren’t increasing that, that pressure.

[00:25:38] Hayley: That’s not to say that we can’t lift weights. We just need to make sure we’re doing it in a way that’s supporting our healing body.

[00:25:48] Roxanne: Because I know I would have, like, when I started first incorporating, lifting, and working out in my post partum period, I would have times where I would have increased prolapse symptoms- because obviously I have a rectocele, so I have more pressure in the posterior portion of my pelvis anyway, if I have a flare up- but I would also have the beginnings of the hemorrhoid symptoms as well when I like, maybe worked out and didn’t brace as well as I should. And so then I would start to have, the itching and uncomfortable feeling, like a hemorrhoid was coming.

[00:26:21] Hayley: Yeah.

[00:26:22] Roxanne: And so then I’d be like, “Oh, no! Let me focus on doing some intentional breathing today!” And then it would be gone the next day. And I worked with this, with Addie for that postpartum period, finding ways to decrease those feelings, but it was a nice feedback that, “Hey, Roxanne, you fucked up yesterday, fix yourself.” So that I could then, like, when I did the same workouts, I was more intentional to not do that. And I think sometimes it can be a good thing to know, hey, you know what you did yesterday, so like we can improve upon it so that I can get back to not having symptoms. Whereas before I think I probably honestly maybe had a rectocele way before having a baby and it just, I noticed symptoms after having a baby since I’ve like I have a lot of butt stuff issues apparently guys.

[00:27:12] Hayley: Yeah.

[00:27:13] Roxanne: Not that way guys!

[00:27:14] Hayley: So yeah exactly using it as a little barometer of, oh yeah I wasn’t managing my pressure well. Because, external hemorrhoids can be transient, right? I’ve had clients where postpartum they have like really significant, looks like there’s grapes in their butt kind of hemorrhoids, then they work on that rehab, they get that balance, and then they retract.

[00:27:43] Hayley: Are those veins vulnerable in the future? Yeah, they just are. They’re just a little bit more vulnerable because they’ve stretched once before. It’s like a little rubber band that’s gone a little too far. But that doesn’t mean that we can’t increase the resilience in that. And yeah, then now we have this little temperature gauge on how are we, doing? And yeah, that feedback is, can be really helpful.

[00:28:09] Gina: Let’s take a break from this week’s episode to talk about our podcast sponsor, Needed. Needed is a nutrition company that specializes in optimizing nourishment for the perinatal timeframe. So they’re here to support you during your pregnancy, birth, postpartum, all phases of life.

[00:28:23] Gina: They’re a brand that Roxanne and I, yeah, they’re a brand that Roxanne and I have utilized ourselves personally. And so you can trust that any brand that we are going to recommend, we use it because we like it a lot.

[00:28:34] Roxanne: Yeah. So one of the products that Needed has that we really enjoy is their pre and probiotic.

[00:28:39] Roxanne: So our gut health is affected by pre and probiotics that we eat. So our food that we eat and probiotics that we eat affect the bacteria. That is a huge part of our immune system, but also gut health. So having healthy poops every day can be affected by our gut health. So taking a pre and probiotic can help the bacteria within your stomach, be more diversified and fuel that bacteria in your stomach to improve our gut health, to one, lead to decreased symptoms associated with our immune system, such as UTIs or things like that, but also for just our overall healthy poops.

[00:29:16] Roxanne: So we really like their pre and probiotic. We took it during our pregnancies and even I still take it to this day in my postpartum. And if you want to check them out, you can go to thisisneeded.com and use code MAMASTEPOD to get 20 percent off your first order or the first month of your subscription.

[00:29:31] Roxanne: So other than obviously seeing a pelvic floor PT and like working on our breathing and lengthening in that posterior portion, what are things that people can do though to help treat, if they do have an anal fissure, if they do have hemorrhoids, to like help with the discomfort until they can like work on all of those other things?

[00:29:48] Hayley: Yeah, absolutely. So yeah, sitz baths are always going to be great. Things like Preparation H, I’m not sure what the active ingredients is.

[00:29:59] Roxanne: I think it’s, so it’s like Preparation H, there is some stuff that helps with the inflammation. I can’t remember the medicine that is, but it’s also like lidocaine in there to help with the discomfort, is really nice. Maybe there’s like a natural remedy for Preparation H.

[00:30:12] Hayley: Yeah, that’s the classic.

[00:30:14] Roxanne: H stands for hemorrhoid.

[00:30:16] Hayley: Yeah! Yeah, like we’ll use, I’ve used a product called like Rectacare. It’s like a lidocaine cream, particularly for things like fissures where we want to try to help break that like pain tension cycle.

[00:30:32] Hayley: There are, oh my gosh, yes, how else? Sitz baths, external support, like perineal support garments can, sometimes for hemorrhoids offer a little bit of pressure to help that vein be reminded like, “Oh yeah, I don’t need to push down.” And I find that perineal support also prevents us from clenching our pelvic floor so much, because we like trust that external support and that helps with that blood flow.

[00:31:03] Roxanne: Oh!

[00:31:05] Hayley: In the early postpartum, if you’re, if you have a lot of like lower body swelling, we want to help manage that swelling. So sometimes compression wear- compression garments, or the really sexy, like long thigh. But keeping, because it’s a blood flow issue for the hemorrhoids in particular, that we want to make sure that we’re not getting a lot of like veinous pooling, so like that used blood kind of getting settled in the pelvis, which may increase some of that from happening.

[00:31:38] Hayley: Yeah, like your peri, in the immediate postpartum, again, like your peri sprays and things like that, just like helping with some of that discomfort.

[00:31:45] Roxanne: Tux pads, witch hazel pads were my best friends.

[00:31:47] Hayley: Yeah, witch hazel. Watching for kind of skin irritation. Sometimes like barrier creams, I really like, the V, it’s called V Magic. Or there’s some different perineal balms that just help protect that skin barrier so that we’re not, chafing on a hemorrhoid you know chafing happens! And so that can, really help with that.

[00:32:13] Roxanne: Yeah, because I think it would probably help with the fissures too, because the reason it hurts obviously is because it’s expanding and this wound is just like reopening. So moisturizing that area and like having that barrier cream could potentially decrease the pain from it just ripping open, for lack of a better word.

[00:32:31] Hayley: Essentially like a paper cut, but just on your, butthole, yeah. And what would you, the things that we do for a paper, like if you have a paper cut on your finger that like bends a lot, like on your knuckle, every time you bend it, it’s aggravated, so we don’t necessarily want to just hold that still because then it may heal a little tight, so you want to make sure that we’re keeping that moving.

[00:32:56] Gina: Can we talk about what pressure management is? So that’s like a familiar phrase for us and we’re like, “Oh, just breathe.”

[00:33:03] Roxanne: Yeah. I always say, “Oh, diaphragmatic breathing would be really beneficial for you.” And they’re like, “What the fuck is that?” And then I have to send a video.

[00:33:11] Hayley: When we breathe in, air should come- we’re going to do a quick physiology lesson- when we breathe in, our ribcage should expand, and our diaphragm should move down, and our lungs fill. Okay? If we think about that as like a column of air, if we have a more narrow column of air, and our ribcage doesn’t really move out, the pressure has to go somewhere. Some people pull that pressure up, and lots of us then push that pressure down. Instead of sending some of that air outwards, we’re now sending more of that pressure into our bellies. Then, our back body, like below our lower ribs, and our pelvic floor when that air comes in should help us regulate that increase of pressure when we breathe in. So our pelvic floor should be able to expand and accept some of that air. Our back body and our abdomen all should expand to maintain pressure regulation so that there’s not these huge gradients of change. So pressure management, meaning we aren’t seeing this like very dramatic pressure being sent into any one particular area of that. So if we have a very tight back and a very tight rib cage. and a very tight pelvic floor, a very tight butt, we are going to send that air out our belly only and out the front half of our pelvic floor because our vaginal opening inherently is like more susceptible to that increased pressure.

[00:35:10] Hayley: So what happens is not that that’s necessarily problematic for one breath, but when we breathe 22,000 times a day, we’re increasing that posterior pressure, we’re increasing that thoracic pressure, and so then we’re getting too much pressure into the abdomen and onto that anterior pelvic floor.

[00:35:37] Hayley: So how we manage that pressure, sometimes in the traditional world, we’re going to talk about managing that pressure by increasing the abdominal and pelvic floor contraction to manage the air that’s going there. My perspective is, that’s only going to take us so far, and the repetitions and load that we see isn’t going to be able to handle that. And we can’t, we shouldn’t be thinking about our abs and our pelvic floor at all times to manage that increase of pressure. So we need to think about pressure management from increasing the ability of our thorax to expand, of our back body to expand, so that now every breath we take, we’re not seeing these big fluxes in pressure. When we’re doing something harder, like deadlifting, or squatting, or picking up our kid, or picking up the car seat, we need to still be able to access that, essentially like the diversion of pressure into all areas, so that even though now the demand is increased, we have to engage our abs more, we have to engage our pelvic floor more, we are able to do that automatically and we’re able to do that without having to overthink it.

[00:37:02] Hayley: So that’s my practice on pressure management.

[00:37:05] Roxanne: Obviously we get it, we, understand it, but I think that was explained well.

[00:37:08] Hayley: But I think what I tend to see or what people tend to think pressure management is, is just, “Oh, if I have this increased pressure and these increased symptoms down on my pelvic floor, it just must mean I have to squeeze my pelvic floor more.”

[00:37:25] Roxanne: Yeah.

[00:37:26] Hayley: When that’s probably not it, fully, right? That might be a piece of the puzzle eventually, but we need to think about length and inhales, and how we’re distributing pressure as well.

[00:37:43] Gina: I see one of two things is, one, either somebody is like, “Should I clench the entire time? Should I be clenching my core and my pelvic floor all the time?” And I’m like, “Please don’t do that.” Or if somebody is demonstrating breathing, it’s just like belly’s being pushed out, especially pregnancy demos, because it’s really easy to see the belly expand, and then they just suck everything back in. But it’s this like pelvic or like dancing position that’s essentially happening where there’s no back expansion at all. It’s all belly, anterior pelvic floor. If you would just round a little and breathe like that.

[00:38:22] Hayley: Yeah.

[00:38:23] Roxanne: Yeah. Because I think there’s so much emphasis on like that pregnancy, like engaging your deep lateral muscles, which obviously is probably helpful, I’m not going to say it’s not helpful. But also like maybe when we inhale, we’re like expanding in other spaces instead of just doing this abdominal contraction, not thinking about the rest of your body.

[00:38:48] Hayley: When we’re just breathing normally at rest, we shouldn’t be seeing our bellies go out and in dramatically. Even when we’re exercising hard, that shouldn’t be the only thing that changes. We should be seeing big changes in our ribcage motions because our lungs, they’re up here, right? And so if we’re only seeing that air pressure get diverted out the front, it’s telling us that we’re not even oxygenating as well as we could be. So we could think about that from a physiologic, oxygen exchange standpoint, just as much as we could think about that from a pelvic floor standpoint.

[00:39:28] Hayley: And so yeah, I think the, thought of, “Ooh, pressure management being, I’m gonna squeeze my pelvic floor as tight as I can, and then I’m not gonna experience my pelvic floor symptom,” that air pressure’s gonna go somewhere else. Is it gonna go out your butt? Is it gonna go into your back? Are you gonna feel that in your SI joint now? Or are you gonna feel that in your neck now because you’re pulling that air into your neck?

[00:39:59] Hayley: And so, we can’t just like, we can’t be so isolationist when we’re thinking about the pelvic floor. We really have to think about how it’s integrated. Because if the solution that we’re getting is, “Oh, you have a hemorrhoid, that means you have a pressure issue. That means you have to squeeze your pelvic floor more,” I hate to break it to you, that may be making it worse, or creating something else.

[00:40:23] Roxanne: Yeah.

[00:40:24] Hayley: And so, yeah. Just think about it, think about how that, how does that feel to you, right?

[00:40:31] Hayley: Does it feel good to have to squeeze your pelvic floor the entire time you’re squatting?

[00:40:35] Roxanne: No.

[00:40:37] Hayley: That’s not how movement is supposed to be. And our pelvic floor is such a… I feel like our pelvic floor is part of like our automatic systems of our body because it’s so connected to like bowel, bladder and sexual function, is that we really shouldn’t have to think about it that much.

[00:40:56] Roxanne: Yeah.

[00:40:56] Hayley: And so if our entire body is working together well, we don’t have to think about it hardly at all. And so I always remind my clients again, before you had this anal fissure, before you had this hemorrhoid, did you ever think about your pelvic floor? No? That’s our goal. That’s my little soapbox.

[00:41:14] Roxanne: Yeah. I feel like we could have a soapbox on just that for a pretty long time.

[00:41:18] Gina: We go over that with like our postpartum clients too, especially when we do like the rehab series. There’s going to be a lot of thinking right now as we try to recreate these automatic systems again. But the goal is eventually, you don’t have to think about, “Okay, I inhale, my ribcage expands, I’m expanding evenly throughout my abdominal cavity, and then I’m going to lower down into my squat, and then at the bottom I’m going to think, lift up with my pelvic floor as I stand,” eventually that’s going to become automatic, and it’s not going to be, like this constant mental fatigue of figuring out the movement again. But being patient with figuring out that process is like so important.

[00:41:58] Hayley: Yeah, absolutely. So like, when you have knee surgery, you do have, if anyone’s had orthopedic surgery, the muscles around your knee go on vacation after that surgery. We do isolation work to help our brain connect to that muscle again. But once you have that connection, you don’t sit there for six months doing your ACL rehab just squeezing that muscle. That’s actually going to really be a detriment to your rehab. Same thing with the pelvic floor. Once we have that connection, we’ve done that initial rehab because that pelvic floor was like, “WTF, a baby just came out of here,” then we got to think about how it works in system and get that automatic functioning, right?

[00:42:44] Hayley: Like we don’t, every step you take, you don’t think, “Okay, quad, come on!”

[00:42:48] Gina: Yeah.

[00:42:49] Hayley: And so we want to get it to be the same way when it comes to, the rest of our pelvic floors.

[00:42:55] Roxanne: Yeah, no, I like that. So I know we’re, we will just touch on one last thing, because we’ve talked about all the other butt stuff, hemorrhoids, constipation, fissures, I forgot what other stuff we talked about, but we can’t really talk about butt stuff without also talking about incontinence, because that is a huge thing that people are either afraid to seek help or sometimes I think we’ve had some people respond to us and be like, “No one can help me like I am uncontrollably either passing gas or I uncontrollably poop and I don’t know how to stop it and it’s causing me not to leave my house.”

[00:43:29] Hayley: Yes.

[00:43:30] Roxanne: Because no one wants to walk around, again, like poop unfortunately does have a smell for most of us. Pee, not as much like you can walk around with a little bit of pee and a pad and usually, the pad’s going to be scented enough to cover the smell, maybe. But if you have poop in your underwear, people will know. And you’re not a toddler where it’s like a little bit more accepted.

[00:43:50] Roxanne: So what can somebody do, obviously, other than seek pelvic floor PT, but like, why is it potentially happening? And then maybe what are things that people can do until they can get in to see a pelvic floor PT because they do need to live their lives?

[00:44:03] Hayley: Yeah. Yep. So those, again, those mechanisms may be unique person to person. So, if we have IBS or other GI gut things that sometimes is a layer that we want to think about. I’d say it’s similar, it’s sometimes similar to like bladder leakage where it tends, what tends to happen with the bladder is it’ll start with, I have a little bit of frequency, now I have a bit of urgency, now I have urgency incontinence where I’m like running to go pee and don’t make it in time, and then the leaking cascade kind of increases from there. I’d say sometimes it’s similar for anal incontinence, meaning we can’t control our gas or our poop, and fecal incontinence meaning we can’t control our poop. And that poop control stuff, sometimes begins as an issue with fecal urgency, right? I think probably most of us have experienced the like Target or grocery store effect where you get there and you have like this immediate urgent feeling of, “Okay, I gotta go right now.” And so our nervous system gets a little upregulated. Those anal sphincters in our rectum are like contracting of yeah, “It’s time to go. It’s time to go!” Like how our bladder does when we have to go pee, right? Our bladder muscle contracts and it tells us like, “Hey, it’s time to go.” And then we go and we pee. So with our poo, it’s a little more scary.

[00:45:40] Roxanne: Yeah.

[00:45:41] Hayley: It’s a little more stressful.

[00:45:42] Gina: Like cold sweating.

[00:45:43] Hayley: Yeah. and yeah, this is a vagal response. It’s like this vasovagal response can happen. And so I always tell my clients that we’re going to practice this at home first, if this happens frequently at home, but it’s to actually relax. So then the next practical tip is if you’re at the grocery store is put your elbows on the cart or your hands solidly on the cart, get your weight on your heels, open up your back, and breathe into your back, and relax your butt cheeks. And then you can walk like that to the bathroom, or you can try to calm yourself until you can stand up and make it there in time. And that’s really scary to do because it feels like, no, I have 30 seconds.

[00:46:31] Roxanne: Like if I do that, I’m going to poop myself.

[00:46:32] Hayley: But if we think about, I like to use this grocery store, the holding all the groceries analogy. This internal sphincter senses liquid stool and freaks, which is doing its job. It really tightens hard so that liquid stool does not escape. That’s like you clenching your muscles to hold all the grocery bags, and now those muscles are like really tired from holding that up. And if someone adds one more thing, or you have to hold that too long, then you’re just going to drop all the bags.

[00:47:07] Roxanne: Yeah.

[00:47:08] Hayley: Gonna have an accident. Versus, I’m keeping my muscles relaxed, or if I like just slowly straighten my arms, I can keep going.

[00:47:18] Roxanne: Yeah.

[00:47:18] Hayley: I’m not going to drop the bags.

[00:47:20] Roxanne: You got it.

[00:47:21] Hayley: That internal sphincter is still doing its thing. The internal sphincter still knows that there’s liquid stool in there, but I can calm my system down and they can make it inside. I don’t dump all the bags on the floor.

[00:47:33] Hayley: So that’s one piece, but if we essentially, again, one of my hypotheses about this fecal incontinence, anal incontinence, is that we’re holding on too tight and then it’s the fatigue of holding on too tight that makes it hard for us to maintain that continence, versus it being a truly weak muscle. The exception is for anal sphincter injuries. So grade four tears, there may be inherent weakness in that muscle that needs some strengthening because that muscle’s been injured. But for the most part…

[00:48:11] Roxanne: Those are rare.

[00:48:11] Hayley: And they’re rare, but I’d say they have a much higher rate of fecal incontinence. But even in those cases, because there’s so much fear and worry about fecal incontinence, what are we going to do? Of course we’re going to clench. Of course we’re going to clench. But that clenching is then, again, it’s those muscles get tired from being clenched all the time. They’re not meant to be clenched all the time. They’re meant to be a little more relaxed and just medium. And so we need our pelvic floor muscles in that system to be medium a little bit more so they can tolerate when stool comes down onto it. It’s not going to freak and then let go.

[00:48:53] Roxanne: Yeah.

[00:48:53] Hayley: And so that comes with a lot of nervous system regulation. That comes with a lot of learning to trust those pelvic floor muscles and building confidence in those muscles. But, again, addressing some of maybe the gut and other pieces of it with an interdisciplinary team, but definitely is something we are able to fix. And it’s the exact reason why we can’t approach fecal incontinence with kegels either, even though that seems again, 10 years ago, that’s what we thought was helpful for bladder stuff. As we learned more, we’ve evolved and it’s evolved more so with the bladder. But I feel like it hasn’t evolved as much with bowels because it’s, “Oh poo? Ah, yeah, just kegel, just squeeze your anus more.”

[00:49:42] Roxanne: Yeah.

[00:49:42] Hayley: Which may just be increasing that fear, increasing that worry, increasing that stress more and more.

[00:49:51] Hayley: So there are tools if we’re having issues, there are like plugs and there are other devices and tools that we can use to help people be able to integrate more into exercise and life, to help mitigate some of that leakage, and that worry about sanitary issues and smells and things like that. And you deserve to have support through that process, and you shouldn’t feel like you have to navigate all of that on your own. Yeah.

[00:50:24] Roxanne: And I think, it’s hard because it’s just not talked about as much, and so people think, “Oh, if you pee yourself, there are things that they could do and that could improve. But, if I’m pooping myself, there’s no one out there that could help me.” And so they just feel lost. Because again, it’s just not talked about as much, but it is important for them to know, just like with, peeing yourself, there are things you could do to make that better, but there’s also things that people can do to, get back to not having to, have uncontrollable gas or uncontrollable pooping. Because, again, we all deserve to have functioning, good functioning pelvic floors and good quality of life to be able to do the things that we enjoy doing, even though we’ve had a baby, it may be that it has caused some damage to our pelvic floor. There are things that we can do to get back to living our lives, which hopefully this entire episode on butt stuff has helped somebody, obviously, other than just Roxanne.

[00:51:18] Hayley: Somebody! You’re not only one. Yeah.

[00:51:21] Roxanne: But you left with way more information than you were expecting for butt stuff.

[00:51:26] Gina: Butt stuff, yes!

[00:51:27] Hayley: Yeah. And I think, the beauty of the podcast world is that you can listen to this in the privacy of your car and gain that information without having to…

[00:51:39] Roxanne: Put your little air pod in. Listen to this.

[00:51:41] Hayley: And accidentally having your phone play in public…. “Anal fissures?!”

[00:51:48] Gina: But I think it is really important for folks to know like what these things are.

[00:51:52] Roxanne: Yeah.

[00:51:52] Gina: A lot of times you start experiencing symptoms and you’re like…

[00:51:55] Roxanne: “What is happening to me?!”

[00:51:57] Gina: And then it’s like, “Well I don’t want to ask somebody….”

[00:51:59] Roxanne: Exactly.

[00:52:00] Gina: “…about my butthole!”

[00:52:01] Roxanne: Yeah.

[00:52:02] Gina: We were like giggling the whole time talking about it.

[00:52:03] Roxanne: I know. And I have butthole issues.

[00:52:05] Hayley: And I think it’s okay to laugh, right?

[00:52:08] Roxanne: Yeah, like it’s a coping mechanism.

[00:52:10] Hayley: It’s okay. And that’s part of the process of, there’s a grieving process and there’s a coping process and knowing, again, I think what people are really relieved when they start nervously sharing about more of their butt problems and I’m like, “Oh, yeah, cool. Tell me more!” And they’re like, “Oh, you want to hear more about this?”

[00:52:35] Roxanne: Please tell us about your butt.

[00:52:36] Hayley: Please!

[00:52:36] Gina: So it can be resolved.

[00:52:38] Hayley: Yeah.

[00:52:38] Gina: It’s like a big thing, too, where a lot of these like motherhood related issues are just a part of being.

[00:52:44] Roxanne: Yeah, just accept it. But no.

[00:52:46] Gina: When it’s like, there’s resources out there. There’s tools out there where you can find real relief from these symptoms.

[00:52:53] Roxanne: Yeah.

[00:52:54] Gina: From these things that may be impacting your quality of life.

[00:52:57] Roxanne: Yeah.

[00:52:58] Gina: Thank you Hayley, for coming and talking about butt stuff. Where can our listeners learn more from you?

[00:53:04] Hayley: Yeah, so I am, @HayleyKavaPT on Instagram and, Hayley Kava PT is my website, and I am local here at MamasteFit, and yeah, excited to be back.

[00:53:17] Gina: And she also sees virtual clients as well. So if you are not local to us, you can work with her virtually. I’m working with Hayley right now during my pregnancy to help with my pelvic floor, because my back half of my pelvic floor is a little tight. It’s shocking.

[00:53:31] Roxanne: I know, Gina’s been experiencing constipation for nine months.

[00:53:34] Gina: My ribcage does not expand. So if you want to work with Hayley, definitely check out her website. You can work with her one on one. She also has her pelvic balance class, which is pay as much as you want. So you can pay a dollar, you can pay $500 for it. It’s definitely worth every penny. So that you have the tools to know how to move your body, so you don’t need, you should still work with professionals, but you don’t need to have somebody hold your hand through the whole process when you start learning how to use these tools and apply it into your daily life. So definitely check out her stuff.

[00:54:04] Hayley: Yeah. Thank you!

[00:54:05] Gina: And thank you for coming, Hayley.

[00:54:05] Hayley: Yeah, thanks!

[00:54:48] Gina: Thanks so much for listening to this episode all about butt stuff during pregnancy. Hopefully, if you were clicking on this episode thinking it was something else, you are now informed on how to resolve hemorrhoids and constipation.

[00:54:59] Roxanne: And fecal incontinence.

[00:55:00] Gina: You are Googling in the wrong place.

[00:55:02] Roxanne: MamasteFit was not the butt stuff you were looking for.

[00:55:07] Gina: But it is important to know that there is relief to a lot of these issues that you may be having during pregnancy, during the postpartum. Some of these are more common than you think they are because people just don’t talk about them. I would not talk about… I talked about constipation, but if I had other issues, like I might be like, “No, that’s not me.”

[00:55:26] Roxanne: “That’s not me.” I’m over here, “Yeah, I had anal fissures!”

[00:55:29] Roxanne: But even if you’re not pregnant and you’re having any of these issues, addressing them prior to becoming pregnant can be beneficial.

[00:55:37] Gina: And there is relief out there. So you can work with professionals like pelvic floor physical therapists. If you’re not finding relief when working with a professional, find a different professional. And so it’s like Hayley was talking about. If you got knee surgery, you wouldn’t just squeeze your quad over and over again for years. Like we would eventually want to progress that rehab to find function again.

[00:55:58] Gina: And so that’s the same thing with our pelvic floor. If your pelvic floor PT is not getting you off the table and having you start doing things in upright positions to help bridge that gap between rehab and your return to life and to fitness, we need to find a different pelvic floor PT. And this is why I’m so happy that Hayley has a virtual option. If you can’t find an in person PT, that works for you.

[00:56:18] Gina: If you want more support throughout your pregnancy, check on our online prenatal fitness programs and our online childbirth education course. And in the postpartum, we have our postpartum education course, which is like what to expect in the postpartum, which does include some of this stuff as well, in addition to our postpartum fitness programs.

[00:56:34] Gina: And so with our fitness programs, it includes an education course on how to approach the movement, because it’s not just do this random list of exercises in this one way, it’s how you do those exercises that can help you feel comfortable during your pregnancies and find relief and return to fitness in the postpartum.

[00:56:51] Gina: And so you can check out all of our online offerings on our website at mamastefit.com. And as a thank you for listening to this episode, you can use code STORY10 to get 10 percent off any of our online offerings. A lot of them can be bundled together, so you can save an additional 15 percent off.

[00:57:05] Roxanne: And this podcast is sponsored by Needed, a nutrition company focused on the perinatal time frame that both Gina and I have utilized and love and highly recommend.

[00:57:13] Roxanne: And you can go to thisisneeded.com and use code MAMASTEPOD to get 20 percent off your first order, or the first month of your subscription.